Not enough neurotransmitter production:
serotonin: mood, memory, and learning
Glutamate: excitatory and inhibitory behavior, especially for executive functioning
Structural and functional abnormalities: these areas get too excited and can't calm down:
Cingulate cortex: emotion formation, processing, learning, and memory
Orbitofrontal conrtex: emotions, rewards, decision making
Amygdala: Emotions, faces, danger, and threat
Caudate nucleus and basal ganglia: motor processing and ritualistic behavior
Note: it's due to dysregulation in how the regions communicate with one another
1) trauma is re-experienced through intrusive and distressing recollections (e.g. flashbacks, nightmares, etc)
2) avoidance of things that remind you of the event (e.g. people, places)
3) Negative changes in mood and cognitions (e.g. impaired memory of event, self-blame, loss of interest, emotional numbing (e.g. survivor's guilt)
4) Heightened arousal and reactivity
(e.g. irritability, reckless behavior, startle response, difficulty concentrating, sleep problems)
i. The role of the amygdala in anxiety is to take in sensory information and send impulses to the body.
ii. Some of the physiological signs of anxiety are sense of dread, shaking, feeling faint, wobbly legs, rapid heartbeat, choking (short of breath), etc.
These signs can be measured by looking at skin conductance, heart rate, and startle response (measure blink when startled, usually long > habituating causes shorter blink).
iii. The tripartite model of anxiety looks at the similarities and differences between depression and anxiety:
1. Positive Affectivity: Low levels of happy, joy, optimism for
2. Negative Affectivity: High levels of negative thinking about self, others, future in both Depression and Anxiety.
3. Physiological Hyper-arousal: Hyperactive amygdala causing
increased 'fight or flight' & bodily function response in Anxiety.
iv. Anxiety is learned through conditioned responses, in which one begins to associate this stress response to a specific stimulus, like Little Albert.
v. Generalized Anxiety Disorder (GAD)
1. GAD is characterized by worries.
2. The diagnostic criteria for GAD is to have at least 3 of the
following symptoms > restlessness, fatigue, poor concentration,
irritability, muscle tension, sleep disturbance. It must also cause
distress and impair daily functioning.
3. The diathesis-stress model of GAD is that certain people have a biological vulnerability toward developing GAD that is caused by a trigger that leads to the symptoms above.
i. Phobias are persistent and unreasonable fear towards a specific object, causing an interruption with daily life.
ii. Avoidance reinforces phobias by influencing someone to continue to avoid the object because it makes them feel good after doing so.
iii. Phobias are treated through:
1. Exposures: exposure to fear-causing stimulus, slowly.
2. Systematic Desensitization (w/relaxation training): desensitized to stimulus, not to fear. Deep breaths, addressing fear with logic.
3. Flooding: go straight to the scary stimulus, no exposure.
c. Social Anxiety Disorder (SAD)
i. SAD is fear/anxiety about social situations where there may be scrutiny from others. Engaging in avoidance and safety behaviors to decrease
chance of social disaster.
ii. SAD is treated by antidepressants, exposures, cognitive therapy & social
d. Panic Disorder
i. Panic disorder is periodic, short bursts of panic; occur suddenly; peak within 10 minutes.
ii. The diagnostic criteria for Panic Disorder is to have at least 4 trembling, chest pains, tingling, shortness of breath, dizziness, nausea, etc.
e. Obsessive Compulsive Disorder (OCD)
i. Obsessions are persistent thoughts or urges/compulsions are behaviors to reduce anxiety.
ii. The purpose of a compulsion is to reduce anxiety temporarily of recurring thoughts.
iii. Some common OCD themes are dirt/ orderliness/ sexuality/ violence/"checking".
iv. OCD is treated by "Exposure & Response Prevention" (ERP)
1. Face fears
2. Make a choice to NOT do compulsive behaviors when triggered
3. Over time person will actually feel a drop in anxiety level
4. Habituation due to exposure and preventing compulsions.
a. Autonomic Nervous System
i. The role of the sympathetic response is to "fight or flight". The role of the parasympathetic response is to "rest and digest".
i. The diurnal pattern of cortisol is that cortisol levels have a peak in the morning but decrease during the rest of the day. Can be measured with cotton swabs/diary of feelings during the day.
