test 2 exam lectures.docx

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Department
Psychology
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PSY341H1
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Anna Grivas Matejka

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Chapter 7Anxiety Disorders  Anxiety: a mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune  Anxiety disorders involve experiencing excessive and debilitating anxieties; occur in many forms  Many children with anxiety disorders suffer from more than one type Excitement is often associated with anxiety. There are bodily physical symptoms. State of anticipating the future that may be dangerous or scary which fuels the feeling of anxiety. Occurs in many forms. Ie.exam time causes anxiety but functions normally. Have comorbid issues-another diagnoses, another type of anxiety usually or depression. Experiencing Anxiety  Moderate amounts of anxiety are adaptive; we act more effectively and cope with potentially dangerous situations. We behave effectively if we have moderate levels of anxiety and cope better in dangerous situations. Ie/get in car and practice safe driving fueled by moderate level of anxiety.  Excessive, uncontrollable anxiety can be debilitating- balance is very fine. Getting right amount of anxiety, also genetic driven. Use coping mechanisms or get professional help  The neurotic paradox is a self-defeating behavior pattern- individual will know little to be afraid of the even that they are a part of happens to a lot of people but are still terrified and will try to avoid and escape that situation. Ie/not get in a car, to avoid accident.  Fight/flight response. Immediate reaction when you perceive threat and want to escape potential harm. To help people make decisions when appropriate to use fight/flight response.Alot of people have difficulty with make an appropriate choice.  Three interrelated (all work with one another) anxiety response systems:  Physical system: brain is involved to send messages to sympathetic nervous system, produces fight/flight response and activates strong chemicals in order to deal with the perceived danger. Brain release cortical, need in small doses. Good at absorbing and lowering levels. People with anxiety will release too much cortical that has side effects- a response from physical system. Ie/increased heart rate, fatigue, upset stomach, dizzy, numb, lower blood pressure, sweating  Cognitive system: subjective feelings, activate panic, will not be able to concentrate, IQ drops by 20 points, feel like they are having a heart attack or going crazy, imagining harm-side effects  Behavioral system: become aggressive b.c they don’t know what else to do or avoid threat and escaping it in the process. Avoidance- avoid anything to do with anxiety increasing ie/school refusal. Try to act in a way to create a balance, body and brain needs to be in homeostasis so will try to achieve by any means- avoidance, crying, aggression, nail biting, tapping-happens with too much cortical, pacing, clenching jaw. Anxiety:  Future-oriented mood state, which may occur in absence of realistic danger; (on average most people are in danger-chance will fail but not realistic to think definite) characterized by feelings of apprehension and lack of control over upcoming events. Ie/going to fail final even though studying convincing that you will fail. Fear:  Present-oriented emotional reaction to current danger, characterized by strong escape tendencies and surge in sympathetic nervous system. Ie/ fear of airplanes, emotions arise on the plan but if thinking about it then anxiety. Immediacy ignited fear if see a spider but no anxiety when thinking about it. Panic:  Group of physical symptoms of fight/flight response that unexpectedly occur in the absence of obvious danger or threat. Feel calm initially, no danger. Blurred vision, five senses are heightened-clearer vision, hear louder, smell and taste more vivid. Difficult to manage. 1  Moderate fear and anxiety are adaptive, and emotions and rituals that increase feelings of control are common  Normal fears? NormalAnxiety? Normal Worry? Normal rituals? Will vary with developmental stage person is in. normal for child to be anxious for a four year old when parents leave but not for 10 year old. Consider mental age, children fear animals but not normal for adult. Normalcy about age and intensity of child experiences and frequency. 3 yr old anxious at day care, how intense is the anxiety- cry for 15 mins, able to adjust or cannot be left. Anxiety Disorders According to DSM-IV-TR  Nine categories define the features of anxiety disorders. Most common.Assessment is tricky b.c of overlap, so diagnosis not reliable. Diagnosis depends on clincians- problem with anxiety group.  