PSY 211 Unit 2 Anxiety Disorders and Mood Disorders (OER) Reading #1 and #2 Anxiety Disorders Anxiety Disorders-You guessed it. These disorders are characterized by anxiety symptoms (e.g., trembling, fear, dread, sweating, etc.) It is important to note that anxiety involves both physical and psychological symptoms. Recall the “fight or flight” response that you learned in general psychology. Those with chronic anxiety issues (e.g., constant worry) are always in a state of “alarm” in which they experience an increased heart rate, trembling, sweating, etc. Now, consider the impact on how one’s functioning will be affected in day to day life (e.g., irritability, sleep problems, concentration problems, etc.) because of the constant autonomic arousal. No fun!!! a) Specific Phobia-This involves having an irrational fear of a specific stimulus (e.g., spiders). What makes the fear irrational is that the person’s fear response (anxiety) is disproportionate to the actual danger of the stimulus—meaning that the person is getting way too upset about this stimulus. This is different than just being afraid of something—the fear response is much more significant (e.g., racing heart, a desire to get away from the feared stimulus). There can be many different types of specific phobias. People may develop phobias of blood, animals, lightning, etc. Here is a great video on treating a snake phobia with exposure therapy. b) Social Anxiety Disorder (Social Phobia)-This involves the fear of engaging in a behavior while in the presence of others. The individual is afraid of embarrassment or judgement. The most common social phobia is public speaking. You will most likely have to take this class!! Other examples might include walking, eating, or signing one’s name in front of others. c) Panic Disorder-This disorder involves the experience of panic attacks. A panic attack’s symptoms mimic those of a heart attack and so many persons end up in the ER during their first attack. Some individuals also develop something termed Panic Disorder with Agoraphobia. In this disorder individuals start to fear having panic attacks in public places (e.g., Walmart, church, school). As a result, they may start to avoid these places. So, over time, they end up limiting where they go. In some cases, those with the disorder refuse to leave the home and stay away from public places for many years. Now, let’s talk about a behavioral treatment method known as Exposure Therapy-This technique is often used to help people overcome fears/phobias. There are different types. Flooding involves direct exposure to a feared stimulus. So, a clown phobic would have to approach a clown and shake his hand. Gradual Exposure would involve “baby steps.” So, a clown phobic might first be separated, say 30 feet from a clown. Each day, the clown would come closer until the clown phobic could interact with him. Here is the link to a very good video on exposure therapy: d) Generalized Anxiety Disorder-This has been termed the “worry disorder.” It is characterized by chronic worry about either real and or imagined events that could occur. Those with this affliction worry incessantly—meaning as soon as they are finished worrying about issue A they move onto issue B and then C, etc. e) Obsessive-Compulsive Disorder-This disorder is comprised of two main symptoms. Obsessions—Intrusive thoughts that create intense psychological pain. The classic obsession is the idea that after having touched something one believes that they are now “contaminated.” Compulsions-These are repetitive behaviors or rituals one performs in response to obsessions. So, an individual who believes that they are contaminated would feel the need to wash. They will wash, possibly for a long period of time. There may be some temporary anxiety reduction, however the anxiety returns. For instance, the individual who has just washed may think: “Oh no I just touched the dirty faucet—I have to wash again.” Here is a very brief video highlighting the symptoms of this disorder: Now, let spend some time discussing an effective behavioral treatment method for OCD. It is termed: Exposure and Response Prevention. The first part of the treatment involves exposing the OCD patient to the things they fear most (e.g., touching several things that they believe are dirty or contaminated). Then, after exposure, the second phase of treatment, response prevention occurs. This involves preventing the patient from engaging in their usual response. In this case it would likely be hand-washing. So, we would refuse to allow them to wash. Over time, their anxiety should fade and they will start to learn that they can touch things and that they will be just fine. Body Dysmorphic Disorder-This disorder involve a preoccupation with an imagined physical defect. A person sees a problem that does not exist. A person with this disorder might state “My ear is gigantic—look away.” Despite reassurance that they look fine (and they do) they believe the defect is real. Hoarding Disorder-I imagine many of you have seen the TV program that highlights this disorder. This involves the inability to throw things away. It results in a massive accumulation of things a person believes they might need someday. It can be unsanitary and unsafe to reside in such a home. Note: OCD, Body Dysmorphic Disorder, and Hoarding Disorder are classified by the DSM-V under the heading “Obsessive Compulsive and Related Disorders.” Posttraumatic Stress Disorder-This disorder develops in response to the experience of a traumatic event (see the reading for the details). Symptoms include: a) Intrusive thoughts about the past event -These are thoughts about the event that the individual experiences that are obviously not wanted. b) Nightmares of the event. c) Flashbacks-A type of dissociative state in which an individual feels as if they are re-living the event. Please note that the DSM V has classified PTSD as a Traumatic Stress Disorder, a separate and distinct category outside of the Anxiety Disorders. Reading #3 Mood Disorders Mood Disorders-These disorders impact how we feel. Below is what is called a mood continuum. This continuum shows you how mood can vary across the spectrum, from low to high. Mood