6 Anxiety 2 – Panic

Question 1

Into what three categories are anxiety disorders split in DSM 5?

Answer 1

1 Anxiety disorders
2 Trauma and stressor-related
3 OCD and related

Question 2

What was the main treatment for anxiety before CBT?

Answer 2

Drugs

Question 3

Amobarbital and Phenobarbital are examples of what?

Answer 3

Barbiturates

Question 4

Name three examples of Benzodiazepines

Answer 4

Valium, Xanax, Rohipnol

Question 5

What are 4 downsides of using Benzos or Barbiturates for anxiety?

Answer 5

1. Relapse very common
2. Highly addictive
3. Can lead to OD, death
4. Interacts with alcohol

Question 6

Do pills counteract the cause of anxiety?

Answer 6

No, just the symptoms, by slowing nervous system activity.

Question 7

What is the percentage of relapse after SSRIs?

Answer 7

20% within six months; 60% within two years

Question 8

CBT treats anxiety by reducing ________ appraisal and increasing ___________ appraisal

Answer 8

CBT treats anxiety by reducing threat appraisal and increasing coping appraisal

Question 9

What 3 cognitive techniques exist to manage anxiety?

Answer 9

1. Thought diaries to identify automatic thoughts
2. Thought-challenging
   - Socratic questioning
   - Evidence for/against the belief
   - Pros and cons of having thought/belief
3. Cognitive bias modification

Question 10

Do anxious people want to rid themselves of anxious beliefs?

Answer 10

No. In DSM-5 the criterion that an anxious person knows their anxiety is unrealistic has been deleted.

Question 11

What bias of attention is typical of anxious people?

Answer 11

Focus on perceived threat in situation, rather than on whole situation. People need to be taught to pay attention to all info, not just threatening bit.

Question 12

What are the pros and cons of being social phobic?

Answer 12

Pros: if I don’t say anything, no one will hate me
Cons: lead socially barren life

Question 13

Why is holding onto an anxious belief like very expensive life insurance?

Answer 13

Because the cost of the insurance is greater than the thing it covers you for

Question 14

What behavioural techniques exist to reduce threat appraisals?

Answer 14

1. Exposure to feared stimuli (e.g. public transport)

2. Exposure to feared outcomes (e.g. humiliation)

Question 15

What is the difference between flooding and systematic desensitization?

Answer 15

Flooding is chucking someone in the deep end (e.g. snake phobic in snake pit)

Systematic desensitization is taking exposure step by step. Draw up exposure hierarchy –start with just saying ‘snake’, then video, then actually touch a snake.

Question 16

What kind of behavioural intervention is better for correcting appraisals of risk?

Answer 16

Exposure to feared stimulus

Question 17

What kind of behavioural intervention is better for correcting appraisals of cost?

Answer 17

Exposure to feared outcome

Question 18

Most symptoms of panic attacks are symptoms of high __________ arousal.

Answer 18

Most symptoms of panic attacks are symptoms of high autonomic arousal.

Question 19

How long does it take for a panic attack to peak?

Answer 19

Usually a few minutes.

Question 20

What’s the difference between symptoms of panic and symptoms of anxiety?

Answer 20

Nothing. Panic is just high anxiety.

Question 21

Are panic attacks specific to a type of anxiety?

Answer 21

No, they can occur in the context of any anxiety disorder

Question 22

What’s the difference between cued and spontaneous panic attacks?

Answer 22

Cued –in context of other anxiety disorder, e.g. presence of phobic object

Spontaneous –person cannot identify source of fear

Question 23

How many unexpected panic attacks are needed for a diagnosis of Panic Disorder?

Answer 23

At least two unexpected panic attacks.

Question 24

What are panic disorder sufferers afraid of?

Answer 24

Panic attacks and consequences thereof

Question 25

How long must symptoms persist before a diagnosis of Panic Disorder?

Answer 25

One month or more

Question 26

According to Clark’s 1988 cognitive theory of panic, what is the mechanism driving panic?

Answer 26

Bodily sensations are misinterpreted –these cause anxiety –sensations get more intense – anxiety mounts –spirals out of control

Question 27

Why don’t PD sufferers learn they’re not going to die after the 200th panic attacks?

Answer 27

They stop themselves from learning through safety behaviours
e.g. sit at end of row at movies so can exit quickly
lucky amulet
presence of friend in public places

Question 28

Is agoraphobia a reaction to panic?

Answer 28

It can be, but in DSM-5 agoraphobia is not just linked to panic – could result from any source of anxiety, e.g. fear of humiliation etc.

Question 29

What 5 factors predict the development of agoraphobia?

Answer 29

1. High degree of dependent behaviour
2. Weaker beliefs in own coping ability
3. Separation Anxiety, School Phobia
4. Physical concerns: dizziness and fainting
5. More social evaluative concerns

Question 30

What three broad treatments exist for panic/agoraphobia?

Answer 30

1. Cognitive restructuring –recognise automatic thoughts –then challenge
2. Exposure
   - to own bodily sensations (send them running up and down stairs; spin around on office chair). Understand that these sensations aren’t going to kill them.
   - slowly desensitise to avoided situations (friend take to mall, then alone)
   - to feared outcome (e.g. therapist pretends to faint in mall)
3. Reduce safety-seeking behaviours e.g. Get rid of lucky charm (otherwise, sure, the therapist showed me my bodily sensations aren’t dangerous, but I had my amulet)

Question 31

How effective is CBT for Panic Disorder?

Answer 31

Effective in 80-85% of cases