Chapter6

Chapter6 - Chapter 6 Chapter 6 Panic, Anxiety, &...

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Unformatted text preview: Chapter 6 Chapter 6 Panic, Anxiety, & Their Disorders I 0. Fear and Anxiety 1. Phobias Panic, Anxiety, & Their Disorders 2. General category for seven primary anxiety disorders 3. Over 1/3 of US population 4. Over 42 billion dollars in health care costs (30% of national health care) The Fear and Anxiety Response Patterns 5. Prior to 1980, disorders called neuroses 6. To Freud, neuroses were psychological disorders that resulted when intrapsychic conflict produced significant anxiety 7. Maladaptive and self­defeating 8. Defense mechanisms The Fear and Anxiety Response Patterns 9. Fear or panic is a basic emotion that involves activation of the “fight­or­flight” response in the sympathetic nervous system 10.Fear – clear source of danger 0. In absence of danger – panic attack 11.Adaptive value ­ escape The Fear and Anxiety Response Patterns The Fear and Anxiety Response Patterns 12.Anxiety is a general feeling of apprehension about possible danger 1. Anxiety is more oriented to the future and more diffuse than fear 2. It has cognitive/subjective, physiological, and behavioral components 3. Fear and anxiety ­ learned The Anxiety Disorders and Their Commonalities 13.Anxiety disorders have unrealistic, irrational fears or anxieties of disabling intensity as their most obvious manifestation 4. Person can experience more than one The Anxiety Disorders and Their Commonalities 14.The DSM­IV­TR recognizes seven primary types of anxiety disorders 5. Post traumatic stress disorders (ch 5) 6. Specific phobias (I) 7. Social phobias (I) 8. Panic disorder with agoraphobia (II) 9. Panic disorder without agoraphobia (II) 10. Generalized anxiety disorder (II) 11. Obsessive compulsive disorder (II) The Anxiety Disorders and Their The Anxiety Disorders and Their Commonalities 15.There are some important similarities across the anxiety disorders: 12. The basic biological causes of these disorders – genetic vulnerability 0. Neurotransmitter imbalance 13. The basic psychological causes of these disorders – classical conditioning 1. Self­perception of lack of control 14. The effective treatments for these disorders – gradual exposure, cognitive restructuring Phobic Disorders: Description 16.A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger 17.Criteria: 15. 16. 17. 18. Marked and persistent fear Exposure produces anxious response Recognition that fear is excessive Symptoms interfere with functioning Phobic Disorders: Description 18.Upon exposure to stimulus– immediate fear 18. response 19. When encounter stimulus – experience fear like panic attack 20. Situation is irrational 21. Avoidance is reinforced 19.The DSM­IV­TR lists three main categories of phobias: 22. Specific phobia; Social phobia; Agoraphobia Common Specific Phobias Specific Phobias: Prevalence and Age of Onset 20.E.g. Blood­injection­injury phobia occurs in about 3–4% of the population 23. Sight of blood – heart rate & pressure drop 21.16% of women & 7% of men suffer from some form of specific phobia in their life 22.The age of onset for different phobias varies widely 24. Animal phobias – childhood 25. Claustrophobia ­ adulthood Specific Phobias: Causes 23.A range of factors have been implicated in the origins of specific phobias, from deep­seated psychodynamic conflicts to relatively psychodynamic conflicts to relatively straightforward traumatic conditioning of fear 24.E.g. psychodynamic – defense against anxiety coming from id impulses – anxiety is displaced Specific Phobias: Causes 25.Phobias as learned behavior 26.Classical conditioning of fear responses to neutral stimuli – with generalization 26. Vicarious conditioning ­ indirect 27. Sources of individual differences 2. Previous life experiences (protect; vulnerable) 3. Cognitive processes (attention, expectations) 28. Evolutionary preparedness – fears of snakes, the dark, water, germs 4. (example of cows and cattle bars) Specific Phobias: Causes 27.Genetic and temperamental factors are known to affect the speed and strength of conditioning of fear 29. Behaviorally inhibited kids more likely to develop phobias 30. Identical twins both develop phobias Specific Phobias: Treatment 28.Exposure therapy is the most commonly used treatment for specific phobias 31. Systematic desensitization 31. 