Chapter 11: Psychological Chapter 11: Psychological Intervention for Sports Injuries Intervention for Sports Injuries

and Illnessesand Illnesses

Jennifer L. Doherty, MS, LAT, ATCJennifer L. Doherty, MS, LAT, ATCAcademic Program Director, Entry-Level ATEPAcademic Program Director, Entry-Level ATEP

Florida International UniversityFlorida International UniversityAcute Care and Injury PreventionAcute Care and Injury Prevention

Psychological and sociological consequences of injury Psychological and sociological consequences of injury can be as debilitating as the physical aspects of an injurycan be as debilitating as the physical aspects of an injury

Sports medicine team must have an understanding of Sports medicine team must have an understanding of how psyche, emotions and feelings enter into the how psyche, emotions and feelings enter into the treatment processtreatment process

Each athlete will respond in a personal wayEach athlete will respond in a personal way Must insure physical and psychological healing before Must insure physical and psychological healing before

returning to playreturning to play Role of personality and injuries must also be taken into Role of personality and injuries must also be taken into

considerationconsideration

Athletes Psychological Response Athletes Psychological Response to Injuryto Injury

Athletes deal with injury differentlyAthletes deal with injury differently– Viewed as disastrous, an opportunity to show Viewed as disastrous, an opportunity to show

courage, use as an excuse for poor courage, use as an excuse for poor performance, escape from losing teamperformance, escape from losing team

Severity of injury and length of rehabSeverity of injury and length of rehab– Short term (<4 weeks)Short term (<4 weeks)– Long term (>4 weeks)Long term (>4 weeks)– Chronic (recurring)Chronic (recurring)– Terminating (career ending)Terminating (career ending)

No matter the length of time, three reactive phases No matter the length of time, three reactive phases occuroccur– Reaction to injuryReaction to injury– Reaction to rehabilitationReaction to rehabilitation– Reaction to return to play or termination of careerReaction to return to play or termination of career

Other matters that must be considered are past Other matters that must be considered are past history, coping skills, social support and personal history, coping skills, social support and personal traitstraits

Injury may impact a number of factors socially and Injury may impact a number of factors socially and personally and emotions may be uncontrollable personally and emotions may be uncontrollable

The Athlete and the The Athlete and the Sociological Response to InjurySociological Response to Injury Following long term rehabilitation the athlete may feel Following long term rehabilitation the athlete may feel

alienated from the teamalienated from the team Views of involvement and interaction with coaches and Views of involvement and interaction with coaches and

athletes may be disruptedathletes may be disrupted Relationships may become strainedRelationships may become strained

– Athletes may pull away as injured athletes are a Athletes may pull away as injured athletes are a reminder of potential harm that can come to themreminder of potential harm that can come to them

– Friendships based on athletic identification may be Friendships based on athletic identification may be compromisedcompromised

– Remaining a part of the team is critical - less isolation Remaining a part of the team is critical - less isolation and guilt is feltand guilt is felt

Athlete and Social SupportAthlete and Social Support Support can be supplied by organization or others that have gone Support can be supplied by organization or others that have gone

through similar rehabthrough similar rehab– Need to prevent feeling of negative self-worth and loss of identityNeed to prevent feeling of negative self-worth and loss of identity– Stress the importance of remaining a teammateStress the importance of remaining a teammate

Athlete/Athletic trainer relationship is keyAthlete/Athletic trainer relationship is key– Must be developed, strengthened and maintainedMust be developed, strengthened and maintained

Sports specific drills must be incorporated in rehab (ideally during Sports specific drills must be incorporated in rehab (ideally during practice)practice)– Opportunity for reentry into the team, increases levels of effort, Opportunity for reentry into the team, increases levels of effort,

may allow athlete to gain appreciation of skills necessary to may allow athlete to gain appreciation of skills necessary to return to play return to play

Athletic Trainer’s Role in Athletic Trainer’s Role in Providing Social SupportProviding Social Support

Athlete should get the perception that Athlete should get the perception that the ATC caresthe ATC cares– May have a huge impact on success of May have a huge impact on success of

rehab processrehab process– Communication is criticalCommunication is critical– ATC should take an interest in the athletes ATC should take an interest in the athletes

and their well-being before injuries even and their well-being before injuries even occuroccur

