PSYCHOLOGY
AN EXPLORATION
Second Edition
CHAPTER
12
psychological
disorders
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
why study abnormal behavior?
Because abnormal behavior is all around us, many
questions arise: How should one react? What should be
done to help? What kind of person develops a mental
illness? Could this happen to someone close to you?
The key to answering these questions is to develop an
understanding of just what is meant by abnormal
behavior and the different ways in which behavior can
depart from the “normal” path.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Learning Objectives
•
•
•
•
•
•
•
•
LO 12.1
behavior
LO 12.2
models
LO 12.3
LO 12.4
LO 12.5
LO 12.6
LO 12.7
LO 12.8
Explanations of mental illness and defining abnormal
How disorders relate to biological and psychological
Types of psychological disorders
Types and symptoms of anxiety disorders
Types of mood disorders and their causes
Types of eating disorders
Main symptoms, types and causes of schizophrenia
Types and causes of personality disorders
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Early Explanations of Mental Illness
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Trepanning
– Ancient practice where holes were cut
into ill person’s head
– Release evil spirits
• Hippocrates
– Mental illness caused by imbalance of
four humors
• Middle Ages
– Mentally ill were labeled as witches
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
These human skulls clearly show the signs of trepanning, a process in which ancient priests or medicine men cut
holes into the skulls of a living person, perhaps to release the “demons” that were making the person’s behavior
odd or disturbed. Some who were treated in this way must have survived, as the holes show some evidence of
healing. Source: American Museum of Natural History.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
What is Abnormal?
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Statistical Definition
– Frequently occurring behavior would be
normal
– Rare behavior would be considered
abnormal
– But what about “abnormality” such as
high IQ?
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
By what criterion (or criteria) of abnormality might this person be considered abnormal? Would your perception
of him change if he was not in front of a business offering tax services?
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
What is Abnormal?
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Social Norm Deviance
– Going against norms of society
– Deviance from social norms is not
always abnormal behavior
– Situational context
• Subjective Discomfort
– Not all abnormal behavior creates
discomfort
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
What is Abnormal?
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Inability to function normally
– Hard to meet demands of daily living
– Best definition
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
What is Abnormal?
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Sociocultural perspective
– Normal and abnormal behavior seen as
product of behavioral shaping within the
context of influences
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
What is Abnormal?
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Sociocultural perspective
– Cultural relativity
 Need to consider the unique
characteristics of the culture the person
is from
– Culture-bound syndromes
 Disorders found only in particular
cultures
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
A Working Definition of Abnormality
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Is the behavior unusual?
• Does the behavior go against social
norms?
• Does the behavior cause the person
significant subjective discomfort?
• Is the behavior maladaptive, or does it
result in an inability to function?
• Does the behavior cause the person to
be dangerous to self or others?
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Abnormality versus Insanity
LO 12.1
Explanations of mental illness and defining abnormal behavior
• Lawyers and judges
– Determine how law should address
crimes committed under the influence of
mental illness
• Psychologists/psychiatrists
– Assess behavior’s abnormality
– Do not determine sanity
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
This photograph shows Keith, Deanna, Joshua, and Luck Laney of New Chapel Hill, Texas, in seemingly happier
times. On May 12, 2003, Deanna Laney killed her two young sons by crushing their heads with rocks, believing
that God had ordered her to kill her children. On the day of the killings, Deanna suffered a number of visual and
auditory hallucinations. She was found innocent by reason of insanity in 2004 and has been committed to a
maximum security state hospital, where she is undergoing treatment for paranoid schizophrenia.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Models of Abnormality
LO 12.2
How disorders relate to biological and psychological models
