Chap 5&6 Flashcards
Anxiety disorder
Unfounded fear or anxiety that interferes with day-to-day functioning and produces clinically significant distress or life impairment
Fear circuitry in the brain
Amygdala triggers state of fear,starts the hypothalamus pituitary adrenal axis. Slower pathway hippo campus and pre-frontal cortex evaluate danger and can stop the fear response
Primary fear circuit
Amygdala triggers the hypothalamus pituitary adrenal axis to prepare for immediate action fight or flight
Secondary fear circuit
Stimulus simultaneously activates hippo campus and prefrontal cortex which processes the sensory input and evaluates danger associated with the situation if no threat, overrides initial fear response
Amygdala2
Structure associated with processing expression and memory of emotions especially anger and fear
Hippo campus
Part of brain involved in forming organizing and storing memories
GABA
Gamma amino butyric acid an inhibitory neurotransmitter involved in inducing sleep and relaxation. Reduction in GABA receptors in hippo campus and amygdala link to anxiety and fear.
Serotonin to
A neurotransmitter associated with mood sleep and appetite and impulsive behavior.
Allele
The gene pair responsible for a specific trait
Behavioral inhibition
Shyness
Negative appraisal
Interpreting events as threatening, even ambiguous ones
Anxiety sensitivity
Trait involving Fear of physiological changes within the body.
Reappraisal
Minimizing negative responses by looking at the situation from various perspectives. Fewer anxiety symptoms
Phobia
A strong persistent and unwarranted fear of a specific object or situation
Social anxiety disorder
Social phobiainvolves an intense fear of being scrutinized in social or performance situations.fear of doing something embarrassing or humiliating in the presence of others, is out of proportion to the circumstances, and results in avoidance of the situation or intense fear or anxiety when in during the situation. Self-conscious 8.7 % adults in year.
Performance only type of social anxiety disorder
Only in situations where must speak or perform in public
Specific phobia
Extreme fear of a specific object or situation, exposure to stimulus nearly always produces intense panic or anxiety out of proportion to danger. 8.7% adults in Year.
Primary types of specific phobias
Animal or living creatures, natural disasters, blood injections or injury, situational factors or environment. 8.7% of pop.
Agoura phobia
Intense fear of at least two of the following: a being outside the home alone b)traveling via public transportation c)being an open spaces or D)being in stores or theater or E)standing in line or being in a crowd feared because help may not be readily available. Often have anxiety sensitivity. 1% of adults. Can be late onset 11% 65. 31% heritability
Panic attack
Episode of extreme fear accompanied by physiological symptoms. Can cause Agoura phobia
Heritability of phobias
All phobias you have a 31% genetic component
Biological component of phobias
Increased responsiveness of the amygdala and other areas of brain associated with fear. Neural imaging shows phobias have increased physiological responses in reaction to phobia stimuli
Preparedness
Alternate biological view of fear reactions. Fears do not develop randomly. Easier for humans to develop veers to which they are physiologically predispose such as fear of heights or snakes. May have been necessary for human survival,can appear without exposure to conditioning experiences.
Psychological dimension of phobias
Classical conditioning perspective, observational learning perspective, negative information perspective, cognitive behavioral perspective
Classical conditioning perspective
Phobias are conditioned fear responses evolved from psychologist John Watson experiment with little Albert. Childhood fears can be retriggered in adulthood if we are faced with sound smells or events that bring up memory of those fears
Observational learning perspective
Watch the video in which a man received uncomfortable shock response to stimulus. After viewing the video shown the stimulus associated with the shock respondents reacted with fear. Fear response document in neural imaging scans of amygdala. In children whose parents showed anxiety before spelling bee,reported higher anxiety levels more anxious thoughts and greater avoidance of spelling test done than in those with relaxed parent.
