Abnormal Chapter 4

Treatment for Panic Disorder-Cognitive theorists

- Panic-prone people have a high degree of anxiety sensitivity - Misperceive their physiological arousal/symptoms (i.e., death, catastrophe) • BIOLOGICAL CHALLENGE TESTS - Used to produce hyperventilation or other biological sensations - Breath quickly; administer caffeine dose; exercise - Can then ask them to pay attention to experience; they don't die, have a heart attack, etc. COGNITIVE THERAPY (or CBT) - Tries to correct people's misinterpretations of their bodily sensations (Clark, Beck, et al.) - Teach relaxation; challenge beliefs - May use BIOLOGICAL CHALLENGE PROCEDURES - Often helps people with panic disorder • Around 80% are panic-free for 2 years compared with 13% of control subjects • At least as helpful as antidepressants - Combination therapy may be most effective

Systematic desensitization

A behavioral treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to the objects or situations they dread.

Sensitivity refers to a tendency to focus on one's bodily sensations, and to assess them illogically and interpret them as harmful

Anxiety

Although compulsions are considered _____, MOST people who suffer from obsessive-compulsive disorder do not feel as if they can control them.

Voluntary

Anxiety and Fear

What distinguishes fear from anxiety? FEAR is the body's response to threat • immediate, present danger ANXIETY is the body's response to worry • future oriented; apprehension; vague • How are they alike? - Both have the same physiological features and prepare us for action; Both increase respiration, perspiration, muscle tension, etc. • How are they different? - Possibly two different brain circuits

Exposure treatment

tends to be helpful in the treatment of social anxiety disorder.

Generalized Anxiety Disorder (GAD)

• 4% in a year • Usually first appears in childhood or adolescence • Female to Male (2:1) • One quarter are in treatment • Variety of theoretical explanations Dx Checklist Checklist • Generalized Anxiety Disorder 1. For 6 months or more, person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters. 2. The symptoms include at least three of the following: edginess, fatigue, poor concentration, irritability, muscle tension, sleep problems. 3. Significant distress or impairment.

OCD: The Psychodynamic Perspective

• Anxiety disorders - Develop when children fear their id impulses and use ego defense mechanisms to lessen their anxiety • OCD - Is played out in overt thoughts and actions • Id impulses = obsessive thoughts • Ego defenses = counter-thoughts or compulsive actions - Is related to the anal stage of development (Freud) • Period of intense conflict between id and ego • Not all psychodynamic theorists agree • Overall, research has not supported the psychodynamic explanation

Panic Disorder

• Attacks are unforeseen and feature at least four of the following symptoms of panic: - Palpitations of the heart - Tingling in the hands or feet - Shortness of breath - Sweating - Hot and cold flashes, trembling - Chest pains - Choking sensations - Faintness - And fear of dying Dx Checklist Checklist • Panic Disorder 1. Unforeseen panic attacks occur repeatedly 2. One or more of the attacks precedes either of the following symptoms: • (a) At least a month of continual concern about having additional attacks • (b) At least a month of dysfunctional behavior changes associated with the attacks (for example, avoiding new experiences)

OCD: The Behavioral Perspective

• Behaviorists - Concentrate on explaining and treating compulsions rather than obsessions; -Propose that people happen upon their compulsions quite randomly -Compulsions do appear to be rewarded by an eventual decrease in anxiety; but it doesn't last EXPOSURE AND RESPONSE PREVENTION (ERP) (aka Exposure and ritual prevention) • Exposes a client to anxiety-arousing thoughts or situations and then prevents the client from performing his or her compulsive acts • Used in individual and group therapy formats; May involve self-help procedures in home settings • Very effective for majority, especially combined with meds

How Are Specific Phobias Treated?

• Clinical research supports each of the following treatments • The key to success is EXPOSURE actual contact with the feared object or situation • A growing number of therapists are using virtual reality as a useful exposure tool • Use of virtual helmets; computer simulations • But difficult to recreate exact stimuli compared to reality

Treatment for Panic Disorder-The biological perspective

• Drug therapies • Antidepressants are effective at preventing or reducing panic attacks • Function at norepinephrine receptors in the panic brain circuit • Bring at least some improvement to 80 percent of patients with panic disorder • Improvements require maintenance of drug therapy • Some benzodiazepines (especially Xanax [alprazolam]) have also proved helpful but they seem to act indirectly on NE

How Are Specific Phobias Treated?

