Course Learning Outcomes for Unit III. Reading Assignment. Unit Lesson. UNIT III STUDY GUIDE Mood and Anxiety Disorders

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1 UNIT III STUDY GUIDE Mood and Anxiety Disorders Course Learning Outcomes for Unit III Upon completion of this unit, students should be able to: 4. Compare the contributions of nature and nurture in the development of abnormal behavior. 4.1 Discuss the genetic, neurobiological, social, and psychological factors that contribute to the mood disorders. 4.2 Describe how the anxiety disorders tend to co-occur with each other and how gender and culture influence the prevalence of anxiety. 6. Analyze current treatments for mental illness. 6.1 Identify the medication and psychological treatments of mood disorders. 6.2 Describe treatment approaches that are common across the anxiety disorders and how treatment approaches are modified for the specific anxiety disorders. 9. Examine the etiology, epistemology, symptoms, classifications and diagnosis, and treatments of the various disorders. 9.1 Describe the symptoms, the diagnostic criteria, and the epidemiology of mood disorders. 9.2 Describe the clinical features of the anxiety disorders. Reading Assignment Chapter 5: Mood Disorders Chapter 6: Anxiety Disorders Unit Lesson In Unit III, the focus will move to mood disorders and anxiety disorders. As you begin Chapter 5, you see the clinical case of Mary. Mary s case is all too familiar in today s world. Family, work, finances she is facing a myriad of things everyone deals with. When does that go from stress to depression? As you see in the case, Mary encountered additional stress and job loss, which you can assume from the narrative she internalized, and she blamed herself for all of it. The negative thought patterns you studied in Chapter 2 appear to have begun to dominate, as Mary begins to consider herself as incompetent. This shift in thinking is not enough to say Mary is depressed; a more serious degree of impact and impairment is necessary. In the case study, you see the progression of behavioral and physical changes that ensue, leading to the recognition that this is more than just a run of bad luck. The concept of depression is widespread and often incorrect. Bereavement often leads to an assumption of depression, resulting in unnecessary prescriptions to help the person get through. Someone like Mary may have a series of adverse events creating stress, negative thinking, and ultimately depression. But what allows some people to pull it together, be motivated to correct their situation, and move on, while others are disabled by their situation and fall victim to depression? As was discussed in the consideration of the diathesis-stress model, perhaps one explanation is an internal predisposition a diathesis triggered by an external event or series of events. Also, you see from the textbook that a diagnosis of depression requires symptoms that affect many aspects of a person s functioning, well beyond feeling a little down or having a bad day. This is why proper diagnosis is crucial for proper treatment (Kring, Johnson, Davison, & Neale, 2016). PSY 2010, Abnormal Psychology 1

2 These symptoms are not new. Ancient Greeks wrote about people who could not derive pleasure from life. Sigmund Freud viewed depression as aggression turned inward on the self. Cognitive theorists have pointed to negative thought processes that seem to be automatic in depression sufferers. The chart below defines the depressive disorders as outlined in the textbook: Major depressive disorder: Characterized by five or more symptoms such as sad mood or loss of pleasure in activities Persistent depressive disorder (dysthymia): Major depressive disorder that is chronic and lasts for two years or longer Depressive Disorders Premenstrual dysphoric disorder: Added with the release of DSM-5; can be diagnosed if specific mood and physical symptoms are present Disruptive mood disregulation disorder: Characterized by severe outbursts to common stressors and a persistent negative mood for more than a year in children over the age of six The different types of depressive disorders and their descriptions (Kring et al., 2016) Roughly, you have a one in six chance of meeting the criteria for a major depressive disorder in your lifetime. To be such a common diagnosis, it is complex to properly diagnose and to understand the various forms and nuances. Women are twice as likely as men to suffer from the disorder. The textbook discusses the possible causes for these differences, beginning with the Focus on Discovery 5.1 insert on p The other large category of mood disorders deals with bipolar disorders. Bipolar disorders, known as manic depression in earlier years of psychological diagnosis, concern symptoms of mania, defined as intense elation, irritability, or activation that presents itself along with other symptoms (Kring et al., 2016, p. 139). Bipolar I Disorder This disorder must include a single episode of mania during a person's life. This is by far the more serious of the disorders, as episodes tend to recur. Bipolar II Disorder This disorder is characterized more by depression. A person must exhibit one episode of hypomania, not full manic behavior, as with bipolar I. Cyclothymic Disorder This disorder is also called cyclothymia. This is a more chronic form of bipolar II (just as dysthymia is a chronic form of depression). There must be a chronicity factor (of at least two years). It is characterized by ups and downs rather than extreme symptoms of the other disorders. The three main types of bipolar disorder (Kring et al., 2016) Bipolar disorders are less prevalent than major depression, and they are more prevalent in the United States than in other countries (Kring et al., 2016). The course of bipolar disorders can be extremely challenging; many people are unable to work or to retain their employment long-term after manic episodes. Suicidal attempts are found at an increased prevalence among bipolar sufferers than with the majority of illnesses that PSY 2010, Abnormal Psychology 2

