abnormal psych ch 5 by hrguillozet


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									          fear - immediate alarm
          Anxiety - vague sense of being in danger
               people who have anxiety orders have such disabling fear & anxiety
                   that they cannot lead normal lives

   Generalized Anxiety Disorderr
        generalized anxiety disorder - disorder where people experrience excessivve
          anxiety under most circumstances & worry aboutu practically everything
        typically feel restlestless, keyed up, or on edge, tire easily, have difficulty
          concentrating, suffer muscle tension, have sleep problems
        about 3% off the american population
        Sociocultural perspective
               anxiety disorder is most likely to develop in people who are faced
                 with societal conditions that are truly dangerrous
                      dangerous environment
                              nuclear power plant accident, NO during Hurricane
                      poverty
                              less equality, less power, greater vulnerability, run
                                 down commnities, higher crime rate, fewer education
               prevalence is tied to race
                      higher rates in African Americans & hispanics
               not the only factors at work
                      iff they were, everyone in these conditions would have the
        psychodynamic perspective
               Freud believed that all children experience some degree of anxiety as
                 a part of growing up & use ego defense mechanisms to help control it
                      realistic anxiety - face actual danger
                      neurotic anxiety - repeatedly prevented from expressing id
                      moral anxiety - punished/threatened for expressing id
                      some children experience particularly high levels off anxiety ,
                         or their defense mechannisms are inadequate, & may develop
                         generalized anxiety disorder
               psychodynamic explanations
                      some children are overrun by neurotic or moral anxiety which
                         sets the stage for generalized anxiety disorder
                              may come to believve tthat id immpulses are dangerous
                                     become overly anxious whenevver having id
                 a childs deffense mechanisms may be too weak to cope with
                  normal levels of anxiety
                most psychodynamic theorists believe that the disorderr can
                  be traced to inadequacies in thte early relationship between
                  children & their parents
                children who suffered extreme punishment ffor id impulses
                  have higher anxiety later in life
                some research studdies have contradicted psychodynamic
         psychodynamic therapies
                use free association & interpretations of dreams, resistence, &
                       freudian psychodynamic therrapists use these methods
                         to help clients become less affraid of their id impulses
                         and more sucessful in controlling them
                       object relations therapists use them to help anxious
                         patients settle their childhood relationship problemms
                         that continue to produce anxiety in adulthood
                only modest help to persons with generalized anxiety disorder
   The humanist perspective
         propose that generralized anxiety disoorder arises when people stop
           looking at themselvves honestly & acceptingly
                repeated denial of true thoughts, emotions, & behavior makes
                  these people extremely anxious & unable to fulfill their
         children who fail to received unconditionala positivve regard may
           become overly critical of thhemselves & dvelop harsh conditions of
                meet these conditions by distorting/denying true thoughts &
                threatening self judgments keep breaking through & cause
                  intense anxiety
         client centered therapy - practitioners show positive regard for clients
           & emphasize with them
                atmosphere of of genuine acceptance & caring will hellp clients
                  recognize their ttrue thoughts, needs, & emotions
                studies have failed to offer strong support
   the cognitive perspective
         Maladaptive assumptions
                basic irrational assumptions - people are guided by
                  irrational beliefs that lead them to act & react in appropriate
                when people who make thesse assumptions are faced with a
                  stressful evvent, they are likely to interrpret it as dangerous &
                  threatening , to overreacct, & to experience fear
                 leaads them to develop generalized anxiety disorder
                 hold silent assumptions that imply that they are in
                  imminent danger
                       more likely to devvelop in those whose lives
                          have been full of unpredictable negative events
                       avoid being blindsided by looking for signs of
   new wave cognition explanations
        metacognitive theory - people with generalized anxixety
           disorder generally hold both positive & negative beliefs about
                positive - worrying is a useful way of appraising &
                  coping with the threats of life
                       look to examine possible signs off danger
                negative
                       societyy teaches that worrying is a bad thing
                               come to believve that their worrying is
                                 harmful & uncontrollable
