Case 1: Panic DisorderQuestions: 1, 2, 3, 4, 5, 7, 81. The event that seemed to precipitate Joe’s panic attack was the plane flight from Miami. It seemed like Joe felt claustrophobic inside of the plane, and as a result he started to experience a rapid heartbeat. 2. Joe’s case is different from most panic attacks because his attacks did not start until the age of 76. Typically panic disorder begins between late adolescence and the mid-30s. 3. The symptoms of most panic attacks are: shortness of breath, racing heart, chest pain, trembling, sweating, and experiencing a feeling of unreality or detachment. 4. When they experience a panic attack, individuals may first suspect a general medical condition because the symptoms of an attack are very similar to those of a heart attack (i.e. chest pain, lightheadedness, abnormal heartbeat, etc.)5. Dr. Geller was convinced of this because even though the biological aspect, or the physical symptoms of a panic attack, are very scary, they are not actually dangerous. By stepping back and assessing the physical sensations realistically, the sufferer can stay calm cognitively and therefore gain more control over their actions. 6. Dr. Geller instructed Joe to begin getting up and moving around if he experienced a panic attack at night. She also taught him a 20-minute breathing control and muscle relaxation exercise. She took time to explain how Joe was more in control than he thought of his symptoms. She explained that even though his symptoms felt scary, they actually weren’t dangerous at all. Then she told Joe to try going outside 3 times a week in order to expose him to something that might cause his symptoms to flare up. Lastly, Dr. Geller introduced Joe to some interoceptive exposure exercises in order to expose him to panic situations under controlled conditions. The interoceptive exercises Joe used were:-Whole body tension-Breathe through straw-Shake head from side to side-Place head between legs and then lift-Stare at spot on wall-Hold breath-Run in place-Hyperventilate7. Joe’s avoidance of going outside alone led to his diagnosis of agoraphobia. It contributed to his feelings of fear which only made his anxiety and panic attacks more frequent and intense. 8. At the end of his treatment, Joe was full cured of his attacks and had even flown to Europe with his wife Florence. He seemed to no longer be bothered by his condition, but kept note of the exercises that he could use if his symptoms ever returned.Case 4: PTSDQuestions: 2, 3, 4, 6, 8, 10, 112. The neurotransmitter norepinephrine and the hormone cortisol often have abnormal activity in survivors of severe stress. 3. Often times, people who have survived traumatic incidents are left with “scars” that affect their daily lives. In Elaine’s case, she became fearful of almost everything in her life and she incorporated her fears into every conversation she had with her friends. She became angry and cynical, probably because she could tell that no one else shared or understood the fears she was experiencing. People who have survived a traumatic incident are often left with feelings that can’t be easily understood by others. Because of this, the trauma survivor may put up a barrier between themselves and others. Another reason for this might be that trauma survivors don’t want to be told that their fears or emotions are irrational. 4. When Elaine went to see her orthopedist, she became extremely fearful at the suggestion of knee surgery. Sensing her fear, the orthopedist realized that Elaine was in need of more than just physical care, and he referred her to a psychologist. Elaine decided to make an appointment the next morning. 6. The first method Dr. Fehrman suggested was in vivo exposure. In this method, the individual and the therapist make a list of anxiety-provoking situations, ranking them from least provoking to most. Then the individual must enter these situations and remain there for a time, until he or she has experienced a significant drop in anxiety. The exposure exercise is typically repeated several times before the patient begins to experience only minimal anxiety in the exposure setting. The second method Dr. Fehrman suggested was imaginal exposure in which the individual would repeatedly visualized the entire sequence of traumatic events for a long period of time. The client would typically listen to a recorded description that he or she had provided. The repeated exposure desensitizes the client to the memory of the trauma, so that eventually it stops producing any sense of threat. The third method suggested by Dr. Fehrman was cognitive therapy which challenges the individual’s negative cognitions regarding the traumatic event. In this type of therapy, the client writes down or practices less catastrophic and self-damaging interpretations of the trauma, often in conjunction with exposure exercises. 