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PS346 > Anxiety, OCD & Mood Disorders > Flashcards

Anxiety, OCD & Mood Disorders Flashcards

1
Q

What is anxiety and what is an anxiety disorder?

A

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)
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2
Q

Describe some common symptoms of anxiety disorder

A
  • physiological panic symptoms
  • cognitive biases (specifically attending negative)
  • symptoms related to specific early symptoms
    check notion for DSM
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3
Q

What is a specific phobia?

A
  • 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
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4
Q

What are phobic beliefs in regard to specific phobia? (cognitive approach)

A
  • 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

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5
Q

Describe psychoanalytic accounts of specific phobias?

A

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
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6
Q

Describe behavioural accounts of specific phobias

A
  • 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
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7
Q

Describe evolutionary accounts for specific phobias

A
  • 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)
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8
Q

What is the multiple pathways approach to specific phobias?

A
  • different types = different acquisitions

- classical condition or disgust emotion or misinterpretation of bodily senses

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9
Q

What is panic disorder?

A
  • 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)
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10
Q

Describe three interpretations of the acquisition of panic disorder

A

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

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11
Q

Describe treatment for anxiety

A
  • BZ’s and antidepressants (although less recommended due to withdrawal dependency)
  • CBT (exposure or cognitive restructuring) - recommended, especially combined with meds = effective
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12
Q

What are OCD + related disorders?

A
  • 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
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13
Q

Describe the aetiology of OCD

A

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
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14
Q

Describe OCD treatments

A

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
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15
Q

What are the characteristics of a mood disorder?

A
  • 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
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16
Q

Describe examples of depressive disorders

A

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
17
Q

Describe examples of bipolar/and related disorders

A
  • 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
18
Q

What is a manic episode?

A
  • distinct period of at least a week ; criteria on notion picture
  • noticeable change in behaviour and symptoms
19
Q

What is a hypomanic episode?

A
  • 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
20
Q

Describe the prevalence of mood disorders

A

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

21
Q

What is the psychodynamic account for mood disorders?

A
  • 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
22
Q

What is the behavioural explanation for mood disorders?

A
  • 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??
23
Q

Describe Beck’s cognitive theory of depression

A
  • 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
24
Q

What is learned helplessness?

A

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
25
Q

Describe attribution as an explanation of depression

A

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)

26
Q

Describe biological explanations for mood disorder

A

on notion/textbook

27
Q

Describe biological treatments for mood disorders

A

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
28
Q

Describe types of talking therapies used to treat mood disorders

A

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%)
29
Q

What is social skills training?

A

Addresses social deficits

  • role play, feedback, modelling, reinforcement of appropriate behaviours
  • effective and increases social skills, whilst decreasing depressive symptoms
30
Q

What is behavioural activation therapy?

A
  • 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
31
Q

How may computer programmes combat mood disorders?

A
  • beating the blues
  • CBT techniques
  • maximising engagement with projects, case studies
  • challenging thought processes and modifying attributional styles
  • graded exposure
  • better than GP
32
Q

Describe possible risk factors for the development of anxiety disorders

A

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

33
Q

Describe Mowrers two-process model/ fear conditioning for anxiety

A
  • 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
34
Q

Describe genetic/neurobiological factors which may increase the onset of anxiety disorder

A
  • 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
35
Q

Difference between anxiety and fear

A

anxiety: apprehension over an anticipated problem
fear: defined as a reaction to immediate danger (and involves higher arousal than fear)

36
Q

Describe the aetiology of social anxiety disorders

A
  • 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)

PS346 (8 decks)

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