Week 2

Question 1

What are concurrent disorders? (4)

Answer 1

Someone has a substance use disorder as well as at least one other co-occurring mental or psychiatric disorder

People who have concurrent disorders make up less of the population than those with just one or the other

They are not dependent on gender but are more prevalent among 15-24 year olds

People with concurrent disorders have more problems and therefore need more help

Question 2

What does the Lai et al. meta-analysis say about anxiety and mood disorders in people with SUD? (3)

Answer 2

Examined cooccurence of SUD with different disorders

Found that there is a high prevalence of people having substance use disorder among people with any diagnosed anxiety or mood disorders

People with depression are more likely to be alcoholics

Does not indicate causation because it is not a longitudinal study so it cannot tell what came first

Question 3

What does the Swendsen et al. study on transitions from mental disorders to SUDs demonstrate? (3)

Answer 3

Longitudinal study (10 years) that examined the associations of mental disorders with transitions to substance use disorders

Linked depressive, bipolar, anxiety disorders and PTSD to preceding the initial onset of nicotine, alcohol and drug dependence

Confirmed that mental disorders are risk factors because they precede SUDs

Question 4

What are the two main feelings of anxiety disorders? How do they differ? How are they similar?

Answer 4

Fear, a negative emotional state in response to a real or perceived imminent threat to the self; present focused on immediate danger

Anxiety, a negative emotional state that stems from anticipation of future threats; future focused on what if

Both are adaptive and essential for survival, keeping us alive in the olden days?

Question 5

What are the 3 components of anxiety?

Answer 5

Physiological: heightened level of arousal and physiological activation

Cognitive: subjective perception of anxious arousal and associated cognitive processes like worry and rumination (can be good but not when disproportionate and frequent)

Behavioral: safety behaviors like avoidance (which is bad)

Question 6

When does anxiety become bad? (3)

Answer 6

When it is chronic, relatively intense, associated with role impairment and causing significant distress for self or others

They perceive threats when there is no objective threat or the situation is ambiguous, it is disproportionate

How we interpret daily situations and react to situational factors is key

Question 7

What are three common expressions of anxiety?

Answer 7

Catastrophizing: thinking it is the end of the world if/when something happens

Overgeneralizing: one thing goes wrong/happens and letting it affect every other part of your life

Selective abstraction: only seeing specific details (usually negative ones) of the situation while missing others (usually positive ones)

Question 8

According to the DSM, what is a specific phobia? (7)

Answer 8

Marked fear or anxiety about a specific object or situation

The phobic object/situation almost always provokes fear/anxiety,

Is actively avoided or endured with intense fear/anxiety

Is out of proportion to the actual danger posed

Is persistent

Causes clinically significant distress or impairment in important areas of functioning

Cannot be better explained by another mental disorder

Question 9

What is social anxiety disorder (SAD)? (3)

Answer 9

Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

The individual fears they will act in a way or show anxiety symptoms that will be negatively evaluated

They are preoccupied with a need to seem perfect and not make mistakes, view themselves negatively even when they’ve done well and have excessive self-criticism

Question 10

What are the cognitive theory’s of specific phobias and SAD? (4)

Answer 10

People who experience these are more likely to attend to negative stimuli, perceive ambiguous information as threatening, believe that negative events are more likely than positive ones to re-occur, and keep rehashing the negative event in their mind

Question 11

What is a biopsychosocial model of SAD and substance use comorbidity?

Answer 11

Social anxiety compounded with risky biopsychosocial factors lead to substance use as a way of coping with social anxiety

Question 12

What does the Walukevich-Dienst et al. study on substances to cope with anxiety demonstrate? (4)

Answer 12

A study on using substances to cope with social anxiety where they tracked people for 2 weeks

High risk days were days in which young adults used substances to cope with social anxiety, and found these days were linked to heavier alcohol use

On high risk cannabis use days, there was more social avoidance

On high risk alcohol/co-use days, there was greater perceived positive alcohol consequences (less worried, more sociable)

Question 13

What are panic attacks? (3) What are the two kinds?

Answer 13

Not a mental disorder but they can occur in the context of any anxiety disorders or mineral health disorders/medical conditions

Panic attacks are indicators for a more serious disorder

Someone having a panic attack may also experience depersonalization (out of body experience) and derealization (not real, loss of control, dying)

Unexpected (no obvious trigger) and expected (in response to a situational trigger)

Question 14

What is panic disorder? (3)

Answer 14

Recurrent unexpected panic attacks/intense surges of fear/discomfort

Symptoms of a panic attack include palpitations, sweating, shaking, shortness of breath, choking, chest pain, nausea, dizziness, chills, numbing/tingling, fear of going crazy/dying, etc.

