Lecture 5 ± Anxiety Disorders ± Part 1
1. Overview of continuum of anxiety from normal to abnormal
Anxiety is experienced by all of us and all living organisms. For some it varies in
severity from mild to extreme severity. Varies in length of time, some times brief, for
others it is the entire day. Anxiety is a response to some kind of future distress or
danger. It is a mechanism for the person to prepare for a future distress or disaster.
Anxiety is an Autonomic response that protects the organism.
(1) Orientation or threat. Mental system is affected-cognitive orientation is wrong.
Person thinks there is a current or future strength
(2) Activation system. Physical symptoms: dizzy, sweat, chest pains or a sense of not
being able to get a good breath
(3) Change in the behavioral system: escape or avoidance behaviors. All natural
anxiety gets represented across these symptoms. They vary across symptoms and
across individuals depending on the situation.
Anxiety is about apprehension of an upcoming event. Immediate emotional reaction.
Activation of the autonomic nervous system and the Autonomic desire to escape
Fear is a more immediate reaction. Activating the same fight or flight system but it is
Î Agoraphobia: fear of being helpless. Crowds
Î Panic disorders with/without agoraphobia
Î Specific phobias: enclosed spaces
Î Social phobia: fear of embarrassment
Î Obsessive compulsive disorder
Î Posttraumatic stress disorder: anxiety response to a traumatic event
Î Acute stress disorder: first 3 mounts like PSD
Î Generalized anxiety disorder: prominently worried.
Panic attacks are fear occurring at inappropriate times. Fears are irrational.
2. Introduction to Panic Disorder
- A discrete period of intense fear or discomfort, in which 4 (or more) of the following
symptoms developed abruptly and reached a peak within 10 minutes:
o Pounding heart or palpitations
o Shortness of breath
o Feeling of choking
o Chest pain
o Feeling dizzy
o Depersonalition (being detached from oneself)
o Fear of going crazy
o Fear of dying
o Chills or hot flashed
- Something triggers the flight or fight attack response. Normal symptoms of the
autonomic system, but since they are frightened by it physiological changes. common
symptoms. Tend to be activated through interpersonal conflict situations (marital
familial. Death illness of significant other) before having a panic attack. about 30%
community surveyed actually had a panic attack in the past 12 months
(PDA) or without (PD) Agoraphobia
- Recurrent unexpected panic attacks
- Fear of future attacks. Person worries of a reoccurrence of these attacks
- Worry about the consequences of attacks
- Person changes behavior due to attack. Avoid social contacts
- Agoraphobia: avoidance of situations in which escape might be difficult.
- Minimum 4 weeks.
- Frequency 5 and a quarter percent.
Behavioral model of anxiety:
- Neutral event (going to a movie) has become associated with a traumatic event/media
information (news article about panic adults increases heart attack)/vicarious
experience (seen other family members). This elicits greater anxiety increase. They
avoidance and the feel better so anxiety decrease. But this gets reinforced and the
person will be more prone to avoid the situation.
- Panic apex anxiety (high point curve) want to leave which brings anxiety. After
activation of autonomic system, and a synthetic nervous system sends messenger to
kill the anxiety after 20 minutes, this is called the habituation curve. Solution talk
A. Defining panic attacks and panic disorder
B. Clinical aspects of panic
C. Videotape of patient with panic disorder
3. Cognitive Model of Panic
Extended cognitive model of panic
- Panic disorder is caused by the unfolding of a vicious cycle. Internal (rapid heart rate)
or external (going into a movie theatre where a previous attack occurred). Appraises
that there is something wrong (activates emotion of fear which activated the
autonomic system) person begins to focus on these sensations, intensification of
sensations, catastrophic misrepresentation and panic eventually avoidance and safety
- David Clark leading model of understanding what is happening in panic disorder.
Suicide estimate rate 20%.
Why does normal panic become panic disorder?
Because of catastrophic misinterpretations:
- Heart attack
- Nervous collapse
- Going crazy