Anxiety, OCD & Mood Disorders Flashcards
What is anxiety and what is an anxiety disorder?
Anxiety: feeling of apprehension over anticipated problem (arousal; can be adaptive for preparedness and threat-avoidance.
Anxiety disorder: excessive or aroused state - constant apprehension and fear - out of proportion, chronic and consistent
- 28% of people have symptoms of anxiety disorder at some point
- anxiety disorder is 9th leading cause of disability
- more than 2/2 people with one anxiety disorder will meet criteria for another (60% = depression)
Describe some common symptoms of anxiety disorder
- physiological panic symptoms
- cognitive biases (specifically attending negative)
- symptoms related to specific early symptoms
check notion for DSM
What is a specific phobia?
- excessive fear triggered by an object/situation
- many avoidance responses
- driven by dysfunctional phobic belief
- prevalence: 13.8%
- occurs cross-culturally (but what they fear influenced by the culture and environment)
notion for DSM
What are phobic beliefs in regard to specific phobia? (cognitive approach)
- dysfunctional beliefs about a stimulus
- rarely challenged (especially as person avoids circumstances where it could’ve been disconfirmed)
- maintained as responses avoid contact
Chaser and prey beliefs:
- individual believes spider will attack, not shake off
Unpredictability/speed beliefs:
- spider is elusive and moves unpredictably
Harm beliefs:
- spider will bite, crawl into privates
Invasiveness:
- spider will crawl on clothes and in bed
response beliefs:
- believes they will be faint, lose control, become hysterical
Describe psychoanalytic accounts of specific phobias?
Phobias = defence against anxiety produced by repressed ID impulses
- fear associated with external things that have symbolic relevance to the repressed ID impulse
- function: avoid confrontation with the real, underlying issues
- this approach has little objective evidence but psychoanalysis gives insight
Describe behavioural accounts of specific phobias
- classical conditioning - Little Albert
- Although - most individuals cannot recall a traumatic incident
- not all people with a trauma develop phonia
- phobias only appear to develop from certain stimuli
Describe evolutionary accounts for specific phobias
- explains why they only appear for certain stimuli (do they tho?)
- biological preparedness (built-in predisposition to fear things that were life-threatening to ancestors) - Seligman
- difficult to substantiate (and random phobias)
What is the multiple pathways approach to specific phobias?
- different types = different acquisitions
- classical condition or disgust emotion or misinterpretation of bodily senses
What is panic disorder?
- DSM-5 criteria in notion (4 or more)
- recurrent, unexpected panic attacks
- abrupt surge of intense fear and urge to flee situation
- worrying about consequence/changing behaviour
- involves depersonalization (outside ones body) and derealisation (feeling the world isn’t real)
Describe three interpretations of the acquisition of panic disorder
Classical conditioning:
- anxiety (anticipation) and panic (dealing with current)
- so in anxiety - learned reaction (CR) to detection of cues (CS) that predict panic
- once conditioned, anxiety develops into panic attacks and panic disorder
- CR and CS strengthened
Anxiety sensitivity:
- fear that the symptoms are harmful (e.g. palpitations sweating etc, difficulty breathing)
- those with panic disorder = significantly higher scores on measures of anxiety sensitivity
- anxiety sensitivity index = greater predictor/ risk of developing disorder
Catastrophic Misinterpretation of bodily senses:
- panic attack = from a misinterpretation of threat - appearing much more dangerous than they are
- tend to interpret ambiguity as threat ; so panic attack triggered by expectancy
- clarks cycle (notion) - vicious cycle
- interoceptive conditioning = response to bodily sensations
Neurobiological factors
- fear circuit: loecus coerulus (norepinephrine production) - more release (more dramatic biological reactions when drug induced)
more stats/ anxiety comments in book
Describe treatment for anxiety
- BZ’s and antidepressants (although less recommended due to withdrawal dependency)
- CBT (exposure or cognitive restructuring) - recommended, especially combined with meds = effective
What are OCD + related disorders?
