Persistent Depressive Disorder Criterion A: ________ mood, more days than not, for __ years. Criterion B: __ or more: - Poor appetite or overeating - Sleep disturbance - Low energy or fatigue - Low self-esteem - Poor concentration/indecisiveness - Feelings of hopelessness Criterion C: never w/o symptoms for more than __ months at a time. Criterion D: symptoms of MDD may be continuously present for 2 years. Criterion E: NO HISTORY of _____/________ episode.

depressed, 2 years 2 or more 2 manic/hypomanic

Exam 2 Flashcards by Anthony Kemmer

Mood Disorders

Depressive Disorders
______ _________ disorder.
_________ _________ disorder.
Bipolar and related disorders
________ disorder __.
________ disorder __.
___________ disorder.

Major depressive disorder
Persistent depressive disorder.

Biopolar disorder I
Bipolar disorder II
Cyclothymic disorder

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Types of moods:

*_________: extreme sadness and gloominess.

*_____/__________: intense/unrealistic feelings of excitement and euphoria.

*_____-moods: symptoms of both mania AND depression.

Depression

Mania/hypomania

Mixed

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Major Depressive Episode

Criterion A: __ of the following criteria, lasting for at least a __ week period, change from ________ functioning.
Depressed mood
Anhedonia (i.e, loss of interest or pleasure)
Appetite/weight disturbance
Sleep disturbance
Psychomotor agitation or retardation
Fatigue/loss of energy
Worthlessness or excessive/inappropriate guilt
Difficulty concentrating/indecisiveness
Suicidal ideation
The episode must cause clinically significant distress/impairment.
Episode not attributable to the effects of a ________ or other medical condition.

substance

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Manic Episode

*Criterion A: distinct period with abnormally elevated or irritable mood and goal-directed activity lasting ≥ __ week.

Criterion B: __ or more of:
Inflated self-esteem/grandiosity
Decreased need for sleep
Talkativeness, pressured speed
Flight of ideas, racing thoughts
Distractibility
Increased goal directed activity or psychomotor agitation
Excessive involvement in pleasurable and risky behaviors
Clinically significant distress, impairment, hospitalization, or psychotic features.
Not due to the physiological effects of a substance or another medical condition.

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True or false:

-You can have an episode without having the disorder.

True

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Hypomanic Episode

Same as manic episode except:
At least __ days.
Noticeable by others, but not severe enough to cause marked impairment in functioning.

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Mixed Episodes

*Meets criteria for BOTH _____ episode and ______ ___________ episode (except in ________).

manic episode ( at least 3 criteria) + major depressive episode (at least 5 criteria)

duration

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Postpartum vs. Baby Blues

*Is giving birth a risk factor for Major Depression?

Pospartum “Blues”
[positive/negative] stressor
Emotional lability, crying easily, irritability, intermixed with happy feelings.

-50-70% often experience these symptoms within 10 days after giving birth.

No, most studies do not uphold this common belief.

positive

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________ ________ disorder
Characterized by persistent down or depressed mood (i.e., sadness and/or loss of interest in pleasurable activities) occurring more days than not.

Major depressive disorder

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Major Depressive Disorder

Criterion A: __ of the following criteria, lasting for at least a __ week duration, change from previous functioning.
DEPRESSED MOOD*
ANHEDONIA* (i.e, loss of interest or pleasure)
Appetite/weight disturbance
Sleep disturbance
Psychomotor agitation or retardation
Fatigue/loss of energy
Worthlessness or excessive/inappropriate guilt
Difficulty concentrating/indecisiveness
Suicidal ideation

*MUST have at least __ of the first two criteria + __ more criteria to have MDD. If not, then it’s just an _________.

1, +4 more

episode

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Major Depressive Disorder

Criterion A: presence of a ______ __________ _______.
Single (initial) episode
Recurrent episode
Criterion B: clinically significant distress/impairment.
Criterion C: episode not attributable to the effects of a substance or other medical condition.
Criterion D: MDE not better accounted for by another disorder.

***Criterion E: NO HISTORY OF _____ or __________ EPISODES.

major depressive episode (MDE)

manic or hypomanic episodes

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When diagnosing someone for MDD, if they have _______ or __________, they are not longer eligible for MDD.

mania or hypomania

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Major Depressive Disorder

Depressive episodes are often time-limited
__ -__ months on average
Greater than 2 years –> chronic MDD (10-20% of diagnoses)
Remission of Symptoms
Greater than 2 months w/o clinically significant symptoms
Inter-episode recovery (i.e, experiencing NO symptoms?)
Recurrence
25-40% within 2 years
60% within 5 years
75% within 10 years
87% within 15 years

6-9

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Major Depressive Disorder

Prevalence
20.9% lifetime, 8.6% 1-year
Gender
1 in __ females vs 1 in __ males (adults)
1:1 male to female during childhood
1:__ male to female by adulthood
Age of onset
Late adolescences-early adulthood
Later onset (≥60 years old) - difficult to determine due to other health related illnesses (e.g., dementia).
Comorbidity
_______ disorders, _________ use disorders, eating disoders, personality disorders

–So if you meet criteria for MDD, there’s a high chance that you’ll likely meet criteria for another disorder as well ( around 56% chance)

1 in 4 females vs 1 in 10 males (adults)

1:2 male to female by adulthood

Anxiety, substance

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_________ _______ Disorder:

-Characterized by persistent down or depressed mood occurring more than not for greater than 2 years.

Persistent Depressive

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Persistent Depressive Disorder

*Criterion A: ________ mood, more days than not, for __ years.

Criterion B: __ or more:
Poor appetite or overeating
Sleep disturbance
Low energy or fatigue
Low self-esteem
Poor concentration/indecisiveness
Feelings of hopelessness
Criterion C: never w/o symptoms for more than __ months at a time.
Criterion D: symptoms of MDD may be continuously present for 2 years.
Criterion E: NO HISTORY of _____/________ episode.

depressed, 2 years

2 or more

manic/hypomanic

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Persistent Depressive Disorder

Prevalence
18.0% lifetime
Age of Onset
Adolescences-early adulthood
> 50% presenting for treatment have an onset before age 21
Course
Average duration is __-__ years, but can persist for 20+ years
Chronic stress increases severity of symptoms
10 year period – 74 percent recover, but 71% of those relapse
Double depression

4-5

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Double depression = _________ ________ disorder + ______ _________episode.

