ch.6

are they ________(less/more) likely to go to clinics for psychological treatment than are people with ____________ or ___________. however...

-less likely; panic disorder; major depressive disorder -they frequently go to doctors for medical complaints (e.g. muscle tension) and are OVERusers of health care resources (similar to ppl with panic disorder)

what makes OCD different from the other anxiety disorders?

-little or no gender difference!

what do they have no appreciation of? "the result is that they fail to escape their _______ world created in their thoughts and images and rarely experience the _________ that posseesses the potential to bring them _______

-logic, over which most ppl conclude its pointless to torment ourselves about things we have no control of -illusory; present moment; joy

what other drug category works on OCD too bc of its selective effects on serotonin? are antidepressant SSRIs or the TCA clomipramine more effective?

-SSRI antidepressants, like fluoxetine (Prozac) -equally effective

which is more widely prescribed - TCAs or SSRIs? which are more preferred by physicians - TCAs, SSRIs, or benzos?

-SSRIS, bc better tolerated by most ppl -both TCAs and SSRIs are preferred over benzos bc of the risks associated w/ benzos

there is a variant of koro syndrom that occurs in ______ nations. how is the west african variant of koro different from the southeast asian version? (what do they report) frequently, what happens with this syndrome for West Africans?

-West African -shrinking of the penis or breasts (but not retraction), which they fear will lead to loss of sexual functioning and reproductive capacity (but not death) -someone esle who was present is blamed and often severely beaten or otherwise punished

from the psychoanalytic viewpoint, what do phobias represent? is this a good view?

-a defense against anxiety that stems from repressed impulses from the id. it is too dangerous to "know" the repressed id impulse, so the anxiety is displaced onto some external object/situation that has some symbolic relationship to the REAL object of anxiety. -nope, criticized (too speculative)

*panic provocation procedures* examples of what they did to provoke panic?

-a variety of biological challenge procedures that provoke panic attachs at higher rates in ppl w/ panic disorder than in ppl w/out panic disorder -infusions of sodium lactate, inhaling air w/ some carbon dioxide, ingesting large amounts of caffiene

the worry must be about what? and its content CANNOT be what?

-about a # of different events/activities, and its content CANNOT be exclusively related to the worry associated with another concurrent disorder (e.g. possibility of having a panic attack)

however, whats wrong with the serotogenic view? what other neurotransmitter systems also seem to be involved, although their role is not yet well understood?

-dysfunction in serotogengic systems cannot by itself fully explain OCD. -the dopaminergic, GABA, and glutamate systems

the exact nature of the _____________ in OCD is unclear. what does current evidence say are involved in OCD symptoms? what drugs can worsen symptoms?

-dysfunction in serotogenic systems -increased serotonin activity and increased sensitivity of some brain structures to serotonin -drugs that stimulate serotogenic systems

in addition, explain what they have related to animals and ppl w/ OCD (term and what it means)?

-the displace activities that many animals engage in under conflict/high arousal resemble the compulsive rituals seen in OCD!

this attentional vigilance can occur when?

-v early stage of cognition, b4 conscious awareness

direct traumatic conditioning is not always necessary for a phobia to develop. what other kind? ex?

-vicarious or observational conditioning: watching a phobic person behave fearfully or watching a nonfearful person undergoing a frightening experience -boy watched grandpa vomit while ding --> vomit phobia

what else do they do (environment)? what avoidance activities might they engage in?

-vigilance for signs of possible threat in environment, and they frequently engage in avoidance activities -procrastination, checking, or calling a loved one frequently to see if he/she is safe

how do they address the problem when exposure isnt feasable, like airplanes? how effective is it?

-virtual reality -result comparable to those w/ live exposure

anxiwty disorders have the ______________ of all mental disorders and are associated with what? are they high or low users of medical services?

-earliest age of onset -w/ an increased prevalence of a # of MC's, including asthma, chronic pain, hypertension, arthritis, cardiovascular disease, and irritable bowel syndrome -very high

anxeity: cog/subjective level -

negative mood, worry about possible future threats or danger, self-preoccupation, and a sense of being unable to predict the future threat or to control it if it occurs

in vivo =

real life

*specific phobia*

said to be present if a person shows strong and persistent fear that is triggered by the presence of a specific object or situation and leads to significant distress and/or impairment in a persons ability to function

what is one advantage to cog-behav therapy over meds? what drug can improve the gains?

they generally produce more long-lasting improvement with very low relapse rates -D-cycloserine added to exposure therapy (more quickly and more substantial gains)

in another study, they asked ppl about memories. the themes of these memories including having been... it is important to keep in mind that, as w/ specific phobias, not everyone who experiences direct or vicarious conditioning in social situations develops a social phobia. _____________ plays a role

"criticized for having an anxiety symptom" (e.g. being red or blushing), and having felt "self-conscious and uncomfortable in public as a consequence of past criticism" such as "having previously been bullied and called a 'nothing'" -individual differences in experiences

ataque de nervios is _______(common/rare) for what age group, especially in Puerto Rico? individuals who experience ataque de nervios also seem to be vulnerable to what?

-COMMON, for children and adolescents -wider range of other anxiety and mood disorders

people with blood-injection-injury typically experience what 2 emotions? what is unique about their physiological response? do these people show this phys pattern to only blood-injury-injection or to other things too? explain this from an evolutionary standpoint is this phobia highly or lowly heritable?.

- the same amount of disgust as fear, sometimes even more disgust than fear -rather than showing a simple increase in heart rate and bp, they show an initial increase, followed by a dramatic drop. this is accompanied by nausea, dizziness, or fainting, which does NOT occur with other specific phobias -ONLY to that phobia, other fear responses are typical. -fainting = inhibit further attack; drop in bp = minimize blood loss -highly heritable

a group of disorders that share symptoms of clinically significant anxiety or fear

-*anxiety disorders*

(OCD and the brain) there has been intense search for brain abnormalities in OCD. this research has revealed that abnormalities occur primarily in where? what is the basal ganglia linked to? PET scans show that ppl with OCD have abnormally _____ levels of activity in 2 parts of the ___________(the orbital frontal cortex and the cingulate cortex/gyrus), which are also linked to the _______. ppl with ocd also have abnormally ____ levels of activity in the ________________, which is part of the ___________. these primitive brain circuits are involved in what? such as what? and these activity in these areas is further increased when?

-*basal ganglia* -basal ganglia linked at the amygdala to the limbic system, which controls emotional behaviors -high -frontal cortex -limbic area -high -subcortical caudate nucleus -basal ganglia -executing primitive patterns of behavior such as those involved in sex, aggression, and hygeine concerns. activity is further increased when symptoms are provoked by obsessive thoughts

as research has revealed the underlying distorted cognitions that characterize social phobia, ____________ techniques have been added to the behavioral techniques, generating a form of _______________

-*cognitive restructuring* -cogntive-behavioral therapy

what is the most effective treatment for specific phobias? *participant modeling* which of these 2 is better, exposure therapy or participant modeling? what is the biological basis for that effectiveness?

-*exposure therapy* - (BT: behavior therapy) controlled exposure.... gradually expose w/ long enough time for fear to go away -therapist calmly models how to interact w/ it. this teaches client its not as scary as they thought, and that their anxiety will gradually dissapate. -participant modeling is often more effective than exposure alone -mediated by changes in the brain activation in the amygdala (centrally involved in the emotion of fear)

when people worry about many different aspects of life (including minor events) becomes chronic, escessive, and unreasonable, in these cases ____________ may be diagnosed

-*generalized anxiety disorder*

another cultur-related syndrome that occurs in places like China and Southeast Asian counties is _____ for men: for women: koro tends to occur in epidemics (sometimes referred to as a form of mass hysteria) - especially in what group and when? what is it often attributed to?

-*koro* -acute fear that the penis is retracting into the body adn that when this process is complete the sufferer will die -less frequently in women: fear that nipples are retracting and their breasts are shrinking -minority groups when their survival is threatening - often attributed to either malicious spirits or contaminated food

historically, anxiety disorders were considered to be what?

-*neruotic disorders*

when the fear response occurs in the absence of any obvious external danger, the person is said to have experienced what? (10)

-*panic attack*

CRH may play an important role in GAD through its effects on the bed nucleus of the ______________ (210)

-*stria terminalis* (an extension of the amygdala), which plays imp role in mediating GAD

DSM5 identifies 2 subtypes of social phobia: ppl with the more general subtype of social phobia often have what? often also have a diagnosis of what other disorder?

-1 centers on performance situations (e.g. public speaking) -1 is more general and includes nonperformance situations (e.g. eating in public) -significant fears of most social situations (rather than simply a few) -often also have a diagnosis of avoidant personality disorder

at present, __ primary neurotransmitter systems are most implicated in panic attacks:

-2 -noradrenergic and serotonergic systems

panic disorder with or without agoraphobia onset:

-20s to 40s, but sometimes in the late teen years

is panic disorder more common in women or men? what about agoraphobia? among ppl with severe agoraphobia, what percent are female?

-2x as common in women -more in women -90% female

is is more common in men or women? is GAD common or rare? how do they tend to function/manage/impairment?

-2x in women -common -most manage to function in spite of high worry and low perceived well-being

what drug is GOOD and what does it do? what about the drug by itself?

-D-cycloserine - known to facilitate extinction -can enhance effectiveness of exposure therapy for fear of heights in VR -d-cycloserine by itself, however, has no effect

(why now?) T/F: BDD is a relatively new disorder. T/F: BDD is only seen in north america. what is 1 reason for increase in prevelance? what is a reason that BDD has been understudied? what is a reason for secrecy and shame? what is one reason people are now seeking trt?

-F! existed for centuries -F! its a universal disorder!!!! -focus on "looks" in culture like $$$ spent on makeup, clothing, fashion etc -most ppl never seek trt. rather, they suffer silently or go to derm/plastic surgeon -worried others will think theyre superficial, silly, or vain, and if they mention it then ppl will notice and focus on it more -lots of media attention

T/F: it is likely that research from bio or psych factors will provide a complete account of this disorder sooooo

-F: it is unlikely that research from either tradition alone will ever provide a complete account for this disorder -biopsychosocial theory needed!

(neurotransmitter and neurohormonal abnormalities) what neurotransmitter is strongly implicated in GAD?

-GABA

what other neurotransmitter has been implicated in the __________ that many ppl with panic disorder have about experiencing another panic attack. this neurotransmitter has been known to do what? whats wrong w/ this neurotransmitter in ppl who have panic disorder tho?

-GABA -anticipatory anxiety -inhibit anxiety -its abnormally low in cortex

at present, it seems that _______, ________, __________ all play a role in anxiety, but the ways in which they interact remain largely _________.

-GABA, serotonin, norepinephrine -unknown

(treatment of body dysmorphic disorder) the treatments for BDD are closely related to those used in the effective treatment of what other disorder? what meds? what is the effectiveness of SSRIs for BDD? but what is possible for these results? how do trt with SSRIs differ for BDD than OCD?

-OCD -antidepressants --> SSRIs; -moderate improvement but many not helped or only modest improvement. BUT this might be bc of inadequate doses of meds -HIGHER doses needed for bdd to be effective than for ocd

what is the efficacy for PCT compared to exposure based techniques that focused exclusively on exposure to external situations? what is the efficacy for these cog and behav treatments compared to medications? these treatments (cog, behav, variants) are also effective for what?

