Anxiety disorder
- experience frequent, intense and irrational fear.
- affect around 10% of the population.
phobic disorders
- fear out of proportion to any real danger.
Generalised anxiety disorder
- non-specific fears and anxiety.
- Hypervigilance results in distractibility, fatigue, irritability and sleep problems
- effects 3-4% of population.
panic disorder
- panic attacks
- increased heart rate, sweating, shaking etc.
- both internal and external triggers.
- can coexist with other disorders (depression and substance abuse).
- often avoid external triggers to cope and can result in agoraphobia.
Anxiety in older adults
- hard to diagnose because symptoms can mimic those of physical illness.
- anxiety does not increase with age.
Theoretical conceptualizations of anxiety disorder
- psychodynamic (repressed urges).
- cognitive behavioural (reinforcement; irrational thinking).
- biological (changes to neural pathways.
Obsessive Compulsive Disorder
Characterised by:
Obsessions: persistent, unwanted and often irrational thoughts and ideas –
○ Compulsions: intentional behaviours or rituals performed in response to an obsession
- Distress levels increase if a person with OCD is prevented from performing their compulsions.
Left untreated, obsessions and the need to perform rituals can take over a person’s life
- OCD is often a chronic, relapsing illness.
Depressive Disorders
characterised by disturbances in emotion and mood (particularly negative mood)
- The most severe form of depression is major depressive disorder - Ranges between 7‐20% (lifetime) - symptoms of depression can vary across the lifetime.
Major depressive disorder
- Symptoms should be present for at least two weeks in a persistent fashion. Five symptoms are needed:
○ At least one must be one of the two main features:
§ Persistent sad mood (most of the day, nearly every day)
§ Anhedonia‐ loss of interest or pleasure in activities (either by subjective report or observations of others)
○ The remainder can be from the following symptoms (nearly every day):
§ Increase or decrease in appetite or weight
§ Increase or decrease sleep
§ Psychomotor agitation or retardation
§ Fatigue
§ Worthlessness or guilty feelings
§ Difficulty concentrating or indecisiveness
§ Recurrent thoughts of death or suicidal thoughts or plans
○ MUST ALSO CHECK: – The symptoms are not due to a direct effect of a drug or medical condition
§ e.g. laboratory testing should be done, including thyroid screening
§ The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Possible Medical causes of depressed mood
- Neurological Illness ○ Parkinson’s disease ○ Epilepsy ○ Sleep apnoea - Systemic Conditions ○ Viral or bacterial infections ○ AIDS - Endocrine Disorders ○ Thyroid disorders ○ Post‐partum effects - Vitamin Deficiencies ○ Vitamin B12 ○ Folate - Other ○ Cancer ○ Kidney Disease
Theoretical conceptualisations of depressive disorders.
- psychodynamic (anger at authority figures).
- cogntive- behavioural (learned helplessness; distorted thinking)
- biological (neurotransmitter dysfunction).
Bipolar disorder
- A mood disorder characterised by alternating periods of depression and mania
- Bipolar disorder, which tends to run in families, typically emerges in adolescence or early adulthood
- Bipolar I: mania and hypomania or major depressive episode.
- Bipolar II: major depression and hypomania
- Cyclothymia: hypomania and mild depression
when is anxiety excessive? when does mood become disordered?
- When it disrupts social or occupational functioning
- When an expected shift in mood due to unusual circumstances (e.g. stress, injury, pregnancy) fails to return to normal
Psychological treatment approaches to mental illness
- Psychodynamic therapies
- Cognitive-behavioural therapies
- Humanistic therapies
- Group and family therapies
- Biological treatments
Psychodynamic approach
- The approach was created by Sigmund Freud (psychoanalysis)
- Freud believed that symptoms reflect unconscious conflicts between:
○ the id
○ the ego
○ the superego
Techniques used for tapping into unconscious processes: - Hypnosis
- Free association
- Dream interpretation
- Freud believed that symptoms reflect unconscious conflicts between:
tranference relationship
The relationship that develops in therapy where the client acts towards the therapist in a similar manner to the way they have learnt to relate to other authority figures.
Examining this relationship can help the client understand how unconscious patterns are developed during childhood and how they influence later life.
Psychodynamic therapy
- Psychoanalysis: patient is on couch and therapist behind them, encouraged to free associate.
Psychodynamic psychotherapy: The patient and therapist are face-to-face. Techniques are goal directed.
cognitive-behavioural therapies
- Cognitive‐behavioural therapies use methods derived from behaviourist and cognitive approaches
- Therapy is typically short‐term and focused on the current behaviours of a person
- Therapists are more directive
Behavioural aspets of CBT
- Behavioural component of CBT involves the notion that our maladaptive behaviour is learned and can therefore be unlearned.
- Key learning principles are operant and classical conditioning.
classical conditioning
- Focuses on the associations people form between a neutral stimulus and an emotion.
- Systematic desensitisation: Technique whereby a patient gradually confronts an imagined fear‐inducing stimulus while in a state that inhibits anxiety (e.g. deep muscle relaxation)
- Exposure: Technique whereby a patient confronts an actual fear‐inducing stimulus
- Flooding
operant conditioning
- Use reinforcement and punishment to modify unwanted behaviours
- Modelling involves the learning of appropriate behavioural responses through the observation of others
- Activity scheduling involves scheduling activities the client has enjoyed in the past or derived sense of achievement
Cognitive componenets of CBT
- The focus of the cognitive component of CBT is on changing dysfunctional thought patterns (automatic thoughts) and challenging cognitive distortions
- Psychological problems do not arise from events per se but the meanings individuals gives to those events.
cognitive distortions
occur because we make errors interpreting incoming information from our environment.
All or nothing thinking: things are one extreme or another.
Disqualifying the positive: rejecting positive experiences by insisting that they don’t count (it’s a fluke).
Catastrophizing: Thinking extreme and horrible consequences will occur due to a minor event.
Hamanistic therapy
- Humanistic therapies focus on the way in which individuals consciously experience the self, relationships and the world
- Gestalt therapy helps people acknowledge their feelings so they can act in accordance with them (unity of mind and body)
- Client‐centred therapy helps clients accept the difference between their ideal self and their actual experiences through the use of unconditional positive regard
