3 Anxiety Disorders: Panic Disorder and Agoraphobia Flashcards
List the DSM-5 criteria for Panic Attacks
An abrupt surge of intense fear or discomfort, peaks within minutes, includes 4 (or more) of the following symptoms
- Palpitations, accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed or faint
- chills or heat sensations
- Parenthesis (numbness or tingling sensations)
- Derealization or depersonalization
- Fear of losing control or “going crazy”
- Fear of dying
Define Panic Attack
Extreme severe anxiety/fear reaction
What are the two types of panic attacks?
Can occur in the context of any anxiety disorders
Expected (cued) Panic Attack
- Context: most anxiety disorders
- Trigger: specific or social phobias
Unexpected (uncued) attack
- unidentifiable trigger
- Context: Panic disorder
- Two unexpected panic attacks are needed for diagnosis
List the DSM-5 criteria for Panic Disorders
A. A recurrent, unexpected panic attacks
B. Symptoms for >1month of either: Anxiety or worry about having another attack (1) and significant behaviour change related to the attack and avoidance (2)
C. Disturbance not attributable to the physiological effects of a substance
D. The disturbance is not better explained by another mental disorder
List the DSM-5 criteria for Agoraphobia
A. Marked fear or anxiety about two (or more) of the following five situations (Using public transport (1), open spaces (2), enclosed spaces (3), standing in line or crowd (4), outside of home alone (5)
B. Fear or avoids these situations because of thoughts that escape might be difficult or help might not be available - may develop panic-like symptoms
C. Agoraphobic situations almost always provoke fear or anxiety
D. Agoraphobic situations are actively avoided, require companion, or endured with intense fear or anxiety
Describe some major changes from DSM-4 and DSM-5
- DSM-4 agoraphobia diagnosed when panic disorder present and in DSM-5 they can be diagnosed separately
- DSM-4 didn’t specify how many situations and in DSM-5 it now does
- In DSM-4 they had to recognise whether it was unreasonable and in DSM-5 they don’t need to recognise its unreasonable
What is some evidence for panic disorder and agoraphobia as separate disorders?
- Most individuals with agoraphobia do not experience panic symptoms -> epidemiological evidence shows 50% with agoraphobia do not show signs of panic attacks
- Comorbidity: Agoraphobia is associated with other disorders too, not just panic disorder
- Agoraphobia associated with other anxiety disorders whereas panic disorder associated with a broader range of disorders
- Different clinical course: Agoraphobia is more persistent/chronic than panic disorder
What is longitudinal evidence for panic disorder and agoraphobia as separate disorders?
Agoraphobia just as frequently precedes panic attacks as panic attacks precede agoraphobia (therefore panic is not considered causal to developing agoraphobia)
Describe the process of Panic disorders
Recurrent, unexpected panic attacks -> worry and anxiety about having more panic attacks -> changes behaviour significantly to minimise or avoid panic attacks
What is the cognitive model of panic (Clark, 1986)
Suggests that panic attacks occur because certain bodily sensations are misinterpreted as indicating a catastrophe, such as a heart attack or loss of control
How does the cognitive model of panic explain when it is perceived by heightened anxiety
- Anxiety in anticipation of an attack
- Heightened anxiety unrelated to the anticipation of panic
Describe the cycle that would occur in anticipation of an attack in the cognitive model of behaviour?
Anxious in anticipation -> selectively focus on body -> notice unpleasant body sensation -> interpret as evidence of impending attack -> activate cycle
Describe the cycle that would occur in heightened anxiety unrelated to the anticipation of panic
Have an argument with partner -> notice body sensation -> catastrophically interpret -> activate cycle
Give an example of Anxiety in anticipation of an attack
Individuals with agoraphobia entering a supermarket where they previously had an attack
How does the cognitive model of panic explain when it is not preceded by heightened anxiety “out of the blue”?
Perception of bodily sensation caused by another emotional state (happiness) or an innocuous event (e.g. getting up quickly and feeling dizzy) which is interpreted as catastrophic
What is the aetiology of panic disorder?
The interaction of invulnerability giving rise to panic disorder
People who develop panic disorder tend to misinterpret their bodily sensations that accompany these panic attacks in a catastrophic manner
Give an example of the aetiology of panic disorder
Walked up 10 flights of stairs and you feel in your body a few physical bodily sensations
-> Someone who is anxiety sensitive (biological factor) might say “something is wrong with me” due to the bodily sensations -> this increases anxiety and puts the body in flight or fight response and leads to a panic attack
Explain the biological processes associated with Panic Disorder
When you beleive there is danger or there is real danger, our bodies go through:
Automatic arousal which includes increased heart rate, in sweating and muscle tension
Hyperventilation and anxious breaking -> disrupt levels of carb dioxide due to increased breathing
How is panic disorder maintained?
- Catastrophic thoughts about normal or anxious physical sensations
- Over-estimating the probability that they will have a panic attack
- Over-estimating the cost of having a panic attack: thinking that the consequences of having a panic attack will be very serious or very negative
How is panic disorder maintained in anxiety sensitivity and focus on internal sensations?
- Monitoring internal sensations
- Normal physical sensations fluctuate and can be misinterpreted as a threat
How is panic disorder maintained in avoidance?
Situations that may trigger similar symptoms (i.e. exercise), that have led to panic attacks in the past, that are hard to escape from
How is panic disorder maintained in safety behaviours?
Behaviours designed to abate anxiety symptoms (but ultimately maintain the symptoms)
In what ways are panic disorder treated?
Cognitive Behavioural Therapy (Level 1 evidence)
What is meant by level 1 evidence?
a meta-analysis or a systematic review of level 2 studies that included a quantitative analysis
Describe the psychoeducation in Cognitive behavioural therapy for treating Panic Disorders
Have this unconscious bias to interpret in the wrong way -> Aspect of psychoeducation tells us all the different things that maintains panic and that gives the rationale of what to continue going for
Describe the cognitive restructuring in Cognitive behavioural therapy for treating Panic Disorders
We do cognitive restructuring to attack some of these cognitive biases that we have about panic due to misinterpreting the thoughts that keep panic going we work at turning those thought patterns around
- Thought monitoring
- Identifying symptoms
- Identifying cognitions
- Cognitive challenging
- Safety behaviours/avoidance
Describe the Interceptive exposure in Cognitive behavioural therapy for treating Panic Disorders
We fear these physiological symptoms that are associated with panic and we catastrophically misinterpret them and we try to stop them or avoid situations that they might come about so we need to expose ourselves to scenarios that bring on the symptoms - so clients are exposed to their own bodily sensations and doing this a sufficient number of times
Describe the graded exposure (for agoraphobia) in Cognitive behavioural therapy
Gradual exposure to more and more fear until you can conquer your fear
What are the steps involved in graded exposure in Cognitive Behavioural Therapy?
- Identify a first small step towards overcoming the feared situation
- Practice this step until it no longer causes anxiety
- Move on to a more difficult step and repeat the practice
- Continue this process until the person can manage the feared situation
List the attributes of cognitive model of panic by Clark (1986)?
Trigger stimulus (internal or external): Perceived threat -> interpretation of sensations as catastrophic -> Body sensations -> Apprehension
