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Chapter 14

PSYC62H3 Chapter 14: Treatments for Anxiety Disorders
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Department
Psychology
Course
PSYC62H3
Professor
Zachariah Campbell
Semester
Winter

Description
Chapter 14: Treatments for Anxiety Disorders DSM Definitions of Anxiety Disorders Many individuals with anxiety disorders also have agoraphobia: profound fear of being in a situation from which escape is difficult or embarrassing, particularly if a panic attack occurs DSM classifies anxiety disorders as: 1. Panic disorders  Panic attacks may appear in any anxiety disorder and occur as the primary feature of panic disorder  Panic attack: strong physiological fear response associated with intense apprehension, fearfulness, or terror 2. Specific phobias  Significant anxiety provoked by exposure to specific feared objects or situations  Phobia: more severe than just a dislike for something  phobias manifest as a strong repulsion to certain situations or things and can cause significant disruptions in normal daily living activities  Are the most common type of anxiety disorder 3. Social phobias (social anxiety disorder)  Fear of being in public or performing in social or public settings  Situations provoke an immediate anxiety response, one that may be severe enough to elicit a panic attack  Second most common type of anxiety disorder 4. OCD  Anxiety arising over obsession and compulsive behaviour that endeavours to reduce anxiety  Obsession = “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress”  Individuals engage in compulsive behaviours to reduce anxiety 5. PTSD  Persistent state of physiological arousal or exaggerated response to certain stimuli, particularly those associated with a traumatic event  Person’s response to the traumatic event must involve intense fear, helplessness, or horror  Some individuals may experience flashbacks in which reality temporarily gives way to a reliving of the traumatic event 6. Generalized anxiety disorder (GAD)  Excessive worry about events, individuals, or activities  individuals constantly feel worried and subsequently exhausted Amygdala’s Role in Anxiety  Amygdala is critical structure for fear and anxiety  Increased activity in the structure is associated with fear, anxiety, and aggression  The amygdala appears responsible for relating stimuli or events to fear and for mediating the physiological and psychological reactions to fear  The amygdala receives information from many parts of the brain  The nervous system sends sensory information, including visual, auditory, touch, and pain, from the thalamus to the amygdala via two pathways: o The thalamo-amygdala pathway sends crude and unprocessed sensory information directly from the thalamus to the amygdala  short route for sensory information from the thalamus  provides the amygdala with only basic features of a stimulus o Thalamo-cortical-amygdala pathway: sends sensory information to the amygdala after processing in the cerebral cortex  long route for sensory information in the thalamus  requires a slightly longer amount of time to reach the amygdala  contains information about what the stimulus is  The hippocampus sends information on the context surrounding the stimulus to the amygdala  if the context of the environment is important for the amygdala’s response to the stimulus, then information sent from the hippocampus will modify this response  Inputs to the amygdala from the PFC act to reduce amygdala activity, resulting in an inhibited reaction to fearful situations  also important for extinction of fear condition/ unlearning fear response  thus important for approach and avoidance behaviours  In addition, hypothalamus and locus coeruleus are important for sympathetic nervous system activation Anxious Feelings, the Amygdala, and Sympathetic Nervous System  After receiving fear-related stimuli, the amygdala sends output signals to the PFC, hypothalamus, and the locus coeruleus  PFC plays a role in determining how we behave in a fearful situation  approach or avoid a fearful stimulus  The hypothalamus and locus coeruleus facilitate physiological reactions to fear  The feelings of fear largely manifest from an activated sympathetic nervous system  Signals from the amygdala and hypothalamus travel to the locus coeruleus, and the locus coeruleus ultimately causes the release of acetylcholine rom preganglionic nerves in the sympathetic nervous system  this in turn causes the release of epinephrine (adrenaline) and norepinephrine (noreadrenaline) from the adrenal gland  If the sympathetic nervous system is active enough, respiration, heartbeat, blood pressure, and sweating increase Stress and the HPA Axis  General adaptation syndrome: stress syndrome occurring in three progressive phases: alarm stage, resistance, and exhaustion o Alarm = characterized by increased physiological arousal in preparation for an energy situation  consists of the acute reactions to fearful stimuli, including activation of the sympathetic nervous system o Resistance = characterized by sustained level of physiological arousal in response to prolonged stress  Hypothalamic-pituitary-adrenal axis: system involved in physiological responses to stress  in response to sustained stress, the hypothalamus elicits the anterior pituitary gland to release ACTH which causes the adrenal cortex to release cortisol  During this sage, the hypothalamus releases corticotrophin releasing factor which in turn elicits the release of adrenocorticotropic hormone (ACTH) from the pituitary gland  ACTH causes the adrenal gland to release cortisol, a stress-related hormone that causes several other effects in the body, including increases in metabolic activity, immune system activity, and glucose and other nutrients o Exhaustion = the body can no longer maintain the high, sustained levels of physiological arousal that occurs during the second stage  this leads to impaired immune system function and reduced metabolic activity of organs throughout the body  Prolonged increases in cortisol levels lead to damage to hippocampus (structure for cognition and site of action for serotonin reuptake inhibitors)  In the hippocampus, high levels of cortisol are associated with damaged and destroyed neurons, decreased hippocampal size, and memory impairments Barbiturates Anxiolytic drugs: drugs prescribed to treat anxiety Along with reduced anxiety, barbiturates produce feelings of well-being and lowered inhibitions Barbiturates are subclassified by time course:  Long-acting barbiturates take effect after approximately 1 hour but effects last for 10-12 hours  low-lipid solubility and slow metabolism  Ultrashort-acting barbiturates = produce effects within 10-20 seconds  maintain drug effects for approximately 30 minutes  high lipid solubility, quickly store in fats, and rapid metabolism  Short-or-intermediate-acting = medium lipid solubility fall in between ultrashort and long-acting time courses  produce effects within approximately 30 minutes but effects last for approximately 8 hours Barbiturates Serve as Drugs of Abuse  Users refer to barbiturates as “downers”= produce feelings of reduced anxiety, well- being, and lowered inhibitions  Also appear to have positive reinforcing effects  nonhuman primates readily self- administer barbiturates  In lab studies with human subjects, participants prefer barbiturates just as well as morphine Chronic Barbiturate Administration  I
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