Hope Roberson

Abnormal Psych
Fall 2017

Chapter 8
 Anxiety disorders  18.1% of U.S. adults
 Panic Attack — a sudden, intense feeling of apprehension, anxiety, or fear; happens in a
situation that wouldn’t suggest danger
 Anxiety = about the future
 Fear = present stimulus
 Two fear processing pathways
o Higher pathway – goes through the cerebral cortex and has high spatial resolution
 Conscious appraisal of the situation
o Lower pathway – goes more directly through the amygdala and is very fast, but
less conscious experience
 Way to respond quickly to potential danger
 Fears can be learned during development
o Rhesus monkeys  able to teach fear of snakes, but not flowers  learned fear
only applies to evolutionarily important objects
 4 ways to evoke fear:
o Painful stimuli
o Pair cues with aversive stimuli
o Present evolutionarily important cues that have survival value for the species
o Create a frustrating situation
o Suggests that anxiety can be produced by expectations that negative events will
happen or positive events will not happen
 Cognitive bias — the tendency to pay attention to certain aspects of the situation different
from the norm; those with AD show more sensitivity to the possibility of potential threats
 Stroop test — psych test used to study cognitive bias; color names in different colored
ink
o “Threat” stroop – name of color is replaced by a threat word
 Anxious individuals show selective Attentional bias toward threat-related
words
 Individuals with anxiety disorder interpret ambiguous stimuli in a negative manner
 AD neurobiology: prefrontal cortex, amygdala, hippocampus
o GABA – inhibitory neurotransmitter
 Believed that those with AD have reduced GABA  less inhibition of
structures involved with threat response
 AD and 4 functional networks:
o Salience (Cingulo-Operator) Network – important in detecting errors/conflict
o Executive Control (Frontoparietal) Network – implements increased cognitive
control
o Ventral Attentional Network – detecting new stimuli
o Default Network – internal processing such as self-inspection, future planning,
emotional regulation
 o Pattern: overactivity in salience and underactivity in executive and default
 9 months – infants react fearfully to strangers
 Anxiety more prevalent in adolescents than mood, behavior, or substance abuse disorders
 Triple Vulnerability Perspective (David Barlow) – three critical components involved in
the development of anxiety-related disorders
o Biological vulnerability – ex: temperament
o Generalized psychological vulnerability – such as believing the world is not safe
o Specific psychological vulnerability – where you learn from early experiences
 Mineka Model (Susan Mineka – learning/evolutionary perspective)
o Monkey experiment  short-term experiences through modeling can have long-
term effects
o Cultural norms teach social concerns
o Each individual requires a series of background conditions for anxiety-related
disorder to develop
 Humans (and monkeys) learn fear of SNAKES more easily than fear of other stimuli
 Separation Anxiety Disorder — a disorder where as children develop they do not show
a normal sense of independence and continue to feel distress when not with their
caregivers
o DSM-5 requires symptoms be present for at least 4 weeks and 3/8 types of
symptoms must be present
o 8 symptoms: 1. Experiencing distress when not with major attachment figures; 2.
Worrying about the well being of attachment figure; 3. Worrying about an event
such as being kidnapped or getting lost; 4. Unwillingness to leave home for fear
of separation; 5. Fear of being alone; 6. Unwillingness to sleep alone or outside
the house; 7. Nightmares related to separation; 8. Complaints of physical
symptoms
o Most prevalent AD for 12 and under (more common in girls)
o Treatment: CBT
 Generalized Anxiety Disorder (GAD) — a disorder characterized by excessive anxiety
and worry that has been present for more than 3 months
o Worries about future events
o Psychological symptoms: feeling on edge, irritability, difficulty concentrating
o Physiological symptoms: problems sleeping, muscle tension, fatigue
o Anxiety must lead to one or more of the following behaviors:
 Avoiding activities that can have negative outcomes
 Over preparation for activities that can have negative outcomes
 Marked procrastination in behaviors due to worries
 Repeatedly seeking reassurance due to worries
o Most frequently diagnosed mental disorder (along with depression)
o Cognitive Avoidance Model – theoretical model that proposes that worry is the
manner in which an individual with GAD attempts to reduce negative emotional
experiences associated with GAD
 Worry serves two functions: prepare for bad events and reduce person’s
emotional response
o Treatment: medication (benzodiazepines, azapirones, antidepressants) and CBT
 Social Anxiety Disorder (SAD) — marked fear/anxiety about one or more social
situations where the individual is exposed to public scrutiny by others  afraid of being
rejected/embarrassed by others; anxiety that’s out of proportion to situation