-PCT better results -cog and behav better than meds -treating nocturnal panic

*phobia* 3 main categories of phobias:

-a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of these feared situations 1. specific phobia 2. social phobia 3. agoraphobia

(a sense of mastery: the possibility of immunizing against anxiety) what is another significant experimental variable strongly affecting reactions to anxiety-provoking situations? what did they find with monkeys?

-a persons history of control over aspects of his/her environment -when raised with more control, they adapted more readily to frightening events and novel anxiety-provoking stimuli

(anxiety sensitivity and perceived control) *anxiety sensitivity*

-a trait-like belied that certain bodily symptoms may have harmful consequences

(biological causal factors) the biological causal factors involved in GAD can be attributed to what?

-genetics -neurotransmitter abnormalities -neurological differences

(neurobiological differences between anxiety and panic) theorists have drawn distinctions between fear, panic, and anxiety, including their neurological bases. fear and panic involve what? what brain areas? what neurotransmitters? general anxiety (anxious apprehension) is different from acute fear or phobia how? general anxiety involves what brain areas? what neurotransmitters? although serotonin may play a role in both anxiety and panic, .... recently, people with GAD have found to have what that is also seen in major depression?

-activation of flight or fight -amygdala (and locus coeruleus) -norepinephrine and serotonin -more diffuse; arousal that prepares for POSSIBLE impending threat -limbic system (especially bed nucleaus of the stria terminalis) -GABA and CRH -probs does so in somewhat different ways -smaller left hippocampal region; (this may represent a common risk factor for the 2 disorders)

fear is the basic emotion (shared by many animals) that involves what? adaptive value?

-activation of flight or fight response of the autonomic nervous system, and is almost instantaneous to an immediate threat -a primitive alarm that allows us to escape

what is often difficult to determine, and why? however, research has shown GAD often develops in ___________ GAD is the most common anxiety disorder for whom?

-age of onset, bc many ppl report being anxious whole lives, and many others report a slow and insidious onset -older adults -older adults

dominance heirarchies are established through __________, and a defeated individual typically displays ______________ thus, its not suprising that ppl w/ social phobia do what?

-aggressive encounters btw members of a social group -fear and submissive behavior but only rarely attempts to escape the situation completely -endure being in the feared situation rather than running away and escaping them

explain the danger schema

-allocate attention more to threatening cues (attentional vigilance)

OCD (stuff about the overview of it is on flashcards)

-alrighttypooooo

for such events to qualify as a full-blown panic attack, there must be what? most of these symptms are _______, althought ____ are _________.

-an abrupt onset of at least 4 of 13 symptoms. -physical; 3; cognitive

what is the efficacy for cognitive-behavioral therapy compared to exposure and response prevention? but some researchers have concluded that the addition of what to what might be better?

-cbt not as effective -exposure and response prevention might be enhanced by addition of cognitive therapy

some researchers have noted similarities btw BDD and eating disorders, especially which one? what are the most striking similarities? what is the difference between ppl with BDD and ppl with anorexia nervosa?

-anorexia nervosa -excessive concern and preoccupation about phys appearance, dissatisfaction with ones body, and distorted image of certain features of one's body -BBD: look normal and yet are terribly obsessed and distressed about aspect of appearance -anorexia: emancipated and generally satisfied with this aspect of their appearance

this conditioning of anxiety to the internal/external cues associated with panic thus sets the stage for the development of 2 of 3 components of panic disorer: explain. ppl w/ panic disorder show greater what? and slower what? and what makes sense abouut this?

-anticipatory anxiety and, sometimes, agoraphobic fears -1st attack gets associated with cues (e.g. heart palps, shopping malls). now anxiety is conditioned to these CSs. now anxious apprehension about having another attack may develop (and agoraphobic avoidance of places where they might occur) -greater generalization, and slower extinction. extinction involves inhibitory learning (which seems to be impaired in panic disorder) so it makes sense they show impaired discriminative conditioning

the other category of medication that is useful in the treatment of panic disorder and agoraphobia is what type of meds? including what kinds? these meds have both advantages and disadvantages compared to the anxiolytics. what is 1 major advantage of the antidepressants? disadvantage of antidepressants? troublesome side effects of antidepressants? these troublesome side effects result in what? how high are relapse rates for antidepressants after discontinued use? how does that compare w/ relapse rates for benzos?

-antidepressants; primarily the tricyclics (TCAS) and SSRIS, and most recently the SNRIs -dont create physio dependence, & can alleviate any comorbid depressive symptoms or disorders -4w before effect, so NOT useful in acute situations -TCAs- dry mouth, constipation, blurred vision SSRIs- interference w/ sexual arousal -many ppl refuse to take meds or discontinue use -quite high (although not as high as w/ benzos)

what type of disorders did W.H.O. find was the most common category of disorders reported in all but one country? what was that country? but the prevelance rates varied from 2.4% (_____) to 18.2% (_______) classify the following countries and decide which ones have high or mod-low rates for anxiety disorders: Colombia, Japan, Nigeria, France, China, Lebanon, Spain

-anxiety disorders -Ukraine -china -US -mod-high rates: Colombia, France, Lebanon -mod-low rates: China, Japan, Nigeria, Spain

(medications) many ppl w/ panic disorder are prescribed what type of meds? including what kinds? advantage of these drugs? howeveer, what are the undesirable side effects? also, with ________ use, most people using _______________ develop _____________. what are the withdrawal symptoms of benzos? what happens w/ withdrawal (whats it like, whats it lead to)? so how are benzos considered when thinking about treating panic disorder and agoraphobia?

-anxiolytic (antianxity meds); the benzodiazepine category (e.g. alprazolam/Xanax or clonazepam/Klonopin) to -v quick (30-60mins), so useful for acute situations of intense panic/anxiety -drowsiness and sedation (which can lead to impaired cog and motor performance) -prolonged; mod-high doses; physio dependence, which results in withdrawal symptoms after discontinuing -e.g. nervousness, sleep disturbances, dizziness, and further panic attacks -withdrawal is very slow and difficult, and it leads to relapse in a high % of cases -these^^^ are the reasons why benzos are NO longer considered as a first-choice treatment

in moderately severe cases = in very seevre cases =

-anxious even venturing outside their hoems alone -utterly disabling, cannot go beyond the narrow confines of home - or even particular parts of the home

the cognitive theory of panic disorder proposes that ppl with panic disorder .... what is this referred to as? explain the vicious circle culminating a panic attack? are the aware? according to the cognitive model, only which ppl go on to develop panic disorder? what can prevent or reduce panic symptoms?

-are hypersensitive to their bodily sensations and give them most dire interpretation possible (e.g. i have a brain tumor) -tendency to catastrophize -scary thoughts cause more physical symptoms, which fuel more catastrophic thoughts -nope, under awareness. these *automatic thoughts* are the triggers of panic -ones w/ this tendency to catastrophize -a brief explanation of what to expect in a panic provocation study!

(Hoarding disorder) hoarding is a condition that has received very LITTLE research attention until the past 15 to 20yrs. shows like Hoarders have brought it to public awareness. how was hoarding traditionally (old) thought as? is hoarding disorder a new disorder to the DSM5?

-as a symptom of OCD -yeah new to DSM5

the subjective experience of excessive worry must also be accompanied by what? (160)

-at least 3 of 6 other symptoms (in box: (1) restlessness or feeling keyed up or on edge (2) being easily fatiqued (3) difficulty concentrating or mind going blank (4) irritability (5) muscle tension (6) sleep disturbances [difficulty falling or staying asleep, or restlessness, unsatisfying sleep])

in *cognitive restructuring*, the therapist does what? after helping the client to understand that such automatic thoughts (which usually occur just below the surface of awareness but can be accessed) offten involve cognitive distortions, the therapist then does what? what might the process of logical reanalysis might involve?

-attempts to help clients w/ social phobia identify their underlying negative, automatic thoughts (e.g. "ive got nothing interesting to say", "no one is interested in me") -helps the client change these inner thoughts/beliefs through logical reanalysis -asking onself questions to challenge the automatic thoughts (e.g. "do i know for certain that i dont have anything interesting to say?", "does being nervous have to lead to or equal looking stupid?")

(cognitive biases and distortions) cognitive factors have also been implicated in OCD. more specifically, ppl with OCD have what, similar to what occurs in other anxiety disorders? ppl w/ OCD also have trouble doing what? so they attempt to do what? BUT as we have noted, trying to supress neg thoughts does what?

-attentional bias toward disturbing material relevant to their obsessions -blocking out negative/irrelevant stuff or distracting stuff; so they attempt to suppress neg thoughts -paradoxically increases them

__________ is a cardinal characteristic of phobias why?

-avoidance -both bc the phobic response itself is unpleasant and because of the person's irrational appraisal of the likelihood that something terrible will happen

this type of general anxiety/apprehension us the essence of GAD, so it is referred to as the "___" anxiety disorder

-basic

why do phobic behaviors tend to be reinforced? in addition, the secondary benefits derive from what?

-bc every time they avoid a situation, his or her anxiety decreases -from being disabled, such as increased attention, sympathy, and some control over the behaviors, can also sometimes reinforce a phobia

(safety behaviors and the persistence of panic) even tho each time they have a panic attack they THINK they are dying, having a heart attack, etc, yet they never do. how come they dont disconfirm their beliefs and just give up the catastrophizing? what is important? this has shown to do what?

-bc they engage in safety behaviors (e.g. breathing slowly, bottle of anxiolytic meds), and they mistakely attribute it to their safety behaviors -imp during treatment to identify these safety behaviors so they can give them up and see. -increase effectiveness of trt

why did the DSM make agoraphobia its own distinct disorder?

-bc they recognized that many ppl with agor dont experience panic

(treatments) treatment for OCD includes ______ and ______ approaches as well as _______

-behav -cog -meds

what is the most effective treatment for OCD? (paradigm, term)

-behav trt called *exposure and response prevention*

what is the efficacy for behavioral trts compared to meds? what happens to those who choose meds over behavior therapy?

-behavior therapy more lasting benefits -may have to stay on drugs indefinitely

(treatments) treatments for panic disorder includes ______________

-behavioral and cog-behav and diff categories of meds

the most important temperamental variable is ____________, which shares characteristics with both _______ and __________ (causal factors) behaviorally inhibited infants who are_____________________ are more likely to become fearful during childhood, and by adolescence to show increased risk of developing social phobia

-behavioral inhibition; neuroticism; introversion -easily distressed by unfamiliar stimuli and who are shy and avoidant

(psychological causal factors of OCD) what is the first theory? what is it derived from?

-behavioral/learning view of OCD, is derived from Mowrer's two-process theory of avoidance learning

what else may play an important role in the development of social phobia, i.e. causal factor? (hint: unpredictable) perceptions of uncontrollability and unpredictability often lead to what? when is this kind of behavior especially likely? consistent with this, ppl with social phobia have a diminished sense of ________________. (causal factor) this diminished expectation of personal control may develop, at least in part, from what? (causal factor)

-being exposed to uncontrollable and unpredictbale stressful events (e.g. parental seperation and divorce, family conflict, sexual abuse) (e.g. paul finding his fiance in bed w/ bff) -submissive and unassertive behavior, which is characteristic of ppl who are socially anxious or phobic -if the perceptions of uncontrollability stem from an actual social defeat -diminished sense of personal control over events in their lives -as a function of being raised in families with somewhat overprotective (and sometimes rejecting) parents

*social phobia* (or social anxiety disorder)

-characterized by disabling fears of 1 or more specific social situations (e.g. public speaking, urinating in public bathroom, or eating or writing in public)

what drugs appear to recude anxiety by increasing GABA activity in certain parts of the brain implicated in GAD? what certain parts of the brain are implicated in GAD that the meds affect?

