PSY3010 Exam 2 Notes PDF

Zoc Summary TITLE: COURSE NAME: Exam 2 Transcripts/Notes PSY3010 The document discusses the topic of anxiety disorders, focusing on their definition, impact, and examples, particularly generalized anxiety disorder (GAD). Anxiety disorders are behaviors that interfere with a person's effective behavior, with anxiety being central to these disorders, causing feelings of foreboding and unease. Normal anxiety can be beneficial and motivating, but when it becomes overwhelming and interferes with daily activities, it may be considered a disorder. The onset and duration of disorders affect their prognosis; sudden onset disorders often have quicker recovery times, while long-developing disorders are harder to treat. The neurotic nucleus and neurotic paradox are key concepts in anxiety disorders, where individuals avoid anxiety-inducing situations and maintain maladaptive behaviors despite knowing they are irrational. Generalized anxiety disorder (GAD) is characterized by continuous anxiety, worry, and motor tension, significantly impacting work, relationships, and daily functioning. Generalized anxiety disorder (GAD) involves chronic and excessive worry about various events and activities without a specific identifiable cause, lasting at least six months and accompanied by at least three symptoms. Individuals with GAD often cannot pinpoint the exact cause of their anxiety, leading them to attribute it to multiple aspects of their life, such as relationships, school, driving, and finances, which are not the true sources. Women are statistically more likely to be diagnosed with GAD than men, making up about two-thirds of cases, while men are more frequently diagnosed with more severe disorders like antisocial personality disorder and pedophilia. The DSM-5-TR criteria for GAD emphasize the chronic nature of the disorder and the requirement for symptoms to be present more days than not over a six-month period. Students are advised to study consistently and effectively to perform well on exams, as poor study habits will likely result in poor grades, and adjustments in study methods are necessary for improvement. The document discusses the performance on a recent exam, the upcoming exam on disorders, and details about anxiety disorders and their treatments. Key points include: Students are expected to perform well on exams using their notes and books, with the next exam focusing on disorders and their treatments. Symptoms of anxiety disorders are universal and include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances, and physical symptoms like palpitations and shortness of breath. Anxiety disorders can be treated with medications such as benzodiazepines, which are effective for generalized anxiety but less so for OCD and phobias. Behavior therapies, particularly exposure therapies and systematic desensitization, are effective for treating phobias by gradually building tolerance to the anxiety-inducing object. Flooding or implosive therapy, which involves sudden exposure to the anxiety-inducing object, is another behavior therapy method, though it can be extreme and is less commonly used today. Implosive therapy, also known as flooding, involves confronting patients with their phobias in a controlled manner, often combined with systematic desensitization, and is effective for various anxiety disorders. Medications, particularly benzodiazepines, can be effective for treating anxiety disorders, though their success varies among individuals, and not all patients require long-term use. Panic attacks are discrete periods of intense fear or discomfort with symptoms peaking within minutes; they are symptoms of panic disorder, not standalone disorders, and can occur without an external trigger. Panic disorder is characterized by recurrent, unexpected panic attacks and persistent concern about having more attacks, often leading to significant anxiety and potential misattribution of triggers. Panic disorder commonly co-occurs with agoraphobia, is more prevalent in women but causes more severe pathology in men, and typically manifests from late adolescence to mid-30s. Women experience anxiety disorders more frequently than men due to a complex combination of learned behaviors, societal biases, and biological factors such as brain chemistry and hormonal fluctuations. Men are more likely to exhibit severe psychopathologies like antisocial personality disorder and alcoholism, influenced by societal teachings and biological factors like testosterone levels. Social anxiety disorder is characterized by a persistent and irrational fear of being scrutinized or evaluated by others, significantly interfering with everyday behavior and often requiring intervention. The disorder typically manifests in late childhood or early adolescence, around the age of 13, and does not show significant gender differences in prevalence. Symptoms of social anxiety disorder include fear of public speaking, using public restrooms, eating, or shopping in public, and it is a highly chronic condition that does not dissipate over time without treatment. Phobias are intense, irrational fears of specific situations or objects, and having symptoms does not necessarily mean one has a disorder. Agoraphobia involves fear of being alone or in open spaces, and fear of public places where escape might be difficult or help unavailable, but it is not always a chronic condition and can wax and wane over time. Specific phobias, also known as situational phobias, are more common in children and can dissipate with age without intervention; they involve fear of specific situations like tunnels or heights. The document discusses examples of irrational fears, such as fear of grasshoppers, going under railroad tracks, and riding elevators, highlighting the irrationality and intensity of these fears. Agoraphobia and specific phobias are differentiated by the underlying reasons for the fear, with agoraphobia linked to fear of incapacitation and specific phobias linked to fear of the situation itself. The document discusses the distinctions between specific phobias and agoraphobic disorders, emphasizing that the nature of the fear (e.g., fear of not being able to get help) determines the classification. Specific phobias can include fears of animals, natural environments, blood injections, or injury, and these phobias can manifest in various ways, such as a child's fear of injections. Substance or medication-induced anxiety disorders can develop during or after severe intoxication or withdrawal, with certain substances like LSD being more likely to cause anxiety disorders. Obsessive-Compulsive Disorder (OCD) involves persistent, repetitive thoughts (obsessions) and ritualized behaviors (compulsions) that aim to reduce anxiety, and the severity can range from mild to highly disruptive. OCD can affect individuals of all ages and genders, and it often involves complex ideations and behaviors that significantly interfere with daily functioning, such as excessive cleaning or the inability to make quick decisions. Individuals with OCD experience significant distress and disruption in daily life due to their compulsive behaviors, which they recognize as irrational but feel compelled to perform. Therapeutic interventions for OCD often focus on behavior therapies like systematic desensitization and implosive therapy, as medication is generally ineffective. Body dysmorphic disorder (BDD) is related to OCD and involves an obsessive focus on perceived physical flaws, leading to repetitive behaviors like mirror checking and excessive grooming, which impair social and occupational functioning. Hoarding disorder is characterized by the persistent difficulty discarding items due to a perceived need to save them, which is distinct from malingering, where individuals are simply too lazy to clean. Effective treatment for these disorders requires skilled therapeutic intervention and is a complex, long-term process, not a quick fix. Hoarding disorder is characterized by a persistent difficulty in discarding possessions, leading to cluttered living areas that compromise their intended use and cause significant distress or impairment. The disorder is not due to other medical conditions like brain injury, dementia, or other psychological disorders such as OCD, although similar behaviors can be seen in these conditions. Hoarding often requires intervention from third parties to manage clutter, but the underlying distress and perceived need to save items remain. Hoarding can create unsafe living environments, posing risks to the individual and others, and significantly impairing daily functioning. Other related disorders include OCD-related conditions like trichotillomania (hair-pulling) and skin-picking disorders, as well as trauma and stressor-related disorders like PTSD, which involve obsessive and intrusive recollections and avoidance behaviors. The document discusses the impact of trauma and stressor-related disorders, particularly focusing on post-traumatic stress disorder (PTSD) and dissociative disorders, and the importance of immediate treatment. PTSD can lead to hypersensitivity to stimuli, such as a dog barking, and may result in rage and violent impulses if not properly managed, often requiring immediate psychotherapeutic intervention. The document emphasizes the importance of treating trauma victims, like the author's daughter who was raped, in close proximity to where the trauma occurred rather than bringing them home, to help them deal with the trauma more effectively. Dissociative disorders, including dissociative amnesia and dissociative fugue, are described as mechanisms for individuals to escape from severe trauma, with dissociative identity disorder (formerly multiple personality disorder) being highlighted as a rare but well-studied condition. The author shares a personal anecdote about meeting Chris Sizemore, the first documented case of multiple personality disorder, and discusses the complexities and unique behaviors associated with dissociative identity disorder. The document discusses the upcoming exam, dissociative identity disorder (DID), and a notable case study: Exam number two is approaching quickly due to fewer chapters being covered compared to the previous exam. Dissociative identity disorder (DID), formerly known as multiple personality disorder, involves the presence of two or more distinct personalities within an individual, each with unique behavior patterns and social relationships. DID is often misrepresented in movies and books, leading to widespread misinformation; it is a rare disorder, primarily diagnosed in the United States, and often linked to severe trauma such as child sexual abuse. The disorder is characterized by high intelligence in individuals, as managing multiple personalities requires significant intellectual capacity. The first documented case of DID was Chris Sizemore, diagnosed in the 1950s; her experiences and subsequent reintegration provide valuable insights into the disorder. The document discusses a class on dissociative identity disorder, highlighting the popularity and interest in the subject, and mentions the book "I'm Eve" and the movie "The Three Faces of Eve," which were based on the life of a woman with the disorder but contained many inaccuracies. The author shares a personal connection with the woman, describing her as insightful and delightful, and recounts their long-term friendship and correspondence until her death. The author, a forensic psychologist, explains his professional involvement in court cases related to dissociative identity disorder, often debunking false claims of the disorder used as a defense. The document touches on the broader topic of dissociative disorders, including those not easily classified, and transitions into discussing somatic symptom disorders and their relation to stress and physiological conditions. The author uses personal anecdotes to illustrate how chronic stress can exacerbate predisposed physical conditions, such as cold sores, and emphasizes the importance of understanding the diathesis-stress model in these disorders. Somatic symptom disorder involves distressing physical symptoms that disrupt daily