Lecture 4 - Phobias and panic Flashcards
What did Freud say about anxiety? (probably don’t need to know)
“One thing is certain,
that the problem of
anxiety is a nodal
point, linking up all
kinds of most
important questions; a
riddle, of which the
solution must cast a
flood of light upon our
whole mental light.”
(Freud, 1917).
What is the difference between fear, anxiety and panic?
Fear: response to a current, present threat (real or perceived), evolved to keep us safe, allows us to get away or cope, enables fight or flight response, very fast, physiological, behavioural, affective, immediate response, usually calms down pretty fast once threat is removed. Cascade of physiological responses.
* Increased heart rate *Blood pressure increases * Increases in hormones
like cortisol and
adrenaline
*Muscle tension * Increased breathing rate *Etc. *Preparation for Action! *Fear is our friend
Anxiety: Feeling threated by potential occurrence (future), absence of a current threat, disorders=interfere with ability to live valued life, lower level physiological response than panic
*Future oriented! *May have some of the
same symptoms as fear
and panic
*Again in the absence of a
current threat
*Anxiety DISORDERS are
disorders of anxiety and
panic
*Fear is our friend
*Stressor can cause anxiety, but not all anxiety caused by a stressor
Panic: Evoked even though no danger present, false alarm, full blown
* Increased heart rate
*Blood pressure increases
* Increases in hormones
like cortisol and
adrenaline
*Muscle tension
* Increased breathing rate
*Etc.
*False alarm!
They all have pretty much the same physiological symptoms
Anxiety disorders
*As a class, among the most common psychological
disorders (lifetime prevalence of around 30-40%)
* In the DSM-5, anxiety-related disorders categorized into
three distinct chapters:
*Anxiety disorders
- Panic disorder, agoraphobia, specific phobia, social anxiety
disorder, and generalized anxiety disorder
*Obsessive-Compulsive and related disorders
- OCD
*Trauma and stressor-related disorders
- PTSD
Vs. in HiTOP
Part of internalizing… separated into fear (specific phobia, social anxiety disorder, panic disorder, OCD) and distress (GAD, PTSD)
Specific phobias
Not just fear, but intense (!) fear of specific object, situation or activity that interferes with ability to live life
5 subtypes:
-Animal-Type (rodents, reptiles, insects)
-Natural Environment-Type (storms, heights)
-Blood/Injection/Injury Type
-Situational Type (tunnels, bridges, elevators,
flying)
-Residual “Other” category
–Very common
–Choking
–Vomiting
–Illness
–Loud noises
–Falling down
- In all cases, fear is not of the
object itself - Instead, fear is of some dire
outcome of interacting with
the object
-Fear of being BITTEN by a
snake
-STUCK in an elevator
-CRASHING in an airplane
*When in the presence of or anticipating
*Recognize that fear is excessive
Nature of the Fear Key to diagnosis
*Fear of airplanes can be
diagnosed as 2 different
phobias, depending on the
reasoning behind the fear
*Anna is afraid of airplanes
because she fears falling from
the sky and dying.
*Sam is afraid of airplanes
because he fears he will be
trapped and unable to escape
if he suddenly starts to feel
dizzy or nauseated (here it would be more agoraphobia..idk im guessing)
Epidemiology, Onset, Course
*Phobias relatively common
*Specific: 12.5%
*Agoraphobia: 1.5%
* 2F:1M
*Comorbidity very high– very often
comorbid with other anxieties and
depression
*Most children outgrow specific fears
*Most don’t become phobic adults
*Not true of other anxiety disorders
Interfere with normal functioning (impairment)
Not of object itself, but of outcome of interaction with it
Nature of fear is key to diagnosis
Most specific phobias have childhood onsets
Agoraphobia much later onset (like 28)
Etiology of specific phobias
Learning Theory by Mowrer:
Fears= result of classical conditioning (Process of associating
two stimuli)
Fears maintained through operant conditioning (Process of associating
a response & its
consequence) : negative reinforcement (avoiding scary behaviour (taking away negative stimulus)… reinforces fear)
Positive reinforcement = increase behavior by giving something good
Negative reinforcement = increase behavior by removing something bad
Positive punishment = decrease behavior by giving something bad
Negative punishment = decrease behavior by removing something good
If Learning Theory is True….
