ABNORMAL PSYCHOLOGY REVIEW NOTES:

ANXIETY DISORDERS:

NB: Some amount of anxiety is beneficial.

What makes anxiety abnormal:
a) elicited by inappropriate cues
b) inappropriate in intensity
c) inappropriate in duration

ANXIETY (in general) Treatment:

- "neurotic conditions  Cognitive therapy -

e.g. anxious, ritualistic
- more women than men
affected
- caused by over-
firing/misfiring of the
HPA(hypothalamic-pit-
adrenal) axis -->
activation of the
amygdala
- very treatable condition
modifying thoughts
 Behavioral therapy
(desensitization,
exposure therapy)
 Meds: benzos; anti-
depressants (SSRIs)

PANIC DISORDER: Treatment:

Recurrent and UNEXPECTED Often accompanied by:
panic attacks (exact # of AGORAPHOBIA - fear abt Psychotherapeutic treatment:
episodes unspecified) being in places from which break association btwn bodily
escape may be symptoms and inducement of
At least 1 month of fear of difficult/embarrassing- leads panic attack.
future panic attacks or its to avoidance of variety of
implications situations. Cognitive behavioral treatment
(CBT) widely used:
Panic attack: intense fear with Specify on axis I: 1. teach anxiety
somatic or cognitive symptoms Panic disorder with/without management strats
such as: cardiac symptoms, agoraphobia. Resp training: diaphragmatic
sweating, trembling, SOB, breathing
choking, chest pain, GI NB: Some people may Progressive muscle relaxation
symptoms, feeling faint or experience agoraphobic (PMR) - reduce muscle tension
detached, dear of losing without having panic disorder: Cognitive therapy: identify
control or dying, tingling, Agoraphobia without panic cognitive distortions that
chills/hot flashes. disorder. worsen anxiety; then change
Abrupt onset with episode interpretation of bodily
peak within 10 mins. Classical conditioning: symptoms and de-catastrophize
Helps to explain inappropriate event

1

NB: Patients often mistake
symptoms for a heart attack
and go to ER rather than
mental professional.
SPECIFIC PHOBIA:
Phobia = excessive or
unreasonable fear of obj or
situation
Fear response - when exposed
to stimulus/ or person avoids
phobic situation
Fear causes marked distress or
impairment in functioning.
SOCIAL PHOBIA:
Excessive and unrealisitc fear
of social or performance
situations due to fear of
embarrassment
triggering of panic:
Panic = CR to neutral stimulus
paired with a stimulus that
naturally produces fear (UCS)
UCS= frightening stimulus
UCR=panic
Neutral= bodily sensations that
are present when frightening
stimulus occurs
CS =bodily sensations
CR = panic
Subtypes:
Animal type
Natural environment type
Situation type
Blood-injection-injury type
Etiology:
Phobia classicially conditioned
response (neutral stimulus
paired with naturally occurring
fear-producing stimulus)
Subtypes:
Specific (anxiety only in
certain social situations)
Generalized (anxiety in
all/most social situations)
NB: Antihypertensives (B-
blockers) may be used in short
term to control physical symptoms
of anxiety.
After patient equipped with
mgt strats - expose to
situations that induce anxiety.
2. expose patient to
anxiety disorders
Break assoc. btwn symptoms
and panic --> exposing person
to bodily symptoms in context
of relaxation --> extinction
phase of classical
conditioning (CS without
allowing CR to occur)
Meds:
Antidepressents: SSRIs,
sedatives (benzos such as
xanax)
Outcome: patients improve
with treatment esp
psychotherapy.
Treatment:
Behavioral therapy:
systematic desensitization
Treatment:
Psychotherapy:
Cognitive therapy: challenge
and replace automatic -ve
thoughts abt self
Behavioral therapy&modeling:
desensitization, rehearsal, role
plays, observation
2