life but do not interfere with affective behavior, as illustrated by the example of a cold sore not preventing lecturing. Illness anxiety disorder, formerly known as hypochondriasis, is characterized by excessive worry about having or acquiring a serious illness despite mild or absent somatic symptoms, leading to frequent doctor visits and health-related behaviors. Individuals with illness anxiety disorder may engage in obsessive behaviors such as saving and analyzing bodily excretions, and they often reject psychological explanations for their symptoms, seeking multiple medical opinions instead. Functional neurological symptom disorder, previously called conversion disorder, involves a loss of physical function (e.g., blindness, paralysis) without an organic cause, often triggered by severe psychological stress or trauma. These disorders are more common in cultures that reinforce sick roles and can be self- reinforcing, especially in situations like war where the disorder provides an escape from threatening circumstances. The document discusses the treatment and understanding of functional neurological symptom disorder and factitious disorders, emphasizing the importance of treatment proximity and the characteristics of personality disorders. Functional neurological symptom disorder is better treated near the location of trauma rather than sending the patient home, as proximity aids recovery. Factitious disorder imposed on the self, formerly known as Munchausen syndrome, involves intentionally producing or faking symptoms to gain attention or sympathy. Factitious disorder imposed on another, previously called Munchausen by proxy, involves making another person, often a child, sick to gain sympathy, which can sometimes lead to severe harm or death. Personality disorders are characterized by significant impairments in self-identity, self- direction, empathy, and intimacy, and are stable across time and situations. Personality disorders are not due to substance use or medical conditions and include various types such as antisocial personality disorder, which is common and potentially dangerous. Zoc Topics 1. Anxiety Disorders Discussion on various anxiety disorders and their impact on behavior. Bullet points: The first group of disorders discussed in the class are anxiety disorders. Generalized Anxiety Disorder (GAD) is a continuous state of anxiety marked by feelings of worry, dread, apprehension, difficulties in concentration, and signs of motor tension. Individuals with GAD display behaviors without being able to readily identify stressors involved in bringing out the anxiety. A major aspect of diagnosing GAD is the inability to identify specific stressors. Social Anxiety Disorder is another type of anxiety disorder discussed in the class. Social Anxiety Disorder is defined as a persistent and irrational fear of social situations. Symptoms of Social Anxiety Disorder can overlap with other anxiety disorders. 2. Definition of Disorders Explanation of what constitutes a disorder and its effects on effective behavior. Bullet points: Disorders are behaviors which interfere with a person's effective behavior. Any behavior which interferes with a person's effective behavior is considered a disorder. A disorder prevents a person from doing things very well. Schizophrenia, for example, can prevent someone from performing tasks like teaching. Anxiety disorders are a type of disorder that affects behavior. Disorders can become overwhelming and are often grouped for study. Anxiety disorders are characterized by anxiety being at the center of the disorder. Anxiety involves a feeling of foreboding or that something is going to happen. Personality disorders involve significant impairment in self-identity or self-direction. Individuals with personality disorders may not have a strong sense of identity. 3. Generalized Anxiety Disorder (GAD) Continuous state of anxiety marked by worry, dread, and motor tension. Bullet points: Generalized anxiety disorder is a continuous state of anxiety marked by feelings of worry, dread, apprehension, difficulties in concentration, and signs of motor tension. GAD involves chronic and excessive worry about a number of events and activities which are not specifically identifiable. The disorder must occur more days than not for at least a six-month period to be diagnosable. A major aspect of the diagnosis is that the stressors involved cannot be readily identified. 4. Symptoms of Anxiety Disorders Common symptoms such as restlessness, fatigue, difficulty concentrating, and sleep disturbances. Bullet points: Restlessness or feeling of being keyed up or on edge. Sense of being easily fatigued or being tired. Difficulty concentrating or mentally going blank very easily. Symptoms are fairly universal across different anxiety disorders. Symptoms include restlessness, fatigue, and difficulty concentrating. 5. Neurotic Nucleus and Neurotic Paradox Concepts used to assess anxiety disorders, involving avoidance and maladaptive behavior. Bullet points: A neurotic nucleus is when the individual tends to avoid situations where the object of their anxiety might be present rather than dealing with that object of their anxiety. The neurotic paradox is when the individual tends to maintain the abnormal behavior in spite of its apparent maladaptive nature. In anxiety disorders, both neurotic nucleus and neurotic paradox are often present. The neurotic nucleus and neurotic paradox are commonalities found in various anxiety disorders. An example of neurotic paradox is someone with a phobia of grasshoppers who avoids leaving the house during summer despite knowing the fear is irrational. The neurotic nucleus involves avoidance behavior, while the neurotic paradox involves persistence in maladaptive behavior. These concepts help in assessing whether an individual is exhibiting an anxiety disorder. The neurotic paradox highlights the persistence of maladaptive behavior despite awareness of its irrationality. The neurotic nucleus and neurotic paradox are not exclusive to anxiety disorders but are also found in other types of disorders. Understanding these concepts is crucial for diagnosing and treating anxiety disorders. 6. Panic Attack and Panic Disorder Discrete periods of intense fear or discomfort with symptoms like palpitations and sweating. Bullet points: Palpitation, pounding heart, accelerated heart, sweating, sensations of shortness of breath, feeling like being smothered, feeling like choking, chest pain or discomfort. Symptoms can develop within seconds or a minute or two, reaching their peak within about a 10-minute period. Anxiety decreases incredibly quickly after the peak of a panic attack. Panic attacks are a major aspect of panic disorder but not a disorder per se. Recurrent and unexpected panic attacks are a key feature of panic disorder. Having multiple panic attacks in a month may indicate panic disorder. Persistent concern about having another attack for at least one month is a criterion for panic disorder. Heart rate increases dramatically during a panic attack. Anxiety decreases dramatically after the peak of a panic attack. 7. Social Anxiety Disorder Persistent and irrational fear of social situations where one might be scrutinized. Bullet points: It's a persistent irrational fear of and compelling desire to avoid situations where the individual might be exposed or come under the scrutiny or evaluation of other people. It's highly persistent and irrational, doesn't make any logical sense. Symptoms of social anxiety disorder can include fear of using public laboratories due to irrational beliefs about being judged. Individuals with social anxiety disorder may fear speaking or performing in public. Social anxiety disorder is characterized by irrational and persistent fears that are not based on logical reasoning. The disorder involves a compelling desire to avoid social situations where one might be evaluated by others. The fear associated with social anxiety disorder is not related to a fear of contracting diseases but rather to being judged or scrutinized. Social anxiety disorder can manifest in specific situations, such as fear of using public restrooms or public speaking. 8. Phobias Intense, irrational fears of specific objects or situations, such as agoraphobia and specific phobias. Bullet points: Phobias are morbid, irrational, intense fears. Phobias are fears of something that the person should not be afraid of. Agoraphobia involves the fear of public places where escape may be impossible or help unavailable in case of sudden incapacitation. Specific phobias are more common in children than adults. The mean age for individuals exhibiting specific phobias in children is about 10 years old. Specific phobias are also called situational phobias. Specific phobias are specified in the DSM-5-TR. A fear of not being able to get help when needed would be classified as an agoraphobic type of disorder. Specific phobias can include fears of objects like grasshoppers. Simply showing a symptom does not mean that you have a phobia. 9. Obsessive-Compulsive Disorder (OCD) Anxiety disorder characterized by recurrent thoughts (obsessions) and repetitive behaviors (compulsions). Bullet points: OCD is an anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and ritualized types of compulsions designed to reduce anxiety. Obsessions are recurrent thoughts, such as thinking about something over and over again. Compulsions are repetitive behaviors, like washing hands excessively. Example: A woman with a cleanliness concern who had severe OCD. Obsessive thoughts can be about various things, such as a breakup or divorce. Compulsive behaviors can be extreme, like washing hands 500 times a day without any logical reason. OCD can severely impact daily functioning, such as being unable to log on to a computer or teach a class. Illness anxiety disorder is related to OCD but is very specific and involves excessive health-related behaviors. 10. Body Dysmorphic Disorder Preoccupation with perceived physical flaws that are not observable to others. Bullet points: Body dysmorphic disorder is a form of OCD or related disorder. It involves a preoccupation with one or more perceived deficits or flaws in physical appearance that are not observable or appear very slight to others. These preoccupations cause clinically significant stress or impairment in social, occupational, or other important areas of functioning. The preoccupations are not better accounted for by concerns with body fat or weight as in eating disorders. Individuals may perform repetitive behaviors like mirror checking, excessive grooming, skin picking, or seeking reassurance. These behaviors are not due to narcissistic personality disorder but are specific to body dysmorphic disorder. The disorder can lead to multiple cosmetic surgeries, such as several nose jobs. Individuals with the disorder may compare their appearance with others frequently. The disorder can severely impair the ability to function in the real world. 11. Hoarding Disorder Persistent difficulty discarding possessions, leading to cluttered living areas. Bullet points: Hoarding disorder is when there is a persistent difficulty when discarding or parting with possessions regardless of their actual value. A hoarder's bedroom would be so full of stuff that they wouldn't be able to sleep on their bed. A hoarder's kitchen is so cluttered that they cannot cook on the stove. The difficulty in discarding items is due to a perceived need to save them and distress or anxiety associated with discarding them. If living areas are uncluttered for a hoarder, it is only because of the intervention of a third party like family members or authorities. Hoarding causes clinically significant distress or impairment in important areas of functioning, including maintaining safe environments for self and others. Symptoms result in the accumulation of possessions that congest and clutter active living areas. Cluttered living areas substantially compromise their intended use. 12. Panic Disorder and Agoraphobia Panic disorder often comorbid with agoraphobia, involving fear of open spaces or situations where escape is difficult. Bullet points: About 2% of the population experiences panic disorder. Panic disorder and agoraphobia often occur together. Panic disorder typically occurs from late adolescence to mid-30s. Panic disorder is more common in women but causes more pathology in men. Agoraphobia is the fear of being in open spaces or places where help may not be available in cases of sudden incapacitation. Agoraphobia is about twice as likely in women as in men. About a third to a half of people with panic disorder will also be diagnosed with agoraphobia. Agoraphobia involves fear of public places where escape may be impossible or help unavailable in cases of sudden incapacitation. Agoraphobia can be confused with specific phobias, but it specifically involves fear of public places and open spaces. A person may have a fear of being alone in open spaces without having agoraphobia as a disorder. 