Chapter 5 Psych

a state of immediate alarm in response to a serious, known threat to one’s well being
fear
a state of alarm in response to a vague sense of being in danger
anxiety
experiences of fear and anxiety are often useful when
they prepare us for action — for fight or flight — when danger threatens
when discomfort is too severe or too frequent, lasts too long, or is triggered too easily
people most likely have anxiety
what is the most common mental disorder in US
anxiety disorder
in any given year ____% of the adult US pop. experiences one of anxiety disorders… ____% develop at least one within their lifetime
18% . 29%
one _____ of those with anxiety seek treatment
1/5
most individuals with one anxiety disorder also have
a second disorder
what other disorder is common with anxiety?
depression
how many anxiety disorders are there?
5
name the 5 anxiety disorders
generalized anxiety disorder

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/> phobias
agoraphobia
social anxiety disorder
panic disorders
what is GAD?
Excessive or ongoing anxiety and worry, for at least six months, about two or more activities or events
another name for GAD
free floating anxiety
how many symptoms are needed to be diagnosed with GAD?
3
what are the symptoms of GAD?
Feeling restless
Keyed up, or on edge
Fatigue and/or sleep problems
Difficulty concentrating
Muscle tension
GAD: The Sociocultural Perspective says
People faced with truly dangerous social conditions are at risk
One of the most powerful forms of societal stress is
poverty
As would be predicted by the sociocultural model, there are higher rates of GAD in ______ groups
lower SES
GAD: The Psychodynamic Perspective from Freud says
all children experience anxiety:

Realistic anxiety when they face actual danger

Neurotic anxiety when they are prevented from expressing id impulses

Moral anxiety when they are punished for expressing id impulses

GAD: The Psychodynamic Perspective says that GAD developed for children who
Who experience particularly high levels of anxiety

Who’s defense mechanisms are inadequate

Today’s psychodynamic theorists often disagree with specific aspects of Freud’s explanation of GAD… Researchers have found some support for the psychodynamic perspective:
People with GAD are particularly likely to use defense mechanisms (especially repression)

Adults, who as children suffered extreme punishment for expressing id impulses, have higher levels of anxiety later in life

GAD: The Humanistic Perspective says
When people stop looking at themselves honestly and acceptingly they develop GAD
GAD the Humanistic perspective is illustrated by Carl Rogers:
Lack of “unconditional positive regard” in childhood leads to “conditions of worth”

They have negative thoughts about themselves when they are unable to meet these standards

Practitioners using humanistic “client-centered” approach try to show
unconditional positive regard for their clients and to empathize with them
little research support for
humanistic treatment for GAD
GAD: The Cognitive Perspective looks at two types of assumptions
irrational and silent
GAD: Behavior is influenced by irrational assumptions:
It is a dire necessity for an adult human being to be loved or approved of by virtually every significant person in his community

It is awful and catastrophic when things are not the way one would very much like them to be

GAD: Silent assumptions imply imminent danger:
A situation/person is unsafe until proven safe

It is always best to assume the worst

GAD cognitive perspective: what is the metacognitive theory?
The most problematic assumptions in GAD are the individual’s worry about worrying (meta-worry)
GAD cognitive perspective: Intolerance of uncertainty theory
It is unacceptable that negative events may occur, even if the possibility is very small

They worry in an effort to find “correct” solutions

GAD cognitive perspective: Avoidance theory
Worrying serves a “positive” function for those with GAD by reducing unusually high levels of bodily arousal
GAD: Two kinds of cognitive treatment approaches:
Changing maladaptive assumptions

Helping clients understand the role that worrying plays, and changing their views and reactions to it

for GAD cognitive theory, changing maladaptive assumptions is done by:
Ellis’s rational-emotive therapy (RET)

(Point out irrational assumptions

Suggest more appropriate assumptions

Assign related homework

Studies suggest at least modest relief from treatment)

for GAD cognitive theory, changing reaction to worrying: treatments
Educate pts about the role of worrying in GAD and have them observe their bodily arousal and cognitive responses across life situations

Pt’s learn to identify their worrying and their attempts to control their lives by worrying

Pt’s learn to see the world as less threatening, to adopt more constructive ways of coping, and to worry less

GAD: The Biological Perspective says
GAD is caused by biological factors
“GAD is caused by biological factors”
is supported by
pedigree studies

