What bits of the nervous system are activated in anxiety?
- Anxiety is normal: it helps us to perform better
- Increased adrenaline, cortisol
- Sympathetic, autonomic nervous system
- In the brain you have activation of 5-HT and NA
What are the physical symptoms of anxiety?
- Muscle tension: headaches, pain, fatigue
- Hyperventilation: dizziness, tingling fingers, toes (decrease PCO2 = Ca2+ changes)
- Sympathetic overactivity: increase HR + BP, ectopic beats, sweating, pale skin, dry mouth etc, frequent urination).
What are the psychological symptoms of anxiety?
CNS: poor concentration, memory, feeling unreal
Mood: fear, panic, worry, on edge, irritable
Thoughts: future danger 'fear of dying, losing control, worrying about worry'
What are unhelpful behaviours in anxiety?
1. Pacing room - wringing of hands, sighing
2. Attempts at coping - caffeine, smoking, alcohol, drugs
3. Avoiding - fear provoking situations
4. Asking for reassurance - visiting GP, increase in somatic complaints, checking body
What are the 5 key things to consider in anxiety?
1. Is it a normal reaction to stress? (if so, educate)
2. Is it secondary to a physical illness (e.g. hyperthyroidism) or mental illness (e.g. depression): treat 1st.
3. Lifelong personality trait or state
4. Triggered by a specific object e.g. spider (a phobia) or free floating?
5. If free floating, present from time to time (panic) or all of the time (generalised anxiety)?
What is the neuronal basis of learning theory?
- Learning is a relatively permanent change in behaviour that occurs as a result of experience
- It enables a person/organism to adapt to its environment.
- Amygdala - almond structure in tempral lobes involved in learning and expressing fear
-More axonal connections between neurons?
- Increased efficiency of neurotransmitter release between neurons across synaptic cleft
What are the types of learning?
Associative: learning that certain events go together e.g. classical & operant conditioning
Vicarious: learning by direct observation
Factual transmission: this is an example
Complex: e.g. social learning, emotional intelligence (EQ)
What are the two main models of learning by association?
What is classical conditioning?
What is operant conditioning?
Give an overview of the pavlolv dog model of classical conditioning
Give some real-life examples of classical conditioning:
- Food cues: salivation to pictures of chocolate
- Music in films e.g horror - enhances emotions
- Meeting an old friend: memories return
- Conditioned emotions (albert the rat): origin of phobias?
- Visit to dentist/doctors surgery: pain/anxiety linked to white coats, disinfectant smell, equipment
- Chemotherapy: anticipatory nausea entering room
- Treatment of bed-wetting: (pad and bell)
In operant conditioning, what is positive reinforcement?
- Involves presenting a pleasant stimuli after a desired behaviour has occured.
- Increases likelihood of desired behaviour
E.g. praise for a good exam result
Reinforcers can be primary (food, water, escape from pain/cold) and secondary (money, praise, attention, success)
- Reinforcer must be immediate/linked to act (explains lack of willpower in those trying to lose weight, stop smoking, cut down alcohol etc)
What are the types of positive reinforcement?
1. Continuous reinforcement = every response is reinforced (rare in real life)
2. Partial reinforcement = reinforcement occurs, but not after every response e.g.
1. Ratio schedules = depend on the number of responses e.g. factory workers get paid for every 3 shirts made.
2. Interval schedules = depend on the time intervals e.g. nurse only gives paracetemol every 4 hours if patient asks
3. May be fiexed (predictable) or variable (unpredictable e.g. slot machines)
What are some important rules to remember with positive reinforcement?
- People work harder under partial than continuous reinforcement
- Effort increases with time or ratio (more work, less pay) to a point.
- Extinction of a response much slower with partial vs continuous reinforcement and also much slower with unpredictable v predictable schedules.
What is shaping?
Shaping is rewarding behaviours with increases approximate to the desired more complex behaviour e.g. learning to walk, talk, drive, play piano, animal trainers
What is chaining?
Chaining is breaking down complex behaviours into a series of simple acts: each reinforces the next (or last) in chain.
Reinforcers first act e.g. 1st holding spoon then later add need to put spoon into bowl to get praise
All types of positive reinforcement.
What is negative reinforcement?
Negative reinforcement is often confused with punishment.
It is the removal of an adverse stimulus after a desired behaviour has occured.
e.g. baby cries, mum picks up baby, baby stops crying.
Mum negatively reinforces action (e.g. do it next time)
But baby is positively reinforced to cry.
Negative reinforcemenet increases a particular behaviour (unlike punishment)
What is a Phobia?
- A phobia is a marked and persistent fear
- It is triggered by a specific object/situation
- Leads to avoidance of that situation
- Interfered significantly with life
What are the three types of phobia?
- Agoraphobia (public places, crowds, shops) - 6%
- Social Phobia (eating, speaking, performing) - 4%
- Specific phobia (animals, heights, needles) - 9%
What maintains a phobia?
How does habituation as an exposure treatment work?
How do you treat phobias?
- Graded exposure (physiological adaptation, stay in situation until fear goes)
- SMART targets
- Anxiety ladder
What is punishment?
- Presentation of an unpleasant stimulus after an undesired behaviour occurs
To be effective, punishment must..
1) Link response to consequence (no time delay)
2) Be consistently applied (reinforced)
3) Sufficiently applied the first time (not built up)
Example: chil solded for drawing on wall, adult burns hand when touching hot pan prisons
What are the problems with punishment?
- Physical or emotional harm or injury e.g. smacking
- Paraxodical attention can act as positive reinforcer of negative behaviour (any attention better than none)
- Teaches aggression as a model to solve difficulties
- No alternative behaviour provided (reward = repeat this, punishment = stop it)
- Leads to fear/dislike of person and situation (= classical conditioning)
What is Extinction?
- A decrease in behaviour by withholding a previous reward (classical or operant) e.g.
- A child crying in bed every night: remove reinforcing parental attention by leaving to cry for 10 minutes before checking, then 20, 40, 60 mins.
- Time out for toddler tantrums (lowers attention)
- Contracts in Psychiatry: help offered conditional upon behaviour not occuring (e.g. self harm, alcohol use)
- Depression: lack of pleasure so stop doing things and achieve less, worsening mood in a vicious circle.
What are 10 symptoms of depression?
How does CBT work for depression?
Cognitive = challenge unhelpful and extreme ways of thinking e.g. using thought records.
Behavioural = behavioural activation, inc. activity scheduling + goal setting e.g. using an activity diary.
Therapy = a talking treatment - using generic skills (empathy, listening, therapeutic relationship)
Describe the link between Depression & Inactivity