13. Functional Neurological Symptom Disorder Loss of physical functioning without an organic cause, often seen in combat veterans. Bullet points: Functional Neurological Symptom Disorder is not under voluntary control and occurs on the unconscious level. These disorders are relatively rare today but more common in times of war. Combat veterans often experience these disorders due to the conflict in their brain between not wanting to die and not wanting to be seen as cowards. It acts as a defense against severe threatening situations, more common in adolescents and early adults. Army physicians prefer to treat affected soldiers close to where the disorder occurred to avoid reinforcing the condition. The disorder must persist for six months or longer to be diagnosed. Previously known as conversion disorders, they have been termed functional neurological symptom disorders for the past decade. The disorder involves losing the function of some part of the body without an organic cause. Functional Neurological Symptom Disorder is a rare condition. 14. Illness Anxiety Disorder Preoccupation with having or acquiring a serious illness without significant symptoms. Bullet points: Preoccupation with having or acquiring a serious illness. Somatic symptoms are not actually present, or if they are present, they are only quite mild. Previously known as hypochondriasis. Term hypochondriasis is no longer used due to its weird connotations. Excessive health-related behaviors are performed. It is a specific type of obsessive compulsive disorder. Example: Constantly examining a minor cut expecting it to get worse. Running to the doctor for very minor issues. 15. Factitious Disorder Intentional production or feigning of symptoms, either imposed on oneself or another. Bullet points: Factitious disorder imposed on the self involves intentionally producing or faking physiological or psychological signs and symptoms. The disorder was previously known as Munchausen syndrome. When imposed on another, it was previously called Munchausen by proxy. Factitious disorder is relatively rare, though not extremely uncommon. Functional neurological symptom disorder is a different, rare disorder where symptoms are not under voluntary control. Malingering is different from factitious disorder; it involves faking symptoms to avoid responsibilities or gain something. Individuals may make others sick to gain attention, a behavior seen in factitious disorder imposed on another. The lecturer has encountered two cases of factitious disorder imposed on another. 16. Personality Disorders Significant impairments in self-identity, self-direction, empathy, and intimacy. Bullet points: Personality disorders are defined by significant impairments in self-identity or self- direction. Individuals with personality disorders often do not have a strong sense of self- identity. They lack the ability for self-direction, such as setting and pursuing goals. Individuals with personality disorders have significant impairments in interpersonal constructs. They seem unable to display empathy. Personality disorders are more prevalent than anxiety disorders and require accurate diagnosis due to their severity. These disorders are stable across time and situations, meaning the individual's behavior remains consistent regardless of context. Individuals with personality disorders cannot appropriately adjust their behavior to different situations. They are unable to identify or understand the trauma others are experiencing. They lack empathy and cannot show intimacy. 17. Dissociative Identity Disorder (DID) Existence of two or more distinct personality states within an individual Bullet points: Dissociative identity disorder is characterized by the existence of two or more distinct personality states within an individual. It is a very rare type of disorder. All dissociative disorders involve the individual trying to escape from severe trauma they have experienced. There is a lack of stable age or gender data related to dissociative identity disorder due to its rarity. Dissociative identity disorder is also known as multiple personality disorder. Individuals with dissociative identity disorders often have high intelligence. The diagnosis of this disorder outside of the United States is almost non-existent. In Britain, dissociative identity disorder is considered a wacky American fad. Movies and popular books often provide false information about dissociative identity disorder. Most movies distort the reality of dissociative identity disorder to make it more interesting. 18. Somatic Symptom Disorder Physical symptoms caused by psychological factors, such as ulcers or migraines. Bullet points: Somatic symptom disorder involves physical symptoms like ulcers and migraines caused by psychological factors. Chronic stress can lower physiological resistance, facilitating predisposed physical conditions. The diathesis stress model explains how stress can lead to physical symptoms like pimples, cold sores, and migraines. Individuals with somatic symptom disorder may actually have physical conditions like ulcers. Somatic symptom disorder is related to anxiety disorders. 19. Post-Traumatic Stress Disorder (PTSD) Anxiety disorder resulting from exposure to a traumatic event, characterized by intrusive recollections and hypervigilance. Bullet points: PTSD results from an actual, threatened, or imagined serious injury. A person can develop PTSD even if the injury did not happen to them but to someone else. PTSD involves the mind obsessing over the traumatic event. PTSD is a specific form of obsessive-compulsive disorder. PTSD can lead to abnormal ways of dealing with trauma. PTSD can coexist with other disorders like phobic disorder, generalized anxiety disorder, and panic disorder. The diathesis-stress model explains why different people develop different disorders from similar stressors. Anxiety is at the center of PTSD, characterized by a feeling of foreboding. Zoc Transcript Let me get exam material for number two out. If you folks develop any questions as we go through this stuff, please feel free to ask me that. Okay. You should have a new PowerPoint up and running, do you? Okay. It says anxiety disorders, everybody cool about that? Let's spend some time discussing this, and again, I'll leave about five minutes, remind me to leave about five minutes at the end of class, and that way if you think of any questions for the exam, exam number one, I'll be able to answer them. Folks, the first part, the material for exam number one, we did not talk about any disorders at all. You know, for exam number two, this is all that we're going to be talking about. We're going to be talking about all kinds of disorders, you know, an incredible amount of disorders that it's going to tax us at times because disorders can become overwhelming. But I put disorders in groups, and the first group of disorders we're going to discuss in this class are the anxiety disorders. And if you guys, I think we may have shown this before. This is the screen by Edward Monk. There's actually a couple of different versions of Monk's screen. This is one of those, and it just shows perhaps, you know, a person experiencing some type of disorder that is having an effect on their behavior. Now let me start by defining what disorders are, okay? Disorders are behaviors which interfere with a person's effective behavior, okay? It's any behavior which interferes with a person's effective behavior. What are we talking about, folks? When we have a disorder, we're not able to do things very well. You know, if I am schizophrenic and I am hearing voices, could I teach very well? No. But I couldn't teach at all. Is that a disorder that's going to, is that a problem that's going to affect my behavior? Yeah, it is. You know, when we take a look at anxiety disorders, if you remember one of our early slides when we were talking about disorders and we were talking about professionals who work in the field, we talked about the psychiatrist, psychotic disorders, psychologists, the anxiety disorders. We take a look at counselors, the situational stress disorders. Well, psychologists are fairly well versed in these types of disorders. And an anxiety disorder, and this is a terrible definition, but it's the best definition that I've been able to come up with in over 45 years of teaching this class, it's any disorder where anxiety is at the center of the disorder. Anxiety, a feeling of foreboding, anxiety, the feeling that something is going to happen. Something is going to happen. You ask this people, what is going to happen? I don't know, but I feel like something is going to happen. That is an anxiety disorder. And there are several of these, as we will see in just a second. Now anxiety is considered to be normal if a stressor is sufficiently severe to bring about the behavior or symptoms. Folks, you, you've decided to take the exam tomorrow. Are exams for the vast majority of students, do they provide some anxiety for students? Yeah. Especially the first exam, because most of you have never had me in a class before. You don't know how I'm going to test. So there's going to be anxiety there. The anxiety is going to maybe interrupt your sleep patterns tonight that you're thinking about taking it early tomorrow by about eight or nine o'clock in the morning. You know, so you go to bed tonight, even though you're tired, the anxiety that the test is running through your mind and you're not able to get to sleep very well. Well, do you have a disorder? No. Is that something which is probably normal? Yeah. Is it good to have some anxiety about exams? Yes. Because that sort of motivates students to try to do better on the exams. So a little bit of anxiety, gosh, that's fine. If the anxiety is so overwhelming that the student has got to drop the exam, might, might that be a disorder? It doesn't mean that the individual does have a disorder, but might that be a disorder? Yeah. Because is it interfering with their effective behavior? Should the individual be able to effectively take an exam, even though they have anxieties relating to that? Yeah. Do I have anxieties about exams? Yeah, I do. You know, I want to make certain that the exams are good exams, and that's why I habitually go through them very frequently. With respect to your, with respect to your PowerPoints, folks, I update these PowerPoints three or four times a week to try to give you the most current information that is out there. You know, you guys are paying me to teach you about psychopathology. Because of that, do I have anxiety that I want to make certain that I do get you the most current types of information, information that is currently regarded as the most accurate information? Absolutely. You know, so gosh, me having anxiety about the PowerPoints, about developing exams, hey, that's normal kinds of things. You know, your anxiety about, about your, you're getting divorced or you're getting married, you know, can good things have anxieties? Yeah. And as long as it's, it's sufficient to bring about what's occurring, as long as it doesn't interfere with your behavior, with your effective behavior, folks, you're, you're in pretty good shape. Now, generally, generally speaking, this is true of all disorders, not just the anxiety disorders, but generally speaking of all