1. Family
2. Finance
3. Work
4. Illness 

1. Diagnostic reliability is low.
2. There is significant overlap between GAD and other anxiety and panic disorders. 

1. People with GAD have both positive and negative beliefs for worry.
2. People with GAD have more metaworries relative to patients with other anxiety disorders.
3. People with GAD have negative beliefs that worry is dangerous.

• Measured negative beliefs about anxiety (e.g., anxiety is dangerous).
• People who held negative beliefs at Time 1 were more likely to have developed GAD at Time 2. 

• Subjects who worried before imagining giving a speech did not experience increased heart rate during imagining.
• Worrying about a film for 15 minutes was associated with less anxiety about the film.

What is evidence that intolerance of uncertainty is an important part of the develpoment of GAD?

(Dugas et al., 2005)

• Subjects were presented with word lists, half of which denoted uncertainty.
• Subjects with high intolerance for uncertainty recalled more uncertain words, as though they had a cognitive bias.

An organism is predisposed to form associations between certain stimuli and responses.

It is alsmost impossible to condition a fear to a neutral or "positive" object.

1. Systematic desensitization
2. Flooding
3. Modeling 

• Exposure to feared social situations.
• Direct teaching of social skills. 

1. Refusal to maintain body weight above a minimally normal weight for age and height.
2. Intense fear of gaining weight, even though underweight.
3. Distrubed body perception.
4. Amenorrhea. 

1. Recurrent episodes of binge eating.
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain.
3. Symptoms continuing, on average, at least twice a week for three months.
4. Undue influece of weight or shape on self-evaluation. 

1. Restricting-type anorexia nervosa
2. Binge-eating/purging-type anorexia nervosa
3. Normal-weight bulimia nervosa
4. Bulimic obesity
5. Obesity 

1. Self-evaluation based on weight.
2. Comorbidity.
3. Prevalence among high SES, young White females. 

1. Amount of weight loss (AN: significantly below ideal; BN: below, normal, obese)
2. Distortion of body perception (AN: severe distortion; BN: less severe distortion)
3. View of disorder (AN: proud; BN: ashamed)
4. Feelings of control (An: rigid self-control; BN: lack of self-control) 

1. Immediately following puberty.
2. Around the age of 18. 

1. Intense cultural pressures to be thin.
2. Unrealistic ideals about what is considered "thin." 

• Three minutes of exposure to "thin-ideal" models.
• Produced feelings of guilt, shame, depression, and body dissatisfaction. 

• Two conditions: pressure or neutral.
• In pressure, talk about how dissatisfied with weight, new diet, etc.
• In neutral, talk about classes and plans for weekend.
• Talking with a body-dissatsified woman produced negative emotions.
• Pressure from other peole is a powerful risk factor. 

Body weight regulation is similar to a thermostat.

Weight is physiologically regulated.

• Prisoners double caloric intake for 6 months.
• Most men gained up to 10% of body weight fairly easily.
• They then became hyperbolic, resisting additional weight gain.
• Most gradually returned to original weight levels.
• They burned excess food through increased metabolic activity. 

• For first three months, ate regulary to establish baseline.
• For next 6 months, restricted to half caloric intake. 
• Men lost about 25% of body weight.
• Changes
• Attitudes and behaviors related to food and eating.
• Binge eating.
• Emotional and personality changes.
• Social changes.
• Physical changes.
• Physical activity.  

Several men reported episodes of binge eating when they had access to food.  For some men, binge eating persisted for some time after normal habits had been reinstated.

Suggests that binge eating is not primarily a psychological response but a biological response to starvation.

Depression was common.

Angry outbursts, irritability, nervousness, anxiety, apathy.

• Decreased need for sleep.
• Dizziness.
• Headaches.
• Reduced strength.
• Cold hands and feet.
• Overall slowing down of the body's physiological processes.
• Decreased metabolic rate (dropped by 40%).
• Changes in percentage of body fat and muscle. 

1. Eating high caloric ("forbidden") foods results in disinhibition of eating.
2. Abstinence violation effect.
3. Suscpetible to other disruptions of their diets (e.g., alcohol, emotional distress, distraction).
4. Dichotomous perception of foods. 

