A Brief Excerpt Summary On Abnormal Psychology: Chapter 5 PDF

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Abnormal Psychology: Chapter 5 Anxiety  What is the difference between fear and anxiety? o Fear/Panic- basic emotions shared by all creatures o Goal is to activate the flight/fight/freeze response when facing danger o Fear- immediate o Panic- misfiring of flight/fright response o Anxiety/panic attacks- no external threat Fear/Anxiety  Fear- Primitive alarm response to imminent danger. Allows you to escape  Anxiety o More diffuse blend of emotions o Includes high levels of negative affect o Worry about possible threat or danger o Sense of being unable to predict threat or to control it if it occurs/future oriented o Learned responses Anxiety Disorders  Most common mental disorder in the U.S. o Yearly, 18% of the adult US population experiences anxiety disorders  Close to 29% develop one at some point in their lives  Only 1/5 of these individuals seek treatment  Most individuals with one anxiety disorder also suffer from a second disorder (depression) Fear/Anxiety  Three components o 1. Cognitive/subjective components  Fear- “I am in danger”  Anxiety- “I am worried about what may happen” o 2. Physiological components  Fear- Increased heart rate/breath  Anxiety- Tension, chronic over arousal o 3. Behavioral components  Fear- Desire to escape or flee  Anxiety- General avoidance Anxiety Disorders/DSM -5 Categories  1. Generalized anxiety disorder  2. Specific phobia  3. Social anxiety disorder (social phobia)  4. Panic disorder  5. Obsessive-Compulsive Disorder (no longer under anxiety disorders)

Abnormal Psychology: Chapter 5

Generalized Anxiety Disorder (GAD)  Onset- typical childhood/adolescents  Chronic or excessive worry about multiple events and activities (including minor events)  Occurs more days than not—6 months or more in duration  Find it difficult to control worry/distressing/impairs quality of life/not attributed to other illnesses (ex: drug use) o Restless/keyed up/on edge o Easily fatigued o Difficulty concentrating or mind going blank o Irritability o Muscle tension o Sleep disturbances GAD: The Sociocultural Perspective  GAD: Social conditions that truly are dangerous o Research (ex: Hurricane Katrina in 2005, Haiti earthquake in 2010)  Powerful forms of societal stress is poverty/race (African American—30%) o Why? Run-down communities, higher crime rates, fewer educational and job opportunities, and greater risk for health problems o Higher rates of GAD in lower SES group  Since race is closely tied to stress in the U.S., it is not surprising that it is also tied to the prevalence of GAD o In any given year, African Americans are 30% more likely than white Americans to suffer from GAD o Multicultural researchers have not consistently found a heightened rate of GAD among Hispanics in the U.S., although they do note the prevalence of nervous in that population  Although poverty and other social pressures may create a climate for GAD, other factors are clearly at work o How do we know this?  Most people living in “dangerous” environments do not develop GAD. o Other models attempt to explain why some people develop the disorder and others do not. Treatment Options  Psychodynamic Perspective and Humanistic Perspective (same approaches as other disorders) Ex: anxiety/neurotic energy/person centered approach—secure in meeting needs)  Cognitive Perspective  Biological Perspective

Abnormal Psychology: Chapter 5

GAD Cognitive Therapies  Cognitive therapies -GAD caused by maladaptive assumptions o Changing maladaptive assumptions  Albert 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  Aaron Beck: Hold silent assumptions that imply imminent danger o A situation/person is unsafe until proven safe o It is always best to assume the worst GAD: The Biological Perspective  GAD is caused chiefly by biological factors o Support by family studies  Biological relatives- HAD (~15%) vs. general population (~6%)  In normal fear reactions o Key neurons fire more rapidly o A feedback system is triggered—brain and body activity work to reduce excitability  Some neurons release GABA in inhibit neuron firing, thereby reducing experience of fear or anxiety o GAD- malfunctions in the feedback system o Possible reasons: too few receptors, ineffective response  More complicated picture: o Increased activity- Amygdala o Decreased activity  Cortexes  Prefrontal- emotions, empathy, compassion  Anterior cingulate  Limbic system- emotional formation and processing learning and memory  Biological treatments o Antianxiety drug therapy  Early 1950s: Barbiturates (sedative-hypnotics)  Late 1950s: Benzodiazepines  Provides temporary, modest relief  Rebound anxiety with withdrawal and cessation of use  Physical dependence is possible  Produce undesirable effects (drowsiness, etc.)  Mix madly with certain other drugs (especially alcohol)

