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ANXIETY DISORDERS Fear: basic emotion enabling quick response when faced with imminent threat Anxiety: a negative mood characterized by bodily symptoms, physical tension, and apprehension about the future; physiological symptoms and set of behaviors involved - You will be more anxious about what the future will hold Panic: involves activation of fight or flight response of autonomic nervous system - Anxiety will bring high negative effects, intense worry Anxiety disorders: persistent; have panic, anxiety or both at core -Irrational sources of, unrealistic levels of anxiety -Anxiety or fear comes on unexpectedly My notes Panic is a fear response to some innocent stimuli that is usually out of proportion to actual threat Bear on Tv : Panic Abuse in childhood can cause a lot of psychological shit. Children will follow their categories. COMPONENTS OF ANXIETY Cognitive components: mind: “I feel anxious about getting something done” - negative mood, worry, self-preoccupation, sense of being unable to predict future or control it, anxiety about getting something done Physiological components: body: increased heart rate and respiration Behavioral components: behavior: avoidance of particular situations Why do we have Anxiety? Anxiety and fear are adaptive: people perform better when slightly anxious Starts fight or flight mechanism, helps prepare better for future Too much is bad STATS FOR ALL ANXIETY DISORDERS Women tend to be more prone to psychological disorder Phobias (Fear of…) is the most common anxiety disorder Why? because it is specific to the disorder 1. POST-TRAUMATIC STRESS DISORDER Symptoms and Diagnostic Criteria Re-experiencing Re - experiencing the trauma Suppression of this will make them come more - Flashbacks: (War veterans) - Physiological: (change in heartbeat) due to certain ques to the trauma - Mind and body are placing you in that situation again to relive it. - Dreams Typical traumatic events: Women = rape | Men = combat This re-experience is necessary for diagnosis (at least one) AVOIDANCE OF ASSOCIATED STIMULI

Avoidance or effort to avoid distressing memories, thoughts, feelings (Never wants to talk about it or associate anything with it) Avoidance or effort to avoid external reminders of the event COGNITION & MOOD ALTERATIONS - Inability to remember important aspect of trauma - Negative beliefs about self, world, future - Distorted cognitions about cause and consequences of events, persistent negative emotional state, - Anhedonia: lack of interest in pleasurable things or lack of pleasure when you do them), - Feeling of detachment or estrangement - Inability to experience positive emotions PTSD only know what happened in the event and not how it came to be. Issue is that there are gaps of memory. You will only have the trauma event. You can’t look at anything before it or after it as if it never occurred. PERSISTENT INCREASED AROUSAL *must have 2 or more for diagnosis Elevated cortisol levels, Fight or flight response results in either fear or anger (same physio, diff emotion), Difficulty falling or staying asleep, Irritability or outbursts of anger, Reckless or self destructive behavior, Difficulty concentrating, Hypervigilance (looking for danger to extreme extent, always on edge), Exaggerated startle response DIAGNOSTIC CRITERIA Symptoms must last more than one month after the trauma Must cause (clinically significant) distress or impairment Specify: Acute (lasts less than 3 months, diagnosed within first 4 weeks after trauma, then short-lived; least severe, best diagnosis Chronic (lasts 3 months or longer) With Delayed Onset (symptoms begin 6 months or more after the trauma, hardest to treat) PTSD STATS ○ 6.8% of population have had PTSD in their lives ○ Most common traumas are sexual assault & combat ○ Men & women equally likely to have PTSD ○ Women more likely to have ANY anxiety disorder CAUSES Biological predisposition ● Overactive amygdala could cause stronger fear response (or vice versa) ● Hypothalamic pituitary adrenal axis could create false alarm stress ● People with already high cortisol levels Psychological predisposition ● Experience of childhood stress (more likely to have PTSD as adult if abused as child, or if in financially unstable environment)

● Level of control in life in general ● Stability of family unit Protective factors ● Social support (fam and friends, true for all psych disorders) ● Positive coping skills (good parenting, minor stress learned to deal) TREATMENT Re-experiencing (EXPOSURE) ■ Reduce their fear ■ Extinction of the learned fear response? ■ Develop better coping mechanisms You can imagine the fear or you can face the fear. SPECIFIC PHOBIA ● Irrational fear of specific object or situation that interferes with individual’s ability to function ● Occur in majority of the populations ● The reaction will be greater than usual: irrational fear with no danger DIAGNOSTIC CRITERIA AND SYMPTOMS Excessive fear Immediate anxiety Situations can be avoided or endured with large amount of distress Affects daily life SPECIFIC TYPES Animal Type Blood-Injection-Injury Type (seeing blood, getting a shot, etc.) Natural Environment Type (heights, storms, water, swimming) Situational Type (planes, elevators, closed spaces, flying – not heights, public speak) Other Type (things that don’t fit above-guns) BLOOD INJECTION-INJURY TYPE People become light-headed and pass out rather than become feared Phobia with the strongest heritability Fainting at the sight of blood has a unique evolutionary advantage—it impedes blood loss due to the significant drop in blood pressure (drops blood pressure) Sweating, hypervigilant, increased respiration, hyper-ventilation Only phobia with opposite response (faint, etc.) CAUSES Learned behavior

