EXAM 2 Flashcards
What are the vulnerabilities to anxiety disorders?
Biological (to negative mood states)
Specific Psychological
General Psychological
What is the avoidance technique for anxiety?
Avoid thinking about their future worries, do not see it objectively
GAD Treatments?
- Benzodiazepines & CBT
What is CBT-G
Provide a model of intolerance of uncertainty, unhelpful thoughts and avoidance
Treatment for Panic Disorder
Benzodiazepines, SSRI, SNRI, CBT-P
What is CBT for Panic Disorder
- Normal (i.e., harmless) physiologic changes in breathing, heart rate, muscle activity are perceived → mistaken for a problem → arousal → panic attack
CBT-NP (Nocturnal Panic)
- Address insomnia – improving sleep will reduce arousal and ↓ likelihood of panic
- Same as daytime protocol but nocturnal rationale and exposures
How does a Phobia develop
Experiential- vicarious (seeing but even informational is possible) Informational transmission (if you warned about danger, you can begin to fear that object) - alarm symptoms in presence of object
Recipe for Phobia development
- Scary experience/situation
- Genetic predisposition (e.g., snake, heights and trapped)
- Post- experience focus on whether it will recur
What are the 4 categories of PTSD
Intrusive, avoidance, cognitive-emotional, hyperarousal
What is the fear structure
- A trauma memory is a type of fear structure which contains:
o Stimuli during the trauma (e.g., alone, smells)
o Physiological and behavioural responses during the trauma (e.g., freezing, screaming)
o Meaning of the responses (e.g., “I’m too blame” “I’m incompetent”)
Persistent trauma reaction
o Avoidance: of any part of the trauma memory (e.g., sleeping with light on, don’t go out)
o Unhelpful beliefs such as, “the world is dangerous” or “I am incompetent, to
blame” etc.
Imaginal exposure PTSD
- Revisiting (repeatedly)
o Talking about the trauma is not re-experiencing it - Make sense of the trauma, rather than shutting down processing
- Learn that thinking about the trauma is not dangerous
In vivo exposure PTSD
- Develop a list of situations that have been avoided since the trauma
- Inquire about safety (i.e., it is possible that they actually live in an
unsavoury neighbourhood)
OCD Treatment
- Exposure and response prevention (ERP; e.g., Abramowitz, Taylor & McKay, 2012)
o Expose to triggers (e.g., contaminants) and prevent the response (no washing)
o Client learns that no harm occurs – rituals don’t matter - Drugs are less effective and people relapse when off them (e.g., Dougherty, Rauch, & Jenike, 2012)
PAP Therapy
- Positive Airway Pressure (PAP) therapy eliminates events and can reverse the diseases apnea causes
Process S: Homeostatic Mechanism
- Sleep drive determines the quantity of deep sleep and the quality
- Homeostatic system is associated with adenosine (by product of cells working, making you sleepier, makes up for lost sleep)
Process C: The body click
- Timing
- Clock determines timing of sleep especially after REM sleep timing and timing of alertness
- Clocks all over body muscles, eating, eyes (light), master keeper of clocks SEN
- SEN coordinates all these clocks - Managing Drift
- There is drift in our clock because it is no longer than 24 hours
o Regular bedtimes, regular rise times and regular light exposure ‘set’ the clock and manage drift
Homeostatic Perpetuating factors
- We need to “build” sleep drive to have continuous and quality sleep, therefore behaviours that will have a negative impact on this build-up will be:
Process C/Circadian perpetuating factors
- Optimal sleep is produced during a dynamic, idiosyncratic timing window, therefore the
following behaviours would have a negative impact on sleep
The third process: the arousal system
The arousal system can trump the sleep promoting system
o Allows us adequate respond to dangerous threats
- When overactive, the arousal system interferes with the processes controlling sleep.
Sleep extension
- Provide MORE time in bed when there is sleepiness:
o Subjective complaints of sleepiness
o Sleep efficiency upwards of 90%
o Sleep onset latencies less than 10 minute
CBT-I and physiology
- CBT-I improves neurophysiology of sleep: ↓high frequency & ↑ slow wave activity in the EEG
Sleep restriction therapy
o Match time-in-bed with current average sleep production (add 30 minutes for normal sleep onset latency)
Bulimia side effects
Bulimia side effects
- Facial distortions from salivary gland enlargement (vomiting)
- Loss of and damage to teeth from vomiting
- Potentially fatal cardiac arrhythmia or kidney failure, from electrolyte imbalances
- Subsequent substance abuse, smoking
- depression, weight gain
difference between anorexia and bulimia
anorexia, you lose weight, bulimia is lack of control in eating and binges are big
ED treatment
- SSRIs help some with bulimia but not long-term so they are combined with CBT, - CBT-E has good efficacy and an approach that addresses the common factors across disorders eating, Interpersonal Psychotherapy (IPT) focuses solely on interpersonal issues and is as effective as CBT, - Motivational interviewing may be helpful before therapy to enhance readiness for change
CBT For ED
- Normalize eating behaviours
o In bulimia and BED, there are frequent scheduled small meals and in anorexia they are hospitalized until safe weight is achieved
Depressants
- Decrease central nervous system activity
- Alcohol, hypnotics, anxiolytics
- Symptoms: relaxation
- Withdrawal: agitation, anxiety
- Long-term withdrawal: delirium tremens, vomiting, hallucinations, death
Stimulants
- Increase central nervous system activity (enhance GLU, NE, DA)
- Caffeine, nicotine, amphetamines, cocaine
- Symptoms: alertness, energy
- Side effects: impaired judgment/functioning, paranoia, heart racing, chills, nausea, vomiting , respiratory depression, seizures, coma
- Withdrawal: fatigue, in cocaine: apathy
Opioids
- Oxycodon, morphine, heroin
- Symptoms: euphoria, drowsiness, slowed breathing, analgesia
- Withdrawal: nausea and vomiting, aches, chills, diarrhea, insomnia, prolonged (many days) and painful
Cannabis
- Altered perception, mood swings, in large doses hallucinations and paranoia – wide variations in report of symptoms
- Concentration, sleep, memory, motivation, interpersonal and occupational problems can occur in long term use
- Withdrawal: diminished appetite, irritability, headaches, loss of focus, cold sweats, chills, depression and anxiety
- Long-term problems include insomnia
- There are medicinal products being tested for medical problems such as cancer pain, which typically have low tetrahydrocannabinols (THC)
Hallucinogens
- LSD – a fungus associated with hallucinations, perceptual changes, depersonalization, dilated pupils, sweating, rapid heartbeat and blurred vision
Treatments for Substance disorder
- Agonist substitution
o Methadone - Antagonist treatments
o Naltrexone - Aversive treatment
o Antabuse
Psychosocial treatments for SA
- Inpatient facilities
o Expensive; assist through - Alcoholics Anonymous (AA)
o Social support - Controlled use/ Harm reduction/Controlled drinking
o Safe injection sites (SISs) - Component therapy (coping skills, contingencies, community)
- Motivational enhancement to increase readiness for change