Separation Anxiety Disorder (SAD)- need this for child to survive, reaction they need, obtain proximity to caregiver for survival. 7 months to 4 years old (preschool). Insecure attachment if no SAD-have not bonded emotionally so feel no anxious (problem). Diad needs intervention for secure attachment.  GeneralizedAnxiety Disorder (GAD)  Specific Phobia  Social Phobia (SocialAnxiety Disorder)  Obsessive-Compulsive Disorder (OCD)  Panic Disorder (PD)  Panic Disorder with Agoraphobia  Posttraumatic Stress Disorder (PTSD)  Acute Stress Disorder  Significant associations exist between nearly all anxiety disorders Separation Anxiety Disorder- SAD  Age-inappropriate, excessive, and disabling anxiety about being apart from parents or away from home. Need 3 or more symptoms if 2 strong ones can’t be diagnosed. If anticipated, the idea of caregiver leaving is enough. Excessive worry about possible harm, persistent. DSM problem-no definition so criticism of diagnosis, varies to clinicians. Clinical opinion of consensus-reliable. Prevalence and Comorbidity  SAD is one of the two most common childhood anxiety disorders  Occurs in 4-10% of children-population based sample. Prevalent in girls than boys.  More than 2/3 of children with SAD have another anxiety disorder either concurrently or future. 50% for depression sometime in their life. Justify intervention before symptoms commonly occur  Children with SAD may also display specific fears of getting lost, or of the dark  School reluctance or refusal is common in older children with SAD- not a diagnosis, major functioning as arguing criteria. Major in older kids. Onset, Course, and Outcome  SAD has the earliest reported age of onset of anxiety disorders (7-8 years of age) and the youngest age at referral. Manifests first, average is 7-8 so deferred until school age. Lack of referral until kids are older.  Progresses from mild, moderate, severe. Triggered my major stress ie/moving houses, new school transition, divorce, death- occur before onset.  SAD persists into adulthood- one third continue to have SAD.  As adults, more likely to experience? Relationship difficulties, mood disorders, functional impairments in social interactions, School Reluctance and Refusal-not a diagnosis  School refusal behavior:  Refusal to attend classes or difficulty remaining in school for an entire day 2  Equally common in boys and girls btw ages 5-11. If difficulty in grade 1, hard in preschool too, peaks at second grade- academic pressure, social demands in kindergarten.  Fear of school may be fear of leaving parents (separation anxiety), but can occur for many other reasons  Serious long-term consequences if it remains untreated  Difficult to treat- parents biggest issue have a hard time watching their child meltdown, GeneralizedAnxiety Disorder  Some worry is a part of normal development  Generalized anxiety disorder (GAD):  Excessive, uncontrollable anxiety  Worrying can be episodic (stopped and started again) or almost continuous (never stops)- worried about many things daily.  Worry excessively about minor everyday occurrences- making person miserable and others a person would say and shouldn’t worry about it.  Accompanied by at least one somatic symptom- long lasting, can withstand without medical attention ie/chronic headache, muscle pain, continuous shaking-can live with these. If life threatening then not associated with GAD. Must have 3 symptoms out of 6. Fatigue, irritable.  Anxiety is pieced with worry not depression  Prevalence- 3-6% will be diagnosed. No difference btw girls and boys, slightly higher in teenage girls. No difference until adulthood b.c hormonal, environment. More socially acceptable for girls to externalize and express anxiety whereas in boys it is not.-by product of social acceptance and if girls can have these types of symptoms then girls will come to help and boys will keep it to themselves.  Comorbidity- GAD highly comorbid to other disorders and depression  Onset- 10-14 years of age. Not high school years- grade 5, 6,7,8  Course- older you get more symptoms develop. When 10 meet criteria at 14 if continue to meet then more intense. Consider early intervention.  Outcome- depression. Persist overtime if left untreated. Specific Phobia  Age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine- maladaptive behavior. Needs to last atleast 6 months. Ie.After tsunami, children having phobias to extreme weather, cant diagnose b.c normal covered in media. So not disorder. Needs to last longing and disabling: minimal threat. Belief system needs to be persistent: parents done research to show no tsunami of living location but still feared.  Evolutionary theory: infants are biologically predisposed to learn certain fears: age appropriate for fear then not sure not misdiagnosing.  