disorders, the more sudden the onset of the disorder, the more sudden the disorder comes upon the person, generally, the quicker the offset. That you cannot begin to believe the number of parents and spouses I've had to talk to that their, their, their son or daughter, husband or wife had been hospitalized because of a psychological disorder, that I did an initial diagnosis of the person, you know, I then go out and I need to talk to the, the parents, the family. Are those people anxious? Yeah, they're incredibly anxious to hear that information. And one thing that really tends to blow their mind is when I come out, that there was a particular, she was actually a neighbor and her husband was, was overseas, he was in the Air Force and he was serving some tour overseas. And she came over to my house one day and she was just acting really, really bizarre. This woman had lost contact with reality and she had never shown any signs or symptoms of being schizophrenic in the past. So, it was obvious this individual needed hospitalization and it was, it was fortunate when I called up her mother, her father, when I called up her brothers and sisters, when I called up her husband, I said, you know, that she, she has this diagnosis, which is a terrible, terrible diagnosis, but I said that she's going to be all right, you know, because the disorder, she had so many stressors playing upon her while her husband was gone. She just couldn't take it anymore. And she lost contact with reality, that she was hospitalized, she was given appropriate medication and in less than 12 hours, that the person was fairly normal once again. You know, and, and the parents, the family, her husband was going to fly home. I said, don't do it. I said, she's going to be fine. You know, she'll be around family members. I says, if you want to come home, come on home. But I said that she's going to be fine, I will guarantee it. And the reason why is because the development of the disorder was so darn quick. You know, again, it just happened. It was like day and night. One day, she's fine. The next day, she's crazy as hell. Okay. Generally, not always, generally in those cases, the individual is going to be fine. It's when the individual has developed a problem over time, over years, the individual has been showing symptoms of a particular disorder for a long period of time, whether it be an anxiety disorder or a psychotic disorder, post-traumatic stress disorder, or whatever the case may be, that the individual has been displaying these initial symptoms over a long period of time, they finally reached a head to where the person has lost contact with reality. Boy, it's, I hate to talk to parents. I hate to talk to family members under those circumstances, you know, because the prognosis, the outcome is not going to be good. And when you give negative, a negative prognosis to a family, you know, they begin to, what can we do? You know, we'll change. We'll feed her better. You know, we'll treat her better. Well, it's, it's not, it's not that easy. It would be nice if we had a medication that could help everybody. It would be nice if we have nutritional concerns that could help a person overnight and things like this. But boy, I'll tell you, when things have a long time to develop and fester, it's, it's very difficult to successfully treat those individuals. Now, like I say, it's not just with the anxiety disorders. It's with every disorder we will talk about this semester. Now, with anxiety disorders, specific to anxiety disorders, there's what is known, there is what is known as the neurotic nucleus and the neurotic paradox. And we always look for those to, to try to assess, yeah, this individual is in fact exhibiting an anxiety disorder. A neurotic nucleus is when the individual tends to avoid situations where the object of their anxiety might be present rather than dealing with that object of their anxiety. Let me give you a very simple example and then I'll give you examples as we go through these different disorders. Folks, let's assume I'm afraid of grasshoppers. Let's assume I have a severe phobia. I mean, it is so severe, I don't even leave my house. You know, and let's say that Missy and her husband invite me over for dinner this weekend. Well, gosh, are there still a lot of grasshoppers out there? Yeah, I hate grasshoppers. I don't want one to jump on it. You know, and there's, there's some irrationality, the neurotic paradox, which I'll talk about in a second. There's some weird sorts of thinking about this. But what I will tell Missy and her husband, gosh, it would be great, but I can't do it this weekend. I have already made other plans. Have I made other plans? No, but my phobia prevents me from going to your house because I might be confronted with a grasshopper or with multiple grasshoppers and I have a phobia. It's not just a little fear like I don't like, I don't like grasshoppers, but do I have a phobia of them? No. Can I go outside? Yeah. If one jumps on me, do I knock it off? Yeah. You know, I don't like them. I don't have a fear of them, but I don't like them. Is it going to prevent me from going over to Missy's house or in her husband's house for dinner? No, that won't. Again, if I have a phobia, if I have an anxiety disorder, will it prevent me from doing that? Yes, it will. And again, this will become apparent as we begin talking about these disorders. The neurotic paradox, the neurotic paradox is when the individual tends to maintain the behavior, the abnormal behavior, in spite of its apparent maladaptive nature. If you were to talk to me, Missy now, let's say she's not a friend of mine. Let's say that she's my therapist and we're going through my phobia of grasshoppers. And she sits there and she asks me, you know, Joe, should most people have a fear? She'll sit there and say, Joe, should you have a fear of grasshoppers to the point that you can't leave your house during the summer? I'll say, yeah. She says, why is that? Because, you know, if like a thousand of them suddenly jumped on you, it could take away your breath and you could die. Joe, what's the chances of that? Well, it could happen. Joe, what's the chances of that? Well, the chances are not that big, but it could happen, OK, that they know it's not likely to occur. It's obvious if I have this particular phobia that I should understand that it doesn't represent a real danger to me. But in spite of my behavior being maladaptive, in spite of my phobic disorder being maladaptive and me knowing that it is maladaptive, is it weird for somebody to have a phobia of grasshoppers, you ask me? And I say, yes, you know, that in spite of its apparent maladaptive nature, I know it's maladaptive to have this particular phobic disorder. I continue with that maladaptive behavior. Does that make sense? Even though I know the behavior is crazy, I know I shouldn't have that fear. I know I shouldn't be anxious in that particular situation. I know there's no real danger. Do I still adhere to that maladaptive behavior? Yeah, I do. So like I say, in anxiety disorders, we tend to see both of these cropping up when we actually have a disorder. The first disorder that we're going to be talking about in this class. So guys, after several weeks of this class, we're actually hitting our very first disorder. You know, you guys will get sick of disorders because this will be what we talk about until the end of the semester. But of one disorder under this anxiety disorder heading. So this is the major heading, anxiety disorder. One anxiety disorder is a generalized anxiety disorder, often just abbreviated GAS. The definition of a generalized anxiety disorder is a continuous state of anxiety marked by feelings of worry, dread, apprehension, difficulties in concentration, and signs of motor tension. What the heck does that mean? It means that I am keyed up all the time. I have anxiety continuously. Every day, I am under a great deal of anxiety to the point that I can't work right. I've been fired from three jobs because of my generalized anxiety disorder. I've lost relationships. I've been in good relationships, but because of my generalized anxiety disorder, I have failed in those relationships because they have put a strain on them. Is this interfering? Is my generalized anxiety disorder interfering with my affective behavior? Yeah. If we talk to me about the neurotic nucleus, now because of my anxiety disorder, if I get into a relationship, it's only going to cause more anxiety. So I'm going to stay away from all relationships. Neurotic paradox, I know that it's dumb to be afraid not to get involved with somebody. Even though I know that that's maladaptive, I'm going to continue to display my anxieties for being in a relationship. So does it follow the line of what we've defined as a disorder? And the answer is yes. Okay, now let's go down to this bulleted point first. Generalized anxiety disorder, and I don't know why I said S there. That's stupid. G-A-D. Generalized anxiety disorder does not involve being able to readily identify the actual cause of the anxiety. Okay, if the individual says, well, it's relationships. Well, that's probably not true. Okay, you're sort of making up an excuse. Okay, in a generalized anxiety disorder, there's nothing really sufficient to bring about that. There's nothing that has happened to the individual to bring about that particular behavior. The individual, as with a lot of anxiety disorder folks, that we're not able to identify the actual cause of the anxiety. Well, what are you anxious about? Well, I'm anxious about everything. Well, give me some example. Well, I'm anxious about going to school. I'm anxious about driving. I'm anxious about being around other people. I'm anxious as to the amount of money I'm making. I have all of these anxieties. Well, folks, you know, are those really producing that anxiety? No. With the individual, with the generalized anxiety disorder folks, that individual is just displaying the behaviors without being readily able to identify stressors involved in bringing that out. And in these first couple of anxiety disorders that we will be talking about, folks, a major aspect of the diagnosis is they cannot be identified. Anxiety cannot be readily identified, folks. It just evades us. Again, the person might say, well, it's everything. Well, what's everything? You know, they might feel pressured to say things. So then that's when they say things like their job and relationships and school and driving and financial things, you know, that they're just throwing words out. And those are not really identifiable aspects which are causing that particular disorder. I know this sounds counterintuitive, you know, them not being able to do it. If they are able to identify a specific cause of it, like I am afraid of grasshoppers. Why? Because when I was a little kid, a bully down the street grabbed me and he forced me to eat a grasshopper and he stuck a grasshopper up my nose. Well, can we see that? Well, that's a fear. You know, is that a general anxiety disorder? That is not a generalized anxiety disorder, folks. That would be a phobic disorder in that case because there is a specific identifier which causes the disorder which can be readily identifiable. Now, one thing we're going to find, folks, is that with respect to anxiety disorders, women make up the majority of individuals exhibiting these disorders. We're not being chauvinistic by saying this. This is just the statistics. Women tend to show general anxiety disorders more frequently than men. Why? Probably due to a thousand different things. You know, one of the big things is multiple factors related to learning. Like that woman that bound her feet, that Chinese woman that bound her foot. You know, is that due to faulty learning? Yeah, it is. You know, so, and again, is there just one thing? No, there's a multitude of things that are causing it. But women make up about two-thirds of individuals diagnosed with a generalized anxiety disorder. Now, ladies, women, don't feel too concerned about that right now. The reason being is that when we talk about antisocial personality disorder, you know, over 85% of the individuals