The ATC should do the followingThe ATC should do the following– Be a good listenerBe a good listener– Be aware of body languageBe aware of body language– Project a caring imageProject a caring image– Find out what the problem isFind out what the problem is– Explain the injury to the athleteExplain the injury to the athlete– Manage the stress of the injuryManage the stress of the injury– Help the athlete return to competitionHelp the athlete return to competition

Predictors of InjuryPredictors of Injury Some psychological traits may predispose athlete to injurySome psychological traits may predispose athlete to injury

– No one personality typeNo one personality type– Risk takers, reserved, detached or tender-minded Risk takers, reserved, detached or tender-minded

players, apprehensive, over-protective or easily players, apprehensive, over-protective or easily distracteddistracted

– Lack ability to cope with stress associated risksLack ability to cope with stress associated risks– Other potential contributors include attempting to Other potential contributors include attempting to

reduce anxiety by being more aggressive, continuing to reduce anxiety by being more aggressive, continuing to be injured because of fear of failure, or guilt associated be injured because of fear of failure, or guilt associated with unattainable goalswith unattainable goals

Stress and the Risk of Injury Stress and the Risk of Injury

Stress = positive and negative forces that can Stress = positive and negative forces that can disrupt the body’s equilibriumdisrupt the body’s equilibrium– Tells body how to react Tells body how to react

A number of studies have indicated negative A number of studies have indicated negative impact of stress on injury particularly in high impact of stress on injury particularly in high intensity sportsintensity sports– Results in decreased attentional focus, create Results in decreased attentional focus, create

muscle tension (reduces flexibility, coordination, muscle tension (reduces flexibility, coordination, & movement efficiency)& movement efficiency)

Living organisms have the ability to cope Living organisms have the ability to cope with stress - without stress there would with stress - without stress there would be little constructive or positive activitybe little constructive or positive activity

Individual engages in countless stressful Individual engages in countless stressful situations dailysituations daily– Fight or flight response occurs in reaction to Fight or flight response occurs in reaction to

avoid injury or other physically and avoid injury or other physically and emotionally threatening situationsemotionally threatening situations

Physical Response to StressPhysical Response to Stress

Stress is a psychosomatic phenomenonStress is a psychosomatic phenomenon– Physiologic responses are autonomic, Physiologic responses are autonomic,

immunologic and neuroregulatory.immunologic and neuroregulatory.– Hormonal responses result in increased cortisol Hormonal responses result in increased cortisol

releaserelease– Negative stress produces fear and anxietyNegative stress produces fear and anxiety

Acute response causes adrenal secretions causing Acute response causes adrenal secretions causing fight or flight responsefight or flight response

Adrenaline causes pupil dilation, acute hearing, muscle Adrenaline causes pupil dilation, acute hearing, muscle responsiveness increases, increased BP, HR and responsiveness increases, increased BP, HR and respirationrespiration

– Two types of stress -- acute and chronicTwo types of stress -- acute and chronic AcuteAcute - threat is immediate and response instantaneous; - threat is immediate and response instantaneous;

response often entails release of epinephrine and response often entails release of epinephrine and norepinephrinenorepinephrine

ChronicChronic - leads to an increase in blood corticoids from - leads to an increase in blood corticoids from adrenal cortexadrenal cortex

– When athlete is removed from sport because of injury or illness When athlete is removed from sport because of injury or illness it can be devastating - impact on attaining goalsit can be devastating - impact on attaining goals

– Athlete may fear experience of pain and disabilityAthlete may fear experience of pain and disability Anxiety about disability, Anxiety about disability, Injury is a stressor that results from external or internal Injury is a stressor that results from external or internal

sensory stimulussensory stimulus Coping depends on athlete’s cognitive appraisalCoping depends on athlete’s cognitive appraisal