OBSESSIVE-
COMPULSIVE
DISORDERS (OCD):
1. Recurrent obsessions or
compulsions
[obsessions: unwanted
thoughts, impulses, images that
increase anxiety]
[Compulsions: repetitive
behaviors/mental acts
performed to decrease
anxiety]
2. Obsessions/compulsions are
time consuming or distressful
3. Insight is present (person
recog. that fears are irrational)
4. Symptoms are not explained
by another disorder
(obsessions with foods,
alcohol)
Etiology:
relatively strong genetic
component to OCD.
Patients appear to be inheriting
a brain with structural,
functional and chemical
abnormalities:
 Seratonin deficiency;
 Overactivity of specific
brain circuitry (loop
that includes frontal
lobe&motor networks)
Meds: antidepressants (SSRIs)
Treatment:
Usually 5-10 yr delay in
treatment due to lack of recog
or concealment of disorder
Behavioral psychotherapy:
"Exposure&Response
Prevention"
1. expose to feared
situation
2. avoid engaging in
compulsion
practiced in therapy and home
good results after 2-3 wks
considered at least as effective
and longer lasting than meds
Meds: All SSRIs and 1 TCA
(Anafranil - >clomipramine)
approved
Psychosurgery:
2 brain parts are intentionally
lesioned to disrupt overactive
circuitry in severe and
treatment-resistant OCD
1. anterior cingulate gyrus
(cingulotomy)
2. internal capsule
(capsulotomy)
Gamma knife (radiation)
procedure is replacing surgical
lesioning
Deep brain stimulation:
dwelling brain electrode with
pacemaker implanted in chest
Electrical impulses to neural
circuitry implicated in OCD
FDA approved as humanitarian
device for severe and
treatment-resistant OCD
3
POSTTRAUMATIC
STRESS DISORDER
(PTSD):
Person MUST be exposed to
an extreme traumatic stress:
Extreme trauamtic stress:
actual or threatened death or
serious injury to self/others in
which person responded with
negative emotion
Exposed: direct experience,
witnessing or learning of the
traumatic event
3 symptoms may develop at
any time in future:
Symptoms from all three
categories lasting MORE
than 1 month:
1) re-experiencing the
event
(dreams, recollections,
feeling event reoccur;
psychological or
physiological distress when
encountering symbols)
2) Avoidance of stimuli
or a numbing
response
Aviod thoughts, convos, places
that are reminders, amnesia for
event, anhedonia, detachment
from others, flat affect, sense
of foreshortened future
3) hyperarousal
insomnia, irritability,
concentration probs,
hypervigilance, exaggerated
startle response
NB acute stress lasts 1 mth or less
Onset of symptoms usually Treatment:
being within 2 mths of
trauma but can begin Psychotherapy:
ANYTIME in future. Supportive psychotherapy
Behavioral therapy
Diagnosis of acute stress (desensitization techniques to
disorder requires that diminsh fear response)
symptoms begin within one
month of the stressor Meds: Usually antidepressant
(SSRIs or TCAs)
Vulnerable populations:
young adults; can happen to Under investigation:
anyone @ any age. therapeutic forgetting: drugs to
Orthopedic patients hv high blunt memories
rate of PTSD
Q: What is the diagnosis if:
A. 3 days after trauma and
lasted 3 weeks: Acute
stress disorder
B. 2 weeks after trauma
and lasted 2 months:
PTSD
C. What is your answer to
A&B above if only 2
symptom categories
existed? Adjustment
disorders, NOS.
4
ACUTE STRESS
DISORDER:
Serious traumatic event occurs
in which person has an
immediate -ve emotional
response.
PTSD-like symptoms develop
within one month of trauma.
Symptoms last 4 weeks or
LESS.
Symptoms of all three
categories develop within 1
month of trauma and last a min
of 2 day and max of 1 month.
1. re-experiencing the event
2. avoidance of stimuli or
numbing response
3. hyperarousal
Treatment:
Psychotherapy:
Supportive psychotherapy
Behavioral therapy (relaxation
and desensitization techniques
to diminish fear)
Meds:
Anxiolytic meds (benzos for
fast acting effects)

GENERALIZED ANXIETY Treatment Differentials:

DISORDER:
UNCONTROLLED anxiety
abt multiple events occurring
majority of day for ≥6 months
Several (≥3) of the following:
Restless, on edge
Decreased concentration
Muscle tension
Fatigue
Irritable
Insomnia
Patients with GAD - first seen
by physician b/c physical
symptoms - typically start at
young age and are chronic
unless treated.
Variety of med conditions can
Cognitive therapy: Anxious cause anxiety disorders, which
patients have a mental bias should be ruled out:
toward assuming -ve A. anxiety disorders due to
outcomes. Goal: get patient to general medical
challege automatic thoughts to condition : thyroid
reduce anxiety probs, menopause
B. substance-induced
Behavioral therapy: train anxiety disorders:
patient to use relaxation caffeine, asthma meds
techniques;
Use biofeedback to learn to
relax muscle tension since
GAD patients tend to be
chronically tense.
Meds:
Acutely: benzos for immediate
anxiolytic effects. Due to side
effects (dependence) BZDs are
recommended only for short
term anxiety treatment.
Chronically: Usually
antidepressant (AD) is used -
take several weeks to hv an
effect.

