Study Plan: Anxiety Disorders, Study Plan: The Etiology and Treatment of Mental Disorders, People and Terms: The Etiology and Treatment of Mental Disorders, Show What You Know: The Etiology and Treatment of Mental Disorders, Self-Check: Anxiety Disor...

Which of the following statements would most likely be made by an individual who has been diagnosed with paranoid personality disorder?

"My boss keeps staring at me. I think she has been spying on my computer and is trying to get the whole office to team up against me."

In a therapy session, Gail, who has a phobia of dogs, is asked to stand near a dog. This action reactivates her fear response. The therapist exposes her to dogs repeatedly while giving her support. Gail was never bit or harmed during these sessions. Eventually the fear response was reduced and she was less afraid of dogs. What specific technique is the therapist using?

"extinction of the fear response" in the application of reconsolidation therapy

Somatogenic theories

(from the Greek word soma meaning body, therefore biological causes) identify disturbances in physical functioning resulting from either illness, genetic inheritance, brain damage, or imbalance.

obsession

(uncontrollable, reoccurring thoughts

Emil Kraepelin (1856-1926)

-Pioneered classification of mental illness based on biological causes -Published 1st psychiatry text (1883) --Mental illness as syndrome -Cluster of symptoms that co-occur -Proposed two major syndromes --Dementia praecox --Manic-depressive psychosis was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology, and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century's end. Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as "symptomatic" and to his view as "clinical." This turned out to be his paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome—common patterns of symptoms over time—rather than by simple similarity of major symptoms in the manner of his predecessors. Drawing on his long-term research, and using the criteria of course, outcome, and prognosis, he developed the concept of dementia praecox, which he defined as the "sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age." This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the dementia part signifying the irreversible mental decline). As a colleague of Alois Alzheimer, he was a co-discoverer of Alzheimer's disease (thought to be a brain disease leading to dementia), and his laboratory discovered its pathological basis. This may have led to the medical model of illness.

To receive a diagnosis for neurocognitive disorder due to TBI how many of the following symptoms must present in a patient: loss of consciousness, posttraumatic disorientation, confusion, or neurological impairment?

1

how long do panic attacks usually last

10 minutes

To receive a diagnosis for HIV Neurocognitive disorder how many cognitive domains of impairment must be present in the patient's behavior?

2

OCD prevalence

2.3%

Maeve was recently told that she was in the early stages of Parkinson's disease. She learns that ________of people with Parkinson's also experience neurocognitive decline, so she is working to learn as much as she can and be proactive about her cognitive health to prevent decline as much as possible.

20%-60%

Felicity is a chronic alcoholic who is showing symptoms of alcohol-related dementia during the most common onset period. How old is Felicia?

55

Frontotemporal disorders primarily affect patients younger than ________ years of age.

60

If a doctor has suspicions that a person has "Picks disease" what test can be done to examine the patient's neurons for damage to the brain?

A MRI scan of the brain looking for damage in the frontal or temporal lobes.

Humorism

A belief held by ancient Greek and Roman physicians (and until the 19th century) that an excess or deficiency in any of the four bodily fluids, or humors—blood, black bile, yellow bile, and phlegm—directly affected their health and temperament.

M'Naghten Rule

A common law test of criminal responsibility, derived from M'Naghten's Case in 1843, that relies on the defendant's inability to distinguish right from wrong.

positive correlation

A correlation where as one variable increases, the other also increases, or as one decreases so does the other. Both variables move in the same direction.

a stereotype

A generalized belief about a group of people

Malleus Maleficarum

A textbook for judges, to identify and destroy witches

psychoanalytic theory

A theory developed by Freud that attempts to explain personality, motivation, and mental disorders by focusing on unconscious determinants of behavior

The Humanistic Perspective

According to the humanistic perspective, anxiety may develop if people do not see themselves honestly or do not practice self-acceptance. In this model, client-centered therapy is encouraged to help patients accept themselves and not be so self-judgemental. One humanistic type of treatment for anxiety is motivational interviewing.

Alan is having a psychotic episode. Which of the following describes his experience?

Alan hears someone speaking to him, but there is no one there or he hears odd sounds like radio static.

I believe that humans have innate worth, but also that we naturally engage in both rational and irrational patterns of thinking and behavior. Thus, much of human suffering is caused by our own irrational thinking, exaggerated emotional reactions, and unproductive behaviors. We can improve our ability to function well by adopting a healthier acceptance of ourselves and others and working to develop more rational thought processes. Who am I?

Albert Ellis

Sylvia is a 75-year-old retired school teacher who currently lives independently with her husband. Recently, Sylvia has begun to act confused in the mornings, has had difficulty expressing herself clearly, and has had more anxiety. One morning, she even got dressed and told her husband that she needed to find her school papers to give back to the children. As a result, her husband was concerned and asked her to go to the doctor to check-in. The doctor ran blood tests, did a brain scan, and used several dementia screening tools. He found that Sylvia's brain scans had some evidence of amyloid plaque on them. What kind of neurocognitive disorder do you think she will likely receive a diagnosis for?

Alzheimer's disease

Ruth is a woman in her late seventies who has recently begun to show emotional mood shifts and confusion in familiar situations. About three years ago, and since then, Ruth has demonstrated memory loss like losing her keys or getting lost in the grocery store. Now, Ruth is easily disoriented and has difficulty recognizing faces, places, or her relationship to a person. Her symptoms are continuing to gradually get worse and she now cannot remember what decade it is and often gets confused about which stage of life she is experiencing. What diagnosis would you give Ruth?

Alzheimer's disease.

Trephination

An ancient operation in which a stone instrument was used to cut away a circular section of the skull, perhaps to treat abnormal behavior.

quasi-experiment

An experiment in which investigators make use of control and experimental groups that already exist in the world at large. Also called a mixed design.

Poverty and Anxiety

As of 2017, 12.3% of Americans were considered in poverty, according to the official poverty measure.[6] People who are in poverty have different health risks than those who are not considered in poverty, as well as different outcomes associated with those risks. People who are in poverty grapple with varying outcomes in physical health, mental health, and access to health care. Examining divergences in health between those above and below the poverty line gives insight into conditions for those who live in poverty. Poverty has a complex relationship with mental health. Being in poverty may itself provoke a condition of elevated emotional stress, known as poverty distress. Poverty is also a precursor or risk factor for mental illness, particularly anxiety or mood disorders. Schizophrenia is also strongly associated with poverty, occurring most frequently in the poorest classes of people all over the world, especially in more unequal countries. In a sort of reciprocating relationship, having a mental illness is also a major risk factor for being in poverty, as having a mental illness may inhibit a person's ability to work or deter employees from hiring him or her. A hypothesis known as the drift hypothesis posits that people with psychiatric disorders (primarily schizophrenia) tend to fall further down the socio-economic ladder as their condition reduces their functionality. The drift hypothesis is an effort to establish that people with profoundly limiting psychiatric symptoms are more likely to descend economically, not that the financially challenged are more likely to present severe psychiatric disorders. People experiencing less severe symptoms are less likely to be affected by "drift." The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one's socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, "members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder."[7] The excess stress that people with low socioeconomic status (SES) experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower socioeconomic status (SES) predisposes individuals to the development of a mental illness. Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), bullying, early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behavior, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including the disabled), and socioeconomics (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries). A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders. Food-insecure individuals had an almost threefold risk increase of testing positive for anxiety when compared to food-secure individuals. Contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence, self-efficacy, independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences. Our review suggests that the prevalence and expression of social anxiety depend on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and U.S. samples show the highest rates of social anxiety disorder. Taijin kyofusho, a Japanese term for those who are embarrassed about their appearance or bodies or are fearful of displeasing others, is a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and social anxiety disorder.

Cognitive and Behavioral Perspectives

Because anxiety disorders are connected to the way people perceive situations, cognitive therapies are particularly effective in thinking about and treating anxiety disorders. Some anxiety disorders, such as phobias, also stem from learned experiences, such as traumatic events. Cognitive theories suggest that anxiety disorders develop through thought patterns that overestimate threats to safety, therefore anxiety is caused by cognitive misinterpretations and can be treated by developing strategies to combat these thoughts. Therapies include cognitive behavioral therapy, acceptance and commitment therapy, intolerance of uncertainty therapy. Behavioral theories contend that anxiety disorders are mostly caused by conditioning, by modeling, or through experiences triggering their development, such as in specific phobias. Behavioral therapies often work in conjunction with cognitive therapies (such as in CBT), but they may also include behavior therapy, exposure treatment, systematic desensitization, and flooding.

Michael was diagnosed with schizophrenia when he was 19 years old. He was hospitalized, and he and his psychiatrist have struggled for many months to find the right antipsychotic medication to help him with the least side effects. He is now ready to be discharged to a residential living facility. A major goal of his time there will be to practice and rehearse interpersonal and communication skills, money management, stress management, and some other behaviors to help him integrate into the community on his own. But Michael is an adult, so why is such a program necessary?

Because schizophrenia disrupted the normal process of learning the life skills to be on his own.

Culture

Beliefs, customs, and traditions of a specific group of people. socially shared beliefs, values, norms, expectations, and practices within a group, community, or society at large.[1] For example, returning a stranger's smile is expected in the United States because a pervasive social norm dictates that we reciprocate friendly gestures. A person who refuses to acknowledge such gestures might be considered socially awkward—perhaps even disordered—for violating this expectation. However, such expectations are not universally shared. Cultural expectations in Japan involve showing reserve, restraint, and a concern for maintaining privacy around strangers. Japanese people are generally unresponsive to smiles from strangers (Patterson et al., 2007). Eye contact provides another example. In the United States and Europe, eye contact with others typically signifies honesty and attention. However, most Latin American, Asian, and African cultures interpret direct eye contact as rude, confrontational, and aggressive (Pazain, 2010). Thus, someone who makes eye contact with you could be considered appropriate and respectful or brazen and offensive, depending on your culture (Figure 2). cultural norms change over time: what might be considered typical in a society at one time may no longer be viewed this way later, similar to how fashion trends from one era may elicit quizzical looks decades later—imagine how legwarmers or the big hair of the 1980s would go over on

Dr. Daniels is a practicing marriage counselor. She went through a messy divorce last year and has been experiencing mood disturbances since then. She finds it difficult to give clients her full attention. Her personal feelings about marriage have begun to influence the way she advises her clients. Which of the following roles and responsibilities from the five ethical principles would be in question in this case?

Beneficence and Non-maleficence

Dancing Mania

Between the 11th and 17th centuries, a curious epidemic swept across Western Europe. Groups of people would suddenly begin to dance with wild abandon. This compulsion to dance—referred to as dancing mania—sometimes gripped thousands of people at a time (Figure 2). Historical accounts indicate that those afflicted would sometimes dance with bruised and bloody feet for days or weeks, screaming of terrible visions and begging priests and monks to save their souls (Waller, 2009b). What caused dancing mania is not known, but several explanations have been proposed, including spider venom and ergot poisoning ("Dancing Mania," 2011). Figure 4. Although the cause of dancing mania, depicted in this painting, was unclear, the behavior was attributed to supernatural forces. Historian John Waller (2009a, 2009b) has provided a comprehensive and convincing explanation of dancing mania that suggests the phenomenon was attributable to a combination of three factors: psychological distress, social contagion, and belief in supernatural forces. Waller argued that various disasters of the time (such as famine, plagues, and floods) produced high levels of psychological distress that could increase the likelihood of succumbing to an involuntary trance state. Waller indicated that anthropological studies and accounts of possession rituals show that people are more likely to enter a trance state if they expect it to happen, and that entranced individuals behave in a ritualistic manner, their thoughts and behavior shaped by the spiritual beliefs of their culture. Thus, during periods of extreme physical and mental distress, all it took were a few people—believing themselves to have been afflicted with a dancing curse—to slip into a spontaneous trance and then act out the part of one who is cursed by dancing for days on end.

Biofeedback

Biofeedback is a technique that can be used to track and monitor physiological changes in the body in order to learn to control them. During biofeedback, a person may be connected to sensors to monitor heart rate, temperature, and other biological changes in order to practice controlling their reactions to various situations.

Guido and Marcello are seeing different therapists for different conditions. One therapist is using CBT while the other therapist is using IPT. However, both men seem to be making progress with their concerns, and their lives are improving. Which of the following is a common factor across therapies that may help to explain this result?

Both therapists have done well in creating a sense of hope and that the future will improve.

Gustav has been diagnosed with delusional disorder; his brother, Brandt, has been diagnosed with schizophrenia. Which one of the brothers most likely hears someone speaking to him and replies back to them even though no one else is present?

Brandt

Burt is a 5-year-old boy who has a strong emotional attachment to his parents. During the first days of kindergarten, he had a difficult time separating from his parents during school drop off. The teacher reassures his parents that it is normal and healthy at the beginning of the school year. However, Burt's initial heightened anxiety of leaving his parents does not change and his parents are worried. Burt is later diagnosed with separation anxiety. Which statement below would describe his behavior as a result of his anxiety?

Burt shows extreme emotional distress when his parents leave, has complaints of stomachaches and headaches, and constantly asks for reassurance from his teacher that his parents will come and pick him up.

From the Middle Ages to the Twentieth Century

By the 18th century, people who were considered odd and unusual were placed in asylums. Asylums were the first institutions created for the specific purpose of housing people with psychological disorders, but the focus was ostracizing them from society rather than treating their disorders. Often these people were kept in windowless dungeons, beaten, chained to their beds, and had little to no contact with caregivers. In the late 1700s, a French physician, Philippe Pinel, argued for the more humane treatment of the mentally ill. Pinel suggested that they be unchained and talked to, and that's just what he did for patients at La Salpêtrière in Paris in 1795. Patients benefited from this more humane treatment, and many were able to leave the hospital. Figure 5. This painting by Tony Robert-Fleury depicts Dr. Philippe Pinel ordering the removal of chains from patients at the Salpêtrière asylum in Paris. In the 19th century, Dorothea Dix led reform efforts for mental health care in the United States. She investigated how those who are mentally ill and poor were cared for, and she discovered an underfunded and unregulated system that perpetuated abuse of this population (Tiffany, 1891). Horrified by her findings, Dix began lobbying various state legislatures and the U.S. Congress for change (Tiffany, 1891). Her efforts led to the creation of the first mental asylums in the United States. Figure 6. Dorothea Dix was a social reformer who became an advocate for the indigent insane and was instrumental in creating the first American mental asylum. She did this by relentlessly lobbying state legislatures and Congress to set up and fund such institutions. Despite reformers' efforts, however, a typical asylum was filthy, offered very little treatment, and often kept people for decades. At Willard Psychiatric Center in upstate New York, for example, one treatment was to submerge patients in cold baths for long periods of time. Electroshock treatment was also used, and the way the treatment was administered often broke patients' backs; in 1943, doctors at Willard administered 1,443 shock treatments (Willard Psychiatric Center, 2009). (Electroshock is now called electroconvulsive treatment, and the therapy is still used, but with safeguards and under anesthesia. A brief application of electric stimulus is used to produce a generalized seizure. Controversy continues over its effectiveness versus the side effects.) Many of the wards and rooms were so cold that a glass of water would be frozen by morning (Willard Psychiatric Center, 2009). Willard's doors were not closed until 1995. Conditions like these remained commonplace until well into the 20th century. European psychiatry in the late 18th century and throughout the 19th century struggled between somatogenic and psychogenic explanations of mental illness, particularly hysteria, which caused physical symptoms such as blindness or paralysis with no apparent physiological explanation. Franz Anton Mesmer (1734-1815), influenced by contemporary discoveries in electricity, attributed hysterical symptoms to imbalances in a universal magnetic fluid found in individuals, rather than to a wandering uterus (Forrest, 1999). James Braid (1795-1860) shifted this belief in mesmerism to one in hypnosis, thereby proposing a psychogenic treatment for the removal of symptoms. At the time, famed Salpetriere Hospital neurologist Jean-Martin Charcot (1825-1893), and Ambroise Auguste Liébault (1823-1904) and Hyppolyte Bernheim (1840-1919) of the Nancy School in France, were engaged in a bitter battle over the best explanation for hysteria, with Charcot maintaining that the hypnotic suggestibility underlying hysteria was a neurological condition while Liébault and Bernheim believed it to be a general trait that varied in the population. Josef Breuer (1842-1925) and Sigmund Freud (1856-1939) would resolve this dispute in favor of a psychogenic explanation for mental illness by treating hysteria through hypnosis, which eventually led to the cathartic method that became the precursor for psychoanalysis during the first half of the 20th century. Emil Kraepelin (1856-1926) was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology, and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century's end. Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as "symptomatic" and to his view as "clinical." This turned out to be his paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome—common patterns of symptoms over time—rather than by simple similarity of major symptoms in the manner of his predecessors. Drawing on his long-term research, and using the criteria of course, outcome, and prognosis, he developed the concept of dementia praecox, which he defined as the "sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age." This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the dementia part signifying the irreversible mental decline). As a colleague of Alois Alzheimer, he was a co-discoverer of Alzheimer's disease (thought to be a brain disease leading to dementia), and his laboratory discovered its pathological basis. This may have led to the medical model of illness. As we will discuss later in this course, in psychology, the term medical model refers to the assumption that psychopathology is the result of one's biology, that is to say, a physical/organic problem in brain structures, neurotransmitters, genetics, the endocrine system, etc., as with traumatic brain injury, Alzheimer's disease, or Down's syndrome. One aspect of such a model is that an ill patient should not be held responsible for the condition. The patient should not be blamed or stigmatized for the illness. The medical model is useful in many situations as a guide for diagnosis, prognosis, and research. However, for most mental disorders, exclusive reliance on the medical model leads to an incomplete understanding, and, frequently, to incomplete or ineffective treatment interventions.

Mental Health during the Middle Ages

By the late Middle Ages, economic and political turmoil threatened the power of the Roman Catholic Church. Between the 11th and 15th centuries, supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plagues and famines that laypeople interpreted as brought about by the devil. Superstition, astrology, and alchemy took hold, and common treatments included prayer rites, relic touching, confessions, and atonement. Beginning in the 13th century, the mentally ill, especially women, began to be persecuted as witches who were possessed. At the height of the witch hunts during the 15th through 17th centuries, with the Protestant Reformation having plunged Europe into religious strife, two Dominican monks wrote the Malleus Maleficarum (1486) as the ultimate manual to guide witch hunts. Johann Weyer and Reginald Scot tried to convince people in the mid-to late-16th century that accused witches were actually women with mental illnesses and that mental illness was not due to demonic possession but to faulty metabolism and disease, but the Church's Inquisition banned both of their writings. Witch-hunting did not decline until the 17th and 18th centuries, after more than 100,000 presumed witches had been burned at the stake (Schoeneman, 1977; Zilboorg & Henry, 1941). Also during medieval times, a person with mental illness might be considered to be possessed by demons. If someone was considered to be possessed, there were several forms of treatment to release spirits from the individual. The most common treatment was exorcism, often conducted by priests or other religious figures: incantations and prayers were said over the person's body, and they may have been given some medicinal drinks. Trephining was also practiced during this time—a small hole was made in the afflicted individual's skull to release spirits from the body. Most people treated in this manner died. In addition to exorcism and trephining, other practices involved execution or imprisonment of people with psychological disorders. Still others were left to be homeless beggars. Generally speaking, most people who exhibited strange behaviors were greatly misunderstood and treated cruelly. The prevailing theory of psychopathology in earlier history was the idea that mental illness was the result of demonic possession by either an evil spirit or an evil god because early beliefs incorrectly attributed all unexplainable phenomena to deities deemed either good or evil.

After having some relatively ineffective experiences in counseling before, Min-Jun is concerned about starting CBT. Which of the following is an accurate statement about some of the benefits of CBT compared to other forms of treatment?

CBT achieves significant results in fewer sessions than older therapies and is more cost-effective as a result.

William has a history of drug use and past episodes of psychosis, but he has now been diagnosed with schizophrenia. Which of the following substances was he most likely using?

Cannabis (marijuana)

One of the main differences between reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) is

Children with DSED are more outgoing and more likely to talk to strangers than those with RAD. They may have little to no fear of interacting with people they don't know, to the point where they will venture away with them to somewhere new and unfamiliar.

Aaron and his roommate are studying for an exam in their abnormal psychology course. The roommate looks at Aaron and says, "What is the difference, again, between classical and operant conditioning?" What is the most accurate answer that Aaron can give?

Classical conditioning is about reflexive behaviors linked to an unlearned stimulus while operant is about an organism's voluntary behaviors and what happens afterwards.

John told his brother that his house had been broken into, and that cameras and microphones were set up to record him. Even after his brother came and checked the house to find no evidence, John proceeded to install cameras of his own to catch the perpetrators in the act. John would best fit into which cluster of personality disorders?

Cluster A

Histrionic personality disorder is characterized by an individual being overly dramatic and emotional, engaging in erratic and impulsive behaviors and is part of which cluster of personality disorders?

Cluster B

Avoidant personality disorder is classified under which cluster according to the DSM-5?

Cluster C

Damion thinks that impairments he sees in his patients with schizophrenia like difficulty with explaining moments in their own lives and slow response time in trying to figure things out are actually part of the risk factors for developing the disorder rather than just the effects of the illness. In reaching this conclusion, Damion is making use of which perspective on schizophrenia?

Cognitive perspective

Supernatural Perspectives of Psychological Disorders

Convents throughout Europe in the 16th and 17th centuries reported hundreds of nuns falling into a state of frenzy in which the afflicted foamed at the mouth, screamed and convulsed, sexually propositioned priests, and confessed to having carnal relations with devils or Christ. Although today these cases would suggest serious mental illness, at the time, these events were routinely explained as possession by devilish forces (Waller, 2009a). Similarly, grievous fits by young girls are believed to have precipitated the witch panic in New England late in the 17th century (Demos, 1983). Such beliefs in supernatural causes of mental illness are still held in some societies today; for example, beliefs that supernatural forces cause mental illness are common in some cultures in modern-day Nigeria (Aghukwa, 2012).

Oscar lived in the United Kingdom during the 1980s and loved to go to his local pub to eat hamburgers and chips. Oscar died within six months of his first symptom, which was rapidly progressive dementia, jerky movements, and emotional and personality changes. Within a month of his first symptom, he had a speech impairment and could not work due to poor motor coordination and increased involuntary muscle movements. What disease did Oscar likely have?

Creutzfeldt-Jakob disease.

Durham Rule

Defendant's conduct was a product of mental illness. established that a jury may determine a defendant is not guilty by reason of insanity because the criminal act was the product of a mental disorder

common obsessions

Dirt/contamination Orderliness Religion Sexuality Violence and aggression

In the emergency room, a physician is examining Dayo who was brought in after she began flinching and screaming that she was seeing flashing lights and thought a truck was going to run her over. She has been in an agitated state but has no history of mental disorders. After some prodding, a friend admits that they were at a party where they were taking PCP. Which question would be the most useful for the doctor to ask that might indicate if Dayo is experiencing a substance-induced psychotic episode?

Does Dayo have family members diagnosed with schizophrenia or schizoaffective disorder?

Philippe Pinel and Dorothea Dix

Early pioneers who worked for the humane treatment of the mentally ill.

Adhita is writing a paper on schizophrenia for her class. In discussing the differing hypotheses about the cause of schizophrenia, which sentence below would be the most accurate to include in her paper?

Early studies suggested that an excess of dopamine in the brain produced psychotic symptoms.

Every day after classes, Fahari goes and sits at a bus stop across the street from a house where a young married man lives that she is convinced is in love with her. She waits for him to send a signal of his love for her and has started putting love notes in his mailbox. The two of them have never met, and the young man does not know who she is. What type of delusion is Fahari experiencing?

Erotomanic

Marlena's child is aggressive with siblings and other children on the playground. She is working with a behavior therapist to try and reduce the frequency of these aggressive incidents and increase her child's use of more socially engaging behaviors that will help improve her relationship with others. What is the first step in this process of therapy?

Establish a baseline for the frequency of the aggression.

Myth: Children do not experience mental health problems

Fact: Even very young children may show early warning signs of mental health concerns. These mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors. Half of all mental health disorders show first signs before a person turns 14 years old, and three-quarters of mental health disorders begin before age 24. Unfortunately, less than 20% of children and adolescents with diagnosable mental health problems receive the treatment they need. Early mental health support can help a child before problems interfere with other developmental needs.

Myth: I can't do anything for a person with a mental health problem

Fact: Friends and loved ones can make a big difference. Only 44% of adults with diagnosable mental health problems and less than 20% of children and adolescents receive needed treatment. Friends and family can be important influences to help someone get the treatment and services they need by reaching out and letting them know you are available to help; helping them access mental health services; learning and sharing the facts about mental health, especially if you hear something that isn't true; treating them with respect, just as you would anyone else; and refusing to define them by their diagnosis or using labels such as "crazy."

Mental Health Myths Myth: Mental health problems don't affect me.

Fact: Mental health problems are actually very common. In 2014, about one in five American adults experienced a mental health issue; one in 10 young people experienced a period of major depression; one in 25 Americans lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 American lives each year, more than double the number of lives lost to homicide. Learn more about mental health problems at mentalhealth.gov.

Myth: Personality weakness or character flaws cause mental health problems. People with mental health problems can snap out of it if they try hard enough.

