Psychology Chapter on Anxiety Disorders

Abnormal Psychology: Disorders and Treatment - I

• Quiz 2 is scheduled for December 6, 2024, from 3:15 to 4:45 a.m. in LI-3508.
• The quiz will cover modules 12 (Stress & Health), 13 (Social Psychology), 14 (Personality), and 15 (Abnormal Psychology).
• The quiz format comprises multiple choice questions and short-answer questions, accounting for 35% of the overall grade.

Assessment Tasks

• A term paper, due on December 13, 2024, accounts for 20% of the grade.
• The paper requires a brief introduction of the chosen theory or concept, a critical appraisal of the theory, relevant empirical studies, discussion of practical implications, and use of sources formatted according to APA style.
• The word limit is 1,500 excluding references.

Practical Marks

• Participation in research studies contributes 10% to the overall grade.
• 30 minutes of participation earns +1 mark, and lab studies earn +1.5 marks per 30 minutes.
• Commentary on articles, with 250 words, earns +2 marks.
• One absence incurs -1 mark, and lateness exceeding 5 minutes results in -1 mark.
• The due date for research participation and commentary submission is December 13, 2024.

Attitude toward seeking professional help scale - short form (Fisher & Farina, 1995)

• This is a scale to assess attitudes towards professional help for mental health problems.
• Participants respond using a 0-3 scale (disagree to agree).
• Various statements assess different aspects of attitudes, like perceived need for help, likeliness of seeking help, and perceived value of counseling.

Module 15.1: An Overview of Abnormal Behavior

• This module focuses on describing and evaluating definitions of mental illness.
• It defines and discusses the biopsychosocial model of mental illness, addressing its biological, psychological, and sociological aspects.
• Modules provide examples of cultural influences on abnormal behavior and a description of the DSM-5 categories and their examples.
• It evaluates the assumptions behind DSM-5 and its categorical approach to mental illness.
• The American Psychiatric Association defines mental disorder as a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior.

Module 15.1: Defining Abnormal Behavior

• Defines mental disorder as clinically significant disturbance in cognition, emotion regulation or behavior.
• Applying this definition can be challenging due to disagreements about what constitutes a significant disturbance.
• Abnormal behavior has been described in diverse ways, including attributing it to spirit possession in the past.
• The biopsychosocial model emphasizes biological, psychological, and sociological aspects of abnormal behavior.
• Culture profoundly influences abnormal behavior, by showcasing both normal and abnormal behaviors within that context.

Table 15.1: Categories of Psychological Disorders According to DSM-5

• Classifies psychological disorders using the DSM-5 system.
• Subcategories include neurodevelopmental disorders, bipolar and related disorders, anxiety disorders, trauma-related disorders, and more.
• This is a structured way of classifying disorders to facilitate diagnosis and treatment.

DSM-V (American Psychiatric Association, 2013)

• This document details 11 new diagnostic criteria: shared neural substrates, family traits, genetic risk, environmental risk factors, biomarkers, temperament, cognition, symptom similarity, course of illness, high comorbidity and shared treatment response.
• The module also discusses developmental and lifespan considerations.

DSM-V (American Psychiatric Association, 2013) - Specific Disorders

• Neurodevelopmental disorders include intellectual disabilities, communication disorders, autism spectrum disorders, and related issues.
• Mood disorders encompass schizophrenia spectrum, bipolar & related disorders, depressive disorders, anxiety disorders, obsessive-compulsive & related disorders, and trauma & stressor-related disorders.
• Somatic symptom & related disorders include feeding & eating disorders, elimination disorders, sleep-wake disorders, sexual dysfunctions, gender dysphoria, disruptive impulse-control & conduct disorders.
• Neurocognitive disorders include Alzheimer's Disease, traumatic brain-injury, HIV infection, and related disorders that significantly impact cognitive functioning.
• Personality disorders span cluster A (Paranoid, Schizoid, Schizotypal), cluster B (Antisocial, Borderline, Histrionic, Narcissistic) and cluster C disorders (Avoidant, Dependent, Obsessive-Compulsive).
• Additional conditions like abuse and neglect, are also listed.

