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Chapters 5 and 8

anxiety

apprehension over an anticipated problem

fear

reaction to immediate danger

anxiety disorders

disorders in which fear or tension is overriding and the primary disturbance; include phobic disorders, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, acute stress disorder, and post traumatic stress disorder

phobia

disruptive fear of a particular object or situation that is out of proportion to any danger posed

specific phobia

unwarranted fear caused by the presence of a specific object or situation

panic disorder

characterized by frequent panic attacks that are unrelated to specific situation and by worry about having more panic attacks

panic attacks

sudden attack of intense apprehension, terror, and feelings of impending doom, accompanied by at least four other symptoms (i.e. labored breathing, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, lightheadedness, seating, chills, hot flashes, and trembling)

depersonalization

feeling of being outside ones body during a panic attack

derealization

feeling of the worlds not being real during a panic attack

agoraphobia

defined by anxiety about situations in which it would be embarrassing or difficult to escape if panic symptoms occurred; fear and avoidance of places where they might feel unsafe

generalized anxiety disorder

disorder characterized by anxiety so chronic, persistent, and pervasive that it seems free-floating. individual is jittery and strained, distractible, and worried that something bad is about to happen. pounding heart, fast pulse and breathing, sweating, flushing, muscle aches, a lump in the throat, and an upset gastrointestinal tract are some of the bodily indications.

obsessive compulsive disorder

characterized by persistent and uncontrollable thoughts or urges and by the need to repeat certain acts again and again

obsessions

intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable

compulsions

repetitive clearly excessive behaviors or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occuring

posttraumatic stress disorder

entails an extreme response to a severe stressor, including increased anxiety, avoidance of stimuli associated with the trauma and a general numbing of emotional responses

acute stress disorder

short lived anxiety reaction to a traumatic event; if it lasts more than a month, it is diagnosed as post traumatic stress disorder

subthreshold symptoms

symptoms that do not meet full diagnostic criteria

fear circuit

set of brain structures, including the amygdala, that tend to be activated when the individual is feeling anxious or fearful; especially active amount people with anxiety disorders

neuroticism

personality trait defined by the tendency to react to events with greater than average negative affect

behavioral inhibition

tendency to become agitated and cry when faced with novel toys, people, or other stimuli

safety behaviors

behaviors used to avoid experiencing anxiety in feared situations, such as the tendency of people with social phobia to avoid looking at other people (so as to avoid perceiving negative feedback) or the tendency of people to with panic disorder to avoid exercise (so as to avoid somatic arousal that could trigger a panic attack)

Mowrer's two-factor model

theory of avoidance learning according to which (1) fear is attached to a neutral stimulus by pairing it with a noxious unconditioned stimulus, and (2) a person learns to escape the fear elicited by the conditioned stimulus, thereby avoiding the UCS

prepared learning

our fear circuit may have been "prepared" by evolution to learn fear of certain stimuli

locus ceruleus

the brain region in the fear circuit that is especially important in panic disorder; the major source in the brain of norepinephrine, which helps trigger sympathetic nervous system activity

interoceptive conditioning

classical conditioning of panic attacks in response to internal bodily sensations of arousal (as opposed to the external situations that trigger anxiety)

Anxiety Sensitivity Index

measures the extend to which people resound fearfully to their bodily sensations

fear-of-fear hypothesis

suggests that agoraphobia is driven by negative thoughts about the consequences of having a panic attack in public

orbitofrontal cortex

portion of the frontal lobe located just above the eyes; one of three closely related brain regions that are unusually active in individuals with obsessive-compulsive disorder

anterior cingulate

in the subcortical region of the brain, the anterior portion of the cingulate gyrus, stretching about the corpus callosum

thought suppression

key feature of obsessive-compulsive disorder; has the paradoxical effect of inducing preoccupation with the object of thought

dissociation

process by whereby a group of mental processes is split off from the main stream of consciousness, or behavior loses its relationship with the rest of the personality