• Each model offers treatment approaches but major behavioral and cognitive-behavioral techniques are most widely used • EXPOSURE TREATMENTS - SYSTEMATIC DESENSITIZATION (Joseph Wolpe) - IN VIVO DESENSITIZATION • Other treatments - FLOODING - MODELING

The Sociocultural Perspective:

• GAD most likely to develop in people - Who face ongoing, dangerous societal conditions - Who live in poverty - Who face discrimination, low income, and reduced job opportunities (race) • Although poverty and other social pressures impact GAD - Most people living in dangerous environments do not develop GAD

Features of Obsessions and Compulsions

• Obsessions - Thoughts that feel both intrusive and foreign - Attempts to ignore or resist them trigger anxiety - Have common themes (e.g., contamination) • Compulsions - Voluntary actions or mental "acts" but they feel mandatory/unstoppable - Behaviors reduce anxiety - Behaviors often develop into rituals - Have common forms/themes (e.g., cleaning, ordering, checking)

Exposure and response prevention

A behavioral treatment for obsessive-compulsive disorder that exposes a client to anxiety arousing thoughts or situations and then prevents the client from performing his or her compulsive acts. Also called exposure and ritual prevention.

1.How do behaviorists explain phobias? 2.What evidence exists for these explanations. pg 122-124

1. Behaviorists believe that people with phobias first learn to fear certain objects, situations, or events through conditioning. Once the fears are acquired, the individuals avoid the dreaded object or situation, permitting the fears to become all that entrenched. 2.a Behaviorists propose classic conditioning as a common way of acquiring phobic reactions.

How do biological and cognitive clinicians explain and treat panic disorder?pg 133-136

1. Biological- some biological theorists believe that abnormal norepinephrine activity in the brains locus coeruleus may be central to panic disorder. Others believe that related neurotransmitters or a panic brain circuit may also play key roles. 1b) Treatment- therapists use certain antidepressant drugs or powerful benzodiazepines. 2. Cognitive- theorists suggest that panic- prone people become preoccupied with some of their bodily sensations(anxiety sensitivity) and misinterpret them as signs of medical catastrophe. In turn, they panic and in some cases develop panic disorder. 2.b) Treatment- educate clients about their panic attacks, teach clients to apply more accurate interpretations during distressful situations, and also teach clients to cope better with anxiety by teaching relaxation and breathing techniques. Lastly, they use Biological challenge tests.

Describe and compare the effectiveness of exposure and response prevention and antidepressant medications as treatments for obsessive-compulsive disorder. pg 139-140, 142

1. Exposure and Response prevention is a behavioral treatment for obsessive compulsive disorder that exposes a client to anxiety-arousing thoughts or situations and then prevents the client from performing his or her compulsive acts. (also called exposure and ritual prevention) Many behavioral therapists now use exposure and response prevention in both individual and group therapy formats. 2. Antidepressant drugs help reduce obsessions and compulsions to treat obsessive compulsive disorder and increase brain serotonin activity and produce normal activity in the orbitofrontal cortex and caudate nuclei.

Describe the three behavioral exposure techniques used to treat specific phobias. pg 124-126

1. Exposure treatments- behavioral treatments in which persons are exposed to the objects or situations they dread. 2. systematic desensitization- a behavioral treatment that uses relaxation training and fear hierarchy to help clients with phobias react calmly to the objects or situations they dread. 3. Flooding- A treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless.

