Week 6: PD

Question 1

What % of PD cases have a lifetime comorbid mental diagnosis, and which ones are most common (3)

Answer 1

80%

o Any other anxiety or related disorder
o MDD
o Mild alcohol use disorder

Question 2

What physical conditions are comorbid with PD?

Answer 2

Cardiac arrhythmias, hyperthyroidism, asthma, COPD and irritable bowl syndrome

IMPORTANT TO CHECK PRIOR TO BEGINNING EXPOSURE TREATMENTS!

Question 3

Risk factors for developing PD?

Answer 3

Temperament
-Negative affectivity (neuroticism),
-anxiety sensitivity,
-behavioural inhibition and harm avoidance

Environmental
-Identifiable stressors in months before their first panic attack
-drug use as well

Genetic and Physiological
-Increased risk for panic disorder among offspring of parents with anxiety, depressive, and bipolar disorders

Question 4

3 aspects of panic appraisals in PD

Answer 4

o Catastrophic consequences of panic

o Likelihood of panic in agoraphobic situation

o Perceived self-efficacy in coping with panic

Question 5

Define Anxiety Sensitivity

How does it relate to PD?

Answer 5

Refers to the disposition to believe that symptoms of anxiety are harmful

Individuals with elevated levels of anxiety sensitivity mostly respond with fear to psycho-physiological arousal because they fear possible harmful consequences.

Question 6

What are the steps to Clark’s 1986 cognitive model? (5)

Answer 6

o 1. Trigger (internal or external)
o 2. Perceived threat
o 3. Apprehension
o 4. Body sensations
o 5. Interpretation of Sensations as Catastrophic (then loop back to #2)

Question 7

Evidence Based Treatments for PD (5)

Answer 7

Psycho-education
CBT: Exposure -> Interoceptive exposure
Cognitive Therapy
Medication => SSRI’s
Relaxation/Breathing Technique

Question 8

How to begin analysis for exposure intervention in a PD patient? (3)

How do you explain the rationale?

Answer 8

What was the first thing you noticed?
 Heart racing, sweating

What do you think is happening?
 I am dying/going crazy

What do you do when this happens?
 Hide

Explain that we can’t stop the triggers, but we can intervene on the thoughts and behaviours

Question 9

Is expectancy violation key to treating PD?

Answer 9

Expectancy Violation?
-Newer study: More related to learning
-Self-efficacy instead of expectancy violation

So: Yes, but self-efficacy may prove to be a superior construct

Question 10

What can you try if CBT is not working for a PD client?

Answer 10

EMDR

*Results:
o 2/3rds responded! :D
*Conclusion:
o First indication, that EMDR as a second step intervention has potentially an additional value in panic disorder (and) agoraphobia.
o Seems to be related to worst case future mental imagery.
o First indications that first targeting expectancies via exposure and afterwards targeting the worst case future mental imagery via EMDR seems to generate an additional value.

Question 11

What happens if you combine imipramine with CBT when treating PD?

Answer 11

By the end of maintenance, CBT + imipramine was superior to both CBT alone and CBT + placebo. However, this robust combination treatment produced the highest relapse rate ate follow-up assessment.

Addition of imipramine appeared to reduce the long-term effects of CBT