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DSM: Diagnostic and statistical manual of mental disorder
Classification system
Symptoms
Used universally, mainly in the US
Psychologist, psychiatrists etc.
Anxiety:
general feeling of distress without any immediate danger or threat
great apprehension about possible future dangers
Can’t specify what danger is/what they are afraid off
response absent of visual danger → panic attack → like fear and subjective sense
doom, loose control, die, insane
More common in women
cognitive subjective level: negative mood, worry possible future threat, self preoccupied,
unable to control
physiological level: tension and chronic overarousal→ risk deal dangereous situation →
prepare person for it
Does not produce fight or flight response
Behavioral level: avoid situation of danger encountered but no immediate urge
→ mild/ moderate level adaptive and performance better
chronic and severe→ maladaptive and inhibit performance
most common source for fear is conditioning when an initial neutral stimulus is associated
with negative xeperience
Fear: basic emotion, escape from immediate danger
Activates fight or flight response
alarm reaction
source of danger known
Similarities between anxiety and fear
Behavioral component→ urge to flee because of Threat
Cognitive/subjective components (“I feel afraid”)
Anxiety - anticipation of future threat
Fear - perceived threat
Behavioral components
o Anxiety - avoid situation/feelings
o Fear - urge to escape
Strong fear triggered by presence of specific object/situation
faced phobia→ immediate fear and interfere with daily activity
E.g. claustrophobia
Go to great lengths to avoid phobia
Drop in blood pressure and heart rate, display nausea and dizziness
F. fear, anxiety causes clinically significant distress/ impairmeb´nt of social, occupational and
other improtant areas of functioning
G. the diaturbance is not better explained by another mental disorder
Prevalence/ age of onset / gender differences
Childhood (blood-injection-injury, animals)
Adolescence/early adulthood (claustrophobia, driving phobia)
More common in women
Psychological causal factors ( why does it occur )
, Conditioning
o Classical conditioning (experiencing)
o Vicarious conditioning (observing someone else)
o Operant conditioning (reward and punishment)
Psychoanalytic view - defense against anxiety which stems from repressed impulses
from id
Modeling (how parents react)
Evolution ( causes and influences )
Prepared learning: evolutionary preparedness for certain phobias
o Snakes, water, heights
Biological factors ( causes and influences )
Genes
o S allele: neurotic (more sensitive to fear and development of phobia)
Twin study: monozygotic twins more likely to share phobia than dizygotic twins
Treatments
Exposure therapy: controlled exposure to phobic stimuli→ break association fear
and object
o Participant modeling: observe clinician being exposed to object/sit.and model
appropriate behavior → show fear irrational
o Systematic desentization: practice breathing exercises & fear hierarchy after
teach → expose least fearful to most fearful
o use relaxation techniques to calm the patient
o fear and relaxation can not occur at the same time → learn replace fear with
relaxation
o vivo exposure: presence object in person **
o Imaginal exposure: imagining the object or situation → less intensive and less
effective
o Flooding: exposure to most feared object/situation - no fear hierarchy
o use vivo/ imaginal exposure
o more intensive and more likely client drop out of treatment
Medication
o Does not seem to be effective
o Can enhance effects of exposure therapy
Social Phobia ( Social anxiety disorder )
Fear individuals face in a social situation
Feared of being negatively evaluated or criticised→ worry anxiety smptoms
apparent to others
sign anticipatory fear days or weeks before social event occur
Focused on themselves, internalized
Try to avoid social situation or endure them
Speaking in public, eating in front of others etc.
,
Prevalence/ age of onset / gender differences
More common in women
Begins in adolescence
Comorbidity: 50% suffering from social phobia also suffer from depression
Persistent: 12 year study - 37% recovered
Psychological causal factors ( why does it occur )
Learned behavior: direct of vicarious classical conditioning
Cognitive biases
o Expect to be rejected and to become negatively evaluated (internalized danger
schemas)
o Amygdala shows greater activation to negative faces
Evolution ( causes and influences )
Dominance hierarchy
Biological factors ( causes and influences )
Genetics and interaction environment and temperaments
o High heritability (30%)
o Neurobiological structures:
3. Amygdala→ store memory related to emotional events
o fearful situation HPA axis triggered by amygdala prepare for immediate
action→ fight or flight
2. hippocampus and prefrontal cortex: pathway activated fear stimulus
send signal to hippocampus and PFC→ determine if threath is imagined or real
o Environment plays a more important role
o Behavioral inhibition: specific characteristics - introversion and neuroticism
Treatments
Exposure therapy→ encoruage engage in social situations which cause anxiety
clinicina start role lay various social situations in safe environment
patient get used to it→ go outside and start talking to strangers in public places
(practice outside of therapy as well)
Medication
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