GAD usually treated with

combo BZD &a ADs until the
ADs becomes effective. BZDs
gradually discontinued

5
 SUMMARY TABLE

Diagnosis Differentials Treatment/meds

Panic disorder Random fear; CBT

Recurrent and unexpected
attacks; ≥1 month of fear of
future attacks
With agoraphobia with Avoidance of situations
1. Teach anxiety mgt
strats (resp. training,
PMR, cognitive therapy)
2. Exposure (break
association with anxiety
inducers --> extinction)

Agoraphobia without history of Fear of being in places from

panic disorders which escape may be
difficult/embarrassing
Specific phobia Fear of : A specific Systemic desensitization
object/situation (but not a social
setting)

Social phobia Fear of: social setting & Cognitive

embarrassment
Behavioral&Modelling:
Specific Certain situations Desensitization, rehearsal,
Generalized All situations observation

SSRIs,
B-Blockers-reduce
physical symptoms

OCD A persistent unwanted Exposure and response

thought, time consuming & prevention
distressful;
Recognition that fear is SSRIs, TCA
irrational
Psychosurgery

Deep brain stimulation

PTSD Reminder of traumatic event
symptoms developed at ANY
TIME (usually within 3 mths)
lasting MORE THAN 1 month
Supportive psychotherapy
Behavioral desensitization
SSRIs or TCA

6
ACUTE STRESS DISORDER Immediate -ve emotional
response to traumatic event;
Symptoms develop within one
month of trauma; last 4 weeks
or LESS
GAD Everything
Uncontrolled anxiety about
multiple events occurring the
majority of days for 6 MONTHS
OR MORE
Behavioral therapy
Anxiolytic meds: Benzos
Cognitive therapy
Behavioral therapy
Acutely: benzos (Short
term)
Chronic: Antidepressants
7
REVIEW QUESTIONS:

1Which statement below about panic disorder is true?

People always have warning signs of their own panic attacks
. Most cases of panic disorder develop in people around the age of 20
. There is no effective treatment for panic disorder
. Panic disorder affects more men than women.

2Pedro is so intimidated by the possibility of having a panic attack that he stays home
the majority of the time. If he does go out, he insists that one of his friends
accompany him in case he has a panic attack. In addition to having panic disorder,
Pedro might also be described as being _________.
social phobic
agoraphobic
claustrophobic
arachnophobic

3The most effective medications for panic disorder are _________________.

benzodiazepenes lactate compounds antidepressants
norepinephrine compounds

4Phobias are intense __________ fears that cause impairment.

rational general social irrational

5According to research, the most effective approach to successfully treating phobias is

__________ therapy.
psychodynamic humanistic behavior family

6Gina’s therapist is helping her to overcome her fear of flying by training her in
relaxation techniques and orally presenting her with gradually more frightening

8
situations in which she performs activities related to airports and getting on a plane.
This technique is known as ___________________.
systematic desensitization flooding thought stopping biofeedback

7Natasha gets nervous when other people watch her eat lunch. She is worried that her
behavior will catch the attention of others and that they might mock her and make fun
of the way she eats. This fear typically forces her to eat in her office. These symptoms
suggest that Natasha has ___________________.
panic disorder simple phobia social phobia obsessive compulsive
disorder.

8The most common type of feared situation for someone with social phobia is
____________________.
meeting new people using public bathrooms eating in public speaking
in public

9What is the primary difference between social phobia and agoraphobia?

Social phobia is specific to certain situations and agoraphobia is more
generalized
. Social phobia happens to adolescents, but agoraphobia does not
. Men are more likely to have social phobia, and women are more likely to have
agoraphobia
Twins may develop agoraphobia but not social phobia.

10____________________ disorder is the most prevalent anxiety disorder in older adults.