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Direct experience Vicarious experience: something that happened: easier to treat Information transmission: message they send their kids to fear ○ Gender roles may explain why women have more phobia than men ○ Classical conditioning or learning strong evidence for development ○ Evolutionarily programmed to fear some things: color in animals

TREATMENT ○ Learned response can be unlearned: extinction ○ Relaxation ○ Exposure to feared stimuli (flooding, fear hierarchy) ■ Can be unlearned through classical conditioning or operant ○ Flooding: single exposure till it’s gone ○ Fear Hierarchy: List all the things that induce from least to most to extinct the fear. PANIC ATTACK Sudden experience of intense fear or acute discomfort usually accompanied by physical symptoms of anxiety Three types: 1. Situationally Bound/Cued (always in a situation and not elsewhere) 2. Unexpected/Uncued (“out of the blue”) 3. Situationally Predisposed (more likely in a situation, but not always occurring) ● Are episodic, all physiological symptoms of flight or fight response ● Panic attack is needed to diagnose Panic disorder: but can’t be the only thing to diagnose ● Symptoms sounds like a heart attack. Think about how people react to anxiety People with panic disorder experience the same feeling as adrenaline junkies except they are full of fear ● People with anxiety disorders will have panic attacks ● Panic attacks: rapid onset: could last for minutes ● People with panic disorder have often gone to the ER; thought to have a heart attack ● Must have at least 4 symptoms to be diagnosed PANIC DISORDER Recurrent unexpected panic attacks At least 1 panic attack followed by one month or more of one of the following ○ Persistent concern of having another anxiety attack ○ Significant maladaptive change in behavior due to the attack PREVALENCE: ○ 3.5 % of pop has met criteria for panic in their lives ○ Women are more susceptible than men ○ Onset 15-24 y/o (rare in prepubescent children) Agoraphobia: Marked and persistent fear that is excessive or unreasonable in two (or more) of the following situations ■ Using public transport

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Being in open spaces Being in enclosed spaces Standing in line or in a crowd Being outside of the home alone

Fear or avoid because escape might be difficult or help might not be available Situation almost always provokes fear or anxiety Actively avoid situation, need a companion, or endure with distress Clinically significant distress or impairment Is NOW its own disorder Most common in women (because more acceptable for women to avoid fears?) CAUSES OF PANIC DISORDER ● Biochem abnormalities or sensitivity to biological challenges resembling anxious arousal (panic provocation agents: sodium lactate-from exercise, caffeine, CO2); hypersensitive to elevated cortisol levels) ● Amygdala: overly sensitive fear circuits ● “fear of fear” model ● Catastrophizing physical symptoms of anxiety/ “anxiety sensitivity” ● Usually appears after negative life event or during high stress ● 30% of adults will experience a panic attack at some point in their lives ● 3 components to panic disorder 1) interceptive symptoms 2) anticipatory anxiety of having another attack and 3) agoraphobic anxiety

PSYCHOLOGICAL TREATMENT Idea is that panic is a learned response that can be unlearned: classical conditioning : extinction EXPOSURE (fear hierarchy) People may not realize they are avoiding something Interoceptive exposure (exposure to physical states of your body) ■ Designed to induce sensations of panic ■ Practice the ones most like symptoms to understand that they are just bodily sensations and don’t imply impending doom Situation exposure: try out things that are anxiety provoking Cognitive therapy ■ Examine and argue against thoughts of panic ■ Treat symptoms how to teach rational arguments against thoughts of panic PHARMACOTHERAPY OF PANIC Benzodiazepines (fast acting but sedating and addictive) ■ May feel worse because of fear of not having drugs to rely on ■ bad withdrawal symptoms (addictive) ○ SSRIs and Tricyclics used for prevention and taken continuously, usually ppl also have benzos for when feel attack coming on