Persistent depressive disorder + major depressive episode

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MDD: Causal Factors

*Biopsychosocial Model

Biological factors
Genetic influences
Neurochemical
Hormonal

Yuh

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MDD: Biological Factors

*Genetic Factors

Family Studies
-Individuals who are first degree relatives of individuals w/ depression have a __-__x increased risk of developing MDD themselves
-These individuals tend to develop ______ first.
-Earlier onset

-Twin studies
–__________ twins 2x as like to develop MDD as
________ twins twins
–But, most variance accounted for by
non-shared environment

-Adoption studies
–More depression in biological relatives
of depressed adoptees

3-5

anxiety

Monozygotic (identical), dizygotic

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VERY IMPORTANT
*As a biological vulnerability, having two [long/short] _________-________ genes [increases/decreases] your risk of developing depression, if you’ve experienced _________ life events.

two short serotonin-transporter genes

increases

stressful

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MDD: Biological Factors

Neurochemical Factors
_________ Hypothesis
-Low _________ as biological risk factor
-Levels of __________ and ________ determine direction of mood disorder.

**Low serotonin + low norepinephrine and low dopamine
= depression

Hormonal Factors
-Cortisol – signal for response to medication?

Permissive

serotonin

norepinephrine and dopamine

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Low _______ + low __________ and low ________

= depression

serotonin, norepinephrine, dopamine

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People with depression tend to have [higher/lower] levels of cortisol.

higher

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MDD: Causal Factors * Psychological/environmental factors - Stressful life events - Cognitive theories - Interpersonal factors

Yuh

MDD: Psychological factors * Stressful life events - -Stronger association with initial depressive episode - -Long-term stress --> abnormal nucleus accumbens functioning. Explanation: - Stressful live events are associated with that first onset of depression, they're less associated with recurrent episodes. - Long term stress is associated with increased _______, and what we see is that over time, the stress makes the nucleus accumbens _________. - The nucleus accumbens is associated with producing _________ in response to pleasure, and what we see in stress and cortisol levels overtime, is that it makes the nucleus accumbens not respond in terms of pleasurable events, and in fact, it can make things worse, and we see this non-response to acute stress.

cortisol malfunction dopamine

MDD: Cogntive Theories *_____'s Cogntive Model - Negative Cognitive Triad - You have negative views about the _____, the ______, and _______. - This series of thoughts feed into each other, and feed into depression. - You can imagine that having negative views about the self (I'm worthless) + negative views about the world (everyone hates me b/c I'm worthless) + negative views about the future (I'll never be good at anything b/c everyone hates me) would lead to feeling pretty bad. * Depression is maintained by these thoughts. - All or non thinking, selective abstraction - Leads to depressive schemas

Beck's world, future, yourself

People w/ depression perceive the world more __________.

accurately.

MDD: Cognitive Theories * ________: - The process by which individuals explain the causes of behavior and events in a negative manner. * ________ _________: - Sense of powerlessness - The idea that people don't have any power or control to change what's going on around them, and that they're making all these negative attributions. - They can't do anything about all these negative events around them and it's their fault to the extent that they cannot change. * ___________ theory: - Pessimistic attributional style - We go from this learned helplessness component, to when you add in this "why?" component, we get hopelessness. - Simply feeling hopeless enough can lead people to depression.

Attribution Learned helplessness Hopelessness theory

MDD: Interpersonal Factors * Interpersonal Factors - Lack of ______ ______ - Poor social skills - Relationship distress - -Excessive-__________ seeking (trying to solicit that you are worthy). - -________ feedback seeking (I'm so dumb, that was stupid of me...saying these things to get people to say positive things about them). - These factors both _______ onset of depression and are _________ by depression. - Related to high rates of relapse/recurrence

social support reassurance Negative precede, worsened

MDD: Evolutionary Approach * Resource conservation: - Perceived loss leads to in-the-moment _________ and energy _________ for later - Stay stuck in same situation without reward * _______ __________ hypothesis: - De-escalating approach (withdraw, give up power) - Social dominance...there is always a loser, and that person always has to withdraw. The way to maintain this social hierarchy, sometimes you have to submit to being the loser, and these depressive symptoms/behaviors can be a de-escalation or signal of submission. * ______ risk hypothesis - Interpersonal disruption - Protects against future losses by withdrawing * Attachment: - Experience of loss

protection, conservation (Dr. R doesn't buy this theory too much) Social competition Social

Depressive Disorders: Biologically-Based Treatments *Medications - __________ Oxidase ________ (MAOIs) - -Inhibits the enzyme responsible for breakdown of _________ and __________ - -Used for **atypical depression** - _______ Antidepressants - -Increases monamines (norepinephrine) - -50% do not respond - Selective Serotonin Reuptake Inhibitor (SSRIs) - -Prozac, Zoloft, Paxil - -Takes up to 6 weeks to work -Newer generation drugs – Effexor (SNRI) and Wellbutrin (NDRI)

Monoamine Oxidase Inhibitors serotonin, norepinephrine Tricyclic

What is the primary medication for depression?

Selective Serotonin Reuptake Inhibitors (SSRIs)

Depressive Disorders: Biologically-Based Treatments * ___________ Therapy (ECT) - **Severe depression, non-responders** *Transcranial Magnetic Stimulation -Pulsating magnetic fields stimulate certain regions in the cortex (5 days/week 2-6 weeks) -Recent review supports effectiveness * Light therapy - Originally used for seasonal affective disorder

Electroconvulsive

Depressive Disorders: Psychotherapy Treatments * _________ _________ (BA) - Refers to increasing activities and interactions - behavioral scheduling - Getting people to do the things they're used to doing again. - Very effective, maybe as effective as CBT *_________-________ therapy (CBT) -10-12 sessions -Focus on ____ and ____, what's maintaining the disorder *right now?* -Identify dysfunctional thoughts and challenge them -Engage in behavioral activation -As effective as medications, and BETTER at preventing relapses and recurrences.

Behavioral Activation Cognitive-behavioral here and now

If you use medication and CBT simultaneously, vs medication vs CBT, anything with CBT has better outcomes. Why?