-benzodiazepines -limbic system, and by suppressing the stress hormone cortisol

(medications) many clients with GAD consult family physicians, seeking relief from their "nerves" or anxieties, etc. most often, what type of meds are prescribed? including what kinds? benzos are used - and misused - for (what symptoms)? what do benzos NOT help? drawbacks to benzos? what newer med is effective? what are its benefits? what are the drawbacks of buspirone?

-benzodiazepines (anxiolytics), such as Xanax or Klonopin -tension relief, reduction of other somatic symptoms, and relaxation. their effects on worry and other psychological symptoms are NOT as great -physio and psych dependence and withdrawal and are therefore difficult to taper. -buspirone (anxiolytic); not sedating, doesnt lead to physio dependence, and has greater effects on psychic symptoms (more than benzos) -takes 2-4w

list of all the biases and studies for ppl with BDD

-biased attention and interpretation of info relating to attractiveness - they selectively attend to pos/neg words like "ugly" or "beautiful" more than other emotional words not related to appearance -tend to interpret ambiguous facial expressions as contemptuous or angry -greater discrepancy than controls btw judgements of their "actual" face and their "ideal" face -when asked to choose pic that best matched their faces, controls picked ones more symmetrical that their real faces, but BDD ppl didnt have this bias -differences in visually processing other ppl's faces - bias for extracting local, detailed features rather than global/holistic processing of faces -when shown pic of their own face, greater activation in areas w/ inhibitory processing and the rigidity of behavior and thinking (the orbitofrontal cortex and the caudate) -BDD have performance deficits on tasks measuring executive functioning (e.g. manipulating info, planning, organization), which is thought to be guided by prefrontal regions -dont know if places a causal role, but def serves to perpetuate the disorder once it starts

(cog biases and maintenance of panic) how are ppl w/ panic disorder biased? do the info-processing biases cause, happen as a result, or help maintain panic disorder?

-biased in the way they process threatening info - interpret ambigious body sensations as threatening, & attention is automatically drawn to threatening info (e.g. study: greater activation to threatening words) -not clear whether it causes. but it def does help maintain it!

(biological causal factors in ocd) the evidence accumulating from studies suggests what about OCD?

-biological causal factors may play a STRONGER causal role for OCD compared to all the other disorders discussed in this chapter

(causal factors: a biopsychosocial approach to BDD) what approach is best for BDD?

-biopsychosocial

describe hoarding disorder

-both acquire and fail to discard many possessions that seem useless or of very limited value, in part bc of the emotional attachemnt they develop to their possessions -living spaces exteremly clutered and disorganized, interferes w/ activities (e.g. cooking) -severe cases- literally buried alive

people with these varied disorders differ from one another how? specific or social phobia? panic disorder? agoraphobia? GAD?

-both amount of fear or panic vs anxiety symptoms, and in the kinds of objects or situations that concern them -fear/panic not only when faced with spefici object/situation, but also the possibility of encountering their phobic situation -both frequent panic attacks and intense anxiety focused on the possibility of having another one -avoid places (e.g. open street, crowded places) -general sense of diffuse anxiety and worry about potentially bad things that might happen, and also may experience occassional panic attack, but is NOT the focus of their anxiety

(relationship to OCD and eating disorders) how are the symptoms of people with OCD and BDD similar? are people with OCD or ppl with BDD more convinced that their obsessive beliefs are accurate? what neurotransmitters and brain structures are implicated in BDD what treatments work for BDD?

-both have obsessions -both do ritualistic behaviors (e.g. reassurance seeking, mirror checking, comparing, camouflage) -ppl with BBD more convinced -same as OCD- neurotransmitter serotonin, and same brain structures -same as OCD

how are brain activation patterns different between people with OCD w/ hoarding symptoms and people with OCD w/out hoarding symptoms? which suggests what?

-brain activation patterns DIFFERENT btw the 2 -compulsive hoarding may be neurologically distinct from ppl with OCD

panic attacks are fairly _____ but _______, with symptoms developing abruptly and usually reaching a peak intensity within 10 mins; the attacks often subside in 20 to 30 mins and rarely last more than an hour how does this differ from anxiety?

-brief but intense -period of anxiety do not typically have such an abrupt onset and are more long lasting

most of the symotoms for ataque de nervios are the same as panic disoder, but what other symptoms might ataque de nervios include? such attacks are often associated with what kind of events? what symptom is common after the ataque de nervios episode?

-bursting into tears, anger, uncontrollable shouting, & shakiness, verbal or physical aggression, dissociative experiences, and seizure-like or fainting episodes -stressful event related to the family (e.g. news of a death) -amnesia for the episode

what is the long-term administration of clomipramine or fluoxetine do? what about the immediate short-term? so, how long must the drugs be taken?

-causes downregulation of serotonin receptors, further causing a functional decrease in availability of serotonin -INCREASE serotonin levels (and exacerbate symptoms too), but long-term effect is quite different -6 to 12w

(biological causal factors) the biological causal factors of panic disorder include __________________

-genetics, brain activity, and biochemical abnormalities

*panic disorder* what must they have to get a diagnosis? (often referred to as what?)

-characterized by the occurance of panic attacks that often seem to come "out of the blue" -experienced recurrent, unexpected attachs and must have been persistently concerned about having another attack or worried about the consequences of having an attack for at least a month (often referred to as anticipatory anxiety)

*anxiety disorders* among these disorders recognized in the DSM5 are:

-characterized by unrealistic, irrational fears or anxieties that cause significant distress and/or impairments in functioning. 1.specific phobia 2. social anxiety disorder (social phobia) 3. panic disorder 4. agorophobia 5. generalized anxiety disorder

when is the usual onset? what onset of trichotillomania is associated with the most severe course?

-childhood or later -onset post-puberty = more severe course

(prevelance, age of onset, gender differences) GAD tends to be ________. (long lasting or short duration)? after age _____ the disorder seems to disappear for many people. however, it often tends to be replaced by what type of disorder? and how is it characterized? (170)

-chronic -50 -replaced by a somatic symptom disorder and characterized by physical symptoms and health concerns

(neurotransmitter abnormalities) what drug is effective in treating OCD? what category is it from? do other drugs in that category work? why does clomipramine work? what neurotranmitter is strongly implicated in OCD

-clomipramine (Anafranil) is effective, even tho other TCAs are generally NOT very effective -antidepressants -has greater effects on serotonin -serotonin

what medications are effective, with 40-60% of people showing 25-35% reduction. but... in 1/3 of ppl who fail to respond to serotogenic meds, what may be done?

-clomipramine (anafranil) --> TCA antidepressant and , fluoxetine (prozac) --> SSRI antidepressent -but, thats about 30-50% who dont show ANY improvement -small doses of certain antipsychotic meds, sig greater improvement

(psychological causal factors) panic disorder is caused by a number of psychological factors. name all the views/factors (overview)

-cog theory -learning theory -anxiety sensitivity and perceived control -safety behaviors and the persistence of panic -cog biases and the maitence of panic

what form of therapy is effective for BDD (paradigm, type)? how effective? explain the exposure part explain the prevention part what are the treatment gains?

-cog-behav trt, emphasizing exposure and response prevention -marked improvement in 50-80% -identify and change distorted perceptions of body during exposure to anxiety-provoking situations (e.g. wearing something that highlights rather than disguises the "defect") -prevention of checking responses (e.g. mirror checking, reassurance seeking, repeated examination of defect) -well maintained at follow-up

how does the use of cognitive restructuring techniques alone compare to exposure-based techniques? what about the addition of cognitive techniques to exposure therapy? what about medications?

-cognitive restructuring alone has NOT produced results as good, and the addition of cognitive techniques has not added much -meds are ineffective alone, and antianxiety meds may even interfere w/ exposure therapy

what is the 2nd set of techniques? and why?

-cognitive restructuring technique, bc they recognized that catastrophic automatic thoughts may help maintain panic attacks

treatments for social phobia is centered around both __________ and _______ therapies and sometimes involves __________

-cognitive; behavioral; medications

*amygdala* amygdala is the central area involved in what has been called the "_________", w/ connections not only to lower areas like the _____________ but also to higher brain areas like the ____________.

-collection of nuclei in front of the hippocampus in the limbic system of the brain that is critically involved in the emotion of fear -"fear network"; locus coeruleus; prefrontal cortex

for treatments, what will we see? for each disorder, what constitutes the single most powerful therapeutic ingredient? medications work for all anxiety disorders? 2 medications that treat anxiety are:

-commonalitites in effective treatments -graduated exposure (and for certain disorders, added CBT techniques) -NO, all except phobias -antianxeity (anxiolytics) and antidepressant medications

how do exposure therapy and cog-behav therapy differ/same in effectiveness for social phobia? what about this new variant on cog-behav treatment?

-comparable results -might be more effective than exposure therapy

how does cog-behav therapy compare to meds? what about the new variant of cog therapy compared to meds?

-comparable results -new version of cog-behav more substantial improvement than meds

this inflated sense of responsibility for the harm they may cause (thought-action fusion) can motivate what? thus, part of what differentiates normal ppl w/ obsessions and can ordinarily dismiss them from ppl with OCD, is what?

-compulsive behaviors to try and reduce the likelihood of anything harmful happening -this sense of responsibility that makes the thought so concerning to them

what are they driven by? what does mirror gazing in ppl with BDD cause? what other types of behaviors do they typically engage in?

-driven by hope that they'll look different -feel worse -excessive grooming behavior, often trying to camo the defect through hairstyle, clothing, or makeup

men tend to obsess about: women tend to obsess about: age of onset usually?

-genitals, body build, balding -skin, stomach, breasts, buttocks, hips, legs -adolescence

what is part of the reason that compulsive hoarding has become a focus of sig research attention? hoarders are also at risk for what? what is their prognosis for trt? although the normal meds to treat OCD are typically not effective for hoarding disorder, what med is somewhat effective? what is the effectiveness for traditional behavior therapy (exposure and response prevention) for hoarders? what type of therapy is more effective?

-compulsive hoarders are sig MORE disabled (both occupationally and socially) than ppl with OCD -fire, falling, poor sanitation, serious health probs -very poor (poorer than ppl without hoarding symptoms) -one antidepressant- somewhat effective -less effective than for OCD -new intensive and prolonged behav trt that include home visits- more effective

what circuit do they think may be the source of dysfunction? what happens when it is not functioning properly? thus, the ________ of the orbital frontal cortex, which stimulates the "________", combines with a __________ among the orbital frontal cortex, the corpus striatum or caudate nucleus, and the thalamus may be the CENTRAL COMPONENT OF THE BRAIN DYSFUNCTION IN OCD!!!!!

-cortico-basal-ganglionic-thalamic circuit -inappropriate behavioral responses may occur, including repeated sets of behaviors stemming from territorial and social concerns (e.g. checking and aggressive behavior) and from hygiene concerns (e.g. cleaning). -overactivation -"stuff of obsessions" -dysfunctional interaction

what anxiety producing hormone has been strongly implicated as playing an imp role in GAD?

-corticotropin-releasing hormone (CRH)

people with GAD have trouble making _____. not only that, but after they manage to make a decision, they _______ endlessly, even after going to bed, over possible _________

-decisions -worry -errors and unforeseen stuff that may lead to disaster

_________ is especially common among those with panic disorder perhaps related to their fear of having a panic attack, they may also meet criteria for what other disorder?