Abnormal Psychology: Chapter 5  More recently: Antidepressant and antipsychotic medications  Biological treatments o Relaxation training o Biofeedback Phobias  From the Greek word for “fear:  Persistent and unreasonable fears of particular objects, activities or situations  People with a phobia often avoid the object or thoughts about it Specific Phobias  Marked, persistent, and disproportionate fear of a particular object or situation, usually lasting at least 6 months  Exposure to the object produces immediate fear  Avoidance of the feared situation  Significant distress or impairment  Most common: Phobias of specific animals or insects, heights, enclosed spaces, thunderstorms and blood o Acrophobia- fear of heights o Arachnophobia- fear of spiders o Claustrophobia- fear of confined spaces o Cynophobia- fear of dogs o Hemophobia- fear of blood o Chaetophobia- fear of hair o Linonophobia- fear of string o Peladophobia- fear of bald people  US population: 9%  Many suffer from more than one phobia at a time  Women outnumber men at least 2:1  Prevalence differs across racial and ethnic minority groups, the reason is unclear  Vast majority of people with a specific phobia do NO seek treatment How Are Specific Phobias Treated?  Systematic desensitization o Techniques developed by Joseph Wolpe  Teach relaxation skills  Create fear hierarchy  Pair relaxation with the feared objects or situations  Since relaxation is incompatible with fear, the relaxation response is thought to substitute for the fear response  Several types:  In vivo desensitization (live)  Covert desensitization (imaginal)

Abnormal Psychology: Chapter 5 Treatment for Agoraphobia  Behaviorists favor a variety of exposure approaches for agoraphobia  Exposure therapy  Support group  Home-based self-help Social Anxiety Disorder/Social Phobia  Disabling fear of one or more specific social situations- public speaking (most common), public bathrooms, eating/writing in public  Fear of exposure- judgment/negative evaluation from others  Avoidant behaviors/situations cause anxiety/endure with great distress  Moderate Genetic factor (30%)  Medications: anti-depressants/SSRIs Social Anxiety Disorder  Cognitive theorists contend that people with this disorder hold a group of social beliefs and expectations that consistently work against them, including: o They hold unrealistically high social standards and so believe that they must perform perfectly in social situations o They view themselves as unattractive social beings o They view themselves as socially unskilled and inadequate o They believe they are always in danger of behaving incompetently in social situations o They believe that inept behaviors in social situations will inevitable lead to terrible consequences o They believe that they have no control over feelings of anxiety that emerge during social situations  Cognitive theorists hold that, because of these beliefs, people with social anxiety disorder keep anticipating that social disasters will occur, and they repeatedly perform “avoidance” and “safety” behaviors to help prevent or reduce such disasters Treatments for Social Anxiety Disorder  Psychotherapy have proved at least as effective as medication o People treated with psychotherapy are less likely to relapse than people treated with drugs alone o Exposure therapy, individual/group o Cognitive therapies  Social skills training: behavior techniques to help people improve their social functioning  Unlike specific phobias, social anxiety disorders are often reduced through medication (particularly antidepressants)  Several types of psychotherapy have proved at least as effective as medication o People treated with psychotherapy are less likely to relapse than people treated with drugs alone

Abnormal Psychology: Chapter 5 o One psychological approach is exposure therapy, either in an individual or a group setting o Cognitive therapies have also been widely used  Another treatment option is social skills training, a combination of several behavioral techniques to help people improve their social functioning o Therapists provide feedback and reinforcement o In addition, social skills training groups and assertiveness training groups allow clients to practice their skills with other group members. Panic Disorder  Occurrence of panic attacks seem to come “out of the blue”  Recurrent, unexpected attacks  Worry about additional attacks  Must be abrupt onset of 4 out of 13 symptoms  Sufferers often fear they will die, go crazy, or lose control o Attacks happen in the absence of a real threat o At least one month of symptoms o Can be accompanies with agoraphobia Panic Disorder Symptoms  Heat palpitations/rapid heart rate/chest pain  Sweating  Trembling/shaking  Shortness of breath/smothering/choking  Nausea/abdominal distress  Feeling dizzy, unsteadying, light-headed or faint  Chills or heat sensations  Numbness or tingling sensations  Derealization (“its not happening to me) -unreal  Depersonalization (“I’m not myself) -detached  Fear of losing control or “going crazy”  Fear of dying Agoraphobia  Anxiety- about being in places from which escape might be difficult or embarrassing- 6 months of symptoms o Crowds o Theaters o Malls o Cars, buses, trains, planes o Standing in line o Elevators or other similar situation to these