• Restrained Eaters and normal eaters.
• Consumed a "preload" of zero, one, or two milkshakes.
• Restrained eaters consumed more on the taste test following a "preload" consumption of two milkshakes.

1. ED patients are chronically REs.
2. Similar triggers for overeating (e.g., alcohol, emotional events, perceived diet breaking).
3. Dichotomous perception of foods. 

• Followed 15 year old girls for a year.
• Those who were dieting were 8 times more likely than nondieters to develop an ED.   

• Experimentally induced binge-eating by reducing caloric intake.
• 62% of normal subjects on a restricted diet reported binge-eating.
• Dieting is a risk factor. 

A struggle for control is the central psycholgoical issue in the development of ED. 

Exceptionally "good" girls never go through the adolescent struggle for autnomy.  Dieting becomes an attempt to wrestle control.

Families of anorexis are "enmeshed."  As a result, they do not have the opporutnity to establish themsleves as independent persons. 

EDs are a battle for control.

1. Self-monitoring
2. Weekly weighing
3. Prescription of regular eating patterns
4. Self-control strategies
5. Exposure and response prevention 

1. Help the patient identify a problematic thought.
2. Evaluate the evidence in support of her thought.
3. Evaluate the evidence against her thought.
4. Come to a "reasoned conclusion" as a result of challenging the problematic thought.

• Patients were randomly assigned to CBT, behavioral therapy, or IPT.
• At the end of the treatment, CBT worked the best.
• At twelve months, IPT patients looked better than CBT patients. 
• Feeling accepted by another person is largely related to accepting one's own body.

• Men are less likely to diet.  
• Cultural standards are looser for men.
• When men want to lose weight, they are much more likely to exercise. 

1. Homosexuality
2. Obesity as a child
3. Certain sports (e.g., wrestlers, jockeys) 

Women with a secure relationship with God experienced less pressure, less thin-ideal internalization, less body dissatisfaction, and less dieting.

A secure relationship with God disrupted the pathways from the sociocultural variables to body dissatisfaction and dieting.

• Exposed women to spiritual, religious, and neutral affirmations.
• Women exposed to religious affirmations improved in how they felt about their appearance. 

1. Body appreciation
2. Body acceptance by others
3. An emphasis on what the body can do rather than how it looks
4. Eating in response to hunger instead of rigid dietary rules or negative emotions 

1. Intrusive
2. Recurrent
3. Unwanted
4. Inappropriate 

An obsession strikes.  Anxiety mounts.  Repetitive acts provide a way out. 

1. Behavioral: observable acts
2. Mental 

1. Washing
2. Checking
3. Symmetry
4. Hoarding
5. Requesting reassurances
6. Rubbing, touching, tapping, ordering 

1. Counting
2. Counter-image 

Abnormal activity of basal ganglia and orbital frontal region.

Serotonin also plays a role.

1. Blame themselves for intrusive thoughts and expect terrible outcomes.
2. Try to "neutralize" their thoughts with actions (or other thoughts). 

• The actions are reinforced by the reduction in anxiety.
• The belief that thoughts are dangerous is reinforced.
• As fear of thoughts increases, so does the number of thoughts. 

Obsession ("dangerous" thought).

Anxiety.

Compulsion.

Anxiety decreases - compulsions are negatively reinforced; fear of thoughts is increased.

Increase in obsessive thoughts and compulsions.

REPEAT.

People with OCD:

• Are more depressed.
• Have higher standards of morality.
• Believe thoughts equal actions.
• Believe they should have perfect control over their thoughts. 

1. Exposure and response prevention
2. Habituation training
3. Cognitive reinterpretation 

1. Conversion disorder
2. Somatization disorder
3. Pain disorder 

1. Hypochondria
2. Body dysmorphic disorder

The beautiful lack of concern.

Associated with conversion disorder, although this is no longer required for diagnosis.

1. Four different kinds of pain symptoms
2. Two gastrointestinal symptoms
3. One sexual symptom
4. One neurological-type symptom 

1. Obsessive, unshakeable conviction that one has a serious physical disease.
2. Individual misinterprets normal bodily occurrences.
3. Patient is sincere in his conviction that something is really wrong.