                receiived considerable reasearch support
        intolelrance of uuncertainty theory - certain individuals
           believe that any posssibility of a negative event occurring, no
           matter how slim, means that the event is likely to occur
                causes perons with the disorderr to survey all situations
                  in order to help reduce potential terrrible consequences
                stuck in a problem solving loop
                receivved considerable research support
        avoidance theory - people with this disorderr havve greater
           bodily arousal than otherr people & that worrying actually
           serves to reduce this arousal
                worrying serves as a quick, though ultimately
                  maladaptive, way of coping with unpleasant bodily
   cognitive therapies
        changing maladaptive assumptions
                rational-emotive therapy - therapists point out the
                  irrational assumptions held by clients, suggest more
                  appropriate assumptions, & assigns homework that
                  challenge old assumptions & apply new ones
                bring at least modest relief
        focusing on worrying
                therapists guide clients to recognize & change their
                  dysfunctional use of worrying
                          cleints are expected to see the world as less threatening,
                           adopt more constructivve ways of dealing with arousal,
                           & worrry less about the fact that they worry so much
                        mindfulness based cognitive therapy
                                accept thougghts & worries as just mere events
                                   of the mind
   the biological perspective
         believve that the disorderr is caused by biological factors
         was supported by family pedigree studies - research that determines
           how many & which relatives of a person with a disorder share the same
                people with generalized anxiety are more likely to have
                   relatives with the same disorder
                        may also be an effect of shared environment
         GABA Inactivity
                benzodiazepines - a family of drugs that provide relief to
                READ BOOK
         biological treatments
                antianxiety drug therapy
                        sedative-hypnotic drugs - drrugs that calm people in low
                           doses & help them fall asleep in high doses
                                benzodiazopines
                                increase the ability of GABA to bind to GABA
                                        reduce GABA's ability to stop neuron firing
                                          & reduce anxiety
                           benzodiazopines often providde temporary relief for
                           people with generalized anxiety disorder
                                potentital dangerrs
                                        anxiety retuurns stronger when
                                          medication is stopped
                                        addictive
                                        can produce undesirable side effects
                                              drowsiness, lack of coordination,
                                                 depression, & ettc
                                        mix badly with other substances
                        antidepressants are also helpful to many people with
                           generalized anxiety
                                increase activity of serotonin
         relaxation training - technique used to treat generala anxiety whose
           notion is thatt physcial relaxation will leaad to a state of psychological
                ex. teach clients to release muscle tension, meditation
                      modest improvement in patients
                 biofeedback - ussing electrical signals from the body to train people to
                  control physiological processses
                      often uses an electromyograph (EMG) - provides feedback
                          about the levvel of muscular tension in the body
                      only modest effect on anxiety

   Phobias
        phobia - persistent and unreasonable fear of a particular object, activity, or
        phobias are differrent that fears in that they are more intense & persistent
          and the desire to avoid the object or situation is greater
               their fears often dramatically interfere with their life
        specific phobia - persistent fear of a specific object or situation
               when suffferers are exposed to the object or situation, they typically
                  experience immediate fear
               8.7% of fall people in America havve the symptoms of a specific phobia
               women are twice as likely to havve a specific phobia
               the vast majority of people with a specific phobia dont seek treatment
                      try to just avoid the objects they fear
        social phobia - fear of social or performance situations in which embarassment
          may occur
               may be narrow
                      ex. talking in public in front of others
               may be broad
                      general fear of functioning poorly in front of others
               can interfere greatly with one's life
               most people keep their social phobias as a secret
                      may be misinterpreted as snobbery, lack of interest, or
               7.1% of people in US & western countries
               often begins in late childhood & may continue into adulthood
               may be more common in Asian & African americans than white
        agoraphobia - fear of venturing into public places
        panic attacks - unpredictable attacks of terror
        what causes phobias?