Fact: Mental health problems have nothing to do with being lazy or weak and many people need help to get better. Many factors contribute to mental health problems, including the following: biological factors, such as genes, physical illness, injury, or brain chemistry life experiences, such as trauma or a history of abuse family history of mental health problems People with mental health problems can get better and many recover completely. Learn more about mental health recovery at mentalhealth.gov.

Myth: People with mental health needs, even those who are managing their mental illness, cannot tolerate the stress of holding down a job.

Fact: People with mental health problems are just as productive as other employees. Employers who hire people with mental health problems report good attendance and punctuality as well as motivation, good work, and job tenure on par with or greater than other employees. When employees with mental health problems receive effective treatment, it can result in lower total medical costs, increased productivity, lower absenteeism, and decreased disability costs.

Myth: Prevention doesn't work. It is impossible to prevent mental illnesses.

Fact: Prevention of mental, emotional, and behavioral disorders focuses on addressing known risk factors such as exposure to trauma that can affect the chances that children, youth, and young adults will develop mental health problems. Promoting the social-emotional well-being of children and youth leads to the following: higher overall productivity better educational outcomes lower crime rates stronger economies lower health care costs improved quality of life increased lifespan improved family life

Myth: There is no hope for people with mental health problems. Once a friend or family member develops mental health problems, he or she will never recover.

Fact: Studies show that people with mental health problems get better and many recover completely. Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. There are more treatments, services, and community support systems than ever before, and they work.

Myth: People with mental health problems are violent and unpredictable.

Fact: The vast majority of people with mental health problems are no more likely to be violent than anyone else. Most people with mental illness are not violent and only three to 5% of violent acts can be attributed to individuals living with a serious mental illness. In fact, people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population. You probably know someone with a mental health problem and don't even realize it because many people with mental health problems are highly active and productive members of our communities.

Myth: Therapy and self-help are a waste of time. Why bother when you can just take a pill?

Fact: Treatment for mental health problems varies depending on the individual and could include medication, therapy, or both. Many individuals work with a support system during the healing and recovery process.

DSM-5 criteria for OCD

For a diagnosis of obsessive-compulsive disorder, the following must be present: , , or both, and the following must be true: The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) and/or cause significant impairment in social, occupational, or other important areas of functioning; symptoms are not caused by the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition; symptoms are not better explained by those of another mental disorder (e.g., generalized anxiety disorder, hoarding disorder, or autism spectrum, etc). It should also be specified whether or not the individual has good or fair insight (meaning they recognize their OCD beliefs are probably not true—such as someone who understands that washing their hands seven times in the morning and the evening will not prevent cancer, even though they continue with the compulsion anyway), or if they have poor insight (meaning, they think their OCD beliefs are probably true), or if they have delusional beliefs (indicating that they are convinced their OCD beliefs are absolutely true). It should also be noted whether or not they have been diagnosed with a tic disorder in the past or present.

Galen

Greek anatomist whose theories formed the basis of European medicine until the Renaissance (circa 130-200) rejected the notion of a uterus having an animistic soul, he agreed with the notion that an imbalance of the four bodily fluids could cause mental illness. He also opened the door for psychogenic explanations for mental illness by allowing for the experience of psychological stress as a potential cause of abnormality. Galen's psychogenic theories were ignored for centuries, however, as physicians attributed mental illness to physical causes throughout most of the millennium.

For several weeks now Diego has been living on his own, although he receives support from a visiting social worker and participates in a day treatment program where he is part of a group focused on Social Skills Training. What kinds of activities does Diego engage in with this group?

He participates in role-plays and receives feedback and discusses how to use the skills in his life.

Julio just lost his wife yesterday to suicide; although she had experienced periods of depression over the years, he had not expected her to attempt suicide. He now has to care for his three children alone. Which of the following situations would most likely qualify Julio to be diagnosable with brief psychotic disorder?

He shows psychotic symptoms within a couple of weeks that last for 10 days and then stop

Shania is suffering from PTSD following her experiences of losing a friend in combat while being deployed with the Air Force. Her therapist specializes in memory reconsolidation. What might her therapist do to help Shania reduce the anxiety she feels related to her experiences?

Her therapist might have her explain the experience in detail, then immediately work on techniques to reduce the emotional impact of the memory.

What were the main ideas of Freud in regards to gender identity achievement?

Heterosexuality results from repression of bisexuality, the original sexual orientation, during the phallic stage of psychosexual development, after which gender identity becomes possible.

Doris is a shy, eccentric 60-year-old woman living alone following the death of her mother, with whom she had lived for her whole life. At her mother's funeral, her brother Todd and his wife Cynthia try to persuade her to sell the house, especially the possessions that Doris has collected and saved over the years. Most of the items are of no value, except for sentimental reasons they cannot understand. The clutter has become hazardous, as Doris herself can hardly move through the house. There isn't anywhere to sit anymore, but Doris can manage to get to her bed, where she spends most of her time. One day, fed up, Todd and Cynthia arrive with Doris's therapist, planning on decluttering her house, but when Cynthia tries to throw out a pencil, Doris angrily throws them out of her house. Which of the following disorders is Doris likely to have?

Hoarding disorder

A famous folk singer, Woody Gutherie started showing irritability of mood and compulsive behaviors at age 35. Eventually the emotional and behavioral turned into difficulty controlling voluntary movements. During the later stages of this disease, he had progressively worse chorea and significant impairment in his emotion, judgment, and cognitive functioning. What neurodegenerative disorder did the folk singer have?

Huntington's disease

Before a university researcher can test their hypotheses by collecting data, a(n) ________ must provide ethical oversight

IRB

Neo struggles with social anxiety and agoraphobia. He avoids social interactions with others if he can, and is afraid that if he goes outside or to the store, that something terrible will happen. Which of the following approaches fits with CBT principles?

In sessions, Neo identifies negative thoughts that impact his view of himself, and practices exposure methods.

Which of the following statements explains the development of personality disorders according to the behavioral perspective?

Individuals learn to behave in certain ways and their personalities are shaped by environmental reinforcements and consequences.

IRB

Institutional Review Board, review research in advance to ensure ethical considerations are met

Outside of the United States, the ________ is used for clinical assessment, where the ________ is used as a clinical research tool.

International Classification of Diseases; Diagnostic and Statistical Manual of Mental Disorders

Andi grew up in a family with multiple characteristics. Her father has social phobia and so tends to be quiet and reserved while her mother is gregarious and outgoing. One of her sisters experiences panic attacks, but the other is a cheerleader, and her brother is the captain of the high school debate team. Is Andi likely to develop an anxiety disorder?

It depends on the specific genes she inherited and how much stress she experiences in her life.

Which of the following statements is correct to describe the relationship between separation anxiety disorder and other anxiety disorders?

It is highly comorbid with other behavioral disorders, especially generalized anxiety disorder.

Jessica's Treatment

Jessica is an imaginary person, but behavior therapy is used by thousands of therapists with their clients every day. Review the following table to discover how Jessica's therapy progressed. Her story is based on a fairly typical series of therapy sessions, though please understand that each person's course of therapy is unique.

Discuss why thoughts, feelings, or behaviors that are merely atypical or unusual would not necessarily signify the presence of a psychological disorder. Provide an example.

Just because something is atypical or unusual does not mean it is disordered. A person may experience atypical inner experiences or exhibit unusual behaviors, but she would not be considered disordered if they are not distressing, disturbing, or reflecting a dysfunction. For example, a classmate might stay up all night studying before exams; although atypical, this behavior is unlikely to possess any of the other criteria for psychological disorder mentioned previously.

Which of the following descriptions of Kate most accurately reflects the characteristics of someone who has been diagnosed with histrionic personality?

Kate is excessively dramatic and emotional, feeling uncomfortable if she is not the center of attention. She will even be seductive or provocative in order to gain attention.

Which example below best demonstrates how someone might exhibit symptoms of body dysmorphic disorder?

Kit is 53 years old and works as a nurse in a retirement home. She never married and has always felt that men were turned off because of the shape of her nose, which she considers to be unusually large and crooked. Despite being reassured by friends and family members that her nose looks normal and that she is fairly attractive, she is overly conscious of the shape of her nose and thinks it negatively affects her overall appearance.

Jean-Martin Charcot

Known as the founder of modern neurology, taught and influenced Freud

Recent studies have shown that even when income and insurance issues are taken into account, ethnic minorities access and utilize mental health treatments at significantly lower rates. Which are the following are both likely reasons for this pattern?

Lack of access to bilingual services and fear concerning additional stigma Lack of access to bilingual services and fear concerning additional stigma

Laura's Law

Laura's Law allows California counties to decide whether to opt to implement a community-based, court- monitored outpatient treatment program. These programs require outpatient treatment for a seriously mentally ill person who is unlikely to survive safely in the community without supervision, has a history treatment noncompliance, and presents a serious risk of harm to self or others. At the present time some, but not all, California counties have adopted Laura's Law.

Which of the following persons is most likely to be diagnosed with brief psychotic disorder?

Layla is a woman from Vietnam who recently moved to America and recently gave birth to her first child. Taisha is a woman from Kenya who recently gave birth to her second child.

How do Lewy bodies cause changes in brain tissue for patients diagnosed with a neurocognitive disorder?

Lewy bodies are abnormal aggregations of protein that develop inside nerve cells.

________ involves following a group of research participants for an extended period of time.

Longitudinal research

Jameliah is a clinician who assesses clients when needed. Jameliah recently has wanted to focus on an assessment tool that may determine levels of depression and schizophrenia, so she is utilizing the ________ on individuals.

MMPI

If a doctor has suspicions that a person has vascular neurocognitive disorder what medical screening tool can they use?

MRI or CT brain scan.

For several years now Terri has struggled with intense depressive episodes. During some of these episodes, she has told her family and others that she is actually dead; even when doctors have pointed out that she has a heartbeat and temperature, she insists that she has already died. During some of these episodes, she also describes feeling her bones cracking as they decay and can hear ghosts speaking to her. When treatment reduces her depression, the psychotic symptoms are no longer evident. Which of the following is the most likely diagnosis for her given this information?

Major depression with psychotic symptoms

Which of the following statements is true about sexual function/dysfunction?

Masters and Johnson identified four phases of the sexual response: cycle-excitement, plateau, orgasm, and resolution.

Horacio has decided to participate in group therapy. What is one of the ways that this participation may benefit him and others in the group?

Members can point out each other's problematic behavioral patterns.

What you'll learn to do: define mental disorders and explain how they are classified

Mental disorders are conditions characterized by abnormal thoughts, feelings, and behaviors. Although challenging, it is essential for psychologists and mental health professionals to agree on what experiences and actions constitute the presence of a mental disorder. Inner experiences and behaviors that are atypical or violate social norms could signify the presence of a disorder; however, each of these criteria alone is inadequate. It is generally accepted that a mental disorder is defined by significant disturbances in thoughts, feelings, and behaviors. These disturbances must reflect some kind of dysfunction (biological, psychological, or developmental), must cause significant impairment in one's life, and must not reflect culturally expected reactions to certain life events. In this section, you will learn about how disorders are defined, and also how they are diagnosed and classified. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is essentially a classification manual that clinicians can use to read about the criteria, prevalence, risk factors, and details of over 200 disorders.

Why learn about abnormal psychology?

Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (51.5 million in 2019), of which there were an estimated 13.1 million adults, or 5.2% of the population aged 18 or older with a serious mental illness. A 2015 study showed that 45% of the American homeless had some form of mental illness, and 25% had a more serious mental illness at some point during their lives.

Mila is anxious about getting to know her new coworkers. When she sees them together at the coffee shop during her lunch break, she feels anxious. Which of the following scenarios would indicate that she likely has an anxiety disorder and not just a normal fear response?

Mila decides to avoid her coworkers altogether by quietly eating alone back at her desk in the office.

Montreal Cognitive Assessment (MoCA)

Mild cognitive dysfunction; Attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking calculations and orientation

What are the differences between major and mild neurocognitive disorders?

Mild neurocognitive disorder means a less extreme decline in one or more areas of cognitive functioning.

In addition to the use of antipsychotics to treat psychotic symptoms, treatment for schizoaffective disorder is more likely to include which forms of treatment compared with schizophrenia?

Mood stabilizing medication and psychotherapy

Leila and John are from the same country and generally have similar life histories in terms of their development, education, and life stressors. Which one of them has a greater risk of receiving a diagnosis of schizophreniform disorder?

Neither; unlike some other disorders, men and women have equal rates of this disorder.

Sabrina is a 55-year-old woman who has started to act "off" in her family's opinion. Sabrina has always been a person who is "on edge" but recently she has begun to have difficulty remembering where she is, has had a slower walking pace and takes shorter steps, and asks to talk to people who are not in the room. Her family is concerned about the progressive decline of their mother and they take her to a neurologist. While a biopsy cannot be conducted to check for aggregations of protein on her nerve cells, the doctor thinks this is likely. What diagnosis is the doctor likely to give her?

Neurocognitive disorder with Lewy bodies

What are the primary causes of neurocognitive disorders?

Neurodegenerative diseases such as Alzheimer's disease, Parkinson's Disease, and Huntington's disease

Elena has been suffering from increased difficulty thinking and speaking logically to others as well as talking to people that others don't see for the past couple of weeks. Her family takes her in to see a physician. Can the doctor diagnose her with schizophrenia?

No. Her psychotic symptoms have only lasted for two weeks, which is not enough time for a diagnosis.

Maurice is a 15-year-old high-school student referred for treatment by his health teacher, who became worried by Mark's irrational concern about getting ill and vomiting. The teacher had discussed vomiting as an involuntary response to illness. From that class forward, Maurice would shun anyone who appeared to be sick at school. His friends wondered why he wasn't talking to them. He became so obsessed with getting ill that he also started carrying hand sanitizer everywhere he went and avoided the school restrooms. He would no longer touch food that he thought might be contaminated by germs. What is the probable diagnosis for Maurice?

OCD

Whenever Tania eats at a restaurant, she thinks about the number of people who may have touched her silverware. When no one is looking, she puts the silverware into her pocket, goes to the ladies room, and washes the silverware in hot water several times, without ever feeling like they are clean. Tania might be suffering from

OCD

Roald is a clinician. A new patient has been admitted to the hospital for evaluation when he threatened his girlfriend and repeatedly telling her that he knew she was cheating on him. Roald has determined that in order to diagnose the patient, he needs to differentiate between delusional disorder and schizophrenia. Which one of the following situations would contribute to Roald diagnosing delusional disorder?

On the unit, the patient functions well, gets along, and does not show any unusual behaviors.

A person with a specific phobia experiences extreme distress in response to a particular stimulus or situation. How does a person who has a specific phobia respond to the stimuli differently than someone with agoraphobia?

Once the stimulus has been removed, a person can recover from extreme fear reaction.

For the past 12 years, Ryan has suffered from flashbacks in which he relives the horrors of his nine months of active duty while he was deployed in Iraq. While in Iraq, Ryan witnessed and experienced a number of traumatic incidents. He spoke about fellow soldiers who were killed and injured in service and talked about survivor's guilt. One of his most vivid memories involves a convoy that he witnessed being hit by improvised explosive devices. He has flashbacks that occur unexpectedly in the middle of the day, and Ryan is thrown back into the emotional reality of his war experiences. Ryan has found that alcohol provides the only escape that he needs when he feels distressed about the flashbacks. Ryan has developed which disorder?

PTSD

Rasheem is a 31-year-old man who was discharged from the army in 2015 after serving two tours of duty in Iraq. He has been experiencing significant difficulty sleeping and has nightmares. During his second tour, he experienced trauma he has never spoken with anyone about, but he talks about having intrusive memories of the traumatic events. He avoids anything that makes him think of his time in combat and he spends much of his time alone because seeing friends makes him feel irritable, and he doesn't want to snap at anyone. He is easily startled by noise and motion and is unnecessarily hypervigilant. His wife urges him to see a psychologist because he is "not the man that she married." The psychologist most likely diagnosed Rasheem with

PTSD

Audrey was a victim of molestation when she was 18 years old. Her medical evaluation revealed that she possesses two short versions of a gene that regulates the neurotransmitter serotonin. Audrey is at a significantly higher risk of developing

PTSD.

Rasheem is a 31-year-old man who was discharged from the army in 2015 after serving two tours of duty in Iraq. He has been experiencing significant difficulty sleeping and has nightmares. During his second tour, he experienced trauma he has never spoken with anyone about, but he talks about having intrusive memories of the traumatic events. He avoids anything that makes him think of his time in combat and he spends much of his time alone because seeing friends makes him feel irritable, and he doesn't want to snap at anyone. He is easily startled by noise and motion and is unnecessarily hypervigilant. His wife urges him to see a psychologist because he is "not the man that she married." The psychologist most likely diagnosed Rasheem with

PTSD.

Keyon has been experiencing extrapyramidal side effects from his antipsychotic medication that concern him greatly. What types of side effects is Keyon most likely experiencing?

Pain in his muscles, restlessness, and repetitive shrugging that he can't control.

Panic disorder is often associated with other mental health conditions. Which of the following statements is correct in distinguishing panic disorder from panic attacks:

Panic attacks are more common and panic disorder is much less common.

PANDAS

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections ** another cause for OCD Though symptoms often fade over time, low-level anxiety and OCD/TIC issues may remain permanently, and there are times where the exacerbation can take four to six months to remit. Treatment for this diagnosis includes antibiotics, IVIG (an intravenous pooled blood product comprising immunoglobulins that is used in treating immune deficiencies), plasmapheresis or plasma exchange (PEX) (a process during which the harmful auto-antibodies are removed from the blood system), and others such as cognitive-behavioral therapy (CBT), tonsillectomy, and probiotics. Generally, the best treatment for acute symptoms is antibiotics, and CBT to help manage neuropsychiatric symptoms.

Which of the following statements best describe the psychodynamic perspective in regards to OCD?

People with OCD have unconscious conflict that they are trying to cope with, and this conflict comes from a clash between the id (usually a sexual or aggressive urge) and the superego (the desire to do the right thing and follow socially acceptable behavior).

Definition of psychological disorder

Perhaps the simplest approach to conceptualizing psychological disorders is to label behaviors, thoughts, and inner experiences that are atypical, distressful, dysfunctional, and sometimes even dangerous as signs of a disorder. For example, if you ask a classmate for a date and you are rejected, you probably would feel a little dejected. Such feelings would be normal. If you felt extremely depressed—so much so that you lost interest in activities, had difficulty eating or sleeping, felt utterly worthless, and contemplated suicide—your feelings would be atypical, would deviate from the norm, and could signify the presence of a psychological disorder because they are more intense and persistent than normal feelings of rejection or disappointment. Just because something is atypical, however, does not necessarily mean it is disordered.

Which of the following statements is true with regard to the APA Guidelines for Psychological Practice with Lesbian, Gay and Bisexual Clients?

Psychologists are encouraged to recognize how their attitudes and knowledge about lesbian, gay, and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated.

etiology of OCD

Research shows that obsessive-compulsive disorder is influenced by factors. However, in the case of PANDAS, children can also be affected by OCD due to a complication with strep throat. More research is needed to understand the root cause of OCD and how/why it manifests itself in the way it does. Risk factors include a history of child abuse or other stress-inducing event.

Roland is anxious and upset. The psychologist he went to see just explained the assessment results and told him that he has schizoaffective disorder. Roland says, "What caused this? How could this happen?" What is the most accurate answer the psychologist could give?

Right now, we don't have a specific answer; it is probably due to a combination of genetic, biological, psychological, and social factors.

Wyatt v. Stickney

Right to treatment decision- established minimum standards of treatment for individuals in mental health facilities

Buddy has been diagnosed with OCD and is always concerned about his lucky numbers. Whenever he looks at dates on a calendar or chooses a day to do a particular activity, he is excessively preoccupied with lucky and unlucky numbers. From the humanistic perspective, how would this behavior be explained?

Ron is attempting to work toward self-actualization, but finds himself stuck and unable to move forward.

Rich has been a therapist for over fifteen years and most of that time he has used an assessment tool that uses random pictures to provoke an immediate response. Rich is looking to determine anxiety and depression in individuals, so he utilized the ________ for assessment.

Rorschach Inkblot Test

Although human sexual behavior is much more complex than that seen in rats, what are some parallels between animals and humans that can be drawn from research in the field of sexual motivation and behavior?

Sexual motivation and the ability to engage in sexual behavior can also be dissociated in humans.

If Stevie is showing evidence of positive signs of schizophrenia, what might that look like?

She demonstrates uncommon or unusual thoughts and behaviors.

Regina has a diagnosis of neurocognitive disorder with Lewy bodies. What are the unique symptoms that distinguishes her diagnosis from other neurocognitive disorders?

She experiences fluctuating cognition, hallucinations, and most uniquely, sleep disturbances

Sheila is a young woman who has social anxiety disorder. Which of the following case studies would indicate that Sheila is a person with social anxiety disorder?

She fears using public restrooms.

Which of the following individuals is most likely to have hoarding disorder based on the description of symptoms alone?

Sheri is a 49-year-old woman who has suffered depression and anxiety. She lives alone and works in a hospital gift shop. She has problems getting organized and has a hard time throwing away business papers, newspapers, and magazines. Her apartment is filled with books, stationery, crafts, plastic packages, cardboard boxes, and all sorts of other things. She has little room to live. Ashamed by the state of her apartment, she has told no one about her behavior and never invites anyone into her apartment. This has gone on for 10 years.

Aiko has been studying persons with schizophrenia who seem to have more negative symptoms than others with the illness. They also struggle to understand what other people are feeling during interactions or to understand why people make decisions and choices. Aiko's study participants appear to be impaired in what major area?

Social cognition

Anay has schizophrenia, hears voices, sometimes has difficulty in trying to express himself to others, and shows unusual behaviors at times. He lives in a place where his behaviors are seen as a channel or connection to the spiritual side of life, and he is physically and emotionally supported by his community and even sought out for input and insights to help others. This reduces his stress significantly, and he functions reasonably well in his community. Seeking to understand his situation in its own context is an example of what perspective?

Sociocultural perspective

Sophia is taking a typical antipsychotic for her schizophrenia while Madison was prescribed an atypical antipsychotic for her schizoaffective disorder. What is the major difference between these two drugs?

Sophia's medication is a strong antagonist for D2 receptors while Madison's is a weaker antagonist.

Lisa is a college professor who wanted to research intelligence levels. Lisa focused on the IQ of participants and looked to determine an assessment tool that would create a normal distribution of answers, she used the ________ for assessment.

Stanford-Binet Intelligence Test

Stefon is being treated in a partial hospitalization setting for schizophreniform disorder. He was placed on an atypical antipsychotic medication, but it does not seem to be working very well. Which of the following is a strategy that is likely to be attempted next by the psychiatrist?

Switch Stefon to another second-generation antipsychotic medication.

________ is a disorder that results from people taking dopamine-receptor blocking medications like antipsychotics and metoclopramide that causes people to have involuntary movements such as jerking, repetitive, and movements of the mouth (e.g, grimacing, sticking out the tongue, and smacking the lips).

Tardive Dyskinesia.

Principle E: Respect for People's Rights and Dignity

The APA general principle concerning respect for people's rights and dignity recognizes individuals' rights to privacy and confidentiality. Psychologists are to respect the individuals' rights while also acknowledging the worth of the individual by taking judicious precautions and engaging in positive, professional interactions, avoiding the influence of any personal bias towards the individual or group. This entails awareness of the vulnerabilities experienced by any particular population of people and necessitates understanding of and respect for diversity, including, but not limited to, factors concerning gender, race, religion, disability, and socioeconomic status.

ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT

The APA's Ethical Principles of Psychologists and Code of Conduct (often referred to as the Ethics Code) "provide(s) guidance for psychologists and standards of professional conduct that can be applied by the APA and by other bodies that choose to adopt them." Areas covered include but are not limited to the clinical, counseling, and school practice of psychology; research; teaching; supervision of trainees; public service; policy development; social intervention; development of assessment instruments; conducting assessments; educational counseling; organizational consulting; forensic activities; program design and evaluation; and administration. The Ethics Code applies to these activities across a variety of contexts, such as in-person, postal, telephone, internet, and other electronic transmissions. These activities shall be distinguished from the purely private conduct of psychologists, which is not within the purview of the Ethics Code.

Felipe was diagnosed with schizophrenia when he was younger and was prescribed a first-generation antipsychotic medication to reduce the intensity of his psychotic symptoms. These drugs were initially developed based on what major idea at the time?

The Dopamine Hypothesis of schizophrenia

Phillipe is a therapist who relies on several different assessment tools to inform his practice. He uses ________, mostly with his older patients, to see if a patient has any issues with cognitive decline, and relies on ________ to inform the diagnosis for many of his school-aged patients.

The Mini-Mental Status Exam; behavioral rating scales

Validity

The ability of a test to measure what it is intended to measure

epidemiology for OCD

The average onset occurs between ages 8-12 and late to early adulthood. Approximately 1 in 100 adults in the United States have obsessive-compulsive disorder. Obsessive-compulsive disorder affects about 2.3% of people at some point in their lives while rates during any given year are about 1.2%. It is unusual for symptoms to begin after the age of 35, and half of people develop problems before 20. Males and females are affected about equally and it occurs worldwide.

Principle A: Beneficence and Non-maleficence

The beneficence and non-maleficence principle of the APA general principles guides psychologists to perform work that is beneficial to others yet does not hurt anyone in the process of carrying out that work. Psychologists are to remain aware of their professional influence and the potential consequences therein on individuals and groups who seek counsel with the psychologist, especially with respect to preventing misuse or abuse, while additionally maintaining awareness of how the psychologist's own physical and mental health may influence their work. Among professional interactions and research, psychologists ought to respect and protect the rights and welfare of patients and participants.

