Abnormal Psych Exam 4-6

to be diagnosed, symptoms have to exist for at least 6 weeks-norm is 3 months

--panic attacks, restlessness, under/overeating, chest pain, headaches, worry, tense

-lack control about what makes them anxious

-maladaptive behavior/skills

---cutting, drinking, not eating at all, hair pulling

Explanation: childhood anxiety not resolved

1. Realistic anxiety- from a real situation

ex: always lacked $ as a child, still anxious over $

2. Neurotic anxiety- always punished for expressing id

ex:now have hard time having fun

3. Moral anxiety- afraid to make moral mistakes

General Techniques

-used to treat all psychological problems and includes: free association, transference, resistance, and dreams

Theorists propose that GAD, like other psychological disorders

-Childhood criticisms

-Threatening self-judgements break through and cause anxiety

-Stop looking @ themselves honestly & w/ self acceptance

-Unconditional positive regard

Psychological problems are often caused by dysfunctional ways of thinking-including excessive worry

-Maladaptive assumptions

---Irrational & silent assumptions

ex: i'm going to fail out of college or not going to get a job

ex: silent assumption: i'm never good enough

(silent assumption is your own personal insecurities that come out through excessive worry)

-Mindfulness- wants you to become aware of your ugly thoughts and be okay with them

---- pay attention to body's response

-Changing Thoughts (Rational Emotive Therapy)

A. Assumptions (look @ them)

B. Identity assumption & attack belief

C. Change that thought

-Individuals worry about worrying (metaworry)

-most problematic assumption in GAD

-have both positive and negative beliefs about worrying (so more prone to get GAD)

-they cannot tolerate the fact that negative events may occur, even if the possibility of the occurrence is very small.

-they worry in an effort to find correct solutions, but are always unsure if correct solution is the right one

------leads to intolerable levels of uncertainty

-worrying serves a "positive" function for those w/ GAD by reducing unusually high levels of bodily arousal

ex: more concerned over exam/presentation so they do better than those that don't worry about it

-Amygdala- fear

-Prefrontal cortex- decision making, planning

-Anterior Cingulate Cortex- reaction between the 2

1. Fear/ anxiety presents itself

2. Body responds to fear/anxiety

3. Body recognizes that fear actually exists (fight or flight), fear does not exist, so body calms back down

anxiety about doing right/ wrong

-may have ongoing problems in their anxiety feedback system

-perhaps too few GABA receptors or GABA receptors do not readily capture the NT

---Early 1950's: Sedative-Hypnotic drugs-the drug slows down the neurons in the person with anxiety(person can sleep, make good decisions, slow them down to match what weare-average speed)

-Physical relaxation will lead to psychological relaxation-teachthem this (#1 way is having you exercise)

-Research indicates that relaxation training is moreeffective than placebo or no treatment

-Best when used in combination with cognitive therapy(attacking thoughts/beliefs and change them) or biofeedback(way your bodyresponds to the relaxation)

-give patient anxious thoughts

-watch how their brain is responding on a screen (EMG)

-puts something in them to relax

-see how they relax-see not just physically and their physical response but also scientifically

-Persistent and unreasonable fears of particular objects,activities, or situations

-Often involves avoidance of the object or thoughts about it

-Interrupts persons daily functioning

1. marked, persistent, disproportionate fear of aspecific object, situation, lasting six months or more

2. Immediate anxiety is usually produced byexpose to the object

3. Avoidance of feared situation

4. Significant distress or impairment

-fear only occurs when it happens/when were around it –weall have fears but don’t all have phobias

-Many people with this avoid crowded places, driving, andpublic transportation

-inability to control what’s going on (underlying problem)

-Many people are also prone to experience “PANIC ATTACKS”-Symptoms typically last 6 or more months

-each model offers explanations, but evidence tends tosupport the behavioral explanations

Phobias develop though:

-ClassicalConditioning

-Modeling(observation and imitation) -Stimulus Generalization- responses to one stimulus are also produced by similar stimuli

-Evolution-survival

Systematic Desensitization (Wolpe)

–steps: teach relaxationskills, make fear hierarchy, confront the fear

-In Vivo Desensitization vs Covert:

-In Vivo(in life)-real life situation, be exposed to situation (ex: heights-standoutside on the rooftop)

-Covert (imagined/created)-one way: close her eyes, have her imagine this, ask how she’s feeling;

2ndway: game simulation of phobia (ex: the roller coaster

-Flooding

-Modelling (therapist is the role model)

-Severe, persistent, and IRRATIONAL anxiety about social orperformance situations in which scrutiny by others and embarrassment MAY OCCUR

-May beNARROW-specific (ex: eating in public, talking in front of class, walking up tostrangers & ask questions)- easier to treat bc its one specific thing

-May beBROAD-doing anything in front of other people and being judged (free floating)

-InBOTH FORMS-anxiety overall and something specific as well

1.Marked, disproportionate, and persistent fear oranxiety about one or more social situations in which indiv is exposed topossible scrutiny by others, typically lasting 6 +months

2. Fear of being negatively evaluated by oroffensive to others

3.Anxiety is almost always produced by exposure tothe social situation

4. Avoidance of feared situations

5. Significant distress or impairment

-People with this disorder hold a group of social beliefsand expectations that consistently work against them:

-Unrealisticallyhigh social standards (need to be perfect 24/7, cant make mistakes)

-concernedw/ how other people see them & their own beliefs

-Views ofthemselves as unattractive and socially unskilled

- Beliefthat inept (fail/mess up) behavior will inevitably end in terrible consequences -Feelingsthat they have no control over anxious feelings in social settings

-Believethey are helpless (most difficult to treat)

-Two components must be addressed: -Overwhelmingsocial fear

-lack ofsocial skills

What ways can help:

-Medication-useantidepressants not antianxiety meds

-Psychotherapy

-Cognitive-ABCmethod

-Exposuretherapy

-Socialskills training-therapist trying to understand/learn emotions behind theiranxiety, not just trying to get them to do the thing they’re anxious about

-Assertivenesstraining groups

-feature at least four of the following symptoms of panic:

palpitations of the heart, tingling in the hands or feet, shortness of breath,sweating, hot or cold flashes, trembling, chest pains, choking sensations,faintness, dizziness, nausea, a feeling of unreality, fear of losing control, and fear of dying

1. RECURRENT unexpected panic attacks

2. A month or more of one of the following symptoms after atleast one of the attacks. a).persistent concern or worry about having additional attacks-thinking about itall day (overwhelmed with worry)

b).significant maladaptive(poor-ex: cutting, eating disorder, run away from home)change in behavior related to attacks

Panic- we all have this-extreme anxiety reaction, can result when a real threat suddenly emerges

Panic attacks-more than one quarter of people have one or more panicattacks at some point

-we all get them every once and a while

Panic disorder-Diagnosis -need to have panic attacks for 1+ month and constantworrying about having another

-needs to be consistent

-NOREPINEPHRINE: neurotrans whose abnormal activity islinked to panic disorder and depression

-LOCUS CERULEUS: small area of the brain that seems to beactive in the regulation of emotions; many of its neurons use norepinephrine

-antidepressants are effective at preventing or reducingpanic attacks-take consistently –most times for a long time

-function at norepinephrine receptor in the panic braincircuit

COG THERAPY: tries to correct people’s misinterpretations oftheir bodily sensations

Steps:

1. Educate clients

2. Teach clients to apply more accurateinterpretations (esp when stressed)

3. Teach clients skills for coping with anxiety

Cog therapy: may use BIOLOGICAL CHALLENGE PROCEDURES

-used to produce panic in participants or clients by havingthem exercise vigorously or perform some other potentially panic-inducingtask in presence of researcher or therapist

