Chapter 6 – Panic, Anxiety, And Their Disorders Flashcards
Distinguish between fear and anxiety
Anxiety involves a general feeling of apprehension about possible future danger, and fear is an alarm reaction that occurs in response to immediate danger.
The most common way of distinguishing between the fear and anxiety response patterns has been whether there is a clear and obvious source of danger that would be regarded as real by most people. When the source of danger is obvious, the experienced emotion has been called fear. With anxiety, however, we frequently cannot specify clearly what the danger is.
Recently, researchers have proposed a more fundamental distinction between the fear and anxiety responses saying that fear is a basic emotion shared by many animals that involves activation of the fight-or-flight response of the autonomic nervous system.
The anxiety response pattern is a complex blend of unpleasant emotions and cognitions that is both more oriented to the future and much more diffuse than fear. Like fear, it has not only cognitive/subject of components but also physiological and behavioural components. Although there is no activation of the fight or flight response as there is with fear, anxiety does prepare or prime a person for the fight or flight response should be anticipated danger occur. May also create a strong tendency to avoid situations where danger might be encountered, but there’s not the immediate behavioural urge to flee with anxiety as there is with fear
What are the seven primary types of anxiety disorders?
Specific phobia; social phobia; panic disorder with or without agoraphobia; generalized anxiety disorder; obsessive-compulsive disorder; acute stress disorder; post dramatic stress disorder
Describe the various causal factor theories of phobias
Psychoanalytic: phobias represent a defense against anxiety that stems from repressed impulses from the ID which are displaced onto some external object or situation that has some symbolic relationship to the real object of the anxiety
Learning theory: phobic behaviour is developed through classical conditioning. The response can readily be conditioned to previously neutral stimuli when the stimuli are paired with traumatic or painful events and these phobic fears would generalize to other, similar objects or situations
Can also be developed through vicarious conditioning by simply watching a phobic person behaving fearfully with his or her phobic object. vicarious or observational classical conditioning.
Individual differences in learning me also play apart, for example, having exposure to a non-fearful parent behaving on fearfully with the phobic object may serve as a protective factor and immunize a child against the effects of later seeing the phobic parent behaving fearfully with the phobic object.
Evolutionary preparedness for learning certain fears and phobias: over the course of evolution, those primates and human to rapidly acquired fears certain objects or situations that post real threats to our early ancestors may have enjoyed a selective advantage. Prepared fears are not inborn or innate but rather are easily acquired or specially resistant to extinction
Biological causal factors: genetic and temperamental variables affect the speed and strength of conditioning of fear
What are some of the most effective treatment approaches for phobias?
Exposure therapy – involves controlled exposure to the stimuli or situations that elicit phobic fear. Clients are gradually placed – symbolically or increasingly under real life conditions – in those situations they find the most frightening so that their fear begins to subside.
What is an effective treatment approach for social phobias?
Cognitive restructuring him where the therapist attempts to help clients with social phobia identify their underlying negative, automatic thoughts and to change these inner thoughts and beliefs through logical reanalysis
List the diagnostic criteria for panic attacks
A discrete period of intense fear or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak within 10 minutes:
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Derealization or feelings of unreality or depersonalization or being detached from oneself
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias- numbness or tingling sensations
- Chills or hot flushes
Describe the diagnostic criteria for panic disorder
- recurrent unexpected panic attacks
- And persistent concern about having additional attacks; worry about the implications of the attack or its consequences; a significant change in behaviour related to the attacks
Panic disorder can be with Agoraphobia, without Agoraphobia, and there can be agoraphobia without history of panic disorder
Contrast panic attacks and other types of anxiety
Panic attacks are fairly brief but intense, with symptoms developing abruptly and usually reaching peak intensity within 10 minutes. The attacks usually subside in 20 to 30 minutes and rarely last more than an hour. Periods of anxiety, by contrast, do not usually have such an abrupt onset and are more long-lasting
Summarize the prevalence, age of onset, and comorbidity for panic disorder
The national comorbidity survey – replication study found that approximately 4.7% of the adult population has had panic disorder with or without agoraphobia at sometime in their lives, with panic disorder without agoraphobia being more common.
