Exam 2 Material Flashcards
What are stressors?
External demands or events
What is stress?
the byproduct of poor or inadequate coping
What are the 5 stress risk factors?
Genetics
Experience of 1+ crisis
Significant life events
Individual perception of stressor
Individual stress tolerance/threshold
What are the 7 stress protective factors?
Male gender
older age
higher education
economic resources
positive outlook
self-confidence
social support
What are the 6 key factors of stress?
Severity
Chronicity
Timing
Degree of Impact on life
Predictability/level of expectation
Controllability
What are the other factors of stress?
Crises
Life changes
What does the sympathetic-adrenomedullary (SAM) system do?
Fight or Flight
What does the Hypothalamus-pituitary-adrenal (HPA) system do?
Produces cortisol
What are the short-term implications of stress?
compromised immune system
What are the long term implications of stress?
Global immunosuppression
Inflammation –> health problems like cardiovascular disease, diabetes, osteoporosis
Psychiatric problems
What is Adjustment disorder?
Adjustment disorder is STRESS (not trauma) specific
An atypical psychological response to a “common” stressor
What is the time period for Adjustment Disorder
Symptoms emerge within 3 months of the stressor but do not persist for more than and additional 6 months
What is the prevalence of adjustment disorder?
Very common!
May be used more for insurance coding
5-20% in outpatient setting
50% in inpatient setting
What are the comorbidities of adjustment disorder?
medical illness and injury
What is trauma?
A very difficult or unpleasant experience that causes someone to have mental or emotional problems for a long time
NOT something that is common to the human experience
What is Acute Stress disorder?
Acute stress is TRAUMA related
it is a psychological response to a “traumatic” stressor/trauma
What is the timeline for acute stress disorder?
Symptoms must last at least 3 days and up to 1 month after traumatic event
What are the five categories for Acute Stress Disorder symptoms?
Intrusion Symptoms
Negative Mood
Dissociative Symptoms
Avoidance Symptoms
Arousal Symptoms
What is the prevalence of Acute Stress Disorder?
<20% in non-interpersonal trauma (not perpetrator)
20-50% in interpersonal trauma (perpetrator)
What is Post-Traumatic Stress Disorder (PTSD)?
Psychological response to a “traumatic” stressor / trauma
What is the timeline for PTSD?
Symptoms must remain present for 1+ month(s) (no cap for how long these can persist)
What are the four categories for PTSD symptoms?
Intrusion Symptoms (1+)
Avoidance Symptoms (1+)
Negative Alterations in Cognition and Mood (2+)
Arousal and Reactivity Symptoms (2+)
What is the difference between Depersonalization and Derealization?
Depersonalization: persistent/recurrent experiences of feeling detached from body (dream state; self or body isn’t real; time moving slowly)
Derealization: persistent/recurrent experiences that world is unreal, dreamlike, distant or distorted
Why does PTSD develop?
The SAM systems does not turn off following the threat or trauma
Our SAM system is our smoke alarm: it needs to go off when there is smoke, but it starts to go off with non-threatening smoke (birthday candle, steam, toaster)
PTSD is a snowball effect
What is the prevalence of PTSD?
Lifetime prevalence in the US is 6.8%
Highest rates (33-50%) among survivors of military combat and/or captivity, rape, politically or ethnically motivated internment and genocide
What are the comorbidities of PTSD?
80% more likely to have at least one other diagnosis
depression, bipolar, anxiety, or substance abuse disorder
What are the Biological and Sociocultural causal factors of PTSD?
Gender: females have higher cortisol levels
Genetics
Reduced Hippocampus size
Higher risk for PTSD with a membership in a minority group
What are some preventions of PTSD?
Psychological debriefing
Stress Inoculation (talking you through the stress)
What are some treatments for Stress Disorders?
Pharmacotherapy: antidepressants or anti-psychotics
Prolonged Exposure
Cognitive Processing Therapy: thinking about trauma differently
Cognitive-Behavioral Conjoint Therapy: couples-base intervention
How does having a relationship effect those with PTSD?
Having a supportive environment can “buffer” effects of trauma
Disclosure strengthens the relationship and lowers PTSD symptoms
What is fear?
a state of alarm in response to a specific immediate threat
What is anxiety?
a state of alarm in response to a vague sense of danger
What is the difference between fear and anxiety?
