Chapter 5 Flashcards
The Rochester test is an example of a…. test
projective
Part of mental status exam clinician asks about where they ae patient knows where they are….
sensorium
Car accident
brain injury
What kind of test?
Neuropsychological
One of the most extensively used personality tests
Has L scale
MMPI
Optimal level of arousal is suggested by the…….
Yerkes Dodson Law
According to Mower’s……..theory, both………and………can account for acquisition of fears and phobias
two factor
classical conditioning
operant conditioning
….. and ……. are highly comorbid because the first one can lead to persistence and widespread avoidance of unescapable situations
Agoraphobia
panic disorder
Psychotherapeutic anxiety treatment almost always involves some form of……
exposure
….. ……. disorder can be distinguished from…… symptom disorder on the basis that the former has less to do with the symptoms and more to do with their ……
Illness anxiety disorder
Somatic symptom disorder
meaning
Functional neurological disorder (aka …. disorder) what does functional mean?
conversion
A symptom without organic cause
What is the difference between anxiety
fear and panic
Anxiety is a negative mood state where you feel threatened by a potential negative future event
Fear is a response to a threat right here right now
Panic, closely related to fear but false alarm.
There’s no “real threat” it’s a false alarm
Can progress to panic attack
When is anxiety adaptive? When is it maladaptive?
This is explained by the Yerks Dodson curve.
The optimal level of arousal helps our performance by increasing our attention and investment.
Anxiety can be helpful by:
- promoting cautious and attentive behaviour
- when the concern is realistic and when it fades after the event
However, when anxiety gets too powerful our performance is inhibited
What are the biological causes of anxiety?
Anxiety sensitivity is heritable at 30-50%
There’s no one gene that gives you anxiety, it can just make you more susceptible to it
ex. some people are born more uptight
increased sensitivity to arousal
Brain function and anxiety:
Parts that matter and control it
Amygdala: fear centre
- overly responsive to new threats
Cortex down regulate limbic system
Anxiety sensitivity= amygdala insufficiently down regulation of limbic system
What neurotransmitters effect anxiety?
GABA: neurotransmitter that has a calming effect
Norepinephrine: mood arousal attention
serotonin:regulate mood.
Behavioural factors for anxiety
What is mowrer’s two factor behavioural theory?
- Fear learned through classical conditioning:
Neutral stimulus (CS) is paired with frightening or painful stimulus (US). - Maintained through operant conditioning:
Avoiding that CS reduces anxiety
(in the short term-not facing anxiety worsens it in the long term because it never has the opportunity to be disproved)
What is modelling?
Learning by observing others
Psychological causes to Anxiety:
Personality traits
Cognitive factors
Social
Personality traits that give us an “anxiety sensitivity”
Cognitive Factors
- Aron Beck
* Thoughts mediate how we feel
*We are conditioned to pay attention to things that align with our belifs
* View world as uncertain and themselves as unable to cope with stress
Intolerance of uncertainty
Positive beliefs about worry (think its helpful or useful)
Poor problem orientation
Cognitive avoidance (avoid threat, never learn to face it)
Social
* Stressful life events trigger our biological vulnerabilities
*our reactions to stress runs in our families
What are Barlow’s three Vulnerabilities models
Vulnerability (Diathesis) is a generalized biological vulnerability
Ex. Tendency to be uptight is heritable
Generalized psychological vulnerability (feel like events are uncontrolled or dangerous)
- Low self esteem inability to cope
- Grew up in a world that was dangerous and out of your control
- Never learned how to cope with adversity
Specific psychological vulnerability (physical sensations are dangerous)
- You learn to be anxious from experiences
Ex. Parents deathly afraid of dogs and so are you
- Panic
- Hypochondriac
What is the most common type of psychological disorder?
What does anxiety have a high comorbidity with?
Who is the most effected?
Social anxiety
Women
Comorbidity with depression
Generalized Anxiety disorder
What are the main symptoms?
What is it?
Timeline?
What is it?
Uncontrollable unproductive worrying (pathological worry) about everyday events
Symptoms:
*Muscle tension !!!
*Irritability
*Sleep issues
*Restlessness
*fatigue
*Difficulty concentrating
6 months
GAD Statistics
Onset?
How many?
What age?
