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Chapter 6

Abnormal Psychology Chapter 6

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University of Guelph
PSYC 3390
Mary Manson

Chapter 6 12/1/2012 2:13:00 PM The Fear and Anxiety Response Patterns - Fear or panic is a bbasic emotion that involves activation of the fight or flight response of the sympathetic nervous system—fear is an almost instant reaction to an imminent threat, its adaptive value is that it allows us to escape from imminent danger - Fear and panic have three components like: cognitive and subjective; physiological; behavioural—these components are only loosely coupled - Anxiety is a complex blend of unpleasant emotions an cognitions that is both more oriented to the future and much more diffuse than fear Overview of the Anxiety Disorders and their Commonalities - There are seven primary types of anxiety disorders: phobic disorders, panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive compulsive disorder and posttraumatic stress disorder - The common genetic vulnerability is manifested at a psychological level by the personality trait called neuroticism—a proneness to experience negative mood states, this involves the limbic system in the brain (emotional part) and th eneurotramisster substances that are involves are GABAm norepinephrine and serotonin - A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of these feared situations: there are specific phobias, social phobias and agoraphobias Specific Phobias - Showing strong and persistent fear that is excessive or unreasonable and is triggered by the presence of a specific object or situation—individuals often show an immediate fear response that often resembles a panic attack - DSM-IV-TR: criteria for specific phobia: marked or persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation/exposure to phobic stimulus almost invariably provokes an immediate anxiety response or panic attack/person recognizes that the fear is excessive or unreasonable/phobic situation avoided or endured with intense anxiety or distress/symptoms interfere significantly with normal functioning, or there is marked distress about the phobia/duration of at least six months - Blood-injection-injury phobia occurs in 3 to 4 percent of the population— people typically experience as much disgust as fear and show a unique physiological response when confronted with the sight of blood or injury by showing an initial acceleration followed by a dramatic stop in both heart rate and blood pressure accompanied by nausea, dizziness and fainting - This could have a specific purpose: by fainting, the person being attacked might inhibit further attack and if an attack did occur, the drop in blood pressure would minimalize blood lose - 12% of people have a specific phobia and among these people, over 75% have at least one other specific fear that is excessive - most phobias are more common in women than men - 90 to 95% of people with animal phobias are women, but the gender ratio is less than 2:1 for blood-injury phobia - animal phobias usually begin in childhood as do blood-injection-injury phobias and dental phobias - claustrophobias and driving phobias tend to begin in adolescence and early adulthood - 58% cited traumatic conditioning experiences as the sources of their phobias, some of these traumatic conditioning events were simply uncued panic attacks, which are now known to effectively condition fear which is the most common cause of claustrophobia, accident phobia and dental phobia - escapability and controllability determine whether fear will be conditioned in a traumatic event - the inflation effect suggests that a person who acquired a mild fear of driving following a minor crash might be expected to develop a full-blown phobia if they were later physically assaulted, even if no vehicle was present during the assault - there is a preparedness for certain phobias because over the course of evolution those primates and humans who rapidly acquired fears of certain objects or situations that posed real threats to our early ancestors may have enjoyed a selective advantage - fear is conditioned more effectively to fear-relevant stimuli than to fear- irrelevant stimuli; subliminal activation of responses to phobic stimuli may help to account for certain aspects of the irrationality of phobias— people with phobias may not be able to control their fear because the fear may arise from cognitive structures that are not under conscious control - genetic and temperamental variables affect the speed and strength of conditioning of fear - 32% of inhibited children were to develop multiple specific phobias as opposed to 5% of uninhibited children-and 3 to 4 percent for the control group in the experiment - exposure therapy is the best treatment for specific phobias and involves controlled exposure to the stimuli or situations that elict phobic fear - participant modeling is often more effective than exposure alone - virtual reality environments simulate certain kinds of phobic situations like heights and airplanes, as places to conduct exposure treatment - medications are not beneficial in themselves and some evidence proves that anti anxiety medications may interfere with the beneficial effects of exposure therapy - D-cycloserine is known to facilitate extinction of conditioned fear in animals and may also enhance the effectiveness of small amounts of exposure therapy for fear of heights in a virtual reality environment Social Phobia - Disabiling fears of one or more specific social situations—a person fears that they may be exposed to the scrutiny and potential negative evaluation of others and that they may act in an embarrassing manner, public speaking is the most common manifestation and there is also generalized social phobia which involves significant fears of most social situations and often also have a diagnosis of avoidant personality disorder, about 12% of the population will qualify for a diagnosis at some point in their lives and in Canada, 3-7% report symptoms in a given year - 60% of people with the disorder are women - dSM-IV-TR criteria: marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny of others/exposure to feared social situation almost invariably provokes anxiety or panic/person recognizes that the fear is excessive or unreasonable/feared social or performance situation avoided or endured with great distress or anxiety/symptoms interfere significantly with persons normal routine or occupational or social functioning - social phobias typically begin in adolescence or early adulthood and 50% rd suffer from a depressive disorder at the same time, 1/3 abuse alcohol to reduce their anxiety and in more than 80% of cases where social phobia and alcohol abuse occur in the same person, the phobia had begun first - 56 to 58% of people with social phobia recalled and identified direct traumatic experiences as having been involved in the origin of their social phobias, 92% of an adult sample of people with social phobia reported a history of severe teasing in childhood, compared to only 35% of people with obsessive-complusive disorder - 96% of people remembered some socially traumatic experience that was linked to their own current image of themselves in socially phobic situations - people with generalized social phobia also may be especially likely to have grown up with parents who were socially isolated and avoidant and who devalued sociability, therefore providing ample opportunity for vicarious learning of social fears - humans have an evolutionary based predisposition to acquire fears of social stimuli that signal dominance and aggression from other humans— these social stimuli include facial expressions of anger or contempt, which on average all humans seem to process more quickly and readily than happy or neutral facial expressions - peple develop stronger conditioned responses when slides of angry faces are paired with mild electric shocks than when happy or neutral faces are paired with the same shocks, and even brief subliminal presentations of the angry face were sufficient to activate the conditioned responses - genetics and environmental factors contribute about equally to the development of social anxiety traits - children who reported that they had been behaviourally inhibited were four times more likely to develop social phobia in adolescence than were teens who were inhibited in childhood - several categories of antidepressants can be used to treat social phobias including selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors - medications are generally comparable to cognitive-behavioural treatments and the combinations of the two work just as well atleast in the short term but not long term Panic Disorder with and without Agoraphobia - occurrence of unexpected panic attacks that come out of the blue—person must have experienced recurrent unexpected attacks and must have been persistently concerned about having another attack, worried about the consequences of having an attack, or must have changed his or her behaviour because of the attacks for atleast a month - there must be an abrupt onset of at least 4 of 13 symptoms: most of the symptoms are physical, although three are cognitive: depersonalization or derealization, fear of dying, or fear of going crazy or losing control - panic attacks are brief and intense with symptoms developing abruptly and usually reaching peak intensity within 10 minutes; the attacks usually subside in 20 to 30 minutes and rarely last more than an hour—periods of anxiety do not usually have such an abrupt onset and are more long lasting - panic attacks that occur in panic disorder are often unexpected or uncued in the sense that they do not appear to be provoked by identifiable aspects of the immediate situation—they sometimes occur in situations where they might be least expected, like during relaxation or during sleep (nocturnal panic) - DSM-IV-TR: recurrent and unexpected panic attacks/atleast one of the attacks followed by 1+ month of concern of having another, worrying about consequences and significant change in behaviour/absence of agoraphobia/panic attack not due to physiological effects of a substance or medical condition/panic attacks not better explained by another mental disorder like social or specific phobia - 85% of people having a panic attack may show up repeatedly at emergency rooms or physicians offices for what they think is a medical problem - a single session of psychological treatment can prevent the worsening of panic attacks and the development of panic disorder among individuals presenting to the emergency room following a panic attack - criteria for panic attack: palpitations or pounding heart/sweating/trembling or shaking/sensations of shortness of breath or being smothered/feeling of choking/chest pain or discomfort/nausea or abdominal distress/feeling dizzy or faint/derealization or depersonalization/fear o
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