• Biological model
– Explains behavior as caused by
biological changes
 Chemical, structural, or genetic systems
of the body
• Psychological Models
– Psychodynamic view
 Disordered behavior results from
repressed thoughts, memories, and
concerns in the unconscious mind
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Models of Abnormality
LO 12.2
How disorders relate to biological and psychological models
• Psychological Models
– Behaviorists
 See abnormal behavior as set of learned
responses
– Cognitive theorists
 Abnormal behavior comes from irrational
beliefs and illogical patterns of thought
• Biopsychosocial Model
– Incorporates elements of all models
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
DSM-IV-TR
LO 12.3 Types of psychological disorders
• Diagnostic and Statistical Manual-TR
– Manual of psychological disorders and
their symptoms
– Lists over 250 different disorders
– Describes typical course of illness
– Diagnosis is across 5 axes
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Types of Disorders
LO 12.3 Types of psychological disorders
• Five axes in the DSM-IV-TR
– Clinical disorders
 Mood, anxiety, schizophrenia, ADHD,
eating disorders
– Personality disorders
 Stable and enduring parts of individual’s
personality
– General medical conditions
 Illnesses that could impact adjustment
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Types of Disorders
LO 12.3 Types of psychological disorders
• Five axes in the DSM-IV-TR
– Psychosocial and environmental
problems
 Problem in life such as job loss, divorce
– Global assessment of functioning
 Overall assessment of individual’s
functioning
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Table 12.1 Yearly Occurrence of Psychological
Disorders in the United States
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
The Pros and Cons of Labels
LO 12.3 Types of psychological disorders
• Labels make up a common language in
the mental health community
– Allow psychological professionals to
communicate clearly and efficiently
• Labels establish distinct diagnostic
categories enabling good treatment
• Labels can bias judgment
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Main symptom is excessive or
unrealistic anxiety and fearfulness
– Free-floating anxiety
 Anxiety unrelated to any realistic, known
source
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Phobia
– Irrational, persistent fear of an object,
situation, or social activity
– Social phobia
 Fear of interacting with others
 Being in social situations that might lead
to a negative evaluation
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Table 12.2
Names
Common Phobias and Their Scientific
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Phobia
– Specific phobia
 Fear of objects or specific situations or
events
 Claustrophobia
– Fear of being in a small, enclosed
space
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Phobia
– Specific phobia
 Acrophobia
– Fear of heights
 Agoraphobia
– Fear of being in situation where escape is
difficult or impossible
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Many people get nervous when they have to speak in front of an audience. Fear of public speaking is a common
social phobia. Can you remember a time when you experienced a fear like this?
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Panic disorder
– Panic attacks cause difficulty in
adjusting to daily life
– Panic attack
 Sudden onset of intense panic
 Multiple physical symptoms of
stress
 Often with feelings that one is
dying
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Panic disorder
– Panic disorder with agoraphobia
 Fear of leaving one’s familiar
surroundings
 Possibility of panic attack in public
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Agoraphobia includes a fear of crossing bridges, although this bridge is enough to test anyone’s courage.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Obsessive-compulsive disorder
– Intruding, recurring thoughts or
obsessions create anxiety
– Relieved by performing a repetitive,
ritualistic behavior (compulsion)
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Generalized anxiety disorder
– Experience feelings of dread and
impending doom
– Physical symptoms of stress
– Symptoms lasts six months or more
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Acute Stress Disorder (ASD)
– Symptoms occur within 4 weeks of the
traumatic event
– Include anxiety, dissociative symptoms
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Post-traumatic Stress Disorder (PTSD)
– Symptoms of ASD last longer than one
month
– Symptoms may not occur until 6
months or later after event
• Women are 2x more likely to develop
these disorders
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
After the BP oil spill in April of 2010, anywhere from 35 to 45 percent of people living around or near the Gulf of
Mexico reported suffering symptoms of stress (Abramson et al., 2010).