Emotional Response to StressEmotional Response to Stress

Sports serve as stressorsSports serve as stressors– Besides performance, peripheral stressors can be Besides performance, peripheral stressors can be

imposed on athlete imposed on athlete Expectations of others, concerns about school, work, Expectations of others, concerns about school, work,

familyfamily

– Coach is often first to notice athlete that is Coach is often first to notice athlete that is emotionally stressed emotionally stressed Changes in personality and performance may be indicator Changes in personality and performance may be indicator

of need for change in training programof need for change in training program Conference may reveal need for additional support staff to Conference may reveal need for additional support staff to

become involvedbecome involved

Injury prevention is psychological and physiologicalInjury prevention is psychological and physiological

– Entering an event angry, frustrated, discouraged or while Entering an event angry, frustrated, discouraged or while experiencing disturbing emotional state makes individual experiencing disturbing emotional state makes individual prone to injuryprone to injury

– Due to emotion, skill and coordination are sacrificed, Due to emotion, skill and coordination are sacrificed, potentially resulting in injurypotentially resulting in injury

Athletic trainers must be aware of counseling role they playAthletic trainers must be aware of counseling role they play

– Deal with emotions, conflicts, and personal problemsDeal with emotions, conflicts, and personal problems

– Must have skills to deal with frustrations, fears, and crises Must have skills to deal with frustrations, fears, and crises of athletes andof athletes and be aware of professionals to refer to be aware of professionals to refer to

OvertrainingOvertraining

Result of imbalances between physical load Result of imbalances between physical load being placed on athlete and his/her coping being placed on athlete and his/her coping capacitycapacity

Physiological and psychological factors Physiological and psychological factors underlie overtrainingunderlie overtraining

Can lead to staleness and eventually Can lead to staleness and eventually burnoutburnout

StalenessStaleness– Numerous reasons including, training too long and hard w/out Numerous reasons including, training too long and hard w/out

restrest– Attributed to emotional problems stemming from daily worries Attributed to emotional problems stemming from daily worries

and fears and fears – Anxiety (nondescript fear, sense of apprehension, and Anxiety (nondescript fear, sense of apprehension, and

restlessness)restlessness) Athlete may feel inadequate but unable to say whyAthlete may feel inadequate but unable to say why May cause heart palpitations, shortness of breath, sweaty palms, May cause heart palpitations, shortness of breath, sweaty palms,

constriction of throat, and headachesconstriction of throat, and headaches

– Minimal positive reinforcement may make athlete prone to Minimal positive reinforcement may make athlete prone to stalenessstaleness

Symptoms of StalenessSymptoms of Staleness– Deterioration in usual standard of performance, chronic Deterioration in usual standard of performance, chronic

fatigue, apathy, loss of appetite, indigestion, weight loss, and fatigue, apathy, loss of appetite, indigestion, weight loss, and inability to sleep or restinability to sleep or rest

– Exhibit high BP and pulse rate at rest and during activity and Exhibit high BP and pulse rate at rest and during activity and increased catecholamine release (signs of adrenal exhaustion)increased catecholamine release (signs of adrenal exhaustion)

– Stale athletes become irritable and restlessStale athletes become irritable and restless– Increased risk for acute and overuse injuries and infectionsIncreased risk for acute and overuse injuries and infections– Recognition and early intervention is keyRecognition and early intervention is key

Implement short interruption in training Implement short interruption in training Complete withdrawal results in sudden exercise abstinence syndromeComplete withdrawal results in sudden exercise abstinence syndrome

BurnoutBurnout– Syndrome related to physical and emotional exhaustion Syndrome related to physical and emotional exhaustion

leading to negative concept of self, job and sports leading to negative concept of self, job and sports attitudes, and loss of concern for feeling of othersattitudes, and loss of concern for feeling of others

– Burnout stems from overwork and can effect athlete Burnout stems from overwork and can effect athlete and athletic trainerand athletic trainer

– Can impact healthCan impact health Headaches, GI disturbances, sleeplessness, chronic fatigueHeadaches, GI disturbances, sleeplessness, chronic fatigue Feel depersonalization, increased emotional exhaustion, Feel depersonalization, increased emotional exhaustion,

reduced sense of accomplishment, cynicism and depressed reduced sense of accomplishment, cynicism and depressed moodmood

