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Lecture 3

PS280-Z Lecture 3 – Tuesday July 16th, 2013.docx

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Kathy Foxall

th PS280-Z Lecture 3 – Tuesday July 16 , 2013 Anxiety, Obsessive Compulsive, and Trauma Related Disorder Overview - Most common type of abnormal behaviour because we all do flourish with a simple level of anxiety - Commonalities with mood disorders (for instance, feelings of depression, bipolar) - Some degree of anxiety is normal o Facilitates performance at low levels o Motivating effect o Disruptive at high levels - Who does not experience anxiety? o Psychopaths – to them, all of their behaviours are considered normal, acceptable, and no big deal Maladaptive Anxiety - High levels of diffuse negative emotion - Sense of uncontrollability - Shift in attention to state of self-preoccupation o Paying attention to something but internally paying attention to yourself (such as what is going through your mind and your bodily state) Anxiety vs. Fear - Fear is an alarm reaction to current danger - Anxiety is future-oriented (what if…?) Anxiety Disorders - Panic disorder o Your whole body goes crazy, the feeling of having a heart attack - Phobias - Generalized anxiety disorder o A worry about everything New Categories - Obsessive compulsive related disorders o Obsessive compulsive disorder (OCD)  Obsessing about intrusive thoughts that make you worry and panic o Hoarding, trichotillomania, excoriation - Trauma related disorders o Acute stress disorder (ASD) o Posttramatic stress disorder (PTSD) Historical Perspective - Freud was one of the earliest theorists to recognize the difference between objective fears and neurotic anxiety - In the early 1900s, behaviourists like John B. Watson began to consider fears and phobias in terms of conditioning models Etiology of Anxiety Disorders: Biological Factors - Twin studies o The concordance rate for anxiety disorders in MZ twins is higher than that for fraternal twins - Non-specific risk - Estimated heritabilities range from 30-40% Anatomical Findings: Neural Fear Circuit - Sensory information is directed through the thalamus - The thamalus routes some information directly to the amygdala - From the amygdala, information goes to the hypothalamus, midbrain area, brain stem, spinal cord - Connects to autonomic N.S. through spinal cords - There is some information that goes directly through the brain without going through the thalamus Etiology of Anxiety Disorders: Biological Factors - Complex and interacting neurotransmitter systems such as GABA, serotonin, and noradrenalin o GABA most pervasive neurotransmitter in the brain Behaviour Factors - Classic Conditions (Pavlov) o UCS and UR o Repared pairings of UCS+initially neutral stimulus (smell of food and sound of bell) o Eventually the neutral stimulus becomes a CS o Bellsalivation Cognitive Models of Anxiety - Samuel Beck’s cognitive triad 1. The world is dangerous 2. The future is uncertain 3. Self unable to cope with what may come Attachment Style - Anxious-ambivalent attachment in infancy predicts anxiety at age 17.5 years - Anxious ambivalent attachment is associated with higher divorce rates - Associated with greater anxiety in the workplace - Helps kids determine the level of stability and trustworthiness they can have in close relationships o Once developed, it is the lens they used to determine all of the relationships that they will have in the future - Secure attachment: good response from caregiver - Anxious-ambivalent attachment: when they are in need and the caregiver does not provide to them, they get anxious and worried that they will not get what they need - Parents with an anxious-ambivalent attachment will be very controlling with their children – trying to tell them what to do and not to do Origin of the term ‘Panic’ - Greek God Pan - Used to lie in wait by a bridge and scare travelers to death with blood-curdling screams Panic Attack: Somatic Symptoms - Sudden overwhelming experience of terror involving somatic and cognitive symptoms - DSM-IV-TR requires at least 4 of 13 symtpoms o Palpitations o Neausea o Sweating o Feeling dizzy/light-headed o Trembling/shaking o Fear of losing control/going crazy o Senstations of shortness of o Fear of dying breath/smothering (SOB) o Tingling/numbess of extremities o Feelings of choking o Chills/hot flushes o Chest pain/discomfort Panic Cycle Cognitive Symptoms: Anxiety Sensitivity - Catastrophic misinterpretation of bodily sensations - Panic disorder often leads to agoraphobia (fear of public spaces) o An individual can have a panic disorder without having agoraphobia o Agoraphobia without a panic attack is very rare - Heart palpitations may be interpreted as imminent heart attack - ‘I’m going crazy’; ‘I think I’m dying’ Barlow’s Alarm Theory in Panic Disorder - When there is a real danger, alarm reaction is adaptive - In panic disorder, the person associated panic attacks of situations that triggered them with even minor somatic symptoms - Monitors bodily sensations very closely in an effort to prevent future attacks o Thereby bring about future panic attacks Case Study: Panic Disorder with Agoraphobia - Mrs. M, 67-years old - Lived in apartment - Had not left her home for 20 years - Panic attacks in certain areas of apartment (such as close to the door or the balcony area) Therapies for Panic Disorder and Agoraphobia - Biological treatments o Drug therapy - Psychological treatments o Family involvement o Cognitive-behaviour therapy o Exposure to internal cues that trigger panic Phobias - Fear-mediated avoidance that is out of proportion to the object or situation o Intense distress o Disruptive o Adults and children Epidemiology - Lower prevalence in the elderly - 8.7% of population has a phobia in any given year - 12.5% will develop a phobia at some point - Lifetime prevalence is 15.7% for females, 6.7% for males o Males report their symptoms less than females do (they will internalize, turn to alcohol, get aggressive, or try to ignore it) Class of Phobias - Specific Phobias are unwarranted fears caused by the presence of a specific object or situation such as: o Animals – typically rodents, insects, snakes o Blood, injuries, or injections – interferes with medical care o Situations (planes, elevators) – may interfere with travel and affect where a person will or will not work o Natural environment (water, heights) – fear of heights, thunder, can cross into a situational phobia o Other - e.g., developing an illness Models of Phobias - Equipotentiality premise: equal probabilities of being afraid of various stimuli with conditioning (Watson) - Non-associative model: we do not need experience with certain stimuli to be afraid of them - Biological preparedness: we have evolved to be afraid of certain stimuli, but need minimal experience with it first - Disgust sensitivity: feel that object is disgusting, possibility contaminated Observational Learning - Fears and phobias are also developed through modeling Mower’s Two-Stage Theory - On the acquisition and maintenance of phobias a. Many phobias appear to be acquired through classical conditioning b. Once acquired, a phobia may be maintained through operant conditioning Social Phobia - Fear of social situations o Performance anxiety o Interpersonal interactions - Rooted in the fear of negative evaluations o Inward attentional – feeling that everyone is evaluating us in the same way and become hypersensitive to that Types of Social Phobias - Non-generalized social phobias: fear specific situations/activities o Giving a presentation o Using a bathroom in a public setting o Eating in public - Generalized social phobia Factors Associated with Social Phobia - History of bullying or severe teasing in childhood (92%) - Having parents who were highly critical and controlling - High self focus, low self-esteem, low confidence - High level of fearfulness about making mistakes Treatment of Phobias - Behaviour approaches involve exposure - Systematic desensitiz
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