A man fears that his body is failing him. This fear manifests in terms of constantly brushing his teeth due to fear of developing an infection; constantly checking for bumps after walking down a crowded street, and obsessing about his pain. What is this an example of?

The cultural-specific mental disorder called dhat.

Thomas has been experiencing the sensation that spiders are crawling underneath his skin. He also usually lacks emotional expressiveness in his face or voice when he interacts with others, and he can be difficult to understand sometimes due to jumping around in his sentences or using words that do not exist. What would differentiate Thomas's diagnosis between schizophrenia and schizophreniform disorder?

The duration of his symptoms (how long he has been experiencing them).

Which of the following is a difficulty of defining what it means to have a psychological disorder?

The experience of an atypical symptom alone is insufficient for defining what it means to have a psychological disorder.

Principle B: Fidelity and Responsibility

The fidelity and responsibility principle of the APA general principles inspires psychologists to cultivate a professional and scientific environment built upon trust, accountability, and ethical considerations. Psychologists are bound to the community by way of their profession and must conduct themselves in a responsible and ethical manner while also maintaining a similar check on colleagues. Furthermore, psychologists are expected to altruistically devote some of their time to the community.

Which statement is true about the APA's Ethical Principles?

The general principles represent ethical goals, but do not explicitly inform or instruct adherence to the goals.

Principle C: Integrity

The integrity principle of the APA general principles aims to encourage psychologists to engage in honest, transparent practices within all aspects of the field of psychology. That is, psychologists should not engage in behavior that could be misconstrued as dishonest, exploitative, or otherwise malicious. When deception is appropriately used (most likely during psychological research), psychologists have a responsibility to mitigate the effects of its use on the overall field.

Principle D: Justice

The justice principle of the APA general principles states that people are entitled to the advances made within the field of psychology and to the services offered by professionals within the field. Furthermore, psychologists should prevent unjust practices by remaining aware of their biases, level of competence, and area and limits of expertise.

Prevalence

The number or proportion of cases of a particular disease or condition present in a population at a given time.

American Psychiatric Association (APA) Definition According to the American Psychiatric Association (APA) (2013), a psychological disorder is a condition that is said to consist of the following:

There are significant disturbances in thoughts, feelings, and behaviors. A person must experience inner states (e.g., thoughts and/or feelings) and exhibit behaviors that are clearly disturbed—that is, unusual, but in a negative, self-defeating way. Often, such disturbances are troubling to those around the individual who experiences them. For example, an individual who is uncontrollably preoccupied by thoughts of germs spends hours each day bathing, has inner experiences, and displays behaviors that most would consider atypical and negative (disturbed) and that would likely be troubling to family members. The disturbances reflect some kind of biological, psychological, or developmental dysfunction. Disturbed patterns of inner experiences and behaviors should reflect some flaw (dysfunction) in the internal biological, psychological, and developmental mechanisms that lead to normal, healthy psychological functioning. For example, the hallucinations observed in schizophrenia could be a sign of brain abnormalities. The disturbances lead to significant distress or disability in one's life. A person's inner experiences and behaviors are considered to reflect a psychological disorder if they cause the person considerable distress, or greatly impair his ability to function as a normal individual (often referred to as functional impairment, or occupational and social impairment). As an illustration, a person's fear of social situations might be so distressing that it causes the person to avoid all social situations (e.g., preventing that person from being able to attend class or apply for a job). The disturbances do not reflect expected or culturally approved responses to certain events. Disturbances in thoughts, feelings, and behaviors must be socially unacceptable responses to certain events that often happen in life. For example, it is perfectly natural (and expected) that a person would experience great sadness and might wish to be left alone following the death of a close family member. Because such reactions are in some ways culturally expected, the individual would not be assumed to signify a mental disorder. One simple way to remember the criteria in defining psychological disorders are the four D's: deviance, dysfunction, distress, and danger (and possibly even a fifth D for the duration).[2]

Select the best response regarding the treatment of adjustment disorder.

There has been little systematic research regarding the best way to manage individuals with an adjustment disorder. However, AD sufferers with depressive or anxiety symptoms may benefit from treatments usually used for depressive or anxiety disorders.

In 1955 there were 558,239 severely mentally ill patients institutionalized at public hospitals. Based on changes in treatment of mental health, which may be a contributing factor to the drastic decrease in hospitalizations currently?

There is an increased effectiveness in treatment.

Shannel's friend comes to her for support. Her brother was recently hospitalized after a suicide attempt, and she is trying to grapple with this. She says to Shannel, "This cursed gene runs in my family, and this probably means I'm going to kill myself, too, right?" What is an accurate response that Shannel could give to her friend?

There is no one gene that causes depression; all mental illness results from multiple genes interacting.

Typically, why might a person with mental illness be hospitalized today?

They are an imminent threat to themselves or others.

Which of the following statements best describes an individual diagnosed with narcissistic personality disorder?

They are sensitive to criticism and expect admiration and special treatment from others.

A person with agoraphobia has significant disruptions to their life in which of the following ways?

They will go out of their way to avoid social situations where they do not feel safe.

Ancient Views on Mental Illness

Throughout history there have been three general theories of the etiology of mental illness: supernatural, somatogenic, and psychogenic. Supernatural theories attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin. Somatogenic theories (from the Greek word soma meaning body, therefore biological causes) identify disturbances in physical functioning resulting from either illness, genetic inheritance, brain damage, or imbalance. Psychogenic theories focus on traumatic or stressful experiences, maladaptive learned associations, and cognitions, or distorted perceptions. Etiological theories of mental illness determine the care and treatment mentally ill individuals receive. As we will see below, an individual believed to be possessed by the devil will be viewed and treated differently from an individual believed to be suffering from an excess of yellow bile. Their treatments will also differ, from exorcism to blood-letting. The theories, however, remain the same. They coexist as well as recycle over time. Trephination, as a treatment, is an example of possibly the earliest supernatural explanation for mental illness (Figure 2). Examination of prehistoric skulls and cave art from as early as 6500 BC has identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow the evil spirits trapped within the skull, that were presumed to be causing the symptoms of mental disorder, to be released (Restak, 2000). Trephination ultimately fell out of favor as a treatment for psychological disorders. Figure 2. Evidence of the ancient practice of trephination. Around 2700 BC, Chinese medicine's concept of complementary positive and negative bodily forces (yin and yang) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential (Tseng, 1973) to health and a good life. Mesopotamian and Egyptian papyri from 1900 BC describe women suffering from mental illness resulting from a wandering uterus (later named hysteria by the Greeks): the uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong-smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel). Throughout classical antiquity, we see a return to supernatural theories of demonic possession or godly displeasure to account for abnormal behavior that was beyond the person's control. Temple attendance with religious healing ceremonies and incantations to the gods were employed to assist in the healing process. Hebrews saw madness as punishment from God so treatment consisted of confessing sins and repenting. Physicians were also believed to be able to comfort and cure madness, however. Greek physicians rejected supernatural explanations of mental disorders. It was around 400 BC that Hippocrates (460-370 BC) attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids (i.e., humors)—blood, yellow bile, black bile, and phlegm—was responsible for physical and mental illness. For example, someone who was too temperamental suffered from too much blood and thus blood-letting would be the necessary treatment. Hippocrates classified mental illness into one of four categories—epilepsy, mania, melancholia, and brain fever—and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. Mentally ill individuals were cared for at home by family members and the state shared no responsibility for their care. Humorism remained a recurrent somatogenic theory up until the 19th century. While Greek physician Galen (AD 130-201) rejected the notion of a uterus having an animistic soul, he agreed with the notion that an imbalance of the four bodily fluids could cause mental illness. He also opened the door for psychogenic explanations for mental illness by allowing for the experience of psychological stress as a potential cause of abnormality. Galen's psychogenic theories were ignored for centuries, however, as physicians attributed mental illness to physical causes throughout most of the millennium.

In regards to PTSD, what is the cognitive theory approach?

Traumatic events disrupt a person's perspective on life and the world around them, which ultimately creates a negative viewpoint that has lasting damage, resulting in chronic stress symptoms seen in PTSD.

Olivia is interested in research into schizophrenia. In particular, she wants to understand the role of genetics versus environmental influences in the development of the disorder. Which of the following is the best explanation of why she should avoid using the twin study design?

Twins share physical and social environments so this could interfere with separating the two influences.

Steve has brought his son in for evaluation because his son has begun to say very strange things about being persecuted and at times when he speaks, his sentences do not make any logical sense. This has been going for about a week, and the family has no history of schizophrenia spectrum disorders. After assessment, assuming that Steve's son may be suffering from brief psychotic disorder, what treatment approach would you suggest be considered first?

Use of second-generation antipsychotic medication with follow-up for several months.

treatment for OCD

Various treatments exist for obsessive-compulsive disorders and they range from self-help tools to in-patient care depending on the severity of symptoms. SSRIs are often prescribed. Cognitive-behavioral therapy (CBT) is effective, particularly exposure and response prevention (EX/RP), which involves exposure to the situation that triggers compulsions and then not performing the ritual.

Gina recently was having problems with her boyfriend and has become increasingly frustrated with his unwillingness to help around their house with most things. Gina has talked to her friends and they suggested she go to a therapist. By opting to go to therapy herself, Gina's therapy is considered

Voluntary

Santiago is talking to a friend about the module on schizophrenia in his psychopathology course. The friend says, "That's the one they always show in the movies, right? It's the one that's like a disease and you just inherit it and can't do anything about it, right?" What is the most accurate reply Santiago can make to inform his friend?

Well, genetics are involved, but it's complicated and psychological and other influences are also important.

Stephanie is a child psychologist within a school district. Stephanie is looking for an assessment tool that may help in diagnosing learning disabilities, such as dyslexia and dyscalculia. Stephanie will use the ________ in working with children.

Weschler Intelligence Scale for Children

acceptance and commitment therapy (ACT)

a behavioral treatment based on accepting emotions, choosing goals, and taking action to keep commitments to change behaviors

transference

a client's distorted perceptions of a therapist

Lydia has cancer and has been going to chemotherapy. Her nurses are very supportive and helpful, but during treatment, Lydia feels dizzy and becomes nauseated, even throwing up sometimes during treatment. One day, at the store, she sees one of her nurses and after saying hello, feels nauseated and dizzy. This means that as a result of Lydia's experience, the nurse has become:

a conditioned stimulus

safety behavior

a coping strategy designed to reduce anxiety in social situations by reducing the chance of negative outcomes

substituted judgement

a decision made by a person on behalf of a person who is incompetent and unable to decide for himself or herself

It is now eleven o'clock and Tyrone has not come out of his room nor had breakfast. Slightly concerned, his roommate knocks on the door and peeks into his room to find Tyrone hiding behind his desk. When he asks what is going on, Tyrone says that he knows that the Residential Assistant is monitoring his thoughts and plans to take over his body when he sees him next. What psychotic symptom is Tyrone experiencing?

a delusion

Dysthmia

a depressive disorder where the symptoms are generally less severe than for major depressive disorder, but are present most days and persist for at least 2 years

separation anxiety disorder

a disorder that is characterized by excessive fear of separating from a caregiver

Anthony has recently been feeling anxious due to multiple factors in his life. Anthony has been anxious because of working full-time, going to school full-time, and the stress of taking care of one of his family members. Anthony's family has taught him that individuals that go to therapy are insane and discussed the shame that goes with being treated for any mental illness. Anthony did not seek treatment until he was hospitalized due to the anxiety. Anthony's example is consistent with

a felt stigma

contingency management

a form of treatment that revolves around a reward system with verbal or tangible reinforcement requiring parental involvement

Competencies

a measurable pattern of knowledge, skill, abilities, behaviors, and other characteristics that an individual needs to perform work roles or occupational functions successfully

guardian

a person authorized to give consent on behalf of a person who is unable to decide for himself or herself

A diagnosis of schizoid personality disorder is made when an individual displays which of the following characteristics?

a pervasive pattern of detachment from and disinterest in social relationships, emotional flatness, and a preference for solitary activities

ALI rule

a recommended rule for instructing juries how to find a defendant in a criminal trial is not guilty by reason of insanity; the focus is on the acts and mental state of a defendant at the time he committed the acts constituting the crime

Carl is afraid of heights. He has which type of anxiety disorder?

a specific phobia

Emerson is extremely afraid of heights. He has which type of anxiety disorder?

a specific phobia

hysteria

a temporary loss of cognitive or motor functions, usually as a result of emotionally upsetting experiences greek- describe women suffering from mental illness resulting from a wandering uterus

behavior therapy

a therapy focused on changing behavior; helping patients cope with an anxiety-producing situation by replacing fear with an alternative response

systematic desensitization

a type of exposure therapy consisting of gradual exposure to a feared stimulus that is paired with relaxation training

flooding

a type of exposure therapy when a patient is exposed to high-anxiety inducing situations instead of gradual exposure

Shanza is studying to be a psychologist, and in their class they have been having extended discussions concerning the development of cultural competence. Which of the following is a critical aspect of developing this set of skills?

acceptance of one's own cultural identity, assumptions, beliefs, and behaviors

Lashon was violently attacked in a dark parking lot after work a week ago. Her assaulter took her purse and her car and left her for dead. She is constantly re-experiencing the event through images, dreams, thoughts, and flashbacks. She finds herself avoiding situations that might make her think about the trauma, but she is still so anxious that she cannot concentrate or sleep. Lashon is likely suffering from

acute stress disorder

Elijah is a 25-year-old sales clerk in a sporting goods store who was psychologically healthy until two weeks ago when he survived a wildfire that destroyed his apartment building. He was treated and released within several hours from the emergency room. Since the fire, Elijah has been tormented by vivid images of waking to see his apartment filled with smoke. He described himself as having irritable behavior and angry outbursts (with little or no provocation) toward his friends. At other times, he felt as if he were in a daze, seemingly numb. Elijah continued to experience these symptoms for several weeks, after which they gradually subsided. His symptoms suggest that he might have been suffering from

acute stress disorder.

Lashon was violently attacked in a dark parking lot after work a week ago. Her assaulter took her purse and her car and left her for dead. She is constantly re-experiencing the event through images, dreams, thoughts, and flashbacks. She finds herself avoiding situations that might make her think about the trauma, but she is still so anxious that she cannot concentrate or sleep. Lashon is likely suffering from

acute stress disorder.

The anxiety disorder that is similar to PTSD, but describes a disorder that lasts between three days and one month of a traumatic event, is referred to as

acute stress disorder.

Tianna was a sixteen-year-old Hispanic female who was living in a shelter after being removed from her aunt's house by the child welfare agency. She was living in the shelter for three months. During her interview with a counselor, she reported feelings of worry and anxiety and stated she was very sad. She felt sad every day almost all day long, and her sadness got worse after going to the shelter. She also complained of poor concentration and feelings of hopelessness and she said; "I feel like I will be sad for the rest of my life." Tianna may be experiencing

adjustment disorder

Farzad recently moved several states away from home to live on campus as a freshman. He grew up in a tight-knit family in a small, rural community where he had close friends and positive relationships. He'd chosen this university because it hadn't seemed overwhelmingly large but now that he's here, in a new living situation, surrounded by people he doesn't know, he feels overwhelmed anyway. Always a straight-A student, Farzad is halfway through the semester and having difficulty with his courses. He had a panic attack right before a midterm exam and was referred to counseling by his professor. At the counseling center, he talks to a therapist about feelings of sudden depression, anxiety, and the physical symptoms that he can't explain: chest pain, fatigue, and frequent headaches. His therapist explains he is likely experiencing

adjustment disorder.

Tianna was a sixteen-year-old Hispanic female who was living in a shelter after being removed from her aunt's house by the child welfare agency. She was living in the shelter for three months. During her interview with a counselor, she reported feelings of worry and anxiety and stated she was very sad. She felt sad every day almost all day long, and her sadness got worse after going to the shelter. She also complained of poor concentration and feelings of hopelessness and she said; "I feel like I will be sad for the rest of my life." Tianna may be experiencing

adjustment disorder.

Taylor was bullied by his classmates until he changed schools. Now, as a teenager, he has a strong urge to escape social situations with his peers. He experiences an overwhelming urge to escape from the room and starts to have an intense physical reaction where he feels panicked to the point he cannot breathe, feels very hot, and starts sweating profusely. What anxiety disorder does Taylor likely have?

agoraphobia

Zander was bullied by his fraternity brothers in college. Now, as an adult, he has a strong urge to escape social situations with groups of male peers. He experiences an overwhelming urge to escape from the room and starts to have an intense physical reaction where he feels panicked to where he cannot breathe, feels very hot, and starts sweating profusely. What anxiety disorder does Zander most likely have?

agoraphobia

A diagnosis of dependent personality disorder can be made based on an individual displaying which of the following characteristics?

allowing others to make their decisions for them, a lack of self-confidence, and the ability to do things on their own

social anxiety disorder

also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life

During a clinical interview, Elliott displays clear negative symptoms of schizophrenia. What does this refer to?

an absence or reduction of common behaviors, reactions, and emotions

insanity defense

an affirmative defense by excuse in a criminal case, arguing that the defendant is not responsible for his or her actions due to an episodic or persistent psychiatric disorder at the time of the criminal act

selective mutism

an anxiety disorder characterized by an absence of speech in particular social situations in which a person is expected to speak

specific phobia

an anxiety disorder characterized by excessive, distressing, and persistent fear or anxiety about a specific object or situation

generalized anxiety disorder (GAD)

an anxiety disorder characterized by excessive, uncontrollable, and often irrational worry about events or activities

categorical approach

an approach to classifying mental disorders involving assessment of whether an individual has a disorder on the basis of symptoms and characteristics that are described as typical of the disorder

anxiety

an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination

behavioral Inhibition

an inherited trait characterized by a consistent tendency to show fear and restraint when they are faced with a new social interaction or situation

case study

an observation technique in which one person is studied in depth in the hope of revealing universal principles

When he was growing up, Booker's parents were harsh and punishing much of the time. Freud would say that as a result of this, that Booker has become perfectionistic and neat, very careful and cautious, rarely giving much to others, and stubborn. Freud would say that Booker was fixed in which psychosexual stage?

anal

Considering past treatments for electroconvulsive therapy, current administration of the procedure includes ________, which has shown to be more humane.

anesthesia

Jamie was hospitalized for his schizophrenia during an active psychotic episode. While he was in the hospital, the psychiatrist prescribed an antipsychotic medication to help reduce his symptoms, especially the hallucinations and delusions. The drug that he was given could be classified as what kind of agent?

antagonist

Which of the following pharmacological treatments have shown to considerably reduce the frequency and intensity of both deviant sexual arousal and behavior?

antiandrogens

treatment for PANDAS

antibiotics, CBT

Shirley is a 50-year-old woman who recently became a widow. After losing her spouse Shirley fell into a deep depression, lost intrinsic motivation, and became incredibly lethargic. The doctor prescribed an SSRI medication to help her manage her emotions and improve her quality of life. The medication helped, but she stayed on these medications for 10 years and at 60-years-old she began to notice she had involuntary muscle movements, weakness, and rigidity. What disorder does Shirley have?

antidepressant-associated movement disorder.

agoraphobia

anxiety disorder characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape if one experiences symptoms of a panic attack

panic disorder

anxiety disorder characterized by unexpected panic attacks, along with at least one month of worry about panic attacks or self-defeating behavior related to the attacks

Gender confirmation surgery (or sexual reassignment surgery) refers to

any form of surgical procedure performed on a transgender person in order to change their sex characteristics to better reflect their gender identity.

Timo tested positive for HIV several years ago, but takes highly active antiretroviral therapy and has thus far avoided any serious side effects that could potentially lead to neurocognitive disorder due to HIV. Behavioral signs of the disoder that Timo should look for include

apathy or lethargy.

Obsessive-compulsive and related disorders

are a group of overlapping disorders that generally involve intrusive, unpleasant thoughts, and repetitive behaviors. *elevate unwanted thoughts and repetitive behaviors to a status so intense that these cognitions and activities disrupt daily life.

mental health disorder

are conditions characterized by abnormal thoughts, feelings, and behaviors defined by significant disturbances in thoughts, feelings, and behaviors. These disturbances must reflect some kind of dysfunction (biological, psychological, or developmental), must cause significant impairment in one's life, and must not reflect culturally expected reactions to certain life events.

locus coeruleus

area of the brainstem that contains norepinephrine, a neurotransmitter that triggers the body's fight-or-flight response; has been implicated in panic disorder

orbitofrontal cortex

area of the frontal lobe involved in learning and decision-making ** people with OCD have higher connectivity in this region during symptom provocation **Additionally, researchers have discovered that people diagnosed with OCD actually show under-activation of brain areas responsible for stopping habitual behavior.[1]

negative correlation

as one variable increases, the other decreases

supernatural theories

attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin.

Longitudinal research is complicated by high rates of

attrition

Behavior modification programs have been shown to reduce recidivism in sex offenders. Which forms of therapy have had the most ethical challenges?

aversion therapy

Which of the following examples describe the key characteristics of avoidant personality disorder?

avoids socializing due to extreme sensitivity to negative evaluations and fears of criticism or rejection

b

b

OCD circuit

basal ganglia, anterior cingulate cortex, prefrontal/ orbitofrontal cortex

The cause of social anxiety disorder is unclear, but it is hypothesized to be a combination of genetic and environmental factors. Which of the following describes the genetic component of social anxiety disorder?

behavioral inhibition

compulsion

behaviors that create an urge to repeat an action over and over

exposure therapy

being exposed with a feared stimulus until the anxiety associated with the contact subsides

Which of the following anti-anxiety drugs is most effective in treating a person with generalized anxiety disorder?

benzodiazepines

Present-day research into genetic variation, hormones, and differences in brain functioning and brain structures suggests evidence for what kinds of etiological factors associated with gender dysphoria?

biological

The use of anti-anxiety drugs represent which of the major psychological perspectives related to treatment for anxiety disorders?

biological

These OCD-related disorders

body dysmorphic disorder, hearing disorder, trichotillomania, and excoriation.

Aliya is overly conscious about a mole on her cheek that she has had since birth. She usually spends several hours during the day before the mirror re-applying make-up on the mole. Even though friends and family reassure her that the mole is barely visible, Aliya wants to have plastic surgery to remove it. Aliya's behavior is most likely to be associated with which of the following disorders?

body dysmorphic disorder.

Marc is 30 years old and thinks that the bald spot on his head makes him look old and unattractive. He is overly conscious of his appearance and spends a lot of time looking in the mirror to see if his bald spot is visible. He has also tried many treatments, such as topical creams and steroid injections, to get his hair to grow back. He has spent a lot of time and money on various remedies, but none have been successful. Now he avoids social gatherings. Marc displays signs of

body dysmorphic disorder.

Ryan engages in impulsive and risky behaviors. She frequently makes suicidal references and has a history of self-injurious behaviors. She experiences chronic feelings of emptiness and loneliness, which has led to an unstable sense of self and unhealthy relationships. Her behavior most closely reflects which of the following personality disorders?

borderline

Struggling with chronic depression and feelings of emptiness, Raven has recently been hospitlaized for attempted suicide. She feels that she is worthless and fears that all her loved ones will leave her all alone. She has trouble defining herself, as her moods are erratic and behaviors impulsive. Raven is most likely struggling with which of the following personality disorders?

borderline

Jennyfer experiences chronic feelings of loneliness and emptiness. She spends most of her time home alone watching TV and drinking alcohol. Jennyfer has a tendency to then engage in risky or dangerous behaviors such as driving or spending money. She has trouble forming stable relationships and has a deep fear of abandonment. Jennyfer is displaying key characteristics of

borderline personality disorder.

Unidimensional explanations limit

both our ability to understand how a mental disorder develops and may limit our ability to find effective treatments.

In the past, this tendency led to beliefs that mental disorders were caused

by divine disfavor, demonic possession, or bodily humors

attachment figure

caregivers or adults to whom the individual is attached

In the context of descriptive research methods in psychology, ________ are performed by clinical psychologists for the purpose of having an up-close, in-depth, and detailed examination of an individual's course of treatment.

case studies

Etiology

cause of disease

The etiology for mental disorders is a description of its

causes

Which of the following is NOT included in the DSM-5?

causes of disorders

racial trauma

characteristics similar to PTSD caused by racial discrimination or traumatic experiences connected to race

generalized anxiety disorder (GAD)

characterized by a continuous state of excessive, uncontrollable, and pointless worry and apprehension

anxiety disorder

characterized by excessive and persistent fear and anxiety and by related disturbances in behavior

social anxiety disorder

characterized by extreme and persistent fear or anxiety and avoidance of social situations in which one could potentially be evaluated negatively by others

psychopathic or antisocial behavior

characterized by persistent antisocial behavior, impaired empathy and remorse, and bold, disinhibited, and egotistical traits). Griesinger wrote, "Psychiatry has undergone a transformation in its relation to the rest of medicine. . . . This transformation rests principally on the realization that patients with so-called 'mental illnesses' are really individuals with illnesses of the nerves and brain."[1]

obsessive-compulsive and related disorders:

characterized by the tendency to experience intrusive and unwanted thoughts and urges (obsession) and/or the need to engage in repetitive behaviors or mental acts (compulsions) in response to the unwanted thoughts and urges

Steve is a talented hockey player who has been on elite teams since he was seven years old. He is currently 18-years-old and has a history of concussions from direct hits from other hockey players. Steve is a good student who has a strong athletic career and he wants to sign with a Division I hockey team with an athletic college scholarship. His parents are hesitant to allow him to continue playing high-level hockey because they are afraid of negative cognitive consequences. Which of the following neurocognitive disorders are they afraid their son might have?

chronic traumatic encephalopathy (CTE).

involuntary commitment

civil commitment or involuntary hospitalization—a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily

PTSD learning models suggest that some symptoms are developed and maintained through

classical conditioning.

common compulsions

cleaning, checking, repeating, ordering/arranging, counting ** mental acts such as praying, reciting, counting

Oscar is a patient with Cretuztfeldt-Jakob disease. While Cretuzfeldt-Jakob disease cannot be cured, ________ can be used to address motor movement issues.

clonazepam.