-depression -avoidant personality disorder

VERY commonly have what other diagnosis? it is also related to what, with 80% reported what and 28% reported what? they are also frequentl commorbid with _________ and _______, but not as high as for ___________

-depression -suicide; suicide ideation; suicide attempt -social phobia; OCD; depression

where do people with BDD commonly go/end up at? will a good doc do the surgery or recommend to a psychologist? what often ends up happening? when they do get what they want, are they better?

-dermatologist or plastic surgeon (over 75% seek) -no; they get what they want -almost never satisfied with outcome; still tend to retain their diagnosis of BDD

ppl w/ anxiety sensitivity are more prone to what? anxiety sensitivity also predicts what? what reduces anxiety and even blocks panic? what else can reduce anxiety in a provocation procedure? when does anxiety sensitivity have its greatest effects? how can inidividuals w/ panic disorder be protected against the devel of agoraphobic avoidance?

-devel panic attacks and panic disorder -predicts devel of panic attacks, as well as other anxiety disorders -having a sense of *perceived control* -"safe" person w/ them -in ppl who have low perceived control -if they have high perceived control over their emotions and threatening situations

as already noted, what is the primary difference btw ppl w/ normal and abnromal obsessions?

-differ in degree to which they resist their own thoughts and find them acceptable

what do they say about the different aspects of panic disorder? panic attacks themselves arise from activity in the __________, either by _________ or by _______ for people who go on to devel panic disorder, the ____________ is thought to generate this conditioned anxiety, and is probably also involved in what? finally, the cognitive symptoms (fear of dying or losing control) and overreactions to danger posed by possibly threatening bodily sensations are likely to be ______________.

-different brain areas involved -amygdala; cortical inputs or activity from areas like locus coeruleus -hippocampus (part of limbic system, involved in learning of emotional responses); probs also involved in the learned avoidance w/ agoraphobia -mediated by higher cortical centers

as with specific phobias, social phobia often seems to originate from simple instance of what? (70)

-direct or vicarious classical conditioning (e.g. experiencing or witnessing a perceived social defeat or humiliation, or being or witnessing the target of anger or criticism)

in 2 studies, 58% of ppl with social phobia recalled and identified what? another study founf that ppl w/ social phobia reported a history of what? another study found that ppl w/ social phobia revealed that they showed especially robust conditioning of fear when...

-direct traumatic experiences as having been involved in the origin of their social phobias -severe teasing in childhood -when the US was socially relevant (critical facial expressions and verbal insults) as opposed to more nonspecifically negative stimuli (e.g. unpleasant and painful pressure)

what people are overrepresented among ppl with OCD?

-divorced (or separated) and unemployed ppl

the adaptive value of anxiety is that it helps us plan and prepare. at mild-mod levels of anxiety: when it becomes chronic or severe: (20)

-enhances learning and performance (e.g. upcoming exam) -maladaptive (e.g. anxiety disorders)

(OCD and preparedness) what concepts described earlier can help us understand the occurance and persistence of OCD? the fact that many people with OCD have obsessions and compulsions focused on what, have led researchers to conclude that these features of the disorder likley have what?

-evolutionary stuff from early ancestors -focus on dirt, contamination, other potentially dangerous situations; that these features have deep evolutionary roots

according to the psychoanalytic viewpoint of GAD, the defense mechanisms may become overwhelmed when a person experiences what? this might also happen if what?

-experiences frequent and extreme levels of anxiety, as might happen if id impulses are frequently blocked from expression (e.g. under period of prolonged sexual deprivation).

what was the original behavioral trt for agoraphobia? exposure-based treatments efficacy? what was the limitation of these original trts was what?

-exposure, w/ help of therapist/family member -quite effective, sig improvement (but still 20-40% not improved to a clinically significant degree) -they did not specifically target panic attacks

these social stumili include what?

-facial expressions of anger or contempt (which humans process faster than happy or neutral faces)

what are the most common areas of worry (for ppl w/ GAD)?

-family, work, finances, and personal illness.

like social phobia, taijin kyofusho is ? how do social phobia here differ from taijin kyofusho? ex? what leads to the social avoidance in taijin kyofusho? what disorder commonly is comorbid with taijin kyofusho?

-fear of interpersonal relations or of social situations -here: afraid bc WE may be the object of scuitiny or criticism -Japan: concerned about doing something that will offend or embarras others -may often others by blushing, emitting an offensive odor, staring inappropriately into the eyes of another person, or through their perceived physical defects or imagined deformities (which can reach delusional levels) -this fear of bringing shame on others or offending others is what leads to the social avoidance -body dysmorphic disorder (BDD)

if people who suffer from phobias attempt to approach the object of their phobia, they are overcome with ___________, which may vary from _________________ to full-fledged _________________.

-fear or anxiety -mild feelings of apprehension and distress (usually while still at some distance) -activation of the flight-or-fight response

(evolutionary context) social fears and phobia by definition involve what? it has been proposed that social fears/phobias evoled as what?

-fears of members of one's own species (by contrast, animal phobias involve fear of potential predators). -as a by-product of dominance hierarchies that are a common social arrangement among animals such as primates

specifically, what kind of exposure therapy is highly effective, and for what certain phobias? why is this an advantage? this treatment is also highly effective for who?

-for certain phobias (e.g. small-animal, flying, claustrophobia, blood-injury), when administered in a single long session -ppl more likely to seek treatment if only have to go once -in youth with specific phobias

thus, one factor in contributing to the ________ of obsessive thoughts, and the _________ that are often associated, may be what (and is similar to what other disorder)? e.g. when ocd ppl told to record in diary their thoughts on days when told to supress and not suppress thoughts, what did they report?

-frequency -negative moods -these attempts to suppress them (similar to what was discussed earlier about the effects of attempts to control worry in ppl with GAD) -2x as many intrusive thoughts on days they were attempting to suppress them

what is another common feature of BDD? (2 things)

-frequently seek reassurance from friends and family, but the reassurances almost never provide more than temp relief -frequently seek reassurance for themselves (e.g. checking in mirror)

whats wrong with GAD ppl's GABA? and what does GABA play a role in?

-functional deficiency; GABA plays a role in way our brain inhibits anxiety in stressful situations

*anxiety* *fear*

-general feeling of apprehension about *possible future danger* -alarm reaction that occurs i response to *immediate danger*

(psychoanalytic viewpoint) what is the psychoanalytic viewpoint? what kind of impulses did frued think were primarily involved? what happened to these impulses, according to freud?

-generalized (free-floating) anxiety results from an unconscious conflict btw ego and id impulses that isnt adequately dealt with bc the persons defense mechanisms have either broken down or have never developed -sexual & aggressive; had been blocked from expression or punished upon expression that led up to free-floating anxiety

do people with specific phobias realize that the fear is wild?

-generally, ppl do recognize that their fear is somewhat excessive or unreasonable although occasionally they may not have this insight

*pic of girl and dog: a person who has had ___ experiences with a potentially phobic stimulus, such as this little girl playing with her dog, is likely to be ______ from later acquiring a fear of dogs even if __________.

-good -immunized -she has a traumatic encounter with one

in most cases, OCD has a _________ onset, and once it becomes a serious condition, it tends to be ________, althought the severity of symptoms sometimes _____________.

-gradual; chronic; waxes and wanes over time

displacement activities often involve what? displacement activities may therefore be related to OCD how?

-grooming (e.g. bird preening its feathers) or nesting under conditions of high conflict/frustraton -related to the distress-inducing grooming (e.g. washing) or tidying rituals seen in ppl with ocd, which are often provoked by obsessive thoughts that elicit anxiety

concerned that they may _______________, people with agoraphobia are what?

-have a panic attack or get sick; they are anxious about being in places or situations from which escape would be difficult or embarrassing, or in which immediate help would be unavailable if something bad happens

because the symptoms of panic attack are mostly physcial, it is not suprising that they often what?

-have repeated visits to ERs or physicians' offices for what they are convinced is a medical problem

it has also been shown that our cognitions/thoughts do what? this _________ may help maintain or strengthen phobic fears w/ the passage of time

-help maintain our phobias once they have been acquired. e.g. ppl w/ phobias are constantly on alert (normal ppl tend to direct attention away from threatening stimuli). in addition, phobics also markedly overestimate the probability that feared objects have been, or will be, followed by fightening events. -cognitive bias

some studies have suggested that this heritability is what for panic disorder, but what have other studies found? what does this suggest

-heritability is partly specific for panic (rather than all anxiety disorders), but bunch of other studies found overlap (e.g. ppl w history of phobia at heightened risk for devel panic) -inconsistencies in findings

certain aspects of the conditioning experience, and our response to it, also are imp in determinig the level of fear that is conditioned. what is one powerful example?

-if the event is inescapable or uncontrollable (e.g. bit by dog that cant escape after being bitten) condition more powerfully than the same trauma that is escapable or to some extent controllable

accoridng to the psychoanalytic view of GAD, what is the primary difference between specific phobias and free-floating anxiety?

-in phobias, the defense mechanism of repression and displacement of an external object/situation are at work, whereas in free-floating anxiety these defense mechanisms do not work, leaving the person anxious nearly all the time

(medications) what is the difference between anxiety disorders and OCD in the treatment of these disorders with medications?

-other anxiety disorders respond to a range of drugs, but OCD seems to respond best to meds that affect the serotonin system

(appraisals of responsibility for intrusive thoughts) people with OCD seem to have an inflated sense of what? in turn, this inflated sense of responsibility can be associated with beliefs of what? this is known as _____________

-inflated sense of responsibility -simply having a THOUGHT about doing something is morally equivalent to actually doing ti, or that thinking about the behavior increases their chance of doing so -*thought-action fusion*

learning theory said that initial panic attacks become associated with what?

-initially neutral internal (interoceptive) and external (exteroceptive) cues through an *interoceptive conditioning* (or *exteroceptive conditioning*) process

what is *panic control treatment (PCT)* (paradigm)? what does it target? PCT has several aspects. what is the 1st? 2nd part of PCT? 3rd part of PCT? final part of PCT? (150)

-integrative cog-behav treatment -both agoraphobic avoidance and panic attacks -educated (about anxiety and panic, & how the capacity to experience both is adaptive) -taught to control breathing -taught about logical errors they're prone to make, & learn to subject their own automatic thoughts to a logical reanalysis -exposed to feared situations/body sensations to build up a tolerance to the discomfort

single most common type of social phobia?

-intense fear of public speaking

in __________, clients who, for example, are used to spending 2 to 3 hours a day shpwering and hand washing may be asked to do what? although some people refuse such trt or drop out early, there is what % reduction in symptoms, and what is their QOL like?

-intensive version of this trt; not shower for 3 days (spend no more than 10m). later, only 10m showering and no more than 5 30s hand washing in a day. they're also assigned "homework" (e.g. lady who had to touch roadkill and keep pebble in pocket) -50-70% reduction; improvement in quality of life; 76% remained gains several yrs later

table 6.4 BDD intereference in functioning) what are the top 4 intereference in functioning? which of the following has the higher percentage: ever thought about suicide bc of BDD, ever attempted suicide, ever attempted suicide bc of BDD? what are the average # of days missed of work bc of BDD? what are the average # of days missed of school bc of BDD?