Reacting to Athletes with InjuriesReacting to Athletes with Injuries

Athletic trainers are not usually trained in areas of Athletic trainers are not usually trained in areas of counseling and may require additional trainingcounseling and may require additional training

Respond to individual, not the injuryRespond to individual, not the injury During initial treatment stages, emotional first aid During initial treatment stages, emotional first aid

will be required will be required – Comfort, care and communication should be Comfort, care and communication should be

given freelygiven freely Sports medicine team must be understanding and Sports medicine team must be understanding and

be prepared to answer athlete’s questionsbe prepared to answer athlete’s questions

The Catastrophic InjuryThe Catastrophic Injury– Permanent functional disability Permanent functional disability – Intervention must be directed toward the Intervention must be directed toward the

psychological impact of the trauma and psychological impact of the trauma and ability of the athlete to copeability of the athlete to cope

– Will profoundly affect all aspects of the Will profoundly affect all aspects of the athlete’s functioningathlete’s functioning

Psychological Effects of Injury on Psychological Effects of Injury on the Athletic Trainerthe Athletic Trainer

ATC may also be emotionally affectedATC may also be emotionally affected ATC must make decisions regarding care and ATC must make decisions regarding care and

management of injury based on trainingmanagement of injury based on training Emotional attachment can not cloud judgmentEmotional attachment can not cloud judgment Must remain detached until a later timeMust remain detached until a later time Outside counseling may be sought at a later Outside counseling may be sought at a later

time in order to assist in coping with the time in order to assist in coping with the situationsituation

Psychological Factors of Psychological Factors of Rehabilitation ProcessRehabilitation Process

Successful rehab plan takes athlete’s psyche Successful rehab plan takes athlete’s psyche into considerationinto consideration

Plan involving exercise and modalities must Plan involving exercise and modalities must also include rapport, cooperation and learningalso include rapport, cooperation and learning

Rapport Rapport – is the existence of mutual trust and understanding is the existence of mutual trust and understanding – Athlete must believe therapist has best interests in Athlete must believe therapist has best interests in

mindmind

Co-operationCo-operation– Athlete may begrudge every moment in rehab if process is moving Athlete may begrudge every moment in rehab if process is moving

slowlyslowly

– Blame may be placed on members of the staffBlame may be placed on members of the staff

– To avoid problems, athlete must be taught that healing process is a To avoid problems, athlete must be taught that healing process is a cooperative undertakingcooperative undertaking

– Athlete must feel free vent and ask questions, Athlete must feel free vent and ask questions,

– Athlete must also take responsibility in processAthlete must also take responsibility in process

– Patience and desire are critical in the rehab processPatience and desire are critical in the rehab process

– To ensure maximal positive responses athlete must continually be To ensure maximal positive responses athlete must continually be educated on the processeducated on the process

– Provide information in layman’s language and commensurate with Provide information in layman’s language and commensurate with athlete’s backgroundathlete’s background

Psychological Approaches Psychological Approaches During Various Phases of RehabDuring Various Phases of Rehab With changes in modalities and exercises, With changes in modalities and exercises,

psychological issues must be addressedpsychological issues must be addressed Immediate Post InjuryImmediate Post Injury

– Fear and denial reign - athlete may be experiencing Fear and denial reign - athlete may be experiencing pain and disabilitypain and disability

– Emotional first aid must be administeredEmotional first aid must be administered– Complete diagnosis and explanation must be Complete diagnosis and explanation must be

providedprovided– Athlete must know and understand process and Athlete must know and understand process and

outcomeoutcome

Early Postoperative PeriodEarly Postoperative Period– Following surgery athlete becomes disabled individual and full Following surgery athlete becomes disabled individual and full

explanations must be providedexplanations must be provided– Athlete must maintain aerobic conditioningAthlete must maintain aerobic conditioning

Advanced Postoperative or Rehabilitation PeriodAdvanced Postoperative or Rehabilitation Period– Conditioning should continue to train unaffected body partsConditioning should continue to train unaffected body parts– Confidence must be built gradually and athlete must feel in controlConfidence must be built gradually and athlete must feel in control– Positive reinforcement is critical and milestones must remain Positive reinforcement is critical and milestones must remain

realisticrealistic– Rehab must make transition to more sports specificRehab must make transition to more sports specific