- People don't have the same coping skills who went through CBT - Learned skills on how to identify thoughts and behavior

Depressive Disorders: Psychotherapy Treatments * __________ Therapy (IPT) - Identify and change maladaptive interaction patterns with others - As effective as medications and CBT, but still early in the research - Comes out of the psychodynamic model. - -Idea behind this is that as depression is maintained by these problematic interpersonal relationships, IPT is focusing on helping you figure out how to have better, stronger, more fulfilling interpersonal relationships and getting rid of those 'excessive-reassurance seeking' and 'negative feedback seeking' issues.

Interpersonal

Manic Episode - Review *Criterion A: distinct period with abnormally elevated or _______ mood and goal‐directed activity lasting ≥ __ week * Criterion B: __ or more of: - Inflated self‐esteem/grandiosity - Decreased need for sleep - Talkativeness, pressured speech - Flight of ideas, racing thoughts - Distractibility - Increased goal directed activity or psychomotor agitation - Excessive involvement in pleasurable and risky behaviors * Clinically significant distress, impairment, hospitalization, or psychotic features * Not due to the physiological effects of a substance or another medical condition

irritable 1 3

Hypomania and Mixed Episode - Review * Hypomanic Episode - Same as Manic except: - At least __ days - -Noticeable by others, but not severe enough to cause marked impairment in functioning * Mixed Episodes - Meets criteria for both _____ Episode and _____ ________ Episode (except duration).

4 Manic Major Depressive

________ Disorders | -Characterized by a cycling of manic (hypomanic) and depressive episodes.

Bipolar

Bipolar I Disorder: * Criterion A: At least one ______ episode * Criterion B: Manic and major depressive episode(s) not better accounted for by another disorder. * Remember: - History of major depressive episode(s) [not required] - Symptoms must represent a major change from an individual’s normal mood or behavior.

manic (chances are, if you've had a manic episode, it is likely you will have a depressive episode --> you will cycle from up (mania) to down (depression))

Bipolar II Disorder: * Criterion A: Presence or history of ≥ 1 __________ episode AND ≥ 1 _____ _________ episode * Criterion B: Never experienced a _____ or _____ episode * Remember: - Hypomanic + depressive episodes - Symptoms must represent a major change from an individual’s normal mood or behavior

hypomanic, major depressive (think, Bipolar II need II things) manic, mixed

If you have ever had a manic episode, you CANNOT get a ________ __ diagnosis. If you've had a manic episode = bipolar __.

bipolar II (this is b/c manic trumps hypomanic) I

Cyclothymic Disorder *Criterion A: numerous periods of sub‐clinical __________ symptoms and __________ symptoms for __ years *Criterion B: No symptom‐free periods of __ months, and symptoms present *more than half the time* during 2 years *Criterion C: No ________, _____, or _________ episodes - Not better accounted for by another disorder - Not the result of a substance or other medical condition - Clinically significant distress, impairment **Hint: Think of it as the Bipolar equivalent to Persistent Depressive Disorder

hypomanic, depression, 2 years 2 depressive, manic, hypomanic

MDD is also known as ________ depression.

unipolar

Unipolar mania = you're meeting criteria for _____ but not quite meeting everything for _________.

mania, depression

Bipolar Disorder: Prevalence and Course * Prevalence - Bipolar I ‐ ~1% - Bipolar II ‐ ~1.1% - Cyclothymia ‐ ~2.4% * Gender Ratio - __:__ women to men * Average age of onset - Late adolescence ‐early adulthood – average 22 * Course - Episodic (swings in moods/typical functioning) * Comorbidity - Substance use disorders

1:1 (unlike depression)

Bipolar (mania + depressive) vs. Unipolar (just depressive) * Manic Episodes - Tend to be much [longer/shorter] than depressive episodes * Depressive Episodes (within a Bipolar diagnosis) - Tend to be [less/more] severe than unipolar depression and often have: - -Greater mood lability - -More psychotic features - -More substance abuse - -Greater psychomotor retardation * Overall episodes shorter than MDD, but greater number of episodes during their lifetime. - Rapid cycling – 3‐4 episodes within one year *Prognosis? Bipolar disorder: MANAGEMENT of the symptoms.

shorter more

Mood episodes within bipolar disorder going to be [more/less] severe and dysfunctional.

_______ disorder is one of the most *heritable* disorders.

Bipolar

Bipolar: Biological Factors * Genetic Factors - One of the most _______ disorders - No single ____ responsible * Neurochemical Factors - _________ Hypothesis - -LOW serotonin + HIGH norepinephrine and HIGH dopamine = bipolar disorder * Hormonal factors - Elevated _______ levels during depressive episodes - Thyroid hormone can precipitate manic episodes * Biological rhythms - Disruptions in _____ patterns can trigger manic episodes - Seasonal patterns also common

heritable gene Permissive cortisol sleep

What is the permissive hypothesis for bipolar disorder? _____ serotonin + _____ norepinephrine and ______ dopamine = bipolar disorder

LOW, HIGH, HIGH

Bipolar: Psychological Factors * Similar to unipolar disorders - Stressful life events - Personality - Cognitive patterns *Interpersonal processes very important -Dysfunctional family interactions often linked to onset of _____ episodes --High expressed emotion

manic

Cultural Considerations *Prevalence rates of unipolar depression _____ across countries * Less variability in rates of bipolar disorder - Due to stronger genetic vs. environment component? *Differences in symptom ________ -E.g., depression manifests as physical symptoms in Asian cultures

differ expression

Treatment Medications * Mood **stabilizers**: to keep people from fluctuating too much - _______ (incredibly effective, but very toxic) - Anti_________ (e.g., Depakote) - -Effective, but not as effective for suicidal ideation * Antidepressants - SSRIs - However, antidepressants can trigger manic episode

Lithium convulsants

Bipolar disorder does not ____. It's more about how we manage and keep people _______ over time.

remit, stable

Treatment - Other * Electro_________ Therapy (ECT) - Has been show to help with _____ episodes *Cognitive‐Behavior Therapy (CBT) -Good for ________ symptoms, not as effective for _____ symptoms *Interpersonal and ______ Rhythm Therapy -Taught how to recognize the effect of interpersonal events on their social and circadian rhythms and to regularize these rhythms