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Psychoanalytic
– Repressed urges and desires trying to
enter conscious
– Create anxiety controlled by
the abnormal behavior
• Behaviorists
– Disordered behavior is
learned through reinforcement
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Anxiety disorders can affect children as well as adults.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Cognitive psychologists
– Anxiety comes from illogical, irrational
thought processes
– Magnification
 Interpret situations as far more
dangerous, harmful, or important than
they are
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Cognitive psychologists
– All-or-nothing thinking
 Believe one’s performance must be
perfect or result will be a total failure
– Overgeneralization
 Interpret a single negative event as
pattern of defeat and failure
– Minimization
 Give little importance to one’s successes
or positive events
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Anxiety Disorders
LO 12.4 Types and symptoms of anxiety disorders
• Biological explanations
– Lower levels of GABA and serotonin may
reduce ability to calm reactions to stress
– Panic disorder related to possible defect
in serotonin binding to receptors
– Chemical imbalances may have a
genetic component
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Mood Disorders
LO 12.5 Types of mood disorders and their causes
• Disturbance in emotion, also referred to
as affective disorders
• Dysthymia
– Mild, chronic depression that lasts for at
least two years or more
• Cyclothymia
– Moderate mood swings from sad to
happy in cycles
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Figure 12.1 The Range of Emotions
Most people experience a range of emotions over the course of a day or several days, such as mild sadness, calm
contentment, or mild elation and happiness. A person with a mood disorder experiences emotions that are
extreme and, therefore, abnormal.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Mood Disorders
LO 12.5 Types of mood disorders and their causes
• Major depression
– Severe form of depression
– Comes on suddenly
– Seems to have no external cause
– Risk of suicide
– Most common of diagnosed mood
disorders
– Twice as common in women as men
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Figure 12.2 Prevalence of Major Depressive Disorder
As the most common mood disorder, major depressive disorder has seen an increase in diagnosis with each
decade. From 1936 to 1945, the prevalence of major depression in the population was about 3 percent, with the
onset of symptoms occurring at around ages 18 to 20. By 1966 to 1975, the prevalence had jumped to about 23
percent of the population, and the age of onset had dropped to the early teens.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Mood Disorders
LO 12.5 Types of mood disorders and their causes
• Bipolar disorder
– Severe mood swings between major
depressive episodes and manic episodes
– Manic episodes
 Excessive excitement, energy, and
elation or irritability
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Mood Disorders
LO 12.5 Types of mood disorders and their causes
• Bipolar disorder
– Depressive episodes are
indistinguishable from major depression
– Possible connection with ADHD and
adolescent onset
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Mood Disorders
LO 12.5 Types of mood disorders and their causes
• Psychoanalytic theories
– Anger at authority figures from
childhood turned inward on the self
• Learning theories
– Link depression to learned helplessness
• Cognitive theories
– See depression as the result of
distorted, illogical thinking
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Mood Disorders
LO 12.5 Types of mood disorders and their causes
• Biological theories
– Examine function of serotonin,
norepinephrine, and dopamine systems
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Eating Disorders
LO 12.6 Types of eating disorders
• Anorexia nervosa
– Individual reduces eating
– Weight loss 15 percent below expected
body weight
– Often obsessed with exercise and food
– Health complications
– Distorted body image
– Prognosis for full recovery is not good
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
This young model is not merely thin; by medical standards she is probably at a weight that would allow her to be
labeled as anorexic. The “thin is in” mentality that dominates the field of fashion design models is a major
contributor to the Western cultural concept of very thin women as beautiful and desirable. The model pictured
here is a far cry from the days of sex symbol Marilyn Monroe, who was rumored to be a size 12.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Eating Disorders
LO 12.6 Types of eating disorders
• Bulimia nervosa
– Cycle of “bingeing” or overeating
enormous amounts of food at one
sitting
– Using inappropriate methods for
avoiding weight gain
– Deliberate vomiting and laxative abuse
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Eating Disorders
LO 12.6 Types of eating disorders
• Bulimia nervosa
– Binge often prompted by anxious or
depressed mood
– Health consequences
 Tooth decay, erosion of the lining of the
esophagus, enlarged salivary glands,
mineral imbalances
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Severe break with reality
– Unable to distinguish between fantasy
and reality
• Delusions
– Not found with all forms of
schizophrenia
– Are false beliefs about the world
– Remain fixed
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Delusional disorder
– Psychosis that may or may not be
schizophrenia
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Symptoms of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Delusions of persecution
– Belief that others are trying to harm the
individual
• Delusions of reference
– Belief that others are in communication
with individual
Psychology: An Exploration, Second Edition
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Symptoms of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Delusions of grandeur
