Textbook Notes (363,473)
Canada (158,372)
Psychology (1,867)
PSY240H5 (134)
Chapter 6


16 Pages
Unlock Document

University of Toronto Mississauga
Ayesha Khan

PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS  Anxiety – general feeling of apprehension about possible danger  Anxiety [Freudian perspective] – sign of inner battle or conflict between some primitive desire [from id] and prohibitions against its expression [from ego and superego]  Anxiety disorders affect 25-30% of population at some point in their lives  Neurotic behaviour – maladaptive and self-defeating  Neuroses [Freudian perspective] – psychological disorders that resulted when intrapsychic conflict produced significant anxiety, but in other neurotic disorders anxiety might not be obvious, either to person involved or to others if psychological defence mechanisms able to deflect or mask it THE FEAR AND ANXIETY RESPONSE PATTERNS [historically] Fear – experienced emotion when source of danger is obvious [historically] Anxiety – cannot specify clearly what danger is, experienced intuitively as an unpleasant inner state where we are anticipating something dreadful happening that is not entirely predictable from our actual circumstances Fear  Basic emotion that involves activation of fight-or-flight response of sympathetic nervous system  Instantaneous reaction to any imminent threat, and allows us to escape from this threat  Panic attack – when fear/panic response occurs in absence of any obvious external danger  fear and panic have three components: [loosely coupled components] o cognitive/subjective components *“I feel afraid/terrified” or “I’m going to die”+ o physiological components [increased heart rate, heavy breathing] o behavioural components [strong urge to escape or flee]  primitive alarm response, fear must be activated with great speed to serve its adaptive purpose Anxiety  complex blend of unpleasant emotions and cognitions that is both more oriented to the future and more diffuse than fear  has cognitive/subjective, physiological, and behavioural components o cognitive/subjective components [negative mood, worry about possible future threat/danger, self-preoccupation, sense of being unable to predict future threat or to control it if it occurs] o physiological components [state of tension and chronic overarousal, prepares a person for the fight-or-flight response should anticipated danger occur] o behavioural components [strong tendency to avoid situations where danger might be encountered, not immediate urge to flee like there is in fear]  adaptive value: helps us plan and prepare for possible threat, might enhance learning and performance Many of our sources of anxiety and fear are learned Neutral stimuli repeatedly paired with and reliably predict frightening or unpleasant events can acquire capacity to elicit fear or anxiety themselves Our thoughts and images can also serve as conditioned stimuli capable of eliciting fear or anxiety OVERVIEW OF THE ANXIETY DISORDERS AND THEIR COMMONALITIES DSM-IV-TR recognizes seven primary types of anxiety disorders: - phobic disorders - specific/social/agoraphobia disorders - panic disorder with agoraphobia - panic disorder without agoraphobia - generalized anxiety disorder - obsessive-compulsive disorder - posttraumatic stress disorder PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS  many people with one anxiety disorder will experience at least one more anxiety disorder and/or depression either concurrently or at a different point in their lives  similarities in basic causes of these disorders o biological causes – genetic vulnerability, common genetic vulnerability manifested at a psychological level by personality trait called neuroticism [proneness to experience negative mood states], brain structure centrally involved – limbic system [emotional brain], and neurotransmitter substances most centrally involved are GABA, norepinephrine, and serotonin  effective treatments that help individual understand their distorted patterns of thinking about anxiety-related situations and explore how these patterns can be changed Phobia – persistent and disproportionate fear of some specific object or situation that presents little or no actual danger yet leads to great deal of avoidance of these feared situations, three main categories: 1 – specific phobia 2 – social phobia 3 – agoraphobia SPECIFIC PHOBIAS  diagnosed as having specific phobia if they show strong and persistent fear that is excessive or unreasonable and is triggered by presence of a specific object or situation  when individuals with specific phobias encounter a phobic stimulus, they often show an immediate fear response that often resembles a panic attack, and they go to great lengths to avoid encounters with their phobic stimulus and sometimes avoid seemingly innocent representations of it like photographs or television images  people who suffer from phobias usually know that their fears are somewhat irrational, but they say they cannot help themselves  phobic behaviour tends to be reinforced because every time the person with phobia avoids a fear situation, their anxiety decreases Table 6.1 – Subtypes of Specific Phobias in DSM-IV-TR Animal – snakes, spiders, dogs, insects, birds Natural environment – storms, heights, water Blood-injection-injury – seeing blood or an injury, receiving an injection, seeing a person in a wheelchair Situational – public transportation, tunnels, bridges, elevators, flying, driving, enclosed spaces Other – choking, vomiting, “space phobia” *fear of falling down if away from walls or other support+ Blood-Injection-Injury Phobia 3-4% of the population - afflicted people typically experience as much disgust as they do fear - *show initial acceleration of heart rate and blood pressure followed by a dramatic drop in both heart rate and blood pressure, accompanied by nausea, dizziness, and/or fainting - Evolutionary perspective: by fainting, person being attacked might inhibit further attack; and if an attack did occur, drop in blood pressure would minimize blood loss Age of Onset and Gender Differences in Specific Phobias Lifetime prevalence rate: 12% Among people with specific phobia, 75% have at least one other specific fear that is excessive More common in woman than in men Psychosocial Causal Factors Psychodynamic view: phobias represent a defence against anxiety that stems from repressed impulses from the id, because it is too dangerous to “know” the repressed id impulse, the anxiety is displaced onto some external object or situation that has some symbolic relationship to the real object of anxiety Phobias as Learned Behaviour Fear response can be conditioned to previously neutral stimuli when these stimuli paired with traumatic or painful events, and once acquired phobic fears would generalize to other similar objects/situations PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS Vicarious Conditioning of Phobic Fears Watching a phobic person behaving fearfully with their phobic object can be distressing to the observer and can result in fear being transmitted from one person to another through vicarious or observational classical conditioning Experiment: showed that laboratory-reared monkeys who were not initially afraid of snakes rapidly developed phobic-like fear of snakes simply through observing a wild-reared monkey behaving fearfully with snakes – significant fear acquired after only four to eight minutes of exposure, and no signs that the fear had diminished months later, also monkeys could learn simply through watching videotapes so this suggests that mass media also plays a role in vicarious conditioning of fears and phobias in people Sources of Individual Differences in the Learning of Phobias Differences in life experiences among individuals strongly affects whether or not conditioned fears or phobias actually develop, some of these life experiences may make people more vulnerable to phobias than others, and other experiences may serve as protective factors for development of phobias Experiment: monkeys first shown Nonfearful monkeys behaving nonfearful with snakes were immunized against acquiring fear of snakes when they later saw fearful monkeys behaving fearfully with snakes - Events that occur during a conditioning experience, and before it important in determining the level of fear that is conditioned - Experiences person has after a conditioning experience may affect strength and maintenance of the conditioned fear - Inflation effect – look in lecture notes - Cognitions or thoughts can help maintain our phobias once they have been acquired, people with phobias constantly on the alert for phobic objects or situations and other stimuli relevant to their phobias and phobics markedly overestimate probability that fear objects have been, will be, followed by frightening events Evolutionary Preparedness for the Development of Fears and Phobias Primates and humans seem to be evolutionarily prepared to rapidly associate certain objects with frightening or unpleasant events, this preparedness occurs because over course of evolution, those primates and humans who rapidly acquired fears of certain objects or situations posed real threats to our early ancestors – selective advantage “prepared” fears not innate, easily acquired or especially resistant to extinction People with phobias may not be able to control their fear because the fear may arise from cognitive structures that are not under conscious control Genetic and Temperamental Causal Factors Affect speed and strength of conditioning of fear, so depending on their temperament or personality, people more or less likely to acquire phobias Study: monozygotic twins more likely to share specific phobias than dizygotic twins Same study also showed that nonshared environmental factors [individual experiences not shared by twins] also play role in origins of specific phobias  supports idea that phobias are learned behaviours Treating Specific Phobias Exposure therapy – best treatment for specific phobias – involves controlled exposure to stimuli or situations that elicit phobic fear, clients gradually placed *in imagination or increasing under “real-life” conditions] in situations they find most frightening, and in treatment clients are encouraged to expose themselves to their feared situations for long periods of time that their fear begins to subside - Participant modeling – therapist calmly models ways of interacting with phobic stimulus/situation, allows clients to learn that these situations are not as frightening as they had thought and their anxiety is not harmful and will gradually dissipate - some therapists use virtual reality environments to stimulate certain kinds of phobic situations as places to conduct exposure treatment – too soon to draw effectiveness of this technique PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS - combining cognitive techniques or medications with exposure-based techniques to see if this can produce additional gains – using cognitive techniques alone have not produced results as good as those using exposure-based techniques, and addition of cognitive techniques generally not added much and medication treatments ineffective by themselves - some evidence that anti-anxiety medications may interfere with beneficial effects