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Chapter 7

chap7,9 (supplementary readings)

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CHAPTER 7& 9 CH 7 • Anxiety – a state of fear and apprehension that affects many areas of functioning. Involves 3 basic components:  Subjective reports of tension, apprehension, dread and expectations of inability to cope.  Behavioral responses such as avoidance of the feared situation, impaired speech and motor functioning, and impaired performance on complex cognitive tasks.  Physiological responses including muscle tension, increased heart rate and blood pressure, rapid breathing, dry mouth, nausea, diarrhea, and dizziness. • Anxiety is experienced in 3 basic patterns: A) Panic disorder [generalized anxiety disorder], B) Phobias, C) Obsessive-Compulsive disorder. • Anxiety Disorders – characterized either by manifest anxiety or by behavior patterns aimed at warding off anxiety. • Panic Disorder – anxiety begins suddenly and unexpectedly and soon mounts to an almost unbearable level. Derealization – world seems unreal. Depersonalization – people seem unreal to themselves. A person has panic disorder when he or she has had recurrent unexpected panic attacks, followed by psychological or behavioral problems, such as persistent fear of future attacks.  2 kinds: A) Unexpected (uncued) – attack seems to come out of the blue. B) Situationally Bound (cued)–attack occurs in response to some situational trigger Agoraphobia – fear of the marketplace. Fear of being in any situation from which escape might be difficult. General Anxiety Disorder – main feature is a chronic state of diffuse anxiety. Excessive worry, over a period of at least six months, about several life circumstances. (Usually over family, money, work and health). The ‘resting state’ of panic disorder. 3 major differences between: 1) Their symptom profiles differ. 2) GAD usually has a more gradual onset and a more chronic course than PD. 3) When these disorders run in the family, they tend to run separately. Phobias – involves 2 factors: A) an intense and persistent fear of some object or situation which, as the person realizes, actually poses no real threat. B) avoidance of the phobic stimulus. 1) Specific Phobia – fairly common. Ex: Acrophobia-fear of heights; Claustrophobia-fear of enclosed places; phobias of body injury; and animal phobias (most common). 2) Social Phobia – avoid performing certain actions in front of other people, for fear of embarrassing or humiliating themselves. Ex: public speaking, eating in public, and using public bathrooms. Obsessive-Compulsive Disorder - people suffering from either obsession or compulsion (and usually, both).  Obsession – thought or image that keeps intruding into a person’s consciousness; the person finds the thought inappropriate and distressing and tries to suppress it, but it still returns.  Compulsion – an action that a person feels compelled to repeat again and again, in a stereotyped fashion, though he or she has no conscious desire to do so. Tend to 1 have more natural content. 2 main categories: A) Cleaning Rituals – usually involve responses to obsessions about harm to loved ones; B) Checking Rituals – often accompany obsessions about contamination.  Trichotillomania – the compulsive pulling out of one’s own hair. • Posttraumatic Stress Disorder – a severe psychological reaction, lasting at least one month, to intensely traumatic events – events involving actual or threatened death or serious injury to oneself or others. The person may go on for weeks, months, or years re-experiencing the traumatic event, either in painful recollection or in nightmares. The disorder depends on the relationship with the trauma (how close to death, etc), psychological background, and the nature of the trauma (rape vs. earthquake).  Disaster Syndrome – victims of physical trauma show a definite pattern of response known as DS. In the first phase, shock stage, they are stunned and dazed. In the second stage, suggestibility stage, they become more passive and are willing to take orders from almost anyone. The final stage, recovery stage, they begin to pull themselves together and to approach their situation in a more rational way.  Problems with PST diagnosis: First, currently, non-life threatening events (such as a miscarriage or discovering a spouse’s affair) are classified as adjustment disorder, when they could actually be classified as PSD. Second, is whether it should be grouped with the anxiety disorders. • Neurosis – anxiety disorders. Freud argued that anxiety stemmed not just from external threats but also from internal ones, in the form of id impulses attempting to break through into consciousness. To psychodynamic theorists, the anxiety disorders really differ only in the choice of defense. The nature of the disorder points to the defense, and the nature of the defense points to the underlying conflict. Use free association and dream interpretation to treat neurosis. Humanistic-Existential Perspective – conceptualizes anxiety not simply as an individual problem but as the predictable outcome of conflicts between the individual and society. The seat of anxiety is the self-concept. Neurotics are simply people who are not as successful as others in being inauthentic. Client-Centered Therapy. Paradoxical Intention – patients are told to indulge their symptoms, even exaggerate them. Behavioral Perspective – anxiety arises from faulty learning. We are endangered through avoidance learning. Problems with the avoidance learning theory: 1) Many features of the anxiety disorders are simply not explainable by the theory. 2) Traditional learning theory is hard put to explain why only very select, nonrandom types of stimuli typically become phobic objects. 3) It focuses entirely on concrete stimuli and observable responses without concern for the thoughts that may be involved in anxiety. • Efficacy expectations – people’s expectations based on past performance, as to how well they will be able to cope with the situation. • Fear-of-Fear – physiological changes that accompany the panic attack, become conditioned stimuli for further panic attacks. • Systematic Desensitization – patients draw up a “hierarchy of fears”, a list of increasing anxiety-arousing situations culminating n the situation they most fear. Then they are to relax, and imagine the situations. • In Vivo Desensitization – leading patients through their hierarchies in real life. Dog phobic person will first look at pictures of dogs, then hold a dog collar, etc. Cognitive Perspective – people with anxiety disorders misperceive or misinterpret internal and external stimuli. Evens and sensations that are not really threatening are interpreted at 2 threatening, and anxiety results. Cognitive therapy aims at helpings the patient to interpret bodily sensations in a non-catastrophic way. Biological Perspective – seeks genetic and biochemical links to anxiety. Some anxiety disorders, especially panic disorder, appear to have a genetic component. Recent evidence also suggests that brain chemistry and neurotransmitters influence some forms of anxiety. CH 9 • General Adaptation Syndrome – divides the body’s reaction in to 3 successive stages described by Hans Seyle.  Alarm and Mobilization – a state of rapid, general arousal in which the body’s defenses are mobilized.  Resistance – the state of optimal biological adaptation
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