29.Other therapies include 32. Participant modeling 33. Virtual reality therapies 34. Combining cognitive techniques with exposure­ based therapies 35. E.g. I'm sailing (What about Bob?) Social Phobia: Characteristics 30.Social phobia involves disabling fears of one or more discrete social situations in which a person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others Social Phobia: Causes 31.Social phobias generally involve learned behaviors shaped by evolutionary factors 36. Learning from parents and others 37. Evolution: Social dominance hierarchies 32.Such learning is most likely to occur in people who are genetically or temperamentally at risk 38. E.g. behaviorally inhibited infants Social Phobia: Causes 33.Perceptions of uncontrollability and unpredictability play a role 39. Can lead to submissiveness & unassertiveness 34.Cognitive variables are important 40. Expectations of negative evaluation 41. Self­preoccupation Social Phobia: Treatment Social Phobia: Treatment 35.Treatments for social phobias include 42. Behavior therapy ­ exposure 43. Cognitive­behavioral therapy 5. Identify negative thoughts, cognitive distraction, logical reanalysis 44. Medications – SSRI’s, MAO inhibitors 6. Problems of relapse and side­effects 7. bandaids Panic, Anxiety & Their Disorders II 36.Panic 37.Generalized anxiety 38.Obsessive­compulsive Panic Disorder: Characteristics 39.Panic disorder is characterized by the occurrence of “unexpected” panic attacks that often seem to come “out of the blue” 40.May occur with or without agoraphobia Panic Disorder: Characteristics 41.Pounding heart, sweating, 42.Trembling, choking, nausea, shortness of breath, 42. fear of dying 43.Choking, chest pain, dizziness 44.De­realization, fear of loss of control 45.Numbness, chills 46.Persistent concern about another attack 47.Concern about consequences Panic Disorder: Characteristics 48.The two features of panic attacks that distinguish them from other types of anxiety are: 0. Their characteristic brevity 1. Their intensity 8. Unexpected and uncued 9. Peak within 10 minutes 10. Subside within 30 minutes Panic Disorder: Agoraphobia 49.Many people with panic disorder also develop an agoraphobic fear of situations in which they might have an attack (where physical escape difficult) 50.Criteria for agoraphobia 45. With panic 46. Without panic (rare – due to other physical problems – e.g. epilepsy) Panic Disorder: Prevalence and Age of Panic Disorder: Prevalence and Age of Onset 51.3.5 percent of the adult population have had panic disorder at some time in their lives – usual age of onset 15­24 52.It’s twice as prevalent in women as men – often more severe in women 53.50 percent of people with panic disorder have additional diagnoses – generalized anxiety, social phobia, PTSD, depression Panic Disorder: First Attack 54.Timing of first attack 47. Usually in conjunction with distress or stressful life situation – loss of job, relationship 48. Many folks experience a panic attack without developing panic disorder Panic Disorder: Biological Causal Factors 55.Panic disorder has a moderate heritable component – approx. 1/3 of variance 56.There is a broad range of biochemical panic provocation agents – neurotransmitters involved: norepinephrine; serotonin, GABA 57.There are also several areas of the brain implicated in panic attacks Panic Disorder: Biological Causal Factors Panic Disorder: Psychosocial Causal Panic Disorder: Psychosocial Causal Factors 58.Behavioral and cognitive causal factors include 49. The “fear of fear” model 50. The comprehensive learning theory of panic disorder – process of interoceptive conditioning – bodily sensations become conditioned stimuli 11. Overinterpretation (catastrophizing) of bodily sensations Panic Disorder: The Cognitive Theory of Panic Panic Disorder: Psychosocial Causal Factors 59.Additional cognitive factors 51. Perceived control and anxiety sensitivity – loss of control and high sensitivity – belief that bodily symptoms have harmful results 52. Safety behaviors and the persistence of panic – behaviors that will protect them 53. Cognitive biases and the maintenance of panic – more likely to interpret ambiguous feelings as threatening Panic Disorder: Biological Treatment 60.Medications 54. Minor tranquilizers – e.g. xanax (act quickly) 12. Side effects: drowsiness, addictive 55. Antidepressants – SSRI’s 55. 13. Not addictive, two weeks to effect, side effects Panic Disorder: Psychosocial Treatment 61.Behavioral and cognitive­behavioral treatments 56. Exposure: prolonged exposure to object 14. Also exposure to internal sensations 57. Integrative 15. Taught nature of anxiety 16. Taught controlled breathing 17. Taught to identify automatic thoughts 18. Taught to practice producing sensations via exercise Generalized Anxiety Disorder: Characteristics 62.Generalized anxiety disorder (GAD) is characterized by chronic or excessive worry about a number of events and activities – anxious apprehension 63.General characteristics 58. Restlessness, fatigue, concentration difficulties, irritability, muscle tension, sleep disturbances 59. Worry more days than not for 6 months Generalized Anxiety Disorder: Characteristics 64.Note: many of us worry about what decisions to make and about decisions after they are made ­ however, usually does not seriously interfere with functioning 65.Generalized anxiety disorder is a state of anxious 65. apprehension that is out of control and interferes with functioning Generalized Anxiety Disorder: Prevalence 66.Each year 3% of the population experiences GAD – 6% lifetime 60. (likely many more – many don’t seek help) 67.It is twice as common in women as in men 68.It often co­occurs with other AXIS I disorders – other anxiety and mood disorders Generalized Anxiety Disorder: Psychosocial Causal Factors 69.According to the psychoanalytic viewpoint, the disorder results from conflict between the id and the ego (inadequate defense mechanisms) 70.It may occur in people who have had extensive experience with uncontrollable and unpredictable events (esp. as children) – hyper­vigilance Generalized Anxiety Disorder: Psychosocial Causal Factors 71.Worry plays a central role and is an effort to create a sense of mastery that may immunize against anxiety. 