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Lecture 5

Week 5.doc

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University of Guelph
PSYC 3390
Mary Manson

Week 5 - Chapter 6- Panic and Anxiety • Neurotic behaviour is maladaptive and self-defeating, but these people are not out of touch with reality, incoherent, or dangerous • To Freud, neuroses were psychological disorders that resulted when intrapsychic conflict produced significant anxiety The Fear and Anxiety Response Patterns • Fear or panic is a basic emotion that involves activation of the fight-or-flight response of the sympathetic nervous system (instantaneous) o Allows us to escape from imminent danger o When this occurs in absence of external danger, it is said the person has had a panic attack  Panic attacks also accompanied by subjective sense of impending doom (fears of dying, going crazy, losing control) • Fear and panic have 3 components: o Cognitive/subjective (i.e. I am going to die) o Physiological (increased heart rate) o Behavioural (urge to escape) • Anxiety is a complex blend of unpleasant emotions and cognitions that is more oriented to the future and much more diffuse than fear o Has similar cognitive/subjective, behavioural, and physiological components to fear  Cognitive level- anxiety includes negative mood, worry about later threat of danger, self-preoccupation, sense of being unable to predict future threat or to control it if it occurs  Physiological level- anxiety creates tension and chronic overarousal  Behavioural- anxiety might create strong tendency to avoid situations where danger might be encountered • Adaptive component to anxiety is that it might help us prepare for future threat or danger; can also enhance learning and performance in mild or moderate degrees • Fear and anxiety responses are conditionable (if a certain thing that does not provoke anxiety is constantly paired with something that DOES, eventually the non-anxiety provoking item will start provoking anxiety by itself) Anxiety Disorders and their Commonalities • 7 types of primary anxiety disorders: o Specific phobias o Social phobias o Panic disorder with agoraphobia o Panic disorder without agoraphobia o Generalized anxiety disorder o Posttraumatic stress disorder o Obsessive compulsive disorder • Many people with one anxiety disorder will experience at least one more anxiety disorder and/or depression either concurrently or at another point in their lives • Modest genetic contributions to each of these disorders o Common genetic vulnerability manifested at psychological level by personality trait “neuroticism” (a proneness to experience negative mood states) • Brain structures involved in the limbic system (emotional brain) • Neurotransmitter substances most involved are GABA, norepinephrine, serotonin • People who have perceptions of a lack of control of their environment seem more vulnerable to developing anxiety disorders— development of perceptions of uncontrollability depends on social environment people are raised in o Sociocultural environment affects the things people become afraid or anxious about • For each disorder, graduated exposure to feared cues, objects, and situations until fear/anxiety begins to decrease is the most therapeutic ingredient • Restructuring can be helpful (cognitively change the way the subject sees or thinks about a situation) • Medications can be helpful for all except phobias o 2 categories of medications:  Benzodiazepines (anti-anxiety drugs)  Antidepressants o However, graduated exposure and restructuring are better than medications because there is less of a relapse when discontinued • A phobia is a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger but still leads to a lot of avoidance of these feared situations o 3 main categories of phobias: specific, social, agoraphobia Specific Phobias • A person is diagnosed with a specific phobia if he or she shows strong and persistent fear that is excessive or unreasonable and is triggered by the presence of the situation or object o Immediate fear response when exposed to phobia that sometimes resembles a panic attack • Criteria for specific phobia: o Marked or persistent fear that is excessive or unreasonable, cued by presence or anticipation of specific object or situation o Exposure to phobic stimulus almost invariably provokes an immediate anxiety response or panic attack o Person recognizes that the fear is excessive or unreasonable o Phobic situation avoided or endured with intense anxiety or distress o Symptoms interfere significantly with normal functioning, or there is marked distress about the phobia o Duration of at least 6 months • Blood-injection-injury phobia sufferers experience as much or more disgust as fear o If exposed to blood or injury, this person’s heart rate shows an initial acceleration, followed by a dramatic drop in heart rate and blood pressure o Accompanied by nausea or dizziness/fainting o From an evolutionary standpoint, this unique physiological response pattern may have evolved for a purpose: by fainting, the person being attacked may inhibit further attack, and if an attack did occur, the drop in blood pressure would minimize blood loss o This phobia generally begins in childhood • Specific phobias most common in women • Animal phobias begin in childhood • Claustrophobia begins in adulthood • Psychodynamic view of phobias states that they represent a defense against anxiety that stems from repressed impulses from the id o Since it’s too dangerous to “know” the repressed id impulse, the anxiety is displaced onto some external object or situation that has some symbolic relationship to the real object of anxiety o This view was heavily criticized because it’s too speculative—learning theory is a better way to explain them (fearing something because of what you were exposed to prior) • Classical conditioning appears to account for the acquisition of irrational fears and phobias • Watching someone in distress with his or her own feared object can cause YOU