AD Psychological models Flashcards by Ekta Merwaha

DSM 5 ADs

GAD, PD, phobias (specific, agora, social)

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Diffuse anxiety

no specific object/ situation threatens them, but they still feel very anxious

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GAD
worry is...
lasts...
about ? activities/ events
accompanied by

chronic, uncontrollable and excessive
>3 months
2+
restlessness, muscle tension
significant distress/ impairment

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Panic disorder
(un) or expected?
attacks of terror are
?duration of persistent concerns about attacks +//
significant maladaptive change in ? related to them

both
sudden/ repeated, overwhelming
>1 month
behaviour

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Comorbidity

“with anxious distress” helps rate severity

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Fear

about a specific dangerous object/ situation

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Phobias

fear lasting ? which is out of proportion to the actual danger/ threat of the stimulus (after taking what into account?)

> 6 months

cultural context

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Social anxiety disorder/ phobia
description
duration
specifier

fear of social situations where one is exposed to the scrutiny of others
>6 months
“performance only” specifier

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Agoraphobia
description
duration
specifier

fear of venturing into public spaces
>6 months
experienced in at least 2 different situations

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Anxiety inferred

isn’t experienced, but exists to explain symptoms

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OCD
description
specifiers

recurrent obsessions, compulsions
time consuming- distress/ impairment
tic-related; with good/ fair/ poor/ absent insight/ delusional symptoms

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Baxter et al (2013)
prevalence
gender
>55s
culture

global prevalence of ADs= 7.3%
women 2x likely to be diagnosed with AD (OCD= equal)
20% less likely to have AD/ OCD compared to younger adults
20-50% lower anxiety risk in non-Euro/Anglo cultures

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Behavioural aetiology (phobias)
Mowrer (1947) avoidance-conditioning formulation

Watson+ Raynor (1920)= learned through classical conditioning
maintained through operant conditioning

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Behavioural aetiology (phobias)
Bandura (1986)

modelling

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Behavioural Rx (phobias)

systematic desensitisation (Wolpe, 1958)
flooding
modelling

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Behavioural Rx for social anxiety

social skills training, relaxation, exposure

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Behavioural Rx for OCD

ritual/ response prevention

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Opris (2012)

VR exposure Rx (behavioural model)

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Behavioural evaluation

difference between ADs concerns how much exposure is arranged/ what situations the patient must confront
effective Rx for OCD+ social anxiety

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Deacon+ Abramowitz (2004)
biological Rx
congitive Rx

behavioural Rx= effective for OCD/ social anxiety

cognitive Rx= useful in combination with other Rx

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Seligman (1971)

Behavioural cons

preparedness theory/ selectivity of phobias
non-traumatic phobias (modelling)
prediction
cognitive change

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Clark (1996) cognitive aetiology for panic disorders

catastrophic misinterpretation of bodily stimuli

in/external trigger stimulus- perceived threat- apprehension- bodily sensations- interpret these as catastrophic

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Cognitive Rx

reinterpret scary bodily sensations as due to stress rather than impending dooooom

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Cognitive-behavioural approach

exposure= mimic start of attack (hyperventilating)
make cognitive link between behaviour+ sensations
combine with relaxation and social support

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Tzourmanis (2009)

variant (cognitive analytic therapy) shown to be an effective brief Rx for panic disorder, with maintained benefits at one year follow-up

Cognitive evaluation

difference between disorders depends on what situations are seen as dangerous and what misfortunes are expected to occur

Cognitive benefits

better than behavioural for diffuse ADs (PD/GAD) as no specific trigger useful in combo with other Rx (Deacon+ Abramowitz, 2004)

Prevalent Rx for ADs

CBT

Cognitive problems

usefulness depends on AD | behavioural Rx can be more cost-effective

Psychodynamic aetiology

theory based on attempts to shield ourselves from anxiety

Type of AD depends on | Psychodynamic approach

psychosexual stage at which one is fixated | the defence mechanisms used to protect from id impulses (only partly successful)

OCD is fixation at the ___ stage, reaction formation to ______, obtrusive thoughts linked to ____

anal id impulses unconscious id impulses

Psychodynamic treatment

free association dreams transferance (insight into unconscious conflict)