that have been diagnosed with antisocial personality disorder are men. Antisocial personality disorder, people like Ted Bundy. Would I rather have a generalized anxiety disorder or would I rather be like Ted Bundy? Folks, I would rather have a generalized anxiety disorder. Okay, you take a look at the severity and the severity of a generalized anxiety disorder is nowhere near that of an antisocial personality disorder in individuals. We take a look at pedophiles. The vast majority of pedophiles are men. Okay, well, are there some women that are pedophiles? Yes. But the vast majority of pedophiles are men. Probably close to 90% are men. So while we're just giving the statistics here, folks, we're not making any type of chauvinistic statement. Like I say, we're going to see a lot of disorders that are more common, a lot more serious disorders that are more common in men compared to women. Okay, so those are just the statistics. Are they scientific statistics? Yes. You know, they're not made up. It wasn't just made up by one person. It involved a whole host of clinicians working with individuals and giving statistics regarding these different disorders. DSM-5-TR criteria for generalized anxiety disorder, chronic and excessive worry about a number of events and activity not specifically identifiable. Okay, we've talked about that. Again, it doesn't go away this afternoon. It doesn't go away tomorrow. It's chronic. It must occur more days than not for at least a six-month period of time. We're going to learn that six months is a big factor here. A lot of disorders, not all disorders, but a lot of disorders that you've got to be able to see that disorder present in the individual for a period of at least six months for it to actually be diagnosable. And the worry must be accompanied by at least three of the following symptoms. And the next page will show these different symptoms. But they've got to show at least three of the following symptoms. Under most diagnoses, there will be in excess of three. Okay, when we begin to take a look at these, that there's going to be a ton of these. Now, folks, we really don't have time to get into these different symptoms. But these symptoms, we'll get into them next Tuesday. But these symptoms, folks, will be similar for all anxiety disorders, not just generalized anxiety disorder. Generalized anxiety disorder, chronic and excessive worry about a number of events and activities which are not specifically identifiable. That's the biggie there. It's got to occur at least six months. Okay, got to have at least three of these. So like I said, we'll wait until next week to get into those symptoms. So thank you for letting me get into this new material. Hopefully, we'll be able, when doing this, to get like a day ahead of time by the end of the semester. We can call the class off a day early. Now, before leaving, you guys, do you guys have any questions about the exam? You guys cool about that? I wish you the absolute best. I'm not going to wish you luck. Because luck is not going to help you on a test. Okay, it just won't do it. But I wish you the best. If you study hard, if you've studied since the beginning day of class, then you're going to do well on the exam. There's no two ways about it. If you haven't studied, you're going to do poorly on the exam. Is that how the world should work? Yeah, that's how the world should work. If you study hard, you're going to do well. If you don't study, you're going to do poorly. That makes sense. So if there's no other questions, again, I leave you with following. Always stay safe. Again, Tuesday, excuse me, Thursday around five o'clock, I should have the score specified. Now you're going to have a score soon. Probably soon after. Sometimes it's within five minutes. Sometimes it's within a couple hours that a score will show up on the gradebook for you. And it might say, well, 93.58. And that's the percent that you got correct on that exam. Okay, it will have a score by it as well. More than likely. I don't know if this class, if we have the scores being shown or not. I can't remember. I'll have to check that. But you know, you won't know your real score until Tuesday after I figure out who the high score was. Now, if the high score, if somebody takes the exam today, and they get all. Amy, are you able to view the PowerPoints? Are you able to see me? Are you able to view the PowerPoints and can you hear me? Yes. Thank you very much. I appreciate that. We'll wait about another minute and then I'll talk about the exam just a little bit. Excuse me. And then we'll go on to the material for this next exam. Excuse me. I think I'm coming down with a cold or something. My nose has been running all day and my throat's just been irritated like crazy. Just one of those days. Well, why don't we go ahead and start talking about the exam at first. Folks, both classes did well, both the online class as well as this, the virtual class did very well. In the online class, there was actually a perfect score. One individual got all the questions correct. In this class, the high grade was a 63. There were two of those and that meant that two individuals missed three questions each. The questions were not the same. The questions each student missed were actually different. There were four Ds, as in dogs, in the online class and there was one F in the online class. With respect to the, we take a look at the percent that the percent correct was 84% or 84% was the mean and in fact over 85% of the class earned an A or B in the class. In the virtual class, the average was 87. It was a little bit higher than the online class. As I was saying, when we take a look at the amount of time it took, on average it took the online class 44 minutes and 44 seconds. What's the chances of that on average to take the exam? In the virtual class, it took a little less time. It took on average 38 minutes and 47 seconds. So you folks did very well on the exam. I was informed early on in the exam. During the exam, I tend to stay on the computer. On this page, I'm doing other things, but I stay on the class pages just to make certain that there are no problems and a couple of students did. Two students noticed that one question had been marked incorrectly and one student noticed that there were two questions that had been marked incorrectly. So I went through those questions and they were badly worded questions, folks, they were terribly worded questions. I was actually in the process of modifying those questions. One of those questions on my exam, remember your exam is a little bit different than my exam because of a random assignment. Any two people get exactly the same questions and they get the same questions, but they're not in the same order. My exam is ordered. Every time I look at it, it's exactly the same. One of the questions I screwed up on, and again, this was just my fault and I apologize for it, was the very last question and I was modifying the very last question and I did not finish that modification and I got redirected to some other material for, I think I told you I'm working on a murder case. I got directed to some new information in that particular case and when I got back, I didn't even look at that question. So again, that's totally my fault. But if your exam was graded before I changed those questions, that what I had to do is I had to go back and add points if you missed those two questions. So if you look at your results and you'll actually see the points were given in some cases, as much as two points were given, it shows that you missed a question. But when you look at that individual question, it's actually giving you credit for that question and that just shows that that's one of the poor questions. So everything was copacetic on that, that everybody earned the score that they should have earned. Folks, if you didn't get the score you wanted to on this exam, you still have three more exams to go. And quite obviously, you know, if you got a D or an F on the exam, studying the same way for the second exam as you did for the first exam is a bad idea. You know, you were not successful how you studied for the first exam, again, if you did not do really well on the exam. So you're going to have to change how you study for the exam. If you're not going to change how you're going to study, drop the class. You're wasting your time, okay? If you are going to modify how you're going to study, those students that didn't do as well, that you're going to see an uptick in your grade. So again, you know, can you up your grade? Absolutely. Absolutely you can. If you got a B and you want to earn an A in the class, can you still do that? Yeah. If you earned a C on the exam and you don't want to earn a B, can you still do that? Yes, you can do that. There was one student that got an F on the exam, I think they got a 58 or a 53 or something like that. Again, would they be able to up their grade? Yes. But once again, you're going to have to modify the way that you study for the exams in order to increase your grades on those exams. Do you folks have any questions about the exam? Again, you were given plenty of time. It looks like there were quite a few people that actually took the full hour, which I was surprised at. And many of those, some of those individuals did very well on the exam, that they earned A's on the exam. But some of those individuals actually were the ones that received the low scores. So they were obviously unprepared for the exam, that they were, as I stated last time, last Tuesday, that if you're not prepared for the exam, trying to look up all of the questions and the answers to the questions, as you're taking the exam, you're not going to have enough time to do that. And that's actually what happened in several attempts. So again, you know, not being a fail list, you guys are able to increase your score. Should you guys be getting A's and B's on the exam? Absolutely. That with having access to your notes, to your book, that you should be doing very well. I don't think that there were any questions that were misleading questions outside of the two that I had screwed up on. And again, that's just totally my fault. You guys did really well on the exams, again, which you should have. So do you guys have any questions, comments about the exam? Will the next exam be very similar? It will be, except it will be all about disorders. Since we are discussing disorders now, that the rest of the exam questions will relate to disorders and factors related to the disorders, like how do we treat these disorders and such things as that. All right. No questions? No comments? Correct. If you do have questions, hey, you know, hang around at the end. I've got 15 minutes from the time until my next class. So we'll be able to get in some questions. If you just want to talk to me alone after class, we can make certain that everybody else is off. Just remind me if you want to talk to me, just you and I ourselves, that just remind me to turn off the recording and to turn off the transcript. So nobody will be able to see that other than, well, nobody will be able to see that. I won't even be able to see that at that particular point. All right. Okay. Well, last time, if you remember, we started getting into the anxiety disorders and we talked about generalized anxiety disorder, talked about some of the aspects of the disorder. We did not get into the symptoms of the disorder. Now I'm going to get into these symptoms very quickly. Folks, these symptoms are fairly universal, no matter what anxiety disorder we're talking about. You know, we put this up when we're talking about generalized anxiety disorder, but when we talk about the other anxiety disorders, we're going to sit there and see us coming back to most of these symptoms with these other disorders as well. Now, I'll talk about these if you have questions, but we could just go through them rather quickly. Again, if you do have a question, we have time. So I'm more than happy to discuss any of these that you want me to discuss. There's a restlessness or feeling of being keyed up or on edge. You know, the person's just, when you look at the person, the person