- separate chapter in DSM
- obsessions (intrusive, reoccurring thoughts), compulsions (repetitive behaviours to reduce anxiety) - checking, washing, cleaning
- time-consuming, interfering and may reduce quality of relationships
- usually gradual onset following extreme life event
- 2% prevalence and more common among women
Describe the aetiology of OCD
Inflated responsibility:
- believe they can bring about/prevent negative outcomes (so it is essential to prevent)
- could be actual or moral
- inflated responsibility CAUSES increased compulsions (Lopatka)
- can be measured using the responsibility attitude scale
- Cog model: assumes dysfunctional believes learnt from childhood and maintaining by misinterpreting thoughts
Though Suppression:
- rebound effect; deliberately repressed = increased frequency
- association between suppressed thoughts and negative mood
- believes that thinking about something is as morally wrong as engaging in the action, or thinking about an event can make it more likely to occur. = thought-action fusion
Describe OCD treatments
Exposure and response/ ritual prevention
- focuses on the compulsions
- graded exposure to thoughts (distress) and developing preventative behaviours
- use of exposure hierarchy (by collaborating with client)
CBT
- targetting and modifying dysfunctional beliefs about fears, thoughts, the significance of rituals
- usually challenges responsibility appraisal and over-importance of thoughts / exaggerated threat perception
- education clients (thought doesn’t need to be engaged with or performed)
- behavioural exercises to disconfirm beliefs
Pharmacological treatments
- short term effective and cheap way to treat OCD although common relapses
- SSRI - most prescribed but deemed less effective than therapy
- ERP = equally effective as drugs and enables LT help
What are the characteristics of a mood disorder?
- motivational deficits or increases
- slowness or quickness
- sleep disturbance (too much or too little)
- appetite changes
- negative thoughts, low self-esteem
- episodic disorder
- psychomotor retardation/agitation
- DSM-5 on notion
Describe examples of depressive disorders
Disruptive Mood Dysregulation Disorder:
- new diagnosis
- children up to 12
- persistent irritability and frequent uncontrolled behaviour episodes
- children with this may develop unipolar depressive disorder/anxiety rather than bipolar later
Major Depressive Disorder:
- single episode or recurrent episodes
- severity, presence of psychotic features?
Dysthymia (persistent depressive disorder)
- chronic disorder
- mood disturbances lasting 2 or more years
- criteria on notion (5 or more symptoms for a 2 week period, representing change from previous functioning)
Premenstrual Dysphonic Disorder
- new to DSM
- follows ovulation
- marked impact on functioning
Describe examples of bipolar/and related disorders
- experience depressive symptoms AND elevated mood periods
Bipolar I:
- periods of full-blown mania and depression
- DSM specifies for current/recent mania, current/recent hypomanic or current/recent depressions
- DSM on notion
Bipolar II:
- hypomanic and depressive episodes (not full blown mania)
- 15% of those with the condition go on to developing a full manic episode
Cycothymic disorder:
- 2 year period with many episodes of hypomanic symptoms (that do not meet the period for hypomanic episode)
- depressive symptoms not meeting the criteria for major depressive disorders
What is a manic episode?
- distinct period of at least a week ; criteria on notion picture
- noticeable change in behaviour and symptoms
What is a hypomanic episode?
- notion
- similar to mania episodes but lasts for shorter period of time - 4 days
- episodes not severe enough to cause social impairment or hospitalisation
- no evidence of psychotic features
Describe the prevalence of mood disorders
In the UK
- major depressive = 5-10% in primary care and 10-14% in medical inpatients; possibly some undiagnosed
- 10-15% of older people = symptoms of depression
- 50-90% risk of relapse
- rate in women is 2x higher than men
- varies culturally (SAD occurs more frequently the further you get from the equator)
- ethnic minority focus on mind-body
- onset age decreased
Look on notion for why gender differences
What is the psychodynamic account for mood disorders?
- depression = response to the loss of loved ones (or Freud suggests ‘symbolic lost’ like a job etc
- introjection: individual regresses to oral phase (integrates identity of loved one with own)
- directs feelings onto self - causes anger and self-hatred and self-esteem issues
What is the behavioural explanation for mood disorders?
- depression = lack of appropriate reinforcement for positive and constructive behaviours
- life losses; extinction of existing behaviours (withdrawn and inactive)
- leads to a cycle: lack of initiative and withdrawal - unlikely to lead to reinforcement or progress
- individuals with depression significantly more likely to elicit negative responses in others…
Interpersonal: reassurance-seeking rejected by fam and mountains
- doubting reassurances = frustrating for family
- good example of maintenace but is it the aetiology??
Describe Beck’s cognitive theory of depression
- biased thinking, negative schema and negative triad (self, the world and the future) - self-fulfilling prophecy and systematic thinking biases (notion)
- relatively stable and develops due to childhood experiences
- reactivated by stress
- maintains negative thinking
- may be measured using DAS : those who are depressed endorse negative thinking patterns on this scle
What is learned helplessness?