o ~8% U.S. citizens
o Social evaluations: social interactions, situation where person is observed,
performing in front of others
o Neurobiology: amygdala and insula
 Insula as part of salience network is overactive  so neutral signals
prompt excessive reactivity
 Amygdala may not be inhibited by higher cognitive processes
o Treatment: CBT, medication, exposure therapy, social skills training
 Agoraphobia — a person experiences fear or anxiety in open spaces
o Concerned that escape from situation would be difficult
 Specific Phobia — fear or anxiety about a particular situation or object
o Individual must actively avoid condition/object and must have lasted for 6 or
more months
o Fear causes distress that’s out of proportion
o Over 50% of people with one phobia also had 3+ during lifetime
o Neuroscience aspect:
 Observational learning is a likely reason for individuals with animal
phobias to also have relatives with an animal phobia
 Little Albert
 ACC, insula, medial PFC, OFC, thalamus
o Treatment: exposure therapy
 Panic Disorders — AD defined by recurrent and unpredictable panic-like symptoms
followed by at least 1 month of concern or change in lifestyle
o Concerns about dying; concerned about having another panic attack
o May change behavior to try to prevent panic attacks
o Neuroscience aspects:
 Anxiety  forebrain
 Panic  midbrain, especially basal ganglia and limbic structures
 Decreased gray matter; HPA axis
 Cortisol is NOT released during panic attacks
 Panic attacks  hindbrain, such as hypothalamus and periaqueductal gray
o Treatment: SSRIs, benzodiazepines, CBT  CBT and antidepressant medication
= most effective
 Obsessive Compulsive Disorder — repetitive intrusive, unwanted, upsetting thoughts
(know they are not true and don’t relate to personal history) usually followed by
compulsions (ritualistic, repetitive action that is meaningless)
o Compulsion often develops to offset obsession and results in more anxiety
o Obsessions OR compulsions (doesn’t have to be both)
o Main obsession categories: avoiding contamination, aggressive impulses, sexual
content, somatic concerns, religious concerns, and a need for order
o Autogenous obsessions – thoughts or images that come into a person’s mind;
generally disturbing and may appear without stimulus
 o Reactive obsessions – evoked by environment stimuli
o Four developmental themes in response to stress:
 Loss (obsession is that someone could be lost to the person)
 Physical security in one’s own environment (often check to make sure
everything is in place)
 Environmental cleanliness
 Deprivation of resources or important objects (person often hoards
objects/resources to prevent situation of loss)
o OCRD
 Hoarding Disorder — characterized by an excessive acquisition of objects
and an inability to discard these objects
 Body Dysmorphic Disorder — characterized by a preoccupation with a
perceived flaw in one’s physical appearance
 Men – genitals, body build thinning hair
 Women – skin, stomach, weight
 Trichotillomania (hair pulling disorder) — frequently pulling out one’s
hair
 Excoriation (skin picking disorder) — one picks at one’s own face, arms,
hands, and other body sites  must result in lesion
o Brain associations: dorsolateral PFC, insula, temporal/parietal lobes, cerebellum,
basal ganglia (OFC)
 Less volume in OFC, ACC, basal ganglia, and thalamus
o OCD runs in families  eightfold chance that first degree relatives will develop
OCD
o Treatment: SSRIs and the tricyclic antidepressant clomipramine; greater changes
with CBT; both together show best effects (60%)
 Deep brain stimulation

Chapter 9
 Dissociation — experiencing a disruption in our normal ability to integrate information
from our sensory and psychological processes such as memory and awareness
o Term introduced by Pierre Janet  these experiences result from a traumatic
event
 Resulted from a weak ego that could not deal with the trauma
o Defense mechanism for extremely stressful situations
 Dissociative disorders co-occur with anxiety, mood, and personality disorders
 Dissociative experiences can last for a few minutes or a few hours, but they reoccur
o Significant disruptions in organization of identity, memory, perception, or
consciousness
 Dissociation is separate from PTSD
 Dissociation occurs without voluntary awareness
 Depersonalization — the perception of not experiencing the reality of one’s self;
feelings of detachment or being an outside observer for one’s self
o Onset during adolescence
o Mean duration of illness – 15.7 years
 o Response to stress that increases survival by reducing arousal/anxiety
o Reduced autonomic responses to unpleasant stimuli
o Inhibitory responses to negative information
o Decreased cortical thickness
 Derealization — the experience that the internal world is not solid; feelings of
detachment or as if in a fog/dream or distorted/unreal
 ~50% of all adults have experienced depersonalization/derealization at some point in
their life
 Dissociative Amnesia — an inability to recall important autobiographical information
