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Midterm

Study Guide for Test 2


Department
Psychology
Course Code
PSYB32H3
Professor
Konstantine Zakzanis
Study Guide
Midterm

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PSYB32 Textbook Notes II
Chapter 6: Anxiety Disorders
Anxiety ± unpleasant feeling of fear and apprehension, most common psychological disorder
- Anxiety Disorders ± are diagnosed when subject has feelings of anxiety are clearly present
1) Phobia ± fear and avoidance of objects or situations that do not present any real danger
2) Panic Disorder ± recurrent panic attacks involving sudden onset of physiological symptoms, such
as dizziness, rapid heart rate, and trembling, accompanied by terror and feelings of impending
doom; sometimes accompanied with agoraphobia (fear of public places)
3) Generalized Anxiety Disorder ± persistent, uncontrollable worry, often about minor things
4) Obsessive-Compulsive Disorder - the experience of uncontrollable thoughts, impulses, or images
(obsessions) and repetitive behaviours or mental acts (compulsions)
5) Post traumatic Stress Disorder ± aftermath of a traumatic experience in which the person
experiences increased arousal, avoidance of stimuli associated with the event, and anxiety in
recalling the event
6) Acute Stress Disorder ± symptoms are the same as those of PTSD but last for four weeks or less
Co-morbidity is common due to...
1) Symptoms are various anxiety disorders are not entirely disorder specific
2) The etiological factors that give rise to various anxiety disorders may be applicable to more than
one disorder
Phobia ± implies that the person suffers intense distress and social impairment because of the anxiety
Prevalence: more in women than men
- Claustrophobia ± fear of closed spaces
- Agoraphobia ± fear of public places
- Acrophobia ± fear of heights
- Ergasiophobia ± fear of writing
- Pnigophobia ± fear of choking
- Taphephobia ± fear of being buried alive
- Anglophobia ± fear of England
- Mysophobia ± fear of contamination and dirt
Specific Phobias ± unwarranted fears caused by the presence/anticipation of a specific object or situation
- DSM Subdivided source of fear:
o blood, injuries, and injections
o situations (ex: planes, elevators, enclosed spaces)
o animals
o natural environment (ex: heights and water)
-
Social Phobias - persistent, irrational fears inked generally to the presence of other people
Etiology of Phobias
- Psychoanalytic theories ± phobias are a defence against the anxiety produced by repressed id
impulses, moved onto an object or situations that has some symbolic connection
- Behavioural Theories ± learning as a way phobias are acquired
o Avoidance Conditioning: reactions are learned avoidance responses
1) Classical Conditioning ± fear a neutral stimulus if paired with a fearful/painful event
2) Operant Conditioning - escaping from or avoiding CS, the response is maintained by
its reinforcing consequence of reducing fear
o Modelling ± Vicarious Learning - learn fears thru imitation/observation of others
Anxious-rearing model ± based on the premise that anxiety disorders in children
are due to constant parental warnings that increase anxiety in the child
o Prepared Learning ± fear only certain objects and events (ex: spiders, snakes, heights)
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Prepared Stimuli ± certain neutral stimuli that are more likely than others to
became classically conditioned stimuli
o A Diathesis (predisposition) Is Needed ± a tendency to believe that similar traumatic
experiences will occur in the future may be important in developing a phobia
- Behavioural Model of social phobia ± considers inappropriate behaviour or a lack of social skills
as the cause of social anxiety
- Cognitive Theories ± IRFXVRQKRZSHRSOHVWKRXJKWSURFHVVHVFDQVHUYHDVDGLDWKHVLVDQGRQ
how thoughts can maintain a phobia
1) an attentional bias to focus on negative social information (ex: perceived criticism and hostile
reactions from others)
2) perfectionistic standards for accepted social performances
3) a high degree of public self-consciousness (excessive self-focus increase social anxiety)
- Predisposing Biological Factors ± biological malfunction (a diathesis) that somehow predisposes
them to develop a phobia following a particular stressful event
o Autonomic Nervous System ± the ease with which their autonomic nervous systems
become aroused
Stability-Lability Model: Labile = jumpy individuals, readily aroused
Autonomic Lability ± autonomic nervous system involved in fear and phobic
behaviour, to some degree is genetically determined, heredity may play a role
o Genetic Factors ± blood-and-injection phobia is strongly familial
Therapies for Phobias
- Psychoanalytical approaches ± repressed conflicts
- Behavioural Approaches
o Systematic desensitization ± imagines an increasingly frightening scenes while in a state
of deep relaxation
o In vivio exposure ± exposure to real-life situations