-interference with social functioning (e.g. w/ friends, family, or intimate relationships) due to BDD- 99% -periods of avoidance of nearly all social interactions bc of BDD- 95% -ever felt depressed bc of BDD- 94% -interference w/ work or academic functioning bc of BDD- 90% -ever thought about suicide bc of BDD(63%) --> ever attempted suicide(25%) --> ever attempted suicide bc of BDD(14%) -52 days -49 days

when interpreting ambigious info, what are pll with GAD more likely to do?

-interpret it negatively -remember the threatening stuff

unfortunately, parents of anxious children often have what type of parenting style? this may only serve to promote what kind of thinking in their child?

-intrusive, overcontrolling -anxious behaviors by making them think of the world as an unsafe place in which they require protection and have little control themselves

in *exposure and response prevention*, what is the exposure component? what is the response prevention component? what does preventing allow to happen? this is often as distressing as it sounds, so the treatment usually starts out with what?

-involves having ppl repeatedly expose themselves (either in guided fantasy or directly) to stimuli that provoke obsessions (e.g. contamination fears, touching toilet seat) -requires that they refrain from engaging in the rituals that they would normally to reduce anxiety/distress -allows enough time, so anxiety will dissipate (even if its several hours) -manageable 1st steps in that persons fear hierarchy, and only over time they gradually work up to more intense exposures (e.g. touching bottom of shoe --> sitting on floor of dirty public restroom)

as agor 1st develops, ppl tend to avoid situations in which attacks have occured, but usually what happens to the avoidance?

-it gradually speads to other situations where attacks MIGHT occur

in the 1980s, two new techniques came about bc researchers recognized the importance of panic attacks to ppl w/ agoraphobia. what was one new technique? what is the idea in this technique? ex?

-its a variant on exposure known as *interoceptive exposure*, meaning deliberate exposure to feared INTERNAL sensations. -idea: fear of internal stuff should be treated same as external - through prolonged exposure to those internal sensations so that the fear may extinguish -engage in exercises that bring on internal stuff (e.g. spinning in a chair, hyperventilating, running in place) and stick w/ sensations until they go away, thereby allowing habituation of these situations/fears

in addition, thought suppression leads to a more general increase in obsessive-compulsive symptoms beyond what? finally, naturalistic diary studies of ppl with OCD reveal that they engage in what?

-just frequency -frequent, strenuous, and time-consuming attempts to control intrusive thoughts (although they're not effective)

when is the typical onset for OCD? what about children? childhood or early adolesence onset is more common in ________ (boys/girls) and is associated with _________ and __________.

-late adolescence or early adulthood -can occur in children, where its symptpms are strikingly similar to those of adults -boys; greater severity; greater heritability

what group of people show higher rates for *ataque de nervios*? ataque de nervios is a variant of what disorder?

-latin americans from the caribbean (especially puerto rico) -panic disorder

although many threatening situations can occur that provoke fear or anxeity unconscitionally, many of our sources of fear and anxeity are _______

-learned (conditioning!!)

like specific phobias, social phobias generally involves ___________ such learning is more likely in what ppl?

-learned behaviors that have been shaped by evolutionary factors -ppl who are genetically or temperamentally at risk

what theory is accepted about phobias? it is expected that once they are paired, it would also ____________

-learning theory = classical conditioning -generalize

what percent of ppl w/ OCD experience both obsessions and compulsions? this figure jumps to 98% when what is included?

-over 90% -when mental rituals and compulsions such as counting are included as compulsive behaviors

moreoever, ppl with ocd have low what? in ppl with ocd, their low confidence in their memory ability may contribute to what? an additional factor contributing to their ________ is that ppl with OCD have deficits in their ability to do what?

-low confidence in memory ability (especially for stuff they feel responsible for) -repeating ritualistic behaviors over and over again -repetitive behavior -deficit in ability to inhibit both motor responses and irrelevant info

moreover, bc of their distress and avoidance of social situations, ppl with social phobia on average have _______________(hint: $$$) and approximately 1/3rd have _________ (hint: impairment)

-lower employment rates and lower SES -severe impairment in 1 or more domains of their life

evidence supports the idea that such attentional biases in GAD play a _________ and ________ conversely, what can decrease anxiety?

-maintence -causal role -training them to attend away from threat

the evidence is increasingly strong that GAD and ___________ have a common underlying genetic predisposition what determines whether individuals with a gentic risk develop one or the other disorder? at least part of this common genetic predisposition for both disorders is best conceptualized as ...

-major depression -seems to depend entirely on the specific environmental experiences they have (nonshared) -neuroticism

in one highly effevtive version of such treatments, clients may be assigned excercises in which they do what? they also might receive what ?

-manipulate their focus of attention (internally vs externally) to demonstrate to themselves the adverse effects of internal self-focus -videotapes of themselves to help them modify their distorted self-images

what else is it imp to note?

-many ppl w/ one anxiety disorder will experience at least one more anxiety disorder and/or depression either concurrently or at a diff point in their lives

what is one prob with meds?

-meds must be taken over a long period of time to help ensure that relapse does not occur

(treatments) treatments for GAD involve _____________

-meds or CBT

from the bio perspective, how heritable is it from twin studies?

-mod hertable

according to fam and twin studies, panic disorder has a _________ heritable component. but this genetic vulnerability is manifested at a psych level by what?

-moderate; by neuroticism (related to behavioral inhibition

(bio causal factors: genetic factors) evidence from twin studies reveals a _____________ concordance rate for OCD for mz twins and a lower rate for dz twins. for ex, 80 pars of mz twins, 54% concordance rate for ocd, and 29 pars of dz twins with a 9% concordance rate. this is consistent with a ___________ genetic heritability, although it may be at least partially a _________ _________ ________ evidence also shows that _______ OCD has a higher genetic loading than _______ OCD

-moderately HIGH concordance rate -moderate -nonspecific "neurotic" predisposition. -early-onset -late-onset

results from twin studies have shown a ________ genetic contribution to social phobia. even larger proportion of varince in who develops social phobia is due to _________________ (causal factor), which is consistent with ____________

-modest -nonshared enviornemntal factors -a strong role for learning

finally, in recent years a number of ________ studies have begun to examine the association of OCD with ______________________. what did they find between OCD w/ tourettes and OCD w/out tourettes? suggesting what?

-molecular genetic studies -specific genetic polymorphisms (naturally occuring variations of genes). -there are different genetic polymorphisms btw the 2.; suggesting that these 2 forms of OCD are at least partially distinguishable at a genetic level

(CBT for GAD) has CBT for treating GAD become more or less effective over the years? CBT for GAD usually involves some behavioral techniques like what? and cognitive restructuring techniques like what? GAD initially appears to be what? however advances have been made and studies have shows that CBT approaches resulted in _______ changes on most symptoms measured how does the magnitude of changes seen with CBT compare to benzos? how else has CBT been found useful for GAD?

-more effective -behav: training in muscle relaxation; cog: cog-restructuring aimed at reducing distorted cognitions and info-processing biases, and reducing catastrophizing about minor events -GAD appeared to be the most difficult of the anxiety disorders to treat, and to some extent this is still true. -large -CBT at least as large as benzos, and CBT let to fewer dropouts (i.e. it was better tolerated) -helping ppl who have been using benzos for over a year to successfully taper their meds

anxiety disorders are the most common __________ for ________, and ________ most common in _______

-most common category of disorders for women, and 2nd most common for men

w/ panic disorder, what is the commorbidity? what are ppl w/ panic disorder most often comorbid w/?

-most comorbid w/ at least 1 other disorder -GAD, social phobia, specific phobia, PTSD, depression, and substance-use disorders (especially smoking and alcohol dependence)

how is fear and a panic attack similar? different?

-nearly identical to the state of fear -except that panic attacks are accompanied by a selective sense of impending doom, including fears of dying, going crazy, or losing control ----- these cog symotoms do NOT appear w/ fear states

people who worry about something tend to subsequently to have more _______________ than ppl who do not worry

-negative intrusive thoughts (e.g. ppl with GAD tend to experience more intense neg emotions to sad films)

finally, what other type of treatment is possible? for what people? how do people qualify for this trt? ____% of these intractable cases _______(at least ____ reduction in symptoms) the neurosurgery is designed to do what? however, whats wrong with neurosurgery?

-neurosurgical technoqies -ppl w/ severe, intractable OCD -severe OCD for 5yrs, and must not have responded to any known trt (medication or behavior therapy) -35-40% -respond quite well -1/3 reduction -destroy brain tissue in one of the areas implicated in this condition -can have adverse side effects

these __________ play a key role in __________ high levels of anxiety and worry, especially when?

-positive beliefs about worry; maintaining; especially in the early phases of the development of GAD

are compulsive checking behaviors required for diagnosis? ex of compulsive checking behaviors what is another v common symptom? what happens in severe cases?

-no not necessary -e.g. checking in mirror excessively or hiding or repairig a perceived flaw -avoidance, bc of fear others will see imaginary defect and be repulsed -isolated (never go out, not even to work)

twin studies showed that what factors play a substantial tole in the origins of specific phobias, what what does this support?

-nonshared environmental factors (individual specific experiences not shared by twins); supports idea that phobias are learned behaviors

(prevelance, age of onset, and gender differences) do we know the prevelance? why? do we think its rare? more in men or women? but?

-nope, bc of the great secrecy that surrounds this disorder -not a rare disorder -EQUAL in men and women, but the body parts they tend to obsess about differ btw the genders

one early theory about panic attacks implicated the locus coeruleus in the brain stem and a particular neurotransmitter _________ however today it is recgonized that it is increased activity in what brain area that plays a more central role in panic attacks than does activity in the locus coeruleus?

-norepinephrine -amygdala

what is the efficacy for combining meds with exposure and response prevention compared to behavior therapy alone? what about combining for children and adolescents?

-not much more effective than behavior therapy alone -yes, combining was superior for children and adolescents with OCD

what is imp to remember (how it differs from normal)? about half of ppl with BDD have concerns about their appearance that are what? what is also imp to remember?

-not ordinary concerns, these are complete preoccupation and sig emotional pain -that are of delusional intensity -others do NOT even see the defect, or if they do they they see only very minor thing within normal range

whats wrong with the psychoanalytic viewpoint on GAD?

-not testable, so largely abandoned

does a functional deficiency in GABA in anxious ppl CAUSE anxiety, or does it occur as a consequence of it? but what is apparent?

-not yet known -that the functional deficiency promotes maintenance of anxiety

according to one theory, why do panic attacks occur? abnormally sensitive fear networks may have a partially heritable basis but may also devel as a result of what? BUT whats missing in this picture?

-occur when fear network activated (either by cortical inputs or by inputs from lower brian areas). so panic disorder is more likely in ppl who have an abnormally sensitive fear networks -> neuroanotomic hypothesis -repeated stressful life experiences, particularly early in life -panic attacks are only 1 component, they also are anxious about having another panic attack

GAD comorbidity? many people with GAD also experience what (but do not qualify for diagnosis)?

-often co-occurs w/ other disorders, especially other anxiety disorders (panic disorder, social phobia, specific phobia, PTSD, and major depressive disorder) -panic attacks, but dont meet criteria for panic disorder

given all the traumas that ppl undergo and watch others experience, why dont more people develop phobias? (note: this is also a psych causal factor!) importantly, some life experiences may serve as ________, whereas others experiences may serve as ____________ ex? how is this true for vicarious learning as well (example)? results like these illustrate what?