o Dissociative Fugue — sudden, unexpected travel away from one’s home or
workplace with an inability to recall one’s past
o Memory loss is first person in nature (rather than a global memory disorder)
o Procedural memory not lost
o May last for a few days to a few years
o Occurs most often in a persons 30s-40s
o William James  described case of Reverend Ansel Bourne
o Can be seen in children and older adults
 Dissociative Identity Disorder (DID) — one consistent self does not occur  person
does not have a well-developed “I” or sense of self and experiences different
“personalities” at different times; previously known as multiple personality disorder
o Related to trauma occurring before the age of 5/6  sense of self is developing at
that time
o Presence of two or more distinct personality states or an experience of possession
o Disruptions in memory (three different ways)
 Person may not remember significant parts of his/her life or an event that
would be significant to most people
 Person may not remember how to perform an act or well-learned skills
(like driving or using a computer)
 Person may discover evidence of actions that he/she does not remember
doing
o SCID-D – a screening device for DID developed by Marlene Steinberg
o Alters – alternate personalities that take control of one’s behavior and thoughts;
clearly defined, and each may have its own name, memories, traits, and
behavioral patterns
 Alters might not know of the existence of the others
 Alters take control without host’s awareness
o Child abuse present in over 90% of individuals with DID
o 19.2% smaller hippocampus and 31.6% smaller amygdala
o Sybil – claimed to have 16 personalities (later confessed to lying about
personalities)
o Some people question DID and wonder if instead, these people are simply highly
suggestible
o Similar PET scan brain activation seen in those with DID and PTSD
o Treatment: long-term treatment  typically long-term psychotherapy to integrate
various aspects of personality; CBT
 Somatic Symptom and Related Disorders — individuals are certain something is
wrong with their bodies or health, and display unwarranted anxiety and/or seek
unnecessary medical attention
o Psychosomatic disorder – an actual physical illness in which psychological factors
play a role
o Malingering — individuals fake medical disorder to obtain external rewards such
as not going to work, obtaining financial compensation, receiving paid sick leave,
or avoiding undesired activities
o Factitious Disorder — person is actually creating their symptoms
o Somatic Symptom Disorder — condition in which a person’s somatic/bodily
symptoms cause distress/disruption in physical health that is not consistent with a
medical disorder
 Must display one: have persistent thoughts about seriousness of
symptoms, have a high anxiety level about health or symptoms, or spend
excessive time and energy on health; must have lasted longer than 6
months
 Not satisfied when a professional cannot find a cause for symptoms
o Illness Anxiety Disorder — somatic disorder where an individual is preoccupied
with the possibility of having a serious illness, despite having few if any
symptoms; previously known as hypochondriasis
 Anxiety focused on health issues
 May frequently check one’s body for changes
 Concern with the possibility of developing an illness = IAD (concern with
symptom itself = somatic symptom disorder)
 See personal symptoms as more severe than those seen in other people
o Conversion Disorder — a somatic disorder where a person shows signs of
physical disability, but the disorder does not follow patterns of underlying
physiology/neurology; previously referred to as hysteria
 Glove anesthesia – specific CD where person can’t feel anything in the
hand, but doesn’t follow known physiological or neurological patterns
 Considered to take place in an involuntary manner outside of person’s
consciousness
 Common symptoms: paralysis, seizures, tremors, blindness, anesthesia,
and problems with movement
 High comorbidity with anxiety, depression, and personality disorders
 La belle indifference – the beautiful indifference; individuals lack concern
for their symptoms
 Originally referred to as “wandering uterus”
 Hysteria – series of patients who showed medical symptoms without a
known cause
 Freud worked with these patients early on
 Conversion Reaction – Freud’s idea that psychic energy was
converted into physical symptoms; painful memories/trauma are
not consciously experienced in an emotional manner but rather
converted into physical processes
  Freud learned that patients with CD could recall painful memories under
hypnosis and have normal feeling in afflicted body part
 Dr. Josef Breur  patient Anna O. (Bertha Pappenheim)  lead Freud to
have patients talk about trauma in treatments for CD
 Aka functional neurological symptom disorder, psychogenic disorders, or
functional disorders
 Neuroscience mechanisms not fully understood
 Pavlov  over excitation of subcortical centers due to strong
emotions produced cortical inhibition which could affect sensory