Attacks are also followed by persistent worry or concern and a maladaptive change in behavior

Question 15

What is agoraphobia? (4)

Answer 15

From the Greek word agora meaning marketplace

A cluster of fears surrounding public spaces and being unable to escape or find help should one become incapacitated

Anxiety in public transportation, open spaces, enclosed spaces, lines/crowds, and being out of the house alone

Often co-occurs with panic disorder

Question 16

What are four psychological theories of panic disorder?

Answer 16

The fear-of-fear hypothesis suggests that agoraphobia is not a fear of public places but a fear of having a panic attack in public

The misinterpretation of physiological arousal symptoms suggests that people who have an autonomic nervous system predisposed to be overly active is coupled with a tendency to become very upset by these sensations

The role of vicious circles in panic disorder of overthinking and fear

The role of anxiety sensitivity in panic disorder, where physiological responses prompt more anxiety

Question 17

What is generalized anxiety disorder? (6)

Answer 17

Excessive anxiety and worry occurring frequently and consistently about a number of events and activities (from work to school performance)

Difficult to control the worry

Associated with restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbance

Do not typically seek treatment even thought it typically starts as early as the early teens

It is hard to treat

Highly comorbid with other anxiety and mood disorders

Question 18

What is the role of the intolerance of uncertainty theory in GAD? (3)

Answer 18

Related to control, predication events produce less anxiety than do unpredictable events

Research shows that intolerance of uncertainty plays a large role in the experience of chronic worry and GAD

Particularly relevant when assessing ambiguous situations, with appraisals mediating uncertainty and worry

Question 19

What is the role of approach-avoidance conflicts in GAD? (3)

Answer 19

There is a two-factor model of approach-avoidance: intolerance of uncertainty and fear of anxiety

GAD-prone people have a desire to engage in approach behaviors to reduce their feelings of uncertainty, to know the unknown

But they also simultaneously fear anxiety which promotes the use of avoidance strategies to limit the experience of anxiousness

Question 20

What are the general characteristics of depression disorders? (4)

Answer 20

Much more serious than typical emotional states that everyone feels

Involves significant disturbances in emotion, including extreme sadness or elation/irritability

Are disabling and interfere with daily functioning

Are often associated with other serious psychological problems (panic attacks, substance abuse, personality disorders, sexual dysfunction)

Question 21

What are the 3 helplessness theories of depression?

Answer 21

Learned helplessness, where uncontrollable aversive events leads to a sense of helplessness which leads to depression

Attributional reformulation, where aversive events are attributed to global and stable factors and leads to a sense of helplessness with no possible resolution (as global stable factors are out of your control), leading to depression

Learned hopelessness, where aversive events are attributed to global and stable factors or cognitive factors, leading to a sense of hopelessness due to lack of resolutions and an expectation of an undesirable outcome, leading to depression

Question 22

What is major depressive disorder? (2)

Answer 22

Consistent and frequent depressed mood and markedly diminished interest of pleasure in activities

Often combined with weight, sleep concentration and energy issues as well as feelings of worthlessness, guilt and death

Question 23

What is persistent depressive disorder (dysthymia)? (3)

Answer 23

Consistent and frequent depressed mood for at least 2 years

Presence of poor appetite, in/hypersomnia, low energy and self-esteem, concentration problems and feelings of hopelessness

May also be experienced with episodes of major depressive disorder

Question 24

What are the three kinds of bipolar/mood disorders?

Answer 24

Bipolar I disorder: requires the present of at least 1 manic episode and may be followed by hypomanic or depressive episodes

Bipolar II disorder: requires the presence of at least 1 hypomanic episode and at least 1 major depressive episode and never a manic episode

Cyclothymic disorder: a less debilitating mood disorder with a lower threshold; periods of at least 2 years with moods cycling between variations from our baseline that do not meet criteria for episodes and frequently cooccurs with anxiety disorders

Question 25

What is mania? (3)

Answer 25

An emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractability and impractical grandiose plans

Noticed by others who know them due to loudness, poor planning and annoyingness

Treatment is mood stabilizing medication

Question 26

What is a manic episode? (3)

Answer 26

A distinct period of abnormally and persistently elevated, expansive or irritable mood and increased activity or energy

Lasting at least 1 week for most of every day

Symptoms include inflated self-esteem/grandiosity, decreased need for sleep, talkative, racing thoughts/ideas, distractability, increase in goal-directed activities and involvement in activities with high potential for painful consequences

Question 27

What is a hypomanic episode? (3)

