Middle Adulthood PDF

Sensitivity to taste and smell also Vital Capacity – the maximum volume Middle Adulthood declines in midlife of air the lungs can draw in and expel – between 40 - 65 years of age Some loss of muscle strength is may be...

Sensitivity to taste and smell also Vital Capacity – the maximum volume Middle Adulthood declines in midlife of air the lungs can draw in and expel – between 40 - 65 years of age Some loss of muscle strength is may begin to diminish at about age of usually noticeable by age of 45 40 Middle age can be a time of decline Basal Metabolism – minimum amount Middle-aged adults are less likely to and loss, or it of energy that your body needs to fall asleep at daytime, need less sleep can be a time of mastery, competence, maintain vital functions while resting to maintain alertness, and slow and growth Manual Dexterity generally becomes reductions in slow wave sleeps at night “Afternoon of Life” – Carl Jung less efficient with age Menopause – when a woman Balancing work and relationship Aging brain works more slowly and permanently stop ovulating and responsibilities in the midst of physical have difficulty juggling multiple tasks menstruating and can no longer and psychological changes The ability to ignore distractions conceive a child associated with aging declines with age ⚬ One year after the last menstrual Decrease in the volume of gray period Physical Development matter and myelin begins to break ⚬ Perimenopause (Climacteric) – Physical Changes down with age beginning of menopause; woman’s Age-related visual problems occur Physical activity and fitness are production of mature ova begins to mainly in five areas: associated with higher white and gray decline, and the ovaries produce less near vision, dynamic vision, sensitivity matter volume estrogen to light, visual Meditation affords cognitive benefits Menopause – when a woman search, and speed of processing visual to middle aged permanently stop ovulating and information adults and may help offset declines menstruating and can no longer Presbyopia – difficulty focusing on Skin may become less taut and conceive a child near objects smooth as the layer of fat below the ⚬ Hot flashes, night sweats, vaginal Myopia – nearsightedness surface becomes thinner, collagen dryness, sleep disturbances, mood Presbycusis – gradual hearing loss molecules more rigid, and elastin fibers disturbances, urinary incontinence, ⚬ Men experience hearing loss quickly more brittle cognitive disturbances, somatic than women Middle-aged people tend to gain symptoms, sexual dysfunction ⚬ Noise experienced at the work site weight as a result of accumulation of ⚬ Menopause Hormone Therapy and (occupational noise) body fat and lose height due to SSRIs ⚬ Social noise- concerts, playing music shrinkage of the intervertebral disks At age 30, men’s testosterone levels, like airpods sperm count, genetic quality declines Cadano, Iedsif Croain  Men at this age also experience the second X chromosome and before ⚬ Women experience more stress than sexual dysfunction due to diabetes, menopause, to beneficial effects of men and to be more concerned about obesity, hypertension, depression, etc. estrogen on both cardiovascular and stress cognitive health ⚬ The classic stress response – fight or Physical and Mental Health However, women report being in fair flight – may be more characteristic of Hypertension – high blood pressure, or poor health than men men, activated in part by testosterone increasing important Osteoporosis – bones become thin concern from midlife and the world’s and brittle as a result of calcium Cognitive Development leading preventable cause of early depletion (due to falling of estrogen MEASURING COGNITIVE death levels) ABILITIES IN MIDDLE AGE Cancer has replaced heart disease ⚬ Good lifestyle habits can reduce risk, as the leading cause of death between if started early in life Middle-Aged people are in their prime ages 45 and 64 Breast cancer is responsible for the Individuals who scored the highest in Type 2 Diabetes – mature onset, the largest number of cancer-related the study of Schaie tended to have most common type; develops after age deaths among women high educational levels, flexible 30; glucose levels rise because the ⚬ Risks: overweight, alcoholism, early personalities, intact families, pursue cells lose their ability to use insulin menarche and late menopause, history cognitively complex occupations and Type 1 Diabetes – juvenile-onset, or of breast cancer in the family, no other activities, to be married to insulin-dependent, in which the levels children, did not breast-feed, or late someone more cognitively advanced, of blood sugar rises because the body pregnancy to be satisfied with their does not produce enough insulin ⚬ Treated by removal of part or all accomplishments Excess weight in middle age breast and chemotherapy Fluid Intelligence – ability to solve increases the risk of impaired health ⚬ Mammography – diagnostic x-ray of novel problems, such as problems that and death the breasts require little or no previous People with low socioeconomic status Stress – the damage that occurs knowledge(middle age decline) tend to have poorer health, shorter life when perceived environmental ⚬ Peak in young adulthood expectancy, more activity limitations demands or stressors exceed a ⚬ Many older adults perform in due to chronic disease, and lower well- person’s capacity to cope with them the real world at high levels being than people with higher SES ⚬ Stress in midlife may come from role despite declines in fluid Women have a higher life expectancy changes, career transitions, grown intelligence than men and lower death rates, may children leaving home, and the Crystallized Intelligence – ability to be due to genetic protection given by renegotiation of family relationships remember and use information Cadano, Iedsif Croain acquired over a lifetime, such as emotional intelligence, high in positive Four main needs for meaning that academics (increase in middle age) affect, and open to new ideas and guide how people try to make sense of ⚬ Increase through middle age experiences their lives: and often until the end of life Divergent thinking peaks at late 30s ( Need for Purpose – goals and solve problem in multiple option) fulfillments THE DISTINCTIVENESS OF ADULT Need for Values – enable COGNITION Work and Education people to decide whether Mature adults show increasing Phased Retirement – people reduce certain acts are right or wrong competence in solving problems in works hours or days, gradually moving Need for a sense of efficacy – their chosen field into retirement over a number of years belief that ⚬ Specialized Knowledge or Expertise Bridge Employment – switching to they can control their – form of crystallized another company or new line of work environment intelligence that is related to the Employers see benefits of workplace Need for self-worth process of encapsulation education in improved morale, ⚬ Adults do not usually depend on the increased quality of work, better Well-being in Late Adulthood brain’s information- teamwork and problem solving, and Coping – adaptive thinking or processing-machinery because some greater ability to cope with new behavior aimed at reducing or relieving adult’s fluid intelligence becomes technology and other changes in stress that arises from harmful, encapsulated workplace threatening, or challenging conditions ⚬ Expert thinking often seems Cognitive-Appraisal Model – people automatic and intuitive Religion respond to stressful or challenging ⚬ Such intuitive, experience-based Viktor Frankl said that the three most situations on the basis of two types of thinking is also a characteristic of distinct human qualities are (gestalt analyses: Postformal Thought therapy) spirituality, freedom, and ⚬ Primary Appraisal – people responsibility analyze situation and decide Creativity ⚬ Spirituality, in his view, refers to a ⚬ Secondary Appraisal – people Creativity seems to be the product of human being’s uniqueness of spirit, evaluate what can be done to particular social contexts as well as philosophy, and mind prevent harm individual proclivities ⚬ Having a sense of meaning in life can Older adults tend to use more Characteristics: self-starters, lead to clearer guidelines for living emotion-focused coping than younger risk-takers, independent, one’s life and enhanced motivation to people nonconformist, unconventional, high in take care of oneself and reach goals Cadano, Iedsif Croain Psychosocial Development Midlife Stagnation – disconnected from the corporation into identity schemas Changes communities because of their failure to (Susan Krauss Whitbourne) OCEAN contribute ⚬ Assimilation – interpretation of new - In middle adulthood, Women report higher generativity information via existing cognitive conscientiousness is the highest than men structure maybe due to result of work For men, having a child early is ⚬ Accommodation – involves changing experiences associated with greater generativity cognitive structures to more closely However, unemployed ones will show Maladaptive Tendency: align with what is encountered decrease in agreeableness and Overextension – they no longer Identity Process Theory (IPT) conscientiousness allow themselves to relax and rest ⚬ Identity Assimilation – Middle-aged men who remarry tend Malignant Tendency: involves holding onto a to become less neurotic, those who Rejectivity – no longer participating or consistent sense of self in the divorce decrease in extraversion contributing in the society face of new experiences that do Generativity – involved finding not fit the current understanding meaning through contributing to society The Self at Midlife of the self and leaving a legacy for future Midlife Crisis – changes in personality ⚬ Identity Accommodation – generations and lifestyle during involves adjusting the identity ⚬ Parenting, teaching, middle forties schema to fit new experiences mentorship, productivity, ⚬ Many people realize that they will not ⚬ Identity Balance – stable self-generation or be able to fulfill the dreams of their sense of self while adjusting self-development youth, or that fulfillment of their own their self-schemas incorporate ⚬ Associated with prosocial mortality new information behaviors ⚬ People who do have crisis at midlife Consensual relationships Care – widening commitment to take generally also have crises at other Marriages generally follow a care of persons, products, and the times in their lives as well developmental sequence, with initial ideas one has learned to take care for ⚬ Manifestation of a neurotic sharp declines in marriage satisfaction personality rather than followed by a plateau, then further, developmental phase slower declines over the longer term Identity Process Theory (IPT) – Couples who are sexually satisfied physical characteristics, cognitive are generally satisfied with their abilities, and personality traits are in marriages Cadano, Iedsif Croain  When older adults cohabitate, their Oldest old – 85 and above in muscles involved in breathing, and relationships are more stable than reductions in the ability of cilia those of younger cohabiting adults Physical development Elderly adults are more likely to suffer Higher divorce rates at middle age longevity and aging from Arrhythmia (irregular heartbeat), Divorce is associated with elevated Life Expectancy – the age to which a the muscle walls thicken, and the chance of chronic health conditions person born at a certain time and place valves that control the flow of blood in and mortality in both is statistically likely to live, given his or and out of the heart may no longer sexes, but specially in men her current age and health status open completely Marital Capital – the longer a couple Longevity – actual length of life of Reserve Capacity – backup capacity is married, the more likely they are to members of a population that helps body system function to their have built up joint Mortality Rates – death rates utmost limits in times of stress financial assets, to share the same Human Life Span – longest period In late adulthood, the brain gradually friends, to go through important that members of our species can live diminishes in volume and weight, experiences together, and to get used Women live longer and have lower particularly in the frontal and temporal to the emotional benefits that marriage mortality rates at all ages than men regions can provide Women’s longer lives also have been Hippocampus (memory area) also attributed to their greater tendency to shrinks OLD AGE take care of themselves and to seek Decrease in the number of dopamine 66 - 85 and above medical care, the higher level of social neurotransmitters due to losses of Ageism – prejudice or discrimination support they enjoy, and the rise in synapses based on age women’s socioeconomic status in Older eyes need more light to see, Primary Aging – gradual, inevitable recent decades are more sensitive to glare, and may process of bodily deterioration that have trouble locating and reading signs begins early in life and continues Physical Changes Cataracts – cloudy or opaque areas through years irrespective of what Older skin tends to become paler and in the lens of the eyes, are common in people do to stave it off (nature) less elastic, varicose veins appears in older adults Secondary Aging – results from legs Age-Related Macular Degeneration – disease, abuse, and disuse – factors They become shorter due to disks leading cause of visual impairment in that are often within a person’s control between spinal vertebrae atrophy older adults; the retinal cells in the (nurture) Lungs become less effective because macula degenerate over time, and the Young Old – 65-74 yrs old of reductions in Lung volume, atrophy center of the retina gradually loses the Old Old – 75-84 yrs old ability to sharply distinguish fine details Cadano, Iedsif Croain  Glaucoma – irreversible damage to (abnormal build up of neurofibrillary Psychosocial Development the optic nerve caused by increased tangles and amyloid plaque in the Theory and Research on Personality pressure in the eye brain) Development Loss of strength is greater for lower ⚬ Amnesia – memory loss For Erik Erikson, the crowning than for upper limbs ⚬ Aphasia – inability to express through achievement of late adulthood is Ego Falls, the most common cause of speech Integrity or integrity of the self – need fractures, become increasingly ⚬ Agnosia – inability to recognize to evaluate and accept their lives so as common with age familiar objects, tastes, smells to accept death Functional Fitness – exercises or ⚬ Apraxia – misuse of objects because Wisdom – informed and detached activities that improve daily activity failure to identify them concern with life itself in the face of Older people tend to sleep and dream ⚬ Anomia – inability to remember the death itself less than before driven by the names of things ⚬ Accepting one has lived, normative changes in circadian Vascular – caused by strokes or other without major regrets rhythms issues of blood flow in the brain; may Men typically take longer to develop be due to diabetes and high Maladaptive Tendency: erection and to ejaculate, may need cholesterol; have strokes like episodes Presumption – presumes ego integrity more manual stimulation, may Lewy Bodies – have movement or without actually facing the difficulties of experience longer intervals between balance (stiffness or trembling); old age erections or may have difficulty doing it daytime sleepiness, confusion, or Malignant Tendency: Women have difficulty in arousal, staring; trouble sleeping at night and Disdain – contempt of life, one’s own or orgasm, etc. visual hallucinations anyone’s Huntington’s – resulted from gene Stability declines in late adulthood Physical and Mental Health mutation which impacts movement, Increases in agreeableness, Inactivity contributes to heart disease, behavior, and cognition; personality self-confidence, warmth, emotional diabetes, colon cancer, and high blood also changes, loss of coordination, stability, and conscientiousness and pressure difficulty in swallowing and speaking declines in neuroticism, social vitality, Dementia – the general term for Parkinson’s – uncontrollable and openness to experience physiologically caused cognitive and movements, tremor, stiffness, slow behavioral decline sufficient to interfere movement, prevalent in men than WELL-BEING IN LATE ADULTHOOD with daily activities women; nerve cells in basal ganglia In general, older adults have fewer Alzheimer’s – most common type, become impaired; L-Dopa as treatment mental disorders and are happier and caused by specific changes in the brain more satisfied with life than younger Cadano, Iedsif Croain adults Retirement is a single event but a loneliness, disillusionment, and a Happiness tends to be high in early dynamic adjustment process that is feeling of uselessness adulthood, declines until people reach best conceptualized as a form of Reorientation – people try to figure 50 years of age, and then tends to rise decision making who they are and map their place in again until 85 Five broad categories of resources the world as a retiree As people get older, they tend to seek that help determine how well a person Routine – people accept their out activities and people that give them adjusts to retirement: situation and settle into a new set