-person has recurrent and unwanted thoughts, a drive toperform repetitive and rigid actions, or both

OBSESSIONS: persistent thought, urge, or image that isexperienced repeatedly, feels intrusive, and causes anxiety

COMPULSIONS: repetitive and rigid behaviors or mental actsthat people feel they must perform to prevent or reduce anxiety

The constant maladaptive thoughts and constant worrying;dysfunctional way of thinking

1.Treatment: ABC method-Assumption-Belief-Change the thought entirely

2.Mindfulness: being aware that your excessivethoughts/behaviors are excessive

3. Challenge client to think differently

Two components:

1. Stressor- seeing old friend, test coming up, event; etc. that creates demand (rise to occasion or fly)

2. Stress Response-capacity to react

FEAR- "Package of responses that are physical, emotional, and cognitive

The features of arousal and fear are set in motion by the HYPOTHALAMUS (controls body sensations)- sweating, shaking, etc

1. Stress triggers hypothalamus

2. Pituitary gland secretes hormones that triggers the adrenal cortex

3. Stress hormones are released that trigger arousal and fear reactions (corticosteroids)

hypothalamus-->pituitary gland-->secretion of ACTH--> Adrenal cortex--> corticosteroids

People differ in:

-Their general level of arousal and anxiety

---called TRAIT ANXIETY-naturally anxious/afraid

-Their sense of which situations are threatening

---called STATE ANXIETY-situation based

Acute:

symptoms begin immediately or soon after the traumatic event and last for less than one month

PTSD:

lasts longer than 30 days

As many as 80% of all individuals w/ acute become diagnosed w/ PTSD

-Re-experience traumatic event-flashbacks, dreams, day dream, trigger, any sensations (sound, smell, etc)

-Avoidance- get in car accident in passenger seat- never sit in passenger seat, moving, avoiding social media, avoid people involved

-Reduced responsiveness-not showing emotions, unsocial, not doing things that make them happy, not hearing what people are saying to them

-Increased arousal-more aware of surroundings, paranoid/skeptical

-Negative emotions-depression, helpless, anger, shut down, over/under eat, cutting)

-Guilt- replay events and how they could have prevented it

1. Combat

a). Combat fatigue-during combat

2. Disasters

3. Victimization- rape victims, domestic violence, witness a death, child abuse

4. Terrorism or Torture

Biological and genetic factors

-traumatic events trigger physical changes in brain/body that may lead to severe stress reactions, and in some cases, to stress disorders

--suggests abnormal NT & hormone activity

--damage may also occur esp in the hippocampus and Amygdala

-Genetics- predisposition to fear & stress more than others

Antianxiety and/or Antidepressants

-a set of positive attitudes (called RESILIENCY-ability to bounce back, or hardiness) is protective against developing stress disorders

Risk factors include:

-Impoverished childhood-didn't get food, water shelter, drugs, gang violence, etc

-Psychological disorders in the family

-The experience of assault, abuse, or catastrophe at an early age

-Being younger than 10 years old when parents separated or divorced

Social support-if you have it you will be fine, but ppl w/o it are more susceptible

-Multicultural factors

---view on sharing about trauma

---social support-men have harder time getting this

---severity of trauma

About 1/2 of all PTSD cases improve w/ in 6 months, remainder may persist for years

-Treatment procedures vary

General goals for all programs:

-end lingering stress reactions

-gain perspective on painful experiences

-return to constructive living

-Drug Therapy

-Behavioral exposure techniques

-use flooding and relaxation training

-use EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMPR)-look @ photo, look away when it's too much, look @ it for as long as they can

-Insight therapy (Eclectic model)

-bring out deep seated feelings, create acceptance, lessen guilt

(Psychodynamic, humanistic, cognitive)

-Often use couple, family, or group therapy formats; rap groups-only found in military population

Psychologicaldebriefing (critical incident stress debriefing)