72.Unfortunately, worry has negative consequences: 72. not enjoyable, intrusive, increased sense of vulnerability 73.Worry is associated with an automatic attentional bias toward threatening information in the environment Generalized Anxiety Disorder: Psychosocial Causal Factors 74.Conversely, there are some possible benefits of worry: 61. 62. 63. 64. 65. Potential avoidance of problem Actual avoidance of problem Avoidance of deeper emotional distress (distraction) Coping and preparation Motivational device Generalized Anxiety Disorder: Biological Causal Factors 0. It is modestly heritable (problem of definition?) 0. Strong correlation with depression 1. The neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a role in anxiety 2. CRH (corticotrophic releasing hormone) also plays a role ­ release of adrenaline 3. Neurobiological factors implicated in panic disorders and GAD are not the same 1. With panic: norepinephrine and serotonin Generalized Anxiety Disorder: Treatment 75.Drugs such as Valium are often misused 75. 66. Provide tension relief; calm 'nerves' 76.Buspirone (buspar) seems effective and nonaddictive ­ very slow acting 77.Cognitive­behavioral therapy has become increasingly effective 67. Relaxation, cognitive restructuring, changing perceptions Obsessive­Compulsive Disorder: Characteristics 4. Defined by the occurrence of unwanted and intrusive obsessive thoughts or distressing images 5. These are usually accompanied by compulsive behaviors performed to 0. Neutralize the obsessive thoughts or images 1. Prevent some dreaded event or situation Obsessive­Compulsive Disorder: Characteristics 78.Obsessions – persistent and recurrent intrusive images and thoughts – disturbing and inappropriate 79.Compulsions – overt repetitious behaviors and covert mental acts (counting) 68. Person with OCD feels driven to perform compulsive and repetitive behaviors 69. Is aware that they are irrational 70. Youtube: As OCD as it gets (As Good as it Gets) 70. Obsessive­Compulsive Disorder: Characteristics 6. Obsessions consist most often of 2. 3. 4. 5. Contamination fears Fears of harming oneself or others Lack of symmetry Pathological doubt 7. Compulsions include 6. Cleaning 7. Checking 8. Repeating 9. Ordering/arranging 10. Counting Obsessive­Compulsive Disorder: Prevalence 80.OCD’s one­year prevalence is 1.6% 81.OCD’s lifetime prevalence is 2.5% 82.OCD affects both genders equally Obsessive­Compulsive Disorder: Age of Onset 83.Begins in adolescence to early adulthood 84.Although not uncommon in children 85.Co­occurs with depression, social phobia, panic disorders, GAD Obsessive­Compulsive Disorder: Obsessive­Compulsive Disorder: Psychosocial Causal Factors 86.According to Freud, a person with OCD has been unable to cope with conflicts of the Oedipal stage 71. Conflict of love of parent and fear of results 87.Mowrer developed the two­process theory of avoidance learning 72. Classical conditioning to create anxiety 73. Operant conditioning to reduce anxiety Obsessive­Compulsive Disorder: Psychosocial Causal Factors 88.Obsessions with contamination and dirt appear to have evolutionary roots 74. Grooming rituals, germs, etc. 89.Attempting to suppress unwanted thoughts may increase those thoughts 75. Development of association between negative mood and efforts to suppress Obsessive­Compulsive Disorder: Psychosocial Causal Factors 90.People with OCD seem to think bad thoughts are equivalent to bad deeds 76. Overinflated sense of responsibility 77. Thought­action fusion 91.Research on people with OCD has shown that 91. their attention is drawn to disturbing material relevant to their obsessive concerns 78. Also a lack of confidence in memory Obsessive­Compulsive Disorder: Biological Causal Factors 92.OCD appears moderately heritable 93.Abnormalities in brain function may include 79. Slight structural abnormalities in the caudate nucleus (involving limbic system) 80. high metabolic levels in other parts of the brain (frontal cortex) 94.Serotonin is strongly implicated in OCD Obsessive­Compulsive Disorder: Treatment 95.SSRI’s used most often in treatment 81. Problems of relapse 96.A behavioral treatment involving a combination of exposure and (compulsive) response prevention may be the most effective approach to obsessive­ compulsive disorder 82. Expose to stimuli and prevent response General Sociocultural Causal Factors For All Anxiety Disorders 97.Cultural differences in sources of worry include 97. 83. Yoruba fears of witchcraft (possession) 84. Taijin Kyofusho– a Japanese disorder similar to social phobia (fear of doing something that may offend or embarrass another) 85. Demonstrates role of culture and cognition Unresolved Issues 98.Interdisciplinary research on anxiety disorders End of Chapter 6 ...
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