Fluent Essays

Mid-Term Exam Objective Type MCQs 25 marks Q.1 Note: Mark one suitable option in items 1-25 and attempt rest of the items in the appropriate manner. The pioneer of which of the following models of 1. To understand anxiety disorders we need to take account of: a. only biological factors b. only environmental factors c. both biological and environmental factors d. neither biological nor environmental factors 2. DSM stands for: a. diagnostic and scientific manual of mental disorders b. diagnostic and statistical manual of major disorders c. diagnostic and scientific manual of major disorders d. diagnostic and statistical manual of mental disorders 3. In OCD, ________ are to thoughts as ________ are to actions. a. opinions, convictions b. obsessions, conditions c. obsessions, compulsion d. compulsions, obsessions 4. Behavioural therapy for phobias may involve the following techniques: a. Systematic desensitization. b. Free Association. c. Flooding. d. a & b. 5. When John leaves his house in morning, he always has to check multiple times to make sure that he has locked his front door. If John tries to leave his house without checking his door, or after only checking it once, he is filled with such anxiety and dread that he must abandon whatever else he is doing to return home and check his front door again. John is most likely struggling with a _________. a. mania b. obsession c. ethical dilemma d. compulsion 6. Which of the following is the best example of a compulsion? a. Excessive handwashing b. Difficulty counting c. Fear of stealing things d. Refusing to eat 7. Phobia is: a. Psychosis b. Fear of animals c. Anxiety d. Abnormal irritation 8. Systematic desensitization is used in the treatment of: a. Obsessive-compulsive disorder b. Depression c. Phobia d. Anxiety neurosis 9. A young man gets nervous and complains of palpitation and sweating when he meets his seniors or makes presentations during meetings. He is most likely suffering from: a. Panic disorder b. Social phobia c. Adjustment disorders d. Personality disorder 10. The phenomenon known as __________ refers to individuals who have experienced more than one disorder simultaneously. a. Cohabitation b. Codependence c. Comorbidity d. Coexistence 11. Jack thinks constantly about dirt and germs. He washes his hands hundreds of times a day. Jack is MOST likely suffering from a. Phobic disorder b. Obsessive-Compulsive Disorder (OCD) c. Hypochondriasis d. Generalized anxiety disorder 12. Which of the following are models of Abnormal Psychology? a. Biological b. Behavioural c. Psychodynamic d. All of the above 13. GAD stands for: a. Global Anxiety Disorder b. Generalized Anxiety Disorder c. General Activity Disorder d. Genetic Anxiety Disorder 14. According to Freud, Id works on the ______Principle. a. Imagination b. Fantasy c. Pleasure d. Aggressive 15. Philippe Pinel a. believed that mental illness was due to possession by demons and exorcism was the only useful treatment. b. believed that mental patients needed to choose rationality over insanity, so treatment was aimed at making their lives as patients uncomfortable. c. believed that mental patients were ill and needed to be treated as such – with kindness and caring. d. believed that mental illness was purely a physiological phenomenon, and could only be treated by physical means such as bloodletting. 16. Early writings show that the Chinese, Egyptians, Hebrews, and Greeks often attributed abnormal behavior to often attributed abnormal behavior to a. poor parenting. b. physical disease. c. demonic possession. d. chemical imbalance in the brain 17. During the early twentieth century, a. more asylums and mental hospitals were established. b. most of the institutionalized mentally ill received moral therapy. c. hospital stays tended to be brief. d. housed very few people. 18. A behavioral psychologist would be most likely to use a. hypnotism. b. observational techniques. c. free association. d. dream analysis. 19. The central principle of classical conditioning is that a. after repeated pairings with a stimulus that naturally causes a response, a neutral stimulus will cause a similar response. b. we repeat those actions that we see others engage in. c. the consequences of behavior influence its likelihood of being repeated. d. the interaction of genetics and social factors best explains human behavior. 20.The study and enhancement of positive feelings, traits and abilities a. What is abnormal psychology? b. What is prevention? c. What is Trephination? d. What is positive psychology? 21. The belief in the four humors as a means of explaining temperament a. is inconsistent with a biological explanation for mental illness b. has yet to be disproven. c. proposed that mental disorders were the result of an imbalance. d. provides that first indication that ancient people recognized the significance of the brain in determining behavior. 22. During the Middle Ages in Europe, which of the following was most likely to treat mental illness? a. a priest b. a physician c. a scientist d. a surgeon 23. The study of hypnosis and its relationship to hysteria was the starting point of point for a. the medical model. b. the biological classification of mental disorders. c. psychoanalysis. d. the mental hygiene movement 24. Which of the following is NOT an example of a compulsion someone may have with Obsessive Compulsive Disorder a. Check to see if burner off every time walk into kitchen b. Unlock and relock the door multiple times when leaving home  c. Cleaning glasses every few minutes to make sure stay clean d. All of these are common compulsions associated with Obsessive Compulsive Disorder. 25. Trephination and exorcism a. What was the most common treatment for abnormal behaviors in Europe during the middle ages? b. What were the two most commonly used treatments for abnormal behavior in ancient cultures? c. Why is it so difficult to create one definition for abnormal behavior? d. What did Hippocrates believe was the causes of abnormal behaviors? Subjective Type Q2: Write a detailed note on the history of psychopathology? 13 marks Q3: What are anxiety disorders? Describe in detail. 11 marks Q4: What are the different models of abnormality? 11 marks Assignment 2 Q1: What are the different models of abnormality? Q2: Compare two models of abnormality. What are the strengths and weaknesses of Behavioral Model of psychopathology? Obsessive-Compulsive and Related Disorders Dr. Sumaira Khurshid Tahira Associate Prof NNU, China Obsessive-Compulsive and related disorders • DSM-5 has created the group name obsessive-compulsive-related disorders and assigned four of these patterns to that group: • Hoarding disorder • Trichotillomania (hair-pulling disorder) • Excoriation (skin-picking) disorder • Body dysmorphic disorder. Collectively, these four disorders are displayed by at least 5 percent of all people (Frost et al., 2012; Keuthen et al., 2012, 2010; Wolrich, 2011; Duke et al., 2009) DSM-V And OCSDs 1. Obsessive-compulsive disorder (OCD) 2. Body Dysmorphic Disorder 3. Hoarding disorder 4. Trichotillomania (hair-pulling disorder) 5. Excoriation (skin-picking) disorder 6. Substance/medication-induced obsessive-compulsive and related disorder 7. Obsessive-compulsive and related disorder due to another medical condition 8. Other specified obsessive-compulsive and related disorder 9. Unspecified obsessive-compulsive and related disorder (e.g., body-focused repetitive behavior disorder, obsessional jealousy). Diagnostic Criteria A. Presence of obsessions, compulsions, or both B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of function. C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. D. The disturbance is not better explained by the symptoms of another mental disorder Epidemiological data • International prevalence (1.1\%–1.8\%) ( Weissman et al. 1994 ). • Females are affected at a slightly higher rate than males in adulthood • Although males are more commonly affected in childhood (Ruscio et al. 2010 ; Weissman et al. 1994 ) Epidemiology :study of the incidence and distribution of specific diseases and disorders. The epidemiologist also seeks to establish relationships to such factors as heredity, environment, nutrition, or age at onset. https://www.open.edu/openlearn/health-sports-psychology/health/epidemiology-introduction/content-section-1 Development and Course • In the United States, the mean age at onset of OCD is 19.5 years (25\% of cases start by age 14 years ( Kessler et al. 2005 ; Ruscio et al. 2010 ). • Onset after age 35 years is unusual but does occur. • Males have an earlier age at onset than females: nearly 25\% of males have onset before age 10 years ( Ruscio et al. 2010 ). • The onset typically gradual; however, acute onset has also been reported. OCD is also much more common in individuals with certain other disorders • Schizophrenia or schizoaffective disorder • Bipolar disorder • Eating disorders • Turette’s disorder 2. Body Dysmorphic Disorder • People with body dysmorphic disorder become preoccupied with the belief that they have a particular defect or flaw in their physical appearance. • Actually, the perceived defect or flaw is imagined or greatly exaggerated in the person’s mind (APA, 2013). • Such beliefs drive the individuals to repeatedly check themselves in the mirror, groom themselves, pick at the perceived flaw, compare themselves with others, seek reassurance, or perform other, similar behaviors. 