of emotional gratification ⚬ Individual attributes such as routines They are also better at regulating health and financial status Aging In Place – emotions ⚬ Pre-retirement job-related Group living arrangements for Older Positivity Effect – older adults are variables such as job stress Adults more likely to pay attention to and then ⚬ Family-related variables such ⚬ Retirement Hotel remember positive events than as marriage quality and ⚬ Retirement Community negative events dependents ⚬ Shared Housing Terminal Drop – rapid decline in ⚬ Retirement transition-related ⚬ ECHO (Elder Cottage Housing well-being and life satisfaction approx. variables Opportunity) Housing 3-5 yrs before death ⚬ Postretirement activities ⚬ Congregate Housing Disengagement Theory – normal part Phases of retirement ⚬ Assisted-Living Facility of aging involves gradual reduction in Pre-Retirement – begin to think ⚬ Foster-Care Home social involvement and greater seriously about the life they want for ⚬ Continuing Care Retirement preoccupation with the self themselves in retirement and whether Community Activity Theory – the more active they are financially on track to achieve older people are, the better they age it Personal Relationships in Late Continuity Theory – people’s need to Retirement – makes the transition Adulthood maintain connection between past and from full-time work to retirement Social Convoy Theory – aging adults present is emphasized, and activity is they’ve planned maintain their level of social support by viewed as important, not for its own Contentment – positive phase when identifying members of their social sake but because it represents retirees get to enjoy the fruits of a network who can help them continuation of previous lifestyle lifetime of labor (Honeymoon period) Socioemotional Selectivity Theory – Disenchantment – they may as remaining time becomes short, PRACTICAL AND SOCIAL ISSUES experience some of the emotional older adults choose to spend time with RELATED TO AGING downsides of retirements such as Cadano, Iedsif Croain people and in activities that meet DEATH visions of bright lights or mystical immediate emotional needs The Many, Changing Meanings of encounters Death and Dying Linked to stimulation or damage of Marital Relationships Cultural aspects of death include care various brain areas, most notably in Married couples who are still together of and behavior toward the dying and bilateral frontal and occipital areas in late adulthood are more likely than the dead, the setting, mourning Generally experienced as positive as middle-aged couples to report higher customs and rituals a result of the release of endorphins satisfaction and fewer adjustment Top causes of deaths in 1900s are: Grief – emotional response that problems in their marriages Pneumonia, Influenza, Tuberculosis, generally follows closely on the heels Close marital relationship can Diarrhea, and Enteritis of death moderate the negative psychological Today, the most common are heart Bereavement – response to the loss effects of functional disabilities by disease and cancer of some whom a person feels close reducing psychological distress Thanatology – study of death and Grief Work – working out of Widowhood has been increasingly dying psychological issues associated with increased mortality, Hospice Care – personal, patient- connected with grief often takes the with sharpest declines seen in the first and family-centered, compassionate following path: 6 months following the death of a care for the terminally ill ⚬ Shock and Disbelief spouse Palliative Care – includes relief of ⚬ Preoccupation with the Nonmarital Kinships Ties pain and suffering, controlling of memory of the dead person Older adults who receive more help symptoms, alleviation of stress, and ⚬ Resolution from their children than they give them, attempts to maintain a satisfactory Recovery Pattern – mourner goes over time, are more likely to show quality of life high to low distress increases in psychological stress Delayed Grief – moderate or elevated Relationships with siblings tend to be Facing death and Loss initial grief, and symptoms worsen over among the long lasting of all Terminal Drop or Terminal Decline – time relationships specifically to a widely observed Chronic Grief – distressed for a long To mourn for a sibling is to mourn for decline in cognitive abilities shortly time the lost completeness of the original before death Resilience – the mourner shows a family within which one came to know Near-Death Experience – often low and gradually diminishing level of oneself and can bring home one’s own involving a sense of being out of the grief in response to the death of a nearness to death body or sucked into a tunnel and loved one Cadano, Iedsif Croain  By age 4, children build a partial power, in exchange for feeling less sad with greater sense of purpose, understanding of the biological nature or having a different outcome responsibility, commitment, and of death Depression interconnectedness to others Adjusting to loss is more difficult if a A feeling of sadness and After death of a parent, siblings tends child had a troubled relationship with hopelessness that often results with to be closer the person who died the loss of a loved one Losing a child weakens and destroys ⚬ They do not understand death, but Acceptance the marriage if the marriage is not they understand loss The period of grief when we finally strong Often, teens turn to peers for support come to terms with accepting the Brain Death – neurological condition Young adults will find their entire reality of our loss which states the person is brain dead world collapsing at once when they Focus our energy on Moving forward when all electrical activity of the brain knew they are dying instead of dealing Terror Management Theory has ceased for a specific period of time with other issues human’s unique understanding of Higher portions of the brains dies Middle-Aged and Older adults are death, in concert with self-preservation sooner than lower parts which more prepared with death needs and capacity for fear, results in facilitates breathing and heartbeat Five Stages of Grief common emotional and psychological That is why your brain could be dead Denial responses when mortality, or thoughts but you still have heartbeat for the The period of grieving during which a of death are made salient meantime person refuses to accept the reality of Euthanasia – good death, intended to a situation Significant Losses end suffering or to allow terminally ill Helps us protect ourselves from the Bereavement for women can lead to person to die with dignity shock of the upsetting hardship headaches, memory problems, ⚬ Passive – involves withholding or Anger difficulty with concentration, dizziness, discontinuing treatment that might Can be a Natural response indigestion, loss of appetite, or chest extend the life of a terminally ill patient directed toward oneself, family pain such as life support Members, doctors, God, Distress of loss can be catalyst for ⚬ Active – “mercy killing” involves or even the deceased introspection and growth action taken directly or deliberate to Bargain Losing a parent can push adults into shorten life A person attempts to negotiate or resolving important developmental Advance Directive – contains make compromises issues: achieving a stronger sense of instructions for when and how to Try to make agreements with self and more pressing, realistic discontinue futile medical care ourselves, or a deal with a higher awareness of their own morality, along Cadano, Iedsif Croain ⚬ Living will or a more formal legal document called a durable power of attorney ⚬ Durable Power of Attorney – appoints another person if the maker of the document becomes incompetent to do so Assisted Suicide – physician or someone else helps a person bring about a self-inflicted death Medical, Legal, and Ethical Issues: “The Right to Die” Life Review – a process of reminisce that enables a person to see the significance of his or her life Within a limited life span, no person can realize all capabilities, gratify all desires, explore all interest, or experience all the richness that life has to offer (Finding Meaning and Purpose in Life and Death) Cadano, Iedsif Croain  processes and conflicts those with a bipolar disorder, a Abnormal Cognitive-Behavioral model condition marked by mood swings from - emphasizes behavior, the ways in mania to depression Psychology which it is learned, and the thinking Antipsychotic drugs - help reduce Etiology of Abnormal Behavior that underlies behavior the confusion, hallucinations, and Current Paradigms in Humanistic-Existential model delusions that often accompany Psychopathology - stresses the role of values and psychosis, a loss of contact with reality choices found in schizophrenia and other One-dimensional model (linear) Sociocultural model disorders. - attempts to trace the origins of - looks to social and cultural forces as behavior to a single cause. the keys to human functioning Brain stimulation Multidimensional model Family-social perspectives Electroconvulsive therapy (ECT) - - implies that any particular influence - focuses on an individual’s family and two electrodes are attached to a (behavioral, biological, emotional, social interactions patient’s forehead, and an electrical social, developmental) contributing to Multicultural perspective current of 65 to 140 volts is passed psychopathology cannot be considered - emphasizes an individual’s culture briefly through the brain. Used in out of context and the shared beliefs, values, and thousands of patients, particularly Model (Paradigm) history of that culture those whose depression fails to - A set of assumptions and concepts Biological Model respond to other treatments that help scientists explain and Transcranial magnetic stimulation interpret observations BIOLOGICAL (TMS) - an electromagnetic coil is Demonological model Biological treatments placed on or above a person’s head, - used to explain abnormal functioning sending a current into certain areas of during the Middle Ages, for example, Psychotropic medications the brain. Used in the treatment of borrowed heavily from medieval Antianxiety drugs (minor depression. society’s concerns with religion, tranquilizers or anxiolytics) Vagus nerve stimulation (VNS) - a superstition, and warfare - help reduce tension and anxiety pulse generator is implanted in a Biological model Antidepressants - help improve the person’s neck, helping to stimulate - sees physical processes as key to functioning of people with depression their vagus nerve that then delivers human behavior and certain other disorders electrical signals to the brain. Used in Psychodynamic model Antibipolar drugs (mood the treatment of depression. - looks at people’s unconscious internal stabilizers) - help steady the moods of Cadano, Iedsif Croain Psychosurgery Ego defense mechanism - Strategies Fixation: guilt or anxiety about sex Trephining - the prehistoric practice developed by the ego to control Latency Stage of chipping a hole in the skull of a unacceptable id impulses and to avoid Age: 6 - puberty person who behaved strangely. or reduce the anxiety they arouse. Source of pleasure: sexuality is latent Lobotomy - a surgeon would cut the Elaborated more by Freud’s daughter, or dormant connections between the brain’s frontal Anna Freud. Fixation: none lobes and the lower regions of the Genital Stage brain Psychosexual stages Age: puberty - onwards Deep brain stimulation - electrodes At each stage of development, from Source of pleasure: genitals; sexual are implanted in specific areas of a infancy to maturity, new events urges return person’s brain and connected to a challenge individuals and require Fixation: none battery (“pacemaker”) in the chest that adjustments in their id, ego, and sends a steady stream of low voltage superego Current trends in psychodynamic electricity to targeted brain areas. If the adjustments are successful, therapy they lead to personal growth Short-term psychodynamic therapy Psychological Model Oral Stage – patient chooses a single problem to believe that a person’s behavior, Age: birth – 1 ½ years work on; working only on the whether normal or abnormal, is Source of pleasure: mouth; sucking, psychodynamic issues related to the determined largely by underlying biting, chewing problem psychological forces of which the Fixation: excessive smoking, Relational psychoanalytic therapy individual is not consciously aware. dependency on Others – therapist try to establish more equal Dynamic and interacts with one Anal Stage relationship with patients another Age: 1 ½ years to 3 years (- toilet Sigmund Freud trained) believed that three central forces Source of pleasure: bowel movement shape the personality and that they and urination operate at the unconscious level, Fixation: overly controlling (anal Cognitive-Behavioral Model unavailable to immediate awareness. personality) or easily angered (anal Behavioral dimension Id expulsive) personality Ego Phallic Stage Classical conditioning (Ivan Pavlov) Superego Age: 3 – 6 years A process of learning by temporal Source of pleasure: genitals association in which two events that Cadano, Iedsif Croain repeatedly occur close together in time Extinction - Eliminating a learned Behavioral therapies become fused in a person’s mind and behavior More difficult when the Reinforcements & punishments -> produce the same response; “pairing” behavior was learned through a partial maladaptive behaviors Unconditioned stimulus (UCS) reinforcement schedule Foundation: behavioral assessment The stimulus that naturally produces a Identifying specific circumstances that response Howard Mowrer’s two factor model seem to elicit the client’s unwanted Unconditioned response (UCR) - Combinations of classical and behavior The response created by the operant conditioning can explain the unconditioned persistence of fears Techniques used in behavior Stimulus People develop fear responses to therapy Conditioned stimulus (CS) previously neutral stimuli through Removal of reinforcements The previously neutral stimulus that classical conditioning Aversion therapy when paired with the UCS, elicited the Through operant conditioning, they Flooding same response develop behaviors designed to avoid Relaxation exercises Conditioned response (CR) triggers for that fear modeling The response elicited by the Systematic desensitization conditioned stimulus Classical conditioning = “Elicited” Cognitive dimension Operant conditioning (B.F. Skinner) Operant conditioning = Our thoughts/beliefs (cognition) shape A process of learning in which “Emitted” our behavior & emotions individuals come to behave in certain Causal attribution ways as a result of experiencing Albert Bandura’s Social Learning The attributions we make for events consequences of one kind or another Theory influence our behavior and whenever they perform the Behavior People also learn behaviors by expectations for similar events in the Continuous reinforcement schedule watching other people future - Consistent response; behaviors will Modeling be learned most quickly if they are Observational learning Global assumptions paired with the reward or punishment Modeling Broad beliefs (positive or negative) every time the behavior is emitted A process of learning in which an about: Partial reinforcement schedule - The individual acquires responses by 1) Ourselves reward or punishment occurs only observing and imitating others 2) People sometimes in response to the behavior 3) World Cadano, Iedsif Croain  Test alternative viewpoints about Gestalt therapy - Guides their clients Common dysfunctional situation toward self-recognition and assumptions Try new methods of coping self-acceptance by challenging and 1. I should be loved by everyone for Exposure therapy even frustrating the clients, demanding everything I do A behavior-focused intervention in that they stay in the here and now 2. It is better to avoid problems than to which fearful people are repeatedly during therapy discussions, and face them exposed to the objects or situations pushing them to embrace their real 3. I should be completely competent, they dread emotions. intelligent, and achieving in all I do New wave cognitive-behavioral Role playing 4. I must have perfect self-control therapies Existential therapy - People are Acceptance and commitment therapy encouraged to accept responsibility Cognitive therapies (ACT) - Help clients to accept many of for their lives and for their problems Help clients identify and challenge their their problematic thoughts rather than Therapists try to help clients negative thoughts and dysfunctional judge them, act on them, or try recognize their freedom so that belief systems fruitlessly to change them. they may choose a different Help clients learn problem-solving Mindfulness meditation - Teaches course and live with greater techniques individuals to pay attention to the meaning Short-termThree main goals: thoughts and feelings that are flowing Assist client in identifying their through their minds during meditation Socio-Cultural Model irrational and maladaptive thoughts and to accept such thoughts in a Family systems therapy - Family Teach clients to challenge irrational or nonjudgmental way systems theorists believe that the maladaptive thoughts and consider structure and communication patterns alternative ways of