               Behavioral Explanations
                      propose classical conditioning as a common way of acquiring
                      modeling may cause phobias
                              a person may observe that others are afraid of cerrtain
                                 objects or events & develop fears of the same thing
                      after acquiring a fear response, people try to avoid that fear
               helps maintain phobias
               dont learn that the thing they fear is usually harmless
       stimulus generalization - responses to one stimulus are elicited
          by simular stimuli
               specific fears will blosssom into generalized anxiety
                 disorder when a person acquires a large number of
       how have behavioral explanations fared in research?
               animals & humans can be taught to feaer objects
                 through classical conditioning
                      ex. Little Albert
               research has supported the position that fears can be
                 acquired through modeling
               sevveral lab studies have failed to condition fear
                      researchers have not established that the
                        disorder is ordinarily acquired this way
       a behavioral-evolutionary explanation
               human beings, as a species, have a predisposition to
                 develop certain fears
               preparedness - human beings are prepared to acquire
                 some phobias and not others
               dont know if fear disposition is the result of
                 evolutionary or environmental factors
                      evolutionary
                             predisposition to fear has been
                                transmitted genetically through evolution
                             our ancestors who readily acquired a fear
                                of animals, darkness, & heights were
                                more likely to live longer & reproduce
                      environmental
                             experiences teach us early in life that
                                certain objects are a legit source of fear
   How are phobias treated?
       treatments for specific phobias?
               exposure treatments - treatments in which the
                 individuals are exposed to the objects/situations they fear
                      systematic desensitization - patients learn to
                        relax while gradually facing what they fear
                             substitute relaxation for fear response
                             teach relaxation methods
                             create a fear hierarchy - list of feared
                                object/situations, ordered from mildly to
                                extremely upsetting
                       pair relaxation with the thing they fear
                 flooding
                       people stop fearing things when they are
                          exposed to them repeatedly & made to
                          see that they are actually quite harmless
                       clients are forced to face their feared
                          objects or situations
                       therapists often exaggerate the
                          description so that clients experience an
                          intense emotional arousal
               modeling aka vicarious conditioning
                       therapist confronts the feared object
                          while the participant observes
                               acts as a model to demonstrate
                                 that the persons fear is groundless
                       in participant modeling the client is
                          actively encouraged to join with the
               the key to success in all exposure treatments
                  appears to be the actual contact with the feared
   treatments for social phobias
         newfound sucess for treating social phobias is due in
          part to the the growing recogntion that have 2 distinct
               people with the phobias may have overwhelming
                  social fears
               the people may lack skill at starting
                  conversations, communicating their needs, or
                  meeting the needs of others
         how can social fears be reduced?
               social fears are often reduced through
                       often antidepressants
               several types of psychotherapy have proved to
                  be effective
                       less likely to relapse
                       exposure therapy
                               guide clients to enter & remain in
                                 social sittuations until their fear
               cognitive therapies
                       ex. rrational emotive therapy
                                              may reduce social fear but doesnt
                                               eliminate them fully
                                how can social skills be improved?
                                     social skills training - therapist combines several
                                       techniques in order to help people improve their
                                       social skills
                                            model appropriate social behaviors
                                            role play
                                            rehearse new behaviors
                                            provide feedback & reinforce effective
                                            social skills training groups &
                                               assertiveness training groups
                                                    members try out & rehearse new
                                                       social behavior with other group

   Panic Disorder
        panic attacks - periodic, short bouts of panic that occur suddenly, reach a peak
           within 10 minutes, and gradually pass
        feature at least 4 of the following symptoms
                heart palpitations, tingling in extremities, shortness of breath,
                   sweating, hold & cold flashes, chest pain, choking sensation, faintness,
        people fear they will die, go crazy, or lose control
        panic disorder - having panic attacks repeatedly & without apparent reason &
           experiencing dysfunctional changes in thinking or behavior as a result of the
           attacks for a period of a month or more
        agoraphobia - anxiety disorder in which a person is afraid to be in places oro
           situations from which escape might be diffcult/embarassing or help unavailable if
           panic like symptoms were to occur
                intensity may fluctuate
                panic attacks, or at least some panic like symptoms typically set the
                   stage for agoraphobia
                        after experiencing one or more unpredictable attacks, certain
                           individuals become fearful of having new attacks in public
                not everyone with panic attacks develops agoraphobia
        The biological system
                panic disorder is helped morme by certain antidepressant drugs
                what biological factors contribute to panic disorder?
