All right. Anxiety. Ooh. [LAUGH] all right, so for the next few lectures, about the next four at least I think. What I'm going to try to do is give you a whirlwind tour of psychological disorders. as you probably know Coursera likes us to keep these videos between 10 and 15 minutes if we can, and as you've probably found out I sometimes have trouble with that. I like to speak for a longer time, so 15 minutes is a real constraint for me and it's really going to be a constraint in these next lectures. I'm going to try to stick to it but it'll be tricky because there's so much sort of fascinating stuff. But if I seem to be ramping up the pace a little bit, that's why. So without any more messing around, let's get at it. All right, Week 7, Lecture 2, anxiety disorders. I decided to keep this disclaimer up the whole time just to keep reminding you, you know not to be concerned if you go, oh my goodness I have something like that. That's how everybody feels when they hear about these things. All right, so let's start right with panic attacks because I think panic attacks tells us a little bit about anxiety disorders in general that's very useful. And specifically before we get to panic attacks itself, I'd like you to look at this figure over here and see this little thing in red called the amygdala. It's a part of the brain, and to some extent I like to liken it to the spider sense of Spiderman. It's a, it's a part of the brain that virtually all of our sensory information seems to go through and it becomes active when there's something in the environment that's a threat to our survival. Okay, so it literally is the part of our brain that goes, uh-oh, there's something out there, watch out. And it kicks our whole body. That sympathetic nervous system get us all revved up and ready to flee or fight. and it gets us our sensory system all tuned up. Looking around. And we try to figure out, you know, what's going on in the environment. So generally, anxiety of any kind Kind of starts from the amygdala. It’s the amygdala that kind of, that, that threat of danger. Like even if your boss, every day you go to work your boss doesn’t seem to like you. Well, that’s a threat. Every interaction with that boss is like, man I could get fired, I could lose my job. So in those situations, the amygdala is always a little active. And that's always making you feel a little on edge. Now, in these things called panic attacks, which are much more common for women than men, what seems to be going on, is the amygdala is becoming active for no good reason. Now, this just happens in the brain generally. in all of our brains every part of the brain gets a little bit of random activation every now and then, so for all of us there's probably times when we feel a little anxious or nervous and we don't really know why. But for people who have severe panic attacks, again, that normal feeling is just amplified, so they often, suddenly, out of the blue, they feel terror. They feel like they're in imminent threat. That their life is in danger. And what almost makes it worse is that when they look around their world, there is on real source of the danger. It's almost better to go, oh, it's that guy over there that's creeping me out. He looks a little dangerous. Now, you can at least address the source of it. But if you're looking around and you can't see any danger and yet you feel danger, that's why people with panic attacks often just want to get the heck away from wherever they are. If it happens in a, in a shopping mall, they want to get outta the mall. If it happens on a bus, they have to get off the bus. You know, whatever. Because they're running from something and they don't know what. so they have all these characteristic sympathetic nervous system things, shortness of breath, sweating, dizziness, faintness, feelings of non-reality. So, so this is, to some extent what really makes panic attacks kind of distinct. These people suddenly feel like. That, that notion we call surreal, where they kind of have stepped away from life a little bit and they're watching and they have this feeling that death is imminent. So there's a feeling of dread, like oh my goodness, this is, this is it, this is the end, and that's you know, scary. An, and there's no other word for it. It's a very scary. In fact, when people have had panic attacks, once or twice, they sometimes have something in general called anticipatory anxiety, which is literally the fear of the next panic attack. So even when they're not having a panic attack, they have a memory for how fearful they felt and often, you know, as I say they ran away, they did something that maybe personally embarrassed them, made them stand out a little bit. So they don't want to go through that again. and just via classical conditioning now, they have learned to worry about everything. So they don't want to go into a bus because maybe they had a panic attack in a bus or in a, into a mall or into a subway or, you know, anywhere that they've associated with a panic attack, they now become fearful when they're in that context. So the panic attack is