Return to ActivityReturn to Activity– Athlete generally returns physically ready but Athlete generally returns physically ready but

not psychologically (level of anxiety remains)not psychologically (level of anxiety remains)– Tension can lead to disruption of coordination Tension can lead to disruption of coordination

producing unfavorable conditions for producing unfavorable conditions for potentially new or current injuriespotentially new or current injuries

– To help athlete regain confidenceTo help athlete regain confidence Progress in small incrementsProgress in small increments Instruct athlete on systematic desensitizationInstruct athlete on systematic desensitization

Goal SettingGoal Setting

Effective motivator for compliance in rehab Effective motivator for compliance in rehab and for reaching goalsand for reaching goals

Athletic performance based on working Athletic performance based on working towards and achieving goalstowards and achieving goals

With athletic rehabilitation, athletes are aware With athletic rehabilitation, athletes are aware of the goal and what must be done to of the goal and what must be done to accomplishaccomplish

Goals must be personal and internally Goals must be personal and internally satisfying and jointly agreed uponsatisfying and jointly agreed upon

To enhance goal attainment. the To enhance goal attainment. the following must be involvedfollowing must be involved– Positive reinforcement, Positive reinforcement, – Time management for incorporating goals Time management for incorporating goals

into lifestyle, into lifestyle, – Feeling of social support, Feeling of social support, – Feelings of self-efficacy, Feelings of self-efficacy,

Goals can be daily, weekly, monthly, Goals can be daily, weekly, monthly, and/or yearlyand/or yearly

Mental Training TechniquesMental Training Techniques

Long been used to enhance sports Long been used to enhance sports performance and useful during performance and useful during rehabilitationrehabilitation

Serious emotional disabilities should be Serious emotional disabilities should be referred to professionalsreferred to professionals

A series of techniques are available to A series of techniques are available to help cope help cope

Quieting the Anxious MindQuieting the Anxious Mind– Due to mental anxiety suffered, methods can be used to deal with Due to mental anxiety suffered, methods can be used to deal with

fear of pain, loss of control, and unknown consequences of fear of pain, loss of control, and unknown consequences of disabilitydisability

– Meditation Meditation Meditators focus on mental stimulusMeditators focus on mental stimulus Passive attitude is necessary, involving body relaxationPassive attitude is necessary, involving body relaxation

– Progressive RelaxationProgressive Relaxation Extensively used techniqueExtensively used technique Awareness training in tension and tension’s releaseAwareness training in tension and tension’s release Series of muscle contractions and periods of relaxationSeries of muscle contractions and periods of relaxation

Cognitive RestructuringCognitive Restructuring

Some engage in irrational thinking and Some engage in irrational thinking and negative self-talknegative self-talk

Can hinder treatment progressCan hinder treatment progress Two methods are used to combatTwo methods are used to combat

– Refuting Irrational ThoughtsRefuting Irrational Thoughts Deals with persons internal dialogueDeals with persons internal dialogue Rationale emotive therapy developed by Albert EllisRationale emotive therapy developed by Albert Ellis Basis is that actual events do not create emotions - self Basis is that actual events do not create emotions - self

talk after the fact does (causes anxiety, anger and talk after the fact does (causes anxiety, anger and depression)depression)

– Thought StoppingThought Stopping Excellent cognitive technique used to overcome Excellent cognitive technique used to overcome

worries and doubtsworries and doubts Injured athlete often engages in very negative Injured athlete often engages in very negative

self talkself talk Thought stopping involves focussing undesired Thought stopping involves focussing undesired

thoughts and stopping them on commandthoughts and stopping them on command Immediately followed by positive statementImmediately followed by positive statement

ImageryImagery Use of senses to create or recreate an experience in Use of senses to create or recreate an experience in

the mindthe mind Visual images used in rehab process include visual Visual images used in rehab process include visual

rehearsal, emotive imagery rehearsal, and body rehearsal, emotive imagery rehearsal, and body rehearsalrehearsal