Comorbidity
Over 15 years old more women than men
3% Canada pop
50% of people with GAD also have MDD
Most common in people over 45
Cognitive characteristics of GAD (4)
- Intolerance of uncertainty
- Positive beliefs about worry
- Poor problem orientation (problems need to be avoided, not solved)
- Cognitive avoidance
* Must interfere with ability to function**
What are the pharmacological treatment of GAD
Pro
con
Benzodiazepine: slow down activity in your brain and nervous system
SSRI: block the reuptake of serotonin, making more serotonin available in the brain
Blocks reuptake of neurotransmitters
- Meds work well when you take them (fast acting) but can have side effects and more relapses when you stop
Psychological treatment to GAD
- Longer lasting + effects then drug
- Cognitive behavioural therapy
- Help to process threatening info and improve tolerance of uncertanty
Panic Attack
Symptoms:
1. chest pain
2. Derealization
3. trembling sweating
4. Fear in the absence of real threats (false alarms
- At least one attack followed by one month of….
- Persistent worry about future attacks
- Maladaptive changes in behaviour related to attack ( avoidance)
Agarophobia
What is it?
Comorbidity?
- Fear of the marketplace
- Fear and avoidance of situation that are hard to escape or lead to arousal
- High comorbidity with panic attacks (95%)
- scared to go out and have a panic attack in unescapable place
- Interoceptive cue (inside person)
Agorophobia and dsm-5-tr
Timeline: at least 6 months
Fear of at least two of the following:
- Using public transportation
- Open spaces
- enclosed spaces
- In line or in a crowd
- Outside home alone
Avoid these situations because they inhibit escape and access to help if they have a panic attack
Situations provoke fear and anxiety and are avoided
Stats of Agoraphobia
3.7 % of canadien pop
Onset: 25-29Stats of Agoraphobia
Women: 4.6
Men: 2.8
Cause of agoraphobia
Biological/generalized psychological vulnerability
I
Stress
I
False alarm of somatic senses leads to learned alarm
I
Specific psychological vulnerability (weird physical sensations= danger)
l
Anxious about somatic sensations
l
Panic disorder
l
Agoraphobia with panic disorder
Treatment of panic and agoraphobia drug
Benzodiazepines SSRI SNRI
Pro: Effective when being taken
Con: adversely affect cognitive and motor functioning
90% relapse after you stop taking
Treatment of panic and agoraphobia psychological
Gradual exposure exercise (Fear ladder)
Panic control treatment PCT
(relaxed breathing)
Specific phobia
what is it?
What are the 4 types
An irrational fear of a specific object or situation that interferes with an individual’s life
Fear lasts over 6 months
Fear or anxiety disproportionate to actual danger
- Animal
- Situational
- Natural environmental
- Blood injury injection
** different treatment (heritable and has that vasovagal response (blood vessels open too wide))
Stats of specific phobias
6.4 % of pop
8.9 women
4.1 men
culture specific
Often dont seek treatment because they can work around phobia
Cause
- Traumatic experience
-Biological diatheses
- vicariously experience (information transition)
- False alarm or panic attack
- Anxiety about future contact
Causes avoidance conditioning
*Lessens anxiety in the moment - but it fails to give you the opportunity to disprove the phobia - it just lets it grow
- cultural factors
Treatment phobia
How it works
Options
Blood
Formula
- Fear ladder
- exposure based exercise
- virtual reality exposure therapy
For blood:
- applied muscle tension
- Get blood pressure to go up so you don’t pass out
- then practice exposure therapy
How it works:
Responsiveness diminishes in the fear sensitive network (amygdala, insula cingulate cortex) the more we are exposed but increase in prefrontal cortex (logic areas)
Formula:
frequency intencity duration
Social Anxiety disorder
Fear of being negatively evaluated by people
- Performance anxiety is a subset of this
DSM-5-TR social anxiety
- 6 + months
- fear or anxiety where person is exposed to possible scrutiny by others
- Social situations almost always provoke fear or anxiety
- avoid social situations
- Fear anxiety or avoidance causes significant distress
- fear out of preportion to threat
Stats
13.1 % us
8.1 Canada pop
Onset teen
a little bit more common in women
Affects young less educated single lower income individuals
Cause
Biological vulnerability
Panic attacks in social situations/social trauma
Cognitive biases
*Selectively interpret others as unfriendly
*upward social comparisons
*Fewer social skills
Treatment
Pharmacological
Psychological
Exposure
Drug:
SSRI
Psych:
CB group therapy
- role play situations
- uncover cognitive biases about group situations
Exposure therapy
- social mishap exposure
- Virtual reality exposure
- Social training skills
Interpersonal psychological treatment
Selective mutism
Kids don’t talk in public settings where they would be expected
they are capable of talking