8. The purpose of recording Elaine’s description of her traumatic event was to give her a way of exposing herself to the trauma every day for an extended amount of time. Through listening to her recording, Elaine was able to closely analyze the emotions and fears that stemmed from her accident. 10. Elaine was a child during the Civil Rights Movement. During this time, she was subjected to oppression and harassment from her classmates. In order to survive this cruel treatment, she developed mental and physical quickness. While listening to the recording of her traumatic event, Elaine made a connection between her feelings about the event and this time of oppression during her childhood. Her mental and physical quickness had become her most prized possessions, and her accident as well as the emergency room had dealt a severe blow to these aspects of her self-image. 11. According to the text, post-traumatic stress symptoms last an average of 3 years with treatment, but 5.5 years without. According to the Comer text, more than one-third of people with PTSD fail to respond to treatment even after many years. Case 14: Antisocial Personality DisorderQuestions: 1, 2, 5, 6, 8, 9, 101. What is one of the most common reasons individuals with antisocial personality disorder end up in therapeutic treatment?They are usually required to seek treatment by their school, their employer, or the law. Sometimes they are seeking treatment for another disorder altogether. 2. What inconsistencies did you notice as you read about Jack’s complaints prior to being hospitalized and after he was admitted?Though he claimed he was having suicidal thoughts and symptoms of depression, his manipulative actions towards the other patients were inconsistent with those diagnoses. He eventually admitted as much to his psychiatrist. His other actions, such as running away from the hospital, stealing his psychiatrist’s car, and committing other crimes, were also inconsistent with depression. 5. What behaviors did Jack finally manifest that fit with a diagnosis of antisocial personality disorder?· Constant lying, such as about his symptoms· Complete disregard for the other patients feelings, as well as attempts to manipulate them· Theft and other criminal charges 6. Give three examples from Jack’s mother’s story that suggested Jack was a candidate for a personality disorder as an adult?1. Inability to maintain a healthy marriage, abandoning his spouses when they expected more out of the relationship than just sexual elements.2. Using his charisma to develop false trust between himself and his neighbors, which he took advantage of to molest a 10 year-old girl when he was 12 years old.3. A long history of theft, which began as early as elementary school. 8. Why is treatment usually ineffective for this personality disorder?Patients with APD don’t feel that their behavior is causing them problems. Thus, they don’t typically feel that they need treatment for their disorder. 9. List four criteria that Jack exhibited to convince Dr. Harris that Jack’s diagnosis should be antisocial personality disorder.1. Constant lying/deceitful actions2. Impulsive behavior that was reckless in nature for which he did not show remorse3. Inability to follow social norms4. These symptoms began before adolescence 10. What eventually happens to many individuals who have this personality disorder?Though they may initially experience significant criminal behavior in their teens, people with Antisocial Personality Disorder tend to spend less time in prison and undergo fewer convictions after the age of 40.Case 13: SchizophreniaQuestions; 2, 4, 5, 6, 8/9 (you may answer these together), 12, 13/14 (you may answer these together)2. A) He hallucinated the voice of angels talking to himB) He was delusional that his breath contained a “life force”C) He was unable to perform normal functions and spent most of his time on his own, in his room watching television4. He stopped taking his medication because of the side effects that made him feel dizzy & tired. Also, he did not see a significant reduction in his symptoms.5. Diathesis-Stress model states that some people have a predisposition (diathesis) to the illness, and that stress can easily catalyze schizophrenia in those predisposed individuals.6. Dr. Sorkin used medication to treat Jim’s biological symptoms, such as too much dopamine in his neurological functioning. He used support groups to make sure that Jim was aware of the behaviors that could cause his symptoms to worsen.8. Neuroleptic drugs help by reducing the amount of dopamine in the brain. However, as Parkinson’s Disease is caused by a lack of Dopamine, people on these medications may experience Parkinsons-like symptoms.9. Newer drugs affect dopamine levels