○ SSRIs not helpful in reducing acute experience of panic whereas benzos are helpful for this, which is why they’re taken on an as-needed basis ○ All are effective at reducing panic attacks but relapse very high once off (90%) ○ Interrupt learning process of psychological treatment/exposure therapy SOCIAL ANXIETY DISORDER ● Marked, persistent excessive fear of social or performance situations where person exposed to possible scrutiny by others (ex: pub. speaking, urinating in pub bathroom, eating in public) ● Fear of being evaluated negatively ● Fear is out of proportion with the actual physical, AND SOCIAL (and cultural) threat of the situation ● Persists even if people tell you you’re not being judged ● Differentiated because of WHAT people are afraid will happen SOCIAL PHOBIA: SYMPTOMS AND DIAGNOSTIC CRITERIA ● Exposure to feared situation almost always results in anxiety and may result in situational panics ● Person recognizes fear as unreasonable or excessive (know isn’t true but feel it is) ● Feared social situations avoided or endured w anxiety ● Anxious anticipation or avoidance interferes w routine or goals SUBTYPES Generalized Type: fear of most social situations (parties, talking in class, making phone calls) Non-Generalized Type: fear of public performance, “stage fright,” can stop career advancement STATS AND DETAILS ○ Lifetime prevalence: 13.3% /Slightly more women than men ○ Peak age of onset is 15 years ○ More people with social phobia are single ○ Roughly equal among ethnic groups: Culture influences (symptoms interpreted based on culture, can also influence what is feared) CAUSES All anxiety disorders associated w feeling of lack of control Genetics/temperament ■ “born shy”—behavioral inhibition (personality at birth =temperament) ■ Genetic predisposition (30%) Learned behavior ■ Performing badly in an important social setting ■ Seeing others embarrassed or mocked ■ Most ppl w social phobia can remember “tragic social event” that triggered Evolutionary Predictability- have diminished sense of social control =fear

Cognitive variables: people overestimate visibility of symptoms of anxiety, misinterpret behavior of other as negative Social anxious people interpret ambiguous situations as negative, whereas most people interpret as positive TREATMENT Cognitive-behavioral treatments Group treatment -Practice role-playing feared situations, Cognitive restructuring, Audience is other group members Individual treatment: Fear hierarchy, exposure, etc. Medication can be effective (anxiolytics for performance sitch-but can impair concentration/performance; SSRIs) Better relapse rates w therapy rather than meds GENERALIZED ANXIETY DISORDER (GAD) WORRY –helps plan for the future and make contingency plans if things do not turn out as we hoped It can also be hard to control; is pathological/ difficulty decision-making SYMPTOMS Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities Worry is difficult to control At least 3 of the following symptoms: ■ Restlessness, feeling keyed up or on edge ■ Easily fatigued ■ Difficulty concentrating or mind going blank ■ Irritably ■ Muscle Tension ■ Sleep problems CAUSES Freud: suppressed desires come out in form of anxiety Genetic Predisposition: genetic overlap w depression (share personality trait=neuroticism) Learned worry from parents Stress & anxious apprehension Genetics & biology ■ MDD (depression) & GAD ■ GABA & Serotonin (GABA doesn’t work as well) TREATMENT Benzodiazepines, SSRIs Psychological treatments involve… ■ Relaxation ■ Cognitive Restructuring (convince self don’t need to worry) ■ Exposure to anxiety provoking images (imaginal exposure) to reduce apprehension (as in panic)

Psychological treatment less effective than for other anxiety disorders OBSESSIVE COMPULSIVE DISORDER (OCD) Obsessions: persistent and recurrent intrusive thoughts, images, or impulses experiences as disturbing and inappropriate but has difficulty suppressing Compulsions: Overt repetitive behaviors or more covert mental acts that a person feels driven to perform in response to an obsession (could be counting) neutralizes *Can’t repress thoughts, makes it worse Typical Obsessions ○ Contamination/Germs ○ Harming others or self ○ Need for Symmetry ○ Sexual thoughts/aggressive urges ○ Somatic concerns (think about hurt in stomach a lot) ○ Disaster ○ Religion ○ Magical thinking: when ppl think can control things they can’t (thinking about something will make it actually happen unless engage in compulsion) Typical Compulsions ○ Washing ○ Checking ○ Mental Acts (typically can’t do much about these) ○ Aligning ○ Hoarding ○ Confessing ○ Praying DIAGNOSTIC CRITERIA Can have obsessions or compulsions/ don’t have to be both (90% have both) Causes Marked Distress or Impairment (time consuming) ○ 1+ hour per day or interferes with work, etc Not due to another disorder or medical illness, etc STATS 2.5% lifetime prevalence Slightly more females than males have OCD (although reversed in children) Average age of onset is in mid 20s Tends to be chronic Culture influences types of obsessions and compulsions (religious beliefs, taboos, etc.) Depression highly comorbid w this PSYCHOLOGICAL CAUSES Intrusive thoughts or images are normal and happen to all of us Behavioral approach—compulsion becomes associated with anxiety reduction