thinking Humanistic-Existential Model of some families actually force Encourage clients to face their worst Client-centered therapy - A warm and individual members to behave in a way fears and practice adaptive coping supportive approach that contrasted that otherwise seems abnormal. sharply with the psychodynamic Cognitive-behavioral dimension techniques of the day. Paid little Problematic family relationships Cognitive techniques and behavioral attention to irrational instincts and Inflexible families - Overly rigid & do techniques are combined conflicts. not adapt well to changes within and Behavioral assignments Unconditional positive regard; outside family Gather evidences concerning belief empathy; congruence Cadano, Iedsif Croain  Enmeshed families - Family members treatment in familiar social Nature of genes who are overly involved in the private surroundings as they try to recover Double helix lives of other family members Three types of intervention: The shape of the DNA molecules that Disengaged families - Family Primary intervention is like a spiral staircase members who operate independently Secondary intervention Dominant gene of one another with little parental Tertiary intervention One pair of a gene that strongly Supervision influences a particular trait and we only Triangular relationships Multicultural Model need one of them to determine a trait Parents avoid talking to each Multicultural treatments Recessive gene other Culture-sensitive therapies - Must be paired with another recessive Children are kept involved in Approaches that are designed to help gene to determine a trait, otherwise it all conversations address the unique issues faced by won’t have any effect and activities members of various cultural minority Polygenic groups influenced by many genes, each Problematic family environment contributing only a tiny effect, all of Expressed emotion GENETIC CONTRIBUTIONS TO which, in turn, may be influenced by The degree to which family interactions PSYCHOPATHOLOGY the environment are marked by: Genes - Long molecules of DNA at Genome Overinvolvement various locations on chromosomes An individual’s complete set of genes – Hostility within the cell nucleus consists of more than 20,000 genes Criticism Huntington’s disease - A degenerative disease that causes Quantitative genetics Family-socials treatments deterioration in the basal ganglia which Examines patterns of genetic control Couple therapy - The therapist works produce broad changes in personality, over a range of genes and sums up all with two individuals who are in a cognitive functioning, and motor the tiny effects across many genes long-term relationship behavior without necessarily telling us which (Coaching and feedback) Phenylketonuria (PKU) - Can result in genes are responsible for which effects intellectual disability (previously called Community treatment - Clients, mental retardation) that is present at Molecular genetics particularly those with severe birth and is caused by the inability of - examines the actual structure of psychological difficulties, to receive the body to metabolize phenylalanine genes with increasingly advanced Cadano, Iedsif Croain technologies such as DNA makes someone susceptible to Comes about when genetically microarrays. developing a disorder influenced traits elicit or evoke - these allows scientists to analyze environmental responses from others thousands of genes at once and Caspi et al. (2003) Impulsivity -> negative parenting identify broad networks of genes that a New Zealand study which found that techniques (being spanked) may be contributing to a particular trait individuals with at least two copies of long allele (LL) were able to cope Francis et al. (1999) Linkage studies better with stress than individuals with Demonstrated that calm and supportive Scientists study individuals who have two copies of the short allele (SS) behavior by the mothers could be the same disorder, such as bipolar passed down through generations of disorder, and also share other features, Gene-environment correlation rats independent of genetic influences, such as eye color which allows model because rats born to easily stressed scientists to link known gene locations people with a genetic predisposition for mothers but reared by calm mothers with the possible location of a gene a disorder may also have a genetic grew up more calm and supportive contributing to the disorder tendency to create environmental risk factors that promote the disorder Suomi et al. (1999) Eric Kandel Active gene-environment correlation Demonstrated that emotionally reactive Suggested that the very genetic Passive gene-environment correlation monkeys raised by calm, supportive structure of cells may change as a Evocative gene-environment parents were also calm and supportive result of learning if genes that were correlation when raising their own children, inactive or dormant interact with the Active gene-environment correlation thereby influencing and even reversing environment in such a way that they An individual selects environments the genetic contribution to the become active: the environment turns based on genetically influenced traits expression of personality traits or on certain genes Passive gene-environment Temperaments correlation Diathesis stress model Occurs when genetically influenced Tienari et al. (1994) Hypothesize that both an inherited traits in parents constitute the Found that children whose parents had tendency (a vulnerability) and specific environment for their children; maternal schizophrenia and who were adopted stressful conditions are required to depression -> offspring adjustment as babies demonstrated a tendency to produce a disorder (due to poor parenting practice) develop psychiatric disorders Diathesis = vulnerability; condition that Evocative gene-environment themselves only if they were adopted correlation into dysfunctional families Cadano, Iedsif Croain  Nerve cell branches that transmit Epigenetics outgoing electrochemical impulses to the study of factors other than inherited other neurons DNA sequence, such as new learning Synaptic cleft or stress, that alter the phenotypic - A small space through which the expression of genes impulses must pass to get to the next neuron as neurons are not actually NEUROSCIENCE AND ITS connected to each other CONTRIBUTION TO - The space between the axon of one PSYCHOPATHOLOGY neuron and the dendrite of the other Neurotransmitter Structure of the brain Central nervous system The biochemicals that are released Hindbrain - Processes all information received from the axon of one neuron and Regulates many autonomic activities from our sense organs and reacts as transmit the impulses to the dendrite such as breathing, heartbeat, and necessary receptors of another neuron digestion - Sorts out what is relevant and what Excitatory – increase likelihood that Brainstem - the lower and more isn’t connection neurons will fire; activating ancient part of the brain. Found in - Brain and spinal cord Inhibitory – decrease likelihood that most animals, this structure handles Spinal cord connecting neurons will fire; most of the essential automatic facilitate the sending of messages to suppressing functions such as breathing, and from the brain Norepinephrine (H = Cerebellum - controls motor Neurons (nerve cell) depression) coordination and abnormalities in this Transmit information throughout the Serotonin (L = depression) area may be associated with autism nervous system; Contains a central cell Dopamine (H = schizophrenia) Midbrain body with two kinds of branches: GABA (L = excessive anxiety) Coordinates movement with sensory dendrite and axon. input and contains parts of the reticular Dendrites activating Nerve cell branches that receive Glial cells system which contributes to processes incomplete electrochemical information Outnumbers neurons by a ratio of of arousal and tension, such as for transmission along the neuron about 10 to 1 and plays an active role whether we are awake or asleep Axon in neural activity Forebrain Cadano, Iedsif Croain Top section of the brain that includes Coordinates with the brains stem to Autonomic nervous system the limbic system, basal ganglia, make Regulates the cardiovascular system caudate nucleus, and cerebral cortex sure the body is working properly and the endocrine system and to Thalamus – small region deep inside Somatic nervous system perform various other functions, the brain broadly associated with the Autonomic nervous system including aiding digestion and regulation of behavior and emotion (Sympathetic & regulating body temperature. Hypothalamus – part of the brain Parasympathetic nervous Hypothalamic-pituitary-adrenocortic that