Kailey

toc =Background instruction=
 * 1) Create an explanation of the topic and how you plan to approach it.
 * 2) A list of scholarly sources (your annotated bibliography). You must have at least five sources at this point.
 * 3) Use your notes to get to the next stage – synthesizing the preliminary question to create sub-questions
 * 4) At least THREE specific questions that stem directly from the research you have done so far, and an explanation of how you plan to answer them. Please refer to the EE Conference Rubric and include questions that address the following:

Developing a Research Question

 * Initial question - how do you treat claustrophobia
 * Research question - identify a treatment method - make that the focus
 * Context … Why is this topic worthy of investigation? What makes this topic viable for the EE?

Winter break research

 * What are phobias
 * Cognitive causes
 * biological causes
 * Have you explored claustrophobia - DSM4 - TR - notes needed
 * Treatment options

=Running bibliography= put this into proper APA format and add annotations (2 sentences of why this source is relevant - key concepts/ideas etc) Finish adding all your sources and email me when you've done this so I can see what you've been looking at

-crane -Grahame Hill- Oxford Revision Guides: A S&A Level Psychology- -Levels of analysis in Psychology - Emory University (2011, April 13). Psychologists closing in on causes of claustrophobic fear. ScienceDaily. Retrieved March 10, 2013, from http://www.sciencedaily.com­ /releases/2011/04/110412065809.htm
 * 258-259
 * 16 (the walker-tessner model for psychiatric outcome)

Emory University (2012, October 22). How fear can skew spatial perception. ScienceDaily. Retrieved March 10, 2013, from http://www.sciencedaily.com­ /releases/2012/10/121022081143.htm

[|**http://www.epigee.org/mental_health/claustrophobia.html**]

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=Question= Claustrophobia: -just treatment -just cause -treatment specific to cause
 * how can you create a treatment if your not sure what the cause is
 * but you cant do nothing- even if you dont know the cuase you can still treat it
 * treating symptoms- not root of the problem


 * The extent to which understanding the relationship between etiology and claustrophobia can help us devise an affective treatment plan**

1) help readers understand we don't know what causes claustrophobia 2) how to treat it anyway

=NOTES=

Sub- topics
__** Key learning Outcomes relevant to this topic (the final research question could be derived a specific LO or from a combination) **__ **Cause LOs**
 * (notes for each sub-topic should be listed underneath) **
 * General LOs **
 * ** Discuss the extent to which biological, cognitive, and sociocultural factors influence claustrophobia: **
 * ** Evaluate the psychological research relevant to claustrophobia: **
 * ** Analyze etiologies of claustrophobia **
 * ** Discuss cultural and gender variations in prevalence of claustrophobia **
 * Treatment LOs **
 * ** Evaluate biomedical, individual and group approaches to claustrophobia **
 * ** Discuss the use of eclectic approaches to treatment **
 * ** Discuss the relationship between etiology and therapeutic approach in relation to claustrophobia **

Concepts of normality and abnormality:
(Crane) Normality:
 * -rely on the subjective assessments of clinicians, in combination w/diagnostic tools of classification systems
 * -bell curve
 * -problems with this =some harmful things are in the norm, while some
 * non-dysfunctional things are out of the norm (e.g. obesity vs high IQ)

Abnormality:
 * -abnormal behavior= psychological disorders
 * -difficult to define/diagnose b/c based on symptoms ppl exhibit/report
 * -depends on a series of value judgments based of subjective impressions
 * -sometimes defined as the subjective experience of feeling “not normal” (e.g. anxiety, unhappiness, distress)
 * -unreliable indicator of serious psychiatric problems (e.g. schizophrenia indifferent/unaware of condition)
 * -consider when behavior violates social normls/makes others anxious
 * -problematic b/c cultural diversity affects how ppl view social norms

criteria for normality:
 * -suffering: does the person experience distress and discomfort?
 * -maladaptiveness: does the person engage in behaviors that make life difficult for him or her rather than being helpful?
 * -irrationality: is the person incomprehensible or unable to communicate in a reasonable manner?
 * -unpredictability: does the erson act in ways that are unexpected by himself or her

