differences
• mood or emotion?
• time orientation?
•physiological response?
anxiety vs. fear:
biological vulnerability
• polygenic traits of neuroticism/ negative affect/behavioral inhibition
• vulnerability: anxiety or depression
• neurochemicals (GABA, 5-HT, NE, CRF)
psychological vulnerabilities
Generalized Psychological Vulnerability - sense of uncontrollability
- had unpredictable relationship w/ parents
- had overprotective parents = never learn they can control events
Specific Psychological Vulnerability - “_____ is dangerous” is learned by:
Classical conditioningOperant conditioningInformation transmission
generalized anxiety disorder
• 6 mo+ of uncontrollable worry to many issues
• 3+ of:
restlessness, fatigue, poor concentration,
irritable, muscle tension, sleep probs
• distress or impairment
CRITERIA
NOTEChronic & excessive worry over minor eventsConstant state of apprehension/upsetDifficult to make decisions & doubts if decision is right
-work
-finances
-illness
generalized anxiety disorder
• prevalence 3%
• 2:1 sex ratio
• onset 17-31 yrs (but most “always been this way”)
• prognosis: chronic
generalized anxiety disorder
• biological & generalized psych vulnerabilitiesETIOLOGY
• autonomic restrictors but increased muscle tension
• preferentially direct attention to threatening cues
• interpret ambiguous info in a threatening way
ASSOCIATED FEATURES
generalized anxiety disorder
TREATMENT
• cognitive therapy & relaxation techniques
• medication
- benzodiazepines (AKA anxiolytics)
- antidepressants
benzodiazepines
ValiumLibriumXanaxKlonopin
Also used for sleeping pills &
anti-seizure meds
panic attack
inappropriate fear response
CRITERIA
4+ of:
heart palpitations, sweating, shaking, short of breath, choking, chest pain, nausea, dizzy, derealization/depersonalizaiton, fear of losing control, fear of dying, chills/heat, numbness/tingling
panic attack
cued – conditioned to external cues
uncued – conditioned to interoceptive cues
situationally predisposed
panic disorder
CRITERIA
• recurrent panic attacks
• 1+ for 1 mo+:
- concern about future attacks or consequences
- sig behavioral change (avoidance of external or internal cues)
panic disorder
• prevalence 3%• 2:1 sex ratio• 50-70% will experience a serious depression• 1st attack usually after highly distressing life event
panic disorderETIOLOGY
Biological Vulnerability
to panic attack
General Psycholgical Vulnerabilitypanic is not in my control, something bad will happen
STRESSOR triggers PANIC ATTACK
Specific Psychological Vulnerability
Classical conditioning of either-Interoceptive cues - exteroceptive cues
panic disorder
PRESCRIBED MEDICATION
benzodiazepines & antidepressants
(relapse rates high 50-90% when meds stopped)
COGNITIVE-BEHAVIORAL THERAPY• cued: systematic desensitization
• uncued: induce interoceptive sensations + cognitive restructuring of perceived control + distraction from sensations
TREATMENT
educate about panic attacks
practicerelaxation
agoraphobia
CRITERIA
anxiety about situations where:
- hard to access help
- escape difficult/embarrassing
specific phobia
CRITERIA
• 6+ mo persistent, excessive, irrational fear of an object of situation
• anxiety/fear on exposure
• avoided or endured w/ intense anxiety
• insight that phobia is irrational
specific phobia
• 9% prevalence
• 4:1 sex ratio
• prognosis: chronic
• over 75% have multiple phobias
specific phobiaETIOLOGY
-Direct trauma experience (classical/operant cond)
-Classical conditioning during panic attack
-Vicarious experience
-Information transmission
NOTE-phobia is reinforced (avoidance = decreased anxiety)
-protective factor: previous experience w/ object
-prepared learning
TREATMENT
systematic desensitization
social phobia
CRITERIA
• fear of social/performance situations
• anxiety/fear upon exposure
• insight that fear is irrational
• avoidance behavior impairs functioning
social phobia• 7% prevalence• 1: 1 sex ratio
ETIOLOGY
-Direct experience of a social trauma-Classical conditioning during panic attack-Vicarious experience
NOTE
-Prepared learning for social disapproval-Interpret ambiguous social info as negative-Self-preoccupied w/ bodily responses-Overestimate others’ detection of their anxiety
social phobia
-cognitive-behavioral therapy (CBT)
-social skills training
TREATMENT
PSYCHOTHERAPY
PRESCRIBED MEDICATION
antidepressants
OCD
CRITERIA
• recurrent & persistent thoughts/images
• associated behaviors compelled to perform
(can be mental or physical acts)
• insight to how irrational
• distress, consumes 1+ hr/day, or impairs functioning
ocd
obsessionsrepetitive, unwelcome thoughts
compulsionsrepetitive, almost irresistible action
• germs
• something bad will happen
• symmetry
• religion
• #s
• washing
• counting
• checking
• touching
• rituals
OCD
• 1% prevalence
• sex ratio varies
• prognosis: chronic
• thought-action fusion
NOTE: OCD patients tend to:
-be more depressed than others
-have exceptionally high standards of conduct/morals
-believe thoughts = actions
-believe they should have perfect control over all of their thoughts & behaviors
ocdorbital frontal PFCbasal gangliacingulate
abnormal activation decreases after psychotherapy or medication
PTSD
CRITERIA
• trauma involving death, threat of death, serious injury and reaction of intense fear, helplessness, or horror
• persistent reexperienced 1+ for 1 month:
-Intrusive recollections
-Dreams
-Reliving as illusions, hallucinations, or flashbacks
-Avoidance of relevant stimuli
-Arousal (i.e. insomnia, irritability, hypervigilance)
-Distress or impairment
PTSD
ACUTE STRESS DISORDERPTSD before 1 month has passed
ACUTE PTSDDiagnosed 1 month after trauma
CHRONIC PTSDDiagnosed if PTSD exceeds 3 months
DELAYED ONSET PTSDWhen symptoms do not start immediately
TREATMENTRevisit original trauma, relive emotions, correct assumptions
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