lies beneath the thalamus and is system) al axis (HPA axis) broadly involved in the regulation of Somatic nervous system Hypothalamus -> corticotropin behavior and emotion Controls the muscle so damage in this releasing factor (CRF) area might make it difficult for us to Pituitary gland -> adrenocorticotropic Limbic system engage in any voluntary movement, hormone (ACTH) hippocampus (sea horse) including talking Adrenal glands -> cortisol Stress cingulate gyrus (girdle) Sympathetic nervous system septum (partition) Parasympathetic nervous amygdala (almond) system Sympathetic nervous system Forebrain Primarily responsible for mobilizing the Basal ganglia – controls motor body during times of stress or danger behavior; Damage to this area make us by rapidly activating the organs and change our posture or twitch or shake glands under its control and is thus believed to control motor Heart beats faster; blood flows activity increases to Cerebral cortex – largest part; the muscle; respiration Provides us with our distinctly human increases qualities, allowing us to look to the Parasympathetic nervous system NEUROTRANSMITTER future and plan, to reason, and to Takes over the sympathetic nervous Agonist create. system after it has been active for a Substances that effectively increase Left and right hemisphere while, normalizing arousal, and the activity of a neurotransmitter by Frontal lobe, temporal lobe, facilitating the storage of energy by mimicking its effects parietal lobe,occipital lobe helping the digestive process Antagonist Peripheral nervous system Cadano, Iedsif Croain substances that decrease or block a GABA Thomas Insel Neurotransmitter Neurotransmitter that reduces activity Described a case originally reported by Brain circuits across the synaptic cleft and thus Eslinger and Damasio, about an Neurotransmitter current or neural inhibits a range of behaviors and accountant who developed pathway in the brain emotions, especially generalized obsessive-compulsive symptoms Neurons that are sensitive to one type anxiety after a small area of his orbital frontal of neurotransmitter cluster together Serotonin cortex was removed following surgery and form paths from one part of the Processes information and due to a tumor. brain to the other coordinates movement as well as Inverse agonist inhibits BEHAVIORAL AND COGNITIVE Substances that produce effects Regulates our behavior, mood, and SCIENCE opposite to those produced by the thinking process as well as eating, Cognitive science neurotransmitter sexual, and aggressive behaviors Concerned with how we acquire and Reuptake Action by which a Interaction with dopamine is linked to process information and how we store neurotransmitter is quickly schizophrenia and ultimately retrieve it drawn back into the discharging neuron Norepinephrine Robert Rescorla after being released into a synaptic Controls heart rate, blood pressure, Concluded that simply pairing two cleft and respiration events close in time is not what’s Plays a role in our body’s alarm important in classical conditioning; it is Neurotransmitter reaction; panic attacks only a simple summary a variety of Monoamines Dopamine judgements and cognitive process Serotonin Activates other neurotransmitters combine to determine the final Norepinephrine Associated with exploratory, outgoing, outcome. Dopamine and pleasure-seeking behaviors Learned helplessness Amino Acids Martin Seligman Glutamate IMPLICATIONS FOR People become anxious and Gamma- aminobutyric acid (GABA) PSYCHOPATHOLOGY depressed when they make an OCD attribution that they have no Glutamate Increased activity in: control over the stress in their lives Amino acid neurotransmitter that Orbital surface (whether or not they do in reality) excites many different neurons, leading Cingulate gyrus Learned optimism to action Caudate nucleus Cadano, Iedsif Croain If people faced with considerable action tendency to behave a certain not during stress or exercise anger stress and difficulty in their lives way, elicited by an external event (a affects the heart through decreased nevertheless display an optimistic, threat) and a feeling state (terror) and pumping efficiency at least in people upbeat attitude, they are likely to accompanied by a (possibly) with heart disease function better psychologically and characteristic physiological Physically. Response CULTURAL,SOCIAL,AND Prepared learning Mood INTERPERSONALFACTORS We have become prepared for learning A more persistent period of affect or Dhat syndrome about certain types of objects or emotionality Anxiety-related belief observed in situations over the course of evolution Affect Indian men that one is “losing” semen because this knowledge contributes to Momentary emotional tone that through nocturnal emissions, the survival of the species. accompanies what we say or do; masturbation, or urination Blindspot (unconscious vision) negative and positive affect Fear = excessive semen loss resulting Lawrence Weiskrantz Fight or flight response in illness Phenomenon in which a person is able Alarm reaction that activates during Fright disorders to perform visual functions while having potentially life-threatening emergencies characterized by exaggerated startle no awareness or memory of these Components of emotion response, and other observable fear abilities Behavior and anxiety reactions Black box Physiology unobservable feelings and cognitions Cognition Susto (Latin America) inferred from an individual’s self-report Richard Lazarus Includes various anxiety-based Stroop color-naming paradigm - Changes in a person’s environment are symptoms (e.g., insomnia, irritability, participants are shown a variety of appraised in terms of their potential phobias) and marked somatic words (each printed in different color) impact on that person; the type of symptoms of sweating and increased quickly and asked to name the color in appraisal you make determines the heart rate (tachycardia). which they are printed while ignoring emotion you experience Has one cause: the person believes their message that he/she has become the object of ANGER AND YOUR HEART black magic or witchcraft and is Ironson et al. (1992) suddenly badly frightened. EMOTIONS found that the ability of the heart to Evil Eye Emotion pump blood efficiently through the body Voodoo death dropped significantly during anger but Cadano, Iedsif Croain The sentence of death by a medicine man may create an intolerable autonomic arousal in the participant, who has little ability to cope because there is no social support Equifinality Used in developmental psychopathology to indicate that we must consider a number of paths to a given outcome Cadano, Iedsif Croain  People with anxiety are more likely to the panic attack happens in certain ANXIETY have another situations but not anywhere else Anxiety Unexpected (uncued) panic attack DISORDERS a negative mood state characterized the panic attack happens at random Signs of an Anxiety Disorder by physical tension and apprehension and you don’t have a clue when or Frequent worry that interferes with about the future. Much more diffuse where the next attack will occur daily life than fear. Withdrawal from social life Fear CAUSE OF ANXIETY Fixation on fear of next panic attack an immediate alarm reaction to Biological contributions Irrational fear and avoidance of a danger Inherited tendency to be tense, harmless object, place, or situation Protects us by activating a massive uptight, and anxious Out-of-the-blue panic attacks response from the autonomic nervous Depleted levels of Recurring nightmares, flashbacks, or system which motivates us to escape GABA-benzodiazepine system numbing of past trauma or, possibly, to attack. Behavioral inhibition system (BIS) Fight/flight system Fight-or-flight system -> results from Cigarette smoking as a teenager the activation of two systems controlled Over Responsive limbic system, by the hypothalamus: ANS and including the amygdala adrenal-cortical system Deficient functions of the cortex Responses to threat: (abnormal top-down processing) (1) Physiological (2) Emotional Psychological contributions (3) Cognitive Psychic reaction to danger (4) Behavioral = In anxiety disorders, Panic attack surrounding the reactivation of an these persist in the absence of an abrupt experience of intense fear infantile fearful situation (Freud) objective threat or acute discomfort, accompanied by Early conditioning, modeling or other Anxiety is part of many psychological physical symptoms that usually include forms of learning (behaviorists) disorders: Depression, schizophrenia heart palpitations, chest pain, General sense of uncontrollability (when slipping into a new episode of shortness of