Research studies have investigated predictive factors of major neurocognitive dementia disorders and found three major categories of risk factors. All of the following may increase the risk of dementia EXCEPT

cognitive ability and achievement factors.

Sally has been diagnosed with neurocognitive disorder due to Parkinson's disease. Her dementia is characterized by

cognitive and motoric slowing, executive dysfunction, and impairment in memory retrieval.

Although further research is needed on its effectiveness, Trevor is using an app on his phone to play a video game to help him train his mind to focus on positive images and thoughts in order to reduce stress and anxiety. What form of treatment is he using?

cognitive bias modification

ShaNae and Felipe are going to marriage counseling, because they have had a difficult time getting along and supporting each other in the year since their daughter was born. Which therapeutic approach is likely to be used for their treatment?

cognitive-behavioral therapy

Raymond has struggled with panic disorder for a few months and went to his school counseling center. There, he worked with a therapist to learn more about the situations that cause him anxiety and to recognize his reactions to these stressful situations. He's been working on homework each week to recognize and lower his stress responses related to taking tests and the testing center. Raymond's therapy is an example of

cognitive-behavioral therapy.

James Braid

coined term hypnosis

Which of the following psychological research methods is likely to be most effective for the purpose of determining possible increase of drug/alcohol use in a large population during the coronavirus pandemic?

computerized survey

2700 bc chinese medicine

concept of complementary positive and negative bodily forces (yin and yang) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential (Tseng, 1973) to health and a good life.

Given the complicated nature of HIV and how it affects individual patients, how would a doctor assess and diagnose a neurocognitive disorder for someone who also has HIV?

confirm the presence of HIV infection, rule out other possible CNS causes that could explain dementia, and also check for substance abuse.

How could a physician narrow down the diagnosis of neurocognitive disorder due to HIV?

confirm the presence of HIV infection, rule out other possible CNS causes that could explain dementia, and also check for substance abuse.

Which category of internet offenders uses online child grooming—persuading a youngster to have sex, online and/or offline with an adult?

contact-driven

What is the form of therapy considered as abusive and dangerous, and involves the pseudoscientific practice of trying to change an individual's sexual orientation from homosexual or bisexual to heterosexual using psychological, physical, or spiritual interventions?

conversion therapy

Research that compares multiple segments of the population at the same time is known a

cross-sectional research.

A psychological disorder encompasses all of the behaviors below except:

culturally appropriate behavior that doesn't distress or impair normal functioning

Researchers might use ________ when providing participants with the full details of the experiment if knowing the real purpose of the experiment could skew their responses.

deception

Irresistible Impulse

defense in which the defendant argues that they should not be held criminally liable for their actions that broke the law because they could not control those actions, even if they knew them to be wrong

Hank had a stroke and was hospitalized for a week. On the second day in the hospital, he began hallucinating, showing disorganized speech, and had seroius lapses in his memory. These symptoms improved alsmost completely by the time he was released. Hank was likey diagnosed with

delirium.

Impaired consciousness or changes in mental functioning that occur over the course of hours or days is

delirium.

Bianca is seen as an easy-going, but clingy person. She never disagrees with anyone and waits for other people to decide even the smallest things such as where to eat lunch. She has great difficulty initiating projects or doing things on her own, as she has very little confidence in herself. Bianca prefers to be around others, and feels very uncomfortable when she is alone. Which personality disorder would Bianca most likely be diagnosed with?

dependent

Mesopotamian and Egyptian papyri from 1900 BC

describe women suffering from mental illness resulting from a wandering uterus (later named hysteria by the Greeks): the uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong-smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel).

informed consent

details provided prior to treatment about the therapy technique, the potential risks and benefits of therapy, confidentiality and its limits, and the expected length of therapy

atypical

deviated from normal

Roberto has recently suffered from depression. Roberto's symptoms have been those of major depressive disorder, including being very depressed as well as not getting out of bed for much of anything. Susan has also shown signs of having major depressive disorder, but is able to get out of bed, though she still does not participate in activities she normally enjoys. Because they both meet the criteria for the disorder, but vary in the degree of severity, a ________ approach to describing the disorder is recommended.

dimensional

self-stigma

disgrace people assign themselves because of public stigma

Isabella is a 5-year-old child who was placed with a foster family after years of abuse and neglect. She has adjusted to her foster family, but her foster parents notice that she tends to engage in overly familiar behavior with people she has never even met—like running toward a neighbor that she has never met and jumping into his/he

disinhibited social engagement disorder.

Isabella is a 5-year-old child who was placed with a foster family after years of abuse and neglect. She has adjusted to her foster family, but her foster parents notice that she tends to engage in overly familiar behavior with people she has never even met—like running toward a neighbor that she has never met and jumping into his/her arms. A psychologist might assess whether Isabella has

disinhibited social engagement disorder.

Which type of attachment is seen most often in kids who have been abused or severely neglected?

disorganized attachment

A mental health professional's responsibility to notify a potential victim of a client's harmful intent toward that individual is referred to as

duty to warn or protect.

One of the most effective forms of intervention for neurocognitive dementia disorders is which of the following?

early diagnosis.

Maggie is sitting in the back of the class. Part of her really wants to try and beat her latest score at Candy Crush, but she feels guilty for thinking of that rather than paying attention to the professor. She finally decides that she will get on her phone during a short class break and see if she can get ahead in the game. What part of her personality led her to reach this resolution?

ego

Social anxiety disorder is often described as a condition where a person understands that anxiety is unwarranted, but the anxiety persists. Which of the following answers represents this concept?

egodystonic

Many pedophiles may not perceive anything wrong and view their perceptions and behavior as reasonable and appropriate, thus making their treatment difficult. These types of perceptions and behaviors that are acceptable to the needs and goals of the ego are called

egosyntonic

Greek physicians

ejected supernatural explanations of mental disorders. It was around 400 BC that Hippocrates (460-370 BC) attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids (i.e., humors)—blood, yellow bile, black bile, and phlegm—was responsible for physical and mental illness. For example, someone who was too temperamental suffered from too much blood and thus blood-letting would be the necessary treatment. Hippocrates classified mental illness into one of four categories—epilepsy, mania, melancholia, and brain fever—and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. Mentally ill individuals were cared for at home by family members and the state shared no responsibility for their care. Humorism remained a recurrent somatogenic theory up until the 19th century.

When Lisa was pregnant, she became ill with influenza that was passed on to her baby, Max. As a young adult, Max was diagnosed with schizophrenia. Lisa's uncle and a cousin had also been diagnosed with schizophrenia in their 20s. It appears that developing the flu while early in his development may have increased Max's chances of developing schizophrenia. What is the term used to describe this type of interaction?

epigenetics

Levi is 32 years old and during the past six months, he and his girlfriend have frequently tried to have intercourse, but each time they have become frustrated by Levi's inability to maintain an erection for more than a few minutes. When this happens, Levi becomes very upset and his anxiety gets worse every time he thinks about it. He fears he is "impotent" and will never be able to have a normal sex life, despite his girlfriend's reassurance that things will work out. Levi's condition is an example of

erectile disorder.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

essentially a classification manual that clinicians can use to read about the criteria, prevalence, risk factors, and details of over 200 disorders.

Sheila, a 26-year-old single female, who lives with her family, was admitted to an outpatient department of psychiatry. Sheila suffered from childhood sexual abuse when she was nine years old. The abuse lasted for four years. She presented complaints of excessive skin scratching of the fingers, forearms, and upper back for the last three years. However, in the past two years, the picking has been a daily routine, which was associated with emotional stress, followed by a feeling of relief after picking. She had been treated by her general practitioner and dermatologist for approximately two years, although none of the therapies provided a complete clinical result. Eventually, Sheila was diagnosed as having

excoriation (skin-picking) disorder.

When Aidymarie feels stressed, she often has an urge to pick, squeeze, or scratch at her face. When she engages in this behavior, she feels a sense of relief. A psychologist might assess whether or not Aidymarie has

excoriation disorder.

Isaac has always felt sexually inadequate. He has previously been arrested for public exposure. Each time he has "flashed" an unsuspecting young woman, jumping out at her from behind a doorway, a tree, or a car parked at the sidewalk. Isaac reported to a psychologist that he fantasized that his victim was so impressed by his sexual endowment that she pleaded for him to make love to her. In reality, Isaac has never touched any of these girls, but on several occasions after fleeing the scene, he masturbated immediately after the exposure. This is an example of which of the following disorders?

exhibitionistic disorder

Supernatural treatments

exorcism, torture, and crude surgeries

Kenya locks the door ten times after coming inside because she fears an intrusion. She recently started working with a therapist to discuss this fear, evaluate and rank its severity, and practice imagining ways to tolerate the distress she feels when she doesn't check the locks. Eventually Kenya performed exercises where she kept the doors unlocked without going near the door and started learning strategies to cope with the distress. Which type of therapy is the therapist using with Kenya?

exposure and response prevention

In a therapy session, Gail, who has a phobia of dogs, is asked to stand near a dog. This action reactivates her fear response. The therapist exposes her to dogs repeatedly while giving her support. Gail was never bit or harmed during these sessions. Eventually the fear response was reduced and she was less afraid of dogs. What specific technique is the therapist using?

extinction of the fear response" in the application of reconsolidation therapy

Josyel is asked by his therapist to talk about his traumatic experience and as he does, he tries to keep up with her finger as it moves back and forth rapidly. The therapist explained to him that this process will help him reprocess his memories to lessen the fear he has surrounding the traumatic event. What type of therapy is being used here?

eye movement desensitization and reprocessing

Josyel is asked by his therapist to talk about his traumatic experience and as he does, he tries to keep up with her finger as it moves back and forth rapidly. The therapist explained to him that this process will help him reprocess his memories to lessen the fear he has surrounding the traumatic event. What type of therapy is being used here?

eye movement desensitization and reprocessing (EMDR)

Asylums

facilities for treating the mentally ill in Europe during the Middle Ages and into the 19th century. but the patients received little to no treatment, and many of the methods used were cruel. During the 1800s, Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders.

right to treatment

federal minimum standards for the care of people with mental illness or mental retardation who reside in institutional settings

Patients suffering from paraphilic disorders rarely seek treatment voluntarily, as many individuals

feel indignity, culpability, or discomfiture.

Question Which of the following populations are the most at risk for developing panic disorder?

female children whose parents have the disorder

Which of the following populations are the most at risk for developing panic disorder?

female children whose parents have the disorder

Christine often wondered what intercourse and orgasm would feel like. She realized that she was probably missing something because her friends always described the experience as "mind blowing." In fact, she never could experience orgasm when she was with a man in any kind of sexual activity. She could feel sensual pleasure, but her response to her partners always stopped just short of climax. She is embarrassed to seek professional help, despite her ongoing distress. Which of the following sexual dysfunctions is Christine experiencing?

female orgasmic disorder

Tammy is a school teacher and has two young children. She often says that she has "no time or energy" for sex with her husband, who pressures her for intimacy. Tammy loves her husband, but she does not think about sex and has not wanted to be sexual since the birth of her second child. Although she is sad about the change this has had on her marriage, she feels no motivation to have sexual intimacy. Which of the following sexual dysfunctions is Tammy experiencing?

female sexual interest/arousal disorder

Efraín is hiking along a path in the mountains when he comes around a corner and suddenly sees the path has eroded and there is a 30-foot drop in front of him. His heart begins to pound, his breathing speeds up, and his muscles get tense. What is this reaction called and where is it located in the nervous system?

fight or flight; sympathetic nervous system

Psychogenic theories

focus on traumatic or stressful experiences, maladaptive learned associations, and cognitions, or distorted perceptions. Etiological theories of mental illness determine the care and treatment mentally ill individuals receive. As we will see below, an individual believed to be possessed by the devil will be viewed and treated differently from an individual believed to be suffering from an excess of yellow bile. Their treatments will also differ, from exorcism to blood-letting. The theories, however, remain the same. They coexist as well as recycle over time.

Denise's psychoanalyst asks her to lay on a couch in her office, to relax and close her eyes, and begin to spontaneously speak whatever thoughts come to her mind without editing them. The goal is to identify unconscious patterns or conflicts that Denise is struggling with that can then be addressed in treatment. This form of treatment is described as what?

free association

Taylor is a 65-year-old woman who is demonstrating signs of dementia. In particular, she is exhibiting unusual behaviors like washing the floor with shampoo. Emotionally, she is highly reactive and is more irritable with her spouse and grandchildren. When her daughter recently visited her she noticed that she was also having difficulty when preparing a meal. Taylor had difficulty physically moving around the kitchen and struggled with following the recipe in the correct order. What neurocognitive disorder would you suspect that Taylor is developing?

frontotemporal disorder.

Which disorder is characterized by a discrepancy between an individual's biological sex and his or her gender identity?

gender dysphoria

Samantha is a 15-year-old high school student who has an expressed desire for others to treat or perceive her as a boy; she is uncomfortable with her genitals and wishes she had a penis. It has only been six months since she has had a strong sense of being male despite how feminine others perceive her. Samantha may be diagnosed as having

gender dysphoria.

Which statement is true about general principles from the APA's Code of Conduct?

general principals and ethical goals

Seon Yeong is a young female professional who just graduated from college. She has a family history of anxiety and recently moved to a new area of the country. Seon Yeong has been struggling with feelings of anxiety for the past 10 months. On her own for the first time, she is having trouble sleeping and is also easily fatigued. She worries about financial stability, job performance, and meeting new people in a new city. When she does go out with colleagues, she feels on-edge and irritable. What anxiety disorder is Seon Yeong most likely suffering from?

generalized anxiety disorder

Causes of OCD

genetic disposition, three neurotransmitters: serotonin, dopamine, and glutamate (regulated by genes) brain region called orbitofrontal cortex (responsible for learning and decision making) the orbitofrontal cortex becomes especially hyperactive when they are provoked with tasks in which, for example, they are asked to look at a photo of a toilet or of pictures hanging crookedly on a wall (Simon, Kaufmann, Müsch, Kischkel, & Kathmann, 2010). The orbitofrontal cortex is part of a series of brain regions that, collectively, is called the OCD circuit; this circuit consists of several interconnected regions that influence the perceived emotional value of stimuli and the selection of both behavioral and cognitive responses (Graybiel & Rauch, 2000).

Research has shown a higher prevalence of gender dysphoria in monozygotic twins than dizygotic twins. As a result of this research, GD has also been identified as being associated with

genetic factors.

The distinction between Huntington's disease and Parkinson's disease is that the risk of developing Huntington's disease is dependent on

genetics.

The results of family and twin studies suggest that one of the main causes of obsessive-compulsive disorder is/are

genetics.

The timeline of exposure to feared stimuli for systematic desensitization would be described as which of the following?

gradual

James is diagnosed with trichotillomania. His therapist, who prefers behavioral treatment, has asked him to start counting numbers from 100 in the reverse order whenever he feels an intense urge to pull out his hair. According to James's therapist, such a therapy would help him to get rid of the undesirable habit by learning a new response. Which of the following is being used in this instance?

habit reversal training

Which form of therapy has the highest rate of success in treating trichotillomania, and other body-focused repetitive behaviors, and involves learning a new response to compete with troublesome behaviors?

habit reversal training

Which form of therapy has the highest rate of success in treating trichotillomania, and other body-focused repetitive behaviors, and involves learning a new response to compete with troublesome behaviors?

habit reversal training (HRT) answer

reparative therapy

has been used as a synonym for conversion therapy. There is no reliable evidence that sexual orientation can be changed, and medical institutions warn that conversion therapy practices are ineffective and potentially harmful. Some fundamentalist religious groups have used religious justification for the therapy. However, the International Rehabilitation Council for Torture Victims describes conversion therapy as a form of torture, and now various jurisdictions around the world have passed laws against conversion therapy. The American Psychiatric Association (APA) opposes psychiatric treatment "based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation" and describes attempts to change a person's sexual orientation by practitioners as unethical. There is evidence that LGBT persons resort to psychotherapy at higher rates than the non-LGBT population (Bieschke et al., 2000; King et al., 2007); hence, they may be exposed to higher risk for harmful or ineffective therapies, not only as a vulnerable group, but also as frequent users. There is an identified need for clinicians to be able to work effectively with minority clients, namely LGBT people. The APA's guidelines for psychotherapy with lesbian, gay, and bisexual client (American Psychological Association, 2000, 2012) serve as a main reference. These ethical guidelines highlight, among several issues, the need for clinicians to recognize that their own attitudes and knowledge about the experiences of sexual minorities are relevant to the therapeutic process with these clients and that, therefore, mental health care providers must look for appropriate literature, training, and supervision. There is also some disagreement within the field about the ethical implications of using a treatment that may be less effective than another known treatment, although some psychologists argue that all therapy treatments are equally effective (see: the Dodo bird verdict). The APA was also implicated in helping the Central Intelligence Agency to continue "enhanced interrogation techniques" of detainees under the Bush administration. This presented an obvious violation of the organization's code of ethics and has been addressed by the APA in the form of reports, responses to media outlets, amendments to policies, and rejections of the allegations.

Porsche just did a presentation at work; however, she had a few mistakes that were pointed out by her co-workers and her boss. She returns to her office in tears and when a friend asks what is going on, she says that she is stupid and incompetent, that her boss hates her, and that she is thinking of quitting. What aspect of this scenario fits the "C" of REBT's "A-B-C" model?

her feelings of incompetence, inability, and hopelessness

In flooding therapy, a therapist would start with what level of threatening situation?

highly threatening

Doris is a shy, eccentric 60-year-old woman living alone following the death of her mother, with whom she had lived for her whole life. At her mother's funeral, her brother Todd and his wife Cynthia try to persuade her to sell the house, especially the possessions that Doris has collected and saved over the years. Most of the items are of no value, except for sentimental reasons they cannot understand. The clutter has become hazardous, as Doris herself can hardly move through the house. There isn't anywhere to sit anymore, but Doris can manage to get to her bed, where she spends most of her time. One day, fed up, Todd and Cynthia arrive with Doris's therapist, planning on decluttering her house, but when Cynthia tries to throw out a pencil, Doris angrily throws them out of her house. Which of the following disorders is Doris likely to have?

hoarding disorder

Wyatt Standards

humane psychological and physical environment qualified and sufficient staff for administration of treatment individualized treatment plans minimum restriction of patient freedom.

Charles, a 25-year-old man, has a generalized anxiety disorder and needs treatment. His doctor is recommending treatment that exemplifies a client-centered therapy to help patients accept themselves and be less judgemental towards themselves. Which of the following answers is the correct psychological perspective?

humanistic

mesmerism

hypnotism

________ is to animal research as ________ is to human research.

iacuc; irb

Depression is strongly related to both suicidal ideation and attempt, but it lacks specificity as a predictor,r and little is known about the characteristics that increase the risk of suicide among people with depression. As part of the Australian Rural Mental Health Study, the relationship between depression and suicidal behavior was investigated. The findings of the research state that in 2018, out of 1,051 participants, 364 reported lifetime depression. Of these, 48% reported lifetime suicidal ideation and there were 58 cases of suicide attempts in 2018 due to life-time depression. This reflects the ________ of suicide attempts due to life-time depression in rural Australia during 2018.

incidence

The frequency of new cases of a disorder within a given time period is referred to as

incidence.

In a well-designed experimental study, the ________ variable is the only important difference between the experimental and control groups and we expect that the ________ variable will change as a function of that variable.

independent; dependent

concordance rate

indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder

Weschler Intelligence Scale for Children

individual intelligence test for school children 6-16

Anthony, a young man with an anxiety disorder, volunteers to participate in a psychological study so that he can earn $200. The researchers have informed him that he will be required to reflect upon his adolescence, but they do not explain this experiment is unsuitable for individuals with anxiety. During the experiment, Anthony feels quite a bit of anxiety and asks to withdraw. In this case, the ethics guideline that has most likely been violated is

informed consent

Before participating in an experiment, individuals should read and sign the ________ form.

informed consent

Lauren thought to herself one day that she wanted to find out her memory, knowledge, and verbal skills. Lauren discussed this issue with her doctor and she suggested that Lauren take a specific type of test at a local medical facility. Lauren took a/an ________ to help answer her questions.

intelligence and achievement test

After the end of her marriage, Vasna is struggling with trusting other people and predicting their behaviors, especially in romantic relationships. Vasna is always suspicious and inquisitive to a fault. As a result, she worries about being mistreated and she avoids social interactions, especially with men. Her friends are trying to help her start over in a new life, especially in the possibilities of dating. Which type of therapy would Vasna benefit from?

intolerance of uncertainty therapy

The goal of ________ therapy is to help someone reduce their anxiety by developing the ability to tolerate, cope with, and accept uncertainty.

intolerance of uncertainty therapy

Evelyn has severe suicidal ideation. Despite the fact that she does not want to be hospitalized, her doctor may begin ________ proceedings if Carol is deemed to be a danger to herself.

involuntary commitment

body dysmorphic disorder

involves an excessive preoccupation with an imagined defect in physical appearance

deception

involves purposely misleading experiment participants in order to maintain the integrity of the experiment, but not to the point where the deception could be considered harmful. For example, if we are interested in how our opinion of someone is affected by their attire, we might use deception in describing the experiment to prevent that knowledge from affecting participants' responses. In cases where deception is involved, participants must receive a full debriefing upon conclusion of the study—complete, honest information about the purpose of the experiment, how the data collected will be used, the reasons why deception was necessary, and information about how to obtain additional information about the study.

Kaufman Assessment Battery for Children

is a culturally fair standardized test that assesses intelligence and achievement

Trephination as a treatment

is an example of possibly the earliest supernatural explanation for mental illness (Figure 2). Examination of prehistoric skulls and cave art from as early as 6500 BC has identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow the evil spirits trapped within the skull, that were presumed to be causing the symptoms of mental disorder, to be released (Restak, 2000). Trephination ultimately fell out of favor as a treatment for psychological disorders.

Wilhelm Griesinger (1817-1868),

is remembered for initiating reforms in the treatment of the mentally ill as well as introducing changes to the existing asylum system. Griesinger believed in the integration of the mentally ill into society and proposed that short-term hospitalization be combined with the close cooperation of natural support systems

conversion therapy

is the pseudoscientific practice of trying to change an individual's sexual orientation from homosexual or bisexual to heterosexual using psychological, physical, or spiritual interventions.

Dr. Helen Mayberg conducted a study and found that deep-brain stimulation showed multi-year effectiveness in treating severely depressed, treatment-resistant patients. In order for her study to be considered verifiable

it must be replicable by another researcher.

Viagra is an appealing pharmacological treatment option for individuals with erectile problems because

it provides an easy, safe, and effective treatment solution for approximately 60% of men.

Kim, a nursing assistant who worked in a nursing home, worked long hours for little pay in a difficult facility. Her supervisor was domineering, unpleasant, and unsupportive; he was disrespectful of Kim's personal time, frequently informing her at the last minute she must work several additional hours after her shift ended or that she must report to work on weekends. Kim did not feel as though her hard work was appreciated, either by supervisory staff or by the residents of the home. She was very unhappy over her low pay, and she felt that many of the residents treated her disrespectfully. After several years, Kim dreaded going to work in the morning, and she gradually developed a callous, hostile attitude toward many of the residents. What Kim experienced is known as

job burnout.

Gabriella has recently felt that others are viewing her negatively. For years in school, Gabriella has felt negatively about reading, as she was diagnosed with dyslexia at age fifteen. Gabriella feels stupid and worried constantly that everyone thinks negatively about her because she has had trouble with reading since she started. This negative thought processing could be an example of

labeling theory.

least restrictive alternative

law ruling that a state cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom

Patterns of inner experience and behavior are thought to reflect the presence of a psychological disorder if they ________.

lead to significant distress and impairment in one's life

duty to warn and protect

legal requirement that the practitioner report to authoritiies situations of imminent or life threatening danger by or to a client or situations of child abuse

Olive has a diagnosis of Alzheimer's disease. She had started to leave the stove on at her house, got lost when driving into town, and got easily frustrated while shopping, often finding herself in tears. She recently moved to an assisted living facility. Doctors would describe Olive's diagnosis as

major neurocognitive disorder.

Dr. Diaz is a researcher who thinks that compared to traditional learning in a classroom setting, virtual learning will cause anxiety in young children. What steps should Dr. Diaz follow to conduct a study consistent with the scientific method?

make an observation, ask a question, form a hypothesis, do an experiment, analyze the results, prove or disprove the hypothesis

Mindy is a model with no known medical conditions, but she has recently been on an extreme diet to cope with stress. She has started showing confusion, disorientation, and extreme anxiety. Mindy is likely experiencing delirium due to

malnutrition.

stigma

meaning prejudicial attitudes and discrimination against those who experience mental disorders.