Physiological:
fear: increased heart rate, sweating
anxiety: tension, chronic over-arousal
Behavioral:
fear: desire to run or escape
anxiety: general avoidance
What is the prevalence of an Anxiety disorder?
Most common disorder in the US
18% - annual prevalence in adults
29% - lifetime prevalence in adults
What is the comorbidity of an anxiety disorder?
One anxiety disorder only: 19%
Two or more independent anxiety disorders: 26%
Two or more anxiety disorders, one caused by the other: 55%
What is the timeline for Generalized Anxiety Disorder?
Person must experience symptoms for 6 months
What is the prevalence of GAD?
6% lifetime prevalence
3% annual prevalence
What are the Psychodynamic Formulations of GAD?
and what are the 3 types?
Belief from Freud that everyone experiences anxiety and uses defense mechanisms to help control it
1. Realistic: results from actual danger
2. Neurotic: results from fears of expressing conflicting or unconscious impulses
3. Moral: results from conflicts between underlying impulses and the conscience
What are the cognitive Formulations of GAD?
the result of feeling a lack of control
Included: perception of uncontrollability and unpredictability, negative consequences of worry, and cognitive biases
What are the biological formulations of GAD?
Genetics
Neurotransmitters: GABA and serotonin
HPA system: CRH
What are the treatments for GAD?
finding a combination between therapy and medication
Cognitive-Behavioral Therapy: cut out avoidance strategies
Psychopharmacology: Anxiolytic drugs (Benzodiazepines) or Buspirone
Why are benzodiazepines not always the best treatment for GAD?
They provide modest temporary relief, but can cause rebound anxiety, withdrawal, physical dependence, side effects. Their addictive properties are incredible high
What are Phobias?
Strong, persistent, unreasonable fear of a particular object, activity, or situation
Characterized by avoidance
What is Blood-injection-injury phobia?
One of the only phobias that doesn’t activate the SAMs system like the other phobias. It causes a quick spike and then a drop in blood pressure. Often leads to passing out
What is the prevalence of Phobias?
lifetime prevalence: 12%
What is the psychanalytic explanation for phobias?
They are a defense against anxiety stemming from repressed id impulses
What are the behavioral explanations for phobias?
Phobias are learned behavior
Phobias are maintained through avoidance
Phobias may develop into GAD when a person acquires a large number of them
How might phobias be learned?
Observation and imitation
Vicarious conditioning (person to person)
What is stimulus generalization?
When responses to one stimulus are also elicited by similar stimuli
What are the biological explanations of phobias?
Genetics: superior fear conditioning, enhanced resistance to extinction
Temperament: behavioral inhibition in toddlers is linked to development of specific phobia by age eight
What are the 3 types of treatments for phobias?
Exposure Therapy
Flooding: forced nongradual exposure
Modeling: therapist confronts the feared object in front of the patient
What is social anxiety disorder?
severe, persistent, and irrational fears of social or performance situations in which scrutiny by others and embarrassment/humiliation may occur
narrow: talking, eating, performing in public
broad: general fear of functioning poorly in front of others
What is the prevalence of Social Anxiety Disorder?
Lifetime prevalence: 12%
What are the comorbidities of Social Anxiety Disorder?
Other anxiety disorders
Depression
Substance abuse
What are the psychological factors of Social Anxiety Disorder?
Learned behavior, develops through experiences
Perceptions of uncontrollability and unpredictability
cognitive biases toward “danger schemas” in social situations
What are the biological factors of Social Anxiety Disorder?
Genetics: 12-30% of variance due to genes
Temperament: behavioral inhibition, kids that are really shy or timid
What are the treatments of Social Anxiety Disorder?
Cognitive-Behavioral Therapy through cognitive restructuring or behavioral activation
Medication: antidepressants
What is agoraphobia?
People that are afraid of being in situations where escape might be difficult or embarrassing
Does not have anything to do we how they socialize
What is the prevalence/comorbidity of agoraphobia?
1.4% lifetime
as the intensity of agoraphobia increases, so do the gender differences
Comorbidity: panic disorder
What is the treatment for agoraphobia?
behavioral therapy with an exposure approach
What is Panic Disorder?
Panic = extreme anxiety reaction
reoccurring panic attacks
the person fears he/she will die, lose control, in the presence of no real threat
What are panic attacks?
Panic attacks are short episodes of panic that occur suddenly, reach a peak, and then pass
attacks are recurrent and unexpected - “out of the blue
no specific trigger
What is the prevalence of Panic Disorder?
