260 Lecture Slides

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:
1. intolerance of uncertainty
2. positive beliefs
3. poor problem orientation
4. 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):
1. recurrent/persistent thoughts, urges, or images that are intrusive and cause marked anxiety or distress
2. attempts to ignore/suppress/neutralize such thoughts, impulses, or images with some by performing a compulsions
- compulsions are defined by (1) and (2):
1. repetitive behaviours or mental acts driven to perform in response to obsession or rigid rules
2. 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