-Rosenhan/Seligman (1984); seven criteria to det. “normality”

how can this info help you with your question? (either cause or treatment)
 * 1) //suffering//: does the person experience distress/discomfort?
 * 2) //maladaptiveness//: does the person engage in behaviors that make life difficult to him/her rather than being helpful?
 * 3) //irrationality//: is the person incomprehensible or unable to communicate in a reasonable manner?
 * 4) //unpredictability//: does the person act in ways that are unexpected by him/herself or by other ppl?
 * 5) //vividness & unconventionality:// does the person experience things that are different from most ppl?
 * 6) //observer discomfort:// is the person acting in a way that is difficult to watch or that makes other ppl embarrassed?
 * 7) //violation of moral or ideal standards:// does the person habitually break the accepted ethical/moral standards of the culture
 * *problems with ^: diff. societies have diff cultural norms
 * -hard to diagnose abnormal

__Mental Health Criteria (Tahoda-1958)__
 * -efficient self-perception
 * -realistic self-esteem/acceptance
 * -voluntary control of behavior
 * -true perception of the world
 * -sustaining relationships/giving affection
 * -self-direction/productivity
 * *unemployed deprived of many of ^characteristics

__Eval:__
 * -intuitively appealing, but if ^ criteria applied most ppl= abnormal
 * -value judgements
 * -criteria changing w/norms eg. homosexuality

__Mental Illness Criterion:__ how can this info help you with your question? (either cause or treatment)
 * -medical model: abnormal behavior is of psychological origin (e.g. result of disordered neurotransmission)
 * =>treatment addresses the psychological problems
 * -drug treatment
 * -abnormal behavior= psychopathology- psychological (mental) illness based on observed symptoms of a patient
 * -diagnostic/statistical manual of Mental Disorders= standardized system for diagnosis based on persons clinical/medical conditions/psychosocial stressors/extent to which a persons mental state interferes w/daily life
 * -ethical concerns:
 * -model argues regard ppl w/mental disorders as sick vs morally defective b/v responsibility=removed from patient
 * -eg. preg woman w/o marriage admitted ->asylum
 * -political dissidents diagnosed w/schizo
 * -traditional __ medical model __ = reductionist
 * -most psychiatrists now use biopsychosocial approach to diagnose/treat
 * -Szas’s criticisms of concept of “mental illness”

__Diagnosing Psychological Disorders:__
 * -psychiatrists often have to rely primarily on patients __ subjective __ description of problem
 * -diagnosis 1) formal standardized clinical interview 2) mental health status exam
 * -limitations- Kleinmutz (1967)
 * -info __ may __ be blocked if patient/clinician fails to respect the other
 * -patients anxiety/preoccupation __ may __ affect process
 * -clinicians unique style/ degree of experience/ theoretical orientation __ definitely __ affects interview
 * -additional diagnosing methods used to assist:
 * -direct observation of individuals behavior
 * -brain scanning techniques( CAT / PET)
 * -psychological testing (personality tests/ IQ tests)
 * -ABCS of psychological disorder symptoms:
 * ** -A ** ffective symptoms: emotional elements (fear, sadness, anger)
 * ** -B ** ehavioral symptoms: observational behaviors (crying, pacing, p. isolation)
 * ** -C ** ognitive symptoms: ways of thinking ( pessimism, personalization, self-image)
 * ** -S ** omatic symptoms: physical symptoms (facial twitching, cramping, amenorrhoea)
 * -major classification systems used by western psychiatrists based on
 * -abnormal experiences&beliefs reported by patients
 * -agreement among a # of professionals on criteria
 * *criteria can change (eg. homosexuality)
 * -abnormal psych is a social construction that has evolved over time w/o prescriptive & regulating definitions
 * -argued that DSM-IV=gender&culturally based

//diagnosis//: identifying a disease on the basis of symptoms & other signs

how can this info help you with your question? (either cause or treatment)

__Validity & Reliability of Diagnosis:__
 * -effectiveness of diagnosis an be measured in terms of two variables
 * -reliability: ^ when different psychiatrists agree on a patients diagnosis when using the same diagnostic system; inter-rater reliability
 * -validity: the extent to which the diagnosis is accurate
 * *much more difficult to assess in psychological disorders (e.g. some symptoms may appear in diff disorders)
 * -classification systems= descriptive; does not identify any specific causes for disorders
 * => difficult to make a valid diagnosis for psychiatric disorders b/c there are no OBJECTIVE physical signs of such disorder

Rosenhan (1973)
 * 12 normal patients acted like they had schizo=> 8 admitted
 * warning of pseudo-patients => 41 real patients classified as pseudo
 * -conclusion: not possible to distinguish b/w sane &insane in psychiatric hospitals
 * -if same diagnosis has 50/50 chance of leading to same or different treatment
 * => serious lack of validity
 * -probs due to bias in diagnosis
 * *”clinicians may expect certain groups of patients to be more prone to a disorder, therefore more likely to interpret symptoms as related to that disorder than if they were presented by a diff person”
 * - // overpathologization: // when ^^ occurs consistently to a spec. group