Five DSM-IV subtypes: animal, natural environment, blood-injection-injury, situational, other  Prevalence- 4-10% in children have specific phobia some point in their life. Before age of 18, common in girls, last over 6 months.  Comorbidity- other anxiety disorders, has least amount comorbid b.c this is specific to something that doesn’t have a general predisposition.  Onset- no age where inappropriate, 4 years. Social Phobia (SocialAnxiety Disorder)  Amarked, persistent fear of social or performance requirements that expose the child to scrutiny and possible embarrassment ie/ playing a game with spectators, around peers, over daily situations  Generalized social phobia: most severe, around some type of performance of social engagement. Involves all social situations, person ends up being alone all the time.  View of social anxiety disorder as existing on a continuum. Lifetime prevalence is 6-12 months. Twice as common in girls than boys b.c girls concerned with competancy, others perceptions, internalized. FMRI differences in amygdala- emotion regulation. 3  Prevalence, comorbidity-panic attach, course: last 6 months, persistent, excessive thinking about it all the time. Common when person needs to do something in front of others. 20% go on to panic disorder. Onset- middle adolescence-autonomy, want to be accepted, under age 10 no signs. Peer rejection highly correlated, will develop social phobia. Selective Mutism- rare, child has social skills but selects not to talk to certain people (only family), situational (mute at events), times (afternoon wont speak) anxiety is controlled by the choice not to talk-coping mechanism to stay in homeostasis. Children only control what they eat, what they eliminate, sleep and when to speak.  Failure to talk in specific social situations  Estimate to occur in 0.5% of children  Average age of onset is 3-4 years  May be an extreme type of social phobia b.c often have social anxiety if mute, but there are differences between the two disorders. Social treatment effective- exposure Obsessive-Compulsive Disorder: DSM 4 and 5 small changes: OCD used to be under anxiety disorder now own category b.c research shows OCD has its own neurophysiological.  Recurrent, time-consuming, disturbing obsessions (persistent and intrusive thoughts, ideas, impulses, or images) and then leads to  compulsions (repetitive, purposeful, and intentional behaviors or mental acts) performed to relieve anxiety-action when obsessive thought is present. Maladaptive coping mechanism.  If children have this then involve family into their rituals ie.everyone flicking light three times. Problem with rituals is that compulsions don’t work long term. Short term relief but if compulsion come back then anxiety peaks. No long term relief, time consuming engaging in their rituals. Results in life disturbances, relations suffer, lose their job, health suffers, drops out of school.  Prevalence: rare 1-3%. Boys are twice as likely then girls b.c genetics so boys have a single copy.  Common with other anxiety disorders- depressive anxiety disorder. Loss of family, job  Lots of substance abuse, eating disorders, learning issues b.c cognitively to more capacity to learn. Motor and verbal tics-no control, genetic comorbidity. 9-12 years of age. Chronic two thirds continue to have OCD when diagnosed as children to adulthood. Panic  Panic attack: pressure cooker effect.  Sudden, overwhelming period of intense fear or discomfort accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response. common in adolescence and knows why, children do know cognitively. Its own diagnostic criteria but not quotable-not a diagnosis. puberty onsets-hormonal change. Posttraumatic and Acute Stress Disorder  Panic disorder (PD):  Recurrent unexpected panic attacks followed by at least one month of persistent concern about having another attack, constant worry about the consequences, or a significant change in behavior related to the attacks. Cant go out for embarrassment, anticipatory anxiety.  May lead to agoraphobia: fear of alone or avoiding places with other people. Want a significant other around them to help them.  Prevalence and Comorbidity- 3-4% in teenagers, panic disorder is 1%. Depression and anxiety comorbid. Suicide and substance abuse. Panic attacks easy to treat. Panic disorder is difficult to treat- low reemission rate.  Onset, course, and outcome- onset is stressful event doesn’t mean that maintains it. PTSD: Persistent anxiety following an overwhelming traumatic event that occurs outside the range of usual human experience. By dsm must have a traumatic event. Three core features of PTSD: persisting event and re-experiencing (sound), persisting avoidance (loud noises), numbing of general responsiveness (absent not being able to process around them), extreme 4 emotional arousal- panic attack. Consciously resurfacing the arousal become PTSD. Longer amount of time with more symptoms than acute stress disorder.  Acute stress disorder: Development of at least three dissociative symptoms within one month after a traumatic experience, lasting at least two days but not longer than a month. Mild version of PTSD. Prevalence and Comorbidity  Although at least 2/3 of children in U.S. experience at least one potentially traumatic event by age 16, most do not develop PTSD, except following several traumas or a history of anxiety. Rare development of PTSD. 3% for boys, 6% for girls. 75% comorbid for depression and substance abuse.  Prevalence of symptoms is greater in children who are exposed to life-threatening events  Onset- most trauma is abuse- 1 in4 children. Can be delayed for months or years after traumatic abuse.  Course- correlated to degree of exposure ie. How long, intense, extreme severe of the trauma. When in childhood it occurred- age of child. Younger they are, better off they are b.c cognitively not able to process event so seen more in adults. Persistent and lifelong if untreated leading to suicide.  Outcome- recovery- need strong social support and CBT. Associated Characteristics  Children with anxiety disorders display a number of associated characteristics  Cognitive disturbances  Physical symptoms  Social and emotional deficits  Anxiety and depression Cognitive Disturbances-when anxious, cognitive numbs, slower process, memory impaired, cant pay attention or make sentences.Academic achievement- drop out rates are high. : cognitive disturbances.  Disturbance in how information is perceived and processed  Intelligence and academic achievement: despite normal intelligence, deficits are seen in memory, attention, and speech or language.  Threat-related attentional biases.  Cognitive errors and biases: misread social situations. Ie.person walked away b.c not a good friend. See yourself as deficient to manage your anxiety. Say lose your emotions easily which fuels problems. Physical and Social Symptoms  Somatic complaints  90% have sleep-related problems, including nocturnal panic- abruptly wakening with panic, leads to insomnia, and nightmares. Cycle common for anxiety.  High rates of anxiety in adolescence are related to reduced accidents and accidental deaths in early adulthood. Don’t take risks but higher chance to die from non accidental- suicide, medical condition with high cortical.  Social and Emotional Deficits- low social performance, are viewed as maladjusted. Shy, withdrawn, low self esteem, loneliness and difficulty make friends. Anxiety and Depression  Social phobia, GAD, SAD, and multiple anxiety disorders (not specific phobia) are commonly associated with depression  Negative affectivity- persistent negative mood, nervous, high levels of sadness, anger, guilt  Positive affectivity- joy, enthusiasm and high energy experienced less- lower levels.  Physiological hyperarousal may be unique to anxious children- somatic tension, shortness of breath, dizzyness. 5  Gender, Ethnicity, and Culture: no difference in ethnicity and culture, effects all. Difference is treatment and perceive and understand is different. Ie/children in control. Theories and Causes  Early theories:  Classical psychoanalytic theory- buried experience from the past, use defensives (anxiety) to cope (block/avoid process). Teach new coping mechanisms that are functional and healthier so you don’t experience anxiety any longer.  Behavioral and learning theories- classical conditioning, have a learned experience, been exposed to a fear.Anxiety associated with that stimuli has been learned to be afraid. Long lasting due to the strength of anxiety. Learning theory: talking through to cope ie/child to parent. Temperament  Variations in behavioral reactions to novelty result in part from inherited differences in neurochemistry of brain structures  Amygdala, Projections of amygdala – responds the most with anxiety.  Behavioral inhibition (BI): children are often born with a low threshold for novelty and unexpected stimuli. They react more intensely. Parents should set firm limits, help reduce stress and help cope with difficulties. Parents are key to model emotion regulation.  Development of anxiety disorders in BI children depends on gender, exposure to early maternal stress, and parental response. Family and Genetic Risk  Family and twin studies suggest:  About 1/3 of the variance in childhood anxiety symptoms is genetic. No correlation to the type of anxiety. OCD much more heavily driven by genes. Part of temperament that controls shyness and inhibition is controlled by genetics.Adisposition to become anxious is inherited  Serotonin and dopamine systems are related to anxiety. Heavily regulated by your genes.  Genes are linked to broad anxiety-related traits (e.g., behavioral inhibition).Amygdala, left and right hemisphere is asymmetrical with anxiety and limbic system- Neurobiological Factors Family Factors  Parenting practices may be contributors to childhood anxiety disorders. Parents are controlling of the children, tendency to be over protective, being very involved. Let child be independent and feel confident. When parents model anxious behavior they produce anxious child. If parent is busy, there is less time for bonding, having fun, and less energy with all other practices they are engaged in.  Prolonged exposure to high doses of family dysfunction associated with extreme trajectories of anxious behavior. Ie/ parent has an addiction, anger management are directly associated with child’s anxiety. Lower parental expectations for children’s coping abilities  Low SES: more stress in family is related to anxiety. Parents not realizing that young children understand the stress, parents are dismissive of this.  Insecure early attachments (particularly ambivalent attachment) may be a nonspecific factor Treatment and Prevention  Overview:  Main line of attack for treating anxiety disorders is exposing children to anxiety producing situations, objects, and occasions. But parents protect child from what they are afraid of. In general when treating main technique is to make anxious- exposure.  Treatments for anxiety are directed at modifying:  Distorted information processing-exposure  Physiological reactions to perceived threat: teaching to control parts of the brain that make you anxious. 6  Sense of a lack of control: helping to manage not be in control ie/putting you in a situation with no control of time. Challenging distorted ways, recording physiology reactions.  Excessive escape and avoidance behaviors- block, like a roller coaster: reach peak (most anxiety) and come down. They avoid coming down, feel anxiety rising, use non-functional ways-panic attack, crying, clinging, avoiding in order to stop anxiety and will not know how to ever stop it so will become more anxious. So cannot cope and with same experience will be more anxious. Behavior Therapy  Main technique of behavior therapy is exposure to feared stimulus while providing children with ways of coping other than escape and avoidance  Graded exposure- opposite of flooding-rate from 1 to 10 your feared stimuli. ie/ordering a coffee.  Systematic desensitization- teach child to relax. Use breathing techniques, visual, muscle relaxation. Takes a long time- 7 to 8 sessions. Least anxiety provoking to most.As anxiety increases, coping mechanisms, once back in equilibrium increase anxiety again.  Flooding  Response prevention  Modeling and reinforced practice; in vivo exposure works best (real exposure, better stimulation for the brain)- going to a public place and watch how do others manage with anxiety. Cognitive-Behavior Therapy (CBT)- recreate functional cognitions to behave more functionally. 12-15 week program. How to desentize and relax.  The most effective procedure for treating most anxiety disorders  Teaches children: To understand how thinking contributes to anxiety. How to modify their maladaptive thoughts to decrease symptoms  Almost always used with exposure-based treatments  Coping Cat: emphasizes learning processes and the influence of contingencies and models, as well as role of information processing  Skills training and exposure combat problematic thinking  Computer-based, computer-assisted, and online CBT have also been shown to be effective Cognitive Distortions  All-or-nothing thinking: black and white world. Ie/if do bad on a test, then I am a failure. Very convinced of a thing  Overgeneralization- signal negative effect is a never ending pattern of defeat. One negative experience pollutes other events  Mental filter- dwell on it more excessively- filtering things through a single detail.  Disqualifying the positive-reject all positive insisting that they don’t count.  Jumping to conclusions – negative interpretation with no proof.  Mind reading – jumping to conclusions. Someone is reacting negatively to you without checking first.  The Fortune Teller Error- sub classifications- anticipating things will end badly and are convinced of it. Already established fact.  Magnification (catastrophizing) or minimization: common. Exaggerating the importance of things ie/I will never go to graduate school b.c of test  Emotional reasoning: negative emotions reflect the way things are. I feel it so it must be true. I feel rejected so it is the emotion I am experiencing. 7  Should statements: motivate yourself with should and shouldn’t- like y
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