McGehee (2005) psychodynamic theories may demonstrate success on what basis?

a case by case basis

Mukhopadhyay (2010) neuroimaging shows that

sexual/ aggressive impulses lower processing speed in OCD

Bram+ Bjorginsonn (2004) problems with psychodynamic theory

little evidence that Rx are effective in OCD

Baxter (2013)

conflict populations 60% more likely to report anxiety | lower incomes= more likely to be diagnosed with ADs

McShane (2011)

higher incomes more likely to be diagnosed with ADs

Stein+ Williams (2010) run down-communities have

higher GAD

Marques (2011) race+ GAD

blacks 30% more likely to have GAD than whites

Social treatment

support system+ political action international aid+ community support civil rights egalitarianism

Social evaluation

why some develop it, and others don't

Bond+ Lader (1996) precipitants of disorders rank from internal to external which 2 disorders are trauma/ stress related?

intrusive thoughts/ imagined harm- OCD intense autonomic symptoms- PD the world: chronic apprehension- GAD feared situation/ object- Phobias stressful life change- acute stress disorder life threatening situation- PTSD (ASD+ PTSD are trauma/ stress-related disorders)

Huppert (2009) and Mineka (1998) | which 5 models are included in the integrative hierarchical model of anxiety+ depression

``` tripartite cognitive biological psychodynamic social ```

Watson+ Rayner (1920)

kid conditioned to fear rat, no transferance to blocks, transferance to similar looking/ feeling things, small dark room when done in brighter/ bigger room, fear response decreased emotional transfers occur (a lot) conditioned responses last >1 month (decreased) sucking thumb (erogenous) blocked fear responses fear= inherent/ primal and influences personality ?phobias= (in)direct true conditioned emotional reactions emotional disturbances in adults can't be traced back to sex alone

Mineka, Watson+ Clark (1998)

Europe- mood disorders= A+D | America- splitting> lumping

Anxiety+ depression overlaps a lot

Clark et al (1995)

``` Mineka, Watson+ Clark (1998) Rank in order of suicide attempts depression substance abuse anxiety+ depression ```

SA A+D D

Mineka, Watson+ Clark (1998) | Reasons A+D are often one factor in kids

less differentiated or worse assessment tools

Mineka, Watson+ Clark (1998) | Are ADs more comorbid with each other or depression?

depression

Mineka, Watson+ Clark (1998) which precedes the other?

A precedes D | also said by Huppert, 2009

Huppert (2009) A+D co-occur in what % of patients?

20-40%

Huppert (2009) which AD does depression overlap most/ least with?

GAD/ phobias | also less symptom overlap in PD, OCD+ SP

Huppert (2009) similarities in A+D

overlapping diagnostic criteria, genetics, neurophysiology/chemistry, negative affect/ temperament, perceived control, interpersonal mechanisms, biases in information processing (support from genetic/ twin studies)

Huppert (2009) risk of having an AD if you have a mood disorder is ?x higher? risk of getting MDD if you have an AD is ?x higher than genpop?

3-20 | 5-8

Huppert (2009) possible reasons for the AD/MDD overlap

``` they're different phases of an underlying disorder (common neuroticism) one is a risk factor for the other overlapping genetics/ aetiology 5-HTT gene (amygdala/ cingulate effects) reciprocal causation ```

Huppert (2009) GAD overlap symptoms

fatigue, sleep disturbance, poor concentration

Brown et al (2001) what percentage of MDD meet criteria for GAD if you remove rule-out criteria?

~50%

Huppert (2009) what AD may lead to depression?

PTSD

Watson (2005) PTSD+ GAD should be classed as

distress disorders

Huppert (2009) difference between SAD+ MDD?

SAD= bad feedback from others, MDD= self

Huppert (2009) OCD doesn't respond to TCAs, what about SSRIs?

they work in different brain areas, obsession vs rumination

Huppert (2009) what increases likelihood of AD remission after Rx?

comorbid depression

Barlow's hierarchical model of ADs

unique components with underlying negative affect