DSM and the Categorical Approach to Psychological Disorders

• Psychiatrists and psychologists created the DSM to standardize their diagnostic criteria.
• The DSM is a reference manual providing specific criteria for classifying psychological diagnoses.
• Common criticisms of the categorical approach include that many individuals might fit multiple diagnoses, various disorders may share common underlying causes, and treatments for one disorder may effectively address another condition. Suggesting an alternative to rate people along multiple dimensions of distress.

Mental Illness and the Law

• The insanity defense, less than 1% of criminal cases successfully use in a legal setting to argue the defendant's lack of understanding their actions at time of committing crime.
• Involuntary commitment procedures, used to protect individuals facing mental health crises from themselves & others.

Table 15.2: Six Personality Disorders

• Presents six personality disorders: Antisocial, Avoidant, Borderline, Narcissistic, Obsessive-compulsive, and Schizotypal.
• Each disorder is described in clear terms.

Personality Disorders

• To be diagnosed, personality traits must first appear during adolescence.
• Traits are inflexible, stable, and consistent across various situations, causing significant distress or impairment.
• Personality disorders demonstrate substantial comorbidity with other psychological conditions, such as mood and anxiety disorders.

Borderline Personality Disorder

• This disorder primarily affects women.
• Characterized by mood instability, difficulty maintaining a stable sense of self, and impulsivity.
• A sociobiological model suggests people with BPD overreact to stress and struggle with regulating emotions.

Narcissistic Personality Disorder

• Characterized by superficial charm, dishonesty, and tendencies to exploit others.
• Overlaps significantly with antisocial personality disorder, and it is more common in men, affecting a considerable portion of the jail population.

Prevalence of Common Mental Health Disorders (Table; Page 21)

• Summarizes prevalence rates of various mental disorders as percentages of studied populations, across different countries.

Psychological Viewpoints of Psychopathology

• Psychoanalytic theory proposes that abnormal behavior stems partly from repressed conflicts and urges.
• Behavioral theorists view abnormal behavior as learned through experience and conditioning.
• Cognitive explanations suggest that abnormal behavior originates from irrational beliefs and illogical thinking patterns.

Module 15.2: Anxiety Disorders and Obsessive-Compulsive Disorder

• This module encompasses generalized anxiety disorder, panic disorder, and learned avoidance responses.
• It provides a theoretical framework using classical conditioning to explain the onset of phobias.
• It presents an evaluation of limitations of the classical conditioning model applied to phobias, including evidence not explained easily, and an overview of obsessive-compulsive disorder.

Prevalence Rate of Anxiety Disorders (Figure 15.2)

• Presents data in a visual format showing rates of anxiety disorders across various countries.

Prevalence rate of AD & Phobia (Table; Page 26)

• Provides data on the prevalence rates of anxiety disorders and phobias in various countries (US, China, Japan, Korea, Taiwan, & Hong Kong).

Disorders with Excessive Anxiety

• GAD is a chronic state of anxiety and worry.
• Panic Disorder is defined by recurrent panic attacks involving a surge of intense fear or discomfort.
• Hyperventilation occurs as a symptom when rapid breathing becomes excessive, leading to decreased carbon dioxide in the blood.
• Panic sufferers commonly develop anxiety disorders or agoraphobia—a fear of open or public spaces.
• Social phobia is also associated with intense anxieties about social interactions.

Phobia

• An avoidance behavior is resistant to extinction:
• A phobia is an overwhelming fear that disrupts normal life.
• Phobias are learned, influenced by observed behaviors and experiences.

Learning Fear by Observation (Study 1 & 2)

• Involves lab and wild-born monkeys, and describes two experiments to investigate fear learning through observational experience.
• Results indicate that monkeys learn from observing fearful behaviors in others, demonstrating vicarious learning.
• Suggesting that children can acquire fears by observing others' reactions.