Electrconvulsive manic depressive, manic Social

Suicide *One of top __ leading causes of death -__th leading cause of death overall -3rd among 15‐19 y.o. -However, rates vary considerable across different countries * Gender - Attempts: [men/women] > [men/women] (3X) - Completions: [men/women] > [men/women] *Elevated rates in depressed individuals and other mentally ill -15% of those diagnosed with recurrent MDD

10 10th women > men men > women

Interpersonal Theory of Suicide 1) ________ to commit suicide "Fearlessness and pain tolerance." 2) Perceived ____________ "Others would be better off without me." 3) Thwarted __________ "Idea of isolation, part of a group/not accepted

Capability burdensomeness belongingness

Anxiety Disorders: Part 1

Yuh

***LESS THREAT*** 1) Worry - Primarily _______ - Future oriented 2) Anxiety - Emotional state - Three parts - -______ sensations - -________ - -________ 3) Fear - ________ state - Very _______ - Fight, flight, or freeze ***MORE THREAT***

thoughts Bodily Cognitions Behaviors Emotional specific

Anxiety Disorders: Commonalities *Unrealistic, ________ fears and anxieties of disabling intensity * Biological risks - 30‐40% genetic contribution (moderate) - __________ and startle response - Abnormal cortisol levels - _____ functioning abnormal (works to moderate brain structures associated with the fear response). - Personality --> behavioral inhibition

irrational Amygdala GABA

AnxietyDisorders: Commonalities * Psychological risks - Cognitive distortions - ________ sensitivity - Learning - Perceptions of uncontrollability *Comorbidity w/ other anxiety and mood disorders *Treatment – ________ Therapy

Anxiety Exposure

*General Models of Anxiety - Learning/behavioral perspective - -___________ learning (Relavent to specific phobias. If you see someone is afraid of a snake, you will likely learn to be afraid of the snake just by watching them. - -Aversive stimuli - Cognitive perspective - -Bias toward ______ (people w/ anxiety disorders tend to interpret things as being threatening) - ___________ perspective - -Anxiety disorders are theorized to allow us to disengage in current task to attend to danger

Observational threat Evolutionary

Specific Models of Anxiety 1) Triple vulnerability perspective (Barlow) - ________ vulnerability - General psychological vulnerability - ________ psychological vulnerability

Biological Specific

Specific Models of Anxiety 2) Learning/evolutionary perspective (Mineka) - Biological vulnerability - ________ and cultural *norms* - -Interpretation of stressful experience - --What are people around you doing? - --Is the situation controllable? *Biological + sociocultural = _________ processing

Modeling emotional

Specific Phobia *Criterion A: marked fear and anxiety about a specific ______ or ________ * Criterion B: Provokes ________ fear/anxiety * Criterion C: _________ behavior – or endured with extreme anxiety or fear * Criterion D: Disproportional fear/anxiety * Criterion E: Persistent ≥ 6 months * Criterion F: Clinically significant distress * Criterion G: Not better explained otherwise

object or situation immediate Avoidance

Specific Phobia *Lifetime Prevalence ~3‐12% based on type * Gender ratio - [male/female] > [male/female] - Except for blood‐injection‐injury * Comorbidity - __% have at least one other specific fear * Age of onset – varies - Early to middle childhood

female > male 75

Specific Phobia – Specific Risk Factors * Biological - 46‐59% heritability *Evolutionary preparedness * Behaviorism (i.e., learning theories) - ________ conditioning - -May or may not pair the obj./situation with the physiological response - ________ conditioning (very much maintains anxiety) - -If you are afraid of something, you are going to avoid it. By avoiding it, you are teaching your body that, yes this is something to be fearful of, and you should avoid it. The next time you encounter it, your anxiety will be even higher. - ___________ learning - -Little Albert. If a little kid sees someone be afraid of a roach, then the next time that kid sees the roach, he will be afraid. - Individual Differences? - -Experiences w/ various obj. or situations. - -Controllability - Inescapability

Classical Operant Observational

Specific Phobia ‐Treatment *________ Therapy – Primary behavioral technique * Systematic __________ - Gradual exposure to feared stimulus, while unpleasant, is not harmful and gradually dissipates - -Thinking about the spider - -Then seeing a picture of the spider - -Then going outside to see a spider. - -Then letting a spider crawl on you. -You do not leave systematic desensitization until your anxiety comes _____. * Flooding - Sometimes effective in one long session (e.g. 3 hours) - Completely - Being exposed to your anxiety for a long time and hope it sticks - -Ex: letting spiders crawl on you for hours. * Medications - Not very effective – can interfere with exposure. Why? - -B/c medication will make the exposure therapy less effective

Exposure desensitization down

_______ ______ Disorder: -Characterized by disabling fears of one or more specific social situations

Social Anxiety

Social Anxiety Disorder *CriterionA: marked fear/anxiety of ≥ __ social situations in which a person is exposed to possible _______ of others. *Criterion B: fears that anxiety symptoms will be obvious and subsequently _______ *Criterion C: social situation provokes anxiety or fear *Criterion D: avoided or endured with extreme anxiety or distress * Criterion E: Fear/anxiety disproportional * Distressing and not better explained otherwise.

1, scrutiny (fear of negative evaluation of others) judged

Social Anxiety Disorder *Lifetime Prevalence ~8% * Gender ratio - [Male/Female] > [Male/Female] * Comorbidity - >___% have another anxiety disorder in their lifetime - ≈50% experience _____ _________ - ≈33% abuse alcohol - Higher rates of unemployment, and lower SES * Age of onset - Typically early to mid‐adolescence

Female > male 50 major depression

Social Anxiety Disorder – Specific Factors * Biological - 51% heritability (moderate) - Overactive _____ (fight/flight system) = heightened reactivity to situations - Uninhibited _________ = increased emotional response * Evolutionary - Preserve ______ order. - -If you have someone who is socially anxious, what's the likelihood that they're going to be the leader/alpha of the group? Pretty low. - -S.A.D helps maintain social order of leaders and hierarchy. * Behaviorism (i.e., learning theories) - _______ conditioning - -By avoiding going into those social situations that cause anxiety, you are _________ reinforcing that anxiety, which makes it worse and perpetuates the problem. - Negative social events

insula amygdala social Operant negatively

Social Anxiety Disorder ‐ Treatments * ________ therapy (including CBT component) - This would involve going and talking to people --> if you have social anxiety, then treatment would be to go be ______. * Cognitive‐Behavioral Therapy (CBT) - Cognitive restructuring - -Identify maladaptive automatic thoughts - -Examine evidence for and against such a thought - -Hypothesis testing * Stress‐_________ training - "What are the worst things that could happen? Thinking of the worst case scenarios and explaining what will happen. So what? * _____ _____ training - Giving people the skills and tools to go into social situations - Medication - -Antidepressants – ____s (e.g., Paxil)

Exposure social inoculation Social skills SSRI

_____ Disorder: | -Characterized by panic attacks that "come out of the ____" and fears of having additional panic attacks.