Obsessive-compulsive Panic Generalized anxiety Post-traumatic stress

11Which of the following techniques does a cognitive-behavioral therapist use to treat

an individual with generalized anxiety disorder?

9
 Have client recognize anxiety-producing thoughts and seek more rational
alternative thoughts. Use free association in order to illuminate conflicts that reside
in the person’s unconscious.
Actively listen to the client’s concerns and provide a therapeutic environment rich
in empathy
. Urge the client to develop an enhanced sense of self more in line with his or her
actual self.

12__________ are thoughts and __________ are behaviors.

aversions; obsessions obsessions; phobias compulsions; obsessions
obsessions; compulsions

13The preferred behavioral treatment for obsessive-compulsive disorder is

_________________________.
relaxation training and flooding
biofeedback and positive reinforcement
systematic desensitization and modeling
exposure to situations where rituals occur and response prevention

14Phuong was a passenger in a terrible car wreck that left four of her friends dead.
She has continuous nightmares that go back to that fateful night. In addition to being
emotionally numb about the whole situation, she feels very guilty that she survived the
ordeal. Phuong is most likely diagnosed as having ___________________.
generalized anxiety disorder panic disorder post-traumatic stress disorder
simple phobia

15Supportive therapy and stress management are considered __________ techniques

and imaginal flooding and systematic desensitization are considered __________

10
techniques for post-traumatic stress disorder.

cognitive; behavioral covering; uncovering uncovering; covering

behavioral; cognitive

11
1 The experience of anxiety involves emotional as well as what other components?
. A. cognitive
B. behavioral
C. physical
D. all of the above

2 Carlos gets a thrill out of skydiving and does it as often as he can. During the summer, he is
. a guide taking tourists white water river rafting. He has had some very dangerous
experiences, but seems to thrive on such adventure. Carlos is
A. crazy.
B. highly anxious.
C. a high risk taker.
D. phobic.

3 Tama feels anxious most of the time. She is worried about her job, her family, and her
. house. She worries about everything. In addition, she is having difficulty sleeping and has
started to have severe headaches. Tama would most likely be diagnosed with
A. Panic attacks.
B. PTSD.
C. OCD.
D. GAD.

4 Peggy is afraid of leaving her house because of a fear of having a panic attack and not being
. able to get help. Peggy would most likely be diagnosed with
A. social phobia.
B. agoraphobia.
C. specific phobia.
D. general phobia.

5 Jeff is terribly afraid of dogs, to the point that he can't stand to hear one bark. Jeff suffers
. from
A. social phobia.
B. agoraphobia.

12
 C. specific phobia.
D. general phobia.

6 Sharon was the victim of a brutal attack six months ago. She is experiencing flashbacks, is
. having difficulty sleeping because of nightmares about the event and is experiencing
physiological symptoms when something triggers an aspect of the assault. She is also feeling
detached and is avoiding activities she used to enjoy. Sharon is suffering from
A. GAD.
B. acute stress disorder.
C. PTSD.
D. panic attacks.

7 Tom was robbed three weeks ago at gunpoint and hit several times. For the last three weeks
. he has had considerable trouble sleeping because of nightmares, difficulty concentrating,
exaggerated startle responses, flashbacks and has felt a restricted range of affect. Now
during the fourth week following the attack, Tom is beginning to feel more like his old self.
Tom would be diagnosed with
A. GAD.
B. acute stress disorder.
C. PTSD.
D. panic attacks.

8 A phobia can be created by associating a neutral stimulus with a strong fear response to a
. naturally frightening stimulus. This is a description of
A. operant conditioning.
B. classical conditioning.
C. modeling.
D. prepared conditioning.

9 Linda becomes very anxious and panicky when she is close to a horse. Avoiding horses
. lessens the anxiety, so she does this at all costs, completely avoiding any situation that may
put her in contact with horses. This is an example of

13
 A. operant conditioning.
B. classical conditioning.
C. modeling.
D. prepared conditioning.

1 Kyle's father was afraid of snakes and Kyle became afraid of snakes as a result of watching
0 his father's fear. This is an example of
. A. operant conditioning.
B. classical conditioning.
C. modeling.
D. prepared conditioning.

1 Despite their differences, the psychodynamic, behavioral and cognitive perspectives all
1 share the common belief that clients must
. A. transfer the source of their anxiety onto the therapist to better understand it.
B. tackle the negative thoughts that create the anxiety.
C. look to genetic factors that might explain the anxiety disorder.
D. confront their fears in order to overcome them.

