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psychoanalytic psychotherapy
purpose to uncover unconscious mental processes
countertransference
therapists project their own personal issues or feelings onto the patient
multidimensional integrative approach
biological (genetics)
psychological (behavioural/cognitive processes)
emotional (emotional responses)
social/interpersonal (interactions with others)
behavioural (conditioned responses to situations)
steps of vicarious learning
attention (noticing the model's behaviour)
retention (remembering the model's behaviour)
reproduction (exhibiting the model's behaviour)
causes of anxiety
biological influences (genetic predisposition)
psychological influences (helicopter parents)
social influences (stressful events)
general anxiety disorder criteria
A. excessive anxiety and worry, occurring more days than not for at least 6 months B. individual finds it difficult to control the worry C. 3 of:
restlessness
being easily fatigued
difficulty concentrating
irritability
muscle tension
sleep disturbance
general anxiety disorder causes
runs in families
4 cognitive characteristics of people dx-ed:
intolerance of uncertainty
positive beliefs
poor problem orientation
cognitive avoidance
heightened sensitivity to threats
general anxiety disorder treatment
benzodiazepines (short-term benefits but high risk)
antidepressants (effective with fewer side effects)
psych treatment (effective in short-term AND better in long-term)
CBT (approach rather than avoid threats)
mindfulness and ACT
panic disorder criteria
A. recurrent unexpected panic attacks - abrupt surge of intense fear or intense discomfort that peaks within minutes plus 4 of the following symptoms occur:
palpitations, pounding heart, fast heart rate
sweating
trembling or shaking
sensations of shortness of breath or smothering
feelings of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, light-headed, or faint
chills or heat sensations
paresthesia
derealization or depersonalization
fear of losing control, "going crazy", or dying B. at least one of the attacks has been followed by 1+ month of one or both of the following:
persistent concern or worry about additional panic attacks or their consequences
a significant maladaptive change in behaviour related to the attacks
agoraphobia criteria
A. marked fear or anxiety about 2 or more of the following 5 situations:
using public transportation
being in open spaces
being in enclosed spaces
standing in line or being in a crowd
being outside of the home alone B. the individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms C. the agoraphobic situations almost always provoke fear or anxiety D. the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety E. the fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations, and to the sociocultural context F. the fear, anxiety, or avoidance is persistent, typically lasting for 6+ months
panic and agoraphobia causes
after an unexpected panic attacks or like sensations
vulnerable to anxiety about possibility of another panic attack
normal body sensations interpreted catastrophically
treatment of panic and agoraphobia
medication: benzodiazepines, SSRIs, SNRIs
psychological intervention: panic control treatment/interoceptive exposure, exposure-based interventions
combined psychological and drug treatment: stepped care approach
specific phobia criteria
anxiety about a specific object or situation
almost always provokes immediate anxiety
actively avoided or endured with intense fear or anxiety
out of proportion to the actual danger posed
6+ months
specific phobia contributing factors
traumatic experiences
vicarious experiences
panic attack
social and cultural factors
higher rate in women
specific phobia treatment
exposure-based exercises (modify neural pathways in amygdala, insula, cingulate cortex)
virtual reality exposure therapy
social anxiety disorder criteria
A. marked fear or anxiety about 1+ social situations where scrutiny by others possible B. fears show anxiety symptoms or being negatively evaluated
almost always provoke fear or anxiety
avoided or endured with intense fear or anxiety
out of proportion to the actual threat
6+ months
social anxiety disorder causes
biological vulnerability
biological tendency to social inhibition
conditioned panic attack in a social situation
experience of a difficult social experience
social anxiety disorder treatment
cognitive-behavioural group therapy
virtual reality therapy
SSRIs
somatic symptom disorder criteria
A. 1+ somatic symptoms that are distressing or result in significant disruption of daily life B. excessive thoughts, feelings, and behaviours related to somatic symptoms or health concerns as manifested by at least 1 of:
disproportionate and persistent thoughts about the seriousness of symptoms
persistently high level of anxiety about health or symptoms C. although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically 6+ months)
somatic symptom disorder clinical description
severe pain exacerbated by psychological factors
leads to anxiety and distress
may not be a clear physical reason for pain
DSM-5 emphasizes psychological symptoms
illness anxiety disorder criteria
A. preoccupation with having/acquiring serious illness B. somatic symptoms are not present or are mild if present. the preoccupation is clearly excessive or disproportionate C. there is a high level of anxiety about health, easily alarmed about personal health status D. performs excessive health-related behaviours or exhibits maladaptive avoidance E. illness preoccupation present for 6+ months
somatic symptom and illness anxiety disorder causes
enhanced perceptual sensitivity to illness cues
interpret ambiguous stimuli as threatening
genetic causes
negative life events
"attention seeking" through illness
somatic symptom and illness anxiety disorder treatment
hard to treat
CBT (reduces stress, minimize help-seeking behaviours, relating to others)
conversion disorder criteria
A. 1+ symptoms of altered voluntary motor or sensory function B. clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions C. the symptom or deficit is not better explained by another medical or mental disorder
obsessive-compulsive disorder criteria
A. presence of obsessions, compulsions, or both:
obsessions are defined by (1) and (2):
recurrent/persistent thoughts, urges, or images that are intrusive and cause marked anxiety or distress
attempts to ignore/suppress/neutralize such thoughts, impulses, or images with some by performing a compulsions
compulsions are defined by (1) and (2):
repetitive behaviours or mental acts driven to perform in response to obsession or rigid rules
behaviours/mental acts used to prevent/reduce distress, or a dreaded event or situation; however, they either are not realistically connected with what they are designed to neutralize or are clearly excessive B. obsessions or compulsions are time-consuming or cause clinically significant distress or impairment
vicious cycle of ocd
obsessive thought --> anxiety --> compulsion --> temporary relief --> obsessive thought etc
obsessive-compulsive disorder causes
thoughts regulated by brain circuits
early experiences ("thought-action fusion")
thought suppression leads to compulsion
body dysmorphic disorder criteria
A. preoccupation with 1+ defects or flaws in physical appearance that are not observable or appear slight to others B. at some point, the individual performs repetitive behaviours, or mental acts in response to the appearance concerns
body dysmorphic disorder causes and treatment
insufficient information on psychological or biological predisposing factors
SSRIs
CBT: exposure and response prevention
Note 
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