Negative information perspective
Parents giving negative description of strange animal caused the children to react with more fear than those who receive positive or ambiguous information
Cognitive behavioral perspective
Catastrophic thoughts and cognitive distortion’s including overestimating the threat may cause strong fears to develop thinking a spider will take attack or take revenge increased phobias
Social dimension of phobias
Over protection of socially withdrawn children and lack of support for independence can increase sense of insecurity. Children prevented from developing emotional regulation and coping skills. Negative family interactions at age 3 and family stress in middle childhood both associated with social anxiety symptoms. Punitive maternal parenting style linked with increased tendency to have fearful believes. Victimization by peers in childhood can increase social anxiety
Benzodiazepines
Increase activity of neurotransmitter GABA. They can produce dependence, withdrawal symptoms and paradoxical reaction such as increased talkativeness excessive movement and even hostility and rage and dementia an older adults
SSRI for anxiety
Begin to alter brain chemistry after first dose but require 4 to 6 weeks before they reduce symptoms
Beta blockers
Propranolol or Inderal can reduce physical symptoms of anxiety disorders especially social phobia. These treat high blood pressure and heart conditions
D cycloserine
Drug to treat tuberculosis sometimes used in combination with psychotherapy. Appears to affect brain regions associated with the unlearning of fear. If it doesn’t work it may actually reconsolidate fear and strengthen it
Cognitive behavioral treatments of phobias
Exposure therapy systemic desensitization cognitive restructuring like changing irrational or anxiety arousing thoughts, and modeling therapy
Exposure therapy
Treatment involves gradual increasingly difficult and counters with the feared situation
Apply tension
For individuals who show the physiological pattern of a sudden drop in blood pressure like in blood injury fear by tightening the muscles repeat 5 times can prevent fainting the fear becomes extinguished
Systemic desensitization
Uses muscle relaxation to reduce anxiety associated with phobias While being exposed to item feared while in relaxed state.
Cognitive restructuring
Unrealistic thoughts believed to be responsible for phobias are altered.normalize social anxiety by encouraging to interpret emotional and physical tension as normal anxiety and redirect attention away from themselves in social situations
Modeling therapy
Individual with phobia observes the model of a person coping with our responding appropriately to fear producing situation.
Panic disorder 2.7% per yr.
Recurrent unexpected panic attacks in combination with a)apprehension over having another attack or worry about the consequences of an attack or B)changes in behavior or activities designed to avoid another panic attack. must be present for one month or more 11.2% have them in a year. More attacks with comorbid depression, GAD or substance abuse.
Concordance rates concordance rates
Percentage of relative sharing the same disorder.is higher. Heritability is estimated to be 32% in panic disorder.
Brain in neurochemistry of panic disorder
Brain structures such as amygdala are involved in anxiety disorder, incl panic disorder. Neuroimaging Fewer serotonin receptors results in decreased availability of Serotonin
Psychological demension a panic disorder
Heightened anxiety sensitivity and heightened fear responses to bodily sensations
Cognitive behavioral perspective of panic disorder
Physiological change such as faster breathing increased heart rate occurs; then catastrophic thought development ,thoughts result in increased fear, resulting in more physiological changes. circular pattern develops. Interoceptive conditioning. Has research basis
Interoceptive conditioning
Classical conditioning process in which fear is associated with the perception of bodily changes. Pairing of bodily changes with fear. As this assoc. strengthens, somatic changes can automatically cause panic attack.
Social and social cultural dimensions to panic disorder
Stressful childhood involving separation anxiety, family conflicts, school problems or loss of a loved one and bullying.
Biological treatment of panic disorder
Benzodiazepines and antidepressants also beta blockers to reduce symptoms such as sweating heart palpitations and dizziness. High relapse rates after cessation of drugs therapy.
CBT therapy for panic disorder
Teaching coping statements such as the feeling is not pleasant but I can handle it, help the client identify the antecedents of the panic like what stress am I facing, teaching the clients to self-induce physiological symptoms of panic to extinguish the Interoceptive conditioning that has occurred, correcting catastrophic thinking, and encouraging the client the face symptoms both within the session and the outside world, educated the client about misconceptions regarding the symptoms of panic disorder
Prefrontal cortex
Region of the cortex responsible for executive functioning allows us to manage our attention behavior and emotions
Role ofmedication and anxiety disorders
Directly decrease activity in the amygdala and thus normalize anxiety reactions.
Role of therapy in anxiety disorders
Reduces physiological arousal by strengthening distress tolerance and the ability of the prefrontal cortex to inhibit fear responses.