the real source of the anxiety but it, it can generalize into this anticipatory anxiety so that these people feel anxious all the time. Okay. So that's one good example of a, of a anxiety disorder. We're going to whirlwind so let me change to a different one. and it's going to be a little like this over the next few lectures. So phobic disorders. Phobic disorders are anxiety but much more focused. they're anxiety that's, that's strongly associated with a very specific situation. So, here are supposedly the top ten phobias, although some of these are tricky, like agoraphobia, the, that's often described as the fear of open spaces. But often, it really isn't. so some people with agoraphobia who want to stay in the house all of the time one example of someone who might be like that is someone who suffers frequent panic attacks so they might not want to leave the house not so much because they're afraid of the out doors. But because if they're going to have a panic attack they want to be in their house, they don't want to have it out there. So sometimes, people will extreme epilepsy feel the same way, they don't want to have a seizure out in the tea world, so agoraphobia is kind of tricky. It's called the fear of open spaces, but it's more often more complex than that. But you know, these other ones, claustrophobia which many people have acrophobia which is just the fear of heights. yeah, mysophobia, in the modern world it's the fear of being contaminated by germs, and, and there's a lot, we often just call people germphobes, germaphobia but it's really mysophobia. xenophobia. If you think of what we talked about in the prejudice chapters, xenophobia is this extreme fear and distrust of strangers. So it's kind of, again, like we all have a little bit of that. but some, there are some people who cannot be around anybody that they don't know. So again, the important part of this is that the fear is actually irrational. That, you know, being say in a closet, you can be in a closet for two hours. It might not be a lot of fun but it's not really dangerous. Nothing really horrible is going to happen. But some people if you just close the door while they're in an elevator, they freak out. That's the kind of thing that would make it claustrophobia. You have to really have a strong emotional reaction to something that really isn't that bad. And of course, it has to negatively impact your life, that maladaptiveness again. If you're afraid of heights, but you never have to go in any high area, you're fine. If your afraid of heights and you're a, a high diver, well, you're going to have some problems and you might want to get some therapy for your, for your fear of heights. as you'll see when we do toggle with therapies, these phobias are some of the easiest things to cure. what I find funny about this list when I looked at it, is, a very common phobia, and it's kind of rela-, related I guess to xenophobia. But it is something that's generally called social phobia, which is just a fear of like public speaking or being put in a room with a bunch of people you don't know. Or, going out on a date with somebody. You know, anything that puts you in a situation where you have to be socially engaged with people you do not necessarily know well. This is something that certainly, many of my students have, and, and feel, and worry about it. And I would've expected it to be the number one phobia. But again, maybe, maybe they kind of have that in their, in their xenophobia. All right. Causes, the claim is that many times, these phobias are caused almost like I described with the, with the panic attack that it's an association of these things that can be developed because you actually had some traumatic experience. So some people for example talk about almost drowning in a pool as a child, and then being afraid of water. for example which I guess would be hydrophobia. I, I don't see it there. I will give you one example. When I was very young. I went and saw the movie jaws and that was the first movie I saw like that. After seeing Jaws, I was afraid of going into the ocean. Okay. I had paired ocean with all of those terrible images those scary, scary images, and I was sure if I went into the ocean, I was going to get eaten by a shark. now, I've since scuba dived with sharks so, so that fear hasn't held on. But the claim is those conditioning episodes can hang on with us all through life. Okay? Moving on. Obsessive Compulsive Disorder. Obsessive Compulsive Disorder it doesn't seem like an anxiety disorder right away, but when you think about it, it really is. So first of all, what is it? Well, it is, as advertised, patients who have this link between obsessive thoughts and compulsive behaviors. So m, one example might be somebody who's, there, there are so-called checkers people who are worried about, let's say, leaving the iron on, or leaving any appliance on that might set their house on fire. so iron, stove, you know, things like that, toaster, whatever. and so these people sometimes will do the following behavior. They will iron their clothes, and they'll turn off