Some Phobias Are More Common Than Others

• Common phobias encompass fears of public places, public speaking, heights, air travel, water, strangers, animals, blood, and unusual weather events.
• People demonstrate varying degrees of fear responses conditioned by observed or experienced threats.

Obsessive-Compulsive Disorder (OCD)

• OCD involves recurring thoughts (obsessions) and actions (compulsions) that can significantly interfere with daily life.
• Common compulsions often revolve around cleaning and checking.

Obsessive-Compulsive Disorder (continued)

• Compulsive checkers constantly double-check themselves.
• Repetitive checking can lead to decreased confidence in previous checks.
• Effective treatments for OCD involve exposure to the source of distress while preventing the compulsive behavior.

Explanations for Anxiety Disorders

• Learning models emphasize the acquisition of fears through classical conditioning and maintenance mechanisms involving operant conditioning.
• Learning via observation of others or inaccurate information also contributes to anxiety disorder development.

Explanations for Anxiety Disorders (continued)

• Anxious individuals tend to engage in catastrophic thinking—predicting negative consequences (despite low probability).
• Anxiety sensitivity—a fear of anxiety-related symptoms also contributes to anxieties.
• Neuroticism may influence the likelihood of anxiety disorder development.

Treatment for Phobias

• Exposure therapy (systematic desensitization) is the most effective way to address phobias.
• Involves gradually exposing people to the feared item or situation.
• Systematic desensitization helps by preventing avoidance of feared stimulus, as clients progressively confront the stimulus and learn it's not as threatening as imagined.

Exposure Therapies

• Clients confront feared stimuli, and the goal includes decreasing the intensity of the feared stimuli.
• Earliest examples include systematic desensitization techniques developed by Joseph Wolpe in 1958.
• Method involves gradually exposing clients to anxiety-producing situations, starting with imagined scenes.

Systematic Desensitization

• Based on the principle of reciprocal inhibition—the inability for someone to be simultaneously anxious and calm.
• Employs counterconditioning by repeatedly associating a relaxation response with anxiety-provoking stimuli.
• Can be implemented using imaginal techniques or real-world exposures to create a hierarchy of feared items.

In vivo desensitization & Virtual Reality Therapy

• Involves gradually approaching and confronting fears in real-world situations.
• Virtual reality therapy assists clients gradually approaching their fears in a simulated, safe environment.

Systematic Desensitization (continued)

• Dismantling clinical research confirms that no single component of treatment is crucial.
• This leads to variations of exposure therapies with response prevention components like flooding.
• Treatment demonstrates considerable effectiveness in addressing diverse anxiety disorders, including phobias, OCD, and PTSD.

Systematic Desensitization (Steps)

• Relaxation training is the first step.
• Creating a fear hierarchy follows relaxation training.
• Progressive exposure to the hierarchy is the final step. This involves progressively confronting feared situations.

Desensitization Hierarchy (Example)

• Demonstrates a systematic approach, progressively exposing clients to increasingly anxiety-inducing situations.

Module 15.3: Substance-Related Disorders

• Defines substance dependence/addiction.
• Explains why accurately classifying addictive substances is challenging.
• Discusses different explanations for addiction.
• Describes procedures to identify at-risk individuals for alcohol abuse.
• Details treatments for alcoholism and opiate addiction.

Substance Dependence (Addiction)

• Addiction is characterized by the inability to quit self-destructive habits.
• Addictive substances increase dopamine release in the nucleus accumbens, associated with attention.
• Reasons for addiction persist even if the harmful effects are apparent, like avoiding withdrawal symptoms and stress reduction.
• Addictions alter brain's response to addictive substances strengthening their effects, decreasing responsiveness towards other elements.