Define and compare specific phobias and agoraphobia. pg.120-122

1. specific phobia- is a persistent fear of a specific object or situation. 2. agoraphobia- is an anxiety disorder in which a person is afraid to be in public situations from which escape might be difficult or help unavailable if panic or embarrassing symptoms were to occur

How effective have treatments been for generalized anxiety disorder?p. 109-119

1.Sociocultural- no therapy 2. Psychodynamic- Controlled studies have typically found psychodynamic treatments to be of only modest help to persons with generalized anxiety disorder. ( SHORT-TERM PSYCHODYNAMIC THEORY is an exception to this trend because it has in some cases significantly reduced the levels of anxiety, worry, and social difficulty) 3. Cognitive- modest relief 4. Humanistic- controlled studies have failed to offer strong support for this approach. Although, research does suggest that client-centered therapy is usually more helpful to anxious clients than no treatment. 5. Biological- helpful

Describe the four obsessive-related disorder. pg. 143-145

1.hoarding disorder- A disorder in which people feel compelled to save items and experience significant distress if they try to discard them, resulting in an excessive accumulation of items and possessions. 2. Trichotillomania -A disorder in which people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of their body. Also called hair-pulling disorder. 3. Excoriation disorder-A disorder in which persons repeatedly pick at their skin, resulting in significant sores or wounds. Also called skin-picking disorder. 4. Body Dysmorphic disorder-A disorder in which individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance. The perceived defects or flaws are imagined or greatly exaggerated.

In the 1960s, clinicians discovered that panic disorder was helped MOST by:

Anti depressant drugs

Rational-emotive therapy

A cognitive therapy developed by Albert Ellis that helps clients identify and change the irrational assumptions and thinking that help cause their psychological disorder.

Electromyograph (EMG)

A device that provides feedback about the level of muscular tension in the body

Obsessive-compulsive disorder

A disorder in which a person has recurrent and unwanted thoughts and/or a need to perform repetitive and rigid actions.

Body dysmorphic disorder

A disorder in which individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance. The perceived defects or flaws are imagined or greatly exaggerated.

Hoarding disorder

A disorder in which people feel compelled to save items and experience significant distress if they try to discard them, resulting in an excessive accumulation of items and possessions.

Excoriation disorder

A disorder in which persons repeatedly pick at their skin, resulting in significant sores or wounds. Also called skin-picking disorder

Serotonin

A neurotransmitter whose abnormal activity is linked to depression, obsessive-compulsive disorder, and eating disorders.

Norepinephrine

A neurotransmitter whose abnormal activity is linked to panic disorder and depression.

Gamma-aminobutyric acid (GABA)

A neurotransmitter whose low activity has been linked to generalized anxiety disorder.

Phobia

A persistent and unreasonable fear of a particular object, activity, or situation.

Obsession

A persistent thought, idea, impulse, or image that is experienced repeatedly, feels intrusive, and causes anxiety.

Stimulus generalization

A phenomenon in which responses to one stimulus are also produced by similar stimuli.

Preparedness

A predisposition to develop certain fears.

Biological challenge test

A procedure used to produce panic in participants or clients by having them exercise vigorously or perform some other potentially panic-inducing task in the presence of a researcher or therapist

Modeling

A process of learning in which a person acquires responses by observing and imitating others. Also, a therapy approach based on the same principle.

Classical conditioning

A process of learning in which two events that repeatedly occur close together in time become tied together in a person's mind and so produce the same response.

Panic Disorder

A quarter of the community will have a panic attack at some point in lifetime; however, this is different from panic disorder - Disorder: Happens repeatedly; and person changes their behavior because of it • Panic Disorder: 2.4% in a year; 5% lifetime prevalence • Has same prevalence across various cultures and racial groups; attack features may differ; Tends to develop in late adolescence and early adulthood; Is twice as likely to occur in women than men; 50% more likely to appear in poor people • Is often accompanied by agoraphobia

Orbitofrontal cortex

A region of the brain in which impulses involving excretion, sexuality, violence, and other primitive activities normally arise.

Compulsion

A repetitive and rigid behavior or mental act that persons feel driven to perform in order to prevent or reduce anxiety.

Specific phobia

A severe and persistent fear of a specific object or situation (does not include agoraphobia and social anxiety disorder).

Social anxiety disorder

A severe and persistent fear of social or performance situations in which embarrassment may occur.

Locus coeruleus

A small area of the brain that seems to be active in the regulation of emotions. Many of its neurons use nonrepinephrine.

Biofeedback

A technique in which a client is given information about physiological reactions as they occur and learns to control the reactions voluntarily.

Anxiety sensitivity

A tendency to focus on one's bodily sensations, assess them illogically, and interpret them as harmful.