GAD
Generalized anxiety disorder characterized by persistent high levels of anxiety and excessive and difficult to control worry over life circumstances accompanied by physical symptoms such as feeling restless or tense.must be present on majority of days for at least six months and cause significant distress or impairment in life activities
Pathological worry behavior
Term for GAD. Most spend six hours a day worrying and feeling anxious versus an average of one hour a day for non-clinical samples. Begins in childhood or adolescence. 1.2 to 2.9% per year
Neural imaging GAD
Those with GAD show greater activation of prefrontal cortex in response angry faces suggesting that prefrontal cortex was attempting to regulate the anxiety aroused by the faces. also report higher in Zaidi levels and greater sensitivity to bodily changes and individuals without this disorder
Psychological dimension of GAD
Lower threshold for uncertainty and only a small leaves regarding worry assume worry is an affective way to deal with problems that it prevents negative outcomes from occurring. Negative schemas may play a role in his thinking I am incompetent or the world is dangerous GAD develops when worrying about worry occurs.
Social and socio-cultural dimensions of GAD
Mothers who have anxiety maybe less responsive and engaged with infants increased likelihood child will develop GAD. Conflicts and peer relations including bullying. Poverty poor housing prejudice and discrimination contribute to GAD may be responsible for high prevalence of G a D in African-Americans and Latinos. GAD is twice as prevalent among those with low income. More frequently in individual separated divorced or widowed and in the unemployed
Biological treatment GAD
GAD is ;chronic benzodiazepines are successful but dependence is concern. Antidepressants usually preferred no dependence.
Cognitive behavioral therapy in GAD
60% showed significant reduction to continue 12 months after treatment
Obsessive compulsive disorder
Condition characterized by intrusive repetitive anxiety producing thoughts or a strong need to perform acts or dwell on thoughts to reduce anxiety. At least one hour of time per day and caustic and cause significant stress or impairment in life activities.
Obsessions
Persistent anxiety producing thoughts or images
Compulsions
Overwhelming need to engage in activities or mental asked to counter and siding or prevent the occurrence of the dreaded event.
Common themes of OCD
Contamination such as germs, waste or secretions, errors Or un certainly including obsessions over decisions or anx regarding daily behaviors, unwanted impulses or orderliness striving for symmetry. Compulsions involve repetitive action of them until observable behavior such as handwashing or ordering object of mental after just plain counting a repeating words silently
OCD without compulsive behavior
Only 25%. People describe their obsessive or compulsive thoughts and actions is out of character and not under your voluntary control. 1% per year begins in childhood or adolescence equally common in males and females. Many are depressed to me abuse substances25% of population have symptoms without severity to meet diagnosis
Hoarding disorder
A) an inability to discard items regardless of their value b)a perceived need for items and distress over the thought of giving or throwing them away and c)an accumulation of items that produces congestion and clutter in the living area. 2-5%. 25% of peop with anxiety disorders report significant hoarding symptoms. Cognitive- conviction that objects collected are extensions of themselves feel sense of responsibility toward the items and have guilty feelings at the thoughts of discarding them. CBT treatment, half don’t complete it.
Body dysmorphic disorder
IA) preoccupation with the perceived physical defect in normal appearing person or excessive concern over slight physical defect. B)repetitive behavior such as checking parents and comparing to others c)significant distress or impairment in life activities most maintain strong delusions about their bodies .7 to 2.4 % 60% have anxiety disorder 38% have SAD. Only 9% full remission. Hyper connectivity between visual processing areas of brain and prefrontal cortex and amygdala. CBT promising. But attrition high.
Trichotillomania
Recurrent and compulsive hair pulling. Hair loss and significant distress. Sporadically during the day or continue for hours. Lifetime prevalence of 4% women have 10 times greater likelihood usually occur before age 17
Excoriation disorder
Skin picking involves repetitive and recurrent picking of the skin and results in lesions one hour or more per day thinking about resisting are actually picking the skin. Proceeded by rising tension picking results and feelings of relief or pleasure lifetime prevalence 1.5% in adults most prevalent during adolescence. Three quarters are female. Often comorbid with body dysmorphic disorder or trichotillomania
Biological dimensions of obsessive-compulsive and related disorders
Fourfold increased risk of OCD among close relatives with this order. Greatest for first-degree relatives although nonshared environmental influences are equally important. 1st° relative’s also show impairment in decision-making planning and mental flexibility so these cognitive characteristics may be an Endo phenotype for OCD. Genetic factors also involved in bed and compulsive hoarding and skin picking although environmental factors play a greater role then in OCD.
