anxiety, obsessive compulsive, and related disorders Flashcards
symptom checklist for anxiety diagnosis
- at least 6 months of persistent, disproportionate, and uncontrollable fear
- symptoms include at least three of following: edginess, fatigue, difficulty concentrating, irritability, muscle tension, sleep problems
sociocultural view of anxiety
most likely to develop when ppl faced w frequent threataning situations (like poverty- rate almost twice as high among low income ppl)
psychodynamic view of anxiety
Freud: -ego defense mechanisms used to protect against anxiety
-realistic anxiety when faced w real danger
-neurotic anxiety when repeatedly forced not to express id desires
-moral anxiety when punished for expressing id desires
most psychodynamic therapists disagree w freud abt some things, but agree that its bsed on inadequacies in early parent/child relationship
what do psychodynamic therapists use to treat anxiety?
free association + interpretation of transference, resistance, and dreams
- freudian use these methods to help clients be less afraid of id impulses + able to control them.
- Only short term psychodynamic therapy seems to be successful for anxiety
humanistic view of anxiety
anxiety happens when ppl repeatably deny + dont accept their thoughts, cognitions, and behaviors
-limited support from research
cognitive view of anxiety
anxiety caused mainly by maladaptive assumptions - irrational beliefs causing ppl to act in dysfunctional ways
what is the metacognitive theory of anxiety
ppl with GAD have both positive and negative views of their worrying (worrying is useful/necessary to avoid bad things, but also worrying is apparently bad and i cant control it)
- then they worry about worrying; meta worries
- leads to GAD
what is the intolerance of uncertainty theory
ppl cant handle even tiny chances of a negative event occurring, this causes GAD
avoidance theory
ppl w anxiety have higher levels of body arousal, and worrying serves to REDUCE this arousal (maybe by distrsction)
-leads to anxiety
what is the rational emotive theory?
therapists poitn out the irrational assumptions, suggest more rational ones, and give hw to practice replacing bad assumptions w good ones
what is mindfulness based cognitive therpay
part of acceptance and committment therpay
-clients become aware of their thoughts while they occur and learn to accept them rather than try to eliminate them
what is the biological view of anxiety
anxiety caused by bio issues
- benzo receptors normally recieve gamma-aminobutyric acid (GABA); inhibitory NT
- GABA eventually slows/stops the fear response
- when GABA less able to bind to neurons, anxiety increases
- but, other NT may have important roles too, and causal direction unclear (anxiety may lead to GABA probs)
what brain circuits are invlved in anxiety reactions?
-prefrontal cortex
-anterior cingulate cortex
-amygdala
this circuit often dysfunctional in anxiety ppl
what are the bio treatments for anxiety?
- drugs (benzos and barbiturates, along w some antidepressants and antipsychotics)
- (physical) relaxation training
- biofeedback (therapists use electrical signals from body to train ppl to control phyisological processes, like heart rate. EMG most common; muscle elecricity from tension measurment)
other than drugs, only modest improvement
what is agoraphobia?
fear of being in public places, or sitches where escape/help difficult
twice as frequent for women + poor ppl
panic disorder often accompanies
what is behavioral model of how phobias occur?
phobias acquired thru
- classical conditioning (strong association btween temporally close events
- modeling (from ppl)
strong support from research
stimulus generalization
response from one stimulus begins to be elicited by other similar stimuli (scared of running water, also be scared of milk poured)
-if many phobias, this can make it turn into GAD
preparedness
ppl are evolutionarily ‘prepared’ to develop some phobias more than others, like darkness or heights
flooding
therapists expose the client to the phobia repeatedly w/o relaxation training or buildup, so they learn that its harmless
actual contact more effective
modeling for treating phobias
the therapist confronts it while the client watches
actual contact more effectiv
treatment for agoraphobia
home or group based support; gradual emergence into world.