Brain Chemistry of Addictive Behaviors (Figure 15.7)

• Illustrates the nucleus accumbens, a brain area crucial for motivating responses to factors like drugs, food, and sex.
• Drugs increase dopamine activity within this area.

Is it a problem?: Internet Addiction

• Questions whether internet addiction is a recognized disorder.

Take your side – Is internet addiction a disorder? (DSM-IV criteria)

• Presents arguments for and against considering Internet addiction a disorder according to DSM-IV criteria.
• Arguments include the effects of continued use despite negative consequences (tolerance, withdrawal, significant distress, etc.)

Internet Gaming Disorder (APA, 2013)

• Suggests criteria for diagnosis.
• Chronic internet gaming is frequently used to manage negative moods, has potential for significant distress.
• Lists criteria including preoccupation with gaming, withdrawal symptoms, tolerance (increasing gaming time), unsuccessful attempts to quit, and lost interest in previous activities.

Internet Gaming Disorder (continued)

• Presents additional proposed criteria for diagnosis, including behaviors like excessive gaming despite knowledge of negative consequences, using gaming to escape negative moods, jeopardizing relationships or job/education, and excluding recreational or social internet use.

Internet Gaming Disorder (continued)

• Provides examples of typical behaviors, such as prolonged gaming sessions disregarding basic needs like sleep and food, displaying irritability/anxiety when gaming is interrupted.
• Outlines mild/severe levels of gaming disorder based on the time spent gaming or the extent disruption in daily life.

Internet Gaming Disorder (continued)

• Prevalence is highest in Asian countries.
• Risk factors include computer availability, genetics & physiological elements (unclear).
• Functional consequences include school failure, job loss, marriage difficulties, neglect of family, and comorbidity with other mental illnesses (MDD, ADHD, OCD).
• Excessive use of social media, including Facebook, viewing online pornography, is not considered analogous and warrants future research.

Risk Factors

• Lists factors that increase the chance of experiencing a mental health condition.
• These range from family dysfunction and poor parenting styles to social alienation, poor coping strategies and exposure to negative life events.
• Potential factors include mental health issues (depressed mood, anxiety).

Protective Factors

• Describes factors that support well-being.
• These encompass positive relationships in families, democratic parenting, problem-solving and coping skills, social connectedness within supportive peer groups, involvement in school and a variety of activities.
• Fostering positive self-worth, competency and internal locus of control.

Treatments for IGD

• Lists potential treatments and therapies like behavioral therapy, adventure-based therapy, and mindfulness for mitigating internet gaming disorder.

Alcoholism

• Discusses the habitual overuse of alcohol, genetic predispositions toward early-onset alcoholism in humans.
• Emphasizes how genetic predisposition is a key element for alcoholism.

Predicting Alcoholism

• Suggests that behavioral patterns may predict future alcoholism.
• Highlights studies investigating the abilities of individuals estimating their degree of intoxication after consuming alcohol, pointing out a correlation with the development of alcoholism.

Alcoholism (continued)

• Discusses that those with less than average intoxication are more prone to developing heavy drinking habits than average drinkers.

• Outlines treatments, such as self-help groups, contingency management, and pharmacotherapies (like Antabuse) utilized to assist individuals attempting to quit alcohol consumption or substance abuse.

Opiate Dependence

• Discusses that Opiate use has a rapid onset compared to alcohol/tobacco dependence.
• Outlines treatment strategies, including self-help groups, contingency management, and medication to alleviate cravings (like Methadone).

Table 15.3: Comparison of Methadone and Morphine

• Compares properties of Methadone and Morphine focusing on addictiveness, onset, relieving cravings, rapid withdrawal symptoms (when stopped).

Alcoholics Anonymous (AA)

• Describes Alcoholics Anonymous (AA) as a popular self-help group for those with alcohol addiction.
• AA's method, centered on the 12-step program, emphasizes peer support and shared experiences with little research demonstrating effectiveness.