Which is NOT a category of mental disorders covered in the DSM-5?

medical and biologically influenced disorders

Regina is an 80-year-old woman who has always been able to function on her own. Up until about six months ago, Regina has been able to go to the store alone for her groceries. However, in the past six months, her daughter has noticed that she has difficulty finding the items on her list even though she has been going to the same store for 20 years. In addition, her daughter also witnessed Regina struggling to count her money and change for the store clerk. Regina can articulate what she wants and how much of each grocery item. Regina is showing signs of minor cognitive decline primarily in which of the following cognitive areas?

memory

Usually the first sign of Alzheimer's disease is/are

memory loss.

Thomas is an 80-year-old who has found pride in his ability to function independently. Up until about six months ago, Thomas has been able to go to the store alone for his groceries. However, in the past six months, his daughter has noticed that he has difficulty finding the grocery items on his list even though he has been going to the same store for 20 years. In addition, his son also witnessed him struggling to count her change for the store clerk. Thomas still can clearly state what food items he wants and how much. Thomas is showing signs of minor cognitive decline primarily in which of the following cognitive areas :

memory.

Jackie recently went to the doctor as she was having problems focusing on anything. Jackie's doctor suggested she go to a clinician. Jackie disclosed to the clinician about being distracted all the time, so the clinician asked questions about what symptoms she may have had and their potential severity. The clinician also took note of Jackie's demeanor, behavior, and her patterns of thought. Jackie's clinician was assessing during a/an

mental health examination.

Sam is a 54-year-old man whose wife died recently. Within the same year, he was diagnosed with chronic obstructive pulmonary disease. Six months following, he was dismissed from work as a construction worker because he could keep up with demands of the job. He had to sell his house and move to a different city. Sam became socially isolated and lost his appetite. If Sam were to take the Social Readjustment Rating Scale, the score might indicate that he is at risk for developing

mental health problems

Sam is a 54-year-old man whose wife died recently. Within the same year, he was diagnosed with chronic obstructive pulmonary disease. Six months following, he was dismissed from work as a construction worker because he could keep up with demands of the job. He had to sell his house and move to a different city. Sam became socially isolated and lost his appetite. If Sam were to take the Social Readjustment Rating Scale, the score might indicate that he is at risk for developing

mental health problems.

deinstitutionalization movement

mid 1960s gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms there are psychiatric hospitals run by state governments and local community hospitals, with an emphasis on short-term stays. However, most people suffering from mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to a psychiatrist or to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.

Oscar is being treated for depression. His therapist, Annalise, encourages him to notice his unpleasant thoughts and feelings without trying to avoid them, but to recognize that they are spur of the moment ideas that Oscar does not really believe. She then encourages him to meditate daily to reduce and lower stress. This is likely an example of

mindfulness-based therapy.

Excoriation disorder has a high rate of comorbidity with other psychiatric conditions, especially with

mood and anxiety disorders

Excoriation disorder has a high rate of comorbidity with other psychiatric conditions, especially with

mood and anxiety disorders.

Weschler Adult Intelligence Scale (WAIS)

most widely used intelligence test; contains verbal and performance subtests

An individual who displays an excessive need for admiration, a complete lack of empathy for others, and the belief they are superior to others and deserve special treatment would be diagnosed with which of the following personality disorders?

narcissistic

Dr. Remington does not feel that he has the necessary resources to effectively treat Amoli's condition. He gives Amoli a referral to another clinician because he lacks which of the following core competencies for psychology?

necessary knowledge and skill

Frank seems to be afraid of a lot of things. He worries about driving on the highway and about severe weather that may come through his neighborhood. But mostly he fears mice, checking under his bed frequently to see if any are present.

need more information because we don't know if his worrying is debilitating

Sylvester developed a neurocognitive dementia disorder and died within six months of his first symptom. He started with showing signs of dementia which rapidly progressed and was accompanied by jerky movements. He also developed anxiety and ataxia. Sylvester likely has

neurocognitive disorder due to prion disease.

Harold is a 55-year-old man who has started to "act off" in her family's opinion. Harold has always been an anxious person but recently he has begun to have difficulty remembering where he is, has a slower walking pace and takes shorter steps, and asks to talk to people who are not present in the room. His family is concerned about the progressive decline of their father and they take her to a neurologist. What diagnosis is the doctor likely to give him?

neurocognitive disorder with Lewy bodies.

Jason has Korsakoff's disease from long term alcohol abuse. He is showing signs of dementia as a result of the alcohol damaging the brain. How does alcohol damage the brain directly in neurocognitive dementia disorders?

neurotoxin.

Maurice is a 15-year-old high-school student referred for treatment by his health teacher, who became worried by Mark's irrational concern about getting ill and vomiting. The teacher had discussed vomiting as an involuntary response to illness. From that class forward, Maurice would shun anyone who appeared to be sick at school. His friends wondered why he wasn't talking to them. He became so obsessed with getting ill that he also started carrying hand sanitizer everywhere he went and avoided the school restrooms. He would no longer touch food that he thought might be contaminated by germs. What is the probable diagnosis for Maurice?

obsessive-compulsive disorder

Seventeen-year-old Sheri often felt very depressed and hopeless. She had several oddities at home—rearranging cutlery and turning light switches on and off—and these oddities caused annoyance with family members. She had always tried to live up to every standard (academic, religious, familial) that was placed upon her. Before every exam, she lined up her pencils, erasers, and notebooks exactly the same way, each two fingers apart. She felt a strong urge to complete this task because if she didn't, she would fail her exam. At times, the thought of failing and believing that she is a failure and therefore incapable of success made her ill. Her mother took her to see a counselor. What could be Sheri's diagnosis?

obsessive-compulsive disorder

Kyle is always concerned about harming himself or other people. He feels as if he were going crazy because these thoughts are very intrusive. To be sure that he doesn't harm himself or anyone else, he feels compelled to hide or store away sharp objects such as knives and pizza cutters. His symptoms suggests that he might be suffering from a(n)

obsessive-compulsive disorder.

Whenever Tania eats at a restaurant, she thinks about the number of people who may have touched her silverware. When no one is looking, she puts the silverware into her pocket, goes to the ladies room, and washes the silverware in hot water several times, without ever feeling like they are clean. Tania might be suffering from

obsessive-compulsive disorder.

The pervasive and inflexible need for perfectionism that interferes with one's ability to complete tasks, along with a preoccupation with details and structure are key features of

obsessive-compulsive personality disorder.

multiple relationship

occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

A negative correlation means that

one variable decreases as the other increases.

Nia is terrified of snakes. Her heart pounds and she starts profusely sweating when she even thinks about snakes. Her fear is irrational and she understands that, but she refuses to go anywhere where it is warm enough for snakes to be out in the wild. What kind of specific phobia does Nia have?

ophidiophobia

somatogenic

originating in the body

psychogenic

originating in the mind or emotions

Tracy is being treated for depression and post-traumatic stress disorder (PTSD). Her therapist has asked her to recall a recent happy experience. Tracy answers, "When I was visiting my friends last weekend," but then she is unable to recall or describe any particular events or interactions during that visit that were enjoyable or rewarding. The memory distress that Tracy is showing is called

overgeneralized autobiographical memory (OGM).

enacted stigma

overt acts of stigma and discrimination

A period of time characterized by sudden anxiety and terror is known as a

panic attack

A person with panic disorder experiences extreme distress from anxiety and what other major symptom?

panic attacks

Carol was walking down the street alone and she was attacked on her walk home. After the accident, she was shaken up but did not start experiencing extreme anxiety until six weeks later. One night as she was going home, she saw a figure approaching her and she started to feel like she could not breathe. Her heart rate increased, her vision got blurry, and she felt like she was going to die. She continues to experience this sense of alarm at least once a week. What kind of anxiety is she experiencing?

panic attacks

Iris was walking down the street alone and she was robbed on her walk home near a bus stop. After the accident, she was shaken up but did not start experiencing extreme anxiety until two weeks later. One night as she was going home, she saw a figure standing at a bus stop and she started to feel like she could not breathe. Her heart rate increased, her vision got blurry, and she felt like she was going to die. She continues to experience this sense of alarm at least once a week. What kind of anxiety disorder does Iris most likely have?

panic disorder

Men with antisocial personality disorder are more likely than women with the same diagnosis to

perform behaviors that could easily hurt others or themselves.

panic attack

period of extreme fear or discomfort that develops abruptly; symptoms of panic attacks are both physiological and psychological

obsessions

persistent ideas, thoughts, or impulses that are unwanted and inappropriate, causing marked distress

________ is an approach to treating neurocognitive dementia disorders through medication that is most effective when combined with ________ interventions.

pharmacological; behavioral/environmental.

t was common for them to believe that people with psychological disorders, or those exhibiting strange behavior, were

possessed by demons or were being punished by God or gods for their sins. Following that logic, treatment involved forcing those afflicted to take part in exorcisms, suffer imprisonment, or even face execution.

A 5-year-old boy loses his beloved uncle suddenly to an accident. Six months later, he developed problems sleeping and bedwetting. He complained of stomach aches. He always felt nervous and watchful (on guard), as if something bad were going to happen to him or his family. He began to worry about dying at a young age. He lost interest in the things he used to enjoy, like playing with friends or video gaming. To his parents, he seemed to be more aggressive than before, even violent at times. This behavior was unusual for him. He refused categorically to ride in a car, and going out in public with family became an ordeal. These symptoms seem to suggest which of the following disorders?

post-traumatic stress disorder

Connie was a victim of domestic violence for 10 years. She decided to do exposure therapy when she started having flashbacks of the trauma she had experienced. Her husband had severely abused her and she had had several hospitalizations as a result of kicks to her abdomen, stab wounds, and burns. One day, two years after leaving the abusive relationship, she recalled "feeling the pain of her broken arm" that had already healed. Connie was being treated for which disorder?

post-traumatic stress disorder

Jizaya, a victim of rape, is being treated by her psychologist through a technique called eye movement desensitization reprocessing (EMDR), followed by virtually exposing her to her most feared and hated situation. These methods of psychological treatment are most effective for

post-traumatic stress disorders.

A group of researchers studying the effects of alcohol use on academic achievement in high school asked respondents whether they drank alcohol during the past month. In this instance, the investigators were collecting ________ data.

prevalence

Minor symptoms of psychosis, problems at school or work, or a decline in social functioning are all considered ________ of schizophrenia.

prodromal symptoms

Communicating to the client the potential risks and benefits of the therapy technique and its limits is required so that the client can

provide informed consent.

Kendra's Law

provides for the state's court-ordered involuntary outpatient commitment program, termed assisted outpatient treatment (AOT).

During the late 1800s, hysteria was treated with hypnosis with some level of success compared to previous interventions. This treatment eventually led to a cathartic method and was a precursor for

psychoanalytic therapy.

Which ancient mental illness theory believed that traumatic or stressful experiences would show etiological signs of a psychological disorder?

psychogenic

Larry was having issues recently dealing with a recent breakup with his girlfriend. Larry went to the doctor and discussed his increasing depression; his doctor suggested that Larry be examined for mental illness. Larry agreed that a ________ was in order for him.

psychological assessment

A condition characterized by abnormal thoughts, feelings, and behaviors is called

psychological disorder

Multi-axial system

psychological disorder, chronic disorders, medical conditions, psychosocial stressors, global assessment of functioning

Given the complicated nature of substance abuse and how it affects individual patients, how would a doctor assess and diagnose a neurocognitive disorder?

psychological evaluation including substance abuse history, rule out other possible CNS causes that could explain dementia, and laboratory tests to assess malnutrition.

Audrey was a victim of molestation when she was 18 years old. Her medical evaluation revealed that she possesses two short versions of a gene that regulates the neurotransmitter serotonin. Audrey is at a significantly higher risk of developing

ptsd

Children who experience poverty have constant exposure to stress and trauma. It is suggested that society could improve the lives of children, their development and functioning in later life, and reduce the trauma in their lives by providing which of the following?

quality housing

Studies that investigate differences among groups from a target population without random assignment are known as

quasi-experimental.

the mini-mental status exam

quick method of screening for signs of dementia

Jake is a 4-year-old adopted boy who at the age of two years and four months was brought by his adoptive mother to a child psychiatrist with symptoms of irritability, fearfulness, emotional dysregulation, and attachment issues. The child would rarely or minimally seek comfort when distressed, nor did he respond to comfort from the adoptive mother when distressed. Little is known about Jake's early history. There is suspicion that his mother was neglectful with feeding and frequently left him crying, unattended, or with strangers. He was taken away from his mother's care at seven months due to neglect and placed with his aunt, who after two months decided she was unable to take care of him. Given the abuse pattern of neglect and repeated changes of primary caregivers in Jake's early years, the psychiatrist diagnosed him with

reactive attachment disorder.

Countertransference

redirection of a therapist's feelings toward a client or a therapist's emotional entanglement with a client

Sensate focus is a sex therapy technique that works by

refocusing the participants on their own sensory perceptions and sensuality instead of orgasm or penetrative sex.

Some argue that the DSM-5 lacks ________ because one person could be diagnosed as having a different disorder by different clinicians.

reliability

If an experiment can be easily replicated by another researcher and provide similar results, it is considered

reliable

Compulsions are

repetitive and ritualistic acts that are typically carried out primarily as a means to minimize the distress that obsessions trigger or to reduce the likelihood of a feared event

longitudinal study

research in which the same people are restudied and retested over a long period

Which type of attachment is thought to be the result of a caregiver's inconsistent level of response to their child?

resistant attachment

cultural expectations

roles are to a certain degree molded and shaped by context in which they exist

A person with social anxiety disorder will use which of the following behaviors to control their anxiety and avoid social situations?

safety behaviors

29-year old Mary was admitted to the hospital after threatening suicide. In meeting with the psychiatrist, Mary revealed that she suffered from depression for as long as she could remember, but for the past few months, she had been hearing voices telling her to do certain things. What diagnosis will Mary likely receive?

schizoaffective disorder

James works at an office where everyone is friends and socializes outside of work. Although he's always invited, James always declines to join and shows no gratitude for or interest in the offer. He would rather go home and spend the night alone. James most closely fits the characteristics of which personality disorder?

schizoid personality disorder

Although he tries a little to socialize and fit in, Oliver has always been seen by others as different. He believes he is able to communicate with spirits and dead loved ones through his sixth sense. When he talks with others, they tend to be confused and have trouble following what he is saying. Oliver is most likely to be diagnosed with which personality disorder?

schizotypal

Shanta believes she possesses a sixth sense and therefore knows her coworkers have been talking about her behind her back. Even though they have confirmed that they do not talk about her, she holds onto her suspicions and goes home after work and writes down everything she picks up on from her telepathic abilities. Shanta is displaying characteristics of which personality disorder?

schizotypal

Monica has never had any close friends, and avoids creating any intimate relationships as she believes people would view her negatively and possibly deceive or harm her. When asked about her interests, Monica expresses strange beliefs such as superstitions and communicating with spirits. Monica would most likely be diagnosed with which personality disorder?

schizotypal personality disorder

In which type of attachment is the attachment figure used as a secure base to explore the environment and sought out in times of stress?

secure attachment

There are four types of attachment styles, according to attachment theory. These are

secure attachment, avoidant attachment, resistant attachment, and disorganized attachment.

Jack is a first-grader who has refused to speak to his teacher for three months. Jack will speak to his guidance counselor, assistant teacher, and his classmates but still refuses to speak to his teacher. When his parents ask him why he will not speak to them, he does not explain why but that he does not like to. What anxiety disorder does Jack have?

selective mutism

A child undergoing treatment for selective mutism can receive medication and non-medication interventions. ________ is a specific aspect of therapeutic treatment.

self-modeling

Beth is a child who grew up in foster care for the first three years of her life. Recently, she has been placed in a foster home for adoption. After three months of living with her new family, she starts to display extreme anxiety. She experiences excessive worry about something happening to her foster parents; leaves the house; and often complains of physical symptoms like headaches, nausea, and vomiting. What anxiety disorder does Beth have?

separation anxiety disorder

Electroconvulsive therapy can be most effective and is most often used in alleviating symptoms for people with what type of mental disorder?

severe depression who have not responded to traditional drug therapy

Which of the following elevates the risk for developing PTSD?

severity of the trauma

For a number of years, Wyatt has insisted that his wife, Kaylee, submit him to pain and abusive sexual behavior. Wyatt's requests usually involved pleas that Kaylee bite his genitals, slap his face and then bind him while they were sexually intimate. Over time his requests for pain increased. He was able to get Kaylee to agree to use hot wax and whips to inflict pain. Wyatt has no interest in sexual intimacy other than that involving pain. Which of the following disorders indicates Wyatt's condition?

sexual masochism disorder

An enduring pattern of romantic or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender is called

sexual orientation.

Harry has a diagnosis of Parkinson's disease in the beginning stages. What movements would you find Harry showing?

shaking and rigidity, slowness of movement, and difficulty walking with decreased gait.

According to the APA, a psychological disorder includes significant disturbances in thoughts, feelings, and behaviors that reflect some type of dysfunction. These disturbances lead to

significant distress or disability in one's life.

Panic attacks affect your behavior _______________ as a result of feeling fear about having another panic attack and its consequences.

significantly

The influence of life experiences such as trauma and abuse, as well as the parenting style in which one is raised, reflect which of the main theoretical perspectives on the development of personality disorders?

sociocultural

Anxiety is prevalent across all types of people and is derived from many experiential experiences and physical sources. One example of anxiety-provoking experiences that can lead to an anxiety disorder is racial trauma, which consists of race-based traumatic stress from cumulative exposure to racism. What psychological perspective does racial trauma belong to?

sociocultural perspective

Which psychological perspective best matches with the following statement? The meanings linked to PTSD show cultural variations: in individualistic cultures, appraisals about a vulnerable or inadequate self are common; in collectivistic cultures, appraisals about social functioning or evaluation by others are common.

sociocultural perspective

The consistent manner of administering, scoring, and interpreting a test results in it being ________. If the test is given to a large amount of students, there will be enough data to create referential scores by which to interpret future scores, known as ________.

standardized norms

Until more modern times, psychological disorders were often viewed as

supernatural phenomenom

On the advice of his therapist, Ellis decides to treat his fear of heights by exposing himself to heights gradually, following a hierarchy they created starting with relaxing while imagining small movements upward that get progressively more anxiety-provoking and eventually moving to real-life situations. Which therapeutic method is Ellis using?

systematic desensitization

Which of the following may be considered a major controversy in regards to the diagnosis of paraphilic disorders?

systematically diagnosing sexual preference and the practice of various sexual behaviors with consenting partners as a mental disorder

Li-Jing has been in practice for many years using psychodynamic therapy. However, she thinks she can improve the results of her work by adding in some CBT elements. She goes to a CBT workshop and picks and chooses the methods she thinks would fit best with her perspective and tries them out. Later on, after a webinar on IPT, she also adds in a couple of methods she learned there into her new form of therapy. Li-Jing is using what type of approach now in her treatments?

technical eclecticism

relaxation training

techniques used to reduce anxiety that use strategies like deep breathing (control, slow, and purposeful breathing) and distraction (focusing on alternative things, grounding oneself to their senses)

Some stressors involve traumatic events or situations in which a person is exposed to actual or threatened death or serious injury. Stressors in this category include which of the following?

terrorist attacks

For PTSD, and other stress-related disorders, researchers have found that both genetics and environment play important roles in one's risk for developing PTSD due to trauma. But, genes may not be the only thing affecting the risk factor for PTSD. Recent studies have shown

that smaller hippocampal volume has been correlated with PTSD.

The timeline of emergency treatment is important for recovery from a TBI to prevent neurocognitive decline. What is the most optimal time to start treatment after a TBI?

the "golden hour".

DSM-5

the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders.

referral

the act of directing a patient to a therapist, physician, agency, or institution for evaluation, consultation, or treatment

A person with selective mutism cannot have which of the following conditions?

the failure to speak or understand the spoken language in the environment

public stigma

the general disgrace the public confers on people with mental disorder that can result in prejudice, stereotyping, and discrimination

Ford v. Wainwright

the insane cannot be executed

Debriefing

the post-experimental explanation of a study, including its purpose and any deceptions, to its participants

concordance rate:

the probability that an identical twin will show symptoms or traits of a disorder if one twin has the disorder

working alliance:

the relationship between the client and counselor, aimed at improving outcomes for the client

competence to stand trial

the right to not be prosecuted while one is incompetent to stand trial

A correlation coefficient can indicate

the strength and direction of the relationship between two variables

Angela has issues talking to anyone and has a great deal of anxiety even saying, "Good morning" to others. Angela's therapist suggested role play within therapy where she said good morning and hello, and was given a homework assignment for the following session to say hello and good morning to ten people. This is an example of

the therapist helping the client to set achievable goals.

Which of the following treatments, based on patient response and improvement, is recommended for individuals who have been diagnosed with a personality disorder in Cluster A?

the use of antipsychotic medications

Stanford-Binet

the widely used American revision (by Terman at Stanford University) of Binet's original intelligence test.

A(n) ________ is a general, tentative explanation that proposes explanations for observed behavior that can be used to predict future outcomes whereas a(n) ________ is a specific prediction about the relationship between two or more variables that is to be tested.

theory ; hypothesis

labeling theory

theory that society creates deviance by identifying particular members as deviant

A(n) ________ is a general, tentative explanation that proposes explanations for observed behavior that can be used to predict future outcomes whereas a(n) ________ is a specific prediction about the relationship between two or more variables that is to be tested

theory; hypothesis

intolerance of uncertainty therapy

therapy focused on accepting uncertainty and developing the ability to tolerate and cope with uncertainty to reduce anxiety

The cognitive model of OCD, as proposed by Paul Salkovskis, proposes that everyone will experience intrusive thoughts from time to time, but those with OCD falsely assume that

thinking about an action is the same as doing it

The cognitive model of OCD, as proposed by Paul Salkovskis, proposes that everyone will experience intrusive thoughts from time to time, but those with OCD falsely assume that

thinking about an action is the same as doing it.

The goal of behavior therapy is

to help patients cope with an anxiety-producing situation by replacing fear with an alternative response.

What best describes the purpose of the IRB?

to review proposals for research that involves human participants

Asylums were created to house individuals who suffered from psychological disorders, but what was the focus of these institutions early on?

to shelter them from society ----------------------------- were the first institutions created for the specific purpose of housing people with psychological disorders, but the focus was ostracizing them from society rather than treating their disorders. Often these people were kept in windowless dungeons, beaten, chained to their beds, and had little to no contact with caregivers.

Ethan has been having recurrent desires to wear his wife's clothes. The thought was very distressing to him, but kept coming to his mind again and again. One day when his wife left for work, he closed all the blinds in the house, wore a complete set of her clothes and masturbated in it. Ethan now keeps a small wardrobe of women's underwear, stockings, high heels, makeup, a wig, and dresses. He has been wearing the clothes secretly for the past two years solely for the purpose of pleasure. While at work, he thinks about his secret wardrobe frequently during the day, which causes him to become sexually excited. Eventually, he started wearing women's underwear under his work clothes and sneaking off to the men's room to masturbate. This is an example of

transvestic disorder.

motivational interviewing (MI)

treatment approach centered on questioning the patient so that they increase intrinsic motivation and decrease ambivalence about change; MI focuses on expressing empathy, encouraging self-efficacy, and heightening the dissonance between behaviors that are not desired and values that are not consistent with those behaviors

Rosanna was recently diagnosed with schizophrenia as she has been suffering from delusions as well as hallucinations for about a year. Rosanna has been treated with anti-psychotic psychotropic medication, which is helping her disorder. If Rosanna was suffering from her psychological disorder over 500 years ago, her treatment form may have been

trephination.

Jesse is diagnosed with obsessive-compulsive disorder. He acknowledges that he pulls his hair when he feels anxiety. He sees his broken hairs when he looks in the mirror. His psychologist, who prefers habit reversal therapy, has asked him to start counting numbers from 100 in the reverse order whenever he felt an intense urge to act on the impulse to pull out his hair. Which of the following comorbid disorders is being treated in this instance?

trichotillomania

Madison is a nine-year-old girl who often pulls out her own hair one hair at a time, and these hair-pulling episodes can last for hours at a time. She is unable to stop pulling out her hair, despite the development of several bald patches on her head. Which of the following impulse-control disorders is Madison most likely to have?

trichotillomania

Johann Weyer and Reginald Scot

tried to convince people in the mid-to late-16th century that accused witches were actually women with mental illnesses and that mental illness was not due to demonic possession but to faulty metabolism and disease, but the Church's Inquisition banned both of their writings.

Matt is starting to get into an argument with his wife. At one point, he calls her by the name of his old girlfriend, which doesn't help the situation. Although modern research does not support his strong interpretation of such behaviors, Freud believed that these types of slips revealed what?

unconscious thoughts or desires

Kerry recently went to a therapist for her anxiety and depression, as she had been suffering for the past month with the combination of both. Kerry's therapist asked her questions such as, "What can you tell me about how you feel?" "What did you feel this past month?" and "How is your family?" These assessment questions would be part of a/an

unstructured interview

incompetent

used to describe persons who should not undergo or partake in certain judicial processes, and also for those who lack mental capacity to make contracts, handle their financial and other personal matters such as consenting to medical treatment, etc., and need a legal guardian to handle their affairs

Bernardo is a therapist and has treated clients for over five years. Bernardo has to look at the DSM-5 for diagnostic codes when he assesses and diagnoses his clients. Some of Bernardo's reasoning for using these diagnostic codes is because they are

useful to insurance companies

If an experiment measures what it is supposed to measure, it is considered

valid

If a therapist uses a screening diagnostic tool that identifies someone as having bipolar disorder, but the person doesn't actually have the disorder, then there would be concerns with the ________ of the diagnosis.

validity

Camila was a victim of incest from the age of five until the age of 13. Today, at the age of 30, she has been diagnosed with a paraphilic disorder. According to John Money, her "lovemap" may been

vandalized.

