PSY100H1 Chapter Notes -Locus Coeruleus, Panic Disorder, Generalized Anxiety Disorder

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Published on 14 Apr 2013
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Chapter Seven
Anxiety: state of apprehension, tension and worry; prominent feature in many
psychological disorders; four types of symptoms
oSomatic: muscle tensions; heart palpitations; stomach pain; need to
urinate; accelerated respiration; inhibited stomach acid
oEmotional: sense of dread; terror; restlessness; irritability
oCognitive: anticipation of harm; exaggeration of danger; problems in
concentrating; hyper vigilance; fear of dying; sense of unreality
oBehavioural: escape; avoidance; aggression; freezing; decrease appetitive
responding; increased aversive responding
Adaptive fear: people’s concerns are realistic given the circumstances; amount of
fear experienced is proportional to reality of threat; people’s fear response
subsides when the threat ends
Maladaptive anxiety: concerns are unrealistic; amount of fear out of proportion
to harm threat could cause; concern is persistent when threat passes; anticipatory
anxiety about the future
Neurosis: term used by Freud and other early theorists to refer to disorder in
which anxiety aroused by unconscious conflicts could not be quelled or
channelled by defence mechanisms; could be experienced directly as conscious
symptoms or in maladaptive forms (depression, etc)
Neuroticism: also called negative affectivity or behavioural inhibition; general
tendency towards anxiety from a very early age; may not develop anxiety disorder
until later in life or until experience parenting (over-involved, controlling) that
exacerbates behaviour
Panic disorder
Panic attacks: short but intense periods in which one experienced many
symptoms of anxiety, including heart palpitations, trembling, a feeling of choking,
dizziness, intense dread; characterized by core themes of dizziness related
symptoms, cardio-respiratory distress and cognitive factors; don’t follow set
pattern; about 40% of all young adults have occasional panic attacks
Triggers: might or might not have trigger; most commonly are related to specific
situations (ex: speaking in public); facing a traumatic event can induce a panic
Panic disorder: diagnosable when panic attacks are common occurrence, are not
usually provoked by any particular situation, are causing a person distress and
causing them to change their behaviour; need to frequently experience four or
more and have them interfere with daily living; believe they’re about to die
Theories of panic disorder: biological and psychological
Role of genetics: appears to run in families; biological vulnerability to panic
disorder or to a chronic diffuse anxiety that predisposes one to a disorder
Neurotransmitters and brain: discovery by Donald Klein in 1960s that
antidepressant medications reduce panic attacks; meds affect levels of
norepinephrine, which may be poorly regulated in people with panic disorders,
especially in an area of the brain stem called the locus ceruleus, which is
involved in fear response
oSerotonin: drugs that alter the functioning of serotonin systems are
helpful in reducing panic attacks; animal studies suggest that increases of
serotonin in certain part of brain stem (specifically the periaqueductal
gray) reduce panic like responses while increases in serotonin in
amygdala increase anxiety
oProgesterone: play role in vulnerability to panic attacks; indicated by
women with panic disorders reporting increases in anxiety symptoms
during pre-menstrual periods and postpartum period; can affect activity of
GABA and serotonin; can induce mild chronic hyperventilation
oKindling model: Gorman and colleagues; anticipatory anxiety that many
people with the disorder have chronically sets the stage for the experience
of panic attacks; link has to do with locus ceruleus and limbic system; LC
involved in production of panic attacks and LS involved in diffuse,
anticipatory anxiety; poor regulation in LC causes panic attacks, which
then stimulate and kindle LS, lowering threshold for activation of
diffuse/chronic anxiety, which increases likelihood of dysregulation of
locus ceruleus and thereby of a new attack
oHyperventilation: ingesting small about of carbon dioxide, calcium,
sodium lactate or breathing into a paper bag can induce panic attacks;
initiate physiological changes of fight or flight response (poorly regulated
in those with panic disorder)
Cognitive model: people prone to panic attacks pay very close attention to their
bodily sensations, misinterpret bodily sensations in a negative way and engage in
snowballing catastrophic thinking, exaggerating symptoms and consequences
oAnxiety awareness: belief that symptoms of anxiety have harmful
consequences; females score higher on Anxiety Sensitivity Index
oInteroceptive awareness: heightened awareness of bodily cues that a
panic attack may soon happen; slight sensations of arousal or changes in
bodily functions become conditioned stimuli for more severe symptoms of
panic; study where individuals with “safe person” present were less likely
to experience symptoms of anxiety
Integrated model: combine biological and cognitive theories to create a
vulnerability stress model; biological vulnerability to hypersensitive fight/flight
response AND a tendency to engage in catastrophizing cognitions about somatic
symptoms create panic attacks and hyper vigilance for signs of panic; can be
generalized and result in agoraphobia
Biological treatments: most effective drugs classified as antidepressants and
anti-anxiety; quell immediate symptoms and disorder but relapse high if drugs
discontinued (diminished if also use CBT)
oTricyclic antidepressants: increase levels of norepinephrine and several
other neurotransmitters (including serotonin); ex: imipramine; side effects
include blurred vision, sexual dysfunction, weight gain and dry mouth;
relapse rate once drugs discontinued
oSSRIs: increase functional levels of serotonin in the brain; commonly
used ones are Paxil, Prozac, Zoloft and Celexa; side effects include GI
upset and irritability, insomnia, tremor and sexual dysfunction; as
effective as tricyclics
oBenzodiazepines: suppress CNS and influence functioning in GABA,
norepinephrine and serotonin neurotransmitter systems; approved drugs
are alprazolam and clonazepam; disadvantages are that they are physically
and psychologically destructive, they can interfere with cognitive/motor
functioning and relapse is extremely high after discontinuation
CBT: involves getting clients to confront situations/thoughts that arouse anxiety;
helpful because irrational thoughts can be challenged and changed and anxious
behaviours can be extinguished; at least as effective as drug therapies and more
effective in preventing relapse; questions over whether combining meds and CBT
is additive or deleterious; potential preventative role for CBT in panic disorder
oFirst: teach relaxation and breathing exercises; give people control over
oSecond: clients guided in identifying catastrophizing cognitions they have
about changes in bodily sensations; can keep panic thoughts diary; may
need to experience panic symptoms in front of therapist and can induce
that via interoceptive exposure (engaging in exercises/tasks that bring on
feelings of anxiety)
oThird: clients practice using relaxation/breathing exercises while
experiencing panic in therapy
oFourth: therapist challenges catastrophizing thoughts about bodily
sensations and teaches them to challenge thoughts for themselves
oFifth: uses systematic desensitization therapy to expose client gradually to
situations they most fear while helping them maintain