                        norepinephrine - neurotransmitter whose abnormal activity is
                           linked to panic disorder and depression
                                norepinephrine is irregular in people who suffer from
                                   panic attacks
                        locus ceruleus - area in the midbrain that uses
              emomtional reactions off many kinds are related to brain
                 circuits- networks of brain structures that work togetherr,
                 triggering each other into action & producing a particular kind
                 of emotional reaction
              amygdala - small structure in the brain that processes
                 emotional information
                      is stimulated when a person confronts a frightening
                      stimulates the other brain areas in the circuit that
                         produces panic reactions
                              may function improperly in peopple who
                                 experience panic disorder
                                      predisposition to develop such
                                         abnormalities may be inherited
                              this circuit appears to be different from the
                                 circuit responsible for anxiety reactions
                                      panic disorder is biologically different
                                         from generalized anxiety disorder
        Drug Therapies
              certain antideprressant drugs could prevent panic attacks or
                 reduce their frequency
                      restore proper activity of norepinephrine
                      prevvent of alleviate the symptoms of panic disorder
              in recent years benzodiazepine drugs have proved very
                 effective by indirectly reducing the activity of norepinephrine
                 throughout the brain
              helpful in most cases of panic disorder with agoraphobia
   The cognitive perspective
        full panic reactions are experienced only by people who futher
          misinterpret the physiological events that are occurring within their
        The cognitive explanation
              panic prone people may be very sensitive to certain bodily
                      misinterpret them as signs of medical catastrophe
                              grow increasingly upset about losing control,
                                 fear the worst, lose all perspective, plunge into
              biological challenge tests - therapists produce panic in
                 participants in the presence of a researcher/therapist
              why might some people be prone to such misinterpretations?
                                may experience more frequent or intense bodily
                              poor coping skills or lack of social support
                      anxiety sensitivity - tendency to focus on one's bodily
                         sensations, assess them logically, and interpret them as harmful
                              high degree in panic prone individuals
                 cognitie therapy
                      therapists try to correrct people's misinterpretations of their
                         bodily sensations
                      educate clients about the general nature of panic attacks, actual
                         causes of bodily sensations, & tendency off clients to
                         misinterpret sensations
                      teach clients to apply more accurate interpretations during
                         stressful situations
                      may use biologial challenge procedures to induce panic
                              clients can apply their new skills under supervision
                      often help people with panic disorder
                      are only sometimes efficient for persons whose panic
                         disorders are accompanied by agoraphobia

   Obsessive Compulsive Disorder
        obsessions - persistant thoughts/ideas/images/impulses that seem to invade a
          person's consciousness
        compulsions - repetitive & rigid behaviors or mental actts that people feel they
          must perform in order to prvent or reduce anxiety
        obsessive compulsive disorder -- disorderr in which a person has recurrent
          and unwanted thoughts, a need to perform repetitive & rigid acctions, or both
               obssessions & compulsions feel excessivve or unreasonable
                      cause distress, take up time, interfere with daily functions
        obsessions cause intense anxiety while compulsions are aimed at preventing
          or reducing anxiety
        usually begins by young adulthood and typically persists ffor many years
               symptoms & severity may fluctuate
        Features of Obsessions & Compulsions
               obsessions are thoughts that feel both intrusie and foreign to those
                 who experience them
                      attempts to ignore or resist them may arouse more anxiety
                      often take the form of obsessive wishes, immpulses, images,
                         ideas, or doubts
                      certain basic themes run through the thoughts of most people
                         troubled by obsessivve thinking
                             ex. dirt, contamination, violence, orderliness
               compulsions are similar to obsessions in many ways
                  they are under the voluntary control of the person but they feel
                   they must do them or have little sense of choice in the matter
                recognize their behavvior as unreasonable
                aafter performing a compulsive act, people usually feel less
                   anxious for a short while
                take many forms
                        cleaning compusions, checking compulsions, order &
                           balance, touching, verbal, counting
         most people with OCD experience both obsessions & compulsions
                some justs experience one or the other
                compulsive acts are usually a response to obessive thoughts
                        represent a yeilding to obsessive doubts, ideas, urges
                compulsions sometimes serve to control obsessions
         many people with OCD worry that they will act out on their
                althought many obsessions lead to compulsive acts, they do not
                   usually lead to violence or immoral conduct