Abnormal Psychology: Chapter 5 Fearful of own bodily sensations/avoid arousal states (exercise, watch scary movies, caffeine, etc.)  Avoid situation where attacks took place- isolate/shut-ins  Frequent complication of panic disorder- may not experience panic  5% population diagnoses at some point  Twice as prevalent in women as men- socio-cult  Onset- 20-40 years of age  PA without agoraphobia more common  Treatment o Behaviorists favor a variety of exposure approaches for agoraphobia o Exposure therapy o Support group o Home-based self-help What Biological Factors Contribute to Panic Disorder?  Neurotransmitter at work is norepinephrine o Irregular in people with panic attacks o Research suggests that panic reactions are related to changes in norepinephrine activity in the locus coeruleus  Research conducted in the recent years has examined brain circuits and the amygdala as the more complex root of the problem o It is possible that some people inherit a predisposition to abnormalities in these same areas Panic Disorder: The Biological Perspective  Drug therapies o Antidepressants are effective at preventing or reducing panic attacks  Function at norepinephrine receptors in the panic brain circuit  80% improvement  Improvements require maintenance of drug therapy  Some benzodiazepines (especially Xanax [alprazolam]) have also proved helpful Panic Disorder: The Cognitive Perspective  Misinterpreting bodily sensations  Misinterpret bodily sensations as signs of medical catastrophe; this leads to panic o Experience more frequent or intense bodily sensations o Have experienced more trauma-filled events  High degree of “anxiety sensitivity” o They focus on bodily sensations much of the time, are unable to assess the sensations logically, and interpret them as potentially harmful 

Abnormal Psychology: Chapter 5 Panic Disorder: The Cognitive Perspective  Cognitive therapy: tries to correct people’s misinterpretations of their bodily sensations o Step 1: Educate  About panic in general  About the causes of bodily sensations  About the tendency to interpret the sensations o Step 2: Teach  Teach clients to apply more accurate interpretations (especially when stressed) o Step 3: Teach  Teach clients skills for coping with anxiety  Ex: Relaxation breathing  Cognitive therapy o May also use “biological challenge” procedures to induce panic sensations  Include physical sensations, which cause feelings of panic  Jump up and down  Run up a flight of steps  Practice coping strategies and making more accurate interpretations Obsessive-Compulsive Disorder  Obsessions- thoughts/compulsion- behavior  Disturbing, inappropriate, uncontrollable  Compulsions- overt repetitive behaviors that are ritualized (hand washing, checking, things in order)  Covert mental rituals (counting, praying, words)  Feel driven to perform compulsive behaviors  Goal- reduce distress/prevent dreaded event or situation  Very disabling  No longer under anxiety disorders  Anxiety not an indicator for OCD  Neurologically different  SSRI’s used/not anxiolytics  Attempts to neutralize thoughts  Persistent/intrusive thoughts, images, impulses  Diagnosis is called for when symptoms o Feel excessive or unreasonable o Cause great distress o Take up much time o Interfere with daily functions  Between 1%-2% of U.S. population. 3% over a lifetime  Equally common in men and women and among different racial and ethnic group

Abnormal Psychology: Chapter 5 About 40% of those with OCD seek treatment Onset- Young adulthood and persistent Obsessions o Contamination fears o Fear of harming oneself or others o Need for symmetry o Sexuality o Religion, aggression  Compulsions o Cleaning o Checking o Repeating o Ordering/arranging o Counting o Touching What Are the Features of Obsessions and Compulsions?  Compulsions o “Voluntary” behaviors or mental acts  Feel mandatory/unstoppable o Most recognize that their behaviors are unreasonable  Believe, though, that something terrible will occur if they do not perform the compulsive acts o Performing behaviors reduces anxiety for a short time o Behaviors often develop into rituals OCD: Treatment  Cognitive and Behavioral therapy o Exposure and response prevention (ERP)  Repeat exposure to anxiety-provoking stimuli and are told to resist performing the compulsions  Therapists often model the behavior while the client watches  Homework is an important component  55-85% see improvement  However, as many as 25% fail to improve at all, and the approach is of limited help to those with obsessions but no compulsions o CB- Neutralize negative thoughts/behavior- replace with something that is positive/soothing OCD: The Cognitive Perspective  So, we all have intrusive thoughts…  If everyone has intrusive thoughts, why do only some people develop OCD?   

Abnormal Psychology: Chapter 5 o 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 they can and should have perfect control over thoughts and behaviors OCD: The Biological Perspective  Abnormal serotonin activity- Use of SSRI’s o Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox) o Brings improvements to 50-80% of those with OCD o Relapse occurs if medication is stopped  Abnormal brain structure and functioning o OCD linked brain circuit that concerts sensory information into thoughts and actions  Some areas may be too active, letting through troublesome thoughts and actions  High Genetic Factor- 53% twin study Obsessive-Compulsive-Related Disorders: Finding a Diagnostic Home- DSM-5  Hoarding disorder  Trichotillomania (hair-pulling disorder)  Excoriation disorder  Body dysmorphic disorder Hoarding Disorder  Acquire and fail to discard limited value possessions  Disorganization in living space interferes with daily life  Poorer prognosis for treatment than OCD  Occurs 10-40% of people with OCD  Prevalence may be 3-5% of general population  Neurologically distinct from people with OCD Trichotillomania  Urge to pull out hair from any body location  Preceded by tension and followed by pleasure  Must cause clinically significant distress  Not much is known about the disorder Body Dysmorphic Disorder  Obsessed with perceived or imagined flaw in appearance (skin, breasts, stomach, etc.)  Causes clinically significant distress  Causes of BDD still being researched. There is some heritability and some issues with self-schema...