-one reason is that individual differences in life expereinces strongly affect whether phobias actually develop -risk factors (make them more vulnerable); protective factors -kids who have has previous "fine" visits w/ dentist are less likely to develop phobia after a bad/painful visit than kids w/ fewer "fine" visits. -toddlers who saw mom react positively w/ snakes or spiders show less fear when exposed to snakes or spiders later -how parents and others close to the child can help influence the child's later experiences of fear and anxiety

what was there concern about (2 things) with GAD int he new DSM? what was the outcome?

-one was whether this is the optimal set of criteria (e.g. 6m requirement or excessive worry requirement), and one was whether the name was optimal (vs generalized worry disorder or pathological worry disorder) -conservative approach - no changes made to the diagnosis

part of the problem for research in this areas is due to what?

-one's definition of GAD (what diagnostic criteria should be); so studies show mixed results

what is the average employment rate for BDD? what is their QOL?

-only 50% -quite poor

(box, figure 6.3: neurophysiological mechanisms for OCD) the ________, __________, and ________ are the brain structures most often implicated in OCD. ________ metabolic activity has been found in each of these 3 areas in ppl with ocd.

-orbital frontral cortex -cingulate cortex/gyrus/cortex -basal ganglia (especially the caudate nucleus) -increased

(comorbidity with other disorders) OCD frequently co-occurs with what other disorders? moreover, approximately 20-50% of ppl with OCD experience what disorder at some point in their lives and as many as 80% experience significant what?

-other anxiety disorders (most commonly specific phobia, panic disorder, GAD, and PTSD) -major depression; sig depressive symptoms

also according to learning theory, they can explain the 3rd component as well - the panic attacks themselves. what happens? ex w/ man? what can this also account for? what else does it also underscore? (140)

-panic attack themselves get conditioned to internal cues (e..g heart rate), which is why they seem to "come out of the blue" -man had attack when he heard fave presidential candidate won. he was happy, so to him it seemed suprising/out of blue. but it makes sense bc his heart was racing, which served as internal CS that triggered panic -nocturnal panic attacks -why not everyone who has a panic attack actuallly devels panic disorder - ppl w/ certain genetic, temperamental or personality, or cog-behav vulnerabilities will show stronger conditioning of both anxiety and panic

what is more common, panic attacks or panic disorder?

-panic attacks

(biochemical abnormalities) over 30yrs ago what did they argue? studies, called __________________, produced mixed results - quite different and even mutually exclusive neurobiological processes thus,... (130)

-panic attacks are alarm reactions caused by biochemical dysfunctions -*panic provocation procedures* -no single neurobiological mechanism could possibly be implicated

agoraphobia is a frequent complication of what other disorder? however...

-panic disorder -many ppl w/ agor dont have panic

the ONE med that has shown promise for enhancing responsiveness of _______________ to ________ is ___________

-panic disorder -CBT -d-cycloserine

although research has shown different findings, what did the most recent research say about panic disorder and suicide? (120)

-panic disorder is indeed associated w/ increased risk for suicidal ideation and attempts independent of its relationships w/ comorbid disorders

is panic disorder with or without agoraphobia more common?

-panic disorder without agoraphobia is more common

(cognitive causal factors: the effects of attempting to suppress obsessive thoughts) what happens when people attempt to supress unwanted thoughts?

-paradoxical increase in those thoughts later (e.g. quick dont think about a white bear!)

in human children, experiences with control and mastery often also occur in the context of what? and so what?

-parent-child relationships, and so parents' responsiveness to their childrens needs directly influences their children's developing sense of mastery.

in addition to classic conditioning, what kind of perceptions make people more vulnerable? how does thinking play a role? what about sociocultral environment? what kind of appraoch is best for anxiety disorders?

-perceptions of a lack of control over either their environments or their own emotions (or both) seem to be more vulnerable -faulty or distorted patterns of cognitions -sociocultural environment in which ppl are raised, have diffrrent experiences -biopsychosocial

other research has also implicated the _________________

-periaqueductal gray area in the midbrain

in adults, the common genetic vulnerability is what? what brain areas and neurotransmitters?

-personality trait *neuroticism* - a proneness or disposition to expereince negative mood states that is a common risk factor for both anxiety and mood disorders -limbic system ("emotional brain"), certain parts of cortex -neurotransmitters --> GABA, norepinephrine, serotonin

what is the most common anxiety disroder?

-phobias

from sociocultural perspective, why does BDD seem to be occurring today? what are the self-schemas like of ppl with BDD? what are the possibilities of why these self-schemas occur?

-place great value on attractiveness and beauty, and ppl with BDD often hold attractiveness as their primary value -ideas like "if my appearance is defective, then i am worthless" -reinforced as kids for overall appearance more than for behavior -teased or criticized for appearance

in one experiement ( angry faces paired w electric shock and neutral and happy faced paired with same elevtric shock), even when presented subliminally, the angry faces activate the amygdala. relatedly, ... such results may explain what?

-ppl w/ social phobia show greater activation of the amygdala. -help explain the seemingly irrational quality of social phobia, in that the angry faces are processed very quickly and an emotional reaction can be activated w/out a person's awareness of any threat. the hyperactivity to negative facial expressions is paralleed by heightened neural responses to criticism.

what happened in the experiment (about subliminal stuff) this subliminal activation of responses to phobic stimuli may help to account for what?

-ppl were more scared of rear-relevant stimuli (slides of snakes and spiders) than fear-irrelevant stimuli (flowers + mushrooms), and these could be elicited even when presented subliminally -the irrationality of phobias - that is, ppl w/ phobias may not be able to control their fear bc their fear may arise from cognitive structures that are not under conscious control

the hair pulling is preceded by what? then is followed by what? the symptoms MUST cause ___________ or _______________.

-preceded by increase sense of tension; followed by pleasure, gratification, or relief when pulled out -clin sig distress; impairment in imp area of functioning

if social phobias evoled as a by-product of dominance heirarchies, it is not suprising that humans have an evolutionary based ...

-predisposition to acquire fears of social stimuli that signal dominance and aggression from other humans

as with specific phobias, what has proven to be an effective treatment?

-prolonged and graduated exposure to the feared situation (social situations)

(cognitive biases for threatening info) not only do ppl w/ GAD have frequent frightening thoughts, they also process threatening info in a biased way, perhaps why?

-prominent danger schemas

(psychological causal factors) what are the psychological causal factors for GAD? (all of them)?

-psychoanalytic viewpoint -uncontrollability/unpredictability -sense of mastery -reinforcing properties of worry -neg consequences of worry -cognitive biases

these alternative explanations stem from the observation that what all these bio challenge procedures have in common is that they ...

-put stress on certain neurobiological systems, which in turn produce intense physio symptoms of arousal (e.g. inc heart rate, respiration, bp)

what type of mood state do people with GAD suffer?

-relatively constant, future-oriented mood state of apprehension, chronic tension, worry, and diffuse uneasiness that they cannot control

is social phobia persistent or no?

-remarkably persistnet

it is not surprising then that those with GAD experience a similar amount of what? compared to what other disorder?

-role impairment and lessened quality of life to those with major depression

more recently, researchers have discovered that another neurotranmitter - _________ - is also involved in modulating GAD

-serotonin

genetic and temperamental variables also affect the speed and strength of conditioning. in one study, they found two variants of what gene? (genetic casual factor) kagan found that __________ toddlers at 21 months of age were at higher risk of developing multiple specific phobias by 7 or 8yrs of age than were uninhibited children (35 vs 5 percent); (temperamental causal factor)

-serotonin-transporter gene (the s allele, which has been linked to heightened neuroticism) show superior conditioning than those w/out the s allele -*behaviorally inhibited* (excessively timid, shy, easily distressed, etc)

what other type of meds are also used to treat GAD? how do antidepressants compare to the benzos?

-several categories of antidepressants (like those used to treat panic disorder) -antidepressants have a greater effect on the psychological symptoms of GAD than benzos do

what is the efficacy for a combination of antianxiety meds and CBT? short term? long term? how come there is greater relapse for meds for clients with OR without cognitive or behavioral treatment?

-short term: sometimes produce slightly better results compared to either trt alone -long term: after meds have been tapered (especially benzos), clients on meds w/ or w/out cognitive or behavioral treatment seem to show a greater liklihood of RELAPSE -bc they attributed their gains to the meds rather than to personal efforts

describe what BDD is

-they are obsessed with some perceived or imagined flaw in their appearance to the point they think theyre disfigured/ugly

*neurotic disorders* to freud, how did neurotic disorders develop? sometimes it was expressed _____ (like in anxeity disorders), but other times it wasnt obvious to person or other people, if _________

-show maladaptive and self-defeating behaviors, but they are not incoherent, dangerous, or out of touch with reality --> Psychodynamic term for anxiety-driven mental health conditions that are manifest through avoidance patterns and defensive reactions. -intrapsychic conglict produced anxiety. anxeity was a sign of inner battle btw some primitive desire (id) and prohibitions against its expressio (ego & superego) -overty; defense mechanisms were able to deflect or mask it

(genetic factors) there does seem to be a modest heritability for GAD, but is this smaller or bigger than other anxiety disorders? (200)

-smaller, expect for phobias

lifetime prevelance risk for __________, ______, and _______ is different for ethnic groups. how is the lifetime prevelence risk for these disorders different across ethnic groups? this difference is slighter larger for who? once a disorder develops, are there differences in how persistent it is?

-social phobia, GAD, panic disorder -the risk for those disorders^^ is LOWER among minorities than for white ppl. -ppl under age 45, and from lower SES -no, equally persistent once a disorder develops

what is the most common explanation of the pronounced gender difference in agoraphobia? some evidence indicated that men with panic disorder may be more likely to do what?

-sociocultural! in US, more acceptable for women who panic to avoid the situations and to need a trusted companion. men are prone to "tough it out" bc of social expectations and being more assertive. -so self-medicate w/ nicotine or alcohol and a way to cope w/ and endure panic attacks rather than developing agoraphobic avoidance

(Body Dysmorphic Disorder) how did BDD use to be classified? why? where is it now in the DSM-5? why?

-somataform category, bc preoccupation w/ body -OCD and related category, bc similarities w/ OCD

what does it mean to say that these components are "loosly coupeled"?

-someone might show phys and behavioral indications of fear/panic without much cog component, or vise versa

anxeiety: phsyiological level -

-state of tension and chronic overarousal, which may reflect risk assessment and readiness for dealing with danger should it occur ("something awful may happen, and i had better be ready for it if it does") -NO activation of flight or fight (like fear), but does PRIME for the flight or fight should the danger occur

what does noradrenergic activity do? what does serotonergic acticity do? this fits w/ what results related to meds that treat panic?

-stimulate cardiovascular symptoms associated w/ panic -decrease noreadrenergic activity -the meds (SSRIS) seem to increase serotonergic activity in the brain by also decrease noradrenergic activity (by decreasing noradrenergic activity, it decreases those symptoms)

anxiet: behavioral level -

-strong tendency to avoid situations where dnager might happen, but the immediate behavioral urge to flee is NOT present w/ anxiety as it is with fear

(the negative consequences of worry) obviously, worry can have negative effects. worry itself is not enjoyable and can actually lead to a greater sense of danger and anxiety (and lower positive mood) bc of all the possible catastrophic outcomes that the worrier envisions. in addition, ppl who worry about something tend to what?