is like this, that they have anxiety and that anxiety is being shown. Because of that tenseness, being keyed up, they have a sense of being easily fatigued or being tired. There's a difficulty concentrating or mentally they go blank very easily, that all these anxieties are running through my head if I have this disorder, folks, that I can't seem to concentrate. I can't study for the exam, for example, that I just am not able to do that. Irritability, they get kind of scratchy very easily. There's muscle tension. As I was showing you guys, we take a look at a student in a classroom that has a lot of anxiety and you can actually see the tenseness in their back muscles. There can be sleep disturbances. Sleep disturbances can run the gambit. There can be problems with getting to sleep. Sleep disturbances, could we have things like nightmares or night terrors? Yes. You know, that there's a lot of different sleep disturbances we can see. Palpitation, pounding heart, accelerated heart, yeah. Sweating, some people can sweat. Sensations of shortness of breath or feeling like I'm being smothered. This goes along with feelings of feeling like I'm choking, that I just, I can't, it seems like I can't swallow or anything. Chest pain or discomfort. Now, a lot of these sound like the individual is having a heart attack. You know, if you think an individual is having a heart attack and you're unsure if they're having a heart attack or an anxiety disorder or a panic disorder or something like that, always call 911. Okay, do not make your own diagnosis. If you think that the individual might be having a heart attack, it's important that you get some professionals out there to check the person you're with. There's cabin nausea or abdominal distress. The individual could get things like diarrhea. I could feel dizzy, unsteady, lightheaded, or faint. And again, if you remember, we have to show at least three of these, but more than likely we're going to see a lot more than three of each. You know, we're going to have six or seven of these in the same person. It looks like some of you are still writing, so I'll give you some time to catch up. There can be feelings of derealization. This isn't reality. What I'm living in right now is not reality. It seems like I am in a fantasy world. Or there could be depersonalization. And this is sort of the idea that we feel like we're detached from oneself. Detached from oneself, probably the best example I might be able to give you of this, and this doesn't happen often, but it's kind of like an out-of-body experience. That I sit there and I feel like I'm able to look back at me. You know, I'm somewhere out here in space, but I'm sitting here looking at me. I'm not looking at my mother or my father or a sister or something like that. It's usually focusing in on yourself. Fear of losing control or going crazy is very easy. Fear of dying, that these symptoms can be so severe in some people. Remember that normal curve. Some individuals that do not have this disorder are way low on the symptoms that they experience. You know, other individuals that have a very serious case, that they are on the high end of that normal curve. We can have chills or hot flashes. And we can have paresthesia. Paresthesia is just, I begin to feel numb or I begin to have a tingling sensation or a prickling sensation all over my body. It's on our skin or just underneath the skin. Okay, it's not like deep within the person. It's not like I can feel my liver. My liver is tingling. It's not something like that. It's like, gosh, I have some weird sensations right underneath my skin or on top of my skin. You know, and I sit there and rub those areas and it doesn't help at all. So once again, we need to display at least three of these. Once again, the individual will generally show more than three of these. Do you guys have any questions about these particular symptoms? Again, we'll come back to them as we talk about other anxiety-related disorders as well. Now, usually I don't talk about treatments until the very end when we discuss anxiety disorders. But I thought, gosh, I'm going to talk about this right away. How can we treat some of these anxiety disorders? Well, a very common treatment are drugs or medications. And the major drugs and major medications are what are known as the benzodiazepines. Benzodiazepines, these are anti-anxiety drugs. So they were specifically developed to try to help the individual not experience as severe anxieties. And there's a bunch of these. You know, I've listed just, what, five or six of these. There's a couple of dozen of these. You know, the more common ones, Xanax, Klonopin, Valium, Librium, Valium. Did I say, yeah, I did say Valium. Sorry, I put that in twice. I don't know why I did that. Not paying attention, obviously. And, again, there's a bunch of others. And these tend to be effective. If we have a client who is suffering from some type of generalized anxiety disorder, and we place them on Xanax, for example, under, obviously, a physician's prescription, then we will more than likely see the anxiety reducing. Though might some of the symptoms still be there? Yeah, some of the symptoms could still be there. But they're not going to be to the extreme that the individual once was exhibiting those symptoms. So these particular medications, these benzodiazepines, these anti-anxiety drugs, usually are quite effective. Now, are they effective on everybody? They are not. Are they effective on every anti- anxiety drug? They're not, folks. Usually, the benzodiazepines usually are not effective for things like obsessive compulsive disorder. And they tend not to be as effective with some phobic disorders. With some patients, with some clients, can these be effective with OCD and phobias? The answer is yeah. But that's usually not the case. Usually, with those types of disorders, we've got to place the individual on some other form. If we're going to use some type of medication, we're going to have to put that individual on something other than a benzo. Psychological therapies, okay, behavior therapies tend to be the best. It's interesting, folks. If you have insurance and your insurance covers, to some degree, psychological disorders, that your particular policy is going to limit the number of visits you can make within a calendar year or within a program year of your particular policy. They're not going to cover everything. They might cover 10. They might cover 20 visits to a psychologist or a psychiatrist. And as a result, exposure types of therapies tend to be the most common. Because, again, with respect to behavior therapies, when you remember we barely discussed the idea of behaviorism when we talked about the different psychological theories. You know, we spent most of our time on Freud. I briefly, very briefly discussed behaviorism, and I briefly discussed humanism. Well, these behavior therapies have resulted from those behavior theories. We're not concerned with the past, okay? We're not really concerned with the present. We're concerned with what is happening right now. So when we're concerned with right now and trying to help the individual get over their disorder as quickly as possible, exposure therapies tend to be the most common. Cognitive behavior therapeutic interventions are extremely common as well, but we'll talk about those at the end of the course. Exposure therapies include systematic desensitization. Systematic desensitization, we gradually build up a tolerance of the object of the anxiety. Let's say the example I was giving you guys last time, I'm definitely afraid, let's assume, of grasshoppers. Gosh, probably benzodiazepines are not going to help because is that object still there? Are those grasshoppers still there? The answer is absolutely yes. So even though I take that medication, I see a grasshopper, it's going to spark those memories, those intense memories of my particular psychopathology. And as a result of that, let's try to use systematic desensitization. Gradually build up a tolerance of the object of the anxiety. What this might be, folks, that the individual might be, and this is in rather severe cases, at least for prolonged usage of this. Let's say that my case of being afraid of grasshoppers is very strong. Well, I go in. The first few sessions my therapist is going to do is they're going to help me relax pretty much on command. I want you to close your eyes. I want you to think about good thoughts. I want you to be able to relax as much as you can. But they're going to try to teach me to be able to relax almost at will just by thinking about that. And then what they do is they gradually bring in the object of my anxiety. Now, they're not going to bring in 10,00 grasshoppers. Okay, that's not going to happen. But what they might do to begin with, again, slowly developing an accommodation to the object of my anxieties, that they bring in a photograph, or maybe not a photograph, maybe a painting of a grasshopper. They show that to me. Gosh, if I'm truly anxious, if I truly have a phobic disorder, will I show a lot of anxiety related to that? Yeah, not as much as a real grasshopper, but there's going to be quite a bit of anxiety. Okay, close your eyes. Take some deep breaths. Okay, I get used to looking at that painting of a grasshopper. Then maybe my therapist brings in a photograph. Again, gosh, that looks really real. I have anxiety. Close your eyes. Take deep breaths. Okay, after that, what they might actually do is bring in some baby grasshoppers or something like that. You know, again, close your eyes. They're slowly trying to build up a tolerance for the object of my anxiety. In this particular case, the object of my anxiety are grasshoppers, and my therapist is trying to get me used to seeing grasshoppers. And can this be a fairly effective way of working with certain types of anxiety disorders? Yes, especially phobias. You know, benzodiazepines aren't that great with phobias. Gosh, this can help quite a bit with phobias. You know, I have a fear of heights. We gradually build up a tolerance for heights. We teach you how to relax. Then we take you up maybe to Weber State University on a Sunday. On a Sunday, why? Because nobody else is around. They're not going to be teasing us or anything like this. We go in. We go into the basement. We start walking up the stairs. You begin to show anxiety. Well, let's sit down. Sit down and close your eyes. We can't get you to adjust to that. Well, let's go down a couple of stairs. Okay, we're able to get you to relax. Well, let's then go up a couple of stairs. And this could take, you know, seven or eight different sessions to get you used to ascending heights. Will you ever become, will most people with very severe phobias ever become totally oblivious to their phobia? No. You know, will there always be some thoughts about that in the back of the person's mind? Yeah. It's not that it cures the person, but it successfully treats that. Sort of the opposite, it still is a behavior therapy, but the opposite of exposure therapy is flooding or implosive therapy. And what this is, folks, it's suddenly presenting the person with the object of their anxiety. What this would mean in the old days, back in the 50s, is you stick a person into a room with 500 grasshoppers and you don't let them out. Okay, gosh, did people die of heart attacks under those circumstances? They did. You know, so what implosive therapy is like today, again, you try to treat them, try to calm yourself, close your eyes, take deep breaths. And then you put them in an imagination. An imagination, you imagine yourself being in a room full of grasshoppers and you cannot get out. Again, a person with a true phobic reaction to grasshoppers, would that cause them a great deal of anxiety? And the answer is absolutely. You know, but it's trying to confront them with the object. Well, gosh, you can't get out. You know, are those grasshoppers going to be able to kill you? In some cases, we're not going to use flooding by itself. And this isn't used that frequently. Flooding or implosive therapy is not used that frequently. But when it is used, is it used with systematic desensitization