panic control therapy

cognitive behavior treatment, based on the tendency of individuals with panic disorder to overreact to bodily stimuli, in which sensations are induced physically and coped with under safe conditions

exposure and response prevention

the most widely used and accepted treatment of obsessive compulsive disorder in which the sufferer is prevented from engaging in compulsive ritual activity and instead faces the anxiety provoked by the stimulus, leading eventually to extinction of the conditioned response (anxiety)

imaginal exposure

treatment that involved visualizing trauma related scenes for extended periods of time

anxiolytics

minor tranquilizers benzodiazepines used to treat anxiety disorders

benzodiazepines

any of several drugs commonly used to treat anxiety, such as Valium and Xanax

antidepressants

any drug that alleviates depression; also widely used to treat anxiety disorders

tricyclic antidepressants

group of antidepressants with molecular structures characterized by three fused rings; interfere with the reuptake of norepinephrine and serotonin

selective serotonin reuptake inhibitors

any of various drugs that inhibit the presynaptic reuptake of the neurotransmitter serotonin, thereby prolonging its effects on postsynaptic neurons

beta blockers

any of numerous beta-adrenergic antagonists, competitive inhibitors of a class of receptors for the hormone adrenaline; are approved as cardiovascular drugs but often used to treat social phobia, despite a lack of demonstrated efficacy

mood disorders

disorders, such as depressive disorders or mania, in which there are dialing disturbances in mood

major depressive disorders

symptoms must be present for at least 2 weeks, symptoms include depressed mood or loss of interest and pleasure, plus changes in sleep, appetite, concentration or decision-making, feelings of worthlessness, suicidality, or psychomotor agitation or retardation

episodic disorder

symptoms tend to be present for a period of time and then clear

dysthymic disorder

chronically depressed - more than half of the time for at least two years, they feel blue or derive little pleasure from usual activities and pastimes

mania

state of intense elation or irritability accompanied by other symptoms shown in the diagnostic criteria

flight of ideas

symptom of mania that involves a rapid shift in conversation from one subject to another with only superficial associative connections

mixed episodes

severe symptoms of both mania and depression within the same week

hypomania

less extreme than mania; change in functioning that does not cause serious problems

bipolar I disorder

single episode of mania or a single mixed episode during the course of a person's life

bipolar II disorder

person must have experienced one major depressive episode and at least one episode of hypomania

cyclpthymic disorder

requires symptoms be present for at least two years; frequent but mild symptoms of depression, alternating with mild symptoms of mania

seasonal

episodes happen regularly at a particular time of the year

rapid cycling

person has experienced at least four episodes within the past year

psychotic features

delusions or hallucinations

catatonic features

extreme immobility or excessive peculiar physical movement

postpartum onset

onset within 4 weeks postpartum

melancholic

no pleasure in any activity, does not feel better even temporarily when good things happen, and also experiences at least three other symptoms of depression

tryptophan

amino acid that is the major precursor of serotonin, experimental depletion has found that a lowered serotonin level causes temporary depressive symptoms in people with a personal or family history of depression.

second messengers

adjust postsynaptic receptor sensitivity

g-proteins

play an important role in modulating activity in the postsynaptic cell

reward system

system of brain structures involved in motivation to pursue rewards. believed to be involved in depression, mania, schizophrenia, and substance abuse

cortisol

main stress hormone

Cushing's syndrome

causes over secretion of cortisol, frequently experiences depressive symptoms

expressed emotion

family member's critical or hostile comments toward or emotional over involvement with the person with depression

negative affect

distress and worry

positive affect

happiness and contentment

somatic arousal

sweaty palms, fast heart rate, etc.