2. Body Dysmorphic Disorder • Body dysmorphic disorder is the obsessive-compulsive-related disorder that has received the most study to date. • Researchers have found that, most often, individuals with this problem focus on wrinkles; spots on the skin; excessive facial hair; swelling of the face; or a misshapen nose, mouth, jaw, or eyebrow (Week et al., 2012; Marques et al., 2011). • Some worry about the appearance of their feet, hands, breasts, penis, or other body parts • Also woman worry about bad odors coming from sweat, breath, genitals, or the rectum (Rocca et al., 2010). 2. Body Dysmorphic Disorder Diagnostic Criteria • A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. • B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns. 2. Body Dysmorphic Disorder • C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning • D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. Prevalence • U.S. adults is 2.4\% (2.5\% in females and 2.2\% in males) • Outside approximately 1.7\%–1.8\%, with a similar gender distribution Associated Features Supporting Diagnosis • Ideas or delusions of reference • high levels of anxiety, social anxiety, social avoidance, • Dermatological treatment and surgery are most common, Body dysmorphic disorder appears to respond poorly to such treatments and sometimes becomes worse Delusion of reference: A delusion in which the patient believes that unsuspicious occurrences refer to him or her in person. Patients may, for example, believe that certain news bulletins have a direct reference to them, that music played on the radio is played for them, or that car licence plates have a meaning relevant to them. A delusion is a fixed false belief that is based on an incorrect interpretation of reality. Development and Course • The mean age at disorder onset is 16–17 years • Two-thirds of individuals have disorder onset before age 18. • Chronic course • Individuals with disorder onset before age 18 years are more likely to attempt suicide, have more comorbidity, Course: The period of time in which a disease, sickness, or disorder, generally takes to reach completion. Risk and Prognostic Factors • Environmental: childhood neglect and abuse • Genetic and physiological: Elevated in first- degree relatives of individuals with obsessive- compulsive disorder (OCD) • Gender-Related Diagnostic Issues: similarities than differences in terms of most clinical features although male: genital preoccupations, Muscle dysmorphia female: comorbid eating disorder . Prognostic Factors A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease or the chance of the disease recurring (coming back). Prognosis: The likely outcome or course of a disease; the chance of recovery or recurrence Continue… • Suicide Risk • Rates of suicidal ideation and suicide attempts are high in both adults and children/adolescents • More risk is in adolescents • Many risk factors for completed suicide. Functional Consequences of Body Dysmorphic Disorder • On average, psychosocial functioning and quality of life are markedly poor • About 20\% of youths : dropping out of school. • Impairment in social functioning Comorbidity • Major depressive disorder • Social anxiety disorder (social phobia) • OCD • Substance-related disorders Comorbidity is defined as the co-occurence of more than one disorder in the same individual. 3. Hoarding Disorder • A disorder in which individuals feel compelled to save items and become very distressed if they try to discard them, resulting in an excessive accumulation of items. • People who display hoarding disorder feel that they must save items, and they become very distressed if they try to discard them (APA, 2013). • These feelings make it difficult for them to part with possessions, resulting in an extraordinary accumulation of items that clutters their lives and living areas. 3. Hoarding Disorder • This pattern causes the individuals significant distress and may greatly impair their personal, social, or occupational functioning ( Jabr, 2013; Frost et al., 2012; Mataix-Cols & Pertusa, 2012). • It is common for them to wind up with numerous useless and valueless items, from junk mail to broken objects to unused clothes. Parts of their homes may become inaccessible because of the clutter. • For example, sofas, kitchen appliances, or beds may be unusable. In addition, the pattern often results in fire hazards, unhealthful sanitation conditions, or other dangers 3. Hoarding Disorder Diagnostic Criteria • A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. • B. This difficulty is due to a perceived need to save the items and to distress associated with discarding them. • C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities). Continue…… • D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). • E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease). • F. The hoarding is not better explained by the symptoms of another mental disorder Associated Features Supporting Diagnosis • Common features of hoarding disorder include indecisiveness, perfectionism, avoidance procrastination, difficulty planning and organizing tasks, and distractibility • Animal hoarding ( The most prominent differences between animal and object hoarding are the extent of unsanitary conditions and the poorer insight in animal hoarding.) Prevalence • Nationally representative prevalence studies of hoarding disorder are not available • Affects both males and females,? Greater prevalence among males. • Symptoms appear to be almost three times more prevalent in older adults (ages 55–94 years) • Compared with younger adults (ages 34–44 years) females tend to display more excessive • Acquisition, particularly excessive buying, than do males Prevalence The total number or percentage of cases (e.g., of a disease or disorder) existing in a population, whereas incidence is the number of new cases that develop during a specified time period. Development and Course • Hoarding appears to begin early in life • May first emerge around ages 11–15 years, start interfering with the individual’s everyday functioning by the mid-20s, and cause clinically significant impairment by the mid-30s Comorbidity • The most common comorbid conditions are major depressive disorder (up to 50\% of cases), social anxiety disorder (social phobia),and generalized anxiety disorder Trichotillomania (Hair-Pulling Disorder) • A disorder in which people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body. Also called hair- pulling disorder. • People with trichotillomania, also known as hair-pulling disorder, repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body (APA, 2013). • The disorder usually centers on just one or two of these body sites, most often the scalp. • Typically, those with the disorder pull one hair at a time. • It is common for anxiety or stress to trigger or accompany the hair- pulling behavior. Trichotillomania (Hair-Pulling Disorder) • Some sufferers follow specific rituals as they pull their hair, including pulling until the hair feels “just right” and selecting certain types of hairs for pulling (Keuthen et al., 2012; Mansueto & Rogers, 2012). • Because of the distress, impairment, or embarrassment caused by this behavior, the individuals often try to reduce or stop the hair-pulling. The term ritual is sometimes used in a technical sense for a repetitive behavior systematically used by a person to neutralize or prevent anxiety Associated Features • Hair pulling may be accompanied by a range of behaviors or rituals involving hair.