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MENTAL HEALTHA LOOK AT SOME SPECIFIC CONDITIONS

Anxiety Disorder: PhobiaAaaaaarrrrggghhhh PEACHES!

The Biopsychosocial Framework

ContributingCognitive modelBehavioural modelPsychodynamic modelManagementCBTSystematic desensitisationfloodingContributingSympathetic arousalGABAManagementBenzodiazepines anti depressants ContributingEnvironmental triggerParental modellingTransmission of threat infoManagementNon fear modellingAccurate info

Anxiety disordersAnxiety physiological arousal, feelings of apprehension, unease, worry that something bad is about to happen

Anxiety disorder chronic feelings of anxiety, distress, nervousness, apprehensionLevel of anxiety is so severe that it interferes with everyday lifeMany different types of anxiety disorders

What is a phobiaEveryone is afraid of things, mostly these things are not classed as phobiasPhobias are INTENSE and IRRATIONALCharacterised by an unreasonable fear directed towards a particular object, situation or eventPhobias effect the lives of sufferers

Specific phobia specific situation object or eventThe thing they are afraid of is referred to as the phobic stimulus

DSM phobia categoriesAnimals

Situations

Blood / injections

Natural environments

Other (choking, dying, illness, falling etc)

How many phobias?Traditional phobia names use a Greek prefixMost specific phobias are not listed in the DSM as there are literally too many to listSimply classified as specific phobias

ICD -10 uses the term specific interchangeably with isolated

Some phobias are less specific eg. Agoraphobia These are referred to as complex phobias Anglophobia- Fear of England or English culture

Tyrannophobia- Fear of tyrants

Specific phobiaExposure to the phobic stimulus causes an anxiety responsePanic attack intense anxiety, dizziness, short of breath, tight chest, disorientation, feeling of no controlSYMPATHETIC AROUSAL!

Know that the fear is irrational Feel compelled to avoid the phobic stimulusAnticipatory anxiety can also occur if they think about encountering the phobic stimulus

Biological factorsSome evidence for genetic inheritance predisposition, not a guarantee of a disorder

Sympathetic arousal closely related to stress response, and thus also to phobic response

Problem is that stress response is being elicited with no real threat to the organismThe role of Gamma-amino-butyric acid.GABANot enough Yo gaba gaba makes me anxious!

GABAGamma-amino butyric acid is the primary inhibitory neurotransmitter in the CNS.Inhibits postsynaptic neurons stops them passing on the neural impulse

Helps fine tune brain activity, keeps neural transmission from getting out of control

Without GABA neural activation could spread like fire throughout the brain causing seizures glutimate2nd most common neurotransmitter in the brainExcitatory neurotransmitterMakes postsynaptic neurons more likely to pass on the neural impulseGets the post synaptic neuron excited so it requires less stimulation to make it fire

Also plays a role in learning and memory, strengthening synaptic connections

GABA

Stop the message!GLUTIMATE

Get the message going!GABA and anxietyLack of the neurotransmitter GABA might lead to over stimulation, and thus heightened anxiety

Benzodiazepines a class of drugs that calm down neural activity. Valiam, Xzanax, Rohypnol, Serepax etc.All drugs are either Agonists mimic the activity of a neurotransmitterOr Antagonists inhibit the activity of a neurotransmitterBenzodiasepines - agonists Mimic the activity of GABA in inhibiting post synaptic neural activityEffective in the management of anxiety disorders

So anxiety disorders might be the result of a dysfunctional GABA system, not making enough neurotransmitterOne study showed that anxiety disorder sufferers have 22% less GABA than healthy individuals

Conversely studies show that antagonists can increase anxiety

GABA supplements?GABA like substances found in many foods, supplements also available from health food retailersUnlike drugs that are specifically manufactured for the purpose, there is no evidence that supplements can penetrate the blood brain barrierThe blood brain barrier is a kind of filtration system that only allows certain substances into the brainPapaphobia- Fear of the Pope

Behavioural modelPhobias are learned

Learned through classical conditioning or observational learning

Maintained through operant conditioningBehavioural model Watson and little albert

Arachnophobia UCS spider in sandpitUCR fearNS spidersCS spidersCR fear

Avoidance of spiders or spider related places, images etc is negatively reinforcing, avoiding the bad stimulus.This strengthens further avoidance behaviours Cognitive modelFocus is on thinkingHow do people process informationHow do they think about the phobic stimulus

Key assumption people with phobias have a cognitive bias a tendency to think in a way that involves errors and bad judgement and decision makingCognitive model attentional biasSeek out and notice threatening stimuli over normal stimuliEg. Arachnophobias might notice a spider web in the corner while everyone else is looking at the painting on the wall Tend to be hyper vigilant always looing out for the phobic stimulus

Cognitive model memory biasRemember the bad things more readilyEg. Only remember being dumped by a big wave, not the hundreds of small waves that were enjoyable to jump overMemories reconstructed to be worse than the actual event

Cognitive model interpretive bias Neutral situations or stimuli interpreted as threateningEg. Fluff on the carpet is a spider, a dog running over happily is going to attack

Cognitive model catastrophic thinkingNegative thinking in which things are percieved in the worst possible lightWhat can go wrong will go wrong, and in a big wayOften underestimate their ability to cope with the situation

Socio-cultural factors specific environmental triggersTraumatic event involving the phobic stimulusFear learned through classical conditioningFear persists through operant conditioning

Research shows that the more severe the trauma the more likely it is that a phobia will developIf the trauma is severe enough only one experience is necessary (unlike normal CC where repeated pairings are needed)

Not a complete explanation, some people do not develop phobias despite severe traumaSocio-cultural factors parental modellingChild who observes an extreme fear reaction from a parent may imitate the same reaction

Modelling bravery can help children cope with fears

Socio-cultural factors transmission of threat informationDelivery of information from others about potential threatChildren might develop a phobia if constantly warned about the dangers of going outside alone

Research suggests that fears develop largely due to negative information about a specific event, object or situation being communicated often enoughLutraphobia- Fear of otters

Cognitive behavioural therapyCognitive therapy thinking therapy, aims to address the problems in cognition that contribute to negative emotions and behavioursBehavioural therapy application of classical, operant and observational learning to address behavioural aspects of a disorderAim to retrain the person so that good behaviours become automatic

Key assumption the way that people think influences the way that they feel. Thus changing the thinking can be helpfulCognitive behavioural therapyCBT is focused in the presentRecognition that past events shaped nowHowever focus of CBT is changing the current trend in thinking and behaving

Client taught to identify unhelpful thoughts and to shift thinking to more balanced helpful thoughts

Makes the client responsible for their thoughts rather than being a victim of themCBT and phobiasTries to develop a new understanding of the phobic stimulus

Identify anxiety related thoughts and cognitive biasesLook at evidence that supports/rejects these biasesSwitch from unhelpful irrational thoughts to evidence based rational thoughts

CBT behavioural component Behavioural component aims to address maladaptive behaviours that are a part of the conditionBehavioural experiments go on a plane and notice that it did not crash! steps in behavioural componentMake a predictionReview the evidence for and againstDevise an experiment to test thisNote the resultsDraw conclusions

CBT behavioural componentSystematic desensitisationAttempts to replace fear response with relaxationpatient taught relaxation techniques gradually introduced to fear inducing stimulus while practicing relaxation.

Fear hierarchy CBT behavioural componentFloodingExpose the patient to their fear straight awayThey will panic at first

Soon realise that nothing bad has happened

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