Task 3 - Anxiety & Panic Disorder Flashcards
Panic Attack
Discrete period of intense fear or discomfort;
-symptoms develop abruptly and peak within 10 minutes
in absence of triggers
-> certain situations but not every time
Panic Attack Symptoms
Heart Palpitations Sweating Trembling, shaking Shortness of breath or choking Chest pain, discomfort Nausea Dizziness Derealization/depersonalization
Panic Disorder DSM criteria
A. Recurrent unexpected panic attacks
B. at least one attacks followed by one month or more of:
1. persistent concern about additional attacks
2. worry about implications of attack or consequences
3. clinically significant change in behavior related to attacks
Panic Disorder Characteristics
- diagnosis when panics attacks become common occurrence
- can go with many episodes in a short time and then some time without panic attack
- fear of possessing life threatening illness
- tends to be chronic
- many show generalized anxiety, depression, alcohol abuse
Panic Disorder Prevalence
3-5% lifetime prevalence
- more common in women
- onset usually between late adolescence and mid-thirties
Agoraphobia
Fear of places where there might be trouble escaping or getting help if they become anxious or have panic attack
-> frequently developed by people with panic disorder
Panic Disorder Genetic correlates
10% of first-degree relatives also have it
- twin studies: 30-40% due to genetics (transmitted vulnerability)
- Agoraphobia: attributable in part due to genetics
Panic Disorder Neurobiological Contributors
Different functioning in limbic system (amygdala, hippocampus, hypothalamus)
- dysregulation of norepinephrine in locus ceruleus in brain stem
- > poorly regulated fight-or-flight response
Panic Disorder Cognitive Model
Psychological Factors associated with disorder;
- anxiety sensitivity: belief that bodily symptoms have harmful consequences
- > interoceptive awareness: heightened awareness of bodily cues
- > interoceptive conditioning: slight increases in anxiety elicit conditioned fear
Panic Disorder Integrated Model
Genetic vulnerability leads to vulnerability to dysreguulation of neurotransmitters involved in anxiety
- > lead to cognitive vulnerability: hyperattentive and misinterpretation of bodily sensations
- > anticipatory anxiety (panic disorder) and sometimes conditioned avoidance response (panic disorder + agoraphobia)
Biological Treatments for Panic Disorder
Trycyclic Antidepressants
SSRIs & SNRIs
Benzodiazepines
Tricyclic Antidepressants
Can reduce panic attacks and improve functioning of norepinephrine system & influence serotonin levels
-disadvantages: side effects and relapse upon discontinuation
SSRIs & SNRIs
- effective in anxiety relief
- better tolerated than tricyclic antidepressants
- side effects as well (not as severe as trcyclic)
Benzodiazepines
Suppress CNS by influencing GABA, norepinephrine, and serotonin
- effective at reducing panic attacks
- physically and psychologically addictive: withdrawal symptoms, can interfere with cognitive and motor functioning
Cognitive Behavioral Therapy & Panic Disorder
- Confrontation with situations and thoughts causing anxiety: changing and challenging thoughts to extinguish behaviors
- components:
1. teaching of relaxation and breathing techniques
2. clinician guides in identifying catastrophic cognitions
3. practicing relaxation & breathing techniques while experiencing panic symptoms
4. Therapist challenges catastrophizing thoughts and teaches to challenge them - > relief of panic attacks of 85-90% within 12 wweeks
- > better at preventing relapse
Social Anxiety Disorder DSM criteria
A. marked and persistent fear of one or more social or performance situations; exposed to unfamiliar people or possible scrutiny by others
B. exposure to feared social situation provokes anxiety
C. person recognizes that fear is excessive or unreasonable
D. feared social or performance situations are avoided
E. avoidance/anticipation or distress in situations interferes with normal routine/functioning
F. under 18: duration at least 6 months
G. not due to effects of substance or medication
H. Criterion A is unrelated to another present medical condition
Social Anxiety Disorder Characteristics
- fear of being judged or embarrassed in front of others
- causes disruptions in daily life
- onset as early as preschool
- > often related to bullying or high expectations of parents
Social Anxiety Disorder Symptoms
in social situations:
- trembling
- feelings of confusion and dizziness
- heart palpitations
- full panic attacks
- think others see nervousness and judge them negatively
Social Anxiety Disorder Prevalence
3-7% lifetime prevalence worldwide (US: 12%)
- more common in women
- tends to develop in early preschool or adolescence
- tends to be chronics once developing and if it remains untreated
Biological Theory of SAD
-smaller amygdala
Behavioral Treatments SAD
Exposure in absence of negative consequences to extinguish fear of object or situation
- > systematic desensitization
- Modelling
- flooding
Modeling
Method used in treatment of SAD
- therapist may model (perform) each behavior before asking client to perform it
- > association with calm response of therapist reduces anxiety
Flooding
Intense exposure to feared object until anxiety is extinguished
-> therapist prepares patient with relaxation techniques
Cognitive Behavioral Treatments of SAD
Combination of behavioral with cognitive techniques
- > helps patient identify and challenge negative, catastrophizing thoughts when they’re anxious
- good at preventing relapse
Biological Treatment of SAD
- e.g. Benzodiazepines
- temporary relief but phobia remains
- Antidepressants (monoamine oxidase inhibitors, SSRIs): effective but relapse prone
Generalized Anxiety Disorder DSM Criteria
A. excessive anxiety & worry more days than not for at least 6 months about a number of events or activities
B. person finds it difficult to control worry
C. anxiety & worry associated with 3 or more symptoms (only one required for children
D. focus of anxiety and worry not due to another disorder
E. anxiety causes clinically significant distress or impairment in functioning
F. disturbance not due to effects of substance or medication
Symptoms of generalized anxiety disorder
- Restlessness or feeling keyed up or on edge
- easily fatigued
- concentration problems
- irritability
- muscle tension
- Sleep disturbance
Cognitive Mediation Hypothesis for Panic Attacks
panic disorder patients have a stronger tendency to misinterpret certain bodily sensations
-> more likely to interpret them as signs of impending physical or mental disorder
Panic Disorder & Perceived Control
Interpretation believed to be most influential manipulation in inducing panic attacks as it facilitates expected affect and perceived control
Catastrophic Cognitions in Panic Disorder and Agoraphobia
Hypervigilance to bodily sensations and tendency to focus on autonomic arousal
- > misinterpretation of bodily sensations
- cognitive constructs play role in misinterpretation: information, perceived, control, safety
- attentional and memory bias in favor of physical threat cues
Memory Bias in SAD
People high in Social Anxiety rated negative words as more descriptive than positive words (people low in SAD vice versa)
- recalled significantly less positive words about public selves when anticipating giving a speech
- > bias occurs at retrieval rather than encoding
Social Performance Deficits in SAD
- people with SAD underestimate social performance primarily during speech and to lesser extent during conversation
- actual performance problems during conversation but not during speech
Interpretation and judgmental biases in social phobia
Negative interpretation of all social events irrespective of valence: ambiguous, positive, and negative events rated negatively by SAD patients
-> judgment bias
Clark & Wells cognitive model of SAD
- Social situations interpreted as threatening due to dysfunctional beliefs (high standards for social performance, conditioned beliefs about evaluation)
- Negative Evaluation expected because of dysfunctional beliefs
- > cognitive, somatic, affective, and behavioral responses
Rapee & Heimberg Model of SAD
SAD patients attach importance to receiving positive appraisal by others (assume others to be critical)
- > form prediction about standard of performance they believe others expect & compare it to own mental representations
- > negative evaluation anticipated if discrepancy is dected
- > results in behavioral, cognitive and physical symptoms