Joan is an elderly woman who worked until her early seventies. She was bright, attentive, and lived an independent lifestyle, then her behavior changed gradually following a stroke. Lately, her spouse has noticed that she is having trouble maintaining her attention and navigating her environment outside of the house. Also, she is experiencing urinary incontinence multiple times per week. When her husband tells her he is concerned she tells him to bug off and lacks apathy about his concerns. What neurocognitive disorder does Joan have?

vascular

Latham is a preschooler who has verminophobia (e.g., fear of germs). Latham started going to preschool in March 2020 at the start of the COVID-19 pandemic. She constantly fears that she will contract a sickness because she was informed by her teachers, parents, and siblings that she needs to wash her hands, stand six feet away from people, and not touch her face. Which term best explains how Latham acquired verminophobia?

verbal transmission

Kadir is being treated for PTSD. He begins therapy by making a script of his traumatic memories, and then undergoes six sessions of viewing a computerized combat or war scene on a visor screen. The computerized scenes closely resemble the real combat environment that he experienced during deployment. During the sessions, he is able to converse with the therapist while actively re-experiencing his memories. What type of therapy is being used here?

virtual reality therapy (VRT)

A person's participation in a research project must be

voluntary

Gina recently was having problems with her boyfriend and has become increasingly frustrated with his unwillingness to help around their house with most things. Gina has talked to her friends and they suggested she go to a therapist. By opting to go to therapy herself, Gina's therapy is considered

voluntary

ean-Martin Charcot (1825-1893), and Ambroise Auguste Liébault (1823-1904) and Hyppolyte Bernheim (1840-1919) of the Nancy School in France,

were engaged in a bitter battle over the best explanation for hysteria, with Charcot maintaining that the hypnotic suggestibility underlying hysteria was a neurological condition while Liébault and Bernheim believed it to be a general trait that varied in the population. Josef Breuer (1842-1925) and Sigmund Freud (1856-1939) would resolve this dispute in favor of a psychogenic explanation for mental illness by treating hysteria through hypnosis, which eventually led to the cathartic method that became the precursor for psychoanalysis during the first half of the 20th century.

atypical

would deviate from the norm, and could signify the presence of a psychological disorder because they are more intense and persistent than normal feelings of rejection or disappointment. Just because something is atypical, however, does not necessarily mean it is disordered. ex: red hair,

One example of the tendency to seek simplistic answers is the commonly heard belief that mental disorders are caused by

"a chemical imbalance" in the brain.

Diagnosis of Generalized Anxiety Disorder (GAD)

A diagnosis of GAD requires that the diffuse worrying and apprehension characteristic of this disorder—what Sigmund Freud referred to as free-floating anxiety—is not part of another disorder, occurs more days than not for at least six months, and is accompanied by any three of the following symptoms: restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties. About 5.7% of the U.S. population will develop symptoms of GAD during their lifetime (Kessler et al., 2005), and females are twice as likely as males to experience the disorder (APA, 2013). GAD is highly comorbid with mood disorders and other anxiety disorders (Noyes, 2001), and it tends to be chronic. Also, generalized anxiety disorder appears to increase the risk for heart attacks and strokes, especially in people with pre-existing heart conditions (Martens et al., 2010).

Treatment

Cognitive-behavior therapy and exposure therapy are commonly used to treat specific phobias. CBT is a short-term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior and is effective in treating specific phobias. Exposure therapy is a particularly effective treatment method, as it consists of exposing a patient to the anxiety-inducing situation in manageable chunks. Medications to aid CBT have not been too promising, with the exception of adjunctive D-clycoserine.

Motivational Interviewing

A promising innovative approach to improving recovery rates for the treatment of GAD is to combine CBT with motivational interviewing (MI). Motivational interviewing (MI) is a strategy centered on the patient that aims to increase intrinsic motivation and decrease ambivalence about change due to the treatment. Motivational interviewing (MI) focuses on expressing empathy, encouraging self-efficacy, and heightening the dissonance between behaviors that are not desired and values that are not consistent with those behaviors. Motivational interviewing (MI) is based on asking open-ended questions and listening carefully and reflectively to patients' answers, eliciting "change talk," and talking with patients about the pros and cons of change. Some studies have shown the combination of CBT with MI to be more effective than CBT alone.[3] While there are as many differences in technique, the underlying spirit of the method remains the same and can be characterized in a few key points: Motivation to change is elicited from the client and is not imposed from outside forces. It is the client's task, not the counselor's, to articulate and resolve the client's ambivalence. Direct persuasion is not an effective method for resolving ambivalence. The counseling style is generally quiet and elicits information from the client. The counselor is directive, in that they help the client to examine and resolve ambivalence. Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction. The therapeutic relationship resembles a partnership or companionship.

Problems with Unidimensional Models in Understanding Mental Illness

A system is a set of elements that interact or are interdependent on one another, but forms a coherent whole and interacts with its environment and/or other systems. For example, the car or bus you use for transportation is a mechanical system. It has multiple parts that interact such as the fuel system, the electrical system, the engine, the drive train, the wheels, etc. All these parts work together in a unified way to create movement and speed. If any part of the system fails, such as the engine, the electrical system, or the wheels, the system experiences dysfunction and may no longer work well. In this example, the car is a system and its purpose is transportation or movement. Cars or buses interact with street systems, highway systems, traffic patterns and so, forth as well as gas stations and more, which represent other, larger systems of which it is a part. Similarly, our own bodies are a biological system made up of interdependent parts. Our brains, heart, circulatory system, respiration, digestion, etc., are all interdependent parts that work together. If one part of the system becomes damaged or disabled such as by high blood pressure, diabetes, or a broken leg, it affects the entire system. Our body/biological systems together make life, and of course, we interact with our environment and many other social systems around us such as the medical system, families, schools, churches, and more.

DSM-5 criteria for GAD

A. Excessive anxiety and worry that occurs more days than not for at least 6 months about many events/ activities B. Hard to control worry C. Associated with 3+ symptoms i. Restlessness/ feeling keyed up ii. Being easily fatigued iii. Difficulty concentrating/mind goes blank iv. Irritability v. Muscle tension vi. Sleep disturbance D. Anxiety, worry, physical symptoms cause clinically significant distress or impairment in social, occupation or other important areas od functioning E. Not due to direct physiological or substance or medical conditions

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is a behavioral treatment based on acceptance-based models. ACT is designed with the purpose to target three therapeutic goals: Accept emotions—reduce the use of avoiding strategies intended to avoid feelings, thoughts, memories, and sensations; Choose goals and directions—committing to these plans will decrease a person's literal response to their thoughts (e.g., understanding that thinking "I'm hopeless" does not mean that the person's life is truly hopeless), and Take action—increase the person's ability to keep commitments to changing their behaviors. ACT's goals are attained by switching the person's attempt to control events to working towards changing their behavior and focusing on valued directions and goals in their lives as well as committing to behaviors that help the individual accomplish those personal goals. ACT psychological therapy teaches mindfulness (paying attention on purpose, in the present, and in a non-judgmental manner) and acceptance (openness and willingness to sustain contact) skills for responding to uncontrollable events and therefore manifesting behaviors that enact personal values.

panic disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Have you ever gotten into a near-accident or been taken by surprise in some way? You may have felt a flood of physical sensations, such as a racing heart, shortness of breath, or tingling sensations. This type of physiological reaction is called the fight-or-flight response (Cannon, 1929) and is your body's natural reaction to fear, preparing you to either fight or escape in response to threat or danger. It is likely you are not too concerned with these sensations because you knew what was causing them. But imagine if this alarm reaction came out of the blue, for no apparent reason, or in a situation in which you did not expect to be anxious or fearful. This sudden onset is considered an unexpected panic attack or a false alarm. Because there is no apparent reason or cue for the alarm reaction, you might react to the sensations with intense fear, maybe thinking you are having a heart attack, going crazy, or even dying. You might begin to associate the physical sensations you felt during this attack with this fear and may start to go out of your way to avoid having those sensations again.

Agoraphobia

An individual may also have experienced an overwhelming urge to escape during the unexpected panic attack. This can lead to a sense that certain places or situations—particularly situations where escape might not be possible—are not safe. These situations become external cues for panic. If the person begins to avoid several places or situations, or still endure these situations but does so with a significant amount of apprehension and anxiety, then the person also has agoraphobia (Barlow, 2002; Craske & Barlow, 1988; Craske & Barlow, 2008). Agoraphobia can cause significant disruption to a person's life, causing them to go out of their way to avoid situations, such as adding hours to a commute to avoid taking the train or only ordering take-out to avoid having to enter a grocery store. In one tragic case seen by our clinic, a woman suffering from agoraphobia had not left her apartment for 20 years and had spent the past 10 years confined to one small area of her apartment, away from the view of the outside. In some cases, agoraphobia develops in the absence of panic attacks, and therefore is a separate disorder in DSM-5. However, agoraphobia often accompanies panic disorder. Agoraphobia, which literally means "fear of the marketplace," is characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape or receive help if one experiences symptoms of a panic attack. These situations include public transportation, open spaces (parking lots), enclosed spaces (stores), crowds, or being outside the home alone (APA, 2013). About 1.4% of Americans experience agoraphobia during their lifetime (Kessler et al., 2005).

Anti-Anxiety Drugs

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines (such as Valium and Xanax). Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants. Benzodiazepines used to treat anxiety disorders include the following: clonazepam alprazolam lorazepam Short half-life (or short-acting) benzodiazepines (such as lorazepam) and beta-blockers are used to treat the short-term symptoms of anxiety. Beta-blockers help manage physical symptoms of anxiety, such as trembling, rapid heartbeat, and sweating, that people with phobias experience in difficult situations. Beta-blockers block the effects of epinephrine and reduce heart rate and blood pressure. Taking beta-blockers for a short period of time can help the person keep physical symptoms under control and can be used as needed to reduce acute anxiety. Buspirone (which is unrelated to the benzodiazepines) is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. It is not useful on an as-needed basis.

How do people respond to anti-anxiety medications?

Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may even become dependent on them. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly.

Epidemiology of Separation Anxiety Disorders

Anxiety disorders are the most common type of psychopathology to occur in today's youth, affecting from 5%-25% of children worldwide. Of these anxiety disorders, separation anxiety disorder accounts for a considerable proportion of diagnoses. Separation anxiety disorder may account for up to 50% of the anxiety disorders as recorded in referrals for mental health treatment.[2] Separation anxiety disorder is noted as one of the earliest-occurring of all anxiety disorders. Adult separation anxiety disorder affects roughly 7% of adults. Research suggests that 4.1% of children will experience a clinical level of separation anxiety and 1.6% of adolescents. Of that 4.1%, it is calculated that nearly a third of all cases will persist into adulthood if left untreated. Research continues to explore the implications that early dispositions of separation anxiety disorder in childhood may serve as risk factors for the development of mental disorders throughout adolescence and adulthood. A higher percentage of children are presumed to suffer from a small amount of separation anxiety and are not actually diagnosed. Multiple studies have found higher rates of separation anxiety disorder in girls than in boys, and that paternal absence may increase the chances of separation anxiety disorder in girls. One of the difficulties in the identification of separation anxiety disorder in children is that it is highly comorbid with other behavioral disorders, especially generalized anxiety disorder. Behaviors such as refusal or hesitancy in attending school or homesickness, for example, can easily reflect similar symptoms and behavioral patterns that are commonly associated with separation anxiety disorder but could be an overlap of symptoms. The prevalence of co-occurring disorders in adults with separation anxiety disorder is common and includes a much broader spectrum of diagnostic possibilities. Common comorbidities can include specific phobias, PTSD, panic disorder, obsessive-compulsive disorder, and personality disorders.[3]

Etiology of Social Anxiety Disorder

As with specific phobias, it is highly probable that the fears inherent to social anxiety disorder can develop through conditioned experiences. For example, children who are subjected to early unpleasant social experiences (e.g., bullying at school) may develop negative social images of themselves that become activated later in anxiety-provoking situations (Hackmann, Clark, & McManus, 2000). Indeed, one study reported that 92% of a sample of adults with social anxiety disorder reported a history of severe teasing in childhood, compared to only 35% of a sample of adults with panic disorder (McCabe, Antony, Summerfeldt, Liss, & Swinson, 2003). One of the most well-established risk factors for developing social anxiety disorder is behavioral inhibition (Clauss & Blackford, 2012). Behavioral inhibition is thought to be an inherited trait, and it is characterized by a consistent tendency to show fear and restraint when presented with unfamiliar people or situations (Kagan, Reznick, & Snidman, 1988). Behavioral inhibition is displayed very early in life; behaviorally inhibited toddlers and children respond with great caution and restraint in unfamiliar situations, and they are often timid, fearful, and shy around unfamiliar people (Fox, Henderson, Marshall, Nichols, & Ghera, 2005). A recent statistical review of studies demonstrated that behavioral inhibition was associated with more than a sevenfold increase in the risk of development of social anxiety disorder, demonstrating that behavioral inhibition is a major risk factor for the disorder (Clauss & Blackford, 2012).

DAILY EXPERIENCES OF A PERSON WITH GAD

Before Treatment: "I was worried all the time and felt nervous. My family told me that there were no signs of problems, but I still felt upset. I dreaded going to work because I couldn't keep my mind focused. I was having trouble falling asleep at night and was irritated at my family all the time." After Treatment: "I saw my doctor and explained my constant worries. My doctor sent me to someone who knows about GAD. Now I am working with a counselor to cope better with my anxiety. I had to work hard, but I feel better. I'm glad I made that first call to my doctor."

Exposure and Behavioral Therapy

Behavioral therapies are types of non-medication based treatment that mainly consists of exposure-based techniques. These therapies include techniques such as systematic desensitization, emotive imagery, participant modeling, and contingency management. Behavioral therapies carefully expose individuals by small increments to slowly reduce their anxiety over time and mainly focuses on their behavior. Exposure-based therapy works under the principle of habituation that is derived from learning theory. The core concept of exposure therapy is that anxiety about situations, people, and things do not go away when people avoid the things that they fear, but rather, the uncomfortable feelings are simply kept at bay. In order to effectively diminish the negative feelings associated with the situation of fear, one must address them directly. With separation anxiety disorder, the child may be encouraged to gradually separate from their caregiver (gradual exposure). They may begin by imagining this separation, work toward increasing separation within the therapy setting, and then progress to separating in real-world situations (e.g., school). In order to administer this treatment, the therapist and the anxious child might sit together and identify progressively intense situations. As each situation is dealt with masterfully, the child advances to the next phase of intensity. This pattern continues until the child is able to handle being away from their parent in a developmentally typical way that causes them and their caregiver(s) minimal amounts of stress. While there is some controversy about using exposure therapy with children, it is generally agreed upon that exposure therapy in the context of separation anxiety disorder is acceptable as it may be the most effective form of therapy in treating this disorder and there is minimal risk associated with the intervention in this context.

While he is giving a presentation at a community center on depression, Israel hosts a Q&A session. One of the participants asks Israel a question: "So is depression caused by nature or by nurture?" What would be the most accurate answer that Israel could give?

Both. We use a biopsychosocial model to understand the many factors contributing to a disorder.

Behavior Therapy and Anxiety

CBT and exposure therapy, a type of behavior therapy, are the two most commonly used interventions in the treatment of anxiety disorders. Exposure therapy has its roots in classical conditioning. In exposure therapy, patients make contact with the feared stimuli and this contact is maintained until the anxiety associated with the contact subsides. This process is termed habituation and it can only occur if the patients are prevented from using their usual escape or avoidance behavior (extinction). Several versions of exposure exist. Systematic desensitization (SD) is on the gentler part of the spectrum. Systematic desensitization (SD) is based on the idea of reciprocal inhibition proposing that two opposite emotions can not co-exist (e.g., fear and relaxation are mutually exclusive). In systematic desensitization (SD), relaxation training is followed by gradual (usually imaginary) exposure to the feared stimuli starting with the least feared stimulus. In contrast, flooding involves immediate exposure to the stimulus. Exposure therapy has been described as the most effective way to treat fear. Research indicates that the efficacy of exposure is optimal when it is graduated, repeated, and prolonged with practice tasks clearly specified. Let's look at this case study with Jessica to see this type of therapy in practice.

Cognitive-Behavioral Therapy for Children

CBT focuses on helping children with separation anxiety disorder reduce feelings of anxiety through practices of exposure to anxiety-inducing situations and active metacognition to reduce anxious thoughts. According to Kendall and colleagues, there are four components that must be taught to a child undergoing CBT:[8] recognizing anxious feelings and behaviors discussing situations that provoke anxious behaviors developing a coping plan with appropriate reactions to situations evaluating the effectiveness of the coping plan In the application phase, individuals can take what they know and apply it in real-time situations for helpful exposure. The most important aspect of this phase is for the individuals to ultimately manage themselves throughout the process. In the relapse prevention phase, the individual is informed that continued exposure and application of what worked for them is the key to continual progress. A study investigated the content of thoughts in anxious children who suffered from separation anxiety as well as from social anxiety or generalized anxiety. The results suggested that cognitive therapy for children suffering from separation anxiety (along with social phobia and generalized anxiety) should be aimed at identifying negative cognition of one's own behavior in the threat of anxiety-evoking situations and to modify these thoughts to promote self-esteem and ability to properly cope with the given situation. Cognitive procedures are a form of treatment found to be ideal for older children with separation anxiety disorder. Cognitive procedures utilize techniques that the child's dysfunctional thoughts, attitudes, and beliefs are what lead to anxiety and cause anxious behavior. Children who are being treated with cognitive procedures are taught to ask themselves if there is evidence to support their anxious thoughts and behaviors. They are taught coping thoughts to replace previously distorted thoughts during anxiety-inducing situations, such as doing a reality check to assess the real danger of a situation and then to praise themselves for handling the situation bravely. Examples of such disordered thoughts include polarized thinking, overgeneralization, filtering (focusing on negative), jumping to conclusions, catastrophizing, emotional reasoning, labeling, "shoulds", and placing blame on self and others. Sometimes therapists will involve parents and teach them behavioral tactics such as contingency management. Relaxation training is another way to combat anxiety. Similar to that in exposure-based treatment for phobias, prior to engaging in exposure training, the individual must learn a relaxation technique to apply during the onset of panic attacks. Deep breathing (control, slow, and purposeful breathing) and distraction (focusing on alternative things, grounding oneself to their senses) are commonly used strategies.

Cognitive-Behavioral Therapy

CBT is an example of one type of psychotherapy that can help people with anxiety disorders. CBT teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT has three phases: education, application, and relapse prevention. In the education phase, the individual is informed on the different effects anxiety can have physically and more importantly mentally. Understanding and being able to recognize their reactions will help the person to manage and eventually reduce his or her overall response. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder. CBT can be conducted individually or with a group of people who have similar difficulties. Often "homework" is assigned for participants to complete between sessions. Exposure-based CBTs are effective psychosocial treatments for anxiety disorders, and many show greater treatment effects than medication in the long term (Barlow, Allen, & Basden, 2007; Barlow, Gorman, Shear, & Woods, 2000). In CBT, patients are taught skills to help identify and change problematic thought processes, beliefs, and behaviors that tend to worsen symptoms of anxiety, and practice applying these skills to real-life situations through exposure exercises. Patients learn how the automatic appraisals or thoughts they have about a situation affect both how they feel and how they behave. Similarly, patients learn how engaging in certain behaviors, such as avoiding situations, tends to strengthen the belief that the situation is something to be feared. A key aspect of CBT is exposure exercises, in which the patient learns to gradually approach situations they find fearful or distressing, in order to challenge their beliefs and learn new, less fearful associations about these situations. Typically 50-80% of patients receiving drugs or CBT will show a good initial response, with the effect of CBT more durable. Newer developments in the treatment of anxiety disorders are focusing on novel interventions, such as the use of certain medications to enhance learning during CBT (Otto et al., 2010), and transdiagnostic treatments targeting core, underlying vulnerabilities (Barlow et al., 2011). As we advance our understanding of anxiety and related disorders, so too will our treatments advance, with the hopes that for the many people suffering from these disorders, anxiety can once again become something useful and adaptive, rather than something debilitating. Among the cognitive-behavioral orientated psychotherapies the two main treatments are cognitive behavioral therapy and acceptance and commitment therapy (ACT). Intolerance of uncertainty therapy and motivational interviewing are two new treatments for GAD that are used as either stand-alone treatments or additional strategies that may enhance CBT.

Contingency Management

Contingency management is a form of treatment found to be effective for younger children with separation anxiety disorder. Contingency management revolves around a reward system with verbal or tangible reinforcement requiring parental involvement. A contingency contract is written up between the parent and the child that entails a written agreement about specific goals that the child will try to achieve and the specific reward the parent will provide once the task is accomplished. When the child undergoing contingency management show signs of independence or achieve their treatment goals, they are praised or given their reward. Contingency management facilitates a new positive experience with what used to be filled with fear and anxiety. Children in preschool who show symptoms of separation anxiety disorder do not have the communicative ability to express their emotions or the self-control ability to cope with their separation anxiety on their own, so parental involvement is crucial in younger cases of separation anxiety disorder.

Cultural Factors and Anxiety

Cultural factors that have been related to social anxiety disorder include a society's attitude towards shyness and avoidance, affecting the ability to form relationships or access employment or education, and shame. One study found that the effects of parenting are different depending on the culture: American children appear more likely to develop social anxiety disorder if their parents emphasize the importance of others' opinions and use shame as a disciplinary strategy (Leung et al., 1994), but this association was not found for Chinese/Chinese-American children. In China, research has indicated that shy-inhibited children are more accepted than their peers and more likely to be considered for leadership and considered competent, in contrast to the findings in Western countries. Research indicates that Asian cultures have lower rates of social anxiety when compared with samples from the United States or Russia.[4] Problems in developing social skills, or social fluency, may be a cause of some social anxiety disorder, through either inability or lack of confidence to interact socially and gain positive reactions and acceptance from others. The studies have been mixed, however, with some studies not finding significant problems in social skills while others have. What does seem clear is that the socially anxious perceive their own social skills to be low. It may be that the increasing need for sophisticated social skills in forming relationships or careers, and an emphasis on assertiveness and competitiveness, is making social anxiety problems more common, at least among the middle class. An interpersonal or media emphasis on "normal" or "attractive" personal characteristics has also been argued to fuel perfectionism and feelings of inferiority or insecurity regarding negative evaluation from others. The need for social acceptance or social standing has been elaborated in other lines of research relating to social anxiety. In contrast to the individualistic views of the Western culture, which emphasize individual thought, achievement, and well-being, Eastern cultures operate on collectivism, which focuses on the group and the interdependency of its members rather than any one person. The collectivism view of the self is that it can only be understood through one's social relationships and affiliations. These relationships and affiliations make up a network where the nuclear family shares the closest bonds, followed by the extended family and close friends. Although the collectivism of Eastern cultures creates a strong support system for the group, it produces many stressors that can lead to depression and anxiety. For example, the overwhelming focus on the group rather than the individual can result in feelings of a lost individual identity and sense of self. Moreover, many rules and social norms exist in collective cultures than in individual cultures to maintain the harmony of the group. This combined with the cohesiveness of the group can make social mistakes very public and result in feelings of shame and embarrassment by the individual at fault. Research indicates that these feelings are associated with social anxiety within collectivistic societies. A bigger mistake that affects an individual's reputation or results in the loss of honor has more severe consequences because of the stress associated with maintaining that honor. Taijin kyofusho, a Japanese term for those who are embarrassed about their appearance or bodies or are fearful of displeasing others, is a possible culture-specific expression of social anxiety.[5]

Laura and her friend Selena are studying together. They are trying to figure out the difference between the diathesis-stress (DS) and rGE models of mental disorders. They email you as their professor to ask for clarification. What is the most accurate answer you could give?

DS is a simpler model of simple additive effects while rGE recognizes how genetics and behaviors may interact to generate stress and trigger the diathesis.

Which of the following statements most closely aligns with the humanistic approach?

Each person is inherently good and motivated to be a healthy functioning individual.

Causes of Separation Anxiety Disorder: Risk Factors and Biological and Environmental Contributions

Factors that contribute to the disorder include a combination and interaction of biological, cognitive, environmental, child temperament, and behavioral factors. Children are more likely to develop separation anxiety disorder if one or both of their parents was diagnosed with a psychological disorder.[4] Recent research by Daniel Schechter and colleagues have pointed to difficulties of mothers who have themselves had early adverse experiences such as maltreatment and disturbed attachments with their own caregivers, who then go on to develop responses to their infants' and toddlers' normative social bids in the service of social referencing, emotion regulation, and joint attention, which responses are linked to these mothers own psychopathology (i.e., maternal post-traumatic stress disorder (PTSD) and depression.)[5] These atypical maternal responses, which have been shown to be associated with separation anxiety, have been related to disturbances in maternal stress physiologic response to mother-toddler separation as well as lower maternal neural activity in the brain region of the medial prefrontal cortex when mothers with and without PTSD were shown video excerpts of their own and unfamiliar toddlers during mother-child separation versus free-play.[6] Many psychological professionals have suggested that early or traumatic separation from a central caregiver in a child's life can increase the likelihood of them being diagnosed with separation anxiety disorder, school phobia, and depressive-spectrum disorders. Some children can be more vulnerable to separation anxiety disorder due to their temperament, for example, their level of anxiety when placed in new situations.

