Anxiety and Depression

Do Now

• Compare/contrast anxiety and depression– How would diagnosis differ?– How might different perspectives approach these disorders?

Anxiety Disorders

• Generalized Anxiety Disorder • Panic Disorder• Obsessive-Compulsive

Disorder• Post-traumatic Stress

Disorder• Phobias (Social, Specific)

Generalized Anxiety Disorder (GAD)

• “free floating anxiety”

• In addition to subjective stress, often accompanied by physical symptoms (muscle tension, et cetera)– Think sympathetic and parasympathetic

Panic disorders

• Panic attacks: several minutes of extremely intense feelings of terror, racing heart, faintness, and/or sensations of choking

• Unlike phobias, no obvious stimuli (can be induced in lab by caffeine or carbon dioxide)

• Unlike OCD, can’t stem off of rituals

Fear, Anxiety and Phobia

- Fear is a response to a specific present stimulus. - Anxiety is a state of worry about vague, unidentified, or

future dangers. - - An excessive or inappropriate fear is called a phobia.

Some common phobias:

Acrophobia Fear of heights Monophobia Fear of being alone

Ailurophobia Fear of cats Mysophobia Fear of dirt

Algophobia Fear of pain Nyctophobia Fear of the dark

Aquaphobia Fear of water Ocholophobia Fear of crowds

Arachnophobia Fear of spiders Thanatophobia Fear of death

Astraphobia Fear of lightening Triskaidekaphobia Fear of the number 13

Claustrophobia Fear of enclosed places

Xenophobia Fear of strangers

Cynophobia Fear of dogs Zoophobia Fear of animals

Hemaophobia Fear of blood

Phobias• Population: 14 Million adults• Characteristics

– Intense, irrational fear of a particular object or context• Cultural dependency of phobias

– Kyofusho• In Japan, many people suffer from a vicious cycle of self

examination and reproach which can occur in people of hypochondriacal temperament

• report a fear of offending or harming other people. The focus is thus on avoiding harm to others rather than to oneself

• The role of the amygdala– Processing fearful stimuli– The role of the prefrontal cortex

• Planning behaviors

OCD• Population: 2-3 million• Characteristics

– Irrational, reoccurring thoughts, that can lead to repetitive behaviors

– Feeling that person lack’s control over thoughts, rationality

– Compulsion: unreasonable or excessive acts that reduce the unpleasant tension associated with obsession)

• OCD is associated with the neurotransmitter, serotonin

PTSD• Uncontrollable and

painful reliving of traumatic experience– More often related to

repeated over single event• Extent and frequency of

exposure key

– Can co-occur with several non-anxiety disorders

• EX: depression, alcoholism

Mood Disorders

• Depression– Major depressive disorder

(very intense, at least 2 weeks)

– Dysthymia (less severe, at least 2 years)

• Often, major depressive episodes superimposed over chronic dysthymia

• Seasonal Affective Disorder (SAD)

• Bipolar (manic-depression)– Major bipolar disorder– Cyclothymia (less severe)

What are the symptoms of Depressive Disorders?

Primary Symptoms• Sadness• Self-Blame• Sense of Worthlessness• Absence of Pleasure• Helplessness

Other Symptoms• Changes in sleep patterns• Changes in appetite• Agitated motor movements (Pacing, hand-wringing)• Retarded motor movements (Slowed speech and movements)• Social withdrawal, and decline of previous interests and abilities

Psychological Mechanisms in Depression• Locus of control

– Stable, global, internal attributions for failure

• Learned helplessness (Seligman’s dogs)

– behavioral - wouldn't escape when could

– emotional - listless and frightened

– cognitive - trouble learning new tasks

• Vicious cycle1. Stressful experiences2. Negative explanatory style3. Depressed mood4. Cognitive and behavioral

changes

Genetic Mechanisms in Depression

What causes Depressive Disorders?BiologicalFactors

SituationalFactors

Cognitive Factors Depression Itself

Depression may result when there is too little activity at brain synapses that use monoamine transmitters (dopamine, norepinephrine, seratonin). Depression is especially associated with low seratonin levels Studies have found a small genetic component to depression.

Serious losses that permanently change the nature of one’s daily life can bring on depression. A depressed mood can be an adaptive response in an evolutionary sense to some situations.Depressed people can behave in ways that bring on stressful life events.

Aaron Beck’s Negative Triad: Depressed people have negative views about themselves, the world, and the future. Seligman’s theory of Learned Helplessness: depressed people tend to attribute problems to stable and global factors (depressive attributional style)Abramson’s Theory of Hopelessness: depressed people believe that desirable outcomes will not occur, only undesirable ones will.

Depressed thinking leads to depressed actions, which leads to a depressed mood, which leads to depressed thinking which leads to depressed actions… Depressed people have lower social skills and elicit negative reactions from others.

SAD• Seasonal Affective Disorder

(SAD)– Associated with seasonal

changes in sunlight

– most prevalent nearer the poles

• successfully treated with bright fluorescent bulbs during last few hours of sleep

Bipolar Disorder• Bipolar disorder and cyclothymia• Manic phase associated with elation, energy, confidence

– Also associated with irrational thoughts and behaviors (risk taking, spending sprees, absence from work)

– Some people become extremely irritable and suspicious during manic phase

• In cyclothymia, actual enhanced ability and creativity– In serious bipolar disorder, disorganization of thought and action offsets any

benefits of enhanced creativity– People who suffer through hypomania score higher on “openness to experience”– Much of the research on bipolar disorder and creativity is questionable because

it has not been replicated and relies on anecdotal cases

Causes for Bipolar Disorders

• Biological factors

- Bipolar disorders have a higher genetic component than depressive disorders.

- Evidence suggests that a low level of norepinephrine can lead to depression and a high level to mania.

• Other factors- Manic periods are thought to be a protective defense against the debilitating depressive periods.

- Manic behavior may be caused by low self-esteem.

Suicide• Mindset:

– “The will to survive and succeed and been crushed and defeated… there comes a time when all things cease to shine, when the rays of hope are lost”

• Characteristics– 50-80% attempted by people who are depressed, but most

depressed people never attempt suicide– Third-highest cause of death for 15-24 year-olds

• Boys: fewer attempts, 4x greater success rate• Much higher rate for whites, Native Americans

– Can be rooted in guilt/shame that seems external and permanent

– Suicide ideation• Difference between thought and action

Personality Disorders• "Chronic, inflexible, maladaptive pattern of perceiving, thinking, and

behaving that seriously impairs an individual's ability to function in social or other settings"– Ten recognized by APA, some overlap in symptoms– for instance, obsessive-compulsive personality disorder is

overconscientious, perfectionist, inflexible, preoccupied with details (not the same type of obsessions and compulsions as OCD)

• difference is in degree and range of symptoms– the personality disorders don't include all of the characteristics of

the label disorders– The personality disorders don't exhibit tendencies that are as

severe as other disorders

Personality Disorders Examples

• Paranoid personality disorder - constantly suspicious, perceive threat in innocuous situations

• Histrionic - "drama queens" - need constant attention and engage in dramatic shows of emotion to get it

• Narcissistic - self-important, egotistical, entitled, exploitative, manipulative

• Antisocial - lie, cheat, steal, fight, etc.; low empathy or guilt; "psychopath or sociopaths"