Lecture 4 - Stress and Psychological Outcomes I

Question 1

What is psychopathology?

Answer 1

Psychopathology is a clinically significant disturbance in thoughts, emotions, or behaviours that cause significant distress or functional impairment.

Question 2

What factors play a role in diagnosis?

Answer 2

1) DSM symptoms/criteria
2) functional impairment
3) high distress

Question 3

What are the pros and cons of a diagnosis?

Answer 3

Pros:

• differential diagnosis
• informs treatment
• insurance categories
• prognosis may provide relief to patient

Cons:

• there is stigma associated with a mental illness diagnosis
• probability of misdiagnosis

Question 4

How is culture relevant to diagnosis?

Answer 4

Culture can mediate the symptoms and criteria of a mental illness and influence its diagnosis.

Question 5

What are some differences in how depression presents itself in different cultures?

Answer 5

Western cultures tend to exhibit more psychological cultures, whereas Asian cultures, such as China and India, exhibit more physical symptoms.

Some examples of physical symptoms of depression are feeling sick, having low energy, and inability to sleep.

Question 6

How is culture relevant to psychopathology?

Answer 6

Some, particularly Eastern, cultures have hesitation, shame, and embarrassment in sharing psychological issues. Therefore, culture can mediate the symptoms and criteria of mental illnesses and influence their diagnosis.

Question 7

Describe Slotkin’s (1954) anecdotes about culture and psychopathology.

Answer 7

1) A Menomini (Native American) was diagnosed with a snake phobia before the psychiatrist knew that Menomini’s believe all but one species of snake are evil spirits who come out at night.
2) A social worker was disturbed upon finding a bloody bedsheet hanging on the family clothesline the day after their daughter had been married. She hadn’t known that Balkans do this so neighbors can see the bloody sheet as proof of a daughter’s virginity.

Question 8

What is the difference between fear, anxiety and worry?

Answer 8

Fear is in the moment, and associated with the HPA and SAM axes. Fear is associated with imminent threat, sympathetic arousal, and escape.

Anxiety/worry are interchangeable. Anxiety is more chronic, and it is associated with future threat, muscle tension, and avoidance.

Question 9

What is the difference between normal and pathological anxiety?

Answer 9

Pathological anxiety is at an intensity level higher than normal.

• high sensitivity to perceived threat
• high stress reactivity
• attentional bias to threats -> the brain looks for anxious stimuli, and is wired for negative stimuli, this leads to a vicious cycle

Question 10

What are the main types of anxiety disorders?

Answer 10

• specific phobias
• panic disorder
• agoraphobia
• social anxiety disorder
• generalized anxiety disorder
• obsessive-compulsive disorder
• post-traumatic stress disorder

Question 11

What are the different types of phobias?

Answer 11

Animal: snakes, spiders

Environment (natural): storms, heights, water

Blood, injection, injury

Situational: driving, flying

Question 12

What is the prevalence of phobias?

Answer 12

11%

Question 13

What is the average number of fears people with specific phobias have?

Answer 13

3, however not all of these phobias have to trigger an equal level of fear

Question 14

Which type of phobia has the worst treatment outcomes?

Answer 14

Blood, injection and injury because the symptoms tend to be faiting and disgust, which are very hard to treat and suppress.

Question 15

What is panic disorder?

Answer 15

It is a disorder where the person experiences recurrent and unexpected panic attacks, so they worry about having more panic attacks, and the consequences of having these panic attacks.

Question 16

What is the prevalence of panic disorder?

Answer 16

5%

Question 17

If a person has a panic attack every time they have to give a presentation, what disorder are they likely to have?

Answer 17

Social anxiety disorder with a panic attack specifier

Question 18

What is the difference between having panic disorder and having a panic attack specifier?

Answer 18

Panic attacks in panic disorder are unexpected, whereas panic attacks in a panic attack specifier would be expected, since they are triggered by certain situations.

Question 19

What is the cycle for panic attacks for people who have panic disorder?

Answer 19

Trigger (internal/external) > perceived threat > apprehension > body sensations > interpretations of sensations as catastrophic

This all happens REALLY fast, in a matter of seconds to minutes.

Question 20

What is agoraphobia?

Answer 20

Excessive fear or anxiety about multiple situations where escaping or getting help is difficult.

It’s rare to have agoraphobia without panic disorder. There is a large overlap. However, you can have panic disorder without agoraphobia.

Question 21

What is SAD?

Answer 21

Social Anxiety Disorder is an excessive fear or anxiety about social situations, particularly about judgement or embarrassment.

The judgement or embarrassment surrounds:

i) social competence -> being funny, having interesting conversation topics
ii) physical appearance
iii) anxiety signs -> concerned people will notice flushed skin, sweating, stuttering

Question 22

What is the prevalence of social anxiety disorder?

Answer 22

13% It is the most common anxiety disorder.

Question 23

Why is social anxiety disorder so prevalent?

Answer 23

Likely because we’re evolutionarily wired to be social

Question 24

What is performance only social anxiety disorder?

Answer 24

It is a type of SAD where the person is only anxious in performance situations such as lectures, interviews, or presentations.

Question 25

What is having SAD like?

Answer 25

If you have anxiety before the situation, during the situation, and after the situation (rumination)

Question 26

What is GAD?

Answer 26

People with Generalized Anxiety Disorder have excessive and difficult to control worry about several major and minor things. “worry wart” personality.