“Thought-action fusion” belief that thoughts and actions are the same or that thoughts will make things come to pass –sim to magical thinking Rebound effect in suppression of intrusive thoughts BIOLOGICAL CAUSES OCD perhaps most heritable anxiety disorder ■ OC spectrum Basal ganglia and caudate nucleus (areas seem abnormal in OCD ppl, normal after treatment) ■ May be that brain function involved in inhibiting behavior is not right ■ Failure to encode “did it” messages? Serotonin- low levels of it Strong genetic component TREATMENTS Exposure and Response Prevention ■ Anxiety will diminish over time without ritualizing ■ Helps patients to learn that not ritualizing does not result in disaster or tragedy ■ Exposure goes beyond “normal” behavior to assure lasting effects ■ Fear Hierarchy ■ Expose person to thing & prevent compulsion (exposure) Pharmacotherapy- combo of drugs/therapy not much better than therapy alone ■ SSRIs ■ Effective for 50-70% of individuals who fully engage in it, but HIGH RELAPSE when off drugs (highest relapse rate of anxiety disorders) SUBSTANCE ABUSE AND DEPENDENCE Use of Psychoactive Substances -28 million people worldwide use substances other than alcohol and tobacco -Maybe more because many don’t seek treatment Abuse and dependence depending on: age,socioeconomic status SUBSTANCE USE Terms: Use: The ingestion of psychoactive drugs or substances in moderate amounts which do not interfere with functioning Intoxication: Reversible substance specific syndrome due to intake of a substance which interferes with functioning (fighting, impaired judgement, slowed reflexes, etc.) Most common psychoactive drugs: caffeine, alcohol, nicotine Most common illicit drug: marijuana DSM-5 Substance-Related and Addictive Disorders ● Substance Use Disorders: problematic pattern of use (paranoia,etc.) ● Substance Intoxication: currently experiencing the effects ● Substance Withdrawal: cessation of substance, showing physical signs of cessation SYMPTOMS

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Use more or for longer than intended Desire or failed attempts to cut back Time spent to get substance Cravings (how often you want it) Results in failures to meet obligations Continued use despite problems Giving up or reducing activities Use in dangerous situations Continued use despite knowing problems it causes Tolerance (when you need more to get same effect you would’ve had before) Withdrawal: physical or psychological (DSM concerned w physical bc more dangerous) ● Tolerance: need for increased amounts of substance to achieve desired effect, diminished effect with continued use of same amount of substance ● Withdrawal: characteristic withdrawal symptoms of substance; same or similar substance taken to avoid or relieve withdrawal symptoms ● Comorbidity: estimated that more than ½ of individuals w alcohol use disorders also meet criteria for another psychiatric disorder (highly comorbid with depression); it can be difficult to pull apart how these disorders co-occur

Substances of Abuse 1. Depressants Alcohol- depresses CNS, decreased glutamate in system (neurotransmitter important for memory formation) Barbiturates- strong anti-anxiety and sleep drugs, highly addictive Benzodiazapines: less addictive, more commonly used than barbituates for anxiety ● Effects: slurred speech, incoordination, unsteady gait, hard time holding gaze (shaking eyes), attentional or memory problems, stupor or coma Alcohol Use Disorder 1 in 7 people meet the criteria for alcohol use disorder More than 1/3rd of alcohol abusers suffer from at least one coexisting mental disorder Alcohol abuse cuts across all age, educational, occupational, and socioeconomic boundaries Binge Drinking in College: 44% of college students binge drink Drinking among students is associated with: Hangovers/Missing class, Interpersonal problems, Unprotected/unplanned sex, Police involvement Alcohol induced myopia Good news:Most students reduced drinking SIGNIFICANTLY after college... The Clinical Picture of Alcohol Use Disorder Alcohol has complex and often contradictory effects on the brain At lower levels, alcohol stimulates certain brain cells and activates the brain’s “pleasure areas” At higher levels, alcohol depresses brain functioning Impact of Alcohol Abuse Most commonly abused

Withdrawal (Delirium Tremens): Can include hallucinations, tremors, etc. Cirrhosis of the Liver Brain Damage (may be reversible) Fetal Alcohol Syndrome Social Costs: (Crime, Los tWork, Health Care, Homelessness, DUI costs including deaths) Course of Alcoholism Supporting the Alcoholics Anonymous (AA) approach to alcoholism, it was once believed that alcoholism was a chronic disorder or a “disease” Current research suggests that 20% of individu7k,als with alcohol dependence will have a spontaneous remission -Can have remission after long periods of abstinence Barbiturates (Sedatives) Barbiturates were once w...