Anxiety Disorders: Panic

Question 1

Panic Disorder

Answer 1

• recurrent, unexpected, seem to come out of the blue panic attacks
• major negative life event often precedes the first panic attack

Question 2

Panic Attacks Feel Like

Answer 2

=they take forever
- in reality, < 30min, usually 5-20 min
=shortness of breath
=tightness of chest

Question 3

DSM for Panic Disorder

Answer 3

A. recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes and during which 4 of the following symptoms occur.
1. (you know the symptoms) etc
B. At least one of the attacks has been followed by one month or more of one of the following
1. persistent worry about additional panic attacks and their consequences
2. a significant maladaptive change in behavior since the attacks - avoidance behavior
C. ruled out physiological factors
D. ruled out other mental disorders

Question 4

Agoraphobia

Answer 4

=generalized diverse fear of crowded and social areas
=can develop as a result of panic attacks
-afraid to be in an area where you had one because you don’t want to have another
-afraid to be in new areas where you could have one
-don’t want everyone seeing and responding to you having a panic attack
-avoid activities which raise heart rate - gym,sex

Question 5

Physical Exam for Panic Attacks

Answer 5

• rule out any physiological causes

- people usually think panic attacks or heart attacks or general feeling of losing control

Question 6

1. Panic Disorder Prevalence
2. age of onset
3. Comorbidity

Answer 6

1. 4.7% lifetime prevalence, more common in women
2. 20s and 30s
3. highly comorbid - 83% have another disorder
   - social phobia, depression, anxiety, PTSD, substance abuse
   - 50% with one anxiety disorder will also have depression

Question 7

Etiology of Panic Disorder

Answer 7

• genetics - moderately heritable
• repeated early life stress
• dysfunction in amygdala and limbic system - serotonin, norepinephrine, GABA
• abnormally sensitive fear network
• hypersensitive in relevant biological challenges

Question 8

Learning Theory

Answer 8

• initial panic attacks become associated with initially neutral internal (interoceptive) and external (exteroceptive) cues through conditioning
• CS US pairing explains the anticipatory anxiety and (sometimes) agoraphobia
• internal cues can also trigger the attack (ex racing heart bc of hearing good news). the person may be unaware of these. the body does not discriminate the CS well enough

Question 9

Cognitive Theory

Answer 9

• hyperactive to body sensations
• prone to catastrophic interpretations
• high anxiety sensitivity
• biased attention toward threatening material
• most people have biased attention toward positive, self enhancing material
• worry that a fast heartbeat is the start of another panic attack and therefore have one

Question 10

Why do panic attacks keep occurring? no extinction?

Answer 10

-have them for a long time –> 3 a week for a decade
=people tend to engage in safety behaviors before/during a panic attack
- breathing slowly, anxiolytic meds
-they attribute the reduced anxiety to the safety behaviors rather than realizing there is no physical cause to panic

Question 11

Treatment for Panic Attacks

Answer 11

=interoceptive exposure
-deal with sensations by creating them in fake scenarios and riding them out
-get over fear of these sensations
=cognitive restructuring
-recognizing that no harm is going to come
-neutralizing catastrophic thoughts
-breathing control, muscle relaxation
=medication
-deals with symptoms, but does not get to root cause
-will not give you needed skills after you stop taking it

Question 12

panic circle

Answer 12

perceived threat –> apprehension or worry (about having a panic attack or a distressing situation) –> body sensations –> interpretation of sensations as catastrophic –> perceived threat …..

the circle starts when it is triggered: 
trigger stimulus (internal or external) --> perceived threat or body sensations