Continuum Low-----------------------------Normal----------------------------High (Major Depression) (Mania) “Clinical Depression” --episodes of both depression and mania— ”Bipolar Disorder” So, the low end of the spectrum is Major Depression or Major Depressive Disorder, while the high end is mania. Those with mania have episodes of depression as well—a disorder we call Bipolar Disorder or Manic Depression. Each is described below. Major Depressive Disorder-The predominant symptom here is sad mood or dysphoria. However, there are many different symptoms. Some of these include appetite disturbances, (e.g., eating too much or the loss of appetite), sleep problems, (e.g., excessive sleep known as hypersomnia), difficulties with concentration/attention, inappropriate guilt, (e.g., feeling guilty about an event that occurred 10 years ago and has since been resolved), hopelessness, helplessness, anhedonia (a loss of interest in previously enjoyed activities), psychomotor retardation (slowed movements such as in walking), and psychomotor agitation (e.g., fidgeting). Of significant concern in this illness is suicidal ideation and suicidal intent. Suicidal ideation refers to thoughts or ideas about suicide (e.g., “I wish I would fall asleep and not wake up.”), while suicidal intent refers to how motivated one is to carry out a suicidal act. So, consider the statement “I have a plan and will act on it soon! This would have to be taken seriously as it suggests a strong motivation for suicidal behavior. Now, there different forms of treatment for this disorder. Cognitive Therapy is used to treat those with depression. Dr. Aaron Beck developed Cognitive Therapy for Depression that involves modifying a patient’s negative thinking which leads to depression. This therapy targets 3 main areas of thought: self, world, and future. So, a depressed individual may have negative thoughts about the self (e.g., “I am no good”), the world (e.g., “No one is nice in this world”), and the future (e.g., “Things will never get better”). The idea here is to identify and replace negative and irrational thinking with more appropriate self-talk. Medical Treatments You have all likely heard of the different antidepressant medicines that are on the market (e.g., Prozac, Zoloft, Paxil). Now—let’s get a bit technical here. Serotonin is an important neurotransmitter which governs our mood. It is thought to be too low in depressed persons—not enough is being produced and released into the synapses of the brain. Recall from general psychology that once a neurotransmitter is released into the synapse and binds to the dendrites of the next neuron the process of reuptake occurs and the neurotransmitter is pulled back into the sending neuron for future use. SSRI (Selective Serotonin Reuptake Inhibitors) drugs (e.g., Prozac) block the reuptake of serotonin in the synapses of our brain. So, by blocking reuptake you end up with more serotonin that is available for use and one’s mood should improve. There are two other medical treatments: 1) Electroconvulsive Therapy (ECT)-This is a treatment that is used when medicines and therapy have failed. It involves the administration of an electrical current that is passed through the brain. The voltage must be intense enough to create a seizure. Temporary memory loss may result. This technique is not foolproof and may not work. Here is a good video highlighting the procedure: 2) Transcranial Magnetic Stimulation This is a newer treatment that involves passing an electromagnetic current through one’s brain. Seriously! Watch this video Here is the link to an excellent video which highlights the etiology, symptoms, and treatment of Major Depression. Bipolar Disorder-This disorder involves fluctuating mood states. Specifically, one’s mood shifts between depression (the lowest form of mood) and mania which is characterized by a mood state called euphoria). In euphoria (the highest form of mood), one feels great or “on top of the world.” However, with this symptom come others that are of significant concern. These include: a) Reckless behavior in which an individual engages in activities that place themselves or others in danger (e.g., driving their car way too fast). b) Excessive energy—those with this disorder will speak rapidly and may not sleep for 3 or 4 nights in a row. c) Psychotic states where the individual loses contact with reality—For instance they may become delusional (having false beliefs) and state: “I have written a book that will cure all mental illnesses.” Now, some individuals can experience what is termed hypomania. Essentially, hypomania is a lowered form of mania that is not as severe as a full-blown manic episode. There may be increased energy, however psychotic symptoms are unlikely. There are two forms of Bipolar Disorder: a) Bipolar I Disorder—Involves episodes of depression and mania. Note: Mania is required but depression may not be present, but it usually is. b) Bipolar II Disorder—Involves episodes of depression and hypomania. Bipolar Disorder is treated with medications. One of the most common is Lithium. Here is the link to an excellent overview of this disorder: Here is another brief informative video: 2 Other important Disorders Persistent Depressive Disorder also termed Dysthymic Disorder or Dysthymia. This involves a chronic low-grade depression that lasts for at least two years. It is a milder form of Major Depression. Individuals with this disorder are “down” and may not seem happy to others. They may not even realize that they themselves are depressed! Cyclothymic Disorder (Cyclothymia)-This disorder involves episodes of hypomania and depression. It is a milder form of Bipolar Disorder. Some with this disorder may be capable of putting their energized state into productive use (e.g., cleaning the house). Other Issues: a) Transient Depression--This is a day or two of the “blues.” It is normal and common. b) Double-Depression—This occurs when an individual experiences Persistent Depressive Disorder and periodic bouts of Major Depressive Disorder. This is a problem, because when their Major Depression lifts, they return to the Persistent Depressive Disorder (Dysthymic) state. Thus, they are always depressed.