the iron, and they'll walk away. But then they'll start thinking. Did I turn off the iron? I think I turned off the iron. But did I turn off the iron? I better go check. And so they go and check, fine we've all been there, right, we've all done that. but they go and check, and okay it's off, cool, then they walk away, and then they think, did I really check right? Did I really look at that little light to make sure the light was off? Did I, am I sure? Geez, I'm not sure. So they're now compelled to once again go back and check and they check. They may do this five, six, seven, eight, nine, ten times before they're willing to like, leave the iron. but then sometimes they're worried about something else. Oh, what about the stove. other people are worried about, you know, did they lock the door. So these kinds of people are called checkers, because they have to check things over and over and over again. other obsessive compulsers have different behaviors, so we talk about germaphobes, for example. That's a common one, where somebody feels they have germs on their hands. and so they have to go to a washroom and wash up. And when they wash all up, they feel good. So they've essentially been rewarded of course for behaving that way. but then as soon as they leave the bathroom, they can almost feel the germs building up again. and, you know, maybe they just to the end of the hall, and it's like there's germs all over me. I have to go back and wash my hands again. So they go back. This is the pattern of obsessive compulsive behavior. People just keep doing the same behavior. Checking doors, checking irons, washing hands. Over, and over, and over again. and so obviously it's a problem. if, if you have this severely, it really does interfere with your life. In fact, most people, you know, hate it, wish it would stop. they know they're being irrational, and yet It's so rewarding, every time they check and find out that it's off, or they wash their hands, and they can't seem to stop doing it. so yea you have these rituals that develop. the checkers have this obsessive doubt. There's some people who have this fear of doing something prohibited. So every time they're in some situation, they have this feeling like I'm going to do something stupid. I'm going to do something wrong. I'm going to do something bad. and they keep thinking about that all the time. And so they find it very hard to be in that situation. That's where the anxiety is, right, all that thinking. and yeah there's just all these behaviors that can happen as a result. So this is anxiety at its, at its core but it presents itself through these odd ritualistic behaviors. Another anxiety disorder, and while we're going through with them I thought I'd end with some of the strangest anxiety disorders. You've seen these in movies. they're all interesting fodder for stories and things like that. Every now and then, when somebody seems to be undergoing a ton of anxiety. It seems as though, and these are very controversial these disorders. No one's really, really absolutely sure they're, they're, they're real. Could people be faking it? But, it seems that their situations were, the anxiety causes some break in consciousness that somehow allows the person to escape the anxiety. By a massive change to either their memory or their identity so for example oh how did that happen associative amnesia. This is when somebody experiences some traumatic event and then suddenly forgets everything they know who they are where they're from. so let's say, you know, there's a couple who are very close, and let's say the wife passes away. The husband might suddenly forget who he is, where he lives, and critically the fact that he was married, who he was married to, so this sudden amnesia, trauma induced. Amnesia can theoretically seemingly save this person from the grief and the anxiety they would've felt at being alone. I mean, they're still alone but they don't quite understand what they lost. is the claim so this is kind of interesting. it's a sort of different kind of amnesia that seems to have nothing to do with getting hit on the head everything to do with, some major, major life, stressful event. There's other things that seem to happen with stressful events. One is what's called a dissociative fugue. It's kind of interesting. So it would play out like this. There's this guy, let's say, named Professor Steve Jordans that teaches at the University of Toronto Scarborough, and people get to know him quite well. And then one day, something happens in Steve's life and suddenly he's gone. Nobody knows where he went. He disappears. Two years later, he shows up in Amsterdam, let's say. When we talk to him, he just seems to know the last two years, and he doesn't seem to have a problem with that. He's, he's changed his identity, he dresses different, he likes different kinds of music, he does different activities, he hangs around with obviously completely new people, he's in a new city, and it's like he's a completely different person. It's like he went from being the person he was to this new person and just went into