of exposure therapy SOCIAL PHOBIA  characterized by disabling fears of one or more specific social situations [public speaking, meeting new people, eating or writing in public]  person fears that they may be exposed to scrutiny and potential negative evaluation of others and/or they may act in an embarrassing or humiliating manner, so people will either avoid these situations or endure them with great distress  fear of public speaking most common type of social phobia  generalized social phobia – significant fears of most social situations (rather than few) and have diagnosis of avoidant personality disorder, more common among woman than in men  more than 50% of people with social phobia suffer from one or more additional anxiety disorders at some point in their lives, and about 50% also suffer from depressive disorder at the same time, approximately 33% abuse alcohol to reduce anxiety and help them face situations  not all people with social phobia have full-blown panic attacks Interaction of Psychosocial and Biological Causal Factors Generally involve learned behaviours that have been shaped by evolutionary factors, learning is most likely to occur in people who are genetically or temperamentally at risk Social Phobias as Learned Beahviour Social phobias also seem to originate from simple instances of direct or vicarious classical conditioning People with generalized social phobia also may be especially likely to have grown up with parents who were socially isolated and avoidant and who devalued sociability, this allows ample opportunity for vicarious learning of social fears Parents with anxiety disorders more likely than nonanxious parents to tell their children about potential dangers of a novel situation like playgrounds, which strengthen anxious children’s avoidant tendencies *not everyone who experiences direct or vicarious conditioning in social situations or grows up with socially avoidant parents develops social phobias  because individual differences in experiences plays important role in who develops social phobia [same in specific phobia] Social Fears and Phobias in an Evolutionary Context  fears of members of one’s own species - proposed that social fears and phobias evolved as a by-product of dominance hierarchies that are a common social arrangement among animals, dominance hierarchies established through aggressive encounters between members of a social group, and a defeated individual typically displays fear and submissive behaviour but only rarely attempts to escape the situation so it’s not surprising that people with social phobia endure being in their feared situations rather than running away and escaping them like people with animal phobias do - so if they evolved as by-product then not surprising that humans have evolutionarily based predisposition to acquire fears of social stimuli that signal dominance and aggression from other humans - angry faces processed very quickly and emotional reaction can be activated without person’s awareness of any threat Genetic and Temperamental Factors Genetics and environmental factors contribute about equally to development of social anxiety traits PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS  large proportion of variance in who develops social phobia due to nonshared environmental factors, which is consistent with a strong role for learning  most important temperamental variable – behavioural inhibition, children who are behaviourally inhibited show increased risk for developing social phobia Perceptions of Uncontrollability and Unpredictability Perceptions of uncontrollability and unpredictability often lead to submissive and unassertive behaviour – characteristic of socially anxious or phobic people – this kind of behaviour especially likely if perceptions of uncontrollability stem from actual social defeat People with social phobia have diminished sense of personal control over events in their lives; this sense may develop as a function of having been raised in families with somewhat overprotective parents Cognitive Variables Suggested that people with social phobia tend to expect that other people will reject or negatively evaluate them, leads to sense of vulnerability when they are around people who might pose a threat Argued that danger schemas of socially anxious people lead them to expect that they will behave in an awkward, and unacceptable fashion leading to rejection and loss of status, lead to them being preoccupied with bodily responses and negative self-images in social situations and to overestimating how easily others detect their anxiety *social phobics’ inward attention and somewhat awkward behaviour may lead others to react to them in a less friendly fashion, thus confirming their expectations Treating Social Phobia Behaviour and cognitive-behavioural therapy Behaviour treatments  involve prolonged and graduated exposure to social situations that evoke fear Cognitive-behavioural therapy therapist attempts to help clients identify their underlying negative automatic thoughts and after helping clients understand that these automatic thoughts often involve cognitive distortions, therapist helps clients change these inner thoughts and beliefs through logical reanalysis – process could involve individual challenging these automatic thoughts or client may receive videotaped feedback to help modify their distorted self-images Can be treated with medications, like categories of antidepressants Combination of medication and psychological treatment works just as well as either approach alone *but psychological treatment generally produces more long-lasting improvement when compared to