Disorders with Excessive Anxiety Fear is linked to a specific situation while anxiety is long lasting and diffi cult to escape An anxiety disorder is when a person has consistently higher levels of anxiety than is warranted Anxiety disorders are most common in India followed closely by the U S Study of 6 countries Generalized Anxiety Disorder GAD Almost constantly plagued with exaggerated worries Causes tension irritability relationship problems People with GAD tend to also or eventually have depression panic disor der Responds fairly well to antidepressants and CBT Panic Disorder PD Frequent periods of anxiety and occasional attacks of panic Symptoms of Panic rapid breathing and heart rate dizziness nausea shak ing sweating faintness More common in Whites than Blacks more common in women than men more common in younger adults than older adults Many theories about why it happens hyperventilation results from strong autonomic response this sends signals of suffocation that increase auto nomic response Panic attacks can result in phobias like agoraphobia or social phobia worry of future attacks that might embarrass Responds well to CBT Disorders with Exaggerated Avoidance Result of people learning to avoid the punishment of previously bad situ ations avoidance behaviors Highly resistant to extinction Phobias Extreme persistent fear that interferes with normal living Usually fear is not of the thing itself but of their own reaction when in its presence Fear of fear Prevalence of Phobias 11 of people has at least 1 phobia Most common Open spaces Public Speaking Heights Not being on Solid Ground Flying and or Boats Being with or observed by strangers social phobia Being Alone Dangers or Reminders of Dangers snakes spiders other animals blood injections storms etc Acquiring Phobias Many phobias can be traced to a specific event Some people more predis posed than others John Watson and Albert B Phobias can be learned Watching another s fearful response can learn Fear of an object We are evolutionarily more predisposed to some fears than others seems to depend on how long stimulus has been around cars vs heights Behavior Therapy for Phobias Systematic desensitization a method of reducing fear by gradu ally exposing people to the object of their fear Similar to Skinner s shaping procedure reward of successive approxima tions of behavior Virtual Reality is also successful person can go high in a glass elevator or cross a chasm using VR technology Obsessive Compulsive Disorder Obsession repetitive unwelcome stream of thought Compulsion repeti tive almost irresistible action Obsessions lead to compulsions like an itch leads to a scratch 2 3 prevalence in the US Tends to run in families but no identified gene Cleaning and Checking Compulsions Compulsive cleaning is associated with enhancing one s purity Cleaning tends to be mostly female while checking is evenly distributed Cleaning leaves people feeling better ends Checking may not Exposure therapy with response prevention and antidepressants are effec tive Emotions and Avoidance Oversimplified phobias are about cognitive awareness of a stimulus while OCD is about emotions Awareness is not sufficient attention to emotion and cognition is necessary for relief Substance Dependence Addiction Dependence is when a person finds it difficult or impossible to quit a self destructive habit Nearly all addiction producing substances produce a dopamine response in the nucleus accumbens The nucleus accumbens responds to surprise events but not pleasant events It is also active during seeking an acquisition of the addictive substance What Motivates Addictive Behavior Partly operant conditioning seeking an experience that has been rewarding in the past Motivation to escape unpleasant feelings associated with dependence physical dependence Psychological Dependence strong repetitive desire for some thing without physical symptoms of withdrawal The nucleus accumbens is about attention when people become addicted to a drug they enjoy other things less and attend to other things less Is Substance Dependence a Disease Problematic implies all or none disease or no disease when all evidence points to a continuum Implies need for pharmacological treatment In fact no clear definition for disease Alcoholism The habitual overuse of alcohol Treatment is difficult success rate is unimpressive Goal is to identify at risk individuals and get to them before addiction de velops Genetics and Family Background At least 6 genes associated with alcoholism also associated with other ad dictive behaviors nicotine Type I and Type II alcoholics a Type I male or female later age of onset gradual not as likely to have criminal issues betide II rapid onset largely male early onset and often other legal issues Cultural more common in Irish cultures less in Jews Italians Women who were sexually abused in childhood are at risk for alcoholism Study Men who are the sons of alcoholic fathers experience more stress re lief from alcohol than age matched controls Treatments 10 20 quit on their own estimate Alcoholics Anonymous Antabuse disulfuram Harm reduction contingency management a alcohol alcohol dehydrogenase acetaldehyde b Acetaldehyde acetaldehyde dehydrogenase acetic acid then CO2 water c Antabuse blocks acetaldehyde dehydrogenase Opiate Dependence Morphine heroin previously thought less dangerous than alcohol Post 1900 Made illegal noted to have faster onset of dependency than other drugs Very strong but not life threatening physical dependence Rebound ef fects Becoming a modern day scourge Treatments Avoidance of triggers as part of CBT Drug therapy methadone pills Buprenorphine suboxone naltrexone agonists and antagonists often pre scribed together as long term therapy Depression Major Depression is an extreme condition persisting most of each day for at least 2 weeks usually more The person experiences little interest pleasure motivation activity or ability to concentrate Sadness maybe Lack of happiness definitely 10 of people experiences it Usually transient often recurring Sleep Disturbances and Depression Enter REM sleep quickly 45 mins Early awakening inability to go back to sleep Sleep deprivation is an early diagnostic tool for MDD and can make mat ters worse SAD most common in Scandinavia excessive sleeping and eating during depressed periods Bright light is best treatment Environmental and Genetic Influences on Depression Events that leave one feeling helpless humiliated
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