and motor areas and functionally turn them off
 Motor pathways may be suppressed by inhibitory processes related
to emotional experiences
 Possibly related to midline brain regions associated with
representations of self and emotional regulation
 fMRI study: stimulation on numb limb showed no brain activity;
stimulation on both sides showed activity on both sides of brain for all
patients (Ghaffar, Staines, and Feinstein)
 Mirror neurons  active when we observe movement in others as if we
made the same movement
 Study showed that individuals with functional paralysis showed no
brain activity when they observe movements on the side of their
paralysis (Markus Burgmer and colleagues)
 “go-nogo” study  functional paralysis did not influence motor
preparation in the brain but only the actual movement (Yann Cojan)
 CD may include an inability to turn off the default network and remain in
a more internally focused state
o Factitious Disorder —somatic disorder where a person creates certain symptoms
in order to be seen by a health care professional, with the goal of receiving
attention or sympathy
 FD imposed on self – produces symptoms in self  Munchausen
syndrome
 FD imposed on another – typically a caregiver such as a parent produces
symptoms in child  Munchausen syndrome by proxy (seen almost
exclusively in women)
o Treatment for somatic symptom disorders: most common approach is an
educational one; antidepressant medication, CBT, and family therapy or problem-
solving approach
 CBT most effective at reducing physical symptoms, psychological
distress, and disability
o Phantom limbs – individuals experience sensations in a limb that is no longer
attached to their body  one treatment is using mirror box (involved mirror
neuron system)
o Penfield’s homunculus — a figure displaying the representation of the body in
the brain
 Can explain why an individual who lost their arm may now experience
sensation in “arm” when face is touched  face and arm near each other
  Loss of a body part can result in functioning body parts nearby to take
over the area of the brain

Chapter 10
 Anorexia and bulimia show onset during adolescence
o Symptoms: weight preoccupation, body dissatisfaction, and disordered eating
o Bulimia symptoms stabilize after 18
o Partial genetic component
 Higher prevalence of disordered eating in Hispanics and Native Americans
 Numerous secondary medical problems result from eating disorders  higher death rate,
suicide rates of 4-5%, problems with teeth and gastrointestinal systems
 Prevention programs that involve parents show positive results
 Anorexia Nervosa — eating disorder involving the restriction of food, below normal
weight, a fear of gaining weight, a lack of recognition of the seriousness of current body
weight, and a distorted perception of one’s body
o 3 characteristics: food refusal, onset in adolescence, lack of concern about the
consequences of not eating
o Lower-than-normal BMI
o The most homogenous presentation of a psychiatric disorder
o Subtypes:
 Restricting type – accomplish weight loss through dieting, fasting, and/or
excessive exercise
 Binge eating/purging type – display episodes of binge eating or purging
through self-induced vomiting or the use of laxatives, diuretics, or enemas
o Endophenotype: anxious, perfectionistic with an overemphasis on self-imposed
standards, difficulty with flexibility, obsessiveness around order, exactness, and
symmetry
 The higher the lever of perfectionism, the poorer the recovery from
treatment and the shorter duration before relapse
o Person sees body parts and overall weight as being heavier than they are
o Distortion components  perceptual, emotional, cognitive
 Perceptual – whether one’s self or others are underweight, normal, or
overweight
 Emotional (affective) – whether the person is satisfied or dissatisfied with
his/her own body
 Cognitive – beliefs concerning one’s body image as well as the mental
representation of one’s body
o Commonly deny they have a problem  will say various reasons why they eat or
exercise as they do, which might not fit actual behaviors
o Neuroscience distortion components
 Perceptual – precuneus and inferior parietal lobe
 Emotional/affective – PFC, insula, amygdala
 Insula – processes internal information that gives rise to sense of
self
  Cognitive – hippocampus, ACC, DLPFC, and parietal areas
 Serotonin binding increased in individuals with eating disorders
 Dopamine system different in those with EDs  no sign of reward in
relation to eating
o Other medical issues
 Lower estrogen levels and higher cortisol levels
 Decreased bone density  increases chance of fractures
 Issues with cardiovascular functions
 Reduced GI tract motility
 Decreased brain volume
 Reduction of brain metabolism in specific areas, including the frontal,
cingulate, temporal, and parietal areas
o 50-80% of variance in anorexia and bulimia can be accounted for by genetics
o Anorexia is seen in more developed economies  higher in cultures with
abundant food