Question 27

What are associated symptoms of GAD?

Answer 27

restlessness, muscle tension, irritability

Question 28

What is the prevalence of GAD?

Answer 28

6%

Question 29

What is “excessive” worry?

Answer 29

catastrophization, level of worry higher than average, length of worry longer than average, worry that isn’t realistic and normal

Question 30

Why is worrying reinforcing for anxiety?

Answer 30

Worrying reduces anxiety by creating a perception of management of the anxiety or issue. Sometimes people use worry as a coping mechanism. e.g. creating a study plan instead of studying.

Question 31

How is procrastination related to anxiety?

Answer 31

Worrying can cause procrastination. Also, people who are big worriers tend to have a hard time making decisions.

Question 32

What is OCD?

Answer 32

Obsessive-compulsive disorder consists of obsessions, which are intrusive thoughts and urges, and compulsions, which are repetitive thoughts and actions done to reduce anxiety.

Question 33

What are the categories of OCD?

Answer 33

• contamination
• checking
• symmetry
• sexual/aggressive
• perfectionism

Question 34

Describe the OCD cycle

Answer 34

Obsession/situation = increased anxiety > compulsion > decreased anxiety

Question 35

Why are obsessions so problematic to people with OCD?

Answer 35

Obsessions are ego-dystonic (conflicts with self-image), so they are distressing. They are never about happy things.

Question 36

In OCD, what is a normal vs abnormal obsession?

Answer 36

Abnormal obsessions are more frequent, distressing and hard to ignore

Question 37

Why are people with OCD compelled to act out their compulsions?

Answer 37

Though-action fusion. They believe that their thoughts directly predict an action or outcome. e.g. in-class activity

Question 38

What is the prevalence of OCD?

Answer 38

1-2%

Question 39

Why can OCD be difficult to identify?

Answer 39

Compulsions can be mental, so they can be difficult to tease apart from obsessions

Question 40

What is the biggest factor in developing, maintaining and reinforcing anxiety behaviours?

Answer 40

Safety behaviours

Question 41

What are safety behaviours?

Answer 41

They are a mental or physical action done to avoid anxiety, a situation or an object

Question 42

What is the general cycle for a safety behaviour?

Answer 42

anxiety/trigger > avoidance > temporary reduction in anxiety

The anxiety is maintained and the safety behaviour is reinforced

Question 43

Give an example of a safety behaviour for a specific phobia

Answer 43

trigger: seeing dog > avoidance: avoid parks > temporary reduction in anxiety

Question 44

Give an example of a safety behaviour for panic disorder

Answer 44

trigger: increased heart rate > avoidance: avoid exercise > temporary reduction in anxiety

Question 45

Give an example of a safety behaviour for agoraphobia

Answer 45

trigger: malls > avoidance: only shop online > temporary reduction in anxiety

Question 46

Give an example of a safety behaviour for social anxiety disorder

Answer 46

trigger: planning a date > avoidance: don’t go on dates > temporary reduction in anxiety

Question 47

Give an example of a safety behaviour for generalized anxiety disorder

Answer 47

trigger: planning a trip > avoidance: excessive worrying > temporary reduction in anxiety

Planning trips requires prediction and lots of thought. This may result in overplanning/overthinking

Question 48

Give an example of a safety behaviour for obsessive compulsive disorder

Answer 48

trigger: touch doorknob > compulsion: wash hands x5 > temporary reduction in anxiety

Question 49

McKnight et al. (2016) study

Answer 49

• reading on anxiety and functional impairment
• correlation between anxiety/functional impairment < depression/functional impairment
• however, you can’t say that anxiety is less severe or less impairing than depression
• anxiety is domain-specific, whereas depression is more global
• so functional impairment in anxiety disorders can be avoided through safety behaviours, but that’s still debilitating

Question 50

Anxiety and stress response, CBT study

Answer 50

Wichmann et al., 2017

• measured stress response over course of therapy
• patients with panic disorder had lower cortisol response compared to control
• people with a higher mobility inventory (more agoraphobic symptoms) had lower cortisol concentration

Question 51

Anxiety and stress response, genetics study

Answer 51

Koszycki et al., 2019

• healthy children of low risk vs high risk (anxiety disorder) parents
• measured cortisol response and heart rate variability (how fast you can bring your heart rate back down after stressor)
• higher heart rate variability in low risk children -> good/expected
• blunted cortisol response in high risk kids -> opposite what you’d expect

Question 52

Why do people with anxiety disorders have blunted cortisol response?

Answer 52

People with anxiety disorders don’t necessarily have a higher level of cortisol. They have dysregulated cortisol response -> HPA/SAM. There’s a weaker ability to respond to stress in a beneficial way, and they are unable to adapt to stress properly.

Healthy people have a spike in cortisol in response to stress, but people with anxiety disorders don’t seem to have this. What we know has come from research on healthy people.

Question 53

What is the key area involved in negative emotions?

Answer 53

The amygdala

Question 54

Which areas of the brain modulate anxiety?

Answer 54

the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC)

-> these areas tell the brain not to be overactive with anxiety by decreasing the activity of the amygdala

Question 55

What is the supervisor analogy for the brain of an anxious person?

Answer 55

In an anxious person, the “supervisors” (mPFC & ACC) are not there so the “naughty child” (amygdala), runs wild.