ii. The role of cortisol in stress/anxiety is to prepare us for the day.
c. PTSD and Acute Stress Disorder
i. PTSD and ASD occur after a traumatic event.
ii. Many types of traumatic events/triggers include combat, disasters,
victimization, sexual assault, terrorism, torture.
iii. Types of exposure to trauma include:
1. DIRECT - happened to you.
2. WITNESS - actually saw.
3. INDIRECT - relative/friend had actual or threatened death in violent way.
4. REPEATED INDIRECT EXPOSURE - professionals repeatedly exposed to details of multiple events, multiple times.
iv. The difference between PTSD and Acute Stress Disorder is that the length of the symptoms differ, PTSD can last months/years and may not see
symptoms until way after traumatic events, whereas acute lasts less than a month and symptoms may occur immediately.
v. Treatments for trauma include drug therapy (to reduce arousal), behavioral
exposure therapy (flood & relaxation), insight therapy (process reaction),
family/group therapy (help normalize event), debriefing (can be bad).
d. Dissociative Disorders
i. Dissociative amnesia is inability to recall personal autobiographical
memory associated with a traumatic event (no physiological explanation).
There are 5 types:
1. Localized - before/after event, specific to a time around event
2. Selective - remember different parts but not whole thing
3. Generalize - significant block of memory lost
4. Continuous - memory loss continues after event
5. Dissociative fugue occurs when one forgets their life and takes on a new identity.
ii. Amnesia can be treated by:
1. Psychodynamic therapy (recover repressed memories)
2. Hypnotic therapy (guided recall of forgotten memories)
3. Drug therapy (truth serums)
iii. Dissociative identity disorder is 2 or more different personalities in
someone, AKA multiple personalities. (Each with own memories, talents)
iv. Dissociative identity disorder treatment is:
1. Recognizing the disorder
2. Recovering memories
3. Fusion of subpersonalities
v.Depersonalization/derealization disorder is persistent and recurrent episodes of depersonalization (sense of out of body experience) and
derealization (something isn't right)
a. Unipolar Depression
i. The five symptom domains of unipolar depression are:
1. Emotional - feeling hopeless, sad, lonely
2. Motivational - not motivated to eat or be with partner
3. Behavioral - in room, in bed, isolation, no socialization
4. Cognitive - thoughts of "what's the point", guilt of past, failure
5. Physical - headaches, stomach aches, dizzy, moving slow, tired
ii. The criteria for major depressive disorder is 5 of the symptoms below:
1. Depressed mood, diminished interest, significant weight loss,
insomnia/hypersomnia, fatigue, feeling worthless, can't
concentrate, thoughts of death/suicidal.
2. + happening for 2 weeks with NO mania.
iii. The criteria for a 'depressive episode' is symptoms above plus:
1. 2+ years = Persistent Depressive Disorder (PDD)
2. Not as disabling but persistent = Dysthymia
iv. The biological model of depression explains it may be due to genetics or low levels of norepinephrine/serotonin. The psychological model of
depression explains it may be due to real/imagined loss. The behavioral model of depression explains it may be due to decrease of positive rewards
in life over time. The cognitive model of depression explains it may be due to maladaptive attitudes that are not working like automatic thoughts
with little or no evidence.
v. Treatment approaches to depression are antidepressants (to increase serotonin), ECT (if severe), cognitive-behavioral therapy (CBT - changing
primary attitudes to new way of thinking by acknowledging maladaptive thinking.
vi. The multicultural perspective of depression is we may not know how other cultures perceive depression, as others may have physical symptoms
instead of emotional.
b. Bipolar Depression
i. A manic episode is abnormally and persistently elevated or irritable mood. Increased activity most of the day, everyday for at least 1 week, with at least 3 of these: inflated self-esteem, decreased need for sleep, talkative, racing ideas, activities w/painful consequences.
ii. Differences in the disorders:
1. Bipolar I Disorder: 1 manic episode in someone's life + MDD
2. Bipolar II Disorder: 1 depressive episode + 1 hypomanic episode
(not a whole week of mania, less days)
3. Cyclothymic Disorder: At least 2 years of episodes of hypomania + dysthymia episodes not meeting full criteria for mania or MDD, just lasts longer