1 Some researchers suggest that sustained stress during critical periods of development may
2 permanently damage the cells regulating the functioning of the
. A. CNS.
B. HPA axis.
C. GAD.
D. GABA.

1 Persistent, irrational fears and avoidance of objects

3 A. Generalized anxiety disorder
.
B. Panic disorder
C. Phobias
D. Obsessive-compulsive disorder
E. Posttraumatic stress and acute stress Disorder

14
1 Chronic, debilitating nervousness
4 A. Generalized anxiety disorder
.
B. Panic disorder
C. Phobias
D. Obsessive-compulsive disorder
E. Posttraumatic stress and acute stress Disorder

1 Unwanted anxious thoughts leading to ritual behavior

5 A. Generalized anxiety disorder
.
B. Panic disorder
C. Phobias
D. Obsessive-compulsive disorder
E. Posttraumatic stress and acute stress Disorder

1 Debilitating anxiety symptoms occurring after a traumatic experience

6 A. Generalized anxiety disorder
.
B. Panic disorder
C. Phobias
D. Obsessive-compulsive disorder
E. Posttraumatic stress and acute stress disorder

1 Episodes of acute terror in absence of real danger

7 A. Generalized anxiety disorder
.
B. Panic disorder
C. Phobias
D. Obsessive-compulsive disorder
E. Posttraumatic stress and acute stress Disorder

15
1 Anxiety disorders are associated with
. A. twice the average rate of medical costs.
B. higher risk of cardiovascular disease.
C. twice the risk of suicidal ideation.
D. all of the above

2 While all anxiety disorders share excessively high or frequent levels of anxiety, panic
. disorder and phobias are distinguished by also having high levels of
A. obsession about the feared object.
B. fear
C. compulsion to avoid panic attacks.
D. long term consequences.

3 Kimberly has a persistent and excessive fear of flying. She realizes that this is unrealistic and
. is interfering with her career opportunities. Kimberly would probably be diagnosed with a(n)
A. panic attack.
B. obsession.
C. social phobia.
D. specific phobia.

4 Jorge is required to take a speech class in order to graduate from college. He has put off
. taking the class until his final semester because of his extreme fear of being humiliated or
embarrassed in front of the class. He knows that his fear is unrealistic but the anxiety it
produces makes him consider dropping out of school. Jorge suffers from
A. panic attacks.
B. OCD.
C. social phobia.
D. specific phobia.

5 What separates shyness from social phobia is that people with social phobia
. A. avoid more social situations.
B. feel more discomfort socially.
C. experience symptoms for longer periods of their life.

16
 D. all of the above

6 According to the DSM-IV-TR criteria, for a diagnosis of panic disorder, a person must
. experience recurrent _______ panic attacks.
A. uncued
B. cued
C. persistent
D. life-threatening

7 Panic attacks can be thought of as a misfire of the

. A. anxiety system.
B. trauma system.
C. fear system.
D. fight system.

8 During a panic attack, a person experiences, physiologically, an arousal of the ___________

. nervous system appropriate to the immediate threat to life.
A. central
B. sympathetic
C. parasympathetic
D. adrenal

9 Both Sara and Tara have been diagnosed with panic disorder. Sara, however, is unable to
. leave her house without a great deal of distress. Sara also suffers from
A. compulsiveness.
B. a specific phobia.
C. agoraphobia.
D. all of the above

1 Marge worries constantly about her health, finances and relationships. Her worries are
0 excessive, uncontrollable and causing problems in her daily life. This has been going on for
. about a year. She has found that she is having difficulty concentrating, is restless and

17
 irritable. Marge meets the criteria for which diagnosis?
A. Panic attack
B. Social phobia
C. Generalized Anxiety Disorder
D. Agoraphobia

1 GAD typically begins during

1 A. early adulthood.
.
B. the oral stage.
C. a person's forties when the children are teenagers.
D. adolescence.

1 Among people diagnosed with OCD, _________ symptoms are associated with an early age
2 onset, more indecisiveness, more anxiety and depression, and little insight into symptoms.
. A. hoarding
B. cleaning
C. counting
D. eating