that role and took over. So it's kind of got the amnesia characteristics but it's not that he's walking around saying, I can't remember anything. It's like he suddenly begins a new life. and, and, and doesn't remember the old life. Doesn't try to remember the old life. Just moves into this new state. So a fugue is a split, a break. And the idea is, yeah, he just breaks. So you can kind of think of this as multiple personalities, except it's an abrupt shift from one personality to the next, as a result of some highly stressful life event. Dissociative identity disorder is the formal name for what you probably know of as multiple personality disorder. Multiple personality disorder is when one person seems to have different personalities within them that emerge at different times. So it's like you're talking to one personality. But a little while later, you might be talking to a different personality. You've seen this in movies, you know, the Fight Club would be an example, lots of different movies that play on this. Why is this about anxiety? Well, the prototypical story, the prototypical context, that somebody lived through that becomes a multiple personality disorder patient is one in which they had some major trauma that was usually associated with someone they really loved. In fact, the stereotypical story, which is really that the most common one, would of a, a young person, typically a female, who underwent sexual abuse. But only occasionally and often at the hands of somebody they really love and trust like, for example, their father. So imagine a father who is a drinker not very often. When he is not drinking he is the perfect dad. He is this little girl's father in every image you could imagine, and she loves him. But occasionally, he gets really drunk, and then when he comes home, he's abusive. maybe physically abusive, maybe sexually abusive. What's this child to do as she grows up, and this behavior continues? Um, [SOUND], the, this, the theory is that if she really admits to herself that my dad can be a monster and he can treat me horribly, then she loses her good dad. She loses that relationship. She just says, you know, I don't care that you're only a monster now and then, you're a monster. And we have a problem. The claim is that maybe a young, very young child, that's something different. And that something different is to have this split in personality so that one personality takes control when the abusive father comes home. And that personality accepts it, survives, does what she can do in that situation. But one of the things that somehow happens is that the memory of that situation is kept from another personality. So once the event's over, this child can now shift to this other personality who, who is not aware of the abuse, who has no memory of the abuse, who remains, shall we say, sort of pure and innocent. And so that personality can continue to love her father, go to the park, do all the great father/daughter things they do, and when the monster comes home, this other personality takes over. and so that's, you know, the prototypical patient always has a very hard, worldly, often crass but yet strong personality and that's the one that dealt with the abuse. And they have another one that tends to be much more innocent, much more meek, much more shy, and that's the one that was protected. And then sometimes all these other ones are popping up too. So it's not uncommon that once this happens to a person They don't just have two personalities, they may have three, four, five, six, seven, etc. It can really kind of build up. Are these really distinct personalities or is this some sort of coping mechanism or both? You know, no one's really, really sure. It's a very controversial area. But certainly there are people who fit that story, that seem to show those sorts of behaviors. So a fascinating way of reacting to anxiety. All right, so what do we have here? Just some more videos. Here's one about panic attacks that both explains how they occur and gives you some advice if you suffer from them about how you might be able to avoid them. This is kind of a funny one, the World's Weirdest Phobias, just so you can think about phobias in a, a more fun way. and this, this one is a documentary about multiple personality disorders, so it's a longer one, but it's a really interesting disorder. and so I, I think you'll find it, yeah, something you'll really enjoy and, and find fascinating. on the reading side. here's a, just a, a short little article about obsessive compulsive disorder that's meant to be helpful if you know anybody who has obsessive compulsive disorder. and here's another one that focuses more generally on anxiety disorders, so it encompasses a lot of these. All right? Whew. That was a fast tour through one class of disorders that are called anxiety disorders. And we're going to just keep up this kind of presentation for the next few lectures and have a lot of fun doing it. But again, if you were, you know, see yourself in any of this, that's normal, that's cool. That's how it works. Alrighty, till next time, bye bye.