(search for a particular kind of hair to pull, try to pull out hair in a specific way, may visually examine or orally manipulate) • may be triggered by feelings of anxiety or boredom • varying degrees of conscious awareness, • Hair pulling does not usually occur in the presence of other individuals, except immediate family members. • Some individuals have urges to pull hair from other individuals and may sometimes try to find opportunities to do so surreptitiously. Prevalence • 1\%–2\% : adult Females are more frequently affected • Among children with trichotillomania, males and females are more equally represented Development and Course • Hair pulling may be seen in infants and this behavior typically resolves during early development • Onset of hair pulling in trichotillomania most commonly coincides with, or follows the onset of, puberty. The usual course is chronic • Symptoms may possibly worsen in females accompanying hormonal changes (e.g., menstruation, perimenopause). Functional Consequences of Trichotillomania (Hair-Pulling Disorder) • distress as well as with social and occupational impairment • irreversible damage to hair growth and hair quality. • Infrequent medical consequences like musculoskeletal injury (e.g., carpal tunnel syndrome; back, shoulder and neck pain Diagnostic Markers • A. Dermatopathological diagnosis is rarely required. B. Skin biopsy and dermoscopy (or trichoscopy) of trichotillomania are able to differentiate the disorder from other causes of alopecia. • C. Dermoscopy shows characteristic features like including decreased hair density, short vellus hair, and broken hairs with different shaft lengths (Abraham et al. 2010). Excortiation disorder • A disorder in which people repeatedly pick at their skin, resulting in significant sores or wounds. Also called skin-picking disorder. • People with excoriation (skin-picking) disorder keep picking at their skin, • resulting in significant sores or wounds (APA, 2013). Like those with hair-pulling disorder, they often try to reduce or stop the behavior. Excortiation disorder • Most sufferers pick with their fingers and center their picking on one area, most often the face (Grant et al., 2012; Odlaug & Grant, 2012). • Other common areas of focus include the arms, legs, lips, scalp, chest, and extremities such as fingernails and cuticles. The behavior is typically triggered or accompanied by anxiety or stress 4. Excoriation (Skin-Picking) Disorder Diagnostic Criteria • A. Recurrent skin picking resulting in skin lesions. • B. Repeated attempts to decrease or stop skin picking. • C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. • D. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). • E. The skin picking is not better explained by symptoms of another mental disorder. Thanks Depressive and Bipolar Disorders Dr. Sumaira Khurshid Tahira Associate Prof NNU, China Depressive and Bipolar Disorders Depression: Low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms Mania: State or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking Depressive disorders: Group of disorders marked by unipolar depression Unipolar depression: Depression without a history of _mania___ Bipolar disorder: Disorder marked by alternating or intermixed periods of _mania__ and __depression____ How Common Is Unipolar Depression? Around 9\% of adults in the U.S. suffer from severe unipolar depression in any given year –As many as 5\% suffer from mild forms Around 19\% of all adults experience unipolar depression at some time in their lives The prevalence is similar in Canada, England, France, and many other countries  The rate of depression is higher among poor people than wealthier people What Are the Symptoms of Depression? The picture of depression may vary from person to person Five main areas of functioning may be affected: Emotional symptoms Most people who are depressed feel sad and dejected. They describe themselves as feeling “miserable,” “empty,” and “humiliated.” They tend to lose their sense of humor, report getting little pleasure from anything, and in some cases display anhedonia, an inability to experience any pleasure at all. A number also experience anxiety, anger, or agitation. Continue…. Motivational symptoms (Lacking drive, initiative, spontaneity) Depressed people typically lose the desire to pursue their usual activities. Almost all report a lack of drive, initiative, and spontaneity. They may have to force themselves to go to work, talk with friends, eat meals, or have sex. This state has been described as a “paralysis of will” (Beck, 1967). –Between 6\% and 15\% of those with severe depression die by suicide Continue Behavioral symptoms  Depressed people are usually less active and less productive.  They spend more time alone and may stay in bed for long periods.  may also move and even speak more slowly (Behrman, 2014) Cognitive Symptoms  Depressed people hold extremely negative views of themselves.  They consider themselves inadequate, undesirable, inferior, perhaps evil (Lopez Molina et al., 2014; Sowislo & Orth, 2012).  They also blame themselves for nearly every unfortunate event, even things that have nothing to do with them, and they rarely credit themselves for positive achievements. Continue…. Another cognitive symptom of depression is pessimism. Sufferers are usually convinced that nothing will ever improve, and they feel helpless to change any aspect of their lives. Because they expect the worst, they are likely to procrastinate. Their sense of hopelessness and helplessness makes them especially vulnerable to suicidal thinking (Shiratori et al., 2014; Wilson & Deane, 2010). People with depression frequently complain that their intellectual ability is poor. They feel confused, unable to remember things, easily distracted, and unable to solve even the smallest problems. Continue…. Physical Symptoms • People who are depressed frequently have such physical ailments as headaches, indigestion, constipation, dizzy spells, and general pain (Bai et al., 2014; Goldstein et al., 2011). • Many depressions are misdiagnosed as medical problems at first (Parker & Hyett, 2010). • Disturbances in appetite and sleep are particularly common ( Jackson et al., 2014; Armitage & Arnedt, 2011). • Most depressed people eat less, sleep less, and feel more fatigued than they did prior to the disorder. Some, however, eat and sleep excessively. Diagnosing Unipolar Depression Major Depressive Disorder A severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition. Persistent Depressive Disorder A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression. Premenstrual Dysphoric Disorder A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation. Diagnosing Unipolar Depression • According to DSM-5, a major depressive episode is a period of 2 or more weeks marked by at least 5 symptoms of depression, including sad mood and/or loss of pleasure. • In extreme cases, the episode may include psychotic symptoms, ones marked by a loss of contact with reality, such as delusions—bizarre ideas without foundation—or hallucinations— perceptions of things that are not actually present. • A depressed man with psychotic symptoms may imagine that he cannot eat “because my intestines are deteriorating and will soon stop working,” or he may believe that he sees his dead wife Diagnosing Unipolar Depression DSM-5 lists several types of depressive disorders. • People who go through a major depressive episode without having any history of mania receive a diagnosis of major depressive disorder (APA, 2013). • The disorder may be additionally categorized as ▪ seasonal if it changes with the seasons (e.g, if the depression recurs each winter) ▪ catatonic if it is marked by either immobility or excessive activity ▪ peripartum if it occurs during pregnancy or within 4 weeks of giving birth ▪ or melancholic if the person is almost totally unaffected by pleasurable events. Continue…. People whose unipolar depression is chronic receive a diagnosis of persistent depressive disorder (APA, 2013) Some people with this chronic disorder have repeated major depressive episodes, a pattern technically called persistent depressive disorder with major depressive episodes. Others have less severe and less disabling symptoms, a pattern technically called persistent depressive disorder with dysthymic syndrome. A third type of depressive disorder is premenstrual dysphoric disorder, a diagnosis given to certain women who repeatedly have clinically significant depressive and related symptoms during the week before menstruation. Acute illnesses generally develop suddenly and last a short time, often only a few days or weeks. Chronic conditions develop slowly and may worsen over an extended period of time—months to years Continue… Yet another kind of depressive disorder, disruptive mood dysregulation disorder, is characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper. This disorder emerges during mid-childhood or adolescence What Causes Unipolar Depression? Stress may be a trigger for depression –People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms –Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors What Causes Unipolar Depression? Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition  Researchers have found that as many as 20\% of relatives of those with depression are themselves depressed, compared with fewer than 10\% of the general population The Biological View: Genetic factors What Causes Unipolar Depression? Twin studies demonstrate a strong genetic component:  Concordance rates for identical (MZ) twins = 46\% Concordance rates for fraternal (DZ) twins = 20\% Adoption studies also have implicated a genetic factor in cases of severe unipolar depression Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes The Biological View: Genetic factors Concordance rate: means the. probability of one twin having the disorder if the other already has it expressed as a percentage. To form identical or monozygotic twins, one fertilised egg (ovum) splits and develops into two babies with exactly the same genetic information. To form fraternal or dizygotic twins, two eggs (ova) are fertilised by two sperm and produce two genetically unique children. What Causes Unipolar Depression? NTs: serotonin and norepinephrine  In the 1950s, medications for high blood pressure were found to cause depression  Some lowered serotonin, others lowered norepinephrine The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role  Depression likely involves not just serotonin nor norepinephrine… a complicated interaction is at work, and other NTs may be involved The Biological View: Biochemical factors What Causes Unipolar Depression? Endocrine system / hormone release People with depression have been found to have abnormal levels of cortisol Released by the adrenal glands during times of stress People with depression have been found to have abnormal melatonin secretion sometimes called the “Dracula hormone” because it is released only in the dark. Other researchers are investigating deficiencies of important proteins within neurons as tied to depression The Biological View: Biochemical factors What Causes Unipolar Depression? Model has produced much enthusiasm but has certain limitations: Relies on analogue studies: depression-like symptoms created in lab animals Do these symptoms correlate with human emotions? Measuring brain activity has been difficult and indirect Current studies using newer technology are attempting to address this issue The Biological View Biochemical factors Analogue study refers to a study that creates conditions in the laboratory meant to represent conditions in the real world What Causes Unipolar Depression? Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction  It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge Likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann Area 25 The Biological View :Brain anatomy and brain circuits What Causes Unipolar Depression? This system is the bodys network of activities and cells that fight off bacteria and other foreign invaders  When stressed, the immune system may become dysregulated, which some believe may help produce depression  Support for this explanation is circumstantial but compelling The Biological View Immune System What Causes Unipolar Depression? The Psychological Views Three main models: Psychodynamic model (No strong research) Behavioral model (Modest research support) Cognitive views (Considerable research support) What Causes Unipolar Depression? The Psychological Views : Psychodynamic view Link between depression and grief When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection – a directing of feelings for the loved one onto oneself For most people, introjection is temporary For some, grief worsens over time; if grief is severe and long- lasting, depression results What Causes Unipolar Depression? Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression  Instead of actual loss, some people experience “symbolic” (or imagined) loss instead Newer psychoanalysts (object relations theorists) propose that depression results when peoples relationships leave them feeling unsafe and insecure What Causes Unipolar Depression? Strengths: Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss (e.g., anaclitic depression) Research supports the theory that early losses set the stage for later depression Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss The Psychological Views Psychodynamic view In a famous study of 123 infants who were placed in a nursery after being separated from their mothers, René Spitz (1946, 1945) found that 19 of the infants became very weepy and sad upon separation and withdrew from their surroundings—a pattern called anaclitic depression. What Causes Unipolar Depression? Limitations: Early losses and inadequate parenting sometimes lead to depression but may not be typically responsible for development of the disorder Many research findings are inconsistent Certain features of the model are nearly impossible to test The Psychological Views Psychodynamic view What Causes Unipolar Depression? Depression results from changes in rewards and punishments people receive in their lives Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors, and they spiral toward depression Research supports the relationship between the number of rewards received and the presence or absence of depression Social rewards are especially important The Psychological Views Behavioral view What Causes Unipolar Depression? Strengths: Researchers have compiled significant data to support this theory Limitations: Research has relied heavily on the self- reports of depressed subjects Behavioral studies are largely correlational and do not establish that decreases in rewards are the initial cause of depression The Psychological Views: Behavioral view What Causes Unipolar Depression? Cognitive views  Two main theories:  Negative thinking Learned helplessness The Psychological Views Learned helplessness is a state that occurs after a person has experienced a stressful situation repeatedly. They come to believe that they are unable to control or change the situation, so they do not try — even when opportunities for change become available. What Causes Unipolar Depression? Beck theorizes four interrelated cognitive components combine to produce unipolar depression: Maladaptive attitudes Self-defeating attitudes are developed during childhood Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking The Psychological Views Cognitive views What Causes Unipolar Depression? The Psychological Views Cognitive views Negative thinking Depressed people also make errors in their thinking, including: Arbitrary inferences Minimization of the positive and magnification of the negative Depressed people also experience automatic thoughts A steady train of unpleasant thoughts that suggest inadequacy and hopelessness Arbitrary inference a cognitive distortion in which a person draws a conclusion that is unrelated to or contradicted by the evidence. What Causes Unipolar Depression? Strengths: Many studies have produced evidence in support of Becks explanation: High correlation between the level of depression and the number of maladaptive attitudes held Both the cognitive triad and errors in logic are seen in people with depression  The Psychological Views Cognitive views Cognitive triad: the individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways that lead them to feel depressed. The cognitive triad is at work in the thinking of this depressed person: What Causes Unipolar Depression? Automatic thinking has been linked to depression Limitations:  Research fails to show that such cognitive patterns are the cause and core of unipolar depression Automatic Thughts Numerous unpleasant thoughts that help to cause or maintain depression, anxiety, or other forms of psychological dysfunction. What Causes Unipolar Depression? Learned helplessness This theory asserts that people become depressed when they think that: They no longer have control over the reinforcements (rewards and punishments) in their lives They themselves are responsible for this helpless state  Theory is based on Seligmans work with laboratory dogs There has been significant research support for this model The Psychological Views Cognitive views What Causes Unipolar Depression? Learned helplessness Recent versions of the theory focus on attributions Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression  Example: “Its all my fault” [internal]. “I ruin everything I touch” [global] “and I always will” [stable]. If people make other kinds of attributions, this reaction is unlikely Example: “She had a role in this also” [external], “the way Ive behaved the past couple weeks blew this relationship” [specific]. “I dont know what got into me – I dont usually act like that” [unstable]. The Psychological Views Cognitive views What Causes Unipolar Depression? Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people –This belief is supported by the finding that depression is often triggered by outside stressors –There are two kinds of sociocultural views: • The family-social perspective • The multicultural perspective The Sociocultural View What Causes Unipolar Depression? The Family-Social Perspective The connection between declining social rewards and depression Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals This leads to decreased social contact and a further deterioration of social skills The Sociocultural View What Causes Unipolar Depression? The Family-Social Perspective  Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage  People who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married  There also is a high correlation between level of marital conflict and degree of sadness that is particularly strong among those who are clinically depressed  It also appears that people who are isolated and without intimacy are particularly likely to become depressed in times of stress The Sociocultural View What Causes Unipolar Depression? The Multicultural Perspective Two kinds of relationships have captured the interest of multicultural theorists: Gender and depression A strong link exists between gender and depression  Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression Women also appear to be younger, have more frequent and longer- lasting bouts, and to respond less successfully to treatment The Sociocultural View What Causes Unipolar Depression? The Multicultural Perspective A variety of theories has been offered: The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men The hormone explanation holds that hormone changes trigger depression in many women The life stress theory suggests that women in our society experience more stress than men The Sociocultural View What Causes Unipolar Depression? The Multicultural Perspective Two kinds of relationships have captured the interest of multicultural theorists:  Cultural background and depression Depression is a worldwide phenomenon, and certain symptoms seem to be constant across all countries, including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicide Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country The Sociocultural View What Causes Unipolar Depression? The Sociocultural View The Multicultural Perspective In addition, although overall depression rates are similar, differences exist in specific populations living under oppressive circumstances n a study of one Native American village, lifetime risk was 37\% among women, 19\% among men, and 28\% overall These findings are thought to be the result of economic and social pressures Bipolar Disorders People with a bipolar disorder experience both the lows of depression and the highs of mania –Many describe their lives as an emotional roller coaster Hypomania is a milder version of mania that lasts for a short period (usually a few days) · Mania is a more severe form that lasts for a longer period (a week or more​). Hypomania is a milder form of mania. energy level is higher than normal, but its not as extreme as in mania. It causes problems in your life, but not to the extent that mania can. Bipolar I disorder is diagnosed when a person experiences a manic episode. During a manic episode, people with bipolar I disorder experience an extreme increase in energy and may feel on top of the world or uncomfortably irritable in mood. Bipolar I disorder involves periods of severe mood episodes from mania to depression. Bipolar II disorder is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression. What Are the Symptoms of Mania? Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood Five main areas of functioning may be affected: Emotional symptoms Active, powerful emotions in search of outlet Motivational symptoms Need for constant excitement, involvement, companionship What Are the Symptoms of Mania? Behavioral symptoms Very active – move quickly; talk loudly or rapidly Cognitive symptoms Show poor judgment or planning May have trouble remaining coherent or in touch with reality Physical symptom  High energy level – often in the presence of little or no rest Diagnosing Bipolar Disorders  Criteria 1: Manic episode –Three or more symptoms of mania lasting one week or more  In extreme cases, symptoms are psychotic  Criteria 2: History of mania –If currently experiencing hypomania or depression Diagnosing Bipolar Disorders  DSM-5 distinguishes two kinds of bipolar disorder: – Bipolar I disorder  Full manic and major depressive episodes –Some experience an alternation of episodes –Others have mixed episodes –Bipolar II disorder  Hypomanic episodes alternate with major depressive episodes Diagnosing Bipolar Disorders  Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder –If people experience four or more episodes within a one-year period, their disorder is further classified as rapid cycling Diagnosing Bipolar Disorders  Regardless of particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years –In most cases, depressive episodes occur three times as often as manic ones, and last longer Diagnosing Bipolar Disorders  Between 1\% and 2.6\% of all adults in the world suffer from a bipolar disorder at any given time, and as many as 4\% over the course of their lives –Bipolar I seems to be a bit more common than Bipolar II  The disorders are equally common in women and men –Women may experience more depressive episodes and fewer manic episodes than men and rapid cycling is more common in women  The disorders are more common among people with low incomes than those with high income Diagnosing Bipolar Disorders  A final diagnostic option: – When a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is assigned  Mild symptoms for two or more years, interrupted by periods of normal mood  Affects at least 0.4\% of the population  May eventually blossom into bipolar I or II disorder What Causes Bipolar Disorders? Throughout the first half of the 20th century, the search for the cause of bipolar disorders made little progress  More recently, biological research has produced some promising clues –These insights have come from research into NT activity, ion activity, brain structure, and genetic factors What Causes Bipolar Disorders? Neurotransmitters –After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine What Causes Bipolar Disorders? Neurotransmitters –Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity  Although no relationship with high serotonin has been found, bipolar disorder may be linked to low serotonin activity, which seems contradictory… What Causes Bipolar Disorders? Neurotransmitters –This apparent contradiction is addressed by the “permissive theory” about mood disorders: Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take:  –Low serotonin + Low norepinephrine = Depression –Low serotonin + High norepinephrine = Mania What Causes Bipolar Disorders? Ion activity –Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder  –Some theorists believe that irregularities in the transport of these ions may cause neurons to fire too easily (mania) or to stubbornly resist firing (depression) There is some research support for this theory What Causes Bipolar Disorders? Ion Activity  Neurotransmitters play a significant role in the communication between neurons, ions seem to play a critical role in relaying messages within a neuron.  