-tend to have more negative intrusive thoughts than people who do not worry.

what is another cognitive bias seen in social phobia? moreover it is this negatively biased interpretations that socially anxious people make that are ___________. it has also been suggested that these biased cognitive processes combine to _______ social phobia and possibly to even ________ to its development

-tendency to interpret ambiguous social info in a negative rather than benign manner (e.g. someone smiles at you, does it mean they like you or think youre foolish?) -remembered -maintain -contribute

when panic disorder develops, what is the typical course?

-tends to have a chronic and disabling course, although the intensity of symptoms often waxes and wanes over time

what happened to the term *neurosis*? how has this trend gone a step further in the DSM5?

-term dropped from DSM; some disorders that did not involve obvious symptoms were reclassified (dissociative or somataform disorders), some neurotic disorders were absorbed into the mood disorders category as well -OCD no longer an anxiety disorder - its now its own category of OCD and related disorders

(the world around us box) what is there evidence for certain anxiety disorder related fo different cultures? what is one ex of a Japanese disorder? this disorder is related to the western diagnosis of what?

-that they actually evolved to fit certain cultural patterns -*taijin kyofusho* -social phobia

according to Baxter's theory, what prevents people with OCD from showing normal processes? in this case, what things that normal people can keep under control are NOT under control in ppl with OCD? what may be the reason that this circuit doesnt function properly?

-the dysfunctions in this circuit in turn prevent people w/ oCD from showing the normal inhibition of sensations, thoughts, and behaviors that would normally occur if the circuit were functioning properly -impulses toward aggression, sex, hygiene, and danger that most ppl can keep control "leak through" as obsessions and distract ppl w/ OCD from ordinary goal-directed behavior -abnormalities in white matter

explain the vicious cyccle (80)

-the inward attention and potentially awkward interactions of someone w/ social phobia may lead others to react to them in a less friendly fashion, CONFIRMING their expectations

what else about meds btw people with OCD w/out hoarding and ppl with hoarding disorder? what about genes?

-the meds that treat OCD dont work on ppl w/ hoarding -diff genes for ppl w/ ocd w/ hoarding vs. ppl w/ ocd w/out hoarding

*agoraphobia* sometimes, how might goraphobia develop?

-the most commonly feared and avoided situations include streets and crowded places such as shopping malls, movie theaters, and stores. -as a complication of having panic attacks in 1 or more such situations

in these situations, a person fears that he/she may be exposed to what? (60)

-the scrutiny and potential negative evaluation of others or that he/she may act in an embarrassing or humiliating manner

(The reinforcing properties of worry) what is considered the central feature of GAD?

-the worry process

typically, ppl with agoraphobia are frighted by what (in themselves)? so they avoid what?

-their own bodily sensations, so they also avoid activities that will create arousal (e..g exercising, watching scary movies, drinking caffeine, engaging in sex)

*pic of the monkey: in humans who have a panic attack...

-there is no external threat; panic occurs bc of some misfiring of the response system

when people with GAD worry, what happens to their emotional and physiological responses to aversive imagery? this suppression of aversive emotional physiological responding may serve to what? because worry ____________, it also does what to the person? thus, the threatening meaning of the topic being worried about is _________ (190)

-they are suppressed -reinforce the process of worry -worry suppresses physiological responding, it also insulates the person from fully experiencing/processing the scary topic, and it is known that such full processing is necessary for extinction -maintained

what does "panic attacks are often 'unexpected' or 'uncued'" mean? they might even occur during periods of relaxation or even sleep. the sleep panic attacks are called what?

-they do not appear to be provoked by identifyable aspects of the immediate situation -*nocturnal panic*

what did another experiment with monkeys show? thus importantly (exp w/ monkeys)... (50)

-they easily acquired fears to fear-relevant stuff (toy snakes & crocs) but NOT of fear-irrelevant stuff (flowers & toy rabbit) -thus, both monkeys and humans seem selectively to associate certain fear-relevant stimuli w/ threat or danger -monkeys had no prior exposure to any of that stuff^^, supporting the evolutionary based preparedness hypothesis even more strongly than human experiments (bc humans might condition stronger to snakes bc of preexisting negative associations to snakes)

when a person with a specific phobia encounter a phobic stimulus, what happens with their fear response? not suprisingly, what else do they experience they might even avoid what?

-they often show an immediate fear response that often resembles a panic attack (except that in panic attacks it is uncued/out of the blue, but in phobias there is a clear external trigger) -anxiety if they think they will encounter it or so go to great lengths to avoid it -seemingly harmless representations of it such as photos or tv images (e.g. claustrophobic person avoid a closet or elevator)

how do cognitive factors play a role in the onset and maitenance of social phobia? (causal factor) futher research proposed that these _______ of socially anxious people lead them to expect that they will ______________ (causal factor) such negative expectations lead to their being preoccupied with _______ and with stereotyped, negative ______________; to their _________________________; and to their __________________ of how well they come across to others. such intense self-preoccupation during social situations, even attending to their own heart rate, interferes with their ability to interact skillfully. what may evolve?

-they tend to expecr that ppl will reject or negatively evaluate them. this leads to vulnerability when around ppl who might pose a threat -danger schemas -behave in an awkward and unacceptable fashion, resulting in rejection and loss of status -bodily responses -self-images in social situations -overestimating how easily others will detect their anxiety -misunderstanding -a vicious cycle

(summary sorta of this section/practice 4 u) so again, explain the inflated sense of responsibility. now explain how the inflated sense of responsibility goes further so now explain how normal ppl differ from ocd

-they think theyre responsible. so to them, even thinking about bad things = same as doing it or will inc chances of doing it ---> called THOUGHT-ACTION FUSION. -the inflated sense of responsibility for the harm they could cause motivates them to do compulsions to try and make it less likely theyll do harm -normal ppl can ordinarily dismiss obsessions. OCD ppl differ bc they have this sense of responsibility that makes the thought extra concerning to them

the low tolerance for uncertainty in ppl with GAD suggests what? moreover,...

-theyre especially disturbed by not being able to predict the future (as none of us can) -the greater the intolerance, the more severe the GAD

how do unpredictable and uncontrollable events in GAD differ from PTSD? research thinks that ppl with GAD are more likely to have had a history of what? ppl with GAD have less tolerance for what?

-theyre not as severe and traumatic as w/ PTSD -trauma in childhood, more likely than ppl w/ several other anxiety disorders -less tolerance for uncertainty than nonanxious ppl and even ppl with panic disorder

further compelling evidence of a genetic contribution to some forms of OCD concerns a type of OCD that starts in childhood and is characterized by chronic motor tics. this form of tic-related OCD is linked to ___________, which is known to have a substantial genetic basis. for example, one study found that 23% of first-degree relatives of ppl with tourettes syndrome has what, even tho what?

-tourette's syndrome -had diagnosable OCD even tho tourettes itself is very rare

what is the evidence about trying to control thoughts/worry? (good? bad?) somewhat paradoxically, what can these intrusive thoughts do? as we have noted, perceptions of uncontrollability are also known to be associated with increased anxiety, so what is the viscious cycle?

-trying to control thoughts/worry may paradoxically lead to MORE intrusive thoughts and enhanced perception of being unable to control them -they can serve as a further trigger for more worry, and a sense of uncontrollability over worry may develop in these ppl caught in this cycle in GAD -vicious circle of anxiety, worry, and intrusive thoughts may develop

(perceptions of uncontrollability and unpredictability) as with specific and social phobia, it is not surprising that more fear and anxiety are created due to what? this has led researchers to believe what about their lives? (180)

-uncontrollable and unpredictable aversive events -they have a HISTORY of experiencing many important events in their lives as uncontrollable and unpredictable (e.g. boss or spouse has unpredictable bad moods)

panic attacks are: cued or uncued?

-uncued

(cultural perspectives) cross-cultural research suggests that although anxiety is a _____________, and anxiety disorder _________ exist in all human societies, there are some differences in prevalence and in the form in which the different disorders are expressed in different cultures.

-universal emotion -probably

in contrast to fear and panic, the anxiety response pattern is a complex blend of what?

-unpleasant emotions and cognitions that is both more future oriented and much more diffuse that fear

(Trichotillomania) what is trichotillomania's primary symptom? how did it use to be categorized? why and how is it classifed in DSM5?

-urge to pull out one's hair from anywhere on the body (most often the scalp, eyebrows, arms), resulting in noticable hair loss -inpulse-control disorder -similarities to OCD, so placed in OCD and related category

why are ppl much more likely to have fears of snakes, spirders, water, hights than of motorcycles, guns, chainsaws, even tho the later may be even more traumatic to humans? this is called what? (note: this is also a causal factor) thus, "prepared" fears are not what?

-we are *evolutionarily prepared* to rapicly associate certain objects (e.g. snakes) w/ frightening or unpleasant events -*prepared learning* - bc of course of evolution, those primates and humans who rapidly acquired dears that posed real threats to our early ancestors had an advantage (survived more). (guns and stuff were not present in early history so the didnt convey any selective advantage) -NOT inborn or innate, but rather are easily acquired or especially resistant to extinction

disadvantgae of med trt for OCD?

-when discontinued high relapse rate (like 50-90%)

when/where does the hair pulling usually occur how do they do it?

-when person is alone (or with immediate fam members) -examines hair root, twirls it off, and sometimes pulls the strand btw teeth and/or eats it

the orbital frontal cortex seems to be where what urges come from? these urges are supposed to be filtered by the caudate nucleus as they travel through the _____________ circuit, allowing only the strongest urges to pass on to the thalamus. the caudate nucleus (part of the set of structures called the basal ganglia, which are involved in the execution of voluntary, goal-directed movements) is part of an imp neural circuit linking the orbital frontal cortex to the thalamus. the basal ganglia also include 2 other structures - the globus pallidus and the substantia nigra - that are also involved in this _____________ circuit. the thalamus is an imp relay station that receives nearly all sensory input and passes it back to the cerebral cortex.

-where primitive urges regarding sex, aggression, hygeine, and danger come from (the "stuff of obsessions") -cortico-basal-ganglionic-thalamic circuit

BOTH the Southeast Asain Koro and the West African variant of the syndrome occur in what cultural context?

-where there are serious concerns about male sexual potency

how does one distinguish between whether its fear or anxiet?

-whether there is clear/obvious source of danger that would be regarded as real by most ppl. obvious --> fear (e.g. im afraid of snakes); not specify clearly the danger --> anxiety (e.g. im anxious about my parents health)

social phobia is more common among ________, and it typically begins __________

-women -adolescence or early adulthood

specific phobias are more common in ______(men/women), but ... __________ __________and _________ usually begin in childhood, but other phobias such as ________ and __________ tend to being in _________________ (40)

-women, but it varies by type (e.g. 90% of animal phobias are women, but blood-injection-injury are almost equal) -animal phobias, blood-injection-injury, dental -claustrophobia & driving phobia -adolescence or early adulthood

how long does someone have to experience worry for to be diagnosed, and does it matter if its controllable or not?

-worry must occur most days than not for 6m or more and it must be experienced as difficult to control

in the Yoruba culture of Nigeria, 3 primarly clusters of symptoms are associated with generalized anxiety: however? what do the sources of worry for this Nigerian generalized anxiety focus on? _______ are a major source of anxiety bc they are thought to indicate what? the common somatic complaints are also unusual: (quotes) Nigerians with this syndrome often have fears of what? what other country is this similar to, and these people have worries about what?