Answer 27

A distinct period of abnormally and persistently elevated, expansive or irritable mood and increased activity or energy

Lasting at least 4 consecutive days for most of the day

Symptoms include inflated self-esteem/grandiosity, decreased need for sleep, talkative, racing thoughts/ideas, distractability, increase in goal-directed activities and involvement in activities with high potential for painful consequences

Question 28

What is a major depressive episode? (2)

Answer 28

Depressed mood and/or loss of interest or pleasure present during the same 2-week period and represent a change from the norm

Often combined with weight, sleep concentration and energy issues as well as feelings of worthlessness, guilt and death

Question 29

What is a mixed episode? (3)

Answer 29

Can occur during any of the episodes

Symptoms occur during the majority of days of the episode

The individual experiences rapidly alternating mood (sadness, irritability, euphoria) accompanied by symptoms of mania and depression

Question 30

What are the 3 mechanism seen across conditions that might explain why people with concurrent disorders turn to substance use?

Answer 30

Emotion (dys)regulation, impulsivity and perfectionism

Question 31

What is emotional (dys)regulation? What are the 6 factors of the DERS? (3)

Answer 31

Emotional regulation refers to the use of health strategies to adapts to the demands of the environment and diffuse tough negative emotions

Emotional dysregulation refers to the inability to use healthy strategies to diffuse or moderate negative emotions and instead turning to substance use to cope with strong negative emotions

Difficulties in emotion regulation scale (DERS) include factors like non-acceptance of negative emotions, difficulty engaging in goal-directed behavior, limited access to strategies, impulse control difficulties, lack of emotional awareness, and lack of emotional clarity

Question 32

What does the Stellern et al study on emotional regulation in SUDs show? (2)

Answer 32

Found people with SUDs were more likely to score higher on DERS

Shows a statistically significant correlation between substance use and the ability to regulate emotions

Question 33

What is impulsivity? (3)

Answer 33

Behavior without adequate thought, the tendency to act without thinking ahead or a predisposition toward rapid unplanned reactions to stimuli without regard to the negative consequences

Urgency, both for positive and negative stimuli

Many different maladaptive behaviors are linked to impulsivity, like problems with self-control of emotions and behaviors and the violation of the rights of others/social norms

Question 34

What is the 5 factor model of impulsivity?

Answer 34

Found 4 distinct personality facets associated with impulsivity from self-report measure

Lack of premeditation (careful and purposeful thinking)
Lack of perseverance (seeing things through to the end)
Sensation seeking
Urgency

Question 35

What 2 tasks measure behaviors of impulsivity?

Answer 35

The go/no-go task, which measures patience and the ability to wait

The delay discounting task, which measures the ability to delay gratification for greater reward

Question 36

How does impulsivity relate to addiction? (3)

Answer 36

Trait measures of impulsivity predict experimenting with substances and SUDs

Tasks show people with SUDs value smaller immediate rewards over delayed larger rewards, showing impulsive decision making

Addiction can also lead to cognitive defects that increase impulsivity which in turn increases engagement in risky behaviors like addiction (a cycle)

Question 37

What does the ADHD and SUD initiation study show? (3)

Answer 37

Men with ADHD were more likely to initiate various illicit drug uses over a period of 5 years

They were also more likely to binge drink and have AUD

ADHD predicted these outcomes

Question 38

What is perfectionism? (5)

Answer 38

A personality trait characterized by an overarching desire to meet high standards and self-criticism in response to failing to meet those standards

Often set excessively high standards for themselves and constantly strive for excellence in everything they do

Common in mental disorders associated with SUD (depression, anxiety, eating disorders)

This cycle of constantly raising the bar is exhausting because if you meet them, it is just raised higher until you can’t meet them and if you don’t, it’s devastating

Results in the use of substances to cope

Question 39

What is Hewitt and Flett’s multidimensional perfectionism scale? (3)

Answer 39

Perfectionism comes from and it directed toward many different directions

Self-directed perfectionism from oneself towards oneself

Other-oriented perfection from oneself towards others

Social prescribed perfectionism from others towards oneself

Question 40

What is Shafran et al Clinical Perfectionism theory? (2)

Answer 40

Overvaluing the importance of striving to meet standards and reacting to perceived failure to meet standard with self-criticism

Includes overvaluation of striving/ability and concerns over mistakes

Question 41

What does the Rice and Van Arsdale study on perfectionism and SUDs demonstrate?

Answer 41

The path of perceived stress to drinking to cope to AUD is stronger for participants who were classified has having maladaptive perfectionism than those with adaptive perfectionism (meeting those high standards) and non perfectionism