Neural imaging of OCD
Increased metabolic activity in frontal lobe of left hemisphere-orbitofrontal cortex. suggesting that this area and related neural networks are associated with OCD. Symptoms of OCD suggest deregulation in orbitofrontal-caudate circuit. Orbitofrontal cortex alerts rest of brain when something wrong. If hyperactive produces feeling something deadly wrong. Also decreased activity in caudate nuclei- regulates transmission of impulses. Allows disturbing thoughts to continue unchecked. MRI shows increased activity in caudate nuclei of ind w OCD who were successfully treated with CBT. Also OCD has excessive connectivity between orbitofrontal cortex and prefrontal cortex.
Orbital frontal cortex hyper active
Trigger a feeling that something is not right and produced feeling that something is definitely wrong. Further OCD showed decreased activity in a region that regulates transmission of impulses called caudate nuclei
SSRIs in OCD
Reduce OCD symptoms by targeting overactive neuralconnections between orbital frontal cortex. Abnormalities and serotonin availability presumed to be associated with OCD based on findings that SSRI’s increase availability of serotonin in the brain. Also drugs that are affected with other anxiety disorders but do not increase serotonin are not effective with OCD. Disruptive transmission of glutamate may influence development of OCD also.Kevin mind a drug the triggers release of glutamate shows free up at reduction of symptoms of individuals with severe OCD.
Behavioral treatments in OCD
Induce neural plasticity is that results in more functional, activity retrain the brain so the fear circuitry no longer excavates want to queue for a session for compulsions is present.
Psychological dimension OCD
Certain thoughts or behaviors become associated with an unpleasant event, become a conditioned stimulus. If unpleasant develop avoidance behavior. Avoidance behavior reduce anxiety and reinforce behavior.
Cognitive dimension of OCD
Severe doubts believe that if they do not answer in a certain way negative consequences will occur. Individuals with OCD show exaggerated estimates of her a feeling that if they don’t control their thoughts they will be overwhelmed with anxiety and intolerance of uncertaintyalso display thought fusion
Thought-fusion.
Distressing thoughts regarding an action event or an object become fused with the action event or object. Having these thoughts produces the same emotions as if the event occurred or the actions were carried out
Dis confirmatory bias
Individuals with OCD search for evidence that they may have failed to perform a ritual correctly compulsions occur because they are unable to trust their own memories or judgment and feeling need to determine whether they actually perform the behavior or performance correctly
Social factors in OCD
Overly critical style of parenting minimal parental warmth and discouragement of autonomy. Individuals raised in adversity environments develop maladaptive believes relating to personal responsibility enable leave it’s up to them to prevent harm to themselves or others an overestimate rocks in the feelings of responsibility
Biological treatment of OCD
Only 60% of people respond to SS our eyes and I from the relief is only partial. One third experienced a recurrence of symptoms during the five your follow-up. Greater achievement when combining behavioral interventions with SSRI’s. Increasing interesting use of medications that modulate glutamate
Behavioral treatments and OCD
Combination of exposure and response prevention. Continue actual or imagine exposure to ferrules in situation perhaps flooding or gradual exposure. Response prevention involves not allowing the individual perform the compulsive behavior
Cognitive behavioral therapy for OCD
Focus on correcting dysfunctional believes. Unfortunately up to 30% of those treated with CBT for OCD do not achieve symptom relief
Response prevention
Treatment in which an individual with OCD is prevented from performing a compulsive behavior
Stressors
External events or situations the place physical or psychological demands on us
Stress
Internal psychological or physiological response to a stressor
Adjustment disorder
Reactions to life stressors that are disproportionate to the severity or intensity of the event or situation
Necessary for diagnosis of AD in the DSM-V
Exposure to an identifiable stressor that results in the onset of significant emotional or behavioral symptoms within three months of the event, emotional distress and behavioral symptoms out of proportion to the severity of the stressor and result in impairment, and symptoms last no longer than six months after the stressors.