Seligman
- depression after negative life events
- a cognitive set that makes individuals learn to be helpless, lethargic and depressed
- lack of initiative
- perceived uncontrollability of events
Describe attribution as an explanation of depression
Attribution theories: attributing negative events to causes that cannot be easily changed (like the self)
Depression Attribution style
- internal, stable and global
Hopelessness theory (negative attributional style)
- positive outcomes will not occur
- negative outcomes will occur
- no responses are available to change the state of affairs
thus negative events and negative attributional style increases the risk of cluster symptoms (lack of initiative, apathy, lack of energy)
Describe biological explanations for mood disorder
on notion/textbook
Describe biological treatments for mood disorders
Drug therapy
- tricyclics (although side effects: blurred vision, hypotension)
- MOAO inhibitors
- SSRI’s
- working to increase levels of serotonin and norepinephrine
^^ Depression
- for bipolar: lithium carbonate - but can cause cardiac arythmias
- 80% benefit but unclear how it moderates symptoms
Electroconvulsive Therapy
- most effective in treating depression
- Bini (1938)
- electric current through head of patients resistant
- can provide rapid treatment for life-threatening/unresponsive depression
- contraversy
Describe types of talking therapies used to treat mood disorders
Interpersonal Psychotherapy
- on belief that depression is caused by interpersonal problems
- examines interpersonal issues: lost, conflict, isolation
- identifies issues and works towards resolution
- discussion of negative feelings, problem-solving and improving communication
- effective compared to placebo/ usual care
CBT
- Beck
- identifying negative beliefs
- encouraging adaptive, rational thoughts
- might use a thought record form
Mindfulness CBT
- stress reduction
- combat down periods and negative thinking
- uses meditation and redirection of attention
- awareness of incoming thoughts, acceptance and detachment
- protects against relapse (by 50%)
What is social skills training?
Addresses social deficits
- role play, feedback, modelling, reinforcement of appropriate behaviours
- effective and increases social skills, whilst decreasing depressive symptoms
What is behavioural activation therapy?
- lack of rewards = causes depressive symptoms
- so increasing client access to rewards and monitoring pleasant/unpleasant events
- social and time management training
- effective as other therapies
- notion
How may computer programmes combat mood disorders?
- beating the blues
- CBT techniques
- maximising engagement with projects, case studies
- challenging thought processes and modifying attributional styles
- graded exposure
- better than GP
Describe possible risk factors for the development of anxiety disorders
Gender:
- women are more vulnerable and have more functional impairment
- more biological reactivity to stress although women are more likely to report symptoms
- may face pressure to face fears and also have different life experiences than men (more likely to be sexually assaulted)
Culture
- different depending on where you live
- specific cultural concepts and specific expressions in symptoms
Traits
- neurotic traits
- behavioural inhibition - tendency to cry when faced with novel toys or stimuli (strong predictor of social anxiety)
Cognitive factors
- sustained negative beliefs about the future; believing bad things are likely to happen - this encourages safety behaviours to protect against the feared consequence (also maintain the beliefs)
- perceived lack of control (childhood traumas promote this idea) - external locus of control
- 70% report severe life events before the disorder
- over-evaluation of threat (high attention to threat even when out of conscious awareness)
- intolerance of uncertainty/ ambiguity - increases worry over time
Genetic vulnerability, neurotic traits, decreased function of GABA and serotonin
Describe Mowrers two-process model/ fear conditioning for anxiety
- classic conditioning and relief through avoidance of the CS
- BUT this doesn’t fit very well as most people do not have a traumatic event
- could have been indirectly acquired through modelling or verbal instruction
- many exposed people do not develop anxiety disorders = could be a difference in vulnerability
- anxiety disorders are specifically related to an increase in affective/ psychopathological responses to unpredictable threat
Describe genetic/neurobiological factors which may increase the onset of anxiety disorder
- having family with phobia, increases risk of developing phobia and other disorders (risk of neuroticism)
- fear circuit and amygdala - critical in arousal and conditioning of fear - elevated activity here for different anxiety disorders
- decreased activity in medial frontal cortex (processes anxiety and fear) when perceiving threatening stimuli
- deficits in connectivity with amygdala and medial frontal cortex = specific anxiety
- PET scans shows disruption of serotonin, norepinephrine and GABA all implicated in anxiety
Difference between anxiety and fear
anxiety: apprehension over an anticipated problem
fear: defined as a reaction to immediate danger (and involves higher arousal than fear)
Describe the aetiology of social anxiety disorders
- two process model (could’ve been indirect though)
- too much focus on negative self-evaluations
- attending more to internal cues than external cues (e..g. monitoring own signs of anxiety; heart rate)