o One of the most difficult disorders to treat since many individuals do not want to
be treated
o Maudsley approach — family-based treatment with three phases  weight
restoration, taking control, and developing personal autonomy
o CBT is affective with adults  focuses on irrational thoughts and conclusions
o No good evidence to suggest effectiveness of medication in treatment
o 1/3 of individuals recover about 4 years after onset  year 10, about 50% recover
 beyond this time 73% recover and the other individuals either experience
medical complications from the disorder or die of suicide
o Presence of vomiting and higher anxiety were associated with lower positive
levels of recovery
o Impulsivity was associated with recovery
 Pathways with brain and gut  vagus nerve, HPA axis, immune system (cytokines), and
short-chain fatty acids
o Gut bacteria are involved in the emotionality and eating patterns of those with
eating disorders
o Gut bacteria can influence how medications affect you and may reduce the effects
of some psychotropic medications
o Different forms of gut bacteria can generate specific NTs like GABA
o One case study showed fewer types of bacteria in a person with anorexia
 Bulimia Nervosa — eating disorder involving periods of overeating in which the person
feels out of control, followed by purging
o Main characteristic – periods of overeating followed by an inappropriate attempt
to compensate
 Once they begin eating, they are unable to stop until a large amount of
food has been consumed
o To prevent weight gain  self-induces vomiting or takes laxatives or other
medications to eliminate food; person may also over exercise or fast
o Typically show normal body weights
o Prevalence is higher in developed countries
 o Eating tends to occur in the late afternoon or evening when the person is alone
 Eating often involves sweet foods
 Some individuals feel “numb” when engaging in binge eating episodes
 Purging usually follows shortly after
o Secondary medical problems related to vomiting and overuse of medications like
laxatives  can include menstrual disturbances, dental erosion, and electrolyte
imbalances
o Some type of genetic relationship
o Normal brain volume
o Three major aspects in DSM-5
 Binge eating – person often consumers 2,000 calories in one sitting
 Lack of control over eating
 Purging – aspect of bulimia where a person eliminates food from the body
by such means as vomiting, taking laxatives, diuretics, or enemas
 Psychological aspect where one’s self worth is seen in relation to one’s
weight or body shape
o DSM-5  bingeing and inappropriate compensatory behaviors must occur at least
once a week for 3 months for diagnosis
o CBT = best-evaluated treatment
 40-50% treated with CBT recover
 Psychoanalytic therapy can work, but CBT is more effective
 Antidepressant medications more effective than placebo
 Eating disorders more common in elite athletes than the general population
o Especially in sports associated with lean body types  distance running,
gymnastics, figure skating, swimming, and diving
o Also wrestling  “making weight”
o Judged sports  gymnastics and figure skating
 Binge Eating Disorder — consumption of large amounts of food and the sense that one
cannot control his/her eating behavior
o Higher rates in those that are overweight
o Eating can go as high as 10,000 calories
o Evidence suggests that binge eating runs in families and is not related to obesity
o Few ethnic differences
o DSM-5 requires 3/5 criteria:
 Eating faster than normal
 Eating until feeling uncomfortably full
 Eating large amounts of food when not feeling physically hungry
 Eating alone because of feeling embarrassed by how much one is eating
 Feeling disgusted with oneself, depressed, or very guilty after overeating
o Treatment goals are to cease binge eating, reduce negative emotions and
cognitions, and to lose weight
 Psychosocial treatments, especially CBT, are effective
 Exercise effective too (combined with CBT)
 Limited success with drug treatments
Chapter 7
 Psychological Stress — the uncomfortable reaction when something we do not expect
and cannot control happens to us
o Can lead to strong emotional reactions and sometime psychological disorders
o First depression episode is often linked to a psychologically stressful event
happening in someone’s life
 Severe stress and trauma from childhood abuse and neglect are associated with
depression, substance abuse, and criminal behavior
 Stress can increase symptoms in patients who are bipolar or schizophrenic
 Early stress is associated with later mental and physical health problems
o Changes can be related to psychological factors, developmental changes in the
brain, genetic factors, epigenetic modifications, endocrine factors, and
economic/social factors
 Children show differential responses to environmental influences that are modulated by
genetic factors
o Monoamine oxidase A (MAOA) gene  located on the X chromosome that
makes certain neurotransmitters inactive (such as serotonin, norepinephrine, and
dopamine) and has been associated with aggression in mice and humans