extraversion

personality trait associated with frequent experiences of positive affect

negative triad

negative views of the self, the world, and the future

schemata

mental structure for organizing information about the world

cognitive biases

tendencies to process information in certain negative ways

learned helplessness theory

theory of depression etiology that individuals, through unpleasant experiences and traumas against which their efforts were ineffective, acquire passivity and a sense of being unable to act and to control their lives

attributions

explanations a person forms about why a stressor has occurred 3 dimensions - 1. internal (personal) vs. external (environmental) causes 2. stable versus unstable causes 3. global vs. specific causes

attributional style

person's relatively consistent approach to attribution, for example, the consistent attribution of negative life events to internal, stable, and global causes is thought to dispose to depression

hopelessness theory

cognitive theory of depression that began with learned helplessness theory, was modified to incorporate attributions, and has been modified again to emphasize hopelessness - an expectation that desirable outcomes will not occur and that no available responses can change the situation

interpersonal psychotherapy

short term, here and now focused psychological treatment initially developed for depression and influenced by the psychodynamic emphasis on relationships

cognitive therapy

any behavior therapy procedure that attempts to alter the manner in chick a client thinks about life so that he or she changes overt behavior and emotions

mindfulness based cognitive therapy

focuses on relapse prevention after successful treatment for recurrent episodes of major depression

behavioral activation

people are given activity assignments to provide them with successful experiences and to allow them to think well of themselves

behavioral couples therapy

researcher work with both members of a couple to improve communication and relationship satisfaction

psychoeducational approaches

help people learn about the symptoms of the disorder, the expected time course of symptoms, the biological and psychological triggers for symptoms, and treatment strategies

family-focused treatment

aims to educate the family about the illness, enhance family communication, and develop problem solving skills

electroconvulsive therapy

deliberately inducing a momentary seizure and unconsciousness by passing a 70-130 volt current through the patients brain

egoistic suicide

committed by people who have few ties to family, society, or community

altruistic suicide

committed because the person believes it will be for the good of society

anomic suicide

triggered by a sudden change in a person's relation to society (serious economic and cultural changes)

situationally bound panic attacks

occur in situations you are aware of and only those situations (w/specific phobias or social phobias)

unexpected (uncued) panic attacks

no clue when an attack will come on, associated with panic disorder

situationally predisposed panic attacks

more likely to have a panic attack in a situation when you've had one before, not guaranteed you will, also under panic disorder

polygenic

many genes contribute

increase anxiety

decrease GABA functioning in relation to anxiety

increase panic attacks

high levels of NE in relation to panic attacks

Behavioral inhibition system

activated by signals descending from cortex or ascending from brainstem ( brainstem - amygdala - mPFC (medial prefrontal cortex) )

behavioral inhibition

tendecy to become agitated and cry in novel settings

external cues provoking fear response

similar places or situaitons

internal cues provoking fear response

increases in HR and respiration associated with initial attack (even if due to normal events)

unconscious cues provoking fear response

cues/triggers may travel from eyes directly to amygdala

cognitive risk factors for anxiety

percieved control (history of childhood trauma or punitive parenting), inadequate coping strategies, attention to threat tendency to notice negative environmental cues

social risk factors for anxiety

negative life events - negative cognition can be a consequence, response to stressors runs in families

triple vulnerability threat

biological vulnerability, generalized psychological vulnerability, specific psychological vulnerability

etiology of GAD

GABA system deficits, do not respond as strongly to stressors as people w prominent panic do, autonomic restrictors (less physiological responsiveness, chronically tense muscle tension)

cognitive factors of GAD

less able to identify their own neg feelings, allocate attention to sources of threat more readily, borkovec's cognitive model

Borkovec's Cognitive model

worry negatively reinforcing (removes neg thought processes), allows avoidance of more disturbing emotions, avoidance prevents extinctionh

typical places avoided by agoraphobics

shopping malls, subways, wide streets, tunnels, restaurants, theaters, elevators, being far from home, staying home alone, supermarkets/stores, crowds, planes, escalators

interoceptive avoidance

avoidance of internal physical sensations i.e. running, aerobics, dancing, hiking, drinking caffeinated beverages, etc.