Social skills training

A therapy approach that helps people learn or improve social skills and assertiveness through role playing and rehearsing of desirable behaviors.

Flooding

A treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless.

Relaxation training

A treatment procedure that teaches clients to relax at will so they can calm themselves in stressful situations.

Agoraphobia-

An anxiety disorder in which a person is afraid to be in public places or situations from which escape might be difficult (or embarrassing) or help unavailable if panic-like symptoms were to occur.

Panic disorder

An anxiety disorder marked by recurrent and unpredictable panic attacks.

Stress management program

An approach to treating generalized and other anxiety disorders that teaches clients techniques for reducing and controlling stress

Neutralizing

Attempting to eliminate thoughts that one finds unacceptable by thinking or behaving in ways that make up for those thoughts and so put matters right internally.

According to the text, the_____ perspective has developed treatments that tend to be effective for compulsions but ineffective for obsessions.

Behavioral

Exposure treatments

Behavioral treatments in which persons are exposed to the objects or situations they dread.

Behavioral therapists focus on _____ associated with obsessive compulsive disorder.

Changing Behaviors

According to the text, the leading theory attempting to explain social anxiety disorder is _____. This theory suggests that those who suffer from social anxiety hold a group of social beliefs and expectations that consistently work against them.

Cognitive

Obsessive Compulsive-Related Disorders

DSM-5 has created the group name "ObsessiveCompulsive-Related Disorders" Hoarding disorder Trichotillomania (hair-pulling) disorder Excoriation (skin-picking) disorder Body dysmorphic disorder - With their addition to the DSM-5, it is hoped that these behaviors will be better researched, understood, and treated - as disorders with compulsions at the root

According to the Cognitive Perspective: New Wave Cognitive Explanations:

Cognitive Perspective: New Wave Cognitive Explanations METACOGNITIVE THEORY (Wells) • Both positive and negative value for worry • Positive: worry = "coping" • Negative: Worry is harmful and uncontrollable • People with Generalized Anxiety Disorder worry about worrying (METAWORRY) • This theory IS supported by research INTOLERANCE OF UNCERTAINTY THEORY • Individuals with GAD consider it unacceptable that negative events may occur, even if the possibility is very small; • They worry in an effort to discover or find "correct" solutions • This theory IS supported by research AVOIDANCE THEORY (Borkovec) • Holds that worrying serves a "positive" function for those with GAD by • Anxiety produces high physio arousal • Worry serves to reduce unusually high levels of bodily arousal for those with GAD • This theory IS supported by research

For those suffering from obsessive-compulsive disorder, behaviorists focus on treating _____ rather than obsessions.

Compulsions

Those suffering from obsessive-compulsive disorder (OCD) engage in _____ in an effort to reduce anxiety.

Compulsions

Sedative-hypnotic drugs

Drugs used in low doses to calm people and in higher doses to help people sleep. Also called anxiolytic drugs.

How Is Agoraphobia Treated?

EXPOSURE APPROACH is the most common and effective treatment for agoraphobia • Treatment Impact - Between 60 - 80% of clients with agoraphobia have some success - Improvements are often partial or incomplete / not lasting long term - Can be paired with meds

OCD: The Cognitive Perspective

Everyone has repetitive, unwanted, and intrusive thoughts • But people with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result • Attempt to NEUTRALIZE their thoughts with actions Therapy may include - Psychoeducation; - Guiding the client to identify, challenge, and change distorted cognitions • Research suggests that a combination of the cognitive and behavioral models is often more effective than either intervention alone • If everyone has intrusive thoughts, why do only some people develop OCD? • People with OCD tend to: - Have exceptionally high (maladaptive) standards of conduct and morality (religion may be a factor?) - Believe thoughts are equal to actions and are capable of bringing harm (thinking about murder is same as committing murder) - Believe that they can, and should, have perfect control over their thoughts and behaviors

Studies suggest that individuals with anxiety sensitivities are_____ times more likely to develop panic disorder than other people.