Ions help transmit messages down the neuron’s axon to the nerve endings. Positively charged sodium ions (Na1) sit on both sides of a neuron’s cell membrane. When the neuron is at rest, more sodium ions sit outside the membrane.  When the neuron receives an incoming message at its receptor sites, pores in the cell membrane open, allowing the sodium ions to flow to the inside of the membrane, thus increasing the positive charge inside the neuron. This starts a wave of electrical activity that travels down the length of the neuron and results in its “firing.” What Causes Bipolar Disorders? Ion Activity After the neuron “fires,” potassium ions (K1) flow from the inside of the neuron across the cell membrane to the outside, helping to return the neuron to its original resting state (see Figure). If messages are to be relayed effectively down the axon, the ions must be able to travel easily between the outside and the inside of the neural membrane. Some theorists believe that irregularities in the transport of these ions may cause neurons to fire too easily (resulting in mania) or to stubbornly resist firing (resulting in depression) (Manji & Zarate, 2011; Li & El-Mallakh, 2004) … Anxiety Disorders Dr. Sumaira Khurshid Tahira Associate Prof NNU, China Anxiety • What distinguishes fear from anxiety? • Fear is a state of immediate alarm in response to a serious, known threat to ones well-being • Anxiety is a state of alarm in response to a vague sense of being in danger • Both have the same physiological features – increase in respiration, perspiration, muscle tension, etc. Anxiety Disorders • Most common mental disorders in the U.S. • In any given year, 18\% of the adult population in the U.S. experiences one of the six DSM-IV-TR anxiety disorders • Close to 29\% develop one of the disorders at some point in their lives • Only one-fifth of these individuals seek treatment • Most individuals with one anxiety disorder also suffer from a second disorder • In addition, many individuals with an anxiety disorder also experience depression Anxiety Disorders Generalized anxiety disorder (GAD) Phobias Panic disorder Posttraumatic stress disorder (PTSD) Generalized Anxiety Disorder (GAD) • Excessive anxiety under most circumstances and worry • Symptoms: restlessness, fatigue; difficulty concentrating, muscle tension, and/or sleep problems • Symptoms must last at least six months • The disorder is common in Western society • Usually first appears in childhood or adolescence • Around one-quarter of those with GAD are currently in treatment GAD: The Sociocultural Perspective ▪According to this theory, GAD is most likely to develop in people faced with social conditions that truly are dangerous ▪Research supports this theory (example: Three Mile Island in 1979, Hurricane Katrina in 2005, Haiti earthquake in 2010) ▪One of the most powerful forms of societal stress is poverty ▪Why? Run-down communities, higher crime rates, fewer educational and job opportunities, and greater risk for health problems ▪As would be predicted by the model, there are higher rates of GAD in lower SES groups GAD: The Psychodynamic Perspective • Freud believed that all children experience anxiety • Realistic anxiety when they face actual danger • Neurotic anxiety when they are prevented from expressing id impulses • Moral anxiety when they are punished for expressing id impulses • Some children experience particularly high levels of anxiety, or their defense mechanisms are particularly inadequate, and they may develop GAD GAD: The Psychodynamic Perspective • Psychodynamic therapists use the same general techniques to treat all psychological problems: • Free association • Therapist interpretations of transference (when a client projects feelings about someone else), resistance, and dreams • Specific treatments for GAD • Freudians focus less on fear and more on control of id • Object-relations therapists attempt to help patients identify and settle early relationship problems GAD: The Humanistic Perspective • Theorists propose that GAD, like other psychological disorders, arises when people stop looking at themselves honestly and acceptingly • This view is best illustrated by Carl Rogerss explanation: • Lack of “unconditional positive regard” in childhood leads to “conditions of worth” (harsh self-standards) • These threatening self-judgments break through and cause anxiety, setting the stage for GAD to develop Conditions of Worth are the conditions we think we must meet in order for other people to accept us as worthy of their love or positive regard. As children, we learn that there are certain things we do that please our parents or caregivers, and we strive to do those things. GAD: The Humanistic Perspective • Practitioners using this “ client-centered ” approach try to show unconditional positive regard for their clients and to empathize with them • Despite optimistic case reports, controlled studies have failed to offer strong support • In addition, only limited support has been found for Rogerss explanation of GAD and other forms of abnormal behavior GAD: The Cognitive Perspective • Initially, theorists suggested that GAD is caused by maladaptive assumptions • Albert Ellis identified basic irrational assumptions: • It is a dire necessity for an adult human being to be loved or approved of by virtually every significant person in his community • It is awful and catastrophic (disastrous) when things are not the way one would very much like them to be • When these assumptions are applied to everyday life and to more and more events, GAD may develop GAD: The Cognitive Perspective New wave cognitive explanations. In recent years, several new explanations have emerged: ◼Metacognitive theory ◼Developed by Wells; suggests that the most problematic assumptions in GAD are the individuals worry about worrying (meta-worry) ◼Intolerance of uncertainty theory ◼Certain individuals consider it unacceptable that negative events may occur, even if the possibility is very small; they worry in an effort to find “correct” solutions ◼Avoidance theory ◼Developed by Borkovec; holds that worrying serves a “positive” function for those with GAD by reducing unusually high levels of bodily arousal GAD: Cognitive Therapies • Cognitive therapies • Changing maladaptive assumptions • Elliss rational-emotive therapy (RET) •Point out irrational assumptions •Suggest more appropriate assumptions •Assign related homework •Studies suggest at least modest relief from treatment GAD: Cognitive Therapies • Breaking down worrying • Therapists begin by educating clients about the role of worrying in GAD and have them observe their bodily arousal and cognitive responses across life situations • In turn, clients become increasingly skilled at identifying their worrying and their misguided attempts to control their lives by worrying • With continued practice, clients are expected to see the world as less threatening, to adopt more constructive ways of coping, and to worry less GAD: The Biological Perspective • Biological theorists believe that GAD is caused chiefly by biological factors • Supported by family pedigree studies • Biological relatives more likely to have GAD (~15\%) than general population (~6\%) • The closer the relative, the greater the likelihood Pedigree is the study of family history and genealogy as a means of tracing traits that might be inherited. GAD: The Biological Perspective • GABA (Gamma-aminobutyric acid )inactivity • 1950s – Benzodiazepines (Valium, Xanax) found to reduce anxiety • Why? • Neurons have specific receptors (like a lock and key) • Benzodiazepine receptors ordinarily receive gamma- aminobutyric acid (GABA, a common neurotransmitter in the brain) •GABA carries inhibitory messages; when received, it causes a neuron to stop firing GAD: The Biological Perspective • In normal fear reactions: • Key neurons fire more rapidly, creating a general state of excitability experienced as fear or anxiety • A feedback system is triggered – brain and body activities work to reduce excitability • Some neurons release GABA to inhibit neuron firing, thereby reducing experience of fear or anxiety • Malfunctions in the feedback system are believed to cause GAD • Possible reasons: Too few receptors, ineffective receptors GAD: The Biological