-worry, dreams, and bodily complaints -the sources of worry are v diff from Western society -creating and maintaining a large family and on fertility -dreams --> bewitched -"i have the feeling of something like water in my brain", "things like ants keep on creeping in various parts of my brain", "i am convinced some type of worms are in my head" -paranoid fears of malevolent attack by witchcraft -India --> worries about being possessed by spirits and about sexual inadequacy (in generalized anxiety, more than in Western cultures)

can they focus on ANY body part? what are the more common locations? is it usually one body part?

-yeah (e.g. face too thin or too fat) -skin (73%), hair (56%), nose (37%), eyes (20%), breasts/chest/nipples (21%), stomach (22%), face size/shape (12%) -no many have more than one

a correct diagnosis is not often made for _______. why? what further complicates it? why are prompt diagnosis and treatment important w/ panic disorder? (100)

-years. -due to the normal results on lots of costly medical tests -ppl w/ cardiac problems are 2x risk for developing panic disorder -bc there is as much impairment in social/occupational functioning as that caused by major depressive disorder, and bc panic disorder can contribute to the development or worsening of a variety of medical problems

is exposure and response prevention (and the intensive version) more effective than meds? what drug can improve effectiveness of CBT? but?

-yes more effective -d-cycloserine -this enhancement of d-cycoserine is blocked if the person is also taking an antidepressant

this model predicts, then, that exposure to feared objects or situations should be useful in treating OCD if the exposure is followed by prevention of the ritual, enabling the person to see that the anxiety will subside naturally in time without the ritual. is this a good treatment for OCD? thus, this theory is helpful in explaining what? however, this theory had NOT been useful for explaining what?

-yes, it is the MOST effective form of behavior therapy for OCD (discussed later) -what factors maintain OCD behavior, and geenrated a form of trt -not helpful in explaining WHY ppl with ocd develop obsessions in the 1st place and why some ppl never develop compulsive behaviors

can social phobia be treated with medications? what medicationsa re widely used? (90)

-yes, unlike specific phobias -antidepressants (MAOIs and SSRIs)

nearly than 2/3rds of ppl with social phobia suffer from... approximately 1/3rd __________ to reduce their anxiety and help them face situations they fear

1 or more additional anxiety disorders at some point in their lives, and about 50% also suffer from a depressive disorder at the same time -abuse alchol (e.g. drinking before going to a party)

from the benefits of worrying, explain the following with examples: 1. superstitious avoidance and catastrophe 2. avoidance of deeper emotional topics 3. coping and preparation

1. "worrying makes it less likely that the feared event will occur" 2. "worrying about most of the things i worry about is a way to distract myself from worrying about even more emotional things, things that i dont wanna think about" 3. "worrying about a predicted negative event helps me to prepare for its occurrance"

thus, fear and panic have 3 components:

1. cog/subjective components ("im going to die") 2. physiological components (e.g. increased heart rate and heave breathing) 3. behevaioral components (e.g. strong urge to escape or flee)

people have sought to discover the benefits of worrying are and what actual functions worry serves (bc if worrying is so anxiety provoking then why would they keep doing it). several benefits that ppl with GAD most commonly think derive from worrying are:

1. superstitious avoidance of catastrophe 2. avoidance of deeper emotional topics 3. coping and preparation

DSM5 criteria for Generalized Anxiety Disorder (GAD) p.198: A. B. C. NOTE: 1. 2. 3. 4. 5. 6. D. E. F.

A. excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6m, about a number of events or activities (such as work or school performance). B. the individual finds it difficult to control the worry. C. the anxiety and worry are associated with 3 (or more) of the following 6 symptoms (with at least some symptoms having been present for more days than not for at least 6m): NOTE: only 1 item is required for children 1. restlessness or feeling keyed up or on edge 2. being easily fatigued 3. difficulty concentrating or mind going blank. 4. irritability 5. muscle tension 6. sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) D. the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupation, or other important areas of functioning E. the disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical concern (e.g. hyperthyroidism) F. the disturbance is not better explained by another mental disorder (e.g. anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in OCD, separation from attachment figures in separation anxiety disorder, reminders of past traumatic events in PTSD, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

box DSM-5 criteria for Social Anxiety Disorder (Social Phobia): A. NOTE: B. C. NOTE: D. E. F. G. H. I. J.

A. marked fear or anxiety about 1 or more social situations in which the individual is exposed to possible scrutiny by others. examples include social interactions (e.g. having a conversation, meeting unfamiliar people), being observed (e.g. eating or drinking), and performing in front of others (e.g. giving a speech) NOTE: in children, the anxiety must occur in peer settings and not just during interactions with adults B. the individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. will be humiliating or embarrassing; will lead ti rejection or offend others) C. the social situations almost always provoke fear or anxiety NOTE: in children, the fear or anxiety may be expressed by crying, tantrums, freexing, clinging, shrinking, or failing to speak in social situations D. the social situations are avoided or endured with intense fear or anxiety E. the fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context F. the fear, anxiety, or avoidance is persistent (6m or more) G. the fear, anxiety, or avoidance causes clinically significatn distress in social, occupational, or other important areas of functioning H. the fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition I. the fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder J. if another medical condition (e.g. parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive

box DSM5 criteria for Agoraphobia: A. 1. 2. 3. 4. 5. B. C. D. E. F. G. H. I. NOTE: (110)

A. marked fear or anxiety about 2 (or more) of the following 5 situations: 1. using public transportation (e.g. automobiles, buses, trains, ships, planes) 2. being in open spaces (e.g. parking lots, marketplaces, bridges) 3. being in enclosed places (e.g. shops, theaters, cinemas) 4. standing in line or being in a crowd 5. being outside of the home alone B. the individual fears or avoids these situations bc of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g. fear of falling in the elderly; fear of incontinence) C. the agoraphobic situations almost always provoke fear or anxiety D. the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety E. the fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. F. the fear, anxiety, or avoidance is persistent, typically lasting for 6m or more G. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. H. if another medical condition (e.g. inflammatory bowel disease, parkinsons disease) is present, the fear, anxiety, or avoidance is clearly excessive I. the fear, anxiety, or avoidance is not better explained by the symptoms fo another mental disorder - for ex, the symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder); and are not related exclusively to obsessions (as in OCD), perceived defects or flaws in physical appearance (as in body dysmorphic disorder), reminders of past traumatic events (as in PTSD), or fear of separation (as in separation anxiety disorder) NOTE: agoraphobia is diagnosed irrespective of the presence of panic disorder. if an individual's presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned

(box p.177 - DSM criteria for Specific Phobia) A. NOTE: B. C. D. E. F. G. (30)

A. marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals, receiving an injection, seeing blood) NOTE: in children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging B. the phobic object or situation almost always provokes immediate fear or anxiety C. the phobic object or situation is actively avoided or endured with intense fear or anxiety D. the fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context E. the fear, anxiety, or avoidance is persistent, typically lasting for 6m or more F. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning G. the disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in OCD); reminders of traumatic events (as in PTSD); seperation from home or attachment figures (as in seperation anxiety disorder); or social situations (as in social anxiety disorder)

DSM-5 criteria for Body Dysmorphic Disorder (box) A. B. C. D.

A. preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others B. at some point during the course of the disorder, the indicidual has performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing his or her appearance with that of others) in response to the appearance concerns C. the preoccupation causes clin sig distress/impairment... D. the appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder

DSM5 criteria for obsessive-compulsive disorder (OCD)

A. presence of obsessions, compulsions, or both. obsessions are defined by (1) and (2): 1. recurrent and persistent thoughts, urges, or images that are experienced, at some point during the disorder, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress 2. the individual attempts to ignore or suppresses these thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion) compulsions are defined by (1) and (2): 1. repetitive behaviors (e.g. handwashing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly 2. the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive NOTE: young children may not be able to articulate the aims of these behaviors or mental acts B. the obsessions or compulsions are time-consuing (e.g. take more than 1hr per day) or cause clinically sig distress/impairment in.... C. the obsessive-compulsions symptoms are not attributible to phys effects... or MC D. the disturbance is not better explained by AMD...

box DSM5 criteria for Panic Disorder A. NOTE: 1. p____ 2. s_____ 3. t___ 4. s____ 5. f____ 6. c_____ 7. n____ 8. f____ 9. c___ 10 p___ 11. d___ 12. f___ 13. f___ NOTE: B. 1. 2. C. D.

A. recurrent unexpected panic attacks. a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur NOTE: the abrupt surge can occur from a calm state or an anxious state 1. palpitations, pounding heart, or accelerated heart rate 2. sweating 3. trembling or shaking 4. sensations of shortness of breath or smothering 5. feelings of choking 6. chest pain and discomfort 7. nausea or abdominal distress 8. feeling dizzy, unsteady, light-headed, or faint 9. chills or heat sensations 10. paresthesias (numbness or tingling sensations) 11. derealization (feelings of unreality) or depersonalization (being detached from oneself) 12. fear of losing control or "going crazy" 13. fear of dying NOTE: culture-specific symptoms (e.g. tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. such symptoms should not count as one of the four required symptoms. B. at least one of the attacks has been followed by 1 month (or more) of one or both of the following: 1. persistent concern or worry about additional panic attacks or thier consequences (e.g. losing control, having a heart attack, "going crazy") 2. a significant maladaptive change in behavior related to the attacks (e.g. behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations) C. the disturbance is not attributable to the physiological effects of a substance (e.g. drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism, cardiopulmonary disorders) D. the disturbance is not better explained by another mental disorder (e.g. the panic attacks do not occur in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in OCD; in response to reminders of traumatic events, as in PTSD; or in response to separation from attachment figures, as in separation anxiety disorder)

table 6.1 components of fear and anxiety: (p.175) COMPONENT 1.cog 2.phys 3. behav FEAR 1. 2. 3. ANXIETY 1. 2. 3.

COMPONENT 1. cog 2. phys 3. behav FEAR 1. "i am in danger! 2. increased heart rate, sweating 3. desire to escape or run ANXIETY 1. "i am worried about what might happen" 2. tension, chronic overarousal 3. general avoidance

table 6.3 association btw gender and lifetime risk of anxiety disorders (odds ratios represent the increase in the odds of anxiety disorders associated with female): DISORDER 1. agoraphobia 2. specific phobia 3. panic disorder 4. generalized anxiety disorder 5. social phobia ODDS RATIO 1. 2. 3. 4. 5.

DISORDER 1. agoraphobia (2.0) 2. specific phobia (2.0) 3. panic disorder (1.9) 4. generalized anxiety disorder (1.7) 5. social phobia (1.3)

T/F: there is extensive research for this disorder

F, very early stages of research

Table 6.2 subtypes of specific phobias in DSM5: PHOBIA TYPE 1. 2. 3. 4. 5. EXAMPLES 1. 2. 3. 4. 5.

PHOBIA TYPE 1. animal 2. natural environment 3. blood-injection-injury 4. situational 5. other EXAMPLES 1. snakes, spider, dogs, insects, birds 2. storms, heights, water 3. seeing blood or an injury, receiving an injection, seeing a person in a wheelchair 4. public transportation, tunnels, bridges, evelators, flying, driving, enclosed spaces 5. choking, vomiting, "space phobia" (fear of falling down if away from walls or other support)

explain Mowrer's 2-process theory of avoidance learning.

ppl associate neutral stuff (e.g. doorknobs) w/ frighting stuff (e.g. contamination) through classical conditioning and it elicits anxiety. once made the association, performing actions can reduce the anxiety. doing things like handwashing is reinforced, so its more likely to occur again in future. once learned, such avoidance responses are extremely resistent to extinction.