3 will be discussed. Take a look at Focus on Discovery 5.3 on p. 141 in the textbook for a discussion on mood disorders in highly creative people. What causes such severe disorders as major depression and bipolar disorder? The textbook describes several factors and theories that may contribute to the development of mood disorders (Kring et al., 2016). Genetic factors indicate a hereditary component in some instances of depressions and manias. Brain chemistry and brain structure are promising avenues of investigation. Social factors certainly play a role. Childhood adversity, abuse, neglect, loss of loved ones, or unstable life situations can all predispose an individual to depression. Beyond the physical, neurochemical considerations, the textbook suggests many psychological factors to consider. Neuroticism has been linked to persons who experience greater instances of depressive mood disorders and may also have a correlating genetic component (Kring et al., 2016, p. 150). Cognitive theorists point to the negative thoughts and pessimistic belief symptoms as a central aspect of the disorder. Treatments for mood disorders often include psychotherapy. Interpersonal psychotherapy addresses issues of life transition and exploration. Cognitive therapy works to undo the automatic thoughts and beliefs that lead to repeated negative thought processes. Behavioral therapy involves working with positive reinforcement and activities in which the sufferer will attain this esteem-building feedback. Analytic psychology works to unearth the internal struggles that can torment mood disorder sufferers and to make these unconscious phenomena known. Psychoeducation is often beneficial so that patients have a greater understanding of their own illness (Kring et al., 2016, pp ). Treatments such as psychotherapy have proven to be successful for mood disorders. (Bliusa., 2015) In returning to the case study, you will find that the treatment approach for Mary is one commonly found in practice. Medication can provide quick reduction in symptom intensity, allowing for improved functioning and physical recovery. Ongoing treatment needs to address the various aspects of the psychosocial picture, the life events, negative attributions, relationship problems, and long-held beliefs that contributed to her depression. Medication alone is rarely effective in achieving a permanent reduction in symptoms. Suicidal behavior is often an attention-grabber, and it is certain to garner headlines when the victim is a celebrity or well-known figure. As with all aspects of depression and mood disorders, many factors come into play. As the textbook points out, studies published by the Centers for Disease Control and Prevention (CDC) have found that more than half of suicide attempts involve depression at the time of the event (Kring et al., 2016, p. 167). Chapter 6 addresses anxiety disorders, which are closely linked in some ways with the depressive disorders discussed above. In the new case study in Chapter 6, Jenny is typical of many anxiety sufferers. Anxiety often begins with a physical sensation. In her case, this could have been the result of purely physical factors such as fatigue, fluctuations in blood sugar, or sleep deprivation. In Jenny s case, she began to associate a pattern of thought centered on her potential failure to perform, which prompted PSY 2010, Abnormal Psychology 3

additional physical sensations, resulting in flight from the situation. Anticipation is central to anxiety, as it is the future threat that generates the emotion.

4 additional physical sensations, resulting in flight from the situation. Anticipation is central to anxiety, as it is the future threat that generates the emotion. As you can see, the cognitive component is heavily at play in this disorder and, understandably, in the treatment of it. For a first person description of what a panic attack experience is like, view the video in the Suggested Reading section of this unit. This word cloud depicts some of the many symptoms and effects of anxiety. (maialisa, 2016) Table 6.1 on p. 175 in the textbook describes the anxiety disorders covered in this unit: specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder (Kring et al., 2016). Take time to appreciate the nuances of the disorders, as each carries with it a unique impact on the individual. Toward the end of Chapter 6, you will read about the various treatment options available for anxiety disorders (Kring et al., 2016). Psychotherapy is often useful with its varied theoretical orientations. You may have heard of exposure therapy, a type of cognitive-behavioral treatment that exposes sufferers to the very thing they are afraid of whether that be a spider or a group of strangers. Several groups of medication are used to treat anxiety symptoms, including benzodiazepines, such as Xanax and Valium, as well as serotonin-specific reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) that encourage a greater flow of serotonin and norepinephrine in the synaptic clefts, respectively. References Bliusa. (2015, January 2). Balanced life institute Santa Monica Psychotherapy [Image]. Retrieved from Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2016). Abnormal psychology: The science and treatment of psychological disorders (13th ed.). Hoboken, NJ: Wiley. Maialisa. (2016). Anxiety [Image]. Retrieved from / Suggested Reading The video below was referenced in the Unit III Lesson. It contains an interview with celebrity actress Kim Basinger, and she describes what it is like to have a panic attack. It is an interesting firsthand account of this type of experience. Korkiakoski, A. (2011, October 28). Panic attacks: Kim Basinger, Earl Campbell [Video file]. Retrieved from In order to access the resources below, you must first log into the mycsu Student Portal and access the Academic Search Complete database within the CSU Online Library. This article examines the usability of a predictive suicide model. It contains information from a study that focused on six groups of individuals with differing histories of suicide attempts. Take a few minutes to read this article and learn more about this study. Rajappa, K., Gallagher, M., & Miranda, R. (2012). Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognitive Therapy & Research, 36(6), PSY 2010, Abnormal Psychology 4

5 Many studies focus on why people develop mood or anxiety disorders. This study looks at rumination as a factor in the development of these disorders in adolescents. Wilkinson, P. O., Croudace, T. J., & Goodyer, I. M. (2013). Rumination, anxiety, depressive symptoms and subsequent depression in adolescents at risk for psychopathology: A longitudinal cohort study. BMC Psychiatry, 13(1), PSY 2010, Abnormal Psychology 5

Depressive and Bipolar Disorders

Depressive and Bipolar Disorders Symptoms Associated with Depressive and Bipolar Disorders Characteristics of mood symptoms Affects a person s well being, school, work, or social functioning Continues