Perspective • Promising (but problematic) explanation • Recent research has complicated the picture: • Other neurotransmitters also bind to GABA receptors • Issue of causal relationships GAD: The Biological Perspective • Biological treatments • Antianxiety drug therapy • Early 1950s: Barbiturates (sedative-hypnotics) • Late 1950s: Benzodiazepines •Provide temporary, modest relief •Rebound anxiety with withdrawal and cessation of use •Physical dependence is possible •Produce undesirable effects (drowsiness, etc.) •Mix badly with certain other drugs (especially alcohol) • More recently: Antidepressant and antipsychotic medications GAD: The Biological Perspective • Biological treatments • Relaxation training • Non-chemical biological technique • Theory: Physical relaxation will lead to psychological relaxation • Research indicates that relaxation training is more effective than placebo or no treatment • Best when used in combination with cognitive therapy or biofeedback Placebo: A harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect. GAD: The Biological Perspective • Biological treatments • Biofeedback • Therapist uses electrical signals from the body to train people to control physiological processes • Electromyograph (EMG) is the most widely used; provides feedback about muscle tension • Found to have a modest effect but has its greatest impact when used as an adjunct to other methods for treatment of certain medical problems (headache, back pain, etc.) Phobias From the Greek word for “fear” Persistent and unreasonable fears of particular objects, activities, or situations People with a phobia often avoid the object or thoughts about it Phobias • Fear is a normal and common experience • How do common fears differ from phobias? • More intense and persistent fear • Greater desire to avoid the feared object or situation • Distress that interferes with functioning Phobias • Most phobias technically are categorized as “specific” • Also two broader kinds: • Social anxiety disorder • Agoraphobia Specific Phobias ▪Persistent fears of specific objects or situations ▪When exposed to the object or situation, sufferers experience immediate fear ▪Most common: Phobias of specific animals or insects, heights, enclosed spaces, thunderstorms, and blood Specific Phobias • Each year close to 9\% of all people in the U.S. have symptoms of specific phobia • Many suffer from more than one phobia at a time • Women outnumber men at least 2:1 • Prevalence differs across racial and ethnic minority groups; the reason is unclear • Vast majority of people with a specific phobia do NOT seek treatment What Causes Specific Phobias? • Each model offers explanations, but evidence tends to support the behavioral explanations: • Phobias develop through conditioning Classical Conditioning of Phobia UCR Fear UCR Fear UCS Entrapment Running water CS Running water CR Fear + UCS Entrapment What Causes Specific Phobias? • Other behavioral explanations • Phobias develop through modeling • Observation and imitation • Phobias are maintained through avoidance • Phobias may develop into GAD when a person acquires a large number of them • Process of stimulus generalization: Responses to one stimulus are also elicited by similar stimuli What Causes Specific Phobias? A behavioral-evolutionary explanation ▪ Some specific phobias are much more common than others ▪ Theorists argue that there is a species-specific biological predisposition to develop certain fears ▪ Called “preparedness” because human beings are theoretically more “prepared” to acquire some phobias than others ▪ Model explains why some phobias (snakes, spiders) are more common than others (meat, houses) ▪Researchers do not know if these predispositions are due to evolutionary or environmental factors How Are Specific Phobias Treated? • Systematic desensitization • Technique developed by Joseph Wolpe • Teach relaxation skills • Create fear hierarchy • Pair relaxation with the feared objects or situations •Since relaxation is incompatible with fear, the relaxation response is thought to substitute for the fear response • Several types: • In vivo desensitization (live) • Covert desensitization (imaginal) How Are Specific Phobias Treated? • Other behavioral treatments: • Flooding • Forced non-gradual exposure • Modeling • Therapist confronts the feared object while the fearful person observes • Clinical research supports each of these treatments • The key to success is ACTUAL contact with the feared object or situation • A growing number of therapists are using virtual reality as a useful exposure tool Agoraphobia • Fear of being in public places or situations where escape might be difficult or help unavailable, should they experience panic or become incapacitated • Pervasive and complex • Typically develops in 20s or 30s Explanations for Agoraphobia • Often explained in ways similar to specific phobias • Many people with agoraphobia experience extreme and sudden explosions of fear, called panic attacks • Such individuals may receive two diagnoses—agoraphobia and panic disorder Treatment for Agoraphobia • Behaviorists favor a variety of exposure approaches for agoraphobia • Exposure therapy • Support group • Home-based self-help Social Anxiety Disorder ▪ Marked, disproportionate, and persistent fears about one or more social situations ▪ May be narrow – talking, performing, eating, or writing in public ▪ May be broad – general fear of functioning poorly in front of others ▪ In both forms, people rate themselves as performing less competently than they actually do What Causes Social Anxiety Disorder? Cognitive theorists contend that people with this disorder hold a group of social beliefs and expectations that consistently work against them, including: They hold unrealistically high social standards and so believe that they must perform perfectly in social situations. They view themselves as unattractive social beings. They view themselves as socially unskilled and inadequate. They believe they are always in danger of behaving incompetently in social situations. They believe that inept behaviors in social situations will inevitably lead to terrible consequences. They believe that they have no control over feelings of anxiety that emerge during social situations. Treatments for Social Anxiety Disorder • Only in the past 15 years have clinicians been able to treat social anxiety disorder successfully • Two components must be addressed: • Overwhelming social fear •Address fears behaviorally with exposure • Lack of social skills •Social skills and assertiveness trainings have proved helpful Panic Disorder • Panic, an extreme anxiety reaction, can result when a real threat suddenly emerges • The experience of “ panic attacks, ” however, is different • Panic attacks are periodic, short bouts of panic that occur suddenly, reach a peak, and pass • Sufferers often fear they will die, go crazy, or lose control • Attacks happen in the absence of a real threat Panic Disorder • More than one-quarter of all people have one or more panic attacks at some point in their lives, but some people have panic attacks repeatedly, unexpectedly, and without apparent reason • Diagnosis: Panic disorder • Sufferers also experience dysfunctional changes in thinking and behavior as a result of the attacks •For example, they may worry persistently about having an attack or plan their behavior around possibility of future attack Panic Disorder • Panic disorder often (but not always) accompanied by agoraphobia • People are afraid to leave home and travel to locations from which escape might be difficult or help unavailable • Intensity may fluctuate • Until recently, clinicians failed to recognize the close link between agoraphobia and panic attacks (or panic-like symptoms) What Biological Factors Contribute To Panic Disorder? • Neurotransmitter at work is norepinephrine • Irregular in people with panic attacks •Research suggests that panic reactions are related to changes in norepinephrine activity in the locus ceruleus • Research conducted in recent years has examined brain circuits and the amygdala as the more complex root of the problem • It is possible that some people inherit a predisposition to abnormalities in these areas Panic Disorder: The Biological Perspective • Drug therapies • Antidepressants are effective at preventing or reducing panic attacks • Function at norepinephrine receptors in the panic brain circuit • Bring at