Five

The Biological Perspective:

GAD is caused primarily by biological factors: • Supported by family PEDIGREE STUDIES • Biological relatives more likely to have GAD (~15%) than general population. The closer the relative, the greater the likelihood. • Gamma-aminobutyric acid (GABA) whose low activity has been linked to generalized anxiety. GABA is inhibitory (stops neuron firing); Benzodiazepines The most common group of antianxiety drugs lock into same receptors as GABA does (if it was available) • Malfunction in the feedback loop causes neurons to keep firing in anxiety response; body cannot down-regulate without enough GABA neurotransmitter

DSM-5 Anxiety Disorders

Generalized anxiety disorder (GAD) Specific phobias Social anxiety disorder Agoraphobia Panic disorder

The neurotransmitters serotonin, dopamine, _____ play a key role in the operation of the orbitofrontal cortex.

Glumate, and gamma-aminobutryic acid (GABA)

Obsessive-Compulsive-Related Disorders

Hoarding Disorder • individuals feel compelled to save items and become very distressed if they try to discard them • Resulting in impaired functioning; health threats; social isolation Trichotillomania • People feel compelled to repeatedly pull out hairs from scalp, eyebrows, eyelashes, or other places • Produces bald spots and embarrassment leads to other problems Excoriation Disorder • Disorder in which people feel compelled to repeatedly pick at their skin, • resulting in significant sores or wounds Body Dysmorphic Disorder • individuals believe that they have certain gross defects or flaws in their physical appearance (but they do not in reality) • Perceived defects or flaws are imagined or greatly exaggerated

Treatments for Social Anxiety Disorder

How can social fears be reduced? • Medication (particularly antidepressants) • Therapy • Exposure therapy • Cognitive behavioral therapies • How Can Social Skills Be Improved? • Assertiveness training • Social skills training (e.g., public speaking) • Other behavioral techniques

The onset of social anxiety disorder MOST often occurs in:

Late childhood to early adolescence

How Do Common Fears Differ from Phobias?

More intense and persistent fear • Greater desire to avoid the feared object or situation • Distress that interferes with functioning

Anxiety Disorders

Most common mental disorders in the United States - In any given year, 18% of the adult U.S. population experiences one of the anxiety disorders (DSM-5) - Close to 29% develop one of the disorders at some point in their lives; - Only one-fifth of these individuals seek treatment - Often comorbid with depression • Most individuals with one anxiety disorder also suffer from a second one (and possibly also depression)

Early research linked the neurotransmitter _____ and the brain's locus coeruleus to panic attacks.

Norepinephrine

Excessive and repeated wishes, impulses, images, or doubts are called:

Obsessions

A person with _____ disorder has recurrent and unwanted thoughts, a need to perform repetitive and rigid actions, or both conditions.

Obsessive-compulsive

Treatments for Social Anxiety Disorder

Only in the past 15 years has treatment of social anxiety disorder been successful • Must address the "avoidance" and "safety" and rumination behaviors which have developed and sustain the disorder • Two components must be addressed 1. Overwhelming social fear 2. Lack of social skills

Panic attacks

Periodic, short bouts of panic that occur suddenly, reach a peak within minutes, and gradually pass.

Phobias

Persistent and unreasonable fears of particular objects, activities, or situations; Often involve avoidance of the object or thoughts about it. • SPECIFIC PHOBIAS - Category of DSM-5's label for an intense and persistent fear of a specific object or situation • 12% year prevalence; 14% lifetime; often comorbid 2+ • Gender (2:1 ratio for women) and race differences • AGORAPHOBIA - Broader kind of phobia; fear of places or situations where escape might be difficult or embarrassing; may also have panic attacks or panic disorder (separate) • 1.7% year prevalence; 2:1 ratio for women

Anxiety

Plays a major role in different groups of problems - Obsessive-compulsive-related Disorders (new category in DSM 5)

Behavioral theory suggests that compulsions act as reinforcements because they tend to:

Reduce anxiety

Panic Disorder -The biological perspective

Researchers theorized panic disorder was related to abnormal NOREPINEPHRINE activity - Animal research reveals panic reactions may be related to increases in norepinephrine activity in the LOCUS CERULEUS; similar findings occurred in studies with humans - Results from twin study research suggests predisposition to develop such abnormalities is inherited • Identical twins 31% concordance rate

OCD: The Biological Perspective- Biological therapies

Serotonin-based antidepressants • Bring improvement to 50-80% of those with OCD • Relapse occurs if medication is stopped - Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective

Social Anxiety Disorder (SAD)

Severe, persistent, and irrational anxiety about social or performance situations in which scrutiny by others and embarrassment may occur (broad; narrow; both) - More prevalent in low SES - Some culture-bound disorders are similar - 7.4% in a year; - 13% lifetime prevalence (develop this disorder at some point in their lives) • The leading explanation proposed by cognitive behavioral theorists and researchers - People with this disorder hold a group of social beliefs and expectations that consistently work against them

Russell was first diagnosed with social phobia several years ago. He visited a therapist because of his extreme anxiety about speaking in front of other students in classes. The DSM-5 has made changes to terminology, so Russell's diagnosis will now be referred to as:

Social anxiety disorder

Severe, persistent, and irrational anxiety about social situations is referred to as _____ disorder.

Social anxiety disorder

Caudate nuclei

Structures in the brain, within the region known as the basal ganglia, that help convert sensory information into thoughts and actions

Fear

The central nervous system's physiological and emotional response to a serious threat to one's well-being.

Anxiety-

The central nervous system's physiological and emotional response to a vague sense of threat or danger.

Client-centered therapy

The humanistic therapy developed by Carl Rogers in which clinicians try to help clients by being accepting, empathizing accurately, and conveying genuineness.

Basic irrational assumptions

The inaccurate and inappropriate beliefs held by people with various psychological problems, according to Albert Ellis.

Benzodiazepines

The most common group of antianxiety drugs, which includes Valium and Xanax.

Obsessive-Compulsive Disorder (OCD) (no longer in Anxiety Category - DSM 5)

• Obsessions: Persistent thoughts, ideas, impulses, or images • Compulsions: repetitive/rigid behaviors or mental acts performed to reduce anxiety • Prevalence: 1-2% in year; 3% lifetime prevalence • EQUALLY COMMON in men and women; races (only one so far!) Dx Checklist • Obsessive-Compulsive Disorder 1. Occurrence of repeated obsessions, compulsions, or both 2. The obsessions or compulsions take up considerable time 3. Interfere with functioning 4. Significant distress or impairment

OCD: The Biological Perspective

• Some research provides evidence that these two lines may be interconnected 1. Abnormal SEROTONIN activity 2. Abnormal brain structure and functioning • ORBITOFRONTAL CORTEX and CAUDATE NUCLEI, thalamus, amygdala, and cingulate cortex - SEROTONIN (with other neurotransmitters) plays a key role in the operation of the orbitofrontal cortex and the caudate nuclei - Abnormal neurotransmitter activity could be contributing to the improper functioning of the circu

The Humanistic Perspective:

• Theorists propose that GAD - Never received UPR as a child; Threatening selfjudgments break through and cause anxiety, setting the stage for GAD to develop - Arises when people stop looking at themselves honestly and acceptingly • Carl Rogers - Treatment: - CLIENT-CENTERED THERAPY - UNCONDITIONAL POSITIVE REGARD • Overall, not strong support for this approach in treating anxiety and related disorders

The Biology of OCD

• Two lines of research provide evidence for the key role of biological factors 1. Abnormal SEROTONIN activity (low) 2. Abnormal brain structure and functioning • Structures may be too active in people with the disorder

The Psychodynamic Perspective:

• When childhood anxiety goes unresolved - Freud • Theorized excessive childhood neurotic or moral anxiety sets stage for GAD - Contemporary psychodynamic theorists • Disagree with specific aspects of Freudian explanation of GAD, but agree disorder may be traced to inadequacies in early parent-child relationships • General techniques • Used to treat all psychological problems and include free association, transference, resistance, and dreams • Overall, not strong support for this approach in treating anxiety and related disorders

The Cognitive Perspective:

•Beck and Ellis identified basic irrational assumptions. E.g., • It is a dire necessity for an adult human being to be loved or approved of by virtually every significant person • It is awful and catastrophic when things are not the way one would very much like them to be. •When these assumptions are applied to everyday life and spread to many areas, GAD may develop. • Research does support idea that people with GAD hold MALADAPTIVE ASSUMPTIONS, particularly about dangerousness of the world