-discuss within days of the incident ****

-Major components include:

-Normalizingresponses to the disaster -Encouragingexpressions of anxiety, anger, and frustration

-Teachingself-help skills

-Providingreferrals

pros: don’t ever allow neg emotions to just rest in mindwithout talking about it

cons: pressured to talk about things that really don’t evenmatter to you; create thoughts in your thought process that didn’t originallyupset you but now might bc of the questions they’re asking you

May be:

-Localized-Most common type; loss of all memory ofevents occurring within a limited/specific time period –bc of stressful event

-Selective-Loss of memory for some, but not all,events occurring within a period

-Generalized- Loss of memory beginning with an event,but extending back in time; may lose sense of identity; may fail to recognizefamily and friends (goes backwards)-forget who they were prior to the event,(not the same as altzeimers)

-Continuous- Forgetting continues into the future;quite rare in cases of dissociative amnesia-forget the future, not allowingsenses to take in info, walking around like a zombie (most rare)

-People who forget their personal identities and details oftheir past, but ALSO flee to an entirely different location

-Brief-amatter of hours or days-and ends suddenly

-Long-term-people may travel far from home, take a new name and establish newrelationships, and even a new line of work; some display new personalitycharacteristics

-Iffound, need to do memory repair -Fuguestend to end abruptly

~Don’t even remember who they used to be, they believe whatthey’re saying is true; out of their control~

-Person develops two or more distinct personalities, called“subpersonalities”

-Quiet: notreally going to dominate, come out every once and a while, come out whennecessary

-Host: whoyou naturally were before you got other personalities

-Domineering:dominating sub personality, vicious, get to the point, come up and switchwhenever they want to

-Switching is sudden and not controlled; esp if havedomineering personality because they run everything over the host

-when stress occurs and one personality can’t manage it, thedifferent personalities come to rescue them from that stress

-Mutually Amnesic relationships-don’t even know theother personalities exist, they’re all independent of each other

-Mutually Cognizant(aware) Patterns- aware of theother personalities

-One Way Amnesic Relationships (most common)- onepersonality might know about the others, but some personalities don’t knowabout the others; some of them are more domineering so that’s how they know butthe others don’t

-each personality has a unique set of memories, behaviors,thoughts, and emotions

-Displaydramatically different characteristics, including

-Identifying features: they think that what they’reperceiving is true ( have black hair in real life, but see’s long blonde hair)can change race, age, life in general and believe that and differs between eachpersonality

-Abilities and preferences-allergies and talents can change,color preferences, etc

-Physiological responses-heart beats, stress levels, alldiffer between personalities

by REPRESSION, the most basic ego defense mechanism

-Behaviorists believe that dissociation grows from normalmemory processes and is a response learned through OPERANT CONDITIONING

-Self-Hypnosis: hypnotize themselves; remove themselves fromone identity and put yourself in another identity

often recover on their own

-only sometimes do their memory problems linger and requiretreatment

-people with DID usually require treatment to regain theirlost memories and develop an integrated personality

-treatmentfor dissociative amnesia tends to be more successful than treatment for DID

-leading treatments for these disorders are psychodynamic,hypnotic, and drug

-Psychodynamic therapists

-hypnotic therapy

-intravenous injections of barbiturates

DEPRESSION

-low, sadstate in which life seems dark and its challenges overwhelming

women: most common with crying

men: most common with anger

MANIA

-state ofbreathless euphoria or frenzied energy, overly happy and obsessed, unorganized,impulsive, don’t sleep-energy beyond comprehension, make bad decisions,overspending, make goals or plans that are irrational, think that they’rebeyond humanity

-not doing all of these things at the same time (just options);what it could look like

people with depressive disorders suffer only fromdepression; a pattern where you drop below normal mood and only come back up tothat normal state;

-no history of mania

-mood returns to normal when depression lifts

Symptoms vary

Five main areas of functioning may be affected

-Emotionalsymptoms (crying, anger, disgust, hatred, scared, confused, helpless, ashamed,guilty, etc.)