Difference between adjustment disorders and anxiety or depression
Specific stressor precedes symptoms in Ad, in person experiences an unusually intense reaction to the stressor
For common outcomes after exposure to traumatic incidents
1) resilience stable functioning or few symptoms 2) recovery initial distress with reduction in symptoms overtime 3) delete symptoms if you initial symptoms followed by increasing symptoms overtime 4) chronic systems consistently high trauma related symptoms begin soon after the event
Acute Stress disorder
Flashbacks hypervigilance and avoiding symptoms that last up to one month after exposure to a Traumatic stressor, lasting at least 3 days up to one month
Post-Traumatic stress disorder
Disorder characterized by flashbacks hypervigilance avoidance and other symptoms that last for more than one month and occur as a result of exposure to extreme trauma. 1/2 develop depression.
Major symptom clusters of ASD or PTSD
Intrusion symptoms, avoidance, negative alterations in mood or cognition, arousal and changes in reactivity
Intrusive symptoms
Intrusive thoughts distressing recollections nightmares or flashbacks of the trauma, psychological distress triggered by external or internal reminders of the drama, physical symptoms such as increased heart rate was sweating
Avoidance
Avoidance of thoughts feelings or physical reminders associated with the trauma as well as places events objects that triggered distressing memories of the experience
Negative alterations in cognition or mood
Difficulty remembering details of the event, persistent negative views about oneself or the world, distorted cognitions leading to self blame or blaming others, frequent negative emotions, limited interest in important activities, feeling numb detached or estranged from others, persistent in ability to experience positive emotions
Arousal and changes in reactivity
Feelings of irritability perhaps resulting in verbal or physical aggression, engaging in reckless or self-destructive behaviors, hypervigilance involving constantly remaining alert for danger heightened physiological reactivities such as exaggerated startle response, difficulty concentrating, sleep disturbance
Hypervigilance
Constantly alert and anxious looking threats
Depersonalization
Feeling detached from one’s body or thoughts
Derealization
Persistent sense of unreality
Homeostasis
State of metabolic equilibrium or physiological balance
Biological dimension of PTSD
Minimal fear extinction or decline in fear responses associated with trauma, and heightened reactivity in response to stimuli associated with trauma. Deficiencies in fear extinction occurs when the medial frontal cortex is unable to adequately inhibits your responses when fear extinction does not occur various trauma related choose continue to trigger fear reactions.
Hypothalamus pituitary adrenal axis
System involved in stressing, reactions and regulate body processes such as fight or flight responses
Epinephrine
Hormone released by adrenal gland in response to physical or mental stress also known as adrenaline.
Cortisol
Hormone released by adrenal gland in response to stress
Chronic release of cortisol
Alters brain structures associated with stress regulation. Brain is particularly vulnerable during childhood. Disruptions caused by excess cortisol can lead neuronal loss and affect brain areas such as hippocampus amygdala and cerebral cortex. Perhaps why prefrontal cortex can’t adequately inhibit fear responses.
5H TT LPR
Those with this genotype of the serotonin transporter Jean and increase the sensitivity you’re more prone to heightened anxiety reactions associated with PTSD. If two short alleles
Psychological factors in trauma related disorders
Prexisting depression anxiety and negative emotions such as hostility and anger. These people react more intensely to a Trumatic them because they ruminate about the event for overestimate the probability. of an adverse events following. Tendency to generalize trauma related stimuli to other situations and avoiding associated situations leads to less opportunity for fear extinction. Disfunctional cognitive thoughts increase likelihood of PTSD.
Medication for trauma related disorders
Antidepressant medications workto desensitize fear network by decreasing reactivity of fear network. Works in less than 60% of the people only 20 to 30% so full recovery, D-cycloserine that boosts fear extinction mixed results; Prazosin hypertensive works on nightmares, and Propanol to reduce memory consolidation.
Support, social
Can prevent or diminish PTSD symptoms by affecting brain processes such as the release of endorphins that reduce stress and anxiety. Socially isolated individuals lacking in support systems appear to be more vulnerable to PTSD.