(Biological relatives more likely to have GAD (~15%) than general population (~6%))

The closer the relative, the greater the likelihood. There is, however, a competing explanation of shared environment

GAD: The Biological Perspective says GAD is caused by
GABA inactivity
in 1950s _______ were found to reduce anxiety
Benzodiazepines
Benzodiazepines work because….
Benzodiazepine receptors ordinarily receive gamma-aminobutyric acid (GABA, a common neurotransmitter in the brain) and
GABA makes the neuron stop firing
Malfunctions such has ______ and _______ in the feedback system are believed to cause GAD
To few GABA receptors

AND

Ineffective receptors

Research conducted in recent years indicates that the root of GAD is probably more complicated than a
single neurotransmitter (GABA)
GAD: Biological Treatments
drug therapy

Relaxation training

Biofeedback

drug therapy for GAD
Early 1950s: Barbiturates (sedative-hypnotics)

Late 1950s: Benzodiazepines

More recently: Antidepressant and antipsychotic medications

facts about relaxation training as GAD treatment
Research indicates that relaxation training is more effective than placebo or no treatment

Best when used in combination with cognitive therapy or biofeedback

Biofeedback
uses
electrical signals from the body to train people to control physiological processes
Electromyograph (EMG) provides
feedback about muscle tension
biofeedback found to have its greatest impact when used as an
adjunct to other methods for treatment of certain medical problems (headache, back pain, etc.)
phobia is From the Greek word for ____
fear
a phobia is a
Persistent and unreasonable fears of particular objects, activities, or situations
People with a phobia often avoid
the object or thoughts about it
phobias compared to common fears….
phobias are ….

More intense and persistent fear

Greater desire to avoid the feared object or situation

Distress that interferes with functioning

Most phobias technically are categorized as “specific” which is…..
an intense and persistent fear of a specific object or situation
with phobias When exposed to the object or situation, sufferers experience
immediate fear
most common phobias
animals or insects
heights
enclosed spaces
thunderstorms
blood
Each year close to ______% of all people in the U.S. have symptoms of specific phobia
More than _____% develop such phobias at some point in their lives
9% and 12%
are women or men more likely to have phobia
women 2:1
Vast majority of people with a specific phobia (do/do not) seek treatment
DO NOT
Each model offers explanations for what causes specific phobias, but evidence tends to support the ________ explanations
behavioral
Phobias develop through
conditioning
Other behavioral explanations for What Causes Specific Phobias
Phobias develop through modeling

Phobias are maintained through avoidance

Phobias may develop into GAD when a person acquires a large number of them

What Causes Specific Phobias? A behavioral-evolutionary explanation
Theorists argue that there is a species-specific biological predisposition to develop certain fears

Called “preparedness” because we are theoretically more “prepared” to acquire some phobias than others

Model explains why some phobias (snakes, spiders) are more common than others (meat, houses)

How Are Specific Phobias Treated?
Systematic desensitization

Flooding

Modeling

two types of systematic desensitization
In vivo desensitization (live)

Covert desensitization (imaginal)

what is Flooding
Forced non-gradual exposure
what is Modeling
Therapist confronts the feared object while the fearful person observes
the key to success for phobia treatments is
ACTUAL contact with the feared object or situation
People with agoraphobia are
afraid of being in public places or situations where escape might be difficult, should they experience panic or become incapacitated
In any given year, about ____% of adults experience agoraphobia, women twice as frequently as men
2%
Explanations for Agoraphobia
Although broader than specific phobias, agoraphobia is often explained in ways similar to specific phobias

Many also are prone to experience extreme and sudden explosions of fear – called “panic attacks” – and may receive a second diagnosis of panic disorder