Often starts in the late teenage years, but the average age of onset is 23 to 34 years. It can begin, especially for women, when in a persons 30s or 40s however.
About twice as prevalent in women as in men. Most common explanation of this gender difference is a socio-cultural one where it is more acceptable for women who experience panic to avoid the situations they fear and to need a trusted companion to accompany them when they enter feared situations.
83% of people with panic disorder have at least one comorbid disorder. Most commonly these include generalized anxiety disorder, social phobia, specific phobia, PTSD, depression, and substance-use disorders
Describe recent findings on biological, behavioral, and cognitive influences for anxiety proneness
Biological:
Genetic factors – panic disorder has a moderate heritable component, it is estimated that 33 to 43% of the variance in liability to panic disorder is due to genetic factors.
Panic and the brain: increased activity in the amygdala plays a more central role in panic attacks. The amygdala is the central area involved in what has been called a “fear network”, and panic attacks occur when the fear network is activated, either by cortical inputs or by inputs from lower brain areas. According to this influential theory, panic disorder is likely to develop in people who have abnormally sensitive fear networks that get activated too readily to be adaptive.
Biochemical abnormalities- people with panic disorder are much more likely to experience panic attacks when they are exposed to various biological challenge procedures that are normal people or people with other psychiatric disorders. Such procedures produce panic attacks and panic disorder clients at a much higher rate than in normal subjects and they are called panic provocation procedures. Two primary neurotransmitter systems are most indicated – and noradrenergic and the serotonergic systems
Psychological:
Comprehensive learning theory – initial internal bodily sensations of anxiety or arousal effectively become interoceptive conditioned stimuli associated with higher levels of anxiety or arousal. Initial panic attacks become associated with initially neutral internal and external cues through an interoceptive conditioning process.
Cognitive theory – proposed that individuals with panic disorder are hypersensitive to their bodily sensations and are very prone to giving them the direst possible interpretation. It is a tendency to catastrophize about the meaning of their bodily sensations.
Anxiety sensitivity and perceived control – people who have high levels of anxiety sensitivity are more prone to developing panic attacks and perhaps panic disorder. Anxiety sensitivity is a trait-like belief that certain bodily symptoms may have harmful consequences. Studies have shown that simply having a sense of perceived control reduces anxiety and even blocks panic.
Describe how safety behaviours and cognitive biases help to maintain panic
Safety behaviours and the persistence of panic – disconfirmation where the person is proved wrong that a catastrophic event is going to happen does not occur because people with panic disorder frequently engage in safety behaviours such as breathing slowly or carrying a bottle of medication before or during an attack. They then mistakenly tend to attribute the lack of catastrophe to their having engaged in the safety behaviour rather then to the idea that panic attacks actually do not lead to heart attacks.
Cognitive biases and the maintenance of panic- people with panic disorder are biased in the way they processed threatening information bite interpreting ambiguous bodily sensations as threatening and also interpreting other ambiguous situations as more threatening than do controls. These people seem to have their attention automatically drawn to threatening information in their environment such as words that represent things they fear.
Compare and contrast the major treatment approaches for panic disorder and Agoraphobia
Medications: many people with panic disorder are prescribed anti-anxiety medications or anxiolytics from the benzodiazepine category such as alprazolam (Xanax) or clonazepam (Klonopin). These people frequently show symptom relief from these medications, and many can function more effectively. One major advantage is that they act quickly and so can be useful in a cute situations of intense panic or anxiety, but they also have quite undesirable side effects such as drowsiness and sedation, which can lead to impaired cognitive and motor performance. With prolonged use, people may develop physiological dependence which results in withdrawal symptoms when the drug is discontinued and relapse can be high.
The other category of medication is the antidepressants. One major advantage is that antidepressants do not create physiological dependence in the way benzodiazepines Ken, and they also can alleviate any comorbid depressive symptoms or disorders. A disadvantage is that it takes about four weeks before they have any beneficial effects, so they are not useful in an acute situation where a person is having a panic attack. Side effects such as dry mouth, constipation, and blurred vision and interference with sexual arousal mean that large numbers of people refuse to take the medications were discontinued their use and relapse rates when discontinued are high.