*Onset of phobias should
be linked to some sort of
traumatic experience
* but only 50% of people with trauma develop phobias
-Forgetting?
- Vicarious transmission? (watch someone else have negative interacting with object or being scared of object, then learning to be scared (transmitting fear))
*Why don’t ALL traumatic
experiences lead to
phobias?
Evolutionary Preparedness Theory
*Evolved a sensitivity to
certain stimuli (Seligman)
*Certain fears were
adaptive at one point
-These fears selected for
Experiment:
Baby monkeys. Tried to condition them to be scared of snake vs. tried to condition them to be scared of flowers. Did develop fear of snakes but did not develop fear of flowers when conditioned to.
*Explains why we’re scared of sharks but not of power outlets even though power outlets kill way more people per year
Other reasons:
-Genetics (monozygotic vs dizygotic twins)
-Temperament
Immunizing effect: having a dog and interacting with dog every day, getting bit once won’t likely make you develop a phobia, but if you almost never see dogs and then get bit by one, more likely to develop a phobia of dogs. Same thing with sharks and electric plugs
DSM-5 Panic Disorder
- In Panic Disorder, panic must
be uncued
-MUST be spontaneous
*Stimulus-bound panic=
Phobias
-Respond reliably to the
stimulus (w/ panic)
*Situationally-bound panic =
agoraphobia
-Still not inevitable
-But this is why they tend to
avoid certain places
DSM-5 criteria
* Recurrent unexpected panic attacks
* At least one followed by a month or
more of a persistent concern about
having panic attacks
* Panic not better accounted for by
another disorder (e.g., stimulusbound—phobia)
* A discrete period of fear or discomfort
w/ 4 out of 13 symptoms
- Develop abruptly and peak in
intensity within 10 minutes
- Lots of cardiovascular, autonomic
symptoms
- Some cognitive
Klein: Panic
*Originally anxiety paired with
a negative stimulus (i.e.,
panic attack)
*Avoidance occurs
(agoraphobia)
*Through avoidance, anxiety
is negatively reinforced
-Rather than extinguished
through facing fears and
seeing no negative response.
Differential diagnosis
*Social or simple phobia
can involve avoidance of
similar situations
- BUT motivation is different
-Simple phobias, may
be afraid a bus will
crash
-Social phobias may
avoid crowds b/c they
fear embarrassing
themselves
Panic disorder epidemiology
*About 4-6% lifetime prevalence (panic
disorder)
*Panic 2F:1M
* no significant associations with
race/education
*median age of onset – 24
* range of age of onset – narrower.
-Rarely before adolescence, or after
middle age
- usually between 14-34
*Onset is very abrupt, go from nothing
to panic symptoms.
Psychological Theories of Panic
*David Clark:
*Panic attacks due to catastrophic
misinterpretations of certain bodily
sensations
- Heart palpitation= heart attack
* Magnify
*Vicious cycle
*Symptoms usually internallygenerated, but could come from
caffeine, cocaine, anger
*Reiss & McNally
*Anxiety Sensitivity
-Trait-like differences in how
fearful one is about
physiological sensations of
anxiety
-People high on trait more
likely to panic when they
experience anxiety
Goldstein: Fear of fear!
Bouton, Barlow and Mineka:
Learning theory model
Interoceptive Conditioning
*Spontaneous panic attacks
*Paired with awareness of
early Sx of panic.
* Low level sensations become
CS+
*When unrecognized CS+ is
present, panic attack
*Appears spontaneous, but the
conditioned link was there
(subconscious)
History of Panic
- Introduced in 1980 (DSM-III)
-Prior to 1980, only “anxiety
neurosis”
-Pulled apart GAD and panic (1st
attempt to differentiate fear and
distress/anxious apprehension)
*DSM-III introduced 2 types of
Agoraphobia
-1 with Panic
-1 without
*DSM III-R removed Agoraphobia
from category of phobias - classified it as a complication of
panic.
*DSM-IV Expanded the notion of
panic
-Must include not just panic, but
also apprehension around the
panic
-Now, apprehension is a
necessary component of the
disorder
*Cannot have a diagnosis of panic
disorder w/out apprehension
