Psychology 7b - Psychological Disorders and Interventions

Question 1

What is a panic attack?

Answer 1

• A discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feeling of impending doom.
• During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present.

Question 2

What is agoraphobia?

Answer 2

• Develops as a complication of panic attacks
• Agoraphobia may arise by the fear of having a panic attack in a setting from which escape is difficult (or embarrassing)
• As a result, sufferers of agoraphobia avoid public and/or unfamiliar places, especially large, open, spaces where there are few ‘places to hide‘ or prevent easy escape

Question 3

Describe the biomedical model of panic attack

Answer 3

• Classify mental disorders on the basis of objective markers
• Claims markers can clarify aetiology, confirm diagnosis, identify at risk individuals, determine severity of mental illness and predict the pathway of the disorder

Question 4

Describe psychological therapy

Answer 4

• Help people change maladaptive thoughts, feelings and behaviour patterns
• Psychodynamic therapy
• Behaviour therapies
• Cognitive therapy

Question 5

Describe psychodynamic therapy

Answer 5

• Inner conflict
• Panic attacks are the tip of the iceberg
• There is imbalance between the id, ego and superego.
• Use of dream analysis, associations

Question 6

Describe behaviour therapies

Answer 6

• Maladaptive behaviours are not merely symptoms of underlying problems
• Behaviours are the problem
• Problem behaviours are learned in the same ways as normal behaviours (classical conditioning)
• Influenced by classical and operant conditioning (exposure to CS with absence of CS, use of response prevention - systematic desensitisation, increase in stimulus over time)

Question 7

Apply classical conditioning to phobia development

Answer 7

Before conditioning

• UCS (raised heart rate or supermarket causes no fear or anxiety)
• CS raised heart rate and traumatic incident causes UCR (fear and anxiety)
• Either raised heart rate or supermarket cause high fear and anxiety (CR)
• Two factor maintenance (avoidance of supermarkets/ raised heart rate reduces fear and therefore strengthens tendency to avoid the situations)

Question 8

What is the criticism of the behavioural therapy model?

Answer 8

• Takes a stimulus response model using associations

- Cognitive approach suggests that there is a stimulus, cognition followed by a response

Question 9

Describe Clarks cognitive theory of panic

Answer 9

• Emotions determined following critical appraisal
• Individuals with panic interpret certain bodily sensations in a catastrophic fashion
• Sensations (eg. palpitations, breathlessness) are considered a sign of impending physical or psychological disaser
• Eg. palpatations make people think they are having a heart attach
• Initial trigger, perceived threat, anxiety, anxiety increases physical sensations which can be misinterpreted and there is a cycle of anxiety exacerbating symptoms

Question 10

Apply cognitive theory using example of panic attacks following heart attack

Answer 10

• Internal triggers (out of breath)
• External triggers (supermarket - hard to get help, difficult to escape)
• Notice change in physical sensations
• Increased anxiety and fear (is this a heart attack?) increases heart rate and other symptosm further
• Behavioural impact of heart being monitored, activity stopped and A&E attended

Question 11

What is involved in cognitive behavioural therapy for cardiac anxiety?

Answer 11

• Psychoeducation
• Relaxation techniques
• Cognitive restructuring (discuss other things that may increase heart rate)
• Behavioural experiments (artificially raise heart rate)
• Graded exposure (different situations)
• Relapse prevention (what to do if it happens again)

Question 12

List core features of cognitive behavioural therapy

Answer 12

• Focuses on problematic beliefs and behaviours that maintain disorders (‘here and now’ rather than original causes).
• Goal oriented i.e. Specific and measurable
• Collaborative relationship between therapist and patient
• Brief (8-16 sessions)
• ‘Scientific’ approach e.g. Collecting data, testing hypotheses

Question 13

List symptoms of a depressive episode

Answer 13

• A period of almost daily depressed mood or diminished interest in activities lasting at least two weeks

May include

• Difficulty concentrating, feelings of worthlessness
• Excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide,
• Changes in appetite or sleep,
• Psychomotor agitation or retardation,
• Reduced energy or fatigue.

Question 14

How effective is treatment of depression?

Answer 14

• 54% of adults show improvement after antidepressant treatment
• 35-40% improvement after placebo
• 62% improve after psychotherapy
• 53% of adults show improvement after 12 months when ‘untreated’

Question 15

Is psychotherapy effective?

Answer 15

• 80% of patients show significant improvement, strongest evidence is for CBT (first line treatment for a number of different disorders)
• Comparative trials show effects between different psychotherapies are small
• Shows disorder specificity

Question 16

What are the treatment recomendations for depression?

Answer 16

• Do not use antidepressants to treat mild depression as the risk-benefit ratio is poor
• Consider them in people with a history of moderate or sever depression, mild depression for a long time, or mild depression that persists after other interventions
• CBT recommended for mild to moderate depression
• Little difference between effect of antidepressant and placebo, antidepressant more effective in severe depression

Question 17

What is the treatment for depression relapse prevention?

Answer 17

• Those at significant risk of relapse are offered individual CBT or Mindfullness based cognitive therapy
• CBT for those who relapsed despite medication, and those with significant history
• Mindfulness for people who are currently well but have experienced multiple episodes of depression

Question 18

Describe mindfullness based cognitive therapy

Answer 18

• Paying attention in a particular way: on purpose, in the present moment and non-judgementally.
• Recognising thoughts as thoughts – not ‘you’ and not ‘reality’.
• There is accumulating evidence indicating that cortisol levels decrease following participation in a mindfulness program

Question 19

Describe acceptance and commitment therapy

Answer 19

• Being present
• Acceptance of thoughts
• Identify your values, what is important to you, and then making a commitment to pursue these things
• Applied to individuals with chronic pain

Question 20

What is the evidence for CBT for chronic pain?

Answer 20

• CBT can have positive effects on disability, negative mood and pain self-efficacy when compared with treatment as usual
• ACT efficacious for enhancing general physical functioning and for decreasing distress in comparison to inactive treatment comparisons

Question 21

Describe the cycles of chronic pain

Answer 21

Psychological cycle

• Pain causes anger, anxiety, fear and distress
• Impoverished mood
• Depression
• Results in increased perception of pain

Physical cycle

• Pain
• Anxiety avoidance
• Progressive deconditioning
• Pain with decreasing activity
• Further activity avoidance
• Further deconditioning
• Increased pain

Question 22

Describe acceptance and commitment therapy in chronic pain

Answer 22

• Contact with the present moment rather than fear of heath
• Clarity of what is meaningful rather than pain focus
• Rather than trying to control pain, focus on behaviour reflecting values
• Consider yourself as more than just someone in pain
• Detach from painful thoughs and emotions
• Rather than avoiding pain, accept it