etiology of panic disorder (neurobiological )

locus ceruleus- increase activity produces more norepinephrine causing more anxiety (only those susceptible to panic attacks)

etiology of panic disorder (conditioning)

interoceptive conditioning - classical condition of panic in response to bodily sensations (external and internal cues present for initial attack)

etiology of panic disorder (cognitive)

develop anxiety over possibility of another panic attack, tendency to misinterpret somatic symptoms triggers panic attack

etiology of specific phobias

direct experience - true alarm, experiencing a false alarm (panic attack), being told about danger (info transmission)

etiology of specific phobias (social factors)

more likely to see in females because they are more lily to say they fear something than males because of societies views

problems with mower's two factor model

many people never experience aversive interaction with phobic object, people w phobias tend to fear only certain types of objects (prepared learning), even phobias linked to modeling influenced by prepared learning

etiology of social phobia (cognitive factors)

negative self evaluation - high standards, fear of negative evaluation by others, excessive attention/monitoring internal cues

social phobial 3 possible pathways

1. inherited tendency to be socially inhibited combined with generalized and specific psychological vulnerabilities 2. conditioned through a panic attack 3. real social trauma (true alarm) 92% of adults experience teasing as a child

etiology of OCD (neurobiological)

hyperactive regions of the brain - orbitofrontal cortex, caudate nucleus, anterior cingulate

etiology of OCD (cognitive/behavioral)

operant reinforcement (engage in behaviors take away anxiety), lack of satiety signal, attempts to suppress intrusive thoughts (the more likely you are to do it)

etiology of PTSD

severity and type of trauma, smaller hippocampal volume, increased sensitivity to cortisol, higher levels of CRF, two factor model, perception of control, avoidance coping, dissociation

exposure

face the situation or object that triggers anxiety (face your fears) w/ as many triggers and settings as possible

systematic desensitization

relaxation plus imaginal exposure (70-90% effective), spontaneous recovery possible

cognitive behavioral therapy

increase patients awareness of thoughts due to interoceptive conditioning

panic control therapy

exposure to somatic sensations associated with panic attack in a safe setting, use of coping strategies to control symptoms

panic disorder meds

SSRI's, Xanax (benzodiazapines), relapse high if discontinued

social anxiety meds

beta blockers, tricyclics and MAO inhibitors (last resort because of side effects), SSRIs

Clarks cognitive therapy

learn not to focus attention internally, address beliefs of how others will respond (social phobia treatment)

psych treatment of GAD

meditational approaches to teach patients to be more accepting of their distressing thoughts, relaxation training - promote calmness

cognitive behavioral methods GAD

challence and modify neg thoughts, increase ability to tolerate uncertainty, worry only during scheduled times, focus on present moment

GAD meds

benzos-therapeutic effects modest (less alert more drug dependencies, associated w falls in elderly) paxil and venlafaxine better choices

psych treatment of OCD

exposure plus response (ritual) prevention - intense, reduce not eradicate symptoms

cognitive treatment of OCD

challenge beliefs about anticipated consequences of not engaging in compulsions

OCD meds/surgery

clomipramine (tricyclic), SSRIs, psychosurgery (lesion to cingulate - 30% benefit)

PTSD cognitive therapy

enhanced beliefs about coping abilities, learn not to self blame, CT+exposure - guilt but not symptom reduction

psych treatment of PTSD

exposure to memories and reminders of the original trauma (direct, imaginal, or virtual reality), may initially increase symptoms, more effective ethan meds

MDD neurobiological factors

low levels of NE, DA, and 5-HT

Mania neurobiological factors

high levels of NE, DA, low levels of 5-HT

higher activity

activity in amygdala in MDD and BP

decrease activity

hippocampus activity MDD

overly active

anterior cingulate activity MDD, anhedonia/coping

arbitrary inference

individual does not take into account other possibilities, automatically attribute to themselves

overgeneralization

1 failing signifies that they are a complete failure

vagus nerve stimulation

implanted stimulator that sends impulse to left vagus nerve in the next, sends electrical impulses

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