Panic blue

``` Panic Attack -An abrupt surge of _______ fear or discomfort in which __ of the following symptoms develop abruptly and reaches a peak within minutes: -Palpitations of pounding heart -Sweating -Trembling of shaking -Shortness of breath -Feelings of choking -Chest pain or discomfort -Nausea or abdominal distress -Feeling dizzy, lightheaded, or faint -Chills or heat sensations -Derealization or depersonalization -Fear of losing control of going crazy -Fear of dying -Numbness or tingling sensations ```

intense 4

Panic Attacks * Expected - Occur in conjunction with a specific trigger - Trigger can be internal or external * Unexpected - Occur "out of the blue" - No particular _______ * *Panic disorder is _________. - An individual is **afraid** of having another _____ ______.

trigger unexpected panic attack

Panic Disorder: *Criterion A: recurrent _________ panic attacks *Criterion B: At least __ panic attack followed by at least __ month of: -_________ concern/worry about subsequent attacks -Significant maladaptive change in behavior related to attacks (e.g. designed to avoid panic attacks) *Not due to medical condition or physiological response of a substance *Not better explained by another mental disorder (usually other anxiety disorders).

unexpected 1 , 1 Persistent

Panic Disorder *Lifetime Prevalence ~ 4.7% * Gender ratio - __:__ --> female to male * Comorbidity - As high as __% will experience at least one other disorder - Other anxiety disorders, substance use disorders - 50‐70% experience ______ ________ * Age of onset - Early adulthood, not uncommon for women 30‐40s * Course - Chronic and often disabling – but symptoms can wax and wane

2:1 83% major depression

Panic Disorder– Specific Factors * Biological perspective - 48% heritability (Moderate) - Heightened ______ response to unpredictable threat - Hypothalamus * Behavioral perspective - Classical conditioning - -__________ conditioning (The idea is, if you were to go outside and take the outside stairs to the 4th floor, you're going to be a little winded at the top. And the behavioral model of panic disorder, from the standpoint of classical conditioning, suggests that the physiological sensation of being physically out of breath becomes conditioned to become the panic attack. * **Natural physiological responses become the conditioned stimulus to the panic attack.*** - Operant conditioning - -Negative reinforcement by avoiding whatever elicits a panic response, resulting in making it worse. * Cognitive - Predictions of ___________ - -People w/ panic disorder feel as though they cannot control anything around them.

startle Interoceptive uncontrollability

Agorophobia -Characterized by fear and avoidance of ______ places in which escape would be physically _______ or ________, or in which immediate help would be unavailable if something bad happened.

public difficult, embarrassing

Agoraphobia * Criterion A: marked fear/anxiety about ≥ __: - Using public transportation - Being in open spaces - Being in enclosed places - Standing in line or being in a crowd - Being outside of the home alone *Criterion B: fear/avoidance due to thoughts that escape might be difficult/embarrassing or help will be __________ should a panic attack occur *Criterion C: almost always provoke fear or anxiety *Criterion D: situations are avoided, endured with distress, or require the presence of a companion. *Disproportionate and not better accounted for

2 unavailable

Agoraphobia ‐ Common Situations - Crowds - Theaters - Malls - Parking lots - Cars - Bridges - Standing in line - Elevators - Airplanes - Home alone

Yuh

Panic Disorder and Agoraphonia ‐ Treatment * Medications - SSRIs (e.g., Prozac) - Benzodiazepines (Xanax, Klonopin) - -Upside: they're short acting and treat _________ intense responses - -Downside: they take away those immediate intense responses in the moment and get in the way of _________ therapy. Also highly _______. * Cognitive‐Behavioral Therapy (CBT) - ___________ exposure – targets panic attacks - -Having people experience these panic attack symptoms and then have them sit through it, talk about what's happening. - Exposure to external stimuli - __________ - -External --> situations, places and other things - Cognitive restructuring

immediate exposure addictive Introceptive agoraphobia

Summary *_______ _______ -Anxiety associated with a specific object or situation *_______ ________ ______ -Anxiety associated with the fear of negative evaluation within a social situation *___________ -Anxiety associated with the fear of being in a space/location in which panic symptoms will be embarrassing and/or help will be unavailable * _____ - Fear of fear – unexpected panic attacks

Specific Phobia Social Anxiety Disorder Agoraphobia Panic

Anxiety Disorders Part II and Obsessive-Compulsive and | Related Disorders

Yuh

*_________ ________ Disorder -Characterized by **excessive and unreasonable** anxiety or worry about many different aspects of life

Generalized Anxiety

Generalized Anxiety Disorder *Criterion A: excessive anxiety and worry occurring most days for at least __ months about a variety of things * Criterion B: difficulty controlling the worry * Criterion C: __+ symptoms for more days than not: - Restlessness or feeling keyed up - Being easily fatigued - Difficulty concentrating - Irritability - Muscle tension - Sleep disturbance › Anxiety/worry not confined to features of another mental disorder, or due to substances or other medical condition › Clinically significant distress or impairment in functioning

6 3

Generalized Anxiety Disorder * Prevalence - 3.1% in any 1-year period, 5.7% lifetime * Course - Tends to be ______ * Gender differences - __:__ ratio female to male * Age of onset - Varies * Comorbidity - Often co-occurs with other anxiety or mood disorders

chronic 2:1

GAD - Specific Factors *Biological › 15-30% heritability *Psychological › ________ ________ Model --Worry as a way to prepare for (or prevent) bad events --Worry as a way to reduce emotional response

Cognitive Avoidance

GAD - Specific Factors * Psychological - Perceptions of ___________ - -Vs. sense of mastery - Cognitive biases toward threat - -Hypervigilance (super sensitive to things that could be remotely threatening) - -Interpretation of _________ information that feeds into anxiety (the information coming to us is neither positive/negative, but people with GAD have this negative bias where they interpret that ambiguous information as being threatening). * Evolutionary interpretation? - It makes sense to have general anxiety to be consciously aware of surroundings for survival.

uncontrollability ambiguous