__Ethical Considerations in Diagnosis:__ how can this info help you with your question? (either cause or treatment)
 * -ppl who are different are // stigmatized //
 * __ - __ an indivudual “with schizophrenia” vs “schizonphrenic”
 * -lableing someone for life
 * -disorder in remission
 * -self fufilling prophecy
 * -pejudice/descrimination
 * -schema processing
 * -bias
 * -racial/ethnic: e.g. Jenkins-Hall & Socco (1991)’ evaluated female patients: European american vs african american woman- depressed/non depressed? More AA woman incorrectly diagnosed as depressed than EA woman
 * -confirmation bias: cliniciasn tend to have expectations about the person who consults them (patient is there=> smth to diagnose)
 * => may overract & see abnormality wherever they look (rosenhan 1973)
 * -institutionalization= confounding v. when trying to establish validity of diagnosis; once admitted all behavior= perceived as being a symptom of illness

__Cultural Considerations in Diagnosis:__
 * -conceptions of abnormality differ b/w cultures
 * =>significant influence on validity of diagnosis of mental disorders
 * -culture-bound syndromes (culture spec.)
 * -depression in asia: less ppl depressed or asian ppl less likely to report emotional problems to doctor?
 * -reporting bias
 * - // somatization: // bodily symptoms of psychological disfunction
 * - // affective: // emotional
 * -cultural blindness
 * -prevention:
 * -clinicians should make efforts to learn about the culture of the person being assessed
 * -eval of bilingual patients should really be undertaken in both langs
 * -diagnostic procedures should be modified to ensure that the person understands the requirements of the task

how can this info help you with your question? (either cause or treatment)

-- =Claustrophobia=

General info
Psychological Disorders: Anxiety Disorders Claustrophobia belongs under the set of anxiety disorder
 * (Source???????)**
 * -in ICD-10, referred to as neurotic, stress-related, and somatoform disorders. Broader cat. includes phobias, PTSD, panic disorders, or OCD
 * -phobia

Diagnostic Critera for Specific Phobia

 * (source??????????)**
 * 1) marked and persistent fear that is excessive/unreasonable cued by the presence or anticipation of a spec. object/situation
 * 2) exposure to the phobic stimulus almost invariable provokes an immediate anxiety response *may take form of situationally bound/ situationally predisposed panic attack)
 * in children = crying, tantrums, freezing, clinging
 * 1) person recognizes that the fear is excessive/unreasonable
 * 2) phobic situation= avoided/ endured w/intense anxiety/distress
 * 3) avoidance/ anxious anticipation/ distress in feared situation interferes significantly w/persons normal routine/ occupational and academic functioning/ social activities/ relationships; or marked distress about having the phobia
 * 4) in individuals under 18 yrs, duration= at least 6 months
 * 5) anxiety/panic attacks/ phobic avoidance associated w/spec object/situation are not better accounted for by another mental disorder

which one does Claustrophobia belong to?
 * Types:**
 * -animal type
 * -natural environment type (heights, storms)
 * -blood-injection-injury type
 * -situational type (planes, elevators, closed spaces)
 * -other type
 * -symptom types
 * -affective
 * -behavioral
 * -cognitive
 * -somatic

Specific definitions
DSM-IV-TR - find and paste in below

Biological Level of Analysis

 * -according to the BLOA, spec, phobias should be explainable in terms of
 * -evolutionary adaptation
 * -genetic susceptibility
 * -action of neurotransmitters in spec. regions of brian
 * -roles of hormones


 * Fight or flight:**
 * -activates sympathetic nervous system
 * -adrenaline (h)
 * -neurotransmitter GBA= parasympathetic n. system; returns bod. to normal state after threat
 * -overactivity in the sympathetic n.system &/or under-activity in the p.sympathetic n.system = responsible for phobia
 * -ACTH (adrenocorticotropic hormone) ^ fear
 * -^ GABA=> less anxiety
 * -menstruation=> less anxiety? h. levels
 * -ethical reasons limit research of BLOA humans
 * -strong correlation between amygdala activity in the right hem. of brain and ratings of distress
 * => amygdala is activated after object-recognition areas in the brain indicate that object=threatening=> amygdala works to activate other regions of the brain to support activation of a fight/flight response to stimulus.
 * -classical conditioning has biologically predisposed individual humans to have this biological reaction to some stimuli but not others