60-80% show partial improvement, less effective than for other phobias tho
social anxiety
persistent/severe/irrational anxiety about social/performance sitches where they might be judged. May be narrow (eating in front of others) or broad (general performance anxiety)
-ppl repeatadly judge themselevs to have performed worse than reality
cognitive theory of social anxiety
ppl hold a group of socially related beliefs that work against them:
- unrealistically high social self standards
- self image of socially unskilled, and that inept social behaviors will lead to horrible consequences
- think they cant control social anxious feelings
leads to avoidance/safety behaviors exacerbating issue
treatment for social anxiety
- antidepressant meds
- exposure therapy
- cognitive therapies
COMBINED w social skills training (modeling, rehearsing, role play, with accompanying feedback + reinforcement), most effective
panic attack symptoms
must be at least four of following
- heart palpitations
- hands/feet tingling
- shortness of breath
- sweating
- hot/cold flashes
- trembling
- chest pains
- choking sensations
- faintness
- dizziness
- feeling of unreality
what percent of ppl experience a panic attack at some point in their lives
25%
what brain areas and neurotransmitter is associated w panic?
- norepinephrine (which is why antidepressants help w panic; restore proper functioning of this NT)
- amygdala (stimulated in fearful sitches, then stimulates following areas) hippocampus, ventromedial nucleus of the hypothalamus, central grey matter, and locus coeruleus
cognitive explanation of panic
unexpected bodily sensations are misinterpretaed as medical catastrophe
anxiety sensitivy
focus on bodily sensations much of time, view them irrationally, interpret as harmful
cognitive treatment of panic
1) educate about panic attakcs, actual nature of bodily sensations, misinterpretations
2) learn to apply interpreting during panic, and how to relax+ distract
unclear if drug + therapy is more effective than just therapy
Obsessive compulsive disorder
obsessions: persistent thoughts, ideas, impulses, or images that invade mind
compulsions: repetitive/rigid behaviors/mental acts that ppl feel they must do to prevent/reduce anxiety
usually both, sometimes one
forms obsessions take
- wishes (spouse dying),
- impulses (urge to yell obscenties at work),
- images (dead ppl),
- ideas (germs are everywhere), or
- doubts (concerns that one has made wrong decision)
generally very aware that the thoughts are excessive
forms of compulsions
- cleaning
- checking
- seeking order/balance
- touching
- verbal
- counting
psychodynamic view of OCD
-conscious conflict between id impulses and ego control
id impulses take form of obsessive thoughts, ego defenses as counterthoughts/compulsive acts
little research support for PD view/treatment
psychodynamic three ego defense mechanisms most common for OCD
- isolation (disown unwanted thoughts, view them as foreign)
- undoing (perform acts to ‘cancel out’ the impulses)
- reaction formation (take on lifestyle that directly opposes impulses)
behavioral view of OCD
focus on addressing/treating compulsions, not obsessions
accidental associations form link between reduction of fear and the compulsion
behavioral treatment of OCD
exposure and response prevention (exposed to the anxiety thing, can’t do the compulsion)
pretty effective
cognitive view of OCD
- everyone has these unwanted thoughts, but in OCD ppl blame themselves for the thoughts and try to neautralize them by doing things meant to make matters right
- when the neutralizing thing makes temporary help, likely to be repeated
cognitive treatment
1) educate about how misinterpretaion, excessive sense of responsibility, + neutralziing acts can maintian the OCD
2) guide to identify/challenge/change the obsession
biological research of 2 sources of OCD
1) low serotonin activity
2) abnormal functioning in key brain regions
biological treatment of OCD
drugs can increase serotonin levels and produce more normal activity in orbitofrontal cortex + caudate nuclei
(which normally act as filters for impulses w only strongest getting thru to thalamus [driven to think more and act on them] but in OCD overactivity makes it happen too much)
obsessive-compulsive-related disorders
- hoarding
- trichotillomania (hair pulling)
- dermatillomania (skin picking)
- body dysmorphic
obsessions w an accompanying action (body dysmorphic; obsession w nose- checking in mirror)
diathesis stress view of disorders
certain individuals have a bio vulnerability to a certain disorder which is then brought out by socio / psych factors
