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Introductory Psychology: Anxiety

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lecture 12 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes DSM-IV TR psychiatric disorders including Post-traumatic stress disorder, phobias, Generalized Anxiety Disorders, Obsessive Compulsive Disorder, anterior cingulate

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Introductory Psychology: Anxiety

  1. 1. Psychological Disorders I: Anxiety Brian J. Piper, Ph.D., M.S. 1
  2. 2. Goals• History of Psychological Disorders• Anxiety Disorders 2
  3. 3. Evil Spirits• Release the demons! 3
  4. 4. The Moral ModelPhilippe Pinel from France insisted that madness was not due to demonic possession but an ailment of the mind.Philosophy:•Treat each patient as an individual•Employ former patients•Use psychological interventions before biological ones. 1745-1826 “the treatment of insanity (l’aliénation mentale) without considering the differentiating characteristics of the patients [la distinction des espèces] has been at times superfluous, rarely useful, and often harmful”
  5. 5. Medical Model When physicians discovered that syphilis led tomental disorders, they started using medical models to review the physical causes of these disorders. • Etiology: Cause and development of the disorder. • Diagnosis: Identifying (symptoms) and distinguishing one disease from another. • Treatment: Treating a disorder in a psychiatric hospital. • Prognosis: Forecast about the disorder. 5
  6. 6. The Biopsychosocial Approach Assumes that biological, socio-cultural, andpsychological factors combine and interact to produce psychological disorders.
  7. 7. International Classification of Diseases-10• Published by the World Health Organization to provide uniformity.• International Statistical Classification of Diseases and Related Problems uses 6 digit codes.• Started in 1900, included mental disorders in 1949
  8. 8. Diagnostic & Statistical Manual (DSM)• Published by American Psychiatric Association• DSM-I: 1952: consists of 106 mental disorders• DSM-II: 1968: psychodynamic• DSM-III: 1980: responds to Rosenhan criticisms 8
  9. 9. Diagnostic & Statistical Manual of Mental Disorders (DSM)• Published by American Psychiatric Association• DSM-I: 1952: consists of 106 mental disorders• DSM-II: 1968: psychodynamic• DSM-III: 1980: responds to Rosenhan criticisms• DSM-IV: 1994: 297 disorders• DSM-V: in planning for 2013
  10. 10. Example: ADHD: Inattentive• Symptoms present at school/work and home• 6+ symptoms that have persisted 6+ months and are inconsistent with developmental level – Often fails to give close attention or makes careless mistakes at school or at work. – Has difficulty sustaining attention in tasks or play. – Does not listen when spoken to directly. – Often does not follow through on instructions. – Has difficulty organizing activities. – Is easily distracted. – Is often forgetful in daily activities. 10
  11. 11. ADHD: Hyperactive-Impulsive• Symptoms present at school/work and home• 6+ symptoms that have persisted 6+ months and are inconsistent with developmental level – Often fidgets with hands or feet, leaves seat when staying seated is expected, runs or climbs excessively – Often acts as “driven by a motor” – Often blurts answer before ? Completed – Has difficulty waiting turn – Often interrupts others 11
  12. 12. Joel T. Nigg, Ph.D.
  13. 13. Labels
  14. 14. Anxiety• Anxiety (future) versus Fear (current)• Timing <- 14
  15. 15. Measuring Anxiety I: Open-field
  16. 16. Measuring Anxiety II: Elevated Plus Maze• Developed by Sandra File, Ph.D.• Valium Type Drugs: decrease anxiety• http://www.youtube.com/watch?v=PLcX2MbpmdY ---------------------- Chlordiazepoxide Pellow et al. (1985). J Neurosci Methods 14, 149-167.
  17. 17. Anxiety Disorders Panic Disorder Phobias Generalized Anxiety Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder
  18. 18. Panic DisorderPanic Attack: discrete period of intense fear, 4+symptoms develop abruptly and peak within 10minutes: 1) palpitations 2) sweating 3) trembling 4) shortness of breath 5) choking feeling 6) chest pain 7) dizziness 8) nausea 9) losing control 10) fear of dying
  19. 19. Panic Disorder Panic Attack: discrete period of intense fear, 4+ symptoms develop abruptly and peak within 10 minutes Individual Differences: multi/day versus 1/week Agoraphobia: fear of open-spaces Treatment: anti-anxiety & anti-depressant drugs1st 2:30http://www.youtube.com/watch?v=2gNGUartUEI
  20. 20. Phobia• Marked & persistent fear that is excessive or unreasonable, cued by presence or anticipation of object/situation• The avoidance interferes significantly with normal routine, occupational or social activities. 20
  21. 21. Kinds of PhobiasArachonophobia Phobia of spiders. Acrophobia Phobia of heights.Claustrophobia Phobia of closed spaces. Hemophobia Phobia of blood.
  22. 22. Systematic Desensitization Spider• 1) Create hierarchy of fears ↓• 2) Relaxation techniques• 3) Combine Joseph Wolpe, M.D. 1915-1997
  23. 23. Obsessive-Compulsive Disorder (OCD)Obsessions: recurrent thoughts, images, or feelingsCompulsions: ritualistic behaviors, performed to stopobsession and associated anxietyCommon Obsessions:6)Dirty 2) Aggression 3) Religion 4) SexDifferentiationQuantitative: High intensity, frequency,duration ( > 1 hour/day)
  24. 24. Quantification 24To take test: http://www.psymed.info/psymed/default.aspx?m=Test&id=52&l=3
  25. 25. OCD• 1st Two Minutes:• http://www.youtube.com/watch?v=44DCWslbsN 25
  26. 26. Cingulate Cortex 26
  27. 27. Anterior Cingulate & OCD• OCD and controls completed a difficult continuous performance test during fMRI.• OCD > controls in Anterior Cingulate Cortex 27 Ursu et al. (2003). Psychological Science, 14, 347-353.
  28. 28. Generalized Anxiety Disorder DSM-IV-TR CriteriaA. Excessive anxiety and worry (apprehensiveexpectation), occurring more-days-than-not for at least6 months.B. The person finds it difficult to control the worry.C. three (or more) of the following six symptoms:2. Restlessness3. Being easily fatigued4. Difficulty concentrating5. Irritability6. Muscle tension7. Sleep disturbance
  29. 29. Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute Post-Traumatic Stress Disorder (PTSD):Re-experiencing: nightmares, flashbacks, intrusivethoughtsAvoidance: situation & associatedPhysical Arousal: sleep, concentration, irritability Significant social or occupational impairment :3 min http://www.youtube.com/watch?v=7aFs6695VyQ
  30. 30. PTSD• Lifetime Prevalence: 5% men, 10% women 30
  31. 31. Resilience to PTSD Only about 10% of women and 20% of menreact to traumatic situations and develop PTSD.Holocaust survivors show remarkable resilience against traumatic situations.
  32. 32. Origins of Anxiety• Learn: videotapes of fear response to fake snake or plastic flower• Test: show a stimuli Mineka, S. (1985). J Abnormal Psychol
  33. 33. Origins of Anxiety• Learn: videotapes of fear response to fake snake or plastic flower• Test: show a stimuli• Response: Snake-Fear; Flower- No Fear• Supports Social-Learning & Evolutionary Psychology
  34. 34. Summary• Psychological Disorders & ICD/DSM• Anxiety Disorders – Panic Disorder – Phobias – GAD – OCD – PTSD 34

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