1 This disorder entails an extreme response to a traumatic event, including increased anxiety,
3 avoidance of stimuli associated with the stressor, and a general numbing of emotional
. responses.
A. Panic attack
B. Social phobia
C. Posttraumatic stress disorder
D. Agoraphobia

1 The prevalence of DSM-IV-TR anxiety disorders varies across cultures because cultures
4 differ with regard to
. A. attitudes toward mental illness.
B. stress levels.
C. prevalence of poverty.
D. all of the above

18
1 Researchers have found that people who meet diagnostic criteria for anxiety disorders
5 display less activity in the
. A. hippocampus.
B. basal ganglia.
C. medial prefrontal cortex.
D. amygdala

1 As many as _____ percent of people with panic disorder describe a severe stressor that
6 occurred just before the onset of the disorder.
. A. 30
B. 75
C. 50
D. 80

1 Regardless of the measurement used, observational coding, questionnaires or

7 psychophysiological responses, people who tend to have _______ reactions to _________
. stimuli and events appear to be at greater risk for anxiety disorders.
A. weaker/positive
B. stronger/negative
C. cognitive/positive
D. stronger/positive

1 These protect a person, who has an anxiety disorder, against feared consequences, helping
8 them to maintain overly negative cognitions.
. A. Positive thoughts
B. Safety behaviors
C. Cognitive restructuring
D. All of the above

1 The amount of _________ that people have during a traumatic event seems to be a major
9 variable in whether anxiety disorders develop.
. A. control

19
 B. cooperation
C. participation
D. none of the above

2 This two step behavioral model of specific phobias conditioning includes; 1) the classical
0 conditioning of the fear and 2) through operant conditioning gaining relief from the
. conditioned fear.
A. Mowrer's two-factor model
B. Beck's two-factor model
C. Skinner's two-factor model
D. Freud's two-factor model

2 There is evidence that social phobia is related to attention to _______ cues rather than
1 ________ cues.
. A. cognitive/behavioral
B. structured/unstructured
C. internal/external
D. conscious/unconscious

2 Classical conditioning of panic attacks in response to bodily sensations has been called
2 A. reactive conditioning.
.
B. counter conditioning
C. classical conditioning
D. interoceptive conditioning

2 Karen has distressing negative thoughts about the consequences of having a panic attack in a
3 public place. As a result, she is afraid to leave her house and is considered agoraphobic.
. Karen is experiencing a
A. fear-of-fear.
B. loss of confidence
C. behavioral set back
D. none of the above

20
2 One theory suggests that people with OCD suffer from a deficit in __________, because
4 they fail to gain the internal sense of completion.
. A. behavioral impulses
B. yedasentience
C. early childhood conditioning
D. understanding delayed gratification

2 Traumas that were caused by __________ are more likely to cause PTSD than natural
5 disasters.
. A. fires
B. chronic illness
C. humans
D. all of the above

2 Erin, who is now 30, was sexually assaulted in college. Shortly after the assault she began to
6 dissociate. This behavior has continued for several years. Erin's risk for ongoing PTSD
. symptoms is
A. high
B. low
C. stable
D. b and c

2 While exposure treatments for phobias have become more efficient, this new treatment is
7 more effective than systematic desensitization.
. A. Token distribution
B. Operant exposure
C. In vivo exposure
D. Revisited systematic desensitization

2 The most widely used psychological treatment of OCD is

8 A. EMDR
.
B. PCT
C. ERP

21
 D. CBT

2 Research has found that early interventions using cognitive behavioral approaches that
9 include exposure decreased the risk that _______ would develop into PTSD.
. A. ASD
B. GAD
C. OCD
D. PCT

3 Timma has been diagnosed with OCD, and she also presents with hoarding behaviors. What
0 do we know about the effects of medication treatments?
. A. They are highly effective as hoarding symptoms diminish soon after taking.
B. They are not very effective, as hoarding symptoms often do not diminish.
C. Hoarding symptoms diminish and even disappear after a long time of taking.
D. Medication treatments are never tried with people who have hoarding symptoms.

3 Although these are among the most commonly prescribed medications for social phobia,
1 research doesn't indicate they are effective for this use.
. A. Beta blockers
B. SSRIs
C. Benzodiazepines
D. Tricyclics

3 Most people who stop taking medications for their anxiety disorder
2 A. do well.
.
B. would have gotten better anyway
C. relapse.
D. develop other disorders.

22