least some improvement to 80\% of patients with panic disorder • Improvements require maintenance of drug therapy • Some benzodiazepines (especially Xanax) have also proved helpful Panic Disorder: The Cognitive Perspective • Cognitive theorists recognize that biological factors are only part of the cause of panic attacks • In their view, full panic reactions are experienced only by people who misinterpret bodily events • Cognitive treatment is aimed at correcting such misinterpretations Panic Disorder: The Cognitive Perspective ▪ Misinterpreting bodily sensations ▪ Panic-prone people may be very sensitive to certain bodily sensations and may misinterpret them as signs of a medical catastrophe; this leads to panic ▪ Why might some people be prone to such misinterpretations? ▪ Experience more frequent or intense bodily sensations ▪ Have experienced more trauma-filled events ▪ Whatever the precise cause, panic-prone people generally have a high degree of “anxiety sensitivity” ▪ They focus on bodily sensations much of the time, are unable to assess the sensations logically, and interpret them as potentially harmful Panic Disorder: The Cognitive Perspective • Cognitive therapy: tries to correct peoples misinterpretations of their bodily sensations Panic Disorder: The Cognitive Perspective • Cognitive therapy • May also use “biological challenge” procedures to induce panic sensations • Induce physical sensations, which cause feelings of panic: •Jump up and down •Run up a flight of steps • Practice coping strategies and making more accurate interpretations Obsessive-Compulsive Disorder Made up of two components: Obsessions • Persistent thoughts, ideas, impulses, or images that seem to invade a persons consciousness Compulsions • Repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety Obsessive-Compulsive Disorder • Diagnosis is called for when symptoms: • Feel excessive or unreasonable • Cause great distress • Take up much time • Interfere with daily functions Normal Routines Obsessive-Compulsive Disorder ▪ Classified as an anxiety disorder because obsessions cause anxiety, while compulsions are aimed at preventing or reducing anxiety ▪ Anxiety rises if obsessions or compulsions are resisted ▪ Between 1\% and 2\% of U.S. population suffer from OCD in a given year; as many as 3\% over a lifetime ▪ It is equally common in men and women and among different racial and ethnic groups ▪ It is estimated that more than 40\% of those with OCD seek treatment What Are the Features of Obsessions and Compulsions? • Obsessions • Thoughts that feel both intrusive and foreign • Attempts to ignore or resist them trigger anxiety Take various forms: • Wishes • Impulses • Images • Ideas • Doubts Have common themes: • Dirt/contamination • Violence and aggression • Orderliness • Religion • Sexuality What Are the Features of Obsessions and Compulsions? • Compulsions • “Voluntary” behaviors or mental acts • Feel mandatory/unstoppable • Most recognize that their behaviors are unreasonable • Believe, though, that something terrible will occur if they do not perform the compulsive acts • Performing behaviors reduces anxiety for a short time • Behaviors often develop into rituals What Are the Features of Obsessions and Compulsions? • Compulsions • Common forms/themes: • Cleaning • Checking • Order or balance • Touching, verbal, and/or counting What Are the Features of Obsessions and Compulsions? • Most people with OCD experience both • Compulsive acts often occur in response to obsessive thoughts • Compulsions seem to represent a yielding to obsessions • Compulsions also sometimes serve to help control obsessions OCD: The Psychodynamic Perspective • Anxiety disorders develop when children come to fear their id impulses and use ego defense mechanisms to lessen their anxiety • OCD differs from other anxiety disorders in that the “battle” is not unconscious; it is played out in overt thoughts and actions • Id impulses = obsessive thoughts • Ego defenses = counter-thoughts or compulsive actions OCD: The Psychodynamic Perspective • The battle between the id and the ego • Three ego defense mechanisms are common: • Isolation: Disown disturbing thoughts • Undoing: Perform acts to “cancel out” thoughts • Reaction formation: Take on lifestyle in contrast to unacceptable impulses • Freud believed that OCD was related to the anal stage of development • Period of intense conflict between id and ego • Not all psychodynamic theorists agree OCD: The Psychodynamic Perspective • Psychodynamic therapies • Goals are to uncover and overcome underlying conflicts and defenses • Main techniques are free association and interpretation • Research has offered little evidence • Some therapists now prefer to treat these patients with short- term psychodynamic therapies OCD: The Behavioral Perspective • In a fearful situation, they happen to perform a particular act (washing hands) • When the threat lifts, they associate the improvement with the random act • After repeated associations, they believe the compulsion is changing the situation • Bringing luck, warding away evil, etc. • The act becomes a key method to avoiding or reducing anxiety OCD: The Behavioral Perspective • Behavioral therapy • Exposure and response prevention (ERP) • Clients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions • Therapists often model the behavior while the client watches •Homework is an important component • Between 55 and 85 percent of clients have been found to improve considerably with ERP, and improvements often continue indefinitely •However, as many as 25\% fail to improve at all, and the approach is of limited help to those with obsessions but no compulsions OCD: The Cognitive Perspective • Cognitive theorists begin by pointing out that everyone has repetitive, unwanted, and intrusive thoughts • People with OCD blame themselves for normal (although repetitive and intrusive) thoughts and expect that terrible things will happen as a result OCD: The Cognitive Perspective • To avoid such negative outcomes, they attempt to “neutralize” their thoughts with actions (or other thoughts) Neutralizing thoughts/actions may include: • Seeking reassurance • Thinking “good” thoughts • Washing • Checking OCD: The Cognitive Perspective • If everyone has intrusive thoughts, why do only some people develop OCD? • People with OCD tend to: • Be more depressed than others • Have exceptionally high standards of conduct and morality • Believe thoughts are equal to actions and are capable of bringing harm • Believe that they can, and should, have perfect control over their thoughts and behaviors OCD: The Cognitive Perspective • Cognitive therapists focus on the cognitive processes that help to produce and maintain obsessive thoughts and compulsive acts • May include: • Psychoeducation • Guiding the client to identify, challenge, and change distorted cognitions OCD: The Cognitive Perspective • Cognitive-Behavioral Therapy (CBT) • Research suggests that a combination of the cognitive and behavioral models is often more effective than either intervention alone • These treatments typically include psychoeducation as well as exposure and response prevention exercises OCD: The Biological Perspective • Two recent lines of research provide more direct evidence: • Abnormal serotonin activity • Evidence that serotonin-based antidepressants reduce OCD symptoms; recent studies have suggested other neurotransmitters also may play important roles • Abnormal brain structure and functioning • OCD linked to orbitofrontal cortex and caudate nuclei •Frontal cortex and caudate nuclei compose brain circuit that converts sensory information into thoughts and actions •Either area may be too active, letting through troublesome thoughts and actions OCD: The Biological Perspective • Some research provides evidence that these two lines may be connected • Serotonin (with other neurotransmitters) plays a key role in the operation of the orbitofrontal cortex and the caudate nuclei • Abnormal neurotransmitter activity could be contributing to the improper functioning of the circuit OCD: The Biological Perspective • Biological therapies • Serotonin-based antidepressants • Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox) • Bring improvement to 50–80\% of those with OCD • Relapse occurs if medication is stopped • Research suggests that combination therapy (medication + cognitive behavioral therapy approaches) may be most effective Thanks