– Belief one possesses special powers
• Delusions of influence
– Belief one is controlled by external
forces
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Dr. John Nash is a famous mathematician who won the Nobel Prize for mathematics in 1994. His fame, however,
is more due to the fact that Nash once suffered from a form of schizophrenia in which he experienced delusions
of persecution. He at one time believed that aliens were trying to contact him through the newspaper (delusions
of reference). His life story and remarkable recovery from schizophrenia are portrayed in the 2001 movie A
Beautiful Mind, which starred Russell Crowe as Nash.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Categories of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Disorganized
– Behavior is bizarre and childish
– Thinking, speech, and motor actions
are disordered
• Catatonic
– Person experiences periods of statuelike immobility
– Mixed with bursts of energetic,
frantic movement and talking
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Categories of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Paranoid
– Delusions of persecution, grandeur,
jealousy
– Suspiciousness, hallucinations
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Nathaniel Ayers, a homeless musician, is pictured in 2003 in front of The Midnight Mission shelter in Los Angeles,
California. Mr. Ayers’s life is the subject of the 2009 movie The Soloist starring Jamie Foxx. Mr. Ayers was a
Julliard-trained musician who became mentally ill.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Symptom of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Positive symptoms
– Excesses of behavior
– Occur in addition to normal behavior
– Hallucinations, delusions, distorted
thinking
– Outlook for recovery generally good
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Symptom of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Negative symptoms
– Less than normal behavior
– Absence of normal behavior
– Poor attention, flat affect, and poor
speech production
– Outlook for recovery not good
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Family, twin, and adoption studies
– Strong evidence that genes are a major
means of transmitting schizophrenia
• Stress-vulnerability model
– Genetic “markers” for schizophrenia
– Have physical vulnerability but will not
develop schizophrenia unless exposed
 Environmental or emotional stress at
critical times in development
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Figure 12.3 Genetics and Schizophrenia
This chart shows a definite pattern: The greater the degree of genetic relatedness, the higher the risk of
schizophrenia in individuals related to each other. The only individual to carry a risk even close to that of identical
twins (who share 100 percent of their genes) is a person who is the child of two parents with schizophrenia.
Source: Gottesman (1991).
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Causes of Schizophrenia
LO 12.7 Main symptoms, types and causes of schizophrenia
• Brain Imaging
– Neurons missing myelin in cingulum
bundle
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Nestor et al. (2008) used diffusion tensor imaging to investigate schizophrenia. Two of the brain areas examined
were the cingulum bundle (CB) and the uncinate fasciculus (UF), two fiber pathways. The cingulum bundle is
depicted in the image above. For individuals with schizophrenia, both the CB and UF fiber pathways were found
to have neurons with significantly less myelin, making them less efficient in information transfer, and resulting in
decreased memory and decision-making ability. Image courtesy of Dr. Paul Nestor.
Psychology: An Exploration, Second Edition
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Personality Disorders
LO 12.8 Types of causes of personality disorders
• Persistent, rigid, and maladaptive
pattern of behavior
• Behavior interferes with normal social
interactions
• Ten types of personality disorders
falling in three groups
– Odd and eccentric
– Dramatic and emotional
– Fearful and anxious
Psychology: An Exploration, Second Edition
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Personality Disorders
LO 12.8 Types of causes of personality disorders
• Antisocial personality disorder
– No morals or conscience
– Often behaves in an impulsive manner
– No regard for the consequences of
behavior
Psychology: An Exploration, Second Edition
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Personality Disorders
LO 12.8 Types of causes of personality disorders
• Borderline personality disorder
– Relationships with others are intense
and relatively unstable
– Moody, unstable, lacks a clear sense of
identity, and often clings to others
Psychology: An Exploration, Second Edition
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Causes of Personality Disorders
LO 12.8 Types of causes of personality disorders
• Biological
– Genetic factors may be involved
– Lower than normal stress hormones in
antisocial personality
 May be responsible for their low
responsiveness to threatening stimuli
Psychology: An Exploration, Second Edition
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Causes of Personality Disorders
LO 12.8 Types of causes of personality disorders
• Other Possibilities
– Disturbances in family communications
and relationships
– Childhood abuse, neglect, overly strict
parenting, parental rejection
Psychology: An Exploration, Second Edition
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Taking the Worry Out of Exams
• Determine why you want to do well on
the exam
– Try to find internal motivation
• Develop strategy for managing
cognitive state and behavior
– Review study tips in text
– Schedule review sessions
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Taking the Worry Out of Exams
• Turn thinking around and focus on
energy, not anxiety going into the
exam
• Control body, stay relaxed
Psychology: An Exploration, Second Edition
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