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Lecture 5

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Psychology 2030A/B
David Vollick

Abnormal  Psychology  Chapter  5   Anxiety  Disorders  (pp.121-­‐173)     Anxiety  and  Fear  (pp.126-­‐127)   • Anxiety   o Future-­‐oriented  mood  state  with  marked  negative  affect  (emotion)   and  somatic  (body)  tension   o Apprehension  about  future  danger  or  misfortune   • Fear   o Present-­‐oriented  mood  state  with  marked  negative  affect   o Immediate  fight  or  flight  emotional  response  to  danger  or  threat   o Strong  avoidance/escapist  tendencies   o Abrupt  activation  of  the  sympathetic  nervous  system   • Anxiety  and  fear  are  normal  emotional  states     From  Normal  to  Disordered  Anxiety  and  Fear  (pp.126-­‐127)   •  Characteristics  of  Anxiety  Disorders   o Pervasive  and  persistent  symptoms  of  anxiety  and  fear   o Excessive  avoidance  and  escapist  tendencies   o Symptoms  and  avoidance  cause  clinically  significant  distress  and   impairment     DSM-­‐IV-­‐TR   • Table  5.1     The  Phenomenology  of  Panic  Attacks  (pp.127-­‐128)   • What  is  a  panic  attack?   o Abrupt  experience  of  intense  fear  or  discomfort   o Accompanied  by  several  physical  symptoms  (eg.,  breathlessness,   chest  pain)   • DSM-­‐IV  subtypes  of  Panic  Attacks   o Situationally  bound  (cued)  panic  –  expected  and  bound  to  some   situations   o Unexpected  (uncued)  panic  –  unexpected  “out  of  the  blue”  without   warning   o Situationally  predisposed  panic  –  may  or  may  not  occur  in  some   situations     Biological  Contributions  to  Anxiety  and  Panic  (pp.128-­‐129)   • Diathesis-­‐Stress   o Inherit  vulnerabilities  for  anxiety  and  panic,  not  for  anxiety  disorders   o Stress  and  life  circumstances  activate  the  vulnerability   • Biology  and  Inherent  Vulnerabilities   o Anxiety  and  brain  circuits  –  GABA,  noradenergetic,  and  serotonergic   systems   o Corticotrophin  releasing  factor  (CRF)  and  the  hypothalamic-­‐pituitary-­‐ adrenocortical  (HYPAC)  axis   o Limbic  (amygdala)  and  septal-­‐hippocampal  systems   o Behavioural  inhibition  (BIS)  and  fight/flight  (FF)  systems   o Circuits  are  shaped  by  environment     Psychological  Contributions  (pp.129-­‐130)   • Began  with  Freud   o Anxiety  involves  reactivation  of  an  infantile  fear  situation   • Behaviouristic  Views   o Anxiety  and  fear  result  from  direct  classical  and  operant  conditioning   and  modeling   • Other  psychological  Views   o Early  experiences  with  uncontrollability,  unpredictability,  and   dangerousness   o Stressful  life  events  as  triggers  of  biological/psychological   vulnerabilities  –  eg.,  exercise  producing  similar  physical  sensations  =   an  internal  cue     Toward  an  Integrated  Model  (pp.130)   • Integrative  View   o Biological  vulnerability  interacts  with  psychological  experiential,  and   social  variables  to  produce  an  anxiety  disorder   o Consistent  with  diathesis-­‐stress  model   • Common  Processes:  The  Problem  of  Co-­‐morbidity   o About  half  of  anxiety  patients  have  two  or  more  secondary  diagnoses   o Major  depression  is  the  most  common  secondary  diagnosis   o Co-­‐morbidity  suggest  common  factors  across  anxiety  disorders   o Suggests  a  relation  between  anxiety  and  depression     DSM-­‐IV-­‐TR   • Table  5.3     Panic  Disorder  with  and  Without  Agoraphobia  (pp.130-­‐138)   • Features  Overview  and  Defining   o Experience  of  unexpected  panic  attack   