Visual rehearsal involves coping and mastery Visual rehearsal involves coping and mastery rehearsalrehearsal– Coping rehearsal: visualize problem and way to Coping rehearsal: visualize problem and way to

overcome and be successful overcome and be successful – Mastery rehearsal: visualize successful return from Mastery rehearsal: visualize successful return from

practice to competition activitiespractice to competition activities

Improving Healing ProcessImproving Healing Process

– Emotive rehearsal: aids athlete in gaining confidence by Emotive rehearsal: aids athlete in gaining confidence by visualizing scenes relative to confidence, enthusiasm, visualizing scenes relative to confidence, enthusiasm, and prideand pride

– Body rehearsal: visualization of body healing self Body rehearsal: visualization of body healing self (athlete must understand injury)(athlete must understand injury)

– Important for athlete to be educatedImportant for athlete to be educated– Once situation is understood, athlete is instructed to Once situation is understood, athlete is instructed to

imagine it taking place during therapyimagine it taking place during therapy

Techniques for Coping with PainTechniques for Coping with Pain

Athlete can be taught simple techniques to Athlete can be taught simple techniques to inhibit paininhibit pain

Should never be completely inhibited as Should never be completely inhibited as pain serves as a protective mechanismpain serves as a protective mechanism

Three methods can be used to reduce painThree methods can be used to reduce pain– Tension ReductionTension Reduction– Attention DiversionAttention Diversion– Altering Pain SensationAltering Pain Sensation

– Tension ReductionTension Reduction Work to reduce muscle tension associated with anxiety, pain-Work to reduce muscle tension associated with anxiety, pain-

spasm-pain cyclespasm-pain cycle Increased tension, increases painIncreased tension, increases pain

– Attention DiversionAttention Diversion Divert attention away from pain and injuryDivert attention away from pain and injury Engage athlete in mental problem solvingEngage athlete in mental problem solving Also divert pain by fantasizing about pleasant eventsAlso divert pain by fantasizing about pleasant events

– Altering the Pain SensationAltering the Pain Sensation Imagination is very powerful, and can be positive and negativeImagination is very powerful, and can be positive and negative Can utilize imagination to alter pain sensationCan utilize imagination to alter pain sensation

Mental DisordersMental Disorders Occasionally, athletic trainer must deal with athletes with Occasionally, athletic trainer must deal with athletes with

mental illnessmental illness Must be able to recognize when an athlete is having a Must be able to recognize when an athlete is having a

problem and make referralproblem and make referral Mental illness is any disorder that affects the mind or Mental illness is any disorder that affects the mind or

behaviorbehavior Classified as neurosis or psychosisClassified as neurosis or psychosis

– Neurosis: Neurosis: Unpleasant mental symptom in individual with intact reality Unpleasant mental symptom in individual with intact reality

testingtesting Symptoms include anxiousness, depression or obsession with Symptoms include anxiousness, depression or obsession with

solid base of realitysolid base of reality

– PsychosisPsychosis Disturbance in which there is disintegration in personality and loss Disturbance in which there is disintegration in personality and loss

of contact with realityof contact with reality Characterized by delusions and hallucinationsCharacterized by delusions and hallucinations

Mood DisordersMood Disorders– Range from happiness to sadnessRange from happiness to sadness– Pathological when it disrupts normal behavior, is prolonged and Pathological when it disrupts normal behavior, is prolonged and

accompanied by physical symptoms (sleep and appetite accompanied by physical symptoms (sleep and appetite disturbances)disturbances)

– Depression is also commonDepression is also common Unipolar - feeling move from “normal” to helplessness, loss of Unipolar - feeling move from “normal” to helplessness, loss of

energy, excessive guilt, diminished ability to think, changes in energy, excessive guilt, diminished ability to think, changes in eating and sleeping habits, and recurrent thoughts of deatheating and sleeping habits, and recurrent thoughts of death

Bipolar (manic depression) - goes from exaggerated feelings of Bipolar (manic depression) - goes from exaggerated feelings of happiness and great energy to extreme states of depressionhappiness and great energy to extreme states of depression