-Motivationalsymptoms (not getting out of bed, not socializing, not eating, not going towork, exercise, lack motivation spending time with loved ones, not cleanstuff/yourself, little sex drive)

-Behavioralsymptoms (sleep more, talk less, be by themselves, cutting, hair pulling, dressin dark clothing, taking drugs/drinking, overeat, do things in repetition)

-Cognitivesymptoms (suicide, never good enough, guilt, I’m a bad person, defeat) -Physicalsymptoms-biology (weight loss/weight gain, migraines, breakouts/acne, highblood pressure)

-for the most part, the person will usually have physicalsymptoms that are noticed first; usually what brings people into the doctor’soffice

-A major depressive episode is a period of two or more weeksmarked by 5+ symptoms of depression

-In extreme cases, symptoms are psychotic including:

-Hallucinations(see/hear something that is not there)

-Delusions(believe something to be true that’s not)

MAJOR DEPRESSIVE DISORDER:

-People who experience a major depressive episode with nohistory of mania; you have between 2 weeks and 2 years of an episode

DYSTHYMIC DISORDER:

-Individuals who experience a longer-lasting (atleast two years) but less disabling pattern of depression; symptoms aren’t asintense and are less disabling

-Usually going through treatment and have theepisode for more than 2 years

PREMENSTRUAL DYSPHORIC DISORDER:

A diagnosis given to women who repeatedlyexperience clinically significant depressive symptoms during week beforemenstruation (to help remember: PMS)

DISRUPTIVE MOOD REGULATION DISORDER:

-Characterized by a combination of persistent depressivesymptoms and recurrent outbursts of severe temper; depressive symptoms are alwaysfollowed by extreme anger -Males aremore often diagnosed with this

Stress may be a trigger for depression

-People with depression experience a greater # of stressfullife events during the month just before the onset of their symptoms

-1. REACTIVE (EXOGENOUS) DEPRESSION- external (parentsgetting divorced, being bullied, someone dying, natural disaster, gettingturned down by dream job)

-2. ENDOGENOUS DEPRESSION- internal (low serotonin levels,feelings of guilt, delusions/hallucinations, gaining a lot of weight, not agreat studier/test taker)

Biochemical factors

-Low activity or two NT chemicals SEROTONIN andNOREPINEPHRINE strongly linked to unipolar depression

Immune System

-The body’s network of activities and cells that fight offbacteria and other foreign invaders

-When stressed, the immune system may become deregulated,which some believe may help produce depression

-Long-term illnesses

-Use antidepressants for medication (unless showingpsychotic symptoms)

-ECT (very expensive)

-Link between depression and grief (Freud and Abraham)

-Loss ofsomeone naturally or symbolically ~ Freud

-Newerpsychoanalysts (OBJECT RELATIONS THEORISTS) propose that depression resultswhen people’s relationships leave them feeling unsafe and insecure (childrenwho are neglected/abused, marital relationships)

-Therapists use the same basic procedures for allpsychological disorders

-Freeassociation

-Therapistinterpretation

-Reviewpast events and feelings

-Depression results from changes in rewards and punishmentspeople receive in their lives

-Socialrewards are especially important

-Reintroduce clients to pleasurable activities and events,often using a weekly schedule

-Appropriately reinforce their depressive and non-depressivebehaviors (encouraging good behaviors or not encouraging poor behaviors)

-Help them improve their social skills

-Learned helplessness-when people fail a lot and now theydon’t believe that they can actually do that thing again

-Negative thinking (all thoughts about you are defined bydefeat)

1. Maladaptive attitudes- "i hate myself," poor perception of one's self

2. Cognitive Triad

A. oneself

B. world

C. future

3. Errors in thinking- when they believe their is the truth and there's evidence it's a lie

(easiest thing to fix bc you don't have to convince them-there's a fact)