Childhood trauma
Family conflict or overprotectiveness may increase the impact of stress following exposure to a Trumatic event. Sexual abuse or severe bullying to contribute trauma related disorders mal treatment in individuals family Imay increase anxiety,lead to negative cognitive styles, alter stress-related physiological activity and HPA axis dysfunction or trigger a genetic predisposition towards greater physiological reactivity.
Prolonged exposure therapy
Imaginary and real life exposure to trauma. prolong exposure to avoided thoughts placed or people can help individuals with PTSD realize that these situations don’t present danger and thus extinguish fear reactions.so see if your reactions. Involves asking person to repeatedly re-create the traumatic event in imagination. 86% helped. Used in military
Trauma focused cognitive behavioral therapy
Focuses on helping client identify and challenge disfunctional cognitions about Trumatic event and current beliefs about themselves and others. Address underlying dysfunctional thinking of these concerns about safety for about blaming
Mindfulness training
Shows promise as an intervention for PTSD
Eye movement desensitization and reprocessing
Client visualize traumatic experience while following a theripists fingers from side to side. While substituting positive cognitions.significant reduction in hyper arousal and other symptoms
Psycho somatic
Past term applied to physical disorders such as my hypertension and headaches made worse by psychological factors or behaviors. Attempted to distinguish physical disorders the fact that my psychological factors from conditions considered strictly physical in nature
Psychophysiological disorder.
Any physical disorder that has a strong psychological basis or component. As opposed to psychological factors affecting other medical conditions. Any physical condition where psychological factors contribute to the development of the disorder make the condition worse or delay improvement. In most cases both medical and psychological treatments are needed.
Broken heart syndrome
Reversible cardiac condition, results from toxic levels of up in the front associated with sudden stress. Massive releases stress hormones paralyzes the heart muscle causing it to shut down. Symptoms similar to heart attack. 1% fatal. 7# higher women.
Psycho physiological disorders involve
Actual tissue damage, a disease process for choosing Peerman of immune system, or psychological dysfunction and small and migraine headaches. Both medical treatment and psychotherapy are required
Migraine headache
Inflammation of dilation of cranial arteries pressure on your binders and chemical changes reduce pain may last a few hours for several days accompanied by nausea and vomiting one third individuals experience in Ora. Anomaly in white matter of the brain11.5% one your prevalence often hereditary, more women.
Aura
Unusable physical sensations or visible symptoms such as flashes of light unusual visual patterns or blind spots prior to the headache, or tingling
Tension headache
Produced by prolonged contraction of the scalp and neck muscles resulting in construction of the blood vessels and steady pain mild to moderate last hours to days both sides of head more common in women probably not hereditary
Cluster headaches
Excruciating stabbing burning sensation located in the eye or cheek. Attacks are extremely painful have a rapid onset. 55% report suicidal thoughts. 15 min to 3 hours, more common in men may have tears or stuffy nose. Pain-free periods.
Asthma
Chronic inflammatory disease of the lungs can be aggravated by stress or anxiety. Stress or other triggers class excessive mucus suppressions combine with spasms and swelling of the airwaves. Increased dramatically since 1980’s in us, 8.2% adolescents with the asthma are twice as likely to die from suicide compared to peers without
Immune system
Stress decreases immune system’s efficiency person person susceptibility to disease. Horrible salsa classes immune functioning. Chronic stress increases vulnerability to infection and accelerates progression of disease. Participants undergoing severe stress for one month or more ago or more likely to develop colds
Hardiness
Trait that protects people from harmful effects of stressors include commitment control and openness to challenge
Treatment of psycho physiological disorders
Involve medical treatment for the physical symptoms and psychotherapy to illuminate stress and Anxiety. Include relaxation training ,biofeedback training, cognitive behavioral therapy,talking about the disease,sometimes emotional regulation strategies like anger management.
Relaxation training
Therapeutic technique in which a person acquires the ability to relax the muscles of the body in almost any circumstances. Concentrate on one set of muscles at a time first tensing then relaxing them. Focus on the warmth and looseness in the muscles after relaxing. Practice this several times then proceed to the next muscle group
Biofeedback training
Self-regulation technique that allows people to alter physiological processes in order to improve physical or mental health. Learn to voluntarily control a physiological function such as heart rate or blood pressure by receiving second by second feedback regarding this psiological activity.