AA Alternatives

• Presents controlled drinking, as an effective program—to help people set limits/moderately consume alcohol.
• Relapse prevention is a treatment approach that anticipates setbacks and implements recovery protocols accordingly.

Module 15.4: Mood Disorders, Schizophrenia, and Autism

• This module is designed to assist with describing mood disorders (major depression), its causes, treatments, distinguishing them from bipolar disorder, primary schizophrenia symptoms, genetic/neurodevelopmental hypotheses for schizophrenia and its related treatments.

Symptoms of Depression

• Lists symptoms of depression including cognitive, behavioral & emotional elements.

Mood Disorders

• Describes depression as a recurring condition wherein symptoms fluctuate at different times.

• Highlights that episodes span several months/years.

• Emphasizes the significant impact on functional abilities across various areas of life.

Sample MDD Symptoms

• Lists symptoms associated with Major Depressive Disorder (MDD).

Depression

• Discusses major depression, reporting cultural variations in its presentation and experiencing symptoms.
• Discusses the possibility for repeating episodes, following previous stressful events.

Prevalence Rate of Depression

• Provides data on depression prevalence rates within various countries (US, China, Japan, and Hong Kong)

Eating Disorders

• Describes anorexia nervosa and bulimia nervosa, and their related symptoms—as eating disorders.

DSM-V Assessment criteria & Method

• Details criteria and assessment procedures—for diagnosing eating disorders—according to the DSM-V system.

Conceptual Model of Disordered Eating

• Presents a visual model showing interconnectedness of factors that contribute towards developing eating disorders (anxiety, avoidance of eating, reduction of anxiety).

Explanations for MDD

• Addresses the intricate interplay between biological, societal, psychological, and environmental factors in MDD development, acknowledging significant disruptions/losses of valued elements in a person's life.

Explanations for MDD (continued)

• Behavioral approaches—regarding the reduced positive reinforcement, leading to depression. - Beck's cognitive theory suggesting that depression originates from negative thought patterns/expectations.
• Discusses learned helplessness—as a core concept—in the context of depression, explaining a person's attribution of failures internally and globally. - Emphasizes the importance of genetic factors influencing MDD, highlighting the impact of serotonin, norepinephrine, and dopamine.

Environmental and Genetic Influences on Depression

• Discusses the unsuccessful pursuit for a single gene associated with major depression - but the presence of family mental health histories that may indicate a predisposition to MDD.

• Further explores a link between depression & other conditions (substance use, attention deficit, migraine headaches), suggesting that depression may be followed by issues like anxiety or eating disorders.

Treatments for Major Depression

• Provides details of antidepressants, discussing tricyclic drugs, SSRIs and MAOIs—their method of working, duration of effects & potential advantages/disadvantages.

How antidepressants work? (Figure 15.9)

• Illustrates the mechanism of action of antidepressants, highlighting how they influence the neurotransmitter system—including the role of serotonin, dopamine, norepinephrine.

Treatments for Major Depression (continued)

• Describes cognitive therapy.
• Discusses the recovery rate across varying degrees of severity, noting that milder depression can show spontaneous recovery in several months for a significant number of cases.

Treatments for Major Depression (continued)

• Discusses the choice between psychotherapy and antidepressants, highlighting the advantages and disadvantages of each in relation to treatment effectiveness and duration
• Describes Electroconvulsive Therapy (ECT), a procedure used in situations where other treatments prove ineffective and involves using electrical stimulation to produce seizures, while other treatments focus on cognitive and behavioral changes.

Bipolar Disorder

• Defines bipolar disorder—as a condition characterized by alternating episodes of extreme highs (mania) and lows (depression).
• Describes mania as the opposite of depression, where persistent energy, uninhibited behavior, and irritability are experienced.

Test your knowledge on anxiety disorders with this quiz focused on key characteristics, treatment approaches, and learning mechanisms related to conditions like GAD, panic disorder, and phobias. Explore common misconceptions and effective therapies such as exposure therapy in understanding anxiety disorders.