Abnormal psychology
L1: Anxiety Disorders
Anxiety disorder: unrealistic, irrational fears or anxieties that cause significant distress or
impairments in functioning.
• Disorders have time durations required (6 months)
Defining fear and anxiety
Fear: is an alarm reaction that occurs in response to immediate danger.
Anxiety: involves a general feeling of apprehension about possible future danger.
When does anxiety turn into anxiety disorder?
When the anxiety or fear is unrealistic, irrational.
Phobia: a persistent and disproportionate fear of some specific object or situation that presents
little or no actual danger and leads to a great deal of avoidance of these feared situations.
The three main categories of phobias are:
1. specific phobia: present if a person shows strong and persistent fear triggered by a
specific object or situation and leads to significant distress and/or impairment in a
person’s ability to function.
• people with specific phobias recognize that their fear is somewhat excessive or
unreasonable.
2. social anxiety: characterized by disabling fears of one or more specific social situations.
• a person fears that she may be exposed to the potential negative evaluation of others act in
an embarrassing or humiliating manner. people with social anxiety either avoid these
situations or endure them with great distress.
3. agoraphobia: An intense fear of being in open places or in situations where it may be hard
to escape
Panic disorder: characterized by the occurrence of panic attacks that often seem to come “out
of the blue.”
Panic attack: an abrupt wave of intense fear or intense discomfort that reaches a peak within
minutes, and during which time four (or more) of the following symptoms occur:
1. pounding heart. 2. Sweating. 3. shaking. 4. Sensations of shortness of breath.
5. Feelings of choking. 6. Chest pain or discomfort. 7. Nausea or abdominal distress
Panic attacks are fairly brief but intense, the attacks often subside in 20 to 30 minutes and
rarely last more than an hour. They are often “unexpected”.
L2: contributors to Anxiety and Treatment
Signs and Symptoms of Anxiety
• Feeling nervous - sense of impending danger. - increased heart rate
• Breathing rapidly. - Feeling weak or tired. - Difficulty concentrating
• trouble sleeping - Experiencing gastrointestinal (GI) problems
Biological Contributions to Anxiety and Panic
• Genetic vulnerability
• Anxiety and brain circuits
• Limbic system and the septal-hippocampal systems (a set of structures in the brain that
controls emotion. It contains regions that detect fear)
Social contribution: stressful life event.
The cycle of anxiety
Anxiety -> Avoidance -> short term Relief from Anxiety -> long term anxiety growth
Specific phobias: Causes and treatment
Causes: direct experience – traumatic conditioning – cultural factor – biological and
evolutionary vulnerability.
Treatment: cognitive behavior therapy is highly effective – exposure is critical
Exposure therapy
• Developed to help people confront their fears.
• The exposure to the feared objects, activities, or situations in a safe environment helps
reduce fear and decrease avoidance.
• Avoidance might help reduce feelings of fear in the short term, but over the long term it
can make the fear become even worse.
Exposure therapy can also be paced in different ways:
• Graded exposure: begins with mildly or moderately difficult exposures, then progress
to harder ones.
• Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult
tasks.
• Systematic desensitization: exposure can be combined with relaxation exercises to
make them feel more manageable and to associate the feared objects with relaxation.
There are several variations of exposure therapy:
• In vivo exposure: Directly facing a feared object
• Imaginal exposure: Vividly imagining the feared object
• Virtual reality exposure: technology is used when in vivo exposure is not practical.
• Interoceptive exposure: deliberately bringing on physical sensations that are feared but
harmless.
Exposure therapy helps in several ways:
• Habituation: reactions to feared objects or situations decrease.
• Extinction: Exposure can help weaken previously learned associations between feared
objects.
• Self-efficacy: help show the client that he/she is capable of confronting his/her fears and
can manage the feelings of anxiety.
L3: Obsessive Compulsive Disorder
Two criteria
1. Obsession and compulsions
• Recurrent and persistent thoughts or images that are experienced, at some time
during the disturbance, cause marked anxiety or distress.
• The individual attempts to ignore or suppress thoughts or images, or to
neutralize them with some other thought or action (by performing a
compulsion).
2. Compulsion Definition
• Repetitive behaviors or mental acts (repeating words silently).
• The individual feels driven to perform in response to an obsession.
• The function of compulsion is to STOP something from happening.
DSM 5 Definition of Compulsion: The behaviors or mental acts are aimed at preventing or
reducing anxiety or distress or preventing some dreaded event or situation.