• Followed hypochondria patients for 4-5 years.
• Hypochondria symptoms remitted for those who developed real major medical problems.
• Hypochondria symptoms did not remit for those who did not develop real major medical problems.

1. Obsessive concern over an imagined or trivial defect in one's appearnce.
2. Compulsive behaviors (checking, grooming, seeking reassurance), which take up 3-4 hours of the day, end up reinforcing the concerns. 
3. Poor insight.

Concerns about imagined defect.

Anxiety.

Checking, seeking reassurance.

Anxiety decreases - compulsions and concerns are reinforced.

Increase in concerns and compulsions.

REPEAT.

1. SSRIs
2. Exposure and response prevention 

The key to somatoform disorders is that the patient is unaware of the psycholgoical factors underlying his physical symptoms.

1. Rule out all organic disorders.
2. Confirm evidence of the involvement of psychological factors. 
3. Evaluate whether or not the person is knowingly faking.

• Patient is knowingly faking.
• Patient has no ulterior motive but desires to take on the role of the sick person. 

Motivation.

Individuals with factitious disorder have no ulterior motivation.

Individuals with malingering are motivated by gaining rewards or by avoiding something aversive.

1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity Disorder
4. Deperesonalization Disorder 

1. Two or more distinct personalties.
2. Control of the person by at least two of these personalities.
3. Inability to remember that is too extensive to be due to forgetfulness. 

Certain biological activities were different with different personalities.

The control group (students intetionally faking DID) did not show these biological differences.

White, upper SES women.

Note: This is the identical demographic for people who seek psychotherapy.

Sudden outbursts of aggression, often precipitated by a slight or an insult; later, amnesia for the outburst.

Typically found in men who are usually introverted, brooding, quiet, and inoffensive

1. Usually emerges during therapy for another problem. 
2. Number and type of alters increases the longer the person is in therapy.
3. Patients often deteriorate during treatment.
4. Usually explained in terms of "splitting" in response to severe child abuse, although there is little evidence to substantiate this.

Sociocogntiive explanation:

1. Iatrogenic artifact.
2. Easy to fake.
3. Reinforced for simulating disorder.
4. Allen and Movius, 2000 study on memory.

• Alter A learned 6 words.
• Alter B presented with 42 words.  Indicated recognition of the words.
• Event-related potentials and behavior were consistent with recognition of matieral learned by Alter A.
• Alter B, however, claimed to not recognize the first 6 words; their brain and the time to respond indicated that they indeed did remember. 

• False.
• A big problem is that many DID patients didn't remember childhood abuse until in therapy.
• It is possible to plant false memories (Loftus - Lost in the Mall).
• We tend to have poor source memory.  

1. Self-hypnosis.
2. State-dependent learning (perhaps DID have extremely narrow state-to-memory links). 

1. Localized
2. Selective
3. Generalized
4. Continuous (anterograde) 

• Trauma
• Reexperience of trauma
• Avoidance of reimnders, emotional numbing and detachment
• Hypervigilance and chronic arousal
• Distress or impairment 

• Ruminating
• Sleep
• Support network
• Disruptive childhood 

1. Intensity of traumatic experience (severity, duration, proximity)
2. Social support 

1. Shattered assumptions
2. Meaning of trauma
3. Pre-existing distress
4. Personality/coping style
5. Childhood experiences  

1. Personal invulnerability (bad things aren't going to happen to me)
2. The world is meaningful and just
3. Good people don't experience bad things (blame self) 

• Clean up after an oil explosion.
• Leaders repeatedly point out to them that their efforts were going to be giving finality and comfort to many families.
• Officers who were inducted knew that they were going to experience distress, but they knew that they could handle it. 

Religious people do less well directly after a trauma.

Over time, however, they tend to do better.

1. Genetics (MZ twin more likely to develop) 
2. Physiological hyperreactivity (higher levels of NE and cortisol; abnormal activity of hippocampus and amygdala)

At very high levels of trauma, personal vulnerabilities matter less.

At low levels of stress or trauma, personal vulnerabilities matter more.