medications and with very low relapse rates PANIC DISORDER WITH AND WITHOUT AGORAPHOBIA Panic Disorder  characterized by occurrence of “unexpected” panic attacks that often seem to come “out of the blue”  person must have experienced recurrent unexpected attacks and must have been persistently concerned about having another attack, worried about consequences of having an attack, or must have changed their behaviour because of the attacks [at least for a month] To qualify as full-blown panic attack, must be abrupt onset of at least 4 – 13 symptoms; most symptoms physical, but three are cognitive: 1) depersonalization (a feeling of being detached from one’s body) or derealization (feeling that external world is strange or unreal) 2) fear of dying 3) fear of “going crazy” or “losing control” panic attacks are brief and intense, peak intensity within 10 minutes, attacks usually subside in 20-30 minutes and rarely last more than an hour comparison: periods of anxiety usually don’t have such an abrupt onset or are long-lasting PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS  panic attacks that occur in panic disorder are often “unexpected” or “uncued” in sense that they do not appear to be provoked by identifiable aspects of immediate situation, sometimes occur in situations where might be least expected, but in other cases panic attacks are said to be “situationally predisposed” occurring only sometimes while person is in particular situation (like when driving a car or being in a crowd)  found that early intervention consisting of a single session of psychological treatment can prevent worsening of panic attacks and development of panic disorder among individuals presented to emergency room following a panic attack Agoraphobia Usually develops as complication of having panic attacks in one or more situations like streets, and crowded places (shopping malls, movie theatres, stores, etc.)  concerned that they may have a panic attack or get sick, people with agoraphobia anxious about being in situations or places from which escape would be physically difficult or psychologically embarrassing or immediate help not available if something bad happened, frightened by own bodily sensations  as it first develops, tend to avoid situations where attacks have occurred, but usually avoidance gradually spreads to other situations where attacks might occur  severe case s – may be anxious when venturing outside their homes alone, and in very severe cases, agoraphobia is disabling disorder where person cannot go outside of their house, or sometimes parts of their home Agoraphobia without Panic Usually gradually spreading fearfulness where aspects of environment outside home become threatening, history of “limited symptom attacks” (fewer than four symptoms) or some other unpredictable physical ailment like epilepsy or colitis that makes person afraid of suddenly being incapacitated Prevalence, Gender, and Age of Onset of Panic Disorder with and without Agoraphobia 1.6% suffer from panic disorder and 0.7% suffer from agoraphobia 4.7% of adult population has had panic disorder with or without agoraphobia at some time in their lives Usual age of onset is between ages 15 and 24, especially for men, but especially for women can begin in their thirties or forties, median age of onset has been estimated at 24 years, but twice as prevalent in women as in men, approximately 80-90% female with severe agoraphobia *most common explanation of gender differences in agoraphobia – sociocultural because acceptable for women who experience panic to avoid situations they fear and to need trusted companion to accompany them when they enter feared situations, men more prone to “tough it out” because of expectations and their more assertive instrumental approach to life Comorbidity with Other Disorders More than 50% of people with panic disorder with/without agoraphobia have one or more additional diagnoses, estimated about 30-50% people with panic disorder will experience serious depression at some point in their lives, and may meet criteria for dependent or avoidant personality disorder The Timing of a First Panic Attack First one frequently occurs following feelings of distress or highly stressful life circumstance, but not all people who have panic attack following stressful event go to develop full-blown panic attack disorder Biological Causal Factors Genetic Factors Moderate heritable component, overlap in genetic vulnerability factors for panic disorder and phobias Biochemical Abnormalities People with panic disorder more likely to experience panic attacks when exposed to various biological challenge procedures than normal people or people with other psychiatric disorders Injections of neurotransmitter CCK-4 can trigger panic attacks, particularly in people with panic disorder PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS Broad range of panic provocation agents, some associated with different and even mutually exclusive neurobiological processes Put stress on neurobiological systems which produce intense physical symptoms Two primary neurotransmitter systems most implicated in panic attacks – noradrenergic and serotonergic systems Noradrenergic in certain brain areas can stimulate cardiovascular symptoms associated with panic Increased serotonergic activity decreases noradrenergic activity *medications most widely used to treat panic disorder (SSRIs) seem to increase serotonergic activity in brain but decrease noradrenergic activity, by decreasing this medications decrease many cardiovascular symptoms associated with panic that are ordinarily stimulated by noradrenergic activity *Inhibitory