Treatment

For a patient like Jameela, a combination of CBT and medications is often suggested. At first, Jameela was prescribed the benzodiazepine diazepam, but she did not like the side effect of feeling dull. Next, she was prescribed the serotonin-norepinephrine reuptake inhibitor venlafaxine, but first in mild dosages as to monitor side effects. After two weeks, dosages increased from 75 mg/day to 225 mg/day for six months. Jameela's symptoms resolved after three months, but she continued to take medication for three more months, then slowly reduced the medication amount. She showed no significant anxiety symptoms after one year.[1]

Epidemiology of GAD

GAD affects 5.7% of the U.S. population. Females are two times more likely to develop GAD than males. GAD is comorbid with other anxiety or mood disorders.

The Sociocultural Perspective

Globally, in 2010, approximately 273 million (4.5% of the population) had an anxiety disorder. It is more common in females (5.2%) than males (2.8%). In Europe, Africa, and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%. In the United States, the lifetime prevalence of anxiety disorders is about 29% and between 11 and 18% of adults have the condition in a given year. This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior. In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of substance use disorder.

Introduction to Generalized Anxiety Disorder and Panic Disorder

In this section, you will learn about anxiety disorders, which are a group of disorders in which a person experiences excessive, persistent, and distressing fear and anxiety that interferes with normal functioning. Anxiety disorders can be categorized as generalized anxiety, panic disorder, phobia, agoraphobia, social anxiety, and separation anxiety. Each category of anxiety has its own unique presentation of anxiety through a person's behavior and set of anxiety symptoms. In this first section, we'll learn about generalized anxiety disorder (a relatively continuous state of tension, apprehension, and dread) and panic disorder (when a person is suddenly overwhelmed by panic).

Intolerance of Uncertainty Therapy

Intolerance of uncertainty therapy (IUT) refers to the idea that those with anxiety often experience consistent negative reactions to uncertain and ambiguous events regardless of their likelihood of occurrence. Central to the idea of intolerance of uncertainty is that someone with a high level of intolerance to uncertainty will feel that a new or uncertain situation is stressful and threatening. IUT focuses on helping patients in developing the ability to tolerate, cope with, and accept uncertainty in their life in order to reduce anxiety. IUT is based on the psychological components of psychoeducation, awareness of worry, problem-solving training, re-evaluation of the usefulness of worry, imagining virtual exposure, recognition of uncertainty, and behavioral exposure. Past research has shown support for the efficacy of this therapy with GAD patients with continued improvements in follow-up periods.[2]

Case Study: Jameela

Jameela was a successful lawyer in her 40s who visited a psychiatrist, explaining that for almost a year she had been feeling anxious. She specifically mentioned having a hard time sleeping and concentrating and increased feelings of irritability, fatigue, and even physical symptoms like nausea and diarrhea. She was always worried about forgetting about one of her clients or getting diagnosed with cancer, and in recent months, her anxiety forced her to cut back hours at work. She has no other remarkable medical history or trauma.

Case Study: Jane

Jane was a three-year-old girl, the youngest of three children of married parents. When Jane was born, she had a congenital heart defect that required multiple surgeries, and she continues to undergo regular follow-up procedures and tests. During her early life, Jane's parents, especially her mother, was very worried that she would die and spent every minute with Jane. Jane's mother was her primary caregiver as her father worked full time to support the family and the family needed flexibility to address medical issues for Jane. Jane survived the surgeries and lived a functional life where she was delayed, but met all her motor, communication, and cognitive developmental milestones. Jane was very attached to her mother. Jane was able to attend daycare and sports classes, like gymnastics without her mother present, but Jane showed great distress if apart from her mother at home. If her mother left her sight (e.g., to use the bathroom), Jane would sob, cry, and try desperately to open the door. If her mother went out and left her with a family member, Jane would fuss, cry, and try to come along, and would continually ask to video-call her, so her mother would have to cut her outings short. Jane also was afraid of doctors' visits, riding in the car seat, and of walking independently up and down a staircase at home. She would approach new children only with assistance from her mother, and she was too afraid to take part in her gymnastics performances. Jane also had some mood symptoms possibly related to her medical issues. She would intermittently have days when she was much more clingy, had uncharacteristically low energy, would want to be held, and would say "ow, ow" if put down to stand. She also had difficulty staying asleep and would periodically wake up with respiratory difficulties.[2] TRY IT

What are the possible side effects of anti-anxiety medications?

Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include nausea, blurred vision, headache, confusion, tiredness, and nightmares. Common side effects of beta-blockers include fatigue, cold hands, dizziness or light-headedness, and weakness. Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both conditions. Possible side effects from buspirone include dizziness, headaches, nausea, nervousness, lightheadedness, excitement, and trouble sleeping.

Diagnosing Social Anxiety Disorder

Many people consider themselves shy, and most people find social evaluation uncomfortable at best, or giving a speech somewhat mortifying. Yet, only a small proportion of the population fear these types of situations significantly enough to merit a diagnosis of social anxiety disorder (APA, 2013). Social anxiety disorder is more than exaggerated shyness (Bogels et al., 2010; Schneier et al., 1996). To receive a diagnosis of social anxiety disorder, the fear and anxiety associated with social situations must be so strong that the person avoids them entirely, or if avoidance is not possible, the person endures them with a great deal of distress. Further, the fear and avoidance of social situations must get in the way of the person's daily life or seriously limit their academic or occupational functioning. For example, a patient at one clinic compromised her perfect 4.0 grade point average because she could not complete a required oral presentation in one of her classes, causing her to fail the course. Fears of negative evaluation might make someone repeatedly turn down invitations to social events or avoid having conversations with people, leading to greater and greater isolation. The heart of the fear and anxiety for a person with social anxiety disorder is that they may act in a humiliating or embarrassing way, appear foolish; show symptoms of anxiety (blushing), or do or say something that might lead to rejection (such as offending others). The kinds of social situations in which individuals with social anxiety disorder usually have problems include public speaking, having a conversation, meeting strangers, eating in restaurants, and, in some cases, using public restrooms. A person with social anxiety disorder fears any situation that could potentially draw attention to the person. For example, one patient went out of her way to avoid any situation in which she might have to use a public restroom for fear that someone would hear her in the bathroom stall and think she was disgusting. If the fear is limited to performance-based situations, such as public speaking, a diagnosis of social anxiety disorder-performance only is assigned. Although many people become anxious in social situations like public speaking, the fear, anxiety, and avoidance experienced in social anxiety disorder are highly distressing and lead to serious impairments in life. For example, adults with social anxiety disorder are more likely to experience lower educational attainment and lower earnings (Katzelnick et al., 2001); perform more poorly at work; be unemployed (Moitra, Beard, Weisberg, & Keller, 2011); and report greater a dissatisfaction with their family lives, friends, leisure activities, and income (Stein & Kean, 2000).

Treatment for Panic Disorder

Panic disorder is generally treated with psychotherapy, medication, or both. A type of psychotherapy called cognitive-behavioral therapy (CBT) is especially useful as a first-line treatment for panic disorder. CBT teaches different ways of thinking, behaving, and reacting to the feelings that come on with a panic attack, which can begin to disappear once a patient learns to react differently to the physical sensations of anxiety and fear that occur during panic attacks. Some types of medications to help treat panic disorder include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers, and benzodiazepines. SSRIs and SNRIs are commonly used to treat depression, but they are also helpful for the symptoms of panic disorder. They may take several weeks to start working or may also cause side effects, such as headaches, nausea, or difficulty sleeping. Beta-blockers can help control some of the physical symptoms of panic disorder, such as rapid heart rate. Although doctors do not commonly prescribe beta-blockers for panic disorder, they may be helpful in certain situations that precede a panic attack. Benzodiazepines, which are sedative medications, are powerfully effective in rapidly decreasing panic attack symptoms, but they can cause tolerance and dependence if used continuously.

acquisition of Phobias through Learning

Many theories suggest that phobias develop through learning. Rachman (1977) proposed that phobias can be acquired through three major learning pathways. The first pathway is through classical conditioning. As you may recall, classical conditioning is a form of learning in which a previously neutral stimulus is paired with an unconditioned stimulus (UCS) that reflexively elicits an unconditioned response (UCR), eliciting the same response through its association with the unconditioned stimulus. The response is called a conditioned response (CR). For example, a child who has been bitten by a dog may come to fear dogs because of her past association with pain. In this case, the dog bite is the UCS and the fear it elicits is the UCR. Because a dog was associated with the bite, any dog may come to serve as a conditioned stimulus, thereby eliciting fear; the fear the child experiences around dogs, then, becomes a CR. The second pathway of phobia acquisition is through vicarious learning, such as modeling. For example, a child who observes his cousin react fearfully to spiders may later express the same fears, even though spiders have never presented any danger to him. This phenomenon has been observed in both humans and nonhuman primates (Olsson & Phelps, 2007). A study of laboratory-reared monkeys readily acquired a fear of snakes after observing wild-reared monkeys react fearfully to snakes (Mineka & Cook, 1993). The third pathway is through verbal transmission or information. For example, a child whose parents, siblings, friends, and classmates constantly tell her how disgusting and dangerous snakes are may come to acquire a fear of snakes. Interestingly, people are more likely to develop phobias of things that do not represent much actual danger to themselves, such as animals and heights, and are less likely to develop phobias toward things that present legitimate danger in contemporary society, such as motorcycles and weapons (Öhman & Mineka, 2001). Why might this be so? One theory suggests that the human brain is evolutionarily predisposed to more readily associate certain objects or situations with fear (Seligman, 1971). This theory argues that throughout our evolutionary history, our ancestors associated certain stimuli (e.g., snakes, spiders, heights, and thunder) with potential danger. As time progressed, the mind has become adapted to more readily develop fears of these things than of others. Experimental evidence has consistently demonstrated that conditioned fears develop more readily to fear-relevant stimuli (images of snakes and spiders) than to fear-irrelevant stimuli (images of flowers and berries) (Öhman & Mineka, 2001). Such prepared learning has also been shown to occur in monkeys. In one study (Cook & Mineka, 1989), monkeys watched videotapes of model monkeys reacting fearfully to either fear-relevant stimuli (toy snakes or a toy crocodile) or fear-irrelevant stimuli (flowers or a toy rabbit). The observer monkeys developed fears of the fear-relevant stimuli but not the fear-irrelevant stimuli.

Margaret is a woman diagnosed with generalized anxiety disorder who also has a history of family trauma. Margaret feels a surge of anxiety and calls her doctor reporting the following symptoms: chest pain and fast heart rate, difficulty breathing, nausea, headache, and stress about losing control. Margaret has no history of heart disease, but there is a family history of anxiety. She is currently undergoing lots of stress at her employment. Margaret has experienced these symptoms once a week for three months. Her doctor sends her to the ER and she gets a diagnosis of panic disorder. Why is Margaret at higher risk for panic disorder?

Margaret is a woman, has a genetic history, and experienced trauma.

Behavior Therapy in Action: How Does It Work?

Meet Jessica. She is smart, ambitious, creative, and full of energy. She is studying at a university, majoring in business. After she graduates, she wants to live in interesting places and get solid training and experience with a good corporation. Her dream is to start her own company, to be her own boss, and to do things that she can take pride in. For her, financial success and doing something worthwhile must go hand-in-hand. But Jessica has a secret. She is terrified of speaking in front of people who are not her close friends. She has fought these fears for a long time, but she has never been able to conquer them. She is also aware of the fact that she will need to be able to speak to strangers comfortably and convincingly if she is going to meet her goals in business. Now that you and your client have agreed upon your goals, it is time to choose a particular technique for the therapy. As a behavioral therapist, you are looking for a method to allow Jessica to learn a new response to the thought of public speaking. Now the idea terrifies her. After therapy is over, she should no longer be terrified and she may even look forward to the opportunity to speak in front of other people. You know that everyone is not the same and different problems may call for different approaches to therapy. For these reasons, you have been trained in a variety of techniques that you can use to customize Jessica's therapy to meet her particular needs. It is time to decide how you are going to help Jessica.

Environmental Causes

Most often, the onset of separation anxiety disorder is caused by a stressful life event, especially a loss of a loved one or pet, but can also include parental divorce, change of school or neighborhood, natural disasters, or circumstances that forced the individual to be separated from their attachment figure(s). In older individuals, stressful life experiences may include going away to college, moving out for the first time, or becoming a parent.

Regina is working on a short essay for her Abnormal Psychology class. She writes, "If the neuron's dendrites receive a few signals or mixed excitatory and inhibitory signals, then it will send a weak signal to the postsynaptic neuron, but if it receives many receptor binding signals, then it will send a strong signal to the next neuron." Is Regina correct?

No; the neuron will either launch an action potential or it will not; there are no weak or strong signals.

Treatment Non-Medication Based Treatment

Non-medication based treatments are the first choice when treating individuals diagnosed with separation anxiety disorder. Counseling tends to be the best replacement for drug treatments. There are two different non-medication approaches to treat separation anxiety. The first is a psychoeducational intervention, often used in conjunction with other therapeutic treatments. This specifically involves educating the individual and their family so that they are knowledgeable about the disorder, as well as parent counseling and guiding teachers on how to help the child. The second is a psychotherapeutic intervention when prior attempts are not effective. Psychotherapeutic interventions are more structured and include behavioral, cognitive-behavioral, contingency, psychodynamic psychotherapy, and family therapy.

Perspectives and Treatment for Anxiety Disorders

Our understanding of anxiety disorders is shaped by multiple psychological perspectives. Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include temperamental traits of shyness or behavioral inhibition in childhood; exposure to stressful and negative life or environmental events in early childhood or adulthood; a history of anxiety or other mental illnesses in biological relatives; and some physical health conditions, such as thyroid problems, heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder.

Symptoms of Generalized Anxiety Disorder (GAD)

People with GAD display excessive anxiety or worry on most days for at least six months about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. **GAD symptoms include feeling restless, wound-up, or on-edge being easily fatigued having difficulty concentrating; mind going blank being irritable having muscle tension difficulty controlling feelings of worry having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Attacks

People with panic disorder experience recurrent (more than one) and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks (e.g., avoidance of exercise or unfamiliar situations) (APA, 2013). As is the case with other anxiety disorders, the panic attacks cannot result from the physiological effects of drugs and other substances, a medical condition, or another mental disorder. A panic attack is defined as a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes. Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying (APA, 2013). Sometimes panic attacks are expected, occurring in response to specific environmental triggers (such as being in a tunnel); other times, these episodes are unexpected and emerge randomly (such as when relaxing). According to the DSM-5, the person must experience unexpected panic attacks to qualify for a diagnosis of panic disorder. Experiencing a panic attack is terrifying. Rather than recognizing the symptoms of a panic attack merely as signs of intense anxiety, individuals with panic disorder often misinterpret them as a sign that something is intensely wrong internally (thinking, for example, that the pounding heart represents an impending heart attack). Panic attacks can occasionally precipitate trips to the emergency room because several symptoms of panic attacks are, in fact, similar to those associated with heart problems (e.g., palpitations, racing pulse, and a pounding sensation in the chest) (Root, 2000). Unsurprisingly, those with panic disorder fear future attacks and may become preoccupied with modifying their behavior in an effort to avoid future panic attacks. For this reason, panic disorder is often characterized as a fear of fear (Goldstein & Chambless, 1978). Panic attacks themselves are not mental disorders and are fairly common in the United States. Approximately 23% of Americans experience isolated panic attacks in their lives without meeting the diagnostic criteria for panic disorder (Kessler et al., 2006). Panic disorder is, of course, much less common, afflicting 4.7% of Americans during their lifetime (Kessler et al., 2005). Many people with panic disorder develop agoraphobia, where they experience fear and avoidance of situations where it is difficult to or to access help during a panic attack. In addition, people with panic disorder often have another mental health disorder, a comorbid disorder, such as other anxiety disorders or a major depressive disorder (APA, 2013).

From a cognitive perspective, a person with panic disorder may have panic attacks based on the following statements?

People with panic disorder interpret normal sensations of the body as a catastrophe, which creates a fearful interpretation cycle.

specific Phobia

Phobia is a Greek word that means "fear." A person diagnosed with a specificphobia (formerly known as simple phobia) experiences excessive, distressing, and persistent fear or anxiety about a specific object or situation (such as animals, enclosed spaces, elevators, or flying) (APA, 2013). Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus (the object or situation that triggers the fear and anxiety). Typically, the fear and anxiety a phobic stimulus elicits is disruptive to the person's life. For example, a person with a phobia of flying might refuse to accept a job that requires frequent air travel, thus negatively affecting their career. Clinicians who have worked with people who have specific phobias have encountered many kinds of phobias, some of which are shown in Table 1.

Acacia inherits a variety of genes from both of her parents. These genes combine and interact with each other, some increasing her chance of developing Bipolar disorder, some possibly reducing her chances. This overall pattern of genetic inheritance for the mental disorder is called what?

Polygenic

Race and Anxiety

Racial trauma or race-based traumatic stress, is the cumulative effects of racism on an individual's mental and physical health. It has been linked to feelings of anxiety, depression, and suicidal ideation, as well as other physical health issues. Racial trauma is not included in the most recent edition of the Diagnostic and Statistical Manual on Mental Disorders (DSM-5), since it does not meet the current criteria. However, researchers such as Robert T. Carter, Thema Bryant-Davis, and Carlota Ocampo have lobbied for its addition. According to them, racial trauma evokes symptoms similar to that of post-traumatic stress disorder (PTSD), hence the push for its recognition as a viable mental health concern. The effects of race-based traumatic stress on individuals depends on their experiences, and the ways in which it can manifest itself can vary significantly as well. Individuals who are exposed to race-based trauma or stress may experience dissociative symptoms following the event. Dissociative symptoms include depersonalization, in which an individual feels disconnected from their body or mind, and derealization, in which an individual has an unreal or distorted sense of experiences. Race-based traumatic stress is a traumatic response to stress following a racial encounter. Robert T. Carter's (2007) theory of race-based traumatic stress implies that there are individuals of color who experience racially charged discrimination as traumatic, and often generate responses similar to post-traumatic stress. Race-based traumatic stress combines theories of stress, trauma, and race-based discrimination to describe a particular response to negative racial encounters. Despite the limited research that examines race-based traumatic stress specifically, trauma research suggests that an individual's response to a stressor is highly dependent on that person's perception of the stressor; what one person may experience as traumatic, another person may not experience as such. These differing responses have been found to be strongly associated with each individual's ability to cope with the said stressor. According to Carter, a professor at Columbia University, race-based traumatic stress is an individual's response to racial discrimination as traumatic or outside of their ability to cope. Race-based traumatic stress can be experienced both directly and indirectly and can occur on an interpersonal level, institutional level, or cultural level. As such, research indicates that race-based traumatic stress can be demonstrated as a number of negative outcomes, including psychopathological symptoms, social inequities, and internalized racial oppression. Research has indicated that children, as well as adults, can experience and be impacted by the reaches of race-based traumatic stress. Through direct experience from peers and/or authority figures, as well as indirectly through media exposure and/or bearing witness to the racial discrimination of their parents, research suggests children of color are particularly vulnerable to race-based traumatic stress.

Causes of Panic Disorder

Researchers are not entirely sure what causes panic disorder. Children are at a higher risk of developing panic disorder if their parents have the disorder (Biederman et al., 2001), and family and twins studies indicate that the heritability of panic disorder is around 43% (Hettema, Neale, & Kendler, 2001). The exact genes and gene functions involved in this disorder, however, are not well understood (APA, 2013). Neurobiological theories of panic disorder suggest that a region of the brain called the locus coeruleus may play a role in this disorder. Located in the brainstem, the locus coeruleus is the brain's major source of norepinephrine, a neurotransmitter that triggers the body's fight-or-flight response. Activation of the locus coeruleus is associated with anxiety and fear, and research with nonhuman primates has shown that stimulating the locus coeruleus either electrically or through drugs produces panic-like symptoms (Charney et al., 1990). Previous findings have led to the theory that panic disorder may be caused by abnormal norepinephrine activity in the locus coeruleus (Bremner, Krystal, Southwick, & Charney, 1996). Conditioning theories of panic disorder propose that panic attacks are classically conditioned responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened (Bouton, Mineka, & Barlow, 2001). For example, consider a child who has asthma. An acute asthma attack produces sensations, such as shortness of breath, coughing, and chest tightness, that typically elicit fear and anxiety. Later, when the child experiences subtle symptoms that resemble the frightening symptoms of earlier asthma attacks (such as shortness of breath after climbing stairs), he may become anxious, fearful, and then experience a panic attack. In this situation, the subtle symptoms would represent a conditioned stimulus, and the panic attack would be a conditioned response. The finding that panic disorder is nearly three times as frequent among people with asthma as it is among people without asthma (Weiser, 2007) supports the possibility that panic disorder has the potential to develop through classical conditioning. Cognitive factors may play an integral part in panic disorder. Generally, cognitive theories (Clark, 1996) argue that those with panic disorder are prone to interpret ordinary bodily sensations catastrophically, and these fearful interpretations set the stage for panic attacks. For example, a person might detect bodily changes that are routinely triggered by innocuous events such as getting up from a seated position (dizziness), exercising (increased heart rate, shortness of breath), or drinking a large cup of coffee (increased heart rate, trembling). The individual interprets these subtle bodily changes catastrophically ("Maybe I'm having a heart attack!"). Such interpretations create fear and anxiety, which trigger additional physical symptoms; subsequently, the person experiences a panic attack. Support of this contention rests with findings that people with more severe catastrophic thoughts about sensations have more frequent and severe panic attacks, and among those with panic disorder, reducing catastrophic cognitions about their sensations is as effective as medication in reducing panic attacks (Good & Hinton, 2009).

Systematic Desensitization

SD works by gradually—step-by-step—exposing the person to situations that are increasingly more anxiety-producing. The anxiety-producing event is called "progressive exposure." By learning to cope with anxiety during less-threatening situations first, the person is better prepared to handle the more threatening situations. Even more important for treatment, the mind learns that nothing horrible happens. This retraining of the subconscious mind means that the situation actually becomes less threatening. The first step in systematic desensitization is the development of a "hierarchy of fears." The hierarchy of fears simply means that you must help Jessica create a list of situations related to her fear of public speaking. Then you create a hierarchy. The creation of the hierarchy means that you have her organize the situations from the least frightening to the most frightening. For the next step in this exercise, you will need to take on Jessica's role as the client. Imagine that you have developed a list of frightening situations, from ones that make you only slightly uncomfortable to ones that nearly make you sick with anxiety. Remember that systematic desensitization works by putting the person in a series of situations. The early ones are not threatening or are only mildly threatening. However, as soon as your client learns to cope with each situation, you start working on the next most frightening situation. So we're ready to start, right? Wrong! Behavior therapy teaches the client to cope with an anxiety-producing situation by replacing fear with an alternative response. A common alternative response is relaxation. The idea is that fear and anxiety cannot coexist with relaxation—if you are relaxed, you can't be fully afraid. However, most people are not very good at relaxing on command. So the behavioral therapist will teach the client how to relax effectively. The techniques are ones often used in meditation—slow breathing and focus on positive thoughts.

Treatment for GAD

SSRIs, SNRIs, buspirone, cognitive behavioral therapy. Both psychotherapies, predominately cognitive-behavioral therapy (CBT), and medications (such as SSRIs) have been shown to be effective in reducing anxiety. A comparison of overall outcomes of CBT and medication on anxiety did not show statistically significant differences (i.e., they were equally effective in treating anxiety). To combat the cognitive and emotional aspects of GAD, psychologists often include some of the following key treatment components in their intervention plan: self-monitoring, relaxation techniques, self-control desensitization, gradual stimulus control, cognitive restructuring, worry outcome monitoring, present-moment focus, expectancy-free living, problem-solving techniques, processing of core fears, socialization, discussion and reframing of worry beliefs, emotional skills training, experiential exposure, psychoeducation, mindfulness, and acceptance exercises.

Sarah is finishing school and is in the process of applying for jobs and has received some interest from potential employers, but also some rejections. Every time that Sarah gets a rejection letter from a company, she feels anxious she will never get another job. Sarah begins to feel a chronic fear of rejection and frets about whether she will get a job. She constantly talks about the job-hunting process, compulsively checks job websites, has difficulty sleeping, and wakes up in the night to revise her resume. In addition, Sarah also finds herself being irritable with her family and colleagues. How would you describe Sarah's behavior?

Sarah exhibits signs of a person diagnosed with an anxiety disorder as her life is disrupted by her anxiety.