4. Automatic thought- even before someone does something, you automatically assume the worst- usually has to do with a trigger

(engrained and we told ourselves its true)

BECKS COGNITIVE THERAPY- designed to help clients recognize and change their negative cognitive processes

Phases:

1. Increase activities and elevating mood

2. Challenging automatic thoughts (ask client how they feel about something then challenge it)

3. Identify negative thinking and biases-get to the root

4. Changing primary attitudes (help them to mold themselves and see themselves as a good quality human being w/ high self esteem)

Family-Social Perspective

-Depression has been tied repeatedly to the unavailability of social support

Depressed clients helped to change their approach to close relationships in their lives

Most effective: Interpersonal Psychotherapy:

-involve fam/friends to client; get close people to the client to challenge neg thoughts outside of therapy; it takes a village-get everyone on the same page

Model holds that 4 interpersonal problems lead to depression:

-Interpersonal loss (death, went to jail)

-Interpersonal role dispute (stay at home parent who wants to work)

-Interpersonal role transition (soldier being deployed or coming back)

-Interpersonal deficits (liars, controlling/manipulative)

main type is behavioral marital therapy (BMT)

-Focus is on developing specific communication and problem-solving skills

-IF marriage is filled w/conflict, BMT is as effective as other therapies for reducing depression

Artifact theory--> idea that women are diagnosed more w/ depression bc they don't know how to identify it in men (women cry more)

Hormone Explanation--> hormones trigger depression; women experience more ups & downs

Life stress theory--> women more prone to stress in life than men; more things that they're worried about

Body dissatisfaction theory--> the world puts a lot of pressure on women to be beautiful; no matter how they look-never satisfied

Rumination theory--> bc women love to talk & have lots of relationships, talk about same problem w. different ppl & make it hard to get over things- constantly reliving it

Lack of control theory--> women can't control a lot of things in life; wage gap; can't control so feel helpless

Culture sensitive clinicians seek to address the unique issues faced by members of cultural minority groups

Special cultural training of therapists heightened awareness

-make sure aware and sensitive to client; believe their experience to be true bc it's true for them

-ppl in this state experience dramatic and inappropriate rises in mood and activity

5 main areas of functioning may be affected:

-Emotional symtoms: extremely happy, overly confrontational and overly confident

-Motivational: achieve dreams that are irrational, overspending, take over meeting at work and usually don't (feel as if they are the boss), companionship, excitement

-Behavioral: impulsive, person talks quickly, don't sleep at all, don't lack energy, move quickly

-Cognitive: i can achieve anything, i am the best person here, i am the prettiest (flamboyant- over the top, attention seeker)

-Physical: shaking, not able to sleep, jittery, heightened in awareness, afraid

Ppl are considered to be in a full manic episode when for at least ONE week

-they display abnormally high/irritable mood, increased activity or energy, and at least 3 other symptoms of mania

-when symptoms are less severe- HYPOMANIC EPISODE

Bipolar 1 Disorder:

-full manic & major depressive episodes

Bipolar 2:

-when person experiences numerous periods of hypomanic (less severe) symptoms and mild depression, DSM-5 assigns a diagnosis of CYCOTHYMIC DISORDER

-symptoms continue for 2+ years interrupted by periods of normal mood

NT's

-low serotonin and high norepinephrine (mania)

Ion Activity

-irregularities in the transport of these ions may cause neurons to fire too easily (mania) or too stubbornly resist firing (depression)

Brain structure

-Basal Ganglia-controls emotions

Cerebellum-coordination and movement

Prefrontal cortex- logical/higher level thinking, decision making, planning, understand risk and reward

Amygdala and Hippocampus

Therapy focuses on medication management (health wise, overdose in manic state, skip pills, etc), social skills, and relationship issues

ADJUNCTIVE THERAPY

-two or more therapy methods

ex: see psychologist and therapist