2.4% each year
5% over a lifetime
typically develops between ages 20-40
What is the comorbidity of Panic disorder?
83% have at least 1 comorbid disorder
50-70% have serious depression at some point in their lives
What is the biological perspective of Panic disorder? Causal Factors
Genetics: 30-34% due to genes
Brain Functioning:
Amygdala –> fear
Hippocampus –> memories, emotional processing
higher cortical centers –> integrate all or that
Biochemical:
Panic provocation procedures
Noradrenergic & serotonergic systems
low levels of GABA, low serotonin
What is the biological perspective of Panic Disorder? Treatments:
Antidepressants: improvement in 80% of patients, stabilization of the serotonin circuit
Anxiolytics also effective
What are the 3 psychological perspectives of Panic Disorder?
Cognitive Theory of Panic
Learning Theory of Panic
Anxiety sensitivity
What is the cognitive theory of panic?
Panic-prone individuals are very sensitive to certain sensations and interpret them as a medical catastrophe (automatic thoughts)
What is the learning theory of panic?
Panic attack becomes associated with neutral internal & external cues. Anxiety becomes conditioned to these stimuli. The more intense the panic attack, the more robust the conditioning will be
What is the anxiety sensitivity of panic disorder?
Focus on bodily sensations, unable to assess logically, interpret as potentially harmful
What is the psychological treatment of Panic Disorder?
Cognitive-Behavioral therapy:
Psychoeducation
Teach about accurate interpretations of bodily sensations
Coping skills
What are obsessions?
Persistent, unwanted thoughts, ideas, impulses, wishes, or images that seem to invade a person’s consciousness
examples: dirt/contamination, violence and aggression, sexuality
What are compulsions?
Repetitive and rigid behaviors (or mental acts) that people feel they must perform to prevent or reduce anxiety
examples: cleaning, checking/repeating, counting
What are the 4 features of compulsions?
“Voluntary” behaviors or “mental acts”
Most persons recognize that such behaviors are unreasonable
Performing behaviors reduces anxiety
Behaviors often develop into rituals
What are the diagnostic criteria of OCD?
presence of obsessions, compulsions, or both
feel excessive or unreasonable
cause great distress
take up much time
interfere with daily function
What is the prevalence and comorbidity of OCD?
Prevalence:
1 year: 1%
lifetime: 2-3%
NO GENDER DIFFERENCES
Comorbidity:
other anxiety disorders
depression 80%
What is the biological perspective of OCD? Causal factors and treatment
Causal factors:
genetics - 3-12x higher in first first-degree relatives
Brain functioning - orbital frontal cortex, cingulate gyrus, and basal ganglia
Neurochemistry - serotonin
Treatment:
Serotonin-based antidepressants
improvement for 40-60% of those with OCD
What is the Psychodynamic perspective of OCD?
Freud -disorders develop when children come to fear their impulses and use ego defense mechanisms to lessen their anxiety
Not the most plausible explaination
What is the Behavioral Perspective of OCD?
Concentrated on explaining and treating compulsions rather than obsessions
Mowrer’s two-process theory of avoidance learning
What is Mowrer’s two-process theory of avoidance learning?
People have anxiety, perform a certain action, and the anxiety lessens. This increases the likelihood that they will perform the action again
What is the Cognitive Perspective of OCD
Focus on the cognitive processes that
help to produce and maintain obsessive thoughts and
compulsive acts
Suppressing unwanted thoughts increases those thoughts
Those with OCD have cognitive biases toward material
relevant to their obsessions
What is the treatment for OCD?
Exposure and response prevention (ERP)
repeated exposure to anxiety-provoking stimuli and are told to resist performing the compulsions
What is Body Dysmorphic Disorder?
People with obsessions with perceived or imagined flaw in appearance; not visible to others
repetitive behaviors or mental acts
What is the prevalence/comorbidity of Body Dysmorphic Disorder?
Prevalence:
2%
NO GENDER DIFFERECES
Comorbidities:
depression, suicide
What does Soma mean?
Body
What is Somatic Symptom Disorder?
A combination of Hypochondriasis, somatization disorder, and pain disorder
What are the 3 diagnostic criteria for Somatic Symptom Disorder?
- 1+ somatic symptom, chronic and distressing
- Dysfunctional thoughts, feelings, behaviors
- symptoms is persistent for 6+ months
What is the prevalence/comorbidity of somatic symptom disorder?
