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