GAD - Treatment *Medications (target the immediate anxiety symptoms) › Benzodiazepines › Antidepressants (SSRIs, etc.) › Azapirones (influences serotonin) *Cognitive-behavioral treatment › Muscle relaxation/relaxation training › Cognitive restructuring › ______ exposure (ex: you get 5 minutes to worry about everything you want) * Acceptance and Commitment Therapy - Mindfulness

Worry

Obsessive-Compulsive and Related Disorders * Obsessive-Compulsive Disorder * Hoarding Disorder * Body Dysmorphic Disorder

Yuh

Obsessive-Compulsive Disorder: -Characterized by the reoccurrence of _________ and intrusive _________ thoughts or distressing images; often accompanied by compulsive behaviors to cope with such thoughts.

unwanted obsessive

Obsessive-Compulsive Disorder *Criterion A: presence of _________ or ________, or both * Criterion B: marked distress, time-consuming, or interfere with _________ - Not attributable to physiological effects of a substance or another medical condition - Not better explained by the symptoms of another mental disorder

obsessions, compulsions functioning

OCD - Obsessions *Obsessions › Recurrent and persistent _______, impulses or images › Intrusive and ________ › Typically cause marked anxiety or distress › Attempts to ignore, suppress, or neutralize them with some other thought or action (often _________) ``` *Common Obsessions › Contamination fears › Fears of harming oneself or others › Pathological doubt › Need for symmetry › Sexual content › Religious content ```

thoughts unwanted compulsions

OCD - Compulsions *Compulsions are defined by: › Repetitive behaviors or mental acts the individual feels driven to perform in response to an ________ › Aimed at ________ or reducing distress › Or to avoid some dreaded event or situations › Behaviors/mental acts NOT realistically tied to what they are targeting › Common Compulsions - Cleaning - Checking - Repeating - Ordering/Arranging - Counting - Hoarding

obsession preventing

OCD *Prevalence › 2-3% and 1.2% (lifetime and 1 year) *Gender Differences › ____ *Age of onset › Late adolescence/ early adulthood *Course › Gradual onset, tends to be ______, symptom severity waxes and wanes *Comorbidity › Other mood and anxiety disorders › Body Dysmorphic Disorder? › Higher rates of divorce and unemployment

None chronic

OCD - Specific Factors ``` *Biological › Heritability (moderate) › Response inhibition -Behaving abnormally › Difficulty ___-_______ -Difficulty paying attention to one thing, then moving to something else, then moving back. ``` * Evolutionary interpretation? - High _____________ to make sure everyone is where they need to be (following stars, buffalo, etc.)

set-shifting conscientiousness

OCD - Specific Factors *Behavioral › Mowrer’s (1947) Two-Process Theory of Avoidance Learning -Classical and Operant conditioning -Mowrer proposed that OCD is initiated and maintained by both C.C and O.C. -You end up w/ this neutral stimulus from C.C that gets paired w/ some ___________ response (fear, anxiety, etc.) and so you end up with this pairing, this neutral stimulus that gets paired with this problematic thought or physiological anxiety reaction. But that's not enough...what's going to maintain that is that you're engaging in behaviors that are going to increase your anxiety. -Your __________ are sometimes termed, "safety behaviors," b/c there's so much distress and anxiety w/ experiencing the obsession that people are engaging in these other behaviors to decrease that anxiety and then they do...so the belief that these compulsions will work means that they work...so then what happens? People keep engaging in the compulsions every time they have the _________. * Cognitive - _______-______ fusion - -It's the idea that your thoughts and actions are linked. - --t's like if you write on the board, "My husband is going to get hit by a car," that by writing it on the board, it will increase the chances that it will actually happen. By my putting it out there and writing it out on the board, I have somehow **linked** that thought with the actual probability of the event happening. - _______ _________ - -The idea is that people don't like to have these obsessions. They are distressing, and awful, and they don't like them. So one thing people do is that they try to suppress these obsessions. They try really hard not to think about the obsessions. But what happens if I tell you not to think of a white bear? You can only think of a white bear. "I can't think about contamination and germs..." You end up thinking about it more. - _________ biases/distortions - -If someone has contamination concerns, what we see is that they are cognitively bias to notice things that are related to contamination (dirty floors, dirty door knobs, people sneezing) but they're also interpreting things that are consistent w/ their OCD pathology.

physiological compulsions obsession Thought-action Thought suppression Cognitive

OCD - Treatment *Medication › Medications that affect _______ systems (SSRIs) --Minor improvements in symptoms, but many non-responders --When discontinued – ________ in symptoms tend to be very high

serotonin relapse

OCD - Treatment *Behavioral and Cognitive-Behavioral › Exposure and ________ prevention -Response being that compulsion...So we're trying to break that link and give them something else that they can do, in the moment, that's more adaptive then engaging in their compulsive behavior - -Very intense for clients, drop out rates high - -Studies suggest 50-70% reduction in symptoms - -75% maintain gains long term *Best is a combination of medication + CBT

response -Response being that compulsion...So we're trying to break that link and give them something else that they can do, in the moment, that's more adaptive then engaging in their compulsive behavior

Body Dismorphic Disorder: -Characterized by obsessions about some perceived or imagined ____ or _____ in one’s appearance to the point one firmly believes he/she is disfigured or ugly.

flaw, flawsq

Body Dysmorphic Disorder *Criterion A: preoccupation with ________ defect in **appearance** *Criterion B: engaged in _________ behaviors or mental acts in response to their concerns. * Clinically significant distress/impairment * Not better explained by an eating disorder

imagined repetitive

Body Dysmorphic Disorder * Prevalence - ~2% of general population - 8% among people with MDD * Gender Ratio - Men = women (?) - Not a lot of data, but we think it's close to 50/50 * Age of onset - Usually adolescence * Comorbidity - High rates of comorbid _________ (50%), _________ behavior - Relationship to eating disorders, OCD, psychosis (delusions)

depression, suicidal

BDD – Specific Factors * Cognitive - Biased attention - Self-_______ about how appearance is very important * Sociocultural - Values of attractiveness and beauty? - -There is an argument that society focuses on beauty and aesthetic more than they used to, which has lead to an increased risk of developing BDD.

