PSYC 4430 Lecture Notes - Lecture 4: Habit Reversal Training, Sympathetic Nervous System, Clomipramine

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8 Feb 2018
Chapter 4: Anxiety, Trauma- and Stressor-Related and Obsessive-Compulsive and Related
1. The complexity of anxiety disorders
a. Anxiety-a future-oriented mood state
i. Apprehension about future danger or misfortune
ii. Physical symptoms of tension
iii. Characterized by marked negative affect
iv. May lead to avoidance of situations likely to provoke fear
b. Feara present-oriented mood state
i. Immediate fight or flight response to danger or threat
ii. Involves abrupt activation of the sympathetic nervous system
iii. Strong avoidance/escapist tendencies
iv. Marked negative affect
2. From normal to disorders anxiety and fear
a. Characteristics of anxiety disorders
i. Pervasive and persistent symptoms of anxiety and fear
ii. Involve excessive avoidance and escape
iii. Cause clinically significant distress and impairment
3. The phenomenology of panic attacks
a. Panic attack: abrupt experience of intense fear
i. Physical symptoms
1. Heart palpitations
2. Chest pain
3. Dizziness
4. Sweating
5. Chills or heat sensations
ii. Cognitive symptoms
1. Fear of losing control, dying, or going crazy
b. Two types
i. Expected
ii. Unexpected
4. Biological contributions to anxiety and panic
a. Genetic vulnerability
i. More likely to be anxious if there is a family history of anxiety
b. Anxiety and brain circuits
i. Depleted levels of GABA are associated with more anxiety
ii. Deficits in norepinephrine and serotonin also associated with greater
5. Psychological contributions
a. Childhoodexperiences with uncontrollability and unpredictability lead to more
b. Stressful life events trigger vulnerabilities
c. Behavioral and cognitive views
i. Invokes conditioning and cognitive explanations
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ii. Anxiety and fear are learned responses
iii. Catastrophic thinking and appraisals play a role
6. In integrated model
a. Integrative viewtriple vulnerability
i. Generalized biological vulnerabilityheritable contribution to negative
1. glass is half ept
2. Irritable
3. Driven
ii. Specific psychological vulnerability (e.g. physical sensations are
potentially dangerous)
1. Anxiety about health?
2. Nonclinical panic?
iii. Generalized psychological vulnerabilitysense that events are
1. Tendency toward lack of self-confidence
2. Low self-esteem
3. Inability to cope
7. Comorbidityhaving more than one diagnosis at once
a. Common across the anxiety disorders
b. Major depression is the most common secondary diagnosis
c. About 50% of patients have 2 or more secondary diagnoses
8. Generalized anxiety disorder: chronic worry
a. Overview and defining features
i. Excessive uncontrollable anxious apprehension and worry about multiple
areas of life (e.g. work, relationships, health)
ii. Persists for six months or more
iii. Accompanied by associated symptoms (e.g., muscle tension, restlessness,
fatigue, irritability, concentration difficulties, sleep disturbances)
b. Warning signs
i. Continuous worry about major and minor events without just cause
ii. Headaches and other aches and pains for no apparent reason
iii. Constant bodily tension, feelings of fatigue, and difficulty relaxing
iv. Frequent irritability
v. Trouble falling asleep or staying asleep
vi. Experience excessive sweatiness or hot flashes
vii. Feeling of having a lump in throat or feeling the need to vomit when
c. Statistics
i. Affects about 3.1% of the general population
ii. Females outnumber males approximately 2:1
iii. Onset is often insidious beginning in early adulthood
iv. Very prevalent among the elderly
v. Tends to run in families
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d. Associated features
i. Persos ith GAD hae ee alled autooi restritors
ii. Less physiological responses to stress than people with other anxiety
iii. Very sensitive to threats
e. Treatment
i. Treatment of GAD is generally weak
1. Psychological interventions
a. Cognitive behavioral therapy (works best)
b. Pharmacotherapybenzos and antidepressants often
c. Meditation therapy
d. Combined treatmentsacute vs. long-term outcomes
9. Panic disorder
a. Overview and defining features
i. Experience of unexpected panic attacks (i.e. a false alarm)
ii. Develop anxiety, worry, or fear about another attack
iii. May develop agoraphobia
b. Warning signs
i. Repeated experience of sudden burst of fear for no reason
ii. Experience of chest pains or a racing heart
iii. Feeling dizzy, difficulty breathing, or experiencing excessive sweating
iv. Frequent stomach problems and the feeling to vomit
v. Shaking trembling or tingling sensations
vi. Feeling out of control
vii. Feelig that oe’s reatios are ureal
viii. Fear or dying or going crazy
c. Panic disorder and agoraphobia
i. Agoraphobiafear of being in places in which it would be difficult to
escape or get help in the event of unpleasant physical symptoms (e.g.,
panic attack, dizziness, vomiting, incontinence)
ii. Panic disorder and agoraphobia often occur together
1. Do’t hae to occur together
2. Coupled together in previous editions of DSM
iii. Facts and statistics
1. Affects about 2.7% of the general population
2. Onset is often acute, mean onset between 20 and 24 years of age
3. 66% of individuals with agoraphobia are female
d. Associated features and treatments
i. Medication treatment
1. SSRIs or benzos
2. Relates rates high after medication discontinuation
ii. Panic control treatment (PCT)
1. Example of CBT for panic
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