Separation Anxiety and Selective Mutism

Separation anxiety disorder is a disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment (e.g., a parent, a caregiver, a significant other, or siblings) called the attachment figure. It is most common in infants and small children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents, and adults. Separation anxiety is a natural part of the developmental process. Unlike separation anxiety disorder (indicated by excessive anxiety), normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem. According to the APA, separation anxiety disorder is an excessive display of fear and distress when faced with situations of separation from the home and/or from a specific attachment figure. The anxiety that is expressed is categorized as being atypical of the expected developmental level and age. The severity of the symptoms ranges from anticipatory uneasiness to full-blown anxiety about separation. Individuals with separation anxiety disorder demonstrate avoidance behaviors. Individuals "typically exhibit excessive distress manifested by crying, repeated complaints of physical symptoms (e.g., stomachaches, headaches, etc.), avoidance (e.g., refusing to go to school, to sleep alone, to be left alone in the home, to engage in social events, to go to work, etc.), and engagement in safety behaviors (e.g., frequent calls to or from significant others, or primary caregivers)."[1] Separation anxiety disorder may cause significant negative effects within areas of social and emotional functioning, family life, and physical health of the disordered individual.

Leo just came out of class where the professor was explaining how mental disorders are the result of a system of elements. He says to you that he doesn't understand why it has to be so complicated. "Why can't we just say that this one illness is due to one thing and another illness is due to something else?" he asks you. What is the most accurate response you can give him?

Simplistic answers don't help us understand what is happening or how to find better treatments.

Social Anxiety Disorder

Social anxiety disorder (formerly called social phobia) is characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others (APA, 2013). As with specific phobias, social anxiety disorder is common in the United States; a little over 12% of all Americans experience social anxiety disorder during their lifetime (Kessler et al., 2005).

Explaining GAD Diagnosis

Some people who are cognitive theorists suggest that worry represents a mental strategy to avoid more powerful negative emotions that perhaps may stem from earlier unpleasant or traumatic experiences (Aikins & Craske, 2001). Indeed, one longitudinal study found that childhood maltreatment was strongly related to the development of this disorder during adulthood (Moffitt et al., 2007); worrying might distract people from remembering painful childhood experiences.

Epidemiology

Specific phobias have a one-year prevalence of 8.7% in the United States with 21.9% of the cases being severe, 30.0% moderate, and 48.1% mild.[1] The usual age of onset is childhood to adolescence. Women are twice as likely to suffer from specific phobias than men.

The Biological Perspective

The biological perspective seeks to understand the neurological and biological connections to anxiety. As mentioned above, some physical conditions can lead to anxiety. Researchers have concluded that several specific neurotransmitters are also connected with anxiety: gamma-hydroxybutyric acid (GABA), serotonin, and norepinephrine (noradrenalin). When the balance of gamma-hydroxybutyric acid (GABA) is disrupted in the body, there is a correlated change in anxiety levels. Because of this, benzodiazepines, drugs that exert their effect through gamma-hydroxybutyric acid (GABA) receptors, are used to help people suffering from acute anxiety. Serotonin is greatly important in anxiety. It is a monoamine neurotransmitter involved in controlling a wide range of behaviors by affecting the neural system, including emotions connected with fear and anxiety. Knockout studies on animals (called that because a certain receptor on the genetic code is knocked out) have shown that animals that have had their serotonin re-uptake transporters knocked out show abnormal responses to fear and anxiety in a number of behavioral conflict tests. These responses confirm the role of serotonin in modulating anxiety. Animals that had their serotonin receptor knocked out showed an increased heart rate and anxiety in a large variety of tasks such as eating and locomotion. The best proof of the function of the serotonergic system in fear and anxiety is the pharmacological evidence. Drugs that change the function of serotonin have beneficial effects on various forms of anxiety. The best pharmacological treatment of anxiety is serotonin re-uptake inhibitors that allow greater levels of serotonin to accumulate and in that way help in treatment of anxiety. Norepinephrine is also an important neurotransmitter in anxiety. Neurons which carry Norepinephrine rise from the locus coereuleus (LC), and these are also a center associated with warnings or alarms. The locus coereuleus (LC) secretes directly into the brain causing an immediate response. Increased levels of norepinephrine cause higher levels of anxiety. In pharmacology, norepinephrine blockers lower the levels of norepinephrine and do the same to a patient as do serotonin re-uptake blockers. Among adults, agents that alter noradrenergic functioning are powerful anxiolytics. Similarly, agents, such as yohimbine, that increase firing of the locus coeruleus (LC) are potent anxiogenic compounds.[1] Due to these connections between anxiety and neurotransmitters, medication is commonly used to treat anxiety. In terms of treating anxiety with medication, it is important to note medication is one option of treatment and not always a one-stop treatment plan. Anti-anxiety medications are not cures for anxiety disorders, but they can help manage some of the symptoms. Medications (anti-anxiety drugs and antidepressants) have been found to be beneficial for disorders other than specific phobia, but relapse rates are high once medications are stopped (Heimberg et al., 1998; Hollon et al., 2005), and some classes of medications (minor tranquilizers or benzodiazepines) can be habit forming.

Selective mutism is characterized by the following:[11]

The consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) persists despite speaking in other situations. The disturbance interferes with educational or occupational achievement or with social communication. The duration of the disturbance is at least one month (not limited to the first month of school). The failure to speak is not due to a lack of knowledge of the spoken language required in the social situation. The disturbance is not better accounted for by a communicationdisorder (e.g., childhood-onset fluency disorder) and does not occur exclusively in people with autism spectrum disorders or psychotic disorders such as schizophrenia. Selective mutism is strongly associated with other anxiety disorders, particularly social anxiety disorder. In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another). Some researchers, therefore, speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations. Particularly in young children, selective mutism can sometimes be confused with an autism spectrum disorder diagnosis, especially if the child acts particularly withdrawn around their diagnostician, which can lead to incorrect diagnosis and treatment. Although people with autism may also be selectively mute, they often display other behaviors—hand flapping, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism. Some people with autism may be selectively mute due to anxiety in social situations that they do not fully understand. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above. The former name elective mutism indicates a widespread misconception among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so. To reflect the involuntary nature of this disorder, the name was changed to selective mutism in 1994. The incidence of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be one in 1,000, or around 0.1%.

Diagnosis of Separation Anxiety Disorder

The duration of this problem must persist for at least four weeks and must present itself before a child is eighteen years of age to be diagnosed as a separation anxiety disorder in children, but can now be diagnosed in adults with a duration typically lasting six months in adults as specified by the DSM-5. As mentioned, separation anxiety is normal in young children, until they age three to four years, when children are left in a daycare or preschool away from their parent or primary caregiver. To be diagnosed with separation anxiety disorder, one must display at least three of the following criteria: recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures persistent and excessive worry about losing major attachment figures or about possible harm to oneself, such as illness, injury, disasters, or death persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure repeated nightmares involving the theme of separation repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

Jin Kyong's mother was killed in a vehicle accident when she was a young girl, just starting school. This event had a significant impact on Jin Kyong's life, including damage to a major neural pathway that has made her more likely to overreact to stress in her life and increasing her chances of experiencing a mental illness. What is this pathway called?

The hypothalamic-pituitary-adrenocortical axis

Types of Phobias

The list of possible phobias is staggering, but four major subtypes of specific phobia are recognized: blood-injury-injection (BII) type, situational type (such as planes, elevators, or enclosed places), natural environment type for events one may encounter in nature (for example, heights, storms, and water), and animal type. A fifth category "other" includes phobias that do not fit any of the four major subtypes (for example, fears of choking, vomiting, or contracting an illness). Most phobic reactions cause a surge of activity in the sympathetic nervous system, increased heart rate, and blood pressure, and possibly a panic attack. However, people with blood-injury-injection (BII) type phobias usually experience a marked drop in heart rate and blood pressure and may even faint. In this way, those with blood-injury-injection (BII) phobias almost always differ in their physiological reaction from people with other types of phobia (Barlow & Liebowitz, 1995; Craske, Antony, & Barlow, 2006; Hofmann, Alpers, & Pauli, 2009; Ost, 1992). BII phobia also runs in families more strongly than any phobic disorder we know (Antony & Barlow, 2002; Page & Martin, 1998). Specific phobia is one of the most common psychological disorders in the United States, with 12.5% of the population reporting a lifetime history of fears significant enough to be considered a phobia (Arrindell et al., 2003; Kessler, Berglund, et al., 2005) (see Table 1). Most people who suffer from a specific phobia tend to have multiple phobias of several types (Hofmann, Lehman, & Barlow, 1997).

Medication

The use of medication is applied in extreme cases of separation anxiety disorder when other treatment options have been utilized and failed. However, research has been difficult to prove the benefits of drug treatment in patients with separation anxiety disorder because there have been many mixed results. Despite all the studies and tests, there has yet to be a specific medication for separation anxiety disorder. Medication prescribed for adults from the Food and Drug Administration (FDA) are often used and have been reported to show positive results for children and adolescents with separation anxiety disorder. There are mixed results regarding the benefits of using tricyclic antidepressants (TCAs), which include imipramine and clomipramine. One study suggested that imipramine is helpful for children with school phobia who also had an underlying diagnosis of separation anxiety disorder. However, other studies have also shown that imipramine and clomipramine had the same effect of children who were treated with the medication and placebo. The most promising medication is the use of selective serotonin reuptake inhibitors (SSRI) in adults and children. Several studies have shown that patients treated with fluvoxamine were significantly better than those treated with a placebo. Research has shown decreasing anxiety symptoms with short-term and long-term use of the medication.

etiology of GAD

There are both genetic and factors that contribute to GAD including shy temperament, exposure to stress and trauma, family history of anxiety, or physical health issues.

Etiology

There are many theories to frame how children develop selective mutism across different psychological domains. Several are presented in the following table

Genetic and Physiological Causes

There may be a genetic predisposition in children with separation anxiety disorder. Experts say, "Separation anxiety disorder in children may be heritable. . . . Heritability was estimated at 73% in a community sample of 6-year-old twins, with higher rates in girls."[7] A child's temperament can also impact the development of separation anxiety disorder. Timid and shy behaviors may be referred to as "behaviorally inhibited temperaments" in which the child may experience anxiety when they are not familiar with a particular location or person.

Common examples of agoraphobia include avoidance of public transportation, open space, enclosed spaces (e.g., elevators, stores, and stadiums), and crowded spaces. What type of behaviors does a person with agoraphobia do to reduce their anxiety?

They go out of their way to avoid social situations where they do not feel safe.

multidimensional approaches to mental disorders

Understanding how systems work, and how interdependent the parts are, helps us to realize why simplistic, unidimensional explanations of mental disorders such as that they are caused by a "chemical imbalance"—a reductionistic or overly simplified biological explanation—or alternatively, that they are caused by a negative relationship with one's mother—an overly simplified psychological and social explanation—are inadequate to fully understand the disorder and its causes. Unidimensional explanations limit both our ability to understand how a mental disorder develops and may limit our ability to find effective treatments. If we are to make progress in reducing stigma against the mentally ill and improving the effectiveness of treatments, we need to begin by seeking to understand more multidimensional models and consider how multiple systems interact in contributing to mental disorders. To be fair, there are a few specific conditions that mimic mental disorders that can be attributed to a single, unitary cause. An example of this is untreated syphilis, which can spread throughout the body, creating damage in multiple organ systems including the brain and lead to psychosis and dementia, possibly even death. However, these types of conditions today are rare, and would not be classified as mental disorders because they are thought of more as medical conditions with biological treatments. In contrast, mental disorders such as attention deficit hyperactivity disorder, major depression, anorexia nervosa, or schizophrenia do not have any single, simple biological or psychological explanation; they are systemic outcomes, influenced by multiple factors, including biological (genetics, hormones, neurotransmitters, and other systems), psychological (learned behaviors, attitudes, emotional responses, cognitive, or social developmental stage), and social and cultural forces (social support or lack of it, rejection, stress) that frequently interact. For instance, there are some studies that implicate prenatal exposure to a virus, which has cultural implications as well as biological, in the development of some forms of schizophrenia. Epigenetics is a newer field of study shedding light on how social, psychological, and environmental influences can actually change which genes in a person's DNA may activate or may be turned off, having significant implications for the development of disorders. Epigenetic effects are a normal part of human development. Every cell in your body has the same DNA, the same genetic code for an entire human being. But as cells develop in the body, they become specialized, meaning that some genes may be activated in some cells and not in the other cells. A good example are the genes that allow cells to detect light; these are turned on or activated in your eye cells, but are turned off or deactivated in all other cells.[1] Thus, it is not surprising that some environmental events or experiences may activate or deactivate specific genes that may increase or decrease (in the case of protective factors like positive social support) the chance someone may develop a mental disorder. Environmental epigenetic effects do not change the DNA itself but influence the expression of our genes. Thus, it is clear that both nature and nurture are relevant to all forms of mental disorders, not just one or the other. This modern, multidimensional approach to understanding mental disorders can help us to avoid labeling persons with mental disorders (or even medical illnesses) as being due to just one cause, thereby reducing stigma. We need to approach each person individually and seek to understand their own biological, psychological, and social history to better understand them and their symptoms. You will learn later in this module that most approaches to the treatment of mental disorders arose from unidimensional perspectives on mental disorders; clinicians today (and researchers), even when they may focus on a particular approach or way of treating a mental disorder, will better serve their clients by recognizing that they are approaching only one element of a system and be open to new information and thorough in their assessments. The next several sections of this module will focus on describing different "models" that explain how mental disorders occur. We begin by exploring multidimensional models and then will explore unidimensional parts or elements of the biopsychosocial system. These elemental models are important because they reflect the history of scientific attempts to understand the etiology of mental illnesses in a coherent way. Newer models built on older ones or were reactions against previous thinking. Although most of them are unidimensional and therefore limited, they each explore different aspects of the whole multidimensional picture and can be useful when we think about what each of them teaches us. These models also lead to the development of different treatment approaches or "orientations."

Panic Disorder

Unexpected panic attacks such as these are at the heart of panic disorder (PD). However, to receive a diagnosis of PD, a person must not only have unexpected panic attacks but also must experience continued intense anxiety and avoidance related to the attack for at least one month, causing significant distress or interference in their lives. People with panic disorder tend to interpret even normal physical sensations in a catastrophic way, which triggers more anxiety and, ironically, more physical sensations, creating a vicious cycle of panic (Clark, 1986, 1996). The person may begin to avoid a number of situations or activities that produce the same physiological arousal that was present during the beginnings of a panic attack. For example, someone who experienced a racing heart during a panic attack might avoid exercise or caffeine. Someone who experienced choking sensations might avoid wearing high-necked sweaters or necklaces. Avoidance of these internal bodily or somatic cues for panic has been termed interoceptive avoidance (Barlow & Craske, 2007; Brown, White, & Barlow, 2005; Craske & Barlow, 2008; Shear et al., 1997).

Safety Behaviors

When people with social anxiety disorder are unable to avoid situations that provoke anxiety, they typically perform safety behaviors: mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes. Safety behaviors include, but are not limited to avoiding eye contact, rehearsing sentences before speaking, talking only briefly, and not talking about oneself (Alden & Bieling, 1998). Other examples of safety behaviors include the following (Marker, 2013): assuming roles in social situations that minimize interaction with others (e.g., taking pictures, setting up equipment, or helping prepare food) asking people many questions to keep the focus off of oneself selecting a position to avoid scrutiny or contact with others (sitting in the back of the room) wearing bland, neutral clothes to avoid drawing attention to oneself avoiding substances or activities that might cause anxiety symptoms (such as caffeine, warm clothing, and physical exercise) Although these behaviors are intended to prevent the person with social anxiety disorder from doing something awkward that might draw criticism, these actions usually exacerbate the problem because they do not allow the individual to disconfirm his or her negative beliefs, often eliciting rejection and other negative reactions from others (Alden & Bieling, 1998). A person might react so strongly to the anxiety provoked by a social situation that they have an unexpected panic attack. This panic attack then becomes associated (conditioned response) with the social situation, causing the person to fear he or she will panic the next time he or she is in that situation. This response is not considered panic disorder, however, because the person's fear is more focused on their social evaluation than having unexpected panic attacks, and the fear of having an attack is limited to social situations. As many as 12.1% of the general population suffer from a social phobia at some point in their lives (Kessler, Berglund, et al., 2005), making it one of the most common anxiety disorders, second only to specific phobia. People with social anxiety disorder may resort to self-medication, such as drinking alcohol, as a means to avert the anxiety symptoms they experience in social situations (Battista & Kocovski, 2010). The use of alcohol, when faced with such situations, may become negatively reinforcing—encouraging individuals with social anxiety disorder to turn to the substance whenever they experience anxiety symptoms. The tendency to use alcohol as a coping mechanism for social anxiety, however, can come with a hefty price tag: a number of large-scale studies have reported a high rate of comorbidity between social anxiety disorder and alcohol use disorder (Morris, Stewart, & Ham, 2005).

June has a 16-year-old daughter, Mabel, who just got her driver's license. June and Mabel have an open and communicative relationship where Mabel listens and respects her mother. On a Saturday night, Mabel told her mother that she would be home at 10 p.m., but is five minutes late. Which would be a sign of an abnormal fear response, indicating that June may be prone to an anxiety disorder?

While trying to watch a movie, June has turned off the sound to be able to listen for the car in the driveway. She is also monitoring her daughter's travel from her cellphone, and has nightmares of her daughter being injured in a head-on collision.

why it matters

Why does one person in a family develop depression while the other sibling does not? If a person's parent or parents were alcoholic, what is the chance that his or her children will develop the same disorder? These are questions related to etiology—the causes of mental disorders. You have already learned about the history of how people and clinicians attempted to explain the development of mental disorders and some of the early treatments that were used as a result of those explanations. In this module, we will expand on what you have learned by exploring the best current scientific understanding of what causes mental disorders, discuss how they arise, and introduce how they can be treated. Understanding these issues is essential to combating the stigma against mental disorders and helping all of us and society find better ways to support those who are struggling with symptoms. In this module, you will see that treatment approaches to mental illness include biological, psychological, and social interventions, all with the goal of alleviating distress and enhancing the person's ability to cope. Because psychological problems can originate from various sources—biology, genetics, childhood experiences, conditioning, and sociocultural influences—clinicians have developed many different therapeutic techniques and approaches. The Ocean Therapy program shown in Figure 1 uses multiple approaches to support the mental health of veterans in the group.

Flooding

You just learned about systematic desensitization, a form of exposure therapy. Flooding is another type of exposure therapy. To understand how it works, let's review a few points from systematic desensitization. In flooding therapy, you would skip the earliest situations described in systematic desensitization and you would move directly to highly threatening situations. Right after Jessica had mastered relaxation, your first session would require Jessica to give an actual talk. You would probably not start with the most extreme situation, but your goal would be to start Jessica in situations that she would immediately rate as nine or 10 on the anxiety scale. Flooding has the potential to be more traumatic for Jessica (for your client), so it must be arranged carefully. But the same principles of learning work for flooding that work for systematic desensitization: The person consciously works to replace anxiety and fear with relaxation. The unconscious parts of the mind learn that the situation does not result in horrible outcomes. New expectations replace old fears. Learning does not just happen immediately. Homework and repeated practice reinforce the new positive response to situations that once produced fear.

generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal What makes a person with generalized anxiety disorder (GAD) worry more than the average person? Research shows that individuals with generalized anxiety disorder (GAD) are more sensitive and vigilant toward possible threats than people who are not anxious (Aikins & Craske, 2001; Barlow, 2002; Bradley, Mogg, White, Groom, & de Bono, 1999). This sensitivity may be related to early stressful experiences, which can lead to a view of the world as an unpredictable, uncontrollable, and even dangerous place. Some have suggested that people with generalized anxiety disorder (GAD) worry as a way to gain some control over these otherwise uncontrollable or unpredictable experiences and against uncertain outcomes (Dugas, Gagnon, Ladouceur, & Freeston, 1998). By repeatedly going through all the possible "what if?" scenarios in their mind, the person might feel less vulnerable to an unexpected outcome, giving him or her the sense that he or she has some control over the situation (Wells, 2002). Others have suggested people with GAD worry as a way to avoid feeling distressed (Borkovec, Alcaine, & Behar, 2004). For example, Borkovec and Hu (1990) found that those who worried when confronted with a stressful situation had less physiological arousal than those who didn't worry, maybe because the worry distracted them in some way. The problem is, all this "what if?"-ing doesn't get the person any closer to a solution or an answer and, in fact, might take them away from important things they should be paying attention to in the moment, such as finishing an important project. Many of the catastrophic outcomes people with GAD worry about are very unlikely to happen, so when the catastrophic event doesn't materialize, the act of worrying gets reinforced (Borkovec, Hazlett-Stevens, & Diaz, 1999). For example, if a mother spends all night worrying about whether her teenage daughter will get home safe from a night out and the daughter returns home without incident, the mother could easily attribute her daughter's safe return to her successful "vigil." What the mother hasn't learned is that her daughter would have returned home just as safe if she had been focusing on the movie she was watching, rather than being preoccupied with worries. In this way, the cycle of worry is perpetuated, and, subsequently, people with GAD often miss out on many otherwise enjoyable events in their lives.

Risk Factors for Anxiety

gender, genetics, physical health, psychosocial environment Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although there have been few investigations aimed at determining the heritability of generalized anxiety disorder, a summary of available family and twin studies suggests that genetic factors play a modest role in the disorder (Hettema et al., 2001). *The risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include the following: temperamental traits of shyness or behavioral inhibition in childhood *Shyness is a risk factor for some anxiety disorders. exposure to stressful and negative life or environmental events in early childhood or adulthood a history of anxiety or other mental illnesses in biological relatives some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder

Michelle is a young female professional who just graduated from college. She has a family history of anxiety and had a difficult childhood as a child of divorce. Michelle has been struggling with her feelings of anxiety for the past eight months. On her own for the first time, she is having trouble sleeping and is also easily fatigued. She worries about her job performance, financial stability, and meeting new people in a new city. When she does go out with colleagues she feels on-edge and irritable. What anxiety disorder is Michelle likely suffering from?

generalized anxiety disorder

People with GAD often experience difficulty in their lives in terms of everyday routine life circumstances. For example, John recently started a new job and was diagnosed with GAD. John shows up on time and completes all the aspects of the job to a satisfactory level. However, John has challenges in his interpersonal relationships at work, especially with his boss. John argues with his coworkers over little things and is extremely impatient and frustrated with the mess they leave in the common areas. What symptom of GAD is John struggling with?

irritable

Epigenetics

is a newer field of study shedding light on how social, psychological, and environmental influences can actually change which genes in a person's DNA may activate or may be turned off, having significant implications for the development of disorders. Epigenetic effects are a normal part of human development. Every cell in your body has the same DNA, the same genetic code for an entire human being.

system

is a set of elements that interact or are interdependent on one another, but forms a coherent whole and interacts with its environment and/or other systems. For example, the car or bus you use for transportation is a mechanical system. It has multiple parts that interact such as the fuel system, the electrical system, the engine, the drive train, the wheels, etc.

There are two main pathways for anxiety treatment, which are often combined. The first avenue is psychotherapy, which is often successful when combined with what other forms of treatment?

medication

Brigette is participating in psychotherapy. Her therapist's major approach is to seek to understand how Brigette understands and relates to significant others in her life with the goal of promoting her own independence and healthy relationships. Which school of psychodynamic therapy does Brigette's therapist belong to?

object relations therapy

A person with panic disorder experiences extreme distress from anxiety and what other major symptom

panic attack

Louisa is anxious about getting to know her new coworkers. When she sees them together at the coffee shop during her lunch break, she feels anxious. As a result of her anxiety, Louisa decides to avoid the situation altogether by quietly avoiding them and eating alone back at her desk in the office every day. During therapy sessions, her therapist is helping her break the cycle of anxiety by focusing on increasing her ability to relax and reframe her belief about worrying in social situations. Which of the following skills will help her begin to start to understand her anxiety cycle?

relaxation techniques and mindfulness

selective Mutism

selective mutism (SM), also known as situational mutism, is an anxiety disorder in which a person normally capable of speech cannot speak in specific situations or to specific people if triggered. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.

Jamel is a high achieving student who also participates in varsity sports. One of Jamel's biggest sources of anxiety is the worry about not getting an A. Jamel feels that if he does not get straight As on all assignments that he will not get into college, be able to stay on the sports team, and be respected by his friends and family. Jamel constantly studies and manages to get straight A's despite his guidance counselor's recommendation that he not put so much pressure on himself. As a result of Jamel's constant worry, Jamal is often sleep-deprived and has difficulty concentrating while hanging out with friends and non-school events. Jamel's pattern of worry and compulsive studying behavior is an example of what features of someone with GAD?

the act of worrying that gets reinforced

Treatment

treatment for selective mutism may rely on psychodynamic/play therapy, behavioral therapy, family therapy, or medications (most often antidepressants). Early treatment may help prevent the self-reinforcement of selective mutism. Self-modeling is a treatment method in which a child with the disorder is videotaped being asked questions by someone (such as a teacher), that they will not answer. Then they are videotaped and asked the same questions by a parent or someone they are comfortable speaking to, this time eliciting a verbal response. The two videos of the conversations are then edited together to show the child directly answering the questions posed by the teacher or other adult. This video is then shown to the child over a series of several weeks, and every time the child sees him- or herself verbally answering the teacher/another adult, the tape is stopped and the child is given positive reinforcement.

To be fair, there are a few specific conditions that mimic mental disorders that can be attributed to a single, unitary cause. An example

untreated syphilis, which can spread throughout the body, creating damage in multiple organ systems including the brain and lead to psychosis and dementia, possibly even death. However, these types of conditions today are rare, and would not be classified as mental disorders because they are thought of more as medical conditions with biological treatments.