breath, and, possibly, Anxiety sensitivity (personality trait) psychosis); Alcoholics use alcohol to dizziness Learned or false alarm dampen anxiety Expected (cued) panic attack Cadano, Iedsif Croain Social contributions People with GAD mostly worry about The disturbance is not better Stressful life events minor, everyday life events explained by another mental disorder Family reaction Clinical description: Theory Excessive anxiety and worry, Experience more intense negative occurring more emotions and have chronically days than not for at least 6 months elevated activity in the sympathetic about a nervous system number of events or activities Make maladaptive assumptions -> Difficulty to control the worry “better to prepare for the worse” Worry and anxiety are associated Hypersensitive in detecting possible with 3 or threats in the environment Comorbidity more of the following 6 symptoms: Past experience of trauma or stressor Major depressive disorder Restlessness/feeling keyed up that were uncontrollable Alcohol or drug abuse (substance use or on edge Cognitive avoidance model -> prefers disorder) Being easily fatigued a chronic but familiar state of distress 20% of patients with PD attempted Difficulty concentrating to sudden shifts in emotion in response suicide Irritability to specific negative events Comparable to individuals with major Muscle tension depression Sleep disturbances (difficulty Statistics Relationship between anxiety and falling asleep One of the most common anxiety suicide is strongest with PD and PTSD or staying asleep, restless, or disorder unsatisfying About two-thirds are female GENERALIZED ANXIETY DISORDER sleep) Earlier and more gradual onset (age: Generalized Anxiety Disorder (GAD) The anxiety, worry, or physical 31) and chronic once it develops Anxiety disorder characterized by symptoms cause clinically significant Most common in adults over 45 years intense, uncontrollable, unfocused, distress or impairment in social, and least common in ages 15 - 24 chronic, and continuous worry that is occupational, or other important areas distressing and unproductive, of functioning Causes accompanied by physical symptoms of The disturbance is not attributable to Anxiety sensitivity muscle tension, irritability, and the physiological effects of a substance Less responsiveness on most restlessness. or another medical condition physiological measures Cadano, Iedsif Croain  Chronically tense (muscle tension) more associated symptoms in adults Chills or heat sensations High sensitivity to threat in general and 1 associated symptoms in children Paresthesias (numbness or tingling Four cognitive characteristics: Median age: 30 sensations) Intolerance of uncertainty Excessive worry and anxiety may Derealization (feelings of unreality) or Positive beliefs about worry occur later in life in, but manifested an depersonalization (being detached Poor problem orientation anxious temperament from Cognitive avoidance Children and adolescents with GAD reality) worry most about concerns of their Fear of losing control or “going crazy” Treatment performance Fear of dying Benzodiazepine (short-term relief) Treatment: At least one of the attacks has been Antidepressants Pharmacotherapy followed by 1 month (or more) of one Psychological treatment (more Psychotherapy: or both of the following: effective long-term) Behavior therapy Persistent concern or worry about CBT Cognitive therapy additional panic attacks Meditation and mindfulness-based psychodynamic Significant maladaptive change in Approaches behavior PANIC DISORDER The disturbance is not attributable to Summary: Panic Disorder the physiological effects of a substance Excessive anxiety and worry of Individuals experience severe or another medical condition almost everything unexpected panic attacks; they may The disturbance is not better Finds it difficult to control the worry think they’re dying or otherwise losing explained by another mental disorder Associated with these symptoms: control Frequency and severity of panic 1. Restlessness/feeling keyed Clinical description: attack up or on edge Recurrent unexpected panic attack Moderately frequent (1/week) 2. Being easily fatigued Palpitations Short burst (daily/weeks/months) 3. Difficulty concentrating or Sweating Less frequent (2 per month) mind going blank Trembling or shaking Full symptoms (4 or more) – required 4. Irritability Sensations of shortness of breath for diagnosis of PD 5. Muscle tension Feelings of choking Limited symptoms (< 4) 6. Sleep disturbanceSummary: Chest pain or discomfort Have been present for more days Nausea or abdominal distress Theory than not for at least 6 months, with 3 or Feeling dizzy Family history Cadano, Iedsif Croain  Poorly regulated fight-or-flight Marked fear or anxiety about two or Independent of panic attacks response more of the following five situations: Fluctuations in progesterone levels Using public transportation Other methods of coping: during premenstrual periods and Being in open spaces 1) alcohol or drugs postpartum Being in enclosed places 2) endure with intense dread Poorly regulated locus coeruleus that Standing in line or being in a Interoceptive avoidance– avoidance lowers threshold for activation of crowd of internal physical sensations anxiety Being outside of the home Pay close attention so bodily aloneAgoraphobia Statistics sensations and misinterprets them in The individual fears or avoids these Onset: early adulthood (mean onset: catastrophic ways situations because of thoughts that 25 – 29 years of age) Increased interoceptive awareness escape might be difficult or help might Males = cope by consume large Conditioned avoidance response not be available in the event of amounts of alcohol (avoiding situations associated with developing panic-like symptoms panic attacks) The agoraphobic situations almost Summary: always provoke fear or anxiety Marked fear or anxiety of specific Agoraphobia The agoraphobic situations are situations due to fear of not being able fear and avoidance of situations in actively avoided, require the presence to escape which a person feels unsafe or unable of a companion, or are endured with These situations are actively avoided to escape in the event of developing intense fear or anxiety. or may require the presence of a panic symptoms or other physical The fear or anxiety is out of companion symptoms, such as loss of bladder proportion to the actual danger 1. Using public transportations control The fear, anxiety or avoidance is 2. Being in open spaces People develop agoraphobia because persistent, typically lasting for 6 months 3. Being in enclosed spaces they never know when these or more 4. Standing in line or being in symptoms might Occur crowd In severe cases, people with Development 5. Being outside of the home agoraphobia are totally unable to leave Karl Westphal (1871) alone the house, sometimes for years on end Fear of the marketplace (Greek) 6 months or more, with 2 or more Agoraphobic avoidance behavior = symptoms Clinical description complication of severe unexpected Reasonable fears and age are panic attacks different Cadano, Iedsif Croain  Exclude short-lived and transient Occurs during delta wave or slow Persistent concern/worry about individuals wave sleep additional panic attacks or their Majority of the individuals with PD Cause: change in stages of sleep to consequences showed signs of agoraphobia and slow- Significant maladaptive change anxiety before the onset of PD wave sleep produces physical related to the attacks Initial onset: 35 sensations of A panic attack is an abrupt surge of mean age: 17 “letting go” intense fear or intense discomfort that Age of onset w/out Panic Isolated sleep paralysis– the reaches a peak within minutes and attacks/disorder: 25-29 individual is unable to move and during which time four (or more) of the Treatment: experiences a surge of terror that panic attack specifier occur Pharmacotherapy resembles a panic attack At least one of the panic attack Psychotherapy: specifier has been followed by 1 month Supportive psychotherapy Causes (or more) of one of the B criteria involves Generalized biological vulnerability Median age: 20-24 the use of psychodynamic Generalized psychological Few cases begin in childhood concepts vulnerability Onset age of 45 is unusual but can and a therapeutic alliance to Specific psychological vulnerability occur promote Treatment: adaptive coping Treatment Pharmacotherapy Insight-oriented Medication Psychotherapy psychotherapy Benzodiazepine Cognitive therapy includes instruction Behavior therapy includes SSRIs about patient’s false beliefs and positive and negative SNRIs information about panic attack reinforcement, systematic Psychological