How is Agoraphobia Treated?
Behavioral therapy with an exposure approach is the most common and effective treatment for agoraphobia
Between _______% of clients with agoraphobia who receive exposure treatment find it easier to enter public places and the improvement lasts for years
60-80%
Social Anxiety Disorder is a
Severe, persistent, and irrational fears of social or performance situations in which scrutiny by others and embarrassment may occur
People judge themselves as performing less competently than they actually do
either ______ or ______
narrow or broad
ex. of narrow for Social Anxiety Disorder
talking, performing, eating, or writing in public
ex. of broad for Social Anxiety Disorder
general fear of functioning poorly in front of others
What Causes Social Anxiety Disorder?
People with this disorder hold a group of social beliefs and expectations that consistently work again them, including:
Unrealistically high social standards or
Views of themselves as unattractive and socially unskilled
Cognitive theorists hold that, because of these beliefs, people with social anxiety disorder anticipate that social disasters will occur and they perform “________” and “_______” behaviors to prevent them
avoidance or safety
In addition for ______________, after a social event, they review the details and overestimate how poorly things went or what negative results will occur
social anxiety disorder
Treatments for Social Anxiety Disorder: Two components must be addressed:
Overwhelming social fear: (Address fears behaviorally with exposure)

Lack of social skills:
(Social skills and assertiveness trainings have proved helpful)

Social fears are often reduced through
medication (antidepressants)
social fears are treated through
medication
psychotherapy
social skills training
psychotherapy is where
People treated with psychotherapy are less likely to relapse than people treated with drugs alone

One psychological approach is exposure therapy, either in an individual or group setting

Cognitive therapies have also been widely used

Social skills training
is where
Therapists provide feedback and reinforcement

Allows pt to practice skills with other group members

Panic
________, an extreme anxiety reaction, can result when a real threat suddenly emerges
_______ are periodic, short bouts of panic that occur suddenly, reach a peak, and pass
panic attacks
Sufferers of _______ often fear they will die, go crazy, or lose control
panic attacks
panic Attacks happen in the absence of a
real threat
More than _______ of all people have one or more panic attacks at some point in their lives, but some people have panic attacks repeatedly, unexpectedly, and without apparent reason
1/4
_______ are when people have panic attacks repeatedly, unexpectedly, and without apparent reason
panic disorders
example 0f ____________: they may worry persistently about having an attack or plan their behavior around possibility of future attack
panic disorder
with panic disorders, women are _____ as likely to as men to be affected
twice
Poor people are ______% more likely than wealthier people to experience these disorders
50%
The prevalence for panic disorders is (the same/different) across cultural and racial groups in the U.S. and seems to occur in cultures across the world
the same
Approximately ______ of those with panic disorder are in treatment
1/3
Panic disorder often (but not always) accompanied by
agoraphobia
Panic Disorder: The Biological Perspective: In the 1960s, clinicians discovered that people with panic disorder were not helped by benzodiazepines, but were helped by ____
antidepressants
Researchers worked ________ from their understanding of antidepressant drugs
backward
What biological factors contribute to panic disorder?
Neurotransmitter

brain circuits

amygdala

genetic factors

which neurotransmitter is a factor that contributes to panic disorder
norepinephrine
norepinephrine is irregular in people with
panic attacks
It is possible that some people with panic disorder inherit a predisposition to abnormalities in the _____ and ______
brain circuits and amygdala
Genetics as a factor of panic disorder: Among monozygotic (MZ, or identical) twins, the rate is as high as ____%

Among dizygotic (DZ, or fraternal) twins, the rate is only ____%

31%

11%

biological treatment for panic disorders
drug therapy
antidepressants function at the _______ receptors in the panic brain circuit
norepinephrine
antidepressents Bring at least some improvement to_____% of patients with panic disorder
80%
Some _________ (especially Xanax [alprazolam]) work for panic disorders
benzodiazepines
Panic Disorder: The Cognitive Perspective: Cognitive theorists recognize that biological factors are only part of the cause of panic attacks
full panic reactions are experienced only by people who misinterpret bodily events
Cognitive treatment is aimed at
correcting misinterpretation of bodily events
Panic-prone people may be very sensitive to certain bodily sensations and may misinterpret them as
signs of a medical catastrophe
why do people experience misinterpretations?
Experience more frequent or intense bodily sensations

Have experienced more trauma-filled events over the course of their lives

They focus on bodily sensations much of the time, are unable to assess the sensations logically, and interpret them as potentially harmful

Panic Disorder: The Cognitive Perspective: the cognitive therapy tries to
Tries to correct people’s misinterpretations of their bodily sensations
what are the 3 steps for cognitive therapy for panic disorders?
Step 1: Educate clients

Step 2: Teach clients to apply more accurate interpretations (especially when stressed)