distress and learn to also fear the item • Differences in life experiences among individuals strongly affect whether or not conditioned fears or phobias actually develop • Events occurring during a conditioning experience are also important in determining the level of fear that is conditioned • Experiences a person has after a conditioning experience may affect the strength and maintenance of the conditioned fear o Inflation effect suggests that a person who acquired something minor that scares them can escalate and “inflate” to a huge phobia if something major happens later • Cognitive bias suggests that people can be rid of phobic fears over the passage of time • Our evolutionary history has affected which stimuli we are most likely to fear o Things like guns and motorcycles weren’t around in our early evolutionary history and so we don’t fear them o To our early ancestors, things like snakes and heights proposed more fear because these are natural things in our environment we’ve always been exposed to (and our early primate ancestors) o This is known as the “preparedness” theory of phobias • Genetic and temperamental variables affect the speed and strength of conditioning of fear • Toddlers before age 2 who were more shy were more likely to develop phobias • Identical twins more likely to share the same specific phobia than nonidentical twins (suggesting that there is a genetic role in phobias) • Exposure therapy is the best treatment for specific phobiasinvolvs controlled exposure to the stimuli or situations that elicit phobic fear o Participant modeling involves a therapist calmly modeling ways of interacting with the phobic stimulus or situation o Virtual reality environments also starting to be used by therapists to stimulate certain kinds of phobic situations, such as heights and airplanes, as places to conduct exposure treatment o Medical treatments are not effective by themselves; neither are cognitive treatments alone. Both of these require exposure o D-cycloserine is known to facilitate extinction of conditioned fear of animals and may also enhance the effectiveness of small amounts of exposure therapy for fear of heights in a virtual reality environment Social Phobia • Social phobia (or social anxiety disorder) is characterized by disabling fears of one or more specific social situations (i.e. public speaking) o Person fears they might be exposed to scrutiny and potential negative evaluation of others o Fear of public speaking is most common type • Generalized social phobia sufferers have significant fears of most social situations and often have a diagnosis of avoidant personality disorder • Social phobia more common in women than in men • Begin later in life rather than in childhood • Social phobias often seem to originate from simple instances of direct or vicarious classical conditioning (such as experiencing or witnessing a perceived social defeat or humiliation, or witnessing the target of anger or criticism) • Social fears and phobias by definition involve fears of members of one’s own species • Ohman and colleagues proposed that social fears and phobias evolved as a by-product of dominance hierarchies that are a common social arrangement among animals such as primates o Dominance hierarchies are established through aggressive encounters between members of a social group, and a defeated individual typically displays fear/submissive behaviour, but rarely attempts to escape the situation completely  So it is not surprising that people with these phobias just endure them rather than run away, like people with animal phobias often do o Humans have an evolutionary based predisposition to acquire fears of social stimuli that signal dominance and aggression from other humans  Social stimuli include facial expressions of anger or contempt, which all humans seem to process more quickly and readily than happy or neutral facial expressions • Genetics and environment contribute equally to development of social anxiety traits • Most important temperamental variable is behavioural inhibition o Behaviourally inhibited infants who are easily distressed by unfamiliar stimuli and who are shy and avoidant are more likely to become fearful during childhood and at risk of developing social phobia through adolescence • Perceptions of uncontrollability and unpredictability often lead to submissive and unassertive behaviour, which is characteristic of socially anxious or phobic people • People with social phobia have diminished sense of personal control over events in their lives (could be from having overprotective parents sometimes) • People with social phobia tend to expect that other people will reject or negatively evaluate them o Leads to sense of vulnerability when around people who might pose threat o Makes people preoccupied with themselves in social situations and assume they are being awkward that they actually behave awkwardly because they are nervous • Best way to treat social phobias is with gradual repeated exposure to social situations o Cognitive techniques have been added to behavioural techniques therapist attempts to help clients identify their underlying negative automatic thoughts (“I have nothing interesting to say”)  After helping clients understand that these automatic thoughts often involve cognitive distortions, therapist helps clients change these inner thoughts and beliefs through logical reanalysis (i.e. asking oneself questions to challenge automatic thoughts “do I know I actually have nothing to say?”)  Client may receive videotaped feedback to help modify distorted self-images o Social phobias sometimes treated with medicationsmost common being antidepressants Panic Disorder with and without Agoraphobia • Panic disorder is defined and characterized by the occurrence of “unexpected” panic attacks that have often seemed to “come out of the blue” o Subject must have recurrent and unexpected panic attacks for at least a month, always be concerned about having another o
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