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2030- lecture 4

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Psychology 2030A/B
David Vollick

Chapter 5: Anxiety Disorders  Exam marks posted SSC 7440  Epigenics; can be passed on from one generation to another; increased chance of depression and anxiety, also heart attack; sudden loss of parent or sibling can increase risk of bipolar or other disorder; chronic panic phobia and similar anxiety disorders may contribute to premature aging; therapy alters brain function; prefrontal lobe is altered in depression therapy; is it better to teach how to cope?; antidepressants work on limbic system; less gray and white matter in dyslexia, decrease in part of the left hemisphere  Anxiety and Fear  2 different concepts  Anxiety o Future-oriented mood state with marked negative affect (mood/emotions) and somatic (body) tension; a lot of physiological changes occur o Apprehension about future danger or misfortune; become problematic when it becomes pervasive and overwhelming  Fear o Preset-oriented mood state with marked negative affect; normal o Immediate fight or flight emotional response danger or threat; can be crippling 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  Characteristics of anxiety disorders  Pervasive and persistent symptoms of anxiety and fear; anxiety is damaging to the immune system and arteries  Excessive avoidance and escapist tendencies  Symptoms and avoidance cause clinically significant distress and impairment  DSM-IV-TR  DSM Table 5.1- Diagnostic Criteria for Panic Attack  The Phenomenology of Panic Attacks  What is a panic attack? o Abrupt experience of intense fear or discomfort o Accompanied by several physical symptoms (i.e. breathlessness, chest pain)  DSM-IV subtypes of panic attacks o Situationalally bound (cued) panic- expected and bound to some situations o Unexpected (uncued) panic- unexpected “out of the blue” without warning; anywhere anytime o Situationally predisposed panic- may or may not occur in some situation  Panic Attacks  In text figure  Biological Contributions to Anxiety and Panic  Diathesis-Stress o Basic genetic predisposition to respond to a stressful situation in a certain way; 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, noradrenergic and setotonergic systems o Corticotropin releasing factor (CRF) and the hypothalamic-pituitary-adrenocortical (HYPAC) axis o Limbic (amygdala) and septal-hippocampal system o Behavioral inhibition (BIS) and fight/flight (FF) system o These systems are very much influenced by our environment; they’re sensitive  Psychological Contributions  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 experience with uncontrollability, unpredictability and dangerousness o Stressful life events as triggers of biological/psychological vulnerabilities i.e. exercise producing similar physical sensations= an internal cue  Towards an Integrated Model  Integrative View o Biological vulnerability interacts with psychological. Experiential, and social variable to produce an anxiety disorder o Consistent with diathesis-stress model  Common Processes: The Problem of Comorbidity o About half of anxiety patients have two or more secondary diagnoses o Major depression is the most common secondary diagnosis o Comorbidity suggests common factors across anxiety disorders o Suggests a relationship between anxiety and depression  DSM-IV-TR  DSM Table 5.3- Diagnostic Criteria for Panic Disorders with Agoraphobia  Panic Disorders with and without Agoraphobia  Features Overview and Defining o Experience of unexpected panic attack o Develop anxiety about having another attack or its implications o Agoraphobia- fear of 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% of the population meet diagnostic criteria for panic disorder o 75% or more with panic disorders are female; could be a diagnostic bias as most are made by males also males are less likely to admit to anxiety o Onset is often acute, beginning between 25 and 29  Causes o Genetic neurobiological vulnerability to stress o Expect worst 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  Medication Treatment of Panic Disorder o Target serotonergic, noradrenergic, and benzodiazepine GABE systems o SSRIs (i.e. 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; i.e. relaxation o Best long-term outcome is with cognitive- behavior therapy alone  Panic Disorder: Treatment  In te
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