Behavioural and cognitive-behavioral treatments: exposure based treatments to feared situations has been shown to help about 60 to 75% of people with Agoura phobia show clinically significant improvement. The idea was to make people gradually face the situations they feared and learned that there was nothing to fear. When limitation of these original treatments was that they did not specifically target panic attacks, so in the 1980s to new techniques were developed, interoceptive exposure – deliberate exposure to feared internal sensations, and cognitive restructuring techniques in recognition that catastrophic automatic thoughts may help maintain panic attacks. Panic control treatment targets both Agoura phobic avoidance and panic attacks. Overall, the magnitude of improvement is often greater with these cognitive and behavioural treatments than with medications. A combination of medication and cognitive-behavioral therapy sometimes produces a slightly superior results compared to either type of treatment alone.
What are the Central features of generalized anxiety disorder?
Excessive anxiety and worry occurring more days than not for at least six months, about a number of events or activities such as work or school performance.
The person finds it difficult to control the worry.
The anxiety and worry are associated with three or more of the following six symptoms – restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; sleep disturbance.
The worry content cannot be exclusively related to the worry associated with another concurrent axis I disorder, or do to the direct physiological effects of a substance or a general medical condition.
Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Describe the psychological and biological causal factors of generalized anxiety disorder
Psychological:
Psychoanalytic viewpoint – results from an unconscious conflicts between ego and ID impulses that is not adequately dealt with because the person’s defence mechanisms have either broken down or have never developed.
Perceptions of uncontrollability and unpredictability – people with GAD may have a history of experiencing many important invents in their lives as unpredictable or uncontrollable and are more likely to have had a history of trauma in childhood.
A sense of mastery the possibility of immunizing against anxiety – a person’s history of control over important aspects of his or her environment is another important experiential variable strongly affecting reactions to anxiety provoking situations.
The central role of worry and it’s positive functions – the worry process is now considered the central feature of GAD. Several of the benefits that people with GAD most commonly think derive from worrying are superstitious avoidance of catastrophe, avoidance of deeper emotional topics, and coping and preparation. Because worry suppresses physiological responding, it also insulates the person from fully experiencing or processing the topics that she or he is worrying about, and it is known that such full processing is necessary if extinction of that anxiety is to occur.
The negative consequences of worry – where he is not an enjoyable activity and can lead to a greater sense of danger and anxiety and lower positive mood. People tend to have more negative intrusive thoughts. Attempts to control thoughts and where he may paradoxically lead to increased experience of intrusive thoughts and enhanced perception of being unable to control them.
Cognitive biases for threatening information – people with GAD process threatening information in a biased way, perhaps because they have prominent danger schemas. They preferentially allocate their attention toward threatening cues when both red and non-threat cues are present in the environment.
Biological causal factors:
Genetic factors – there does seem to be a modest heritability, although perhaps smaller than that for most other anxiety disorders except phobias. Estimate that 15 to 20% of the variance is due to genetic factors. At least part of this common genetic predisposition for GED and major depression is best conceptualized as the basic personality trait commonly known as neuroticism.
Neurotransmitter and neurohormonal abnormalities- A functional deficiency in GABA which ordinarily plays an important role in the way our brain inhibits anxiety in stressful situations.
And anxiety-producing hormone called corticotropin releasing hormone or CRH has also been strongly implicated as playing an important role in GAD.
Evaluate the treatments for generalized anxiety disorder
Medications: medications from the benzodiazepine (anxiolytics) category such as Xanax or Klonopin are used and miss used for tension relief, reduction of other somatic symptoms, and relaxation. Their effects on worry and other psychological symptoms are not as great and can create physiological and psychological dependence and withdrawal. Several categories of antidepressant medications are also used and they seem to have a greater effect on the psychological symptoms, however they take several weeks before their effects are realized
Cognitive behavioural treatment – usually involves a combination of behavioural techniques, such as training in applied muscle relaxation, and cognitive restructuring techniques aimed at reducing distorted cognitions and information-processing vices associated with GAD as well as reducing catastrophizing about minor events.
