Specific Disorders and Treatments I Anxiety Disorders 04 22 2014 I Anxiety disorders are the most common class of disorders 29 a Most anxiety disorders involve i Fear of an object situation or event ii Avoidance of the feared stimulus b Women Men c Early age of onset i More common in women than men i Most people develop their disorder when they are young adults II Origins of Anxiety Disorders a Classical conditioning i Environmental cues become CSs for fear 1 Claustrophobia Elevator CS then trapped US fear UR 2 Soon we show fear CR to the CS alone elevator ii Observational learning monkeys and snakes iii Information transfer 1 Someone told you that you should be afraid iv Preparedness III The Role of Avoidance a Avoidance behavior is negatively reinforcing i Reduces exposure to aversive CSs ii But prevents new learning 1 That the object is in fact not dangerous b You can only get over your fear if you stop your avoidance IV Phobias a Social Phobia i The most common anxiety disorder 1 13 lifetime prevalence ii Fear of social or performance situations 1 Afraid of being judged negatively by others 2 Afraid of doing something embarrassing b Specific Phobia i Fear of a specific object or situation ii Rarely seek treatment iii Interferes with your life c Panic Disorder i History of recurrent unexpected panic attacks 1 Panic attack fear of having more attacks and worry about their consequences 2 Sudden rush of anxiety SNS activation ii Agoraphobia 1 Fear and avoidance of situations where escape may be difficult if an attack occurs V GAD a Generalized Anxiety Disorder b Uncontrollable worry about a number of events must last at least6 months i Constant worry throughout the day c Three of six other symptoms like i Trouble sleeping VI OCD a Obsessions recurrent thoughts that are difficult to control i Examples contamination symmetry safety harming another b Compulsions repetitive behaviors that are performed to control the obsessions i Examples washing counting checking c Most rare disorder only 2 of population VII Cognitive Behavioral Therapy for Anxiety Disorders a CBT for Anxiety Disorders i CBT for anxiety orders is focused on 1 Changing behavior Typically through exposure to feared objects places sensations 2 Modifying maladaptive thinking patterns that maintain or exacerbate anxiety b Out of session homework practice c Behavioral Techniques i Focused on changing observable behavior 1 Exposure to feared situations until anxiety declines 2 Facing your fear a In vivo vs Imaginal exposure i In vivo in real life b Gradually without distraction until fear declines d Cognitive Techniques i Danger and vulnerability are key themes ii Three primary targets 1 More accurate estimations of probabilities a How likely is the feared event to occur b People with these phobias disorders overestimate the odds of something terrible happening 2 More objective understanding of how bad the feared outcome would actually be a Catastrophising 3 More accurate appraisals of one s coping abilities VIII Treatments for Specific Disorders a Panic Disorder i Interoceptive exposure to feared sensations 1 Ex people who are afraid of hyperventilating making them hyperventilate to see that it s not so bad ii In vivo exposure to avoided situations b GAD i Imaginal exposure to feared outcomes 1 Have them imagine what they are afraid of ii Relaxation training 1 Learn to relax all the muscle groups in their body iii Scheduling discrete periods to worry iv Breathing retraining 1 Teaching them the proper way to breathe from their stomach c OCD d PTSD e Phobias i Exposure and response prevention ii Exposure to obsessions prevention of compulsions i Imaginal exposure to memories of the trauma 1 Retelling the event or writing about it ii Cognitive techniques to modify meaning of trauma i In vivo exposure to feared objects situations ii Group therapy often used with social phobia Specific Disorders and Treatments II Mood Disorders And Schizophrenia 04 22 2014 I Major mood Disorders a Major Depressive Disorder b Dysthymia c Bipolar Disorder d 20 lifetime prevalence II Major Depressive Disorder a 17 lifetime prevalence 10 yearly b More common in women c Average onset in 20s and 30s d Much more than being in a sad mood e Comorbid with anxiety and substance use f Major Depressive Episode i At least 2 weeks of 1 Depressed mood nearly every day for most of the day OR 2 Loss of interest or pleasure in most activities anhedonia ii PLUS 4 other symptoms 1 Sleep changes 2 Appetite weight changes 3 Low energy 4 Guilt worthlessness 5 Concentration problems 6 Thoughts of suicide g Major Depressive Disorder Subtypes i Single episode 1 Rarely happens 2 One isolated episode ii Recurrent typical pattern 1 Rarely is a person permanently depressed iii Severe episodes may include psychotic features 1 Hallucinations 2 Delusions iv With postpartum onset 13 of pregnancies III Seasonal Affective Disorder a Depressed mood that coincides with seasonal changes b Usually during winter months c Marked by excess sleeping and eating i Opposite symptom of depression d Treated best with exposure to very bright light high LUX units every AM IV Suicide a 3rd leading cause of death for adolescents young adults b Women attempt more men complete more c Risk factors i Hopelessness biggest factor ii Drug use iii Recent experience of humiliation iv Past attempts v Depression vi Old age in white men 70 particularly d Myths about suicide i Asking someone about suicide makes it more likely that they will do it ii Suicide is committed without warning 1 Talking about death 2 Giving away important possessions 3 Saying out of place goodbyes iii Risk decreases when a severe depression begins improving 1 Risk actually goes up when they begin feeling better a Energy when someone is really depressed they don t have the energy to commit suicide b When they begin feeling better they will have the energy to commit suicide V Dysthymia a Long term less severe form of depression b 2 or more years of depressed mood for more days than not with other symptoms c Doesn t cycle like MDD d Double depression i MDD comorbid with dysthymia VI Bipolar Disorder a Presence of at least one manic episode i Extremely elevated mood decreased sleep high energy risky behaviors talkative inflated self esteem 1 Total opposite of a depressed episode 2 Many patients like the mania because it makes them have more energy and feel more productive b Usually alternate with longer depressive episodes c More