Five primary types of compulsive rituals:
Cleaning
checking
repeating
ordering or arranging
counting
Time Criterion: The obsessions or compulsions are time-consuming (more than 1 hour per day)
cause clinically significant distress in important areas of functioning.
Cause: theory of avoidance learning (1947) = neutral stimuli become associated with
frightening thoughts or experiences.
Example: shaking hands might become associated with the idea of contamination. (COVID)
A cognitive bias: is a systematic error in thinking that occurs when people are processing and
interpreting information in the world and affects the decisions and judgments that they make.
L4: Cognitive Behavioral Therapy
CBT: based on the assumption that emotions, behaviors, and physiological responses are
influenced by thoughts and beliefs.
Core Beliefs: fundamental, inflexible, and generalized beliefs that people hold about
themselves, others, the world, or the future
Formed when interaction with the world and other people happened.
Core beliefs influence automatic thoughts.
Automatic thoughts influence emotion and behavior
Automatic thought: happened spontaneously in response to a situation.
Occur as words or images +No logical sequence +Hard to turn off and articulate.
Goals of CBT therapy= to help client learn to recognize the negative patterns of thought and
replace them with healthier way of thinking.
Stages to change beliefs/thoughts
1. Identify Beliefs and Automatic Thoughts. (Ask questions+ detailed description +Visualize
the situation+ Recreating a situation through role-play).
2. Evaluate Beliefs and Automatic Thoughts
• Socratic Questioning + Assess the outcome of the evaluation.
3. Teach the client to respond to dysfunctional Beliefs and Automatic Thoughts.
Previous automatic thought (therapy notes)
new automatic thought (automatic thought record)
Alternative Methods to Evaluate Automatic Thoughts
1. Behavior Experiments (ask a patient to carry a behavior to test the validity of a thought
or belief)
2. Acting as if (asks the client to consider how she would behave if her thoughts were
different.)
Cognitive Distortions: thinking patterns that are neither based on evidence nor logic.
Catastrophizing: predicting the worst outcome
Personalization: considering oneself responsible for events outside one’s control.
Dichotomous Thinking: interpreting events as either black or white.
Additional techniques in CBT
Reforcing - making decisions- graded task assessment- self comprehension and credit list.
L5: Bipolar Disorder
Bipolar Disorder I: Alternations between full manic episodes and major depressive episodes
• Average age of onset is 15 to 18 years
• Can begin in childhood
• Tends to be chronic
• Suicide is a common consequence
Bipolar Disorder II: Alternations between major depressive and hypomanic episodes
• Average age of onset is 19 to 22 years
• Can begin in childhood
• 10% to 25% of cases progress to full bipolar I disorder
• Tends to be chronic
Features of bipolar II disorder include the following:
• Presence (or history) of one or more major depressive episodes
• Presence (or history) of at least one hypomanic episode
• No history of a full manic episode
• Mood symptoms are not better accounted for by another mental disorder
• Clinically significant distress or impairment of functioning
Manic Episode: A period of abnormally and persistently elevated, irritable mood lasting at least
1 week.
• inflated self-esteem, decreased need for sleep and excessive talkativeness.
• The mood disturbance is severe enough to cause impairment in normal functioning or
requires hospitalization.
Hypomanic episode: Shorter, less severe version of manic episodes lasting at least 4 days.
• Have fewer and milder symptoms
• Associated with less impairment than a manic episode (e.g., Less risky behavior).
“Mixed features” = term for a mood episode with some elements reflecting the opposite
valence of mood.
Example: depressive episode with some manic features.
Cyclothymic Disorder: Chronic version of bipolar disorder.
• Alternating between periods of mild depressive and mild hypomanic symptoms.
• Episodes not meet the criteria for full major depressive episode, full hypomanic, or full
manic.
• Must last for at least 2 years (1 year for children and adolescents).
• Common among females.
Treatment of mood disorder
Antidepressants Fluoxetine (prozac)
Tricyclic antidepressants. Lithium: a common salt - Treatment of choice for bipolar disorder
Electroconvulsive Therapy (ECT)
Effective for medication-resistant depression
A brief electrical current is applied to the brain that results in temporary seizures.
Side effects:
Short-term memory loss, which is usually restored
Some patients suffer long-term memory loss
Mechanism is unclear
Psychosocial Treatments
Cognitive-behavioral therapy: Addresses cognitive errors in thinking
Interpersonal psychotherapy: Focus in improving problematic relationships
Prevention: Preemptive psychosocial care for people at risk.