Step 3: Teach clients skills for coping with anxiety (relaxation, breathing)

cognitive therapy for panic disorders may also use _________ procedures to induce panic sensations
biological challenge
OCD Made up of two components
obsessions and compulsions
obsessions are
Persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness
compulsions are
Repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety
Diagnosis of OCD is called for when symptoms:
Feel excessive or unreasonable

Cause great distress

Take up much time

Interfere with daily functions

Between ____% and _____% of U.S. population suffer from OCD in a given year
1% and 2%
OCD is _____ common in men and women and among different racial and ethnic groups
equally
OCD usually begins by
young adulthood and typically persists for many years, although symptoms may fluctuate over time
It is estimated that more than ____% of those with OCD seek treatment
40%
What Are the Features of Obsessions and Compulsions?
obsessions
compulsions
obsessions are
Thoughts that feel both intrusive and foreign
Attempts to ignore or resist them trigger anxiety
compulsions are
“Voluntary” behaviors or mental acts
performing behaviors for OCD reduce anxiety by
only for a short time
with OCD, behaviors often develop into
rituals
common forms of compulsions:
Cleaning

Checking

Order or balance

Touching, verbal, and/or counting

Compulsive acts often occur in response to
obsessive thoughts
Compulsions seem to represent a yielding to
obsessions
Compulsions also sometimes serve to help control
obsessions
Many with OCD are concerned that they will act on their
obsessions
Compulsions usually do not lead to
violence or “immoral” conduct
OCD: The Behavioral Perspective: Behaviorists have concentrated on explaining and treating
compulsions rather than obsessions
OCD: The Behavioral Perspective: In a fearful situation, they happen to perform a particular act (washing hands)
When the threat lifts, they associate the improvement with
the random act
OCD: Behavioral perpective: After repeated associations, they believe the compulsion is
changing the situation
OCD: The Behavioral Perspective: Treatment
behavioral therapy:
example of behavioral therapy for OCD:
Exposure and response prevention (ERP)
Exposure and response prevention (ERP)
is where
Clients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions
Between ____ and _____ percent of clients have been found to improve considerably with ERP, and improvements often continue indefinitely
55 and 85
with OCD, as many as _____% fail to improve at all from ERP, and the approach is of limited help to those with obsessions but no compulsions
25
OCD: The Cognitive Perspective: Cognitive theorists begin by pointing out that everyone has
repetitive, unwanted, and intrusive thoughts
OCD: The cognitive perspective: People with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that
terrible things will happen as a result
OCD: The Cognitive Perspective: To avoid such negative outcomes, they attempt to “_______” their thoughts with actions (or other thoughts)
neutralize
Neutralizing thoughts/actions may include:
Seeking reassurance

Thinking “good” thoughts

Washing

Checking

People with OCD tend to:
Be more depressed than others

Have exceptionally high standards of conduct and morality

Believe thoughts are equal to actions and are capable of bringing harm

Believe that they can, and should, have perfect control over their thoughts and behaviors

Cognitive therapists focus on the
cognitive processes that help to produce and maintain obsessive thoughts and compulsive acts
Cognitive-Behavioral Therapy (CBT) with OCD:
psychoeducation as well as exposure and response prevention exercises
Research suggests that a combination of the ______ and _______ models is often more effective than either intervention alone
for OCD
cognitive and behavioral
Family pedigree studies provided the earliest clues that OCD may be linked in part to _______
biological factors
Studies of twins found a ______% concordance rate in identical twins, versus _______% in fraternal twins
53% and 23%
OCD: The Biological Perspective: biological therapies
Serotonin-based antidepressants

Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective

Serotonin-based antidepressants
for OCD
Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox)

Bring improvement to 50-80% of those with OCD

Relapse occurs if medication is stopped

In recent years, a growing number of clinical researchers have linked some excessive behavior patterns (e.g., hoarding, hair pulling, shopping, sex) to
OCD
DSM-5 has created the group name “Obsessive-Compulsive-Related Disorders” and assigned four patterns to that group:
hoarding disorder, hair-pulling disorder, excoriation (skin-picking) disorder, and body dysmorphic disorder
Theorists typically account for obsessive-compulsive-related disorders by using the same kinds of explanations that have been applied to
OCD
clinicians typically treat clients with these disorders by applying the kinds of treatment used with OCD, particularly
antidepressant drugs, exposure and response prevention, and cognitive therapy
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