 * Classical conditioning:**
 * =biological process involving the unconscious strengthening of neural connections in the brain according to experience
 * -Ohman et al, 1975
 * -experimented on human participants could he create fear reactions to pictures of prepared stimuli and unprepared stimuli like flowers
 * -easier for him to create the fear response for the prepared items (these responses more likely o last longer than others)
 * => humans are biologically predisposed through an evolutionary process to fear some objects more than others
 * -Bennett-levy and Marteau (1984)
 * -correlational study; measured fear of animals & asked participants to rate them on a certain characteristics (eg ugliness& how suddenly they moved<-- showed strong associations w/fear)
 * =>we carry an innate tendency to fear characteristics of animals rather than the animals themselves
 * -Davey et al. (1998)
 * -what has been selected for in human evolution is fear elicited by stimuli associated w/disease rather than direct predatory attack
 * -ratings of fear strongest for disgust relevant animals (slug/spiders)
 * -disgust reaction (adaptive response to help humans avoid disease)
 * => triggers brain mechanisms that activate the sympathetic nervous system, (fight/flight)
 * -gender differences, female^ b/c threat to herself/children
 * -most disgust in japan, least in india
 * -what does this say?

-evolutionary explanations lack concrete evidence -twin studies offer some support for a genetic cause -Skre et al. (2000) -specific phobias shared by identical twins much more than by non identical twins -Merckelbach et al. (1996) -twin studies usually show some support for genetic inheritance -but what is inherited is not the specific phobia, but a general tendency for neurotic responses (usually manifests itself as specific phobias) -exception: phobia of blood (seems to be inherited more specifically than other phobias)
 * Twin Studies:**
 * HOW DOES THIS FAIL TO PROVE BIOLOGICAL ETIOLOGY??

Weaknesses: -researchers tend to study animal phobias whereas situational phobias = more common -(inheritance of disgust reaction may work as explanation for animal type, but not situational type)

NOW PASTE IN BELOW ANYTHING RELEVANT TO BIO CORRELATE OF CLAUSTROPHOBIA

Sociocultural LOA
Have you come across anything here? (eg. cultural differences in prevalence?)

Interaction between cognitive and biological factors in emotion
Ebsco host- Predictors of Unsuccessful magnetic resonance imaging scanning in older generalized anxiety disorder patients and controls [|http://web.ebscohost.com/ehost/detail?vid=15&sid=3b45b858-ed34-4716-9180-ca94f1404580%40sessionmgr104&hid=12&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=70715294] (haven't read- maybe go back to) "those who experience anxiety during MRI may go on to develop long-term clinical anxiety disorders, particularly claustrophobia (e.g., Fishbain et al., 1988) and panic attack (Koechling et al., 1996), significantly extending the psychological distress experienced by patients beyond the duration of the scan" (cause of both claustrophobia&panic attack disorder)
 * Bi-directional relationship**
 * SOURCE 1**
 * notes:**

Distorted Spatial Perceptions Tied to Claustrophobia []
 * SOURCE 4:**

SOURCE 2: Claustrophobia and the Magnetic Resonance Imaging Procedure [|http://web.ebscohost.com/ehost/detail?sid=f2625b69-4051-411d-b720-e7a46a3e8abd%40sessionmgr12&vid=1&hid=12&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=773161]
 * -theory: individials with claustrophobic fear have problems w/spatial perception
 * -"at this point, we don't know whether it's the distortion in spatial perception that leads to the fear, or vice versa. Both possibilities are likely."
 * -researchers believe claustrophobia/acrophobia are tied to some imbalance in how we normally percieve objects that are close and far away
 * -claustrophobia found in 4% of population (?)
 * -can trigger panic attacks

=Treatment= theoretical approaches to guid treatment
 * General info**
 * -eclectic approach has intuitive appeal but requires therapists to undergo training in a variety of areas
 * -psychologists unable to prescribe drugs but should be aware of how meds affect patients.
 * -psychiatrsits can precribe drugs, should be able to perform selveral diff. therapeutic techniques

Biomedical therapy
treating spec. phobias fucosing on meds to alleviate anxiety symptoms and biofeedback traiing to help the individual manage their own psysiological arousal.