intervention desensitization, flooding, Gradual exposure exercises exposure, relaxation, Panic control treatment self-monitoringSummary: CBT SPECIFIC PHOBIA Cognitive therapy Specific Phobia Virtual therapy Summary (PD): Marked fear or anxiety about a Unidentified and unexpected specific object or situation NOCTURNAL PANIC ATTACKS following any of the panic attack The phobic object or situation almost Nocturnal panic attacks specifier always provokes fear or anxiety Cadano, Iedsif Croain  The phobic object or situation is Runs in families (inherited a strong The fear is common but becomes actively avoided or endured with vasovagal response to blood, injury, or phobic only if severe interference with intense fear or Anxiety possibility or injection) functioning occurs The fear or anxiety is out of Age of onset: 9 years of age Onset: 7 years of age proportion to the actual danger posed by the specific object or situation and Specific phobia (Situational) Theory to the sociocultural context Anxieties involving enclosed places Displaced anxiety (Freud) The fear, anxiety, or avoidance is or public transportation Two-Factor Theory (Mowrer) – persistent, typically lasting for 6 months runs in families Classical and Operant conditioning or more Never experience panic attack Prepared classical conditioning The fear, anxiety, or avoidance outside the context of their phobic causes clinically significant distress or object or situation compared to panic Statistics impairment in social, occupation, or disorder Most prevalent anxiety disorder other important areas of Functioning Onset: mid-teens to mid-20s Sex ratio is 4:1 (female) The disturbance is not better Chronic course explained by the symptoms of another Specific phobia (Natural Declines with old age mental disorder Environment) Phobic stimulus: Extreme fear of situations or events in Specific phobia Animal nature, especially heights, storms, and Causes Natural environment water; clusters together Four ways of developing a phobia: Blood-injection-injury Can be adaptive Direct exposure Situational Onset: 7 years of age Experienced a false alarm other Have to be persistent (at least 6 Observed someone else experience months) and interferes substantially severe fear (Blood-injury-injection) with the person’s functioning Being told about the danger Unreasonable fear and avoidance of exposure to blood, injury, or the Specific phobia (Animal) Causes possibility of an injection Unreasonable, enduring fear of Information transmission – being Victims experience fainting and a animals or insects that usually warned repeatedly about a potential drop in blood pressure develops early in life. danger that leads to the development of a phobia Cadano, Iedsif Croain Treatment Expressing fear or anxiety by crying, Virtual therapy: exposes patients on Exposure-based exercises tantrums, or freezing or clinging the computer screen to interact with Graduated exposure-based exercises Not able to understand the concept of phobic objects or situation. Individuals must tense various avoidance muscle groups during exposure Assess the degree of impairment and SEPARATION ANXIETY DISORDER exercises to keep their blood pressure duration of Separation Anxiety Disorder sufficiently high to complete the fear, anxiety, or avoidance, and Excessive enduring fear, unrealistic practice whether its typical for the child’s and persistent worry in some children Systematic desensitization particular developmental stage that harm will come to them or their Modeling Develops following a traumatic event parents or other important people in Flooding (observed, unexpected, or their life, or that something will happen Applied tension technique informational transmission) to the children themselves that will Usually 6 months) developing a serious disease are distressing or result in significant “disease conviction” disruption of daily life Cognitive features of the disorder the concern is primarily with the idea Attention focused on somatic of being sick instead of the physical symptoms symptom itself Cadano, Iedsif Croain  Care-seeking type = Medical care, Specific psychological Diagnostic Criteria including physician visits or undergoing vulnerability - A. Preoccupation with having or tests and procedures, is frequently learned from family members to focus acquiring a serious illness. used their anxiety on specific physical B. Somatic symptoms are not present Care-avoidant type = Medical care is conditions and illness or, if present, are only mild in intensity. rarely used. o Stressful life event If another medical condition is present o Strong memories of family members or there is a high risk for developing a Statistics getting sick with disease medical condition In primary care settings, the median o Benefits of being sick that leads to (e.g., strong family history is present), prevalence rate for hypochondriasis is the adoption of a sick role the preoccupation is clearly excessive 6.7% but as high as 16.6% for or disproportionate distressing somatic symptoms Treatment C. There is a high level of anxiety Occurs in individuals who are women, Cognitive behavioral therapy about health, and the individual is unmarried, and from lower Reassurance and education easily alarmed about personal health socioeconomic Groups Explanatory therapy - the clinician status. Aside from somatic complaints, goes over the source and origins of the D. The individual performs excessive individuals may have psychological patient’s symptoms in some detail health- related behaviors (e.g., complaints, usually anxiety or mood shows some promise; limited to mild repeatedly checks his or her body for disorders forms of the disorder signs of illness) or exhibits maladaptive individuals with somatic symptom SSRIs – paroxetine (Paxil) avoidance (e.g., avoids doctor disorders overuse and misuse the appointments and hospitals). healthcare system, with medical bills PSYCHOLOGICAL FACTORS E. Illness preoccupation has been as much as nine times more than AFFECTING MEDICAL CONDITIONS present for at least 6 months, but the the average patient Diagnostic Criteria specific illness that is feared may chronic A. A medical symptom or condition change over that period of Time. (other than a mental disorder) is F. The illness-related preoccupation is Causes present. not better explained by another mental enhanced perceptual sensitivity to B. Psychological or behavioral factors disorder illness cues (as measured on stroop adversely affect the medical condition test) and interpret ambiguous stimuli as in one of the following ways: Specifier: threatening 1. The factors have influenced the genetic contribution course of the medical condition as Cadano, Iedsif Croain shown by close temporal association used by neurologists who see the episodic course between the psychological factors majority of patients receiving a and the development or exacerbation conversion disorder diagnosis Cause of, or delayed recovery from, the Astasia-abasia– a type of conversion Freud medical condition. symptom which included weakness in 1. Experience to traumatic event B. Psychological or behavioral factors the legs and difficulty keeping balance 2. Anxiety is unacceptable and the adversely affect the medical condition person repress the conflict making it in one of the following ways: Diagnostic criteria unconscious 1. The factors interfere with the A. One or more symptoms of altered 3. Anxiety increases and threatens to treatment of the medical condition voluntary motor or sensory function. emerge into consciousness and the (e.g., poor adherence). B. Clinical findings provide evidence of person converts it into physical 2. The factors constitute additional incompatibility between the symptom symptoms (primary gain = reduction of well- established health risks for the and recognized neurological or medical anxiety) individual. conditions. 4. Person receives increased 3. The factors influence the underlying C. The symptom or deficit is not better attention/sympathy/avoidance of pathophysiology, precipitating or explained by another medical or mental difficult situation (secondary gain) exacerbating symptoms or disorder. necessitating medical attention. D. The symptom or deficit causes La belle indifference C. The psychological and behavioral clinically significant distress or o individuals seem not the least bit factors in Criterion B are not better impairment in social, occupational, or distressed about their symptoms explained by another mental disorder other important areas of o occurs in lower socioeconomic (e.g., panic disorder, major depressive functioning or warrants medical groups disorder, posttraumatic stress evaluation. o prior experience with real physical disorder).