as well? Yeah. So when we're talking about those anxiety disorders, which are amenable to therapeutic interventions, you know, gosh, these behavior therapies can be quite effective. And they fit into a person's, most people's insurance plans quite well. Questions about those? So now, again, these treatments are not just related to generalized anxiety disorders. They're related to anxiety disorders in general, not generalized anxiety disorders only. Okay. Have I seen these medications be absolutely successful? I have. I've seen individuals change very dramatically as a result of being placed on meds. A lot of people placed on meds, will they have to be on them the rest of their lives? No. You know, are there some individuals that will have to be on the medication the rest of their lives? Again, folks, when you're looking at millions and millions and millions of people that are on these medications, are you going to see a lot of differences in how people react to the medications? Absolutely. Some individuals show virtually no success rates in using benzodiazepines. Other individuals in a very short period of time, they adjust to the anxieties that they don't need the benzodiazepines for long periods of time. Most people need them for a while, you know, that we just don't get over the disorder right away. Why did I put this circled R next to these drugs? Any idea? What does that represent? That means the drug is trademarked. Okay, so supposedly, legally, what we're supposed to do when we give a brand name of a medication, we're supposed to show that that brand name is in fact trademarked. Now, is the generic counterpart trademarked? No. So we don't have to put this circle R, which means it is trademarked with those generic forms of medication. Panic attack. Now, folks, first and foremost, panic attack is not a disorder. Okay, panic attack is a symptom of a disorder. The disorder is panic disorder. Now, let's talk about panic attacks. Again, can you have a panic attack and not have panic disorder? The answer is yes. Okay, what is a panic attack? When we just take a look at a panic attack, how can we substantially define that particular term? Well, it's a discrete period of time. Discrete period of time means it has an onset and an offset that is seen within a particular time period, which we'll talk about in just a second. Okay, it's not a long time period, but it can, for some people, be. It's a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly. Abruptly within a minute or two. Okay, can they develop? The reason why I'm having difficulty with this is can they develop in seconds, folks? They can. So when I was discussing this, I was trying to figure out what do I want to do? Do I want to talk about minutes or do I want to talk about seconds? Usually, it's a minute or two. Can some people, though, develop these particular symptoms within seconds? Yeah. Generally, no matter which way you go, if you develop the symptoms in a minute or two or if you develop the symptoms in seconds, they reach their peak within about a 10-minute period of time. So, again, it's a discrete period where this occurs. And then the anxiety that the individual feels with the panic attack decreases incredibly quickly. And, again, this is not a disorder per se, but rather it's a major aspect of panic disorder. Okay, let's graph what we're talking about with a panic attack. This might be Missy. We're taking a look at Missy. We're taking a look at Dave. And both of them have had panic attacks. Folks, more than likely, you're going to have a panic attack if you haven't already had one. You're going to have a panic attack at some point during your life. It's going to happen. I've had two or three of them. I knew what they were. I knew what they were, so I just wrote them out. You know, I wrote with the I, so to speak. But what happens? We're taking a look at Dave. We're taking a look at Missy. You know, this is their sort of regular heart rate. It's not really high or anything like that. You know, relaxation, it decreases a little bit. When the individual begins to engage in panic attack behavior, we see that it goes up very dramatically. Your heart rate goes up incredibly dramatically. You know, in this particular case, it lasted about two minutes. Okay, from onset to peak, it was only about two minutes. about a two minute period of time and then it begins to decrease the anxieties that we feel decrease very dramatically. Now I'll get back to this graph, but let's talk about some specific symptoms of panic attack, of panic disorder, excuse me. Now can we show all of these symptoms with respect to generalized anxiety disorder? Yeah. But are there some specific ones? Yes. One specific one is recurrent and unexpected panic attacks. I put that number one because that would be the number one thing. If you're having, if you've had, I've had, let's say four panic attacks this month. Might I have panic disorder? I might. And I might want to go see somebody as a result of that. But in addition to this, at least one of the occurrences of panic attacks has been followed by at least a one month period of time of persistent concern about having another attack. In other words, folks, I begin to obsess about this. I had a panic, I've had four panic attacks and after each one of them this month, after each one of them, I have a lot of worry. I have a lot of anxiety about having another one. I become obsessed about this. Okay. It's the only thing that I can think of. Like generalized anxiety disorder, it's not associated with an external trigger. You might think that it has an external trigger. Let me give you an example. I was going to talk about this a little bit later, but let me give you this example now. You are in class. We have a face to face class. You're in my class. You know, you're just going along. Everything's going okay. I'm lecturing. You're getting tired. As a result of that, you're getting kind of sleepy and all of a sudden you go into a panic attack. Okay. You feel like you're going to die. You know, gosh, I'm choking. I can't breathe. You know, that the walls are closing in on me. I feel like I'm going to die. You know, if I could wait that out, boy, it comes down very quickly, but I might not be able to wait that out. I feel like I'm going crazy. I'm in Horvath's class. What do I do? I leave Horvath's class and I get to my car and by the time I get to my car, is the panic attack subsiding? It is. Had I stayed in Horvath's class, would it be subsiding? Yeah, it would have been. Okay. And then when I get home, it's descended quite a bit. So what might my natural instincts be? This couldn't just have happened. This can't just happen out of nowhere. Something had to cause it. What caused it? It was Horvath. You know, did Horvath say something? He must have. What did he say? I can't remember. But he must have said something that made me highly irritable, highly anxious. Because once I got out of the room and got to my car and got home, the symptoms had subsided very dramatically. We don't like to believe that this just happened out of thin air. You know, something just grabbed a hold and threw it in my brain and I had a panic attack. We don't like to think that. We like to think that it had to have a cause. Again, knowing what panic attacks are, when I've had mine, you know, I could feel them coming on. So what I just do is I just sit back and I let it happen. You know, I let, you know, I said to the guys, my heart rate is increasing. I'm going through all the symptoms. I'm having all of the symptoms of a panic attack. I get through that apex. And again, it's amazing how quickly those signs of anxiety can decrease in that particular case. Did I seek medication? Did I seek therapeutic intervention? No, because it was just normal, just a strange thing that happened. You know, I haven't had one probably in 10 years that it's, it's just something that probably not everybody perhaps, but it's something probably that everybody will sit there and show at some time. That's not, as stated, it's not associated with an external trigger. It's not associated with drugs or medication. Could a drug cause that to happen? Yeah, a drug could cause that to happen, folks. I take mescaline, okay? I take a hallucinogenic type of medication like mescaline. I take LSD, you know, I take PCP, fencyclidine, that can those induce me into what I'm thinking is a panic disorder that they can't. Now, the difference, if I pop an LSD tablet or something like that, is this going to last a longer period of time? Is that high going to be a long, yes, much bit longer. So, you know, gosh, that cannot be a panic disorder because it's an associated with a drug or medication. How common is it? Oh gosh, it's, it's hard to say, you know, again, this is where it gets tough for a professor, you know, coming up with a statistic because you read different studies in different areas of the country that are soliciting data from different types of people. It's about 2% of the population. It's very common with agoraphobia. Without agoraphobia, it happens, okay, so I'm having a panic attack, but I don't have agoraphobia, which we'll get into in just a second. Agoraphobia is basically the fear of being in open spaces or spaces where help may not be available in cases of sudden incapacitation. We'll explain that in just a second. But with agoraphobia, it's found about twice as likely in women as in men. With agoraphobia, it's found in about three times as many women as men. Okay, and about a half to about a third of folks with panic disorder will also be diagnosed with agoraphobia. So this is one of those disorders, this is really the first disorder that we've encountered that shows really a strong comorbid link. If we have panic disorder, is it going to be unusual to sit there and see agoraphobia coming along with it? And the answer is no. Okay, the answer is yeah, we're going to sit there and see panic disorder and agoraphobia occurring very closely together. Age range, late adolescence to mid-30s, there's a fairly big age range for panic disorder. It's more common in women, but it causes more pathology in men. Okay, when we take a look at a woman and we take a look at a man, you know, a woman is going to have probably, will be diagnosed with more panic disorder compared to men. But when we take a look at men with the disorder, men will be more traumatized with it. There'll be more pathology in that man's behavior compared to the woman's behavior. There's a couple of disorders that are like that. Questions about that? Again, you know, we go back to these symptoms, can we have any of these symptoms? Yeah, because again, these symptoms tend to be related to anxiety types of disorders. The big thing with panic attack or panic disorder, folks, is we have recurrent and unexpected panic attacks. Okay, make sense? There's got to be at least that one month of obsessing about it as well. But again, just like with generalized anxiety disorder, there is no real external trigger. Again, do I think it's Horvath's class that causes it? Yeah. Am I wrong about that? Yeah, I'm completely wrong. Okay, now could it have been? Because I think it was Horvath's fault that something Horvath said in class, am I facing a lot of trepidation about going to class the next class period? I could. Am I beginning to obsess about this? Yeah. Could I have another one of these? You know, so could I be kind of keyed up at that point? Yeah. The next day, probably when we're taking a look at your heart rate though, your heart rate is probably way up here. You know, you're anticipating that there's going to be a problem. Could that anticipation actually ignite a panic attack at that point in time? Yeah. Again, was it Horvath's class? No, it wasn't. But you were thinking that you were going to have one and you did have one. You know, if you think, well, gosh, this was just weird. It just happened to occur in Horvath's class. And you go into class the next class period and this is what you're showing, you know, you don't have another panic attack. Gosh, it's going to be the same thing. It's going to continue down here. Well, is that a panic disorder? No, you just