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AAPT Level IV Cert / Written Test
Anxiety is fear that interferes with normal, daily functioning (Akiskal & Benazzi, 2006). There are several different categories, including generalized anxiety, panic disorder, and phobias. While these all present themselves in different ways, they are similar in the problems they can cause in daily life. Theories of anxiety and the psychopathology related to feeling anxious include issues with biological, cognitive, and learning perspectives. The biological perspective addresses the receptors in the brain and how the chemicals there work with one another. Cognitive theories deal more with the way people perceive issues, such as feeling as though they do not have control over something. The learning perspective focuses on how people actually learn to be anxious about something, and the changes they learn to make in their lives in order to lower the levels of anxiety they feel (Hockenbury & Hockenbury, 2004; Kato, 2011).
Regardless of the theory to which one subscribes, anxiety is still an adaptive response to a threat. When people have anxiety, they perceive something as a threat that is actually not dangerous, thereby triggering the "fight or flight" response when it is not needed and causing them to feel afraid of something of which they should really not be fearful. Caring for anxious clients has to be done properly, in order to ensure that their anxiety is not raised to an unacceptable level by the treatment. While many medications are prescribed for anxiety, there are other ways to treat clients. These can include cognitive behavioral therapy and exposure therapy. While both of those options can work well, they are often used in combination with medication. The medication brings the anxiety down to a lower level which is easier for the client to control, and from that point he or she can begin working on the issues that surround and contribute to the anxiety.
Anger is defined as a strong feeling of hostility, displeasure, or annoyance. While anger is normal in many cases, there are times when it is wholly inappropriate to the situation. There are also people who do not control their anger well, and that can make them dangerous to themselves and to the general population. Theories of anger involve the reasons behind why people get angry. Some believe, also, that releasing the pent-up anger that a person has is helpful because it causes that person to be less angry. There is significant psychopathology that comes with anger, including intermittent explosive and passive-aggressive personality disorders. These can be based on instinct, social behavior, or motivation (Alonso, et al., 2004). Passive-aggressive people often base their anger on motivation, which intermittent explosive disorder is often more focused on instinct (Weller & Eysenck, 1992).
There are important procedures in caring for angry clients, including ensuring that both the client and the therapist are safe. The risks of working with an angry client can include the client leaving, but can also include the client becoming verbally or even physically abusive. Because that is a concern, the client has to be treated with respect and with care. It can be important that a therapist not "coddle" a client, however, out of fear of making that client angry. That will not solve anything and will not teach the client to handle his or her anger properly. While antagonizing the client is not necessary, the therapist needs to focus on addressing why the client gets angry and what triggers that anger. From that point, the therapist can focus on helping the client find better ways to control, manage, and expel his or her anger. It is not that the client cannot become angry or that anger is an unhealthy emotion. Instead, the issues it that the client must understand that there are healthy and unhealthy ways to express being angry. Healthy ways must be learned and internalized, so they can be used.
Hope and Hopelessness
Hope is defined as a desire and expectation for something to happen. Hopelessness is the opposite of that, when hope has been abandoned (Katschnig, 2010). Depression is more than just sadness. It often also implies apathy, lethargy, and a lack of desire for anything, including things that were once enjoyed. Manic behavior is defined as elevated mood, energy level, or irritability that is abnormal. Suicide is when a person willingly and deliberately ends his or her life. Major depression and bipolar disorder both have interesting psychopathology, which involves both brain chemicals and learned behavior (Berrios, 1999; Clarke, et al., 1993). Issues that take place in a person's life can lead to a depressed state, but major depression does not lift just because life is technically going well. Depression is a chemical imbalance, and will remain a problem without therapy and medication to combat it. The same is true with bipolar disorder, which is not something that can be "cured" and must be managed -- generally with medication.
There are processes and procedures used in caring for clients who feel either hopeful or hopeless. Clients who feel hopeful may sound like a great thing, but if they are hopeful in a way that is delusional or not in keeping with reality, they must be made to understand that their hopefulness is misplaced. They will be continually disappointed if they spend all of their time hoping for things that cannot logically come to pass. As for those who feel hopeless, a combination of medication and talk therapy is often used. Cognitive behavioral therapy can help these patients, as can looking into their past in order to find out the issues they faced and how those issues may have played a part in the hopelessness that they are feeling in the present day. If the moment the client lost hope can be pinpointed, that client can then be helped through a better understanding of that moment and how it cannot and should not define him or her. While this takes time, the rewards can be significant.
Flexibility-rigidity is defined as having either behaviors that are too flexible or too rigid in nature, or having one or the other of these issues regarding specific areas of life (Van't Veer-Tazelaar, et al., 2009). Some people can be too rigid in some areas and far too flexible in others, leading them to struggle with day-to-day activities as well as more complex issues of life. The psychopathology of compulsive personality disorders and disorders of impulse control is important to study, because compulsions can be very dangerous to the person with them and those around him or her. Impulse control is also significant. People with poor impulse control often engage in behaviors that are destructive to themselves and others, such as drinking to excess, drug use, and numerous casual sexual encounters (Torgersen, Kringlen, & Cramer, 2001). While these people may be very rigid in certain areas of their lives, they may have other areas where they exhibit a wild side that offers far too much flexibility in decisions.
There are processes and procedures to care for clients who are experiencing difficulties with either flexible or rigid behaviors. Those who are too rigid much be taught, essentially, to relax. However, in order to do this successfully they also must be made to understand why this will be beneficial to them in their desire to improve their lives. The same is true with clients who are too flexible. If they have poor impulse control, they may understand that what they are doing is dangerous but they may feel as though they are simply not able to stop themselves. Teaching them code words or phrases to use, or another type of technique that can encourage them to evaluate the choices they are making can be very helpful in showing them how they can learn to be less impulsive and flexible. A person needs to be rigid in some aspects of his or her life, in order to make sure he or she is able to carry out daily life tasks and remain safe for behaviors that could be highly detrimental.
Substance Abuse Disorders
The diagnostic criteria for psychoactive substance use disorders include use of the substance habitually, and use of the substance in ways that interfere with everyday life (Willemse, et al., 2004). When people use substances responsibly and do not abuse them, they do not meet the criteria for psychoactive substance use disorders because they are not causing problems for themselves or for others. There are common substances of addiction, including caffeine, nicotine, and alcohol. Their effects are numerous. Alcohol is a depressant, and can also lead to poor motor skills, lack of inhibition, and judgment that is unacceptable or even dangerous. Caffeine raises energy levels, but it also raises heart rate and can cause health problems in people who are sensitive to it. As a stimulant, it can cause jitters, nervousness, and anxiety attacks. Nicotine restricts blood vessels, and can harm many organs in the body. It can also stimulate the nervous system and cause anxiety.
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