   the psychoddynamic perspective
         believe that an anxiety disorder develops when children come to fear
           their own id impulses & use ego defense mechanisms to lessen the
           resulting anxiety
         battle between anxiety provoking id impulses & anxiety reducing
           defense mechanisms is not buried out in the unconscious but played
           out in dramatic thoughts or actions
         3 ego deffense mechanisms related to OCD
                isolation - unconsciously isolating & disowning undesirable &
                   unwanted thoughts & experiencing them as foreign intrusions
                undoing - unconsciously cancelling out an unacceptable desire or
                   act by performing another act
                reaction formation - taking on a lifestyle that directly oposes
                   theirr unacceptable impulses
         Freud traced OCD to the anal stage of development (2 years old)
                shame of negativve toilet training experiences
                feelings of insecurity
                children feel the need to express their strong aggressivve id
                   impulses while at the same time knowing that they should try
                   to restrain & control impulses
         treat clients by helping them uncoverr & overcome their under lying
           conflicts and defenses
                free association
                therapist interpretations
         little research evidence
   the behavioral perspective
         people happen upon their compulsions quite randomly
                  perform compulsions in fearful situations & when the threat
                   lifts, they link the improvement to that particular action
                         believve that the a ction is bringing them good luck or
                            actually chaning the situation
                the act becomes a key method of avoiding/reducing anxiety
         compulsions appear to be rewarded by a reduction in anxiety
         exposure & response prevention - clients are repeatedly exposed to
           things that produce anxiety, obsessive fears, & compulsive behaviors but
           are told to resist performing the behavviors they feel so bound to perform
                used in both individual & group formats
                carry out self help procedures at home
                55-85% success
                limitations
                         few clients overcome all their symptoms
                         manyu people drop out or refuse to take part in
                            treatment because they view it as too
   the cognitive perspective
         everyone has repetitive, unwanted, & intrusivve thoughts
                most people dismiss them or ignore them with ease
                those with OCD typically blame themselvves for such thoughts
                   & expect that somehow terrible things will happen
                         try to neutralize thoughts - thinking or behaving in
                            ways meant to put matters right or to make ammends
         when a neutralizing effort brings about temporary reduction in
           discomfort, it is reinforced & likely to be repeated
                the neutralizing act is used so often that it becomes a
                person becomes more convinved that theirr unpleasant
                   intrusivve thoughts are dangerous
                         thoughts being to occur more frequently & become
         people with OCD are more likely to experrience more intrusive
           thoughtss, resort to more elaborate neutralizing strategies, &
           experience reduction in anxiety after using neutralization techniques
         people with OCD tend to
                be more depressed than others
                havve exceptionally high standards of conduct & morality
                beliee that their intrusive negative thoughts are equivalent to
                   actions & capable of causing harm to themselves or others
                believe that they should have perfect control over all their
                   thoughts & behaviors
         therapists focus treatment on the cognitive processes that help
           produce and maintain iobsessive thoughts & compulsivvee actions
                  provide psychoeducation
                  teach clients about the misinterpretations of unwanted
                   thoughts, excessivvve sense of responsibility, & neutralizing
                help clients identiffy, challenge, & change their distorted
                habituation training - directing clients to call fforth their
                   obsessive thoughts again & again so theat they lose theirr power to
                   frighten or threaten the clients
                        produce less anxiety & trigger fewer new obsessivve
                           thoughts & compulsions
                combination of behavioral & cognitive treatments is more
                   effective than each treatment by itself
   the biological perspective
         OCD may be linked to biological factors
         abnormal serotonin functioning
                serotonin - neurotransmitter li ked to depression, OCD, & eating
                OCD may be caused by low serotonin activity
                other neurotransmitterrs may also play important roles in the
                   devvelopment of OCD
                        glutamate, GABA, dopamine
                serotonin may act as a neuromodulator - chemical whose
                   primmary function is to increase or decrease the activity of other
                   key neurotransmitters
         abnormal brain structure & functioning
                abnormal functioninng of specific regions of the brain may be
                   linked to OcD
                        orbitofrontal cortex, caudate nuclei
                                these regions may become too active leading to a
                                  constant eruption of troublesome thoughts &
                        regions are part of the brain circuit that converts
                           sensory information into thoughts & actions
         biological therapies
                antidepressant drugs
                        increase serotonin activity
                        produce more normal acitivty of the orbitoffrontal
                           cortex & caudate nuclei
                people tend to relapse once medication is stopped
                        leads to a combination of differnt therapies

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