o Virtual reality (VR) exposure ± just as effective as group cognitive behaviour therapy
o Learning Social Skills ± role-playing
o Modelling ± exposure to feared settings by filmed demonstrations
o Flooding - exposed to the source of phobia at full intensity
Secondary gain ± a person with a phobia often settled into an existence in which
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- Cognitive Approaches ± FKDQJHSHUVRVLUUDWLRQDOEHOLHIV, better than drug treatments
o Homework ± in b/w-session learning is considered to be an essential component of CBT
- Biological Approaches ± drugs that reduce anxiety: sedatives, tranquilizers or anxiolytics
o Barbiturates ± first major category, highly addictive present great risk of over dose
o Propanediols (ex: Miltown)
o Benzodiazepines (ex: Valium and Xanax) - additive + severe withdrawal syndrome
o Anti-depressants ± Monoamine oxidase (MAO) inhibitors for treating social phobias
Phenelzine (Nardil) ± weight gain, insomnia, sexual dysfunction, hypertension
Selective serotonin reuptake inhibitors (SSRIs): Prozac ± treat depression
Effective but patients may find it difficult to discontinue use, relapse is common
Panic Disorder ± suffers a sudden and often inexplicable attacks
Diagnosis: recurrent uncued attacks and worry about having attacks in the future
Prevalence: more in women than in men, begins in adolescence, associated with stressful life experiences
DSM: can be with or with agoraphobia
Comorbid: major depression, generalized anxiety disorder, alcoholism, personality disorders, drug use
- Depersonalization ± IHHOLQJRIEHLQJRXWVLGHRQHVERG\
- Derealization ± IHHOLQJRIWKHZRUOVQRWEHLQJUHDOIHDUVRIORVLQJFRQWUROJRLQJFUD]\G\LQJ
- cued panic attacks ± associated strongly with situational triggers
- situationally predisposed attacks ± relationship with stimuli is present but not as strong
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- uncued attacks ± occur in seemingly benign states and in unexpected situations (relaxation or sleep)
Etiology of Panic Disorder
- Biological Theories ± panic disorder runs in families, greater in identical twins, genetic diathesis
o Noragrenergic Activity ± panic caused by over activity in the noradrenergic system
o Cholecystokinin ± a peptide that occurs in the cerebral cortex, amygdale, hippocampus,
and brain stem induces anxiety-like symptoms in rats, panic disorder partially due to
hypersensitivity to CCK
o Creating panic attacks Experimentally ± hyperventilation, lactate, oversensitive CO2
receptors, only worked in those who were already diagnosed or high in fear
- Psychological theories ± the fear-of-fear hypothesis (agoraphobia is not a fear of public places,
but a fear of having a panic attack in public)
o Autonomic systems that is predisposed to be overly active coupled with a psychological
tendency to become very upset by these sensations
o Perceived control ± extreme fear of losing control
Therapies for Panic Disorder and Agoraphobia
- Biological Treatments
o Antidepressants ± SSRIs (Prozac), tricyclic anti-depressants (Tofranil) anxiolytics
(Xanax)
o Drug treatments must be continued indefinitely,
- Psychological Treatments
o Exposure-based treatments, gains maintained for many years
1) Relaxation training
2) A combination of Ellis- and Beck- type cognitive-behavioural interventions,
cognitive restructuring
3) Exposure to the internal cues that trigger panic
Generalized Anxiety Disorder ± all-encompassing worry, persistently anxious often about minor items
Diagnosis: XVXDOO\GRQ¶WVHHNWUHDWPHQWGLIILFXOWWRWUHDWVXFFHVVIXOO\
Prevalence: 5% of general population, more in women than in men, begins mid-teens,
DSM: chronic, further research for the optimal definition
Comorbid: other anxiety disorders, mood disorders
Etiology of Generalized Anxiety Disorder
- Psychoanalytic View ± unconscious between the ego and id impulses
- Cognitive-Behavioural Views ± focuses on control and helplessness
o Learning theorists - anxiety regarded as having been classically conditioned to external
stimuli but with a broader range of conditioned stimuli
o Cognitive theory ± perception of not being in control, uncertainty intolerance
- Biological Perspectives ± genetic component and environment component
o Defect in the GABA system
Therapies for Generalized Anxiety Disorder
- Behavioural Clinicians: Relaxation techniques, a sense of competence by modelling, operant
shaping, or verbal instruction
- Cognitive-Behavioural Approaches: exaggerated exposure to reduce worry
1) Because the patient remains in a fearsome situation, anxiety is believed to extinguish
2) By considering the unlikelihood of the worst fears imagined, the patent alters his cognitive to
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- CBT more superior to drug treatment
- Drug Treatment: have undesirable side effects, relapse when off drugs
o Anxiolytics ± most widespread treatment for GAD (Valium, Xanax, BuSpar)
o Antidepressants ± Tofranil
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