differently than Thorazine, and thus are less likely to cause Parkinson’s-like symptoms.12. Studies have shown that families with high emotions in normal conversations can cause schizophrenia patients to relapse more frequently than those with families who have “calmer” demeanors. Involving Jim’s family might help decrease his chance of relapse by teaching them how to have “good” conversations.13. They were taught how to have more positive communications with Jim when he did something worth praise. They also were taught to avoid scolding him when he did something wrong.14. Jim focused on his job search by learning ways to communicate via telephone and in an interview, show up to the correct location at the correct time, and how to properly research available jobs. Case 15: Borderline Personality DisorderQuestions: 2, 4, 5, 6, 8, 12, 14 2. Why did Karen’s therapist decide to discontinue treatment with her at that time? The therapist felt like Karen was focusing more on getting attention through repeated suicide attempts rather than actually trying to make progress on her underlying condition.4. Describe Karen’s typical relationships with men. Karen needed constant male attention. If her current boyfriend was unable to be as attentive as she needed, she would act out to regain his attention. She kept these men around even after physical abuse, as well as when it became apparent that they were using her sexually. She needed a relationship to feel complete. 5. What was Karen’s “greatest fear” that led to her frequent suicide attempts? Abandonment. Her suicide attempts were usually in response to breakups or other disagreements with men to whom she felt attached. 6. How did Karen’s behavior meet the DSM-5 criteria for borderline personality disorder?· Desperate & frantic attempts to avoid being abandoned· Patterns of interpersonal problems categorized as unstable and intense· Unstable image and sense of herself· Recurrent patterns of suicidal attempts and other body-harming· Unstable moods and emotions, including feeling chronically empty and excessive or inappropriate anger 7. Describe the concept of dialectical behavior therapy. Be sure to describe the six main points of this type of treatment. DBT was developed in the 1990’s, and has been hailed as a largely effective treatment for people with Borderline Personality Disorder. This treatment method has six main points that therapists address with clients:Emotional Dysregulation: people with BPD often have less capacity for negative emotions (anger, anxiety, sadness).Biological Vulnerability: An emotional event, or stimulus, will cause a greater response and a slower rate of recovery for people with BPD. This gives them a higher sensitivity to such stimuli.Skills Deficit: The experience of strong emotions causes BPD patients to respond inappropriately or using destructive behaviors compared to non-BPD responses to similar emotions.Invalidating Environment: The skills deficit experienced by BPD patients often has arisen during the patient’s childhood, which is usually characterized by feelings or thoughts that have not been given the support necessary for positive mental growth.Behavioral Skills Training Groups: BSTG help BPD patients develop these behavioral skills they need to be successful in coping with emotional stimuli.Individual Psychotherapy: Helps to provide emotional support to BPD patients in times of crises, as well as to help them learn to apply their new skills.8. What is Dr. Banks’ primary goal during the pretreatment stage? How did Dr. Banks relate this to Karen in her initial therapy sessions? Dr. Banks hoped to get Karen to commit to therapy for a predetermined amount of time because it is usually difficult to get BPD patients to remain in therapy for the necessary amount of time. During her first two sessions, Dr. Banks did not mention this to Karen and instead spent those sessions empathizing with Karen. Once she had earned her respect and trust, Dr. Banks got Karen to agree to at least 6 months of therapy. Overall, Dr. Banks believed that DBT might take up to 2 years. 12. Why is it common for individuals to use self-destructive behaviors when they are disappointed by life events? It is believed that the experience of physical pain can compete with the emotional pain experienced by people with BPD. Thus, their emotional pain can be somewhat reduced by the experience of this physical pain. Other coping mechanisms can include substance abuse, unsafe sexual practices, and binge eating, among others. 14. What were two therapy-interfering behaviors frequently displayed by Karen?1. Hopelessness: Karen constantly indicated that she felt hopeless and didn’t believe that her treatment plan could be followed.2. Anger: Karen displayed overwhelming bouts of anger to Dr. Banks on many occasions.