o Develop  anxiety  about  having  another  attack  or  its  implications   o Agoraphobia  –  fear  or  avoidance  of  situations/events  associated  with   panic   o Symptoms  and  concern  about  another  attack  persists  for  1  month  or   more   • Facts  and  Statistics   o 3.5%  f  the  population  meet  diagnostic  criteria  for  panic  disorder   o 75%  or  more  with  panic  disorder  are  female   o Onset  is  often  acute,  beginning  between  25  and  29   • Causes   o Genetic  neurobiological  vulnerability  to  stress   o Expect  worse  from  physical  symptoms    Interoceptive  avoidance  can  lead  to  catastrophic   misinterpretation  of  symptoms   o Parents  modeling   o Genetic  basis   • Associated  Features   o Nocturnal  panic  attacks  –  60%  experience  panic  during  deep  non-­‐ REM  sleep  =  not  a  dream     Treatment  (pp.138-­‐141)   • Medication  Treatment  of  Panic  Disorder   o Target  serotonergic,  noradrenergic,  and  benzodiazepine  GABA   systems   o SSRI’s  (eg.,  Prozac  and  Paxil)  –  preferred  drugs   o Relapse  rates  are  high  following  medication  discontinuation   • Psychological  and  Combined  Treatments  of  Panic  Disorder   o Panic  control  treatments  are  highly  effective   o Combined  treatments  do  well  in  the  short  term   o Best  long  term  outcome  is  with  cognitive  behavioural  therapy  alone     *Exposing  patients  to  interceptive  sensations  that  imitate  panic  disorder  symptoms   so  they  can  deal  with  them  and  not  have  any  problems*     DSM-­‐IV-­‐TR   • Table  5.2     Generalized  Anxiety  Disorder:  The  “Basic”  Anxiety  Disorder  (pp.141-­‐143)   • Overview  and  Defining  Features   o Excessive  uncomfortable  anxious  apprehension  and  worry  about  life   events,  problems  sleeping,  inattentive   o Coupled  with  strong,  persistent  anxiety   o GADs  experience  muscle  tension,  fatigue,  irritability;  are  autonomic   restrictors  (fail  to  process  emotional  part  of  thoughts  and  images)  vs.   autonomic  arousal  of  panic   o Persists  for  6  months  or  more   • Facts  and  Statistics   o 3.5%  of  the  general  population  meet  diagnostic  criteria   o Females  outnumber  males  approximately  2:1   o Onset  is  often  insidious,  beginning  in  early  adulthood   o Tendency  to  be  anxious  runs  in  families   o Prevalent  among  elderly     Generalized  Anxiety  Disorder:  Associated  Features  (pp.144)   • Model  of  Quebec  researchers   o Intolerance  of  uncertainty   o Erroneous  beliefs  about  worry   o Poor  Problem  orientation   o Cognitive  avoidance     Treatment  of  GAD  (pp.145-­‐146)   • Treatment  of  GAD:  Generally  Weak   o Benzodiazapines  –  often  prescribed   o Psychological  –  cognitive-­‐behavioural    Exposure  to  worry  process    Confronting  anxiety-­‐provoking  images    Coping  Strategies   o Meditation   o Similar  benefits  as  meds  in  the  short-­‐term   o Better  long-­‐term  results     DSM-­‐IV-­‐TR   • Table  5.4     Specific  Phobias:  An  Overview  (pp.146-­‐148)   • Overview  and  Defining  Features   o Extreme  and  irrational  fear  of  a  specific  object  or  situation   o Markedly  interferes  with  one’s  ability  to  function   o Recognize  fears  are  unreasonable,  but  go  to  great  lengths  to  avoid   phobic  objects   • Facts  and  Statistics   o About  11%  of  the  general  population  meet  diagnostic  criteria  for   specific  phobias   o Females  are  again  over-­‐represented   o Phobias  run  a  chronic  course  with  onset  beginning  between  7
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