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Anxiety Disorders.docx

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Mark Coates

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Chapter ­ Anxiety Disorders Anxiety, fear, and panic • Anxiety – feeling threatened by a hypothetical situation or future event • Fear – feeling threatened by a real or perceived threat • Panic – extreme fear that is unprovoked (a false alarm) • All three engage the flight-or-flight response to a greater or lesser degree – Sympathetic nervous system • Most common disorder we have • *need to be able to distinguish between the 3 terms* • Anxiety – i want to go for a walk in the woods but their might be a bear – “What if?” • Fear – is actually something there you perceive to be dangerous – Actually seeing a bear • Panic – im walking downtown and suddenly im really scared but theres no reason to be scared – Comes out of nowhere – Same type of feeling as if you were being chased by a bear when there is no bear at all Anxiety disorders • Anxiety disorders are the most common of all mental disorders (11-25% lifetime prevalence) • In psychology private practice, you could make a living working with nothing but anxiety disorders • Most patients first experience symptoms as teenagers or early in adulthood, although earlier onset is also common • Prevalence numbers are based on who reports them, who seeks them out and who is actually able to recognize they have one • Very common to have anxiety disorders among children Etiology • There seems to be a non-specific genetic component to anxiety – Anxious people tend to have anxious children, although they are not necessarily afraid of the same things • Subcortical brain areas (amygdala, hippocampus, hypothalamus) involved in fear can become dysregulated by long-term anxiety or fear – Hypercortisolism can lead to larger amygdala, smaller hippocampus, and alter hormone release by the hypothalamus (can be changed) • If your parents have one of the anxiety disorder it is likely you will have some form of anxiety disorder, not necessarily the same one • Huge effect of modeling – How you respond to stress is learned – Also a genetic comepent too but not specific to a certain anxiety disorder • Hypothalamus – controls release of stress hormones • Amygdala- controls fear • Hippocampus – memory, why we remember fearful events better • Two-factor psychological theory: • Classical conditioning causes initial anxiety, operant conditioning maintains it – Being bitten by a snake would cause a learned association between snakes and pain (Classical Conditioning) – Avoiding places where snakes live keeps the patient from learning that snakes are rarely dangerous, and not seeing a snake reinforces the avoidance (Operant Conditioning) • Negative reinforcement: walking along and see a snake, have fear and panic, walking away removes the feelings, reinforces avoidance • Behaviroural view • Cognitive theories emphasize maladaptive beliefs or schemas, our general ways of approaching and understanding the world – The world is a dangerous place – I am vulnerable – I need to be perfect or I will get hurt – If people laugh at me, it is the end of the world • If you tend to see the world in this way you are more likely to develop an anxiety disorders Panic and agoraphobia • A panic attack is not a diagnosable mental illness • 21% of people will have a panic attack at some point in their lives • Panic attacks can be: – Uncued – Situationally bound – Situationally predisposed • You diagnose them with panic disorder – history of repeated, uncontrolled panic attacks • Having a panic attack once a year isnt panic disorder • Presence of the symptoms does not mean they have the disorder- true of all the anxiety disorders • Causes so much stress its really bothering you/ affecting your life • Uncued: out of no where • Situationally bound: only happens in a certain stimulas ex: when seeing a snake • Situationally predisposed: most of the time when i have a panic attack its from a certain situations ex: when driving or before going on stage Symptoms of a panic attack • Increased heart rate • Sweating • Trembling or shaking • Shortness of breath or smothering • Feeling of choking • Chest pain or discomfort • Nausea • Feeling dizzy, lightheaded, or faint • Derealization or depersonalization • Fear of losing control or going crazy • Numbness or tingling sensations • Chills or hot flashes • Very easy to similate these symptoms • Sometimes purposely create a panic attack (like example in class) to treat panic attacks to show that you can create them yourself and show that its uncomforable but it doesnt hurt/ kill you • Helps you manage your panic attacks • Reduces number of panic attacks • Derealization/ depersonalization: im not real anymore, im watching this happen to me • Only have to have 5 of these to have a panic attack Panic Disorder • A. Both (1) and (2): • (1) recurrent unexpected Panic Attacks • (2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following: – (a) persistent concern about having additional attacks – (b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") – (c) a significant change in behavior related to the attacks • Concerned its going to happen again • Worry about what happens if i have a panic attack? • Did you change your behaviour to avoid panic attacks? – Avoiding certain parts of town – Dont go out of the house • Have to have the panic attacks and have to have a fear surrounding the panic attacks • A patient can be diagnosed with Panic Disorder with or without Agoraphobia • Agoraphobia refers to anxiety about being in places where escape might be difficult in the event of having a panic attack; those situations are avoided • Panic disorder must be differentiated from specific phobias, social phobia, and generalized anxiety disorder (all of which can have panic attacks as symptoms) • The lifetime prevalence of Panic disorder is about 1.5% • Agoraphobia: generally fear of leaving the house – Fear of being in the car, plane, bridges, crowded places, etc • Possible to have agoraphobia without panic disorder: – Rare – Only had a panic attack once or twice but are so scared of having it again and being trapped • If you only have panic attacks when you see a snake, you dont have panic disorder, thats a specific phobia with panic attacks as symptoms • Need to ask in wha
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