had a panic attack. Okay. I want to do a sidelight for my discussion on anxiety disorders at this point, folks. You know, you'll notice again that we've talked about the idea that women tend to experience anxiety disorders more than men, and we're not even a tenth of the way through the anxiety disorders. But, you know, we've got to remember, even though we're saying that it's more common in women, do men have anxiety disorders as well? Yeah. And as I told you last time, you know, men usually have more severe types of psychopathology, you know, like antisocial personality disorder, terrible, terrible disorder, you know, things like alcoholism. We tend to see more men displaying alcoholism than women, although that gap is decreasing somewhat, and it has been decreasing for about the past 30 years, you know, that we take a look at pedophilia. Pedophilia is more common in men than in women. So understand, you know, these are just statistics. These are not my statistics. These are statistics. Now, what I wanted to do is I wanted to talk about some of the reasons why perhaps women have anxiety disorders more commonly than men do. First of all, it's a highly complex combination of factors. It's not just a single thing, you know, and we've got to get away from, well, what causes it? Well, again, we could have a thousand different people with the same disorder in front of us, and the cause was a thousand different things. Okay? It's not just one thing that causes a disorder. It's a combination of very complex aspects, which tend to induce a person into a psychological disorder. Well, we take a look at why do anxiety disorders occur more in women than in men, and I wanted to bring in some scientific material. This is not just, you know, all the stuff I give you in this class is scientific, but in this particular case, I just wanted to make sure that you guys knew this wasn't coming just from my brain. This comes from the Journal of Brain and Behavior, as well as other scientific journals. You know, it's not just me making this stuff up or anything like that. Basically, it's learned factors. And remember when I talked to you about this last time, I reminded you of the woman who bound her feet, the older Chinese woman who did the custom, you know, way back when of binding their feet to make their feet smaller. Well, why do women do that and men didn't? Well, they learned. They learned that this was more attractive for a woman to do. It was learned behavior. Is this the only reason why it comes about? No. Learning is not the only reason. But is that one of the main features that can contribute to a person developing these particular disorders? They learned factors how women are taught to react to life events differently compared to men tends to contribute to this being more common in women than in men. If our societies, if the United States society, if they were more gender unbiased, would we see this difference in men and women with the anxiety disorders? We wouldn't. But even though we think that we have an unbiased country, are there still a lot of biases against one gender or another? And the answer is absolutely yes. So women are taught to react to these certain events in life differently than men are. Because of this, that there's going to be more anxiety experienced in these situations. If women are taught, if they learn that this particular life experience should induce quite a bit of anxiety in you, you know, and that comes up, is that likely going to induce you into an anxiety type of disorder? Yeah, it certainly could. Does it mean it will? Absolutely not. Are there biological factors? Now, again, I want to relate this back to the Journal of Brain and Behavior, because this sounds rather chauvinistic, you know, but are there biological factors? Yeah, there's things like brain chemistry. There's hormonal fluctuations. There's reproductive events over a woman's lifetime that can help. Again, these are not my views. These are views of the individuals that have had articles published in the Journal of Brain and Behavior. Same thing happens with men, though. You know, why do men show more antisocial personality disorders than women do? Well, are they taught differently? Yes! We're supposed to be the big tough guys, you know. We should never run away from a fight, you know. Somebody treats us badly, we should engage in some type of behavior that will equalize that. You know, are there hormonal fluctuations? Yes. And can these fluctuations be almost instantaneous? Yeah, and then things like testosterone, you know, can there be an androgen rush that the individual, you know, begins to feel sort of anxious and instead of having some of the other symptoms that we could have, we're taught, you know, it's okay to feel anger. I should be angry with that, and I have been taught if I'm angry that I need to sit there and act on that anger. So don't think that these are just aspects related to women and to these particular anxiety disorders. But again, could they be placed in a different context with respect to men? Yeah. Again, are men taught to be more laid back compared to women? More laid back, that may not be a great word, but more laid back than men, yeah, in many ways they are. Are men taught to be more aggressive than women? Yeah. Now, are there some women that are more aggressive than some men? Yeah, there are. Are there some men that get these disorders more commonly than some women? Yeah, absolutely. So we're not trying to be chauvinistic or anything like this. We're just trying to show how complex these factors certainly can be and how some individuals may show them and other individuals may not. Learning is a big part of that, as we saw when we talked about the faulty learning perspective, you know, and we talked about this with respect to that photograph I showed you of the individual with the KK and the exam question related to that. A disorder that is sort of hard to understand for a lot of people. Does this make sense to you guys? Do you guys have questions about this? Again, am I trying to be chauvinistic? No, I'm trying to be the opposite by bringing this up at this particular point in time instead of waiting until we talk about all of the anxiety disorders. Again, I thought, well, let's talk about this. We've talked about the medication and stuff. Let's talk about some other aspects of this. Another anxiety disorder, folks, that has anxiety in its name, is a social anxiety disorder. Once again, what are some of the symptoms? Gosh, are there any of these symptoms up here? You know, those symptoms can be seen in a social anxiety disorder as well. We take a look at a social anxiety disorder, and as we've defined it here, it's a persistent, I should maybe put at least a comma there, or if not a comma, an and there. A persistent and irrational. So it stays with the individual. It's not something that comes and goes. It's highly persistent. It's irrational. It doesn't make any logical sense. It's a persistent irrational fear of, excuse me, and compelling desire to avoid situations where the individual might be exposed or come under the scrutiny or evaluation of other people. What the heck does that mean? Okay, well, you know, I have social anxiety disorder. Do you think a professor, do you think a teacher could have social anxiety disorder? No. There's absolutely no way. When I first started teaching, when I was in graduate school, I wasn't very anxious. Yeah, because I felt like I didn't know that much over the students. You know, I'm kind of one step above the student, that I'm learning this stuff, and I've got to sit there and teach you stuff that I've just learned, and that was sort of scary. You know, did it prevent me from carrying out my duties as a teacher when I was in graduate school? No. So I didn't have a social anxiety disorder, but did I have anxiety in certain types of social situations? Yes. Let's take this. Let's take a look at the individual that does have a social anxiety disorder, and with their particular social anxiety disorder, they have a fear of speaking or performing in public. Okay, let's assume right now what I decide is this class is going to be from now on a face- to-face class. We're going to hold it in the social science building, and in addition to that, every student is going to have to teach an entire period in the class. Like I might sit there and ask Dave that you're going to have the social anxiety disorder, and you're going to have to talk about that for an hour and a half, hour and 15 minutes. That's a long time just to talk about a single disorder. Somebody else will go, well, you're going to have to spend the entire hour and 15 minutes talking about schizophrenia. Somebody else about post-traumatic stress disorder. Okay, now will that sort of bring up some anxieties in many of you? Yeah, I don't want to get up in front of a class and talk about this stuff. That's kind of scary. I don't want to do that. Okay, will most of you be able to get through that? Yeah. I used to teach the advanced general psychology class, which was a class for students going on to graduate school, but once again, when I started teaching things like forensic psychology and the psychology of criminal behavior, I had to cut back on other classes, so I had to cut back on teaching advanced general. But in that class that I had, everybody, every student was responsible for teaching a section in general psychology. And everybody in that class, and you could tell a lot of times that there would be students in there that they would get up and then start talking, and you could see how nervous they were because they were holding their papers and they were shaking or their voice was trembling. You know, they couldn't get that up. And that soon dissipated with staying up there and talking. Does that individual have a social anxiety disorder? No. Do they have anxiety in certain social situations? Yes, they do. Excuse me. But it's not a social anxiety type of disorder. The individual, remember when we defined what a disorder was, it's something that significantly interferes with effective everyday behavior. The individual that would have to drop the class, I can't do this, I'm too scared of getting in front of people and speaking, I cannot do this. That individual, do they, could they have a social anxiety disorder? Yes. Would we need to do more investigation of it? Yeah, just one thing is not going to be enough. Okay. But gosh, if they do this in other classes, if they do this in their work, if they've had to quit jobs because they've had to do presentations before, all of those taken in combination, are those interfering with the individual's effective behaviors, and the answer is yes. Okay, the fear of using public laboratories. Let's say this is me, and I'm up at school right now, and I have a fear, I have a social anxiety disorder, and part of mine is a fear of using a laboratory, a public laboratory. That's not a fear that I'm going to get a disease or something like that. But it's a fear, and these are strange, these are irrational sorts of ideas, remember this right here, this notion of irrationality. I believe that if somebody's in the room with me, that individual is going to be timing how long it takes me to urinate, you know, or they're going to be sitting there saying, you know, that gosh, you must have some kind of urinary disorder. They are making an evaluation of me, just like this, you guys are making an evaluation of me as I'm talking, giving my paper in the class, and I can't take that, so I leave. Again, and this seems weird, it is weird, it is very irrational, it is very persistent. But let's say on a scale of one to ten, that I have got like a nine and a half urge to urinate right now, and I go to one of the public laboratories, the private ones, you know, the one stall ones that can lock, you know, that's being used right now. So I go into a public restroom, there's somebody else there, I can't use that. So I go down to the second floor, okay, somebody's in that one as well. So I figure, my gosh, you know, my best chance is to drive home and do my business at home

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