Treatment is individualized and might include psychotherapy and Treatment is individualized and might include psychotherapy and antidepressant medicationantidepressant medication

– Seasonal Affective DisorderSeasonal Affective Disorder Characterized by mental depression during certain points of the Characterized by mental depression during certain points of the

yearyear Occurs primarily in winter months due to decrease in sunlightOccurs primarily in winter months due to decrease in sunlight Symptoms include fatigue, diminished concentration, daytime Symptoms include fatigue, diminished concentration, daytime

drowsinessdrowsiness Four times more common in womenFour times more common in women Treated with light therapy stress management, antidepressants Treated with light therapy stress management, antidepressants

and exerciseand exercise

Anxiety DisordersAnxiety Disorders– Contributes to 20% of all medical conditionsContributes to 20% of all medical conditions– Anxiety can cause a variety of physiological responsesAnxiety can cause a variety of physiological responses– Anxiety is abnormal when it begins to interfere with emotional Anxiety is abnormal when it begins to interfere with emotional

well-being or normal daily functioningwell-being or normal daily functioning– Panic AttacksPanic Attacks

Unexpected and unprovoked emotionally intense experience of Unexpected and unprovoked emotionally intense experience of terror and fearterror and fear

Physiological responses similar to someone fearing for lifePhysiological responses similar to someone fearing for life Tend to occur at night and run in familiesTend to occur at night and run in families Behavior modification and meds can be used to treatBehavior modification and meds can be used to treat

– PhobiasPhobias Persistent and irrational fear of specific Persistent and irrational fear of specific

situation, activity, or object that creates desire situation, activity, or object that creates desire to avoid feared stimulusto avoid feared stimulus

May include fears of social situations, height, May include fears of social situations, height, closed spaces, flyingclosed spaces, flying

Symptoms include increased heart rate, Symptoms include increased heart rate, difficulty breathing, sweating and dizzinessdifficulty breathing, sweating and dizziness

Treatment includes behavior modification, anti-Treatment includes behavior modification, anti-depressants and systematic desensitizationdepressants and systematic desensitization

Personality DisordersPersonality Disorders

Everyone has own differences in personality Everyone has own differences in personality traitstraits

In the case of disorders, it is pathological In the case of disorders, it is pathological disturbance in cognition, affect, interpersonal disturbance in cognition, affect, interpersonal functioning or impulse controlfunctioning or impulse control

Generally long in duration and traceable to Generally long in duration and traceable to some eventsome event

Treatment may involve psychotherapy and Treatment may involve psychotherapy and medicationsmedications

ParanoiaParanoia– Having unrealistic and unfounded suspicions about specific Having unrealistic and unfounded suspicions about specific

people or thingspeople or things– Person is constantly on-guard and cannot be convinced that Person is constantly on-guard and cannot be convinced that

suspicions are incorrectsuspicions are incorrect– Overtime resentment develops and ultimately requires the Overtime resentment develops and ultimately requires the

use of medical careuse of medical care

Obsessive-Compulsive DisorderObsessive-Compulsive Disorder– Combination of emotional and behavioral symptomsCombination of emotional and behavioral symptoms

Recurrent, inappropriate thoughts, feelings, impulses, or images Recurrent, inappropriate thoughts, feelings, impulses, or images arising from within arising from within

Cannot be neutralized even though they are known to be wrongCannot be neutralized even though they are known to be wrong

Engage in unreasonable repetitive acts which disrupts normal Engage in unreasonable repetitive acts which disrupts normal daily functioningdaily functioning

Behavioral psychotherapy attempts to restructure environment to Behavioral psychotherapy attempts to restructure environment to minimize tendencies to act compulsivelyminimize tendencies to act compulsively

Medication is also usedMedication is also used

Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder– Re-experiencing of psychologically traumatic eventsRe-experiencing of psychologically traumatic events

– May experience numbing of general responsiveness, May experience numbing of general responsiveness, insomnia, and increased aggression.insomnia, and increased aggression.

– May persist for decadesMay persist for decades

– Group therapy is useful for treatmentGroup therapy is useful for treatment