Has longer-lasting effectiveness than medication
Psychotherapy is helpful in managing the problems that accompany bipolar disorder
Family therapy can be helpful
The Nature of Suicide: Risk Factors
Suicide in the family Pre-existing psychological disorder
Alcohol use and abuse. Stressful life events, especially humiliation
Suicide Prevention
In professional mental health
Preventative programs for at-risk groups
The clinician does a risk assessment
Important: removing access to lethal methods
Clinician and patient develop a safety plan
If you think someone is at risk, talk to them and ensure
In some cases, sign a no-suicide contract
they’re getting needed support.
L5: Mood disorders
Two main categories of mood disorders
1. unipolar depressive disorder: a person experiences only depressive episode.
2. bipolar disorder: a person experiences both depressive and manic episodes.
Depressive episode: loses interest in formerly pleasurable activities for at least 2 weeks, as well
as other symptoms such as changes in sleep or appetite, or feelings of worthlessness.
Depressive mood: It usually involves feelings of extraordinary sadness.
Key Signs of bipolar
• Having inflated self-esteem, thinking you're invincible. (euphoria) more talkative than usual.
• Having racing thoughts (called a “flight of ideas”)
• Increased activity, energy
• Decreased need for sleep.
• Distractibility
Unipolar depressive disorder
1. major depressive disorder
2. persistent depressive disorder
Recurrence: onset of a new episode of depression, occurs in approximately 40 to 50 percent of
people who experience a depressive episode.
Psychotic Features
Delusions are fixed, false beliefs that conflict with reality.
If a person is in a delusional state, they can’t let go of their untrue convictions, despite contrary
evidence.
Lifetime prevalence: the proportion of a population who, at some point in life has ever had the
characteristic.
Unipolar depression nearly 17%
Bipolar disorder nearly 1%
Suicide Risk: suicidal behavior exists at all times during major depressive episodes.
• The most described risk factor is a past history of suicide attempts or threats.
remember that most completed suicides are not preceded by unsuccessful attempts.
• The presence of borderline personality disorder markedly increases the risk of future
suicide attempts.
Catatonia: a state of muscular rigidity or other disturbance of motor behavior such as
overactivity.
L6: Schizophrenia and other psychotic disorders
Schizophrenia: a severe disorder that is often associated with considerable impairments in
functioning.
Disturbed thought, emotion, behavior Lack of emotional expressiveness
Disturbances in movement or behavior Untidy appearance
Psychosis: Gross departure from reality.
which may include:
Hallucinations: Sensory experiences in the absence of sensory input (hearing voices).
Delusions: Rigid, inaccurate beliefs that persist in the face of evidence to the contrary.
• Lifetime prevalence ~1%
• Affects men slightly more often than women
• Onset typically late adolescence or early adulthood
• Signs of the disturbance persist for at least 6 months.
Avolition: lack of motivation or ability to do tasks or activities that have an end goal.
Clinical description of schizophrenia
Three major clusters of symptoms:
• Positive: symptoms that are added on to a person’s experience (hearing voices)
• Negative: symptoms that are taken away or reduced (lack of motivation, diminished affect)
• Disorganized: incoherent and illogical thoughts and behaviors (Inability to organize ideas)
Other psychotic disorders
• Schizophreniform Disorder: Same symptoms as schizophrenia ( 1 month)
• Brief Psychotic Disorder: triggered by extreme stress, symptom duration 1 day to 1 month.
• Schizoaffective Disorder: symptoms of a major mode episode.
Risk factors
biological : not likely that disorder is caused by a single gene
environmental : (Dopamine Theory) Disorder due to excess levels of dopamine.
Note: I skipped the neurotransmitter part from slide 46 to 55
Environmental Factors
• Damage during gestation or birth
• Obstetrical complications rate high in patients with schizophrenia
• A reduced supply of oxygen during delivery may result in loss of cortical matter.
Brain structure and function: Viral damage to fetal brain Presence of parasites called
toxoplasma gondii.
Treatment for schizophrenia
1.Medication
First-generation antipsychotic medications (1950s)
Phenothiazines (Thorazine), butyrophenones (Haldol), thioxanthenes (Navane)
Reduce violent behavior + Block dopamine receptors + Maintenance dosages to prevent relapse
Second-generation antipsychotics Newer medications may improve cognitive function:
Clozapine (Clozaril) Olanzapine (Zyprexa)
Impacts serotonin receptors Risperidone (Risperdal)
Fewer motor side effects
Reduces relapse
2.Cognitive behavioral therapy: Recognize and challenge delusional beliefs.
3. Cognitive remediation training or cognitive and enhancements therapy (CET)
4. Social skills training
5. Family therapy