 Boys who were mistreated during childhood and had a certain form of the
MAOA gene were more likely to be violent and engage in a variety of
antisocial behaviors as adults
 Those without the form of the gene did not display these behaviors, even if
they had been mistreated as children
 Children show differential effects to negative AND positive parental influences
 Early exposure to stress can modify how stress response is expressed later in life
o Children who experience trauma show larger stress responses to social stress later
in life
 Adjustment Disorders — disorders in which reactions to events are out of proportion to
the severity of the event
o Does not require a traumatic event  only an event that is experienced as
distressing
o May interfere with social functioning and job performance
o Reaction must occur within 3 months and not last longer than 6
o Treatment: psychosocial therapy and antianxiety medications
 Acute Stress Disorder — a short-term reaction to traumatic events that lasts from 3 days
to 1 month
o Can occur from watching events happen to a person
o Past 1 month  PTSD
o Clinical symptoms (5 categories)
 Intrusion  involuntary distressing memories, distressing dreams, and
flashbacks
 Negative mood  inability to experience happiness
 Dissociative symptoms  feeling in a fog or inability to remember
important aspects of the trauma
  Avoidance symptoms  avoiding places, people, and situations that
remind one of the trauma
 Arousal symptoms  sleep disturbances, angry outbursts, showing
extreme vigilance, problems with concentration, and a sensitivity to events
that cause a startle
o Highest rates (20-50%) seen when traumatic event involves being assaulted, being
raped, or witnessing a mass shooting
o Greater severity of symptoms associated with: negative appraisals of trauma, high
trait anxiety, showing signs of depression, suicide risk, and not being
married/employed
o Only high trait anxiety, suicide risk, and trauma appraisal significantly predict
severity of symptoms
 PTSD — a long-term reaction to traumatic events that lasts longer than 1 month
o Psychotherapy presented early can reduce the development of PTSD
o PTSD previously known as…
 WWI  shell shock
 WWII & Korean War  neuroasthenia, psychoneurosis, and battle fatigue
o Highest risk is from assaultive violence
o 60% men and 50% of women will experience a serious threat to their life of that
of another close to them during their lifetime
o PTSD is twice as common in women, and women experience PTSD for longer
periods than males
o Higher prevalence in US than elsewhere  greatest prevalence in military
o Appetitive aggression – some individuals seek to commit violent acts and do not
experience distress with these actions; they find these behaviors fascinating,
appealing, and exciting
o DSM-5 criteria
 Individual is exposed to aversive experiences involving potential for
injury/assault
 Intrusions related to the disorder
 Avoidance stimuli involved with the traumatic event
 Changes in cognitive processes (such as an inability to remember
important aspects of ones life, lack of interests, negative attributions about
one’s self, blame of others, negative emotions, detachment, and inability
to experience happiness
 Increased arousal and reactivity (including sleep disturbances, irritability,
and problems with concentration)
o Physiological aspects
 Exposure to severe and chronic stress can damage hippocampal formation
by elevating corticosteroids, which are thought to damage cells, diminish
neuronal regeneration, and reduce dendritic branching
 Hippocampus  encoding of memories including emotional ones
 Amygdala  assessment of threat and fear conditioning
 Medial PFC (including ACC)  inhibition of emotional information
during task performance
 Individuals with PTSD have smaller hippocampus volume than those
without
 Reduced connectivity between ACC and amygdala
 Hyperresponsiveness of amygdala is related to exaggerated fear response
o Treatments
 Help individual move “hot” trauma associations to more “cold,” or
nonreactive, memory processes
 Pharmacological treatments
 Most effective  cognitive and behavioral therapies
 One of the DSM disorders that is mainly treated with psychotherapy
 Exposure therapy for PTSD – designed to have individuals with PTSD re-
experience the original trauma; the person confronts his/her fears and
expectations such that they are reduced
 Goal: have person develop a sense of mastery over the situation
 EMDR  person imagines the traumatic situation while moving his/her
eyes (controversial)
 Seeking Safety – an approach for treating the co-occurrence of PTSD and
substance abuse; five central ideas
 Safety as a priority of treatment
 Integrated treatment that addresses both disorders together
 Focus on ideals such as the meaning of life that are typically lost in
the experience of PTSD and substance abuse
 Incorporates CBT with its emphasis on cognitive, behavioral,
interpersonal, and action domains
 Emphasizes relationship between patient and mental health
professional