 * -use of benzodiazepines criticized
 * -they can have significant side effects (drowsiness, sexual difficulties, increase in aggression/irritability)
 * -patients can develop physical tolerance
 * -drowsiness
 * -do not tackle cause of problem (only minimize symptoms)

Individual Therapy: behavioral, cognitive
behavioral: based on classical conditioning theory, suggests that fear is a learned response to a stimulus and that this association can be broken through various different approaches in therapy
 * -systematic desensitization
 * -hierarchal set of fear situations relating to phobic stimulus, training in muscle relaxation, exposure to stimulus through imagination
 * -good at reducing anxiety levels but not at reducing avoidance behaviors
 * -better long term solution
 * -in vivo exposure (real life exposure)
 * -virtual reality therapy

cognitive
attempt to correct some of faulty thinking that is assumed to be causing the problem
 * claustrophobia- this type of treatment + vivo expusre effective

Group Therapy
-cheaper, but difficult to predict how long it is going to take if individual outcomes are set

=Notes on sources= (everything here needs breaking up and putting under relevant headings)

[]
 * SOURCE 3:**

treatment:


 * -psychotherapy: Psychotherapy : treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication and interventions with the patient. (type of counseling)
 * -cognitive-behavioral therapy (CBT): form of psychological therapy
 * -behavioral therapy
 * -exposure therapy
 * -relaxation techniques (controlled breathing; visualisation)
 * -medication (treats symptoms, not root of problem)
 * -"alternative" treatments? (

Further research: problem with use of drugs- difference between medicinal "treatment" of phobias and therapy


 * SOURCE 5:**

[|**http://psychcentral.com/disorders/anxiety/panic.html**]

panic disorder "While it is not clear what causes the disorder, there is a strong suggestion that the tendency is inherited and runs in families. At one time, researchers believed panic disorder was due primarily to psychological problems. Experts now believe that genetic factors or changes in body chemistry, in combination with stressful circumstances or events, play a pivotal role."

further research- genetic links to claustrophobia? (^^^claustrophobia the same as separation anxiety in this situation?
 * ^^^different cause than claustrophobia.**
 * -each panic attack peaks within about ten min
 * -some repeat in clusters for up to an hr after initial attack (with associated fear of another attack)
 * -anticipatory anxiety (ppl fear having another attack while still in original situation that caused them to have one in the first place)
 * *claustrophobia- if happened to have a panic attack in a closed space, may not want to be in closed spaces anymore (e.g. elevator) b/c fearful of panic attack.
 * -panic disorder more prevalent in woman than men
 * -cognitive behavioral therapy
 * -"People with panic disorder will begin to avoid situations where they fear an attack may occur or situations where help might not be available. This happens with both adults and children with panic disorder.
 * For example, a child may be reluctant to go to school or be separated from her parents. Not all children who express separation anxiety do so because they have panic disorder, and it can be very difficult to diagnose."
 * -panic attacks result in panic disorder
 * -one symptom listed on this website (verify) is "having a fear of places or situations where escape or getting help might be difficult" => claustrophobia?
 * -one symptom listed on this website (verify) is "having a fear of places or situations where escape or getting help might be difficult" => claustrophobia?


 * Source 6**

[|**http://www.epigee.org/mental_health/claustrophobia.html**] "Claustrophobia can develop after a traumatic childhood experience (such as being trapped in a small space during a childhood game), or from another unpleasant experience later on in life involving confined spaces (such as being stuck in an elevator). When an individual experiences such an event, it can often trigger a frightening panic attack; this response then becomes programmed in the brain, establishing an association between being in a tight space and feeling anxious or out-of-control. As a result, the person often develops claustrophobia.
 * Interaction bio and cog - emotion**

Although claustrophobia can cause panic attacks, it is not the same disorder. According to Mark Powers, Ph.D., Associate Professor of Psychology at Southern Methodist University and Co-Director of the [|//Dallas CBT Center//], "Claustrophobia is a specific phobia and not a type of panic disorder. The primary specific threat forecasts for claustrophobia are that either the person will be trapped or run our of air."
 * -panic attacks cause panic disorder; panic disorder causes more panic attacks
 * -panic attacks can cause claustrophobia; claustrophobia can result in panic attacks


 * treatment (put in treatment section)**
 * flooding,

Further Questions/Aspects to Research:

 * 1) -prevalence (global, cultural, gender)
 * 2) -specific causes (inherited factors, prental factors, postnatal factors, stress, neuromaturational factors, traumatic experiences)
 * 3) -specific cures
 * 4) -(a) Rachman and Taylor's (1993) Claustrophobia Questionnaire,
 * 5) b) DSM-IV criteraia for panic attack disorder
 * 6) c) what is the difference between situational panic attacks (claustrophobic situations) and panic attacks as a symptom of claustrophobia? Do you have both disorders? difference in diagnostics
 * 7) d) MRI-panicattacks-claustrophobia