schemas

BBD - Treatment * Treatment - __________ (high doses) -Cognitive behavioral therapy: focus on distorted perceptions, response prevention --E.g. Wear something that highlights their perceived flaw rather than hides it and prevent checking responses (e.g., looking in the mirror)

Antidepressants

_________ Disorder: -Characterized by persistent difficulties discarding or parting with possessions, regardless of their actual _____.

Hoarding value

Hoarding Disorder *Originally thought to be a ____ symptom *Compulsive Hoarding occurs in about 10-40% diagnosed with OCD -However as many as 4/5 (80%) show ONLY compulsive hoarding --> unique diagnosis * Prevalence - 2-5% in the general population

OCD

Hoarding Disorder *Criterion A: difficulty _______ or parting with possessions, regardless of their actual _____ › Perceived need to _____ the items and distress associated with discarding them › Accumulation of possessions that congest and clutter active living areas, and compromises its use. › Clinically significant distress or impairment › Not attributable to another medical condition or better explained by another mental disorder

discarding, value save

Hoarding Disorder *Compulsive hoarders are significantly more impaired than those with OCD without compulsive hoarding symptoms (occupationally and socially) *Significant risk for accidents such as fire and falling, as well as poor sanitation, and other serious health problems * Poorer prognosis - This means that people w/ hoarding disorder are less likely to go into remission from treatment then people w/ OCD. - -So in a sense, they're ______ off. * Causal Factors? * Treatment - Medications – typically not effective - CBT – Exposure w/ response prevention? - -Home visits

worse

OCD - Spectrum Summary *__________-________ Disorder › Obsessions, compulsions, or both that are associated with 'thought-action fusion' *_____ _________ Disorder › Preoccupation with imagined deficit in appearance *________ Disorder › Persistent difficulties discarding possessions to an extent that the accumulation is hazardous

Obsessive-Compulsive Body Dysmorphic Hoarding

Anxiety and Depression Overlap -Few, if any, forms of depression occur in the absence of _______ --60% with ____ have 1+ lifetime anxiety disorder -Share irritability, restlessness, withdrawal

anxiety MDD

Helplessness-Hopelessness Model *Anxiety and depression share expectation of uncontrollability (____________). *Differ in negative outcome expectancy (___________).

helplessness hopelessness

- Anxiety = ___________ | - Depression = ____________ and __________

helplessness helplessness and hopelessness

_______ usually precedes depression.

Anxiety

Trauma and Stress Disorders

Yuh

What Is Stress? * Definition of stress - _______ placed on an organism (i.e., stressors) - Biological and psychological responses to demands * Psychological stress - Internal versus external stress - Positive (_______) vs. Negative (______)

Demands eustress, distress

Negative Stress Response Factors * Genetic - MAOA gene - -Associated with _________ - Serotonin transporter gene - -If you have two short versions of the serotonin transporter gene, the amount of stress you experience will increase your risk of _________. * Psychological - Negative attribution bias will increase negative outcomes of stress - Poor coping skills - -So what you do when you feel stressed out or overwhelmed * Environmental - Early life stress - Lack of resources

aggression depression

Positive Stress Response Factors * Optimism * Self-esteem * ______ support

Social

The Stress Response * Sympathetic-adrenomedullary (SAM) system 1) ___________ stimulates sympathetic nervous system 2) Adrenal medulla secretes __________ and noradrenaline 3) ______ _____ increases

Hypothalamus adrenaline Heart rate

The Stress Response *Hypothalamic-pituitary adrenocortical (HPA) system 1) ___________ releases corticotropinreleasing hormone (CRH) 2) CRH stimulates _______ gland, which secretes adrenocorticotropic hormone (ACTH) 3) Induces the adrenal cortex to produce stress hormones (_______)

Hypothalamus pituitary cortisol

Model of Chronic Stress * _________ ________ _______ - First we are at homeostasis, then there is a stress. Next there is the alarm phase where your body gets ready for the stress. So typically, the threat phase comes in, we experience the alarm phase, and then go back to homeostasis. But now days, there is constantly a stress of something (deadlines, bills, expectation of working more hours, etc.), we see this alarm stage happen, but then nothing changes. So now your body is in this stress-response system and your HPA system continues to function and function, and after a while, your body has nothing left. This is where we see people have stress related illness/symptoms b/c your body can only handle so much. * ________ - -The ability of your body to achieve stability through change. Your body trying to stay stable while your stress system is going out of whack.

General adaptation syndrome Allostasis

The Immune System *There is a link between stress and suppression of the immune system -Wounds heal slower when stressed -Depression associated with decreased immune functioning -Transition from HIV to AIDS more rapid in individuals with high stress -Stress associated with cardiovascular disease

Yuh

Stress and Gender * ____: Flight or flight - Sympathetic activation - Testosterone - Aggression * _______: Tend and befriend - More ___________ response - Oxytocin - Quiet and calm

Men Women parasympathetic

Psychophysiological Disorders ``` *Physical problems related to psychological factors (e.g., stress) ``` *E.g., Irritable bowel syndrome, headaches, sleep disorders, hypertension, coronary heart disease *“Psychological factors affecting other ________ conditions”

medical

Psychological Factors Affecting Other Medical Conditions *Criterion A: ________ symptom/condition present *Criterion B: ___________ factors adversely affect the medical condition (need 1) -Influence the course -Interfere with medical treatment -Constitute additional health risks -Influence pathophysiological, precipitating or exacerbating symptoms, necessitate medical attention *Criterion C: not better explained by another mental disorder

medical psychological

Treatment of Stress-related Physical Disorders * When asked about treatment of stress-related disorders, it's always ________!!! - Most of these psychophysiological disorders, once you develop them, they're there and you can't back up. So our best treatment is _________. If you develop them, it's all about how you ________ the symptoms *Psychological interventions - *Biological Interventions

PREVENTION manage