Prevalence: 5-7%
Comorbidities: Anxiety, Depression
What is the Cognitive Perspective of Somatic Symptom Disorder?
Predisposition to catastrophize pain
Prior experience with illness
Trait-based risk factors:
-Negative affect
-Absorption
-Alexithymia
What are the 2 components of the behavioral perspective of somatic symptom disorder?
Reinforcement - medical treatment provides short-term relief
Observational learning - observe attention or benefits
What are the 2 possible treatments for somatic symptom disorder?
Cognitive-Behavioral Therapy
- ERP
Medical Management
- Doctor will focus on only new complaints
What are the 5 diagnostic criteria of Illness Anxiety Disorder?
- Preoccupation with having or developing a serious illness
- No somatic symptoms, or mild (if present)
- High anxiety about health, easily alarmed about health status
- Excessive health-related behaviors or maladaptive avoidance
- Illness preoccupation present for 6+ months
What are the two perspective of illness anxiety disorder?
- Behaviorists: classical conditioning or modeling
- Cognitive theorists: oversensitivity to bodily cues
What is Illness Anxiety Disorder?
People are worried about developing a symptom that they don’t currently have. “What if?”
What are the treatments for illness anxiety disorder?
receive treatments similar to OCD:
- Antidepressant medication
- ERP
- CBT
What is Conversion Disorder?
Patients presents with physical impairment (blindness, partial-paralysis) but have symptoms that are inconsistent with known neurological or medical diseases. They are psychological
What is the prevalence of conversion disorder?
5% of patients in neurological clinic
.005% of general population
What are the causes of conversion disorder?
Primary gain = reduction in anxiety
secondary gain = sympathy, attention
What is the psychodynamic perspective of conversion disorder?
Unconscious conflict re: sexual desires
anxiety is converted into bodily disturbance
What is the behavioral perspective of conversion disorder?
Reinforcement (positive and negative)
avoid punishment (unable to express feelings)
What are the treatments for conversion disorder?
Behavioral therapy for motor symptoms
cognitive-behavioral therapy for seizures
hypnosis +problem-solving strategies
What is factitious disorder?
Known as Munchausen syndrome
people will go to extremes to create the appearance of illness
may malinger, intentionally fake illness to achieve external gain
may also be imposed on another
What is the prevalence of Factitious disorder?
0.5-0.8% in general hospital setting (hard to say)
What is dissociation?
Disruptions in normally integrated functions
What are the two nonconscious processes associated with dissociative disorders?
Implicit memory - remembering things you cannot consciously recall
implicit perception - responding to sights or sounds even though you cannot report having seen or heard them
What is depersonalization?
sense of self and one’s reality is temporarily lost
What is derealization?
feeling that the external world is unreal and strange; sense of reality of outside world is temporarily lost
What is the prevalence of depersonalization/derealization disorder?
1-2% lifetime
FEMALE = MALE
What is Dissociative Amnesia?
people are unable to recall important information about their lived
often triggered by a high stress event
What are the four things that dissociative amnesia may be?
Localized - loss of all memory of events within a time period
Selective - loss of memory for some events within a time period
Generalized - loss of memory beginning with an event but extending back in time
Continuous - forgetting continues into the future
What is dissociative fugue?
an extreme version of dissociative amnesia
people forget their personal identities and past, and flee to a different location
ends suddenly
FUGUE = FLIGHT
What are the psychological causes of dissociative amnesia?
- unconscious attempts to avoid thoughts about a situation or, in extreme cases, physical avoidance
- large segments of personality and memory are suppressed when there is no clear way to escape
What is Dissociate Identity Disorder?
2+ distinct personalities (alters) each with a unique set of memories, behaviors, thoughts, and emotions
Recurrent episodes of amnesia
What are the awareness levels of DID?
- mutually amnesic: subpersonalities have no awareness of one another
- mutually cognizant patterns: each subpersonality is well aware of the rest
- one-way amnesic relationships: some personalities are aware of others
What is the prevalence of DID?
1.5% community sample, 6% trauma sample
women diagnosed 3-9x more than men
age of onset is usually around age 5
What are some causes of DID?
Potential Post-traumatic
- children attempt to cope with abuse
Sociocognitive theory: Highly suggestible person learns to adopt & enact multiple identities following inadvertent behaviors of clinicians
What is the treatment for DID?
based on Posttraumatic Theory
hypnosis is commonly used
develop an integrate personality