neurotransmitter GABA also implicated in anticipatory anxiety that people with panic disorder have about experiencing another attack, GABA known to inhibit anxiety and been shown to be abnormally low in certain parts of cortex in people with panic disorder Panic and the Brain Locus ceruleus in brain stem and neurotransmitter, norepinephrine [centrally involved in brain activity in this area] Increased activity in amygdala plays more central role in panic attacks than activity in locus ceruleus Amygdala – collection of nuclei in front of hippocampus in limbic system of brain, critically involved in emotion of fear, stimulation of central nucleus of amygdala known to stimulate locus ceruleus and other autonomic, neuroendocrine, and behavioural responses that occur during panic attacks  research suggests amygdala central area involved in “fear network” with connections to lower areas (locus ceruleus) and higher brains areas (prefrontal cortex)  panic attacks occur when fear network activated [by cortical inputs or inputs from lower brain areas], panic disorder likely to develop in people who have abnormally sensitive fear networks that get activated too readily to be adaptive  abnormally sensitive fear networks may have partially heritable basis but may develop as result of repeated stressful life experiences [particularly early in life] people with panic disorder become anxious about possibility of another attack – so different brain areas probably involved in these different aspects of panic disorder  panic attacks arise from activity of amygdala  people who have one or more panic attacks and go on to develop significant conditioned anxiety about having another one in particular contexts – hippocampus generates this conditioned anxiety and probably involved in learned avoidance associated with agoraphobia  cognitive symptoms that occur during panic attacks and overreactions to danger likely to be mediated by higher cortical centers Behavioural and Cognitive Causal Factors Comprehensive Learning Theory of Panic Disorder - “fear of fear” hypothesis – through process of interoceptive conditioning, initial internal bodily sensations of anxiety or arousal effectively become conditioned stimuli associated with higher levels of anxiety or arousal - Comprehensive learning theory of panic disorder – initial panic attacks become associated with initially neutral internal (interoceptive) and external cues through conditioning process o Anxiety becomes conditioned to these CSs and more intense the panic attack, more robust the conditioning that will occur o Conditioning of anxiety to internal or external cues associated with panic thus sets stage for development of two of three components of panic disorder: anticipatory anxiety and agoraphobic fears PSY240 CHAPTER 6 – PANIC, ANXIETY, AND THEIR DISORDERS o When people experience their initial panic attacks, conditioning can occur to multiple different kinds of cues because anxiety becomes conditioned to these CSs, anxious apprehension about having another attack may develop - Panic attacks (themselves) likely to be conditioned to certain internal cues, leads to occurrence of panic that seemingly come out of the blue when people unconsciously experience certain internal bodily sensations (CSs) - People with certain genetic, temperamental, or cognitive-behavioural vulnerabilities show stronger conditioning of both anxiety and panic Cognitive Theory of Panic Panic clients are hypersensitive to their bodily sensations and are very prone to giving them the direct possible interpretation, tendency to catastrophize about meaning of their bodily sensations, person not necessarily aware of making these catastrophic interpretations but thoughts are often just barely out of conscious realm of awareness, these automatic thoughts in a sense triggers of panic *cognitive model proposes that only people with this tendency to catastrophize go on to develop panic disorder - model also predicts that changing their cognitions about their bodily symptoms should reduce or prevent panic - brief explanation of what to expect in a panic provocation study can apparently prevent panic Figure 6.2 - The Panic Circle Any kind of perceived threat may lead to apprehension or worry, which is accompanied by various bodily sensations. According to the cognitive model of panic, if a person then catastrophizes about the meaning of their bodily sensations, this will raise the level of perceived threat, thus creating more apprehension and worry, as well as more physical symptoms, which fuel further catastrophic thoughts. This vicious circle can culminate in a panic attack. The initial physical sensations need not arise from the perceived threat (as shown at the top of the circle), but may come from other sources (exercise, anger, psychoactive drugs, etc.) (As shown at the bottom of the circle). Psychological Explanations of Results from Panic Provocation Studies - Agents produce arousal, and mimic physiological cues that normally precede panic attack or may be taken as sign of some other impending catastrophe - According to cognitive theory, people with panic attacks frequently misinterpret these symptoms as beginning of panic attack or heart attack, which induces vicious circle that would not happen in controls who do not have the same tendency to catastrophize - According to learning theory of panic, those with panic disorder for whom these cues might serve as interoceptive CSs that can trigger anxiety and panic because of their prior associations with panic - Difference between the
More Less

Related notes for PSY240H5

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.