Psychological Interventions (9m35s) * Relaxation training - ____________ breathing - Meditation (physiological benefits, calm focus for a persistent length of time) * Biofeedback - What is the best coping mechanism for you based on your biofeedback? * Stress management - __________ (being present in the moment, not getting distracted by the past or things you have to do in the future) - -Experiencing what you're experiencing in the moment. Don't think it's a feeling of calm and happiness, it's about feeling what you're feeling. * Support groups * Cognitive-behavior therapy

Diaphragmatic Mindfulness

Biological Interventions (14m10s) * Surgery - Heart disease --> not a fix, temporary fix for a problem that's out of hand *Medication (lipid lowering meds, aspirin or other anticoagulants) -______ thins the blood, to decrease risk of heart attack/stroke *Antidepressants

Aspirin

Stress in the DSM-5 *Trauma and Stress-Related Disorders -Post-Traumatic Stress Disorder -Acute Stress Disorder -Adjustment Disorder -Other Specified Trauma and Stressor-Related Disorder -Unspecified Trauma and Stressor-Related Disorder - Reactive Attachment Disorder - Disinhibited social engagement disorder

Yuh

***Less Stress*** - __________ Disorder - _____ Stress Disorder - Post-traumatic Stress Disorder ***More Stress***

Adjustment Acute

Post-Traumatic Stress Disorder -Characterized by intrusive memories to a ________ event, emotional withdrawal, negative cognitions and mood, and heightened autonomic arousal.

traumatic ***cognitive, emotional, physiological component

Post-Traumatic Stress Disorder (17m50s) *Criterion A: exposure to actual or threatened death, serious injury, or sexual violence & fear-based response **MUST have had a ____________ EXPERIENCE * Criterion B: Re-experiencing (≥1) * Criterion C: Avoidance (≥1) * Criterion D: Negative cognitions or mood (≥2) * Criterion E: Arousal (≥2) * Symptoms must last > 1 ______ * Cause distress or impairment in functioning

TRAUMATIC month

PTSD Criteria (18m55s) *Criterion B: Re-experiencing (1+) -Recurrent intrusive distressing ___________ -Recurrent distressing ______ (related to trauma) -Dissociative reactions (Flashbacks) -Intense psychological distress at exposure to trauma linked _____ related to the trauma -Physiological reactivity to exposure to cues

recollections dreams cues

PTSD Criteria (20m57s) *Criterion C: Avoidance (1+) -Efforts to ______ distressing memories, thoughts or feelings about the trauma --Not letting people talk about these topics, avoiding specific people, places, things, etc. -Efforts to avoid external reminders (activities, people, places that remind about trauma)

avoid

PTSD Criteria (21m35s) *Criterion D: _________ alterations in cognition or mood (2+): -Inability to remember important aspects of the trauma -Exaggerated negative beliefs or expectations about oneself (e.g., I am bad, no one can be trusted) -Distorted cognitions about the cause of consequences of the traumatic event –blaming oneself or others

Negative

PTSD Criteria (23m35s) * Criterion E: Marked alterations in arousal or reactivity associated with traumatic events (2+) - Irritability or outbursts of anger - Reckless or self-destructive behavior - ____________ - -They are at heightened awareness looking for threat - Exaggerated ______ response - Difficulty concentrating - Difficulty falling or staying _______

Hypervigilance startle asleep

Post-traumatic Stress Disorder (26m40s) - Prevalence - ~ 8.7% lifetime - 10-31% for _______ * Gender differences - __:__female to male * Age of Onset - _____ b/c you have to have the traumatic experience and it can happen at anytime * Comorbidity - __________ and ________ disorders * Course - Chronic, although symptoms can wax and wane

veterans 2:1 Varies Depression and anxiety

Types of traumas (28m30s) - natural disaster - motor vehicle accident - explosion/fire - warfare or combat - unexpected death - life threatening illness - rape - child abuse - sexual assault - family violence - robbery - stalking - assault with a weapon - abortion * Does having a trauma mean you will develop PTSD? - ???

No - just experiencing a trauma does not mean you will develop PTST

Causal, Risk, and Protective Factors (30m40s) *In what conditions is trauma more likely associated with PTSD? * Is the traumatic event sufficient? - Nature of the stressor - Individual risk factors - -e.g., personality, comorbidity, lack of social support

Interpersonal violence tends to have a higher transition rate to PTSD than other things

Causal, Risk, and Protective Factors (32m10s) * Is the traumatic event sufficient? - Appraisals (cognitive factors) - How are we ________ about the event? That will impact the way in which we respond to the stressor. - -e.g., signs of weakness, people will be ashamed *Biological factors -E.g., Serotonin-transporter gene, Hippocampus (memory) * Protective Factors - Good ________ ability - -Being able to reflect and think about things - --How accurate are your thoughts about the experience

thinking cognitive

Recent Findings (33m40s) *Based on data from ~22,000 military personnel who served in conflicts in Iraq or Afghanistan * Pre-deployment mental health disorder - 1+ disorder 2.52x more likely to screen ________ for PTSD upon return * Injury during deployment - Risk increases with injury severity

positive

Treatment of PTSD (34m54s) *Evidence-based treatments: -Cognitive-Behavioral Therapy (CBT) --Want to decrease the physiological/hypervigilence response ○ Relaxation techniques ○ __________ therapy– in-vivo or imagination (PE) -Re-exposing people to their traumatic event, over and over and over --> The more you're exposed to something, the less stressful it will be. -On the other hand, the more you avoid it, the worse it will become. ○ ________ _________ Therapy (CPT) -How do you process your thoughts about the traumatic experience? -Medications ○ Antidepressants (SSRIs) – effectiveness?

Exposure Cognitive Processing

_______ ______ Disorder (42m30s) *Similar to PTSD -Often less severe in symptom presentation -Occurs within __ weeks of the trauma, lasts >3 days and <30 days

Acute Stress 4

__________ Disorder (44m15s) *A psychological response to a common stressor (e.g., divorce, death, job loss) that results in clinically significant behavioral/emotional symptoms * Symptoms occur within __ months of the stressor onset * Distress or dysfunction present, but you don't have any of the severe symptoms from PTSD **AD is the leave severe

Adjustment 3

Summary * How we _______ a stressor will affect how stressful it is * Stress can impact not only mental health, but _______ health as well * Prevention and stress management is key to avoiding more serious problems

appraise (assess the value or quality of) physical

True or false: | -There is no such thing as a manic disorder.

True

Exam 2 Flashcards

(150 cards)