PSYC 412 Chapter 11: Chapter 11
29 Dec 2016
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# obsessive#compulsive!disorder! (ocd)!is!a!closely!related!to!disorder!that!was!considered!to!be!one!of!the!anxiety! disorders!in!previous!versions!of!the!diagnostic!and!statistical!manual!of!mental!disorders! (dsm): ocd!is!now!included!in!a!separate!chapter!of!the!dsm#5,!related!to!other!disorders!such!as!hoarding,!hair#pulling,! skin#picking,!and!body!dysmorphic!disorder! (perceived!defects!or!flaws!in!physical!appearance)! These!disorders!occur!in!many!forms:: some!children!feel!anxious!when!they!are!separated!from!their!mother!or!away!from!home, others!feel!anxious!only!in!certain!situations,!such!as!travelling!by!airplane!or!when!they!have!to!give!a!talk!in! class, some!have!unpredictable!bouts!of!sudden!and!intense!anxiety!that!they!become!terrified!and!immobilized, some!worry!about!almost!everything!and!feel!anxious!most!of!the!time!for!no!apparent!reason, some!experience!repeated,!intrusive,!unwanted!thoughts!that!produce!anxiety,!and!spend!hours!in!ritualized! behaviour!in!an!effort!to!alleviate!anxiety! # activation!of!this!system!produces!many!important!chemical!and!physical!effects!that!mobilize!the!body!for!action:: chemical!effects:!adrenaline!and!noradrenaline!are!released!from!the!adrenal!glands, cardiovascular!effects:!heart!rate!and!strength!of!the!heart!beat!increase,!readying!the!body!for!action!by! speeding!up!blood!flow!and!improving!delivery!of!oxygen!to!the!tissues, respiratory!effects:!speed!and!depth!of!breathing!increase,!which!brings!oxygen!to!the!tissues!and!removes! waste! # normal!ritualistic!behaviours!in!young!children!include:: preferences!for!sameness!in!environment!(e. g. !watching!same!movie!over!and!over!again), rigid!likes!and!dislikes, preference!for!symmetry!(e. g. !carrying!a!toy!in!each!hand), awareness!of!minute!details!or!imperfections!in!toys!or!clothes!(e. g. !being!bothered!by!a!miniscule!thread!on!a! jacket!sleeve), arranging!things!so!they!are! just!right !(e. g. !insisting!that!different!foods!not!touch!each!other!on!a!plate)! 5: most!children!who!refuse!to!go!to!school!have!normal!intelligence,!suggesting!that!it!is!not!a!difficulty!with! academics!that!leads!to!this!problem, a!fear!of!school!may!be!associated!with!submitting!to!authority!and!rules!outside!the!home!for!the!first!time, being!compared!with!unfamiliar!children, experiencing!the!threat!of!failure, may!be!afraid!of!being!ridiculed,!teased,!or!bullied!by!other!children, being!criticized!or!disciplined!by!their!teachers, child"s!fear!may!result!from!an!excessive!or!irrational!fear!of!being!socially!evaluated!or!embarrassed!when! public!speaking!or!changing!for!gym!class! Soc!encompasses!a!variety!of!social!fears,!including!fear!of!performance!situations!(e. g. !speaking!in!front!of!others)!and! fear!of!interaction!situations!(e. g. !talking!to!others!at!a!party): some!research!has!suggested!that!performance#!and!interaction#related!social!fears!may!differ!from!one!another! in!their!risk!factors!and!clinical!characteristics, thus!identifying!children!with!soc!who!differ!in!their!types!of!social!fears!may!help!to!further!our!understanding! of!this!disorder, to!this!end,!dsm#5!provides!a! performance!only !specifier,!to!identify!youngsters!with!soc!whose!anxiety!is! restricted!to!performance!situations! # a!panic)attack!is!a!sudden!overwhelming!period!of!intense!fear!or!discomfort!that!is!accompanied!by!4!or!more!physical! and!cognitive!symptoms!characteristic!of!the!fight/flight!response: a!panic!attack!is!usually!short,!with!symptoms!reaching!max!intensity!in!10!mins!or!less,!and!then!diminishing! over!the!next!30!mins!or!so, panic!attacks!are!accompanied!by!an!overwhelming!sense!of!imminent!danger!or!impending!doom,!and!by!an! urge!to!escape, panic!attacks!are!not!physically!harmful!or!dangerous! It!is!unclear!why!the!physical!symptoms!of!fight/flight!response!occur!if!an!adolescent!is!not!initially!frightened: one!possibility!is!that!things!other!than!fear!can!produce!these!symptoms,!e. g. !youngster!may!be!distressed,! causing!an!increase!in!the!production!of!adrenaline!and!other!chemicals!that!produce!panic!symptoms, another!possibility!is!that!the!youngster!may!breathe!a!bit!too!fast! (subtle!hyperventilation),!which!can!also! produce!these!symptoms, a!third!possibility!is!that!some!youngsters!are!experiencing!normal!body!changes,!but!notice!these!sensations!far! more!readily! 16: attachment!behaviours!(e. g. !crying,!fear!of!strangers,!and!distress)!represent!active!efforts!by!the!infant!to! maintain!proximity!to!the!caregiver, separation!gradually!becomes!more!tolerable!as!the!child!gets!older, however,!children!who!are!separated!from!their!mothers!too!early,!treated!harshly,!or!fail!to!have!their!needs! met!consistently!show!atypical!reactions!to!separation, early!insecure!attachments!become!internalized!and!that!could!cause!children!to!view!the!world!as! undependable,!unavailable,!hostile,!or!threatening,!and!may!later!develop!into!anxiety!and!avoidance!behaviour! The!parts!of!the!brain!most!often!connected!with!anxiety!involve!neural!circuits!related!to!potential!threat!and!fear! conditioning,!such!as!the!following:: the!hypothalamic#pituitary#adrenal!(hpa)!axis, the!limbic!system,!i. e. !amygdala,!hippocampus! (acts!as!a!mediator!between!the!brainstem!and!the!cortex), the!ventrolateral!and!dorsolateral!prefrontal!cortex, other!cortical!and!subcortical!structures! 18: teens!rely!more!on!areas!of!the!brain!involved!in!basic!fear!responses! (hippocampus,!right!amygdala)!than!on! areas!involved!in!more!reasoned!judgment!about!what!is!safe!or!not! (prefrontal!cortex), this!may!be!one!reason!why!teens!generally!report!more!pervasive!worries!and!are!more!vulnerable!to!stress! related!problems! # brain!scans!of!children!with!gad!suggest!abnormalities!(e. g. !larger!volume)!in!brain!regions!and!circuits!associated!with! social#emotional!information!processing!and!fear!conditioning!(e. g. !amygdala!and!superior!temporal!gyrus): these!studies!also!report!more!pronounced!right#left!hemisphere!brain!asymmetries!in!children!with!gad,! which!have!also!been!reported!in!children!who!are!behaviourally!inhibited!or!anxious/depressed! 21: flooding!is!typically!used!in!combination!with!response)prevention,!which!prevents!the!child!from!engaging!in! escape!or!avoidance!behaviours, more!than!other!approaches,!flooding!may!create!distress,!especially!during!early!stages!of!treatment, this!procedure!must!be!used!carefully,!especially!with!young!children!who!may!no!understand!the!rationale, more!recently,!modified!flooding!procedures!have!been!used!in!controlled!settings!to!effectively!treat!a!variety!of! specific!phobias, for!example,!one@session+treatment! (ost)!begins!with!pre#session!meetings!with!the!child!and!family!to!build! rapport!and!provide!information!about!anxiety!and!therapy, this!is!followed!by!a!2. 5#3!hour!long,!single#session!of!massed!exposure!therapy!that,!in!addition!to!exposure,! uses!a!variety!of!cbt!techniques!(e. g. !reinforcement,!participant!modeling,!etc, this!approach!has!shown!promising!results!but!requires!further!evaluation!with!children!in!clinical!practice! settings! # one!of!the!most!effective!procedures!for!treating!specific!phobias!involves!participant+modeling+and+reinforced+practice: using!this!procedure,!the!therapist!models!the!desired!behaviour!(e. g. !approaching!a!feared!object),!encourages! and!guides!the!child!in!practicing!this!behaviour,!and!reinforces!the!child"s!efforts, although!all!exposure!procedures!are!effective,!real#life,!or!in!vivo!exposure,!works!best! !but!it!is!not!always! easy!to!implement, once!the!child!faces!her!fear!in!a!real#life!situation!with!no!adverse!consequences,!she!is!more!confident!about! doing!it!again! Gad,!sad,!and!soc: a!teen!version!is!also!available, this!approach!emphasizes!learning!processes!and!the!influence!of!contingencies!and!models,!as!well!as!the! pivotal!role!of!information!processing, treatment!is!directed!at!decreasing!negative!thinking,!increasing!active!problem!solving,!and!providing!the!child! with!a!functional!coping!outlook, the!intervention!creates!behavioural!experiences!with!emotional!involvement,!while!simultaneously!addressing! thought!processes! Children!first!learn!to!use!the!following!4!steps!of!a! fear !plan:: f!=!feeling!frightened?! (recognizing!physical!anxiety!symptoms), e!=!expecting!bad!things!to!happen?! (recognizing!anxious!cognitions), a!=!attitudes!and!actions!that!will!help! (coping!self#talk!and!behaviour!to!use!when!anxious), r!=!results!and!rewards! (evaluating!performance!and!administering!self#reward!for!effort)! 22: to!enhance!the!skills!learned!in!therapy,!they!must!practice!using!them!in!anxiety#producing!situations!at!home! and!school, controlled!evaluations!of!this!approach!have!found!it!t!be!extremely!effective, most!children!show!reductions!in!anxiety,!with!71%!of!children!freed!of!their!primary!diagnosis!at!the!end!of! treatment!and!54%!not!meeting!the!criteria!for!any!anxiety!disorder, for!many!children,!these!gains!have!been!maintained!for!7#19!years!after!treatment, compared!to!children!who!were!responsive!to!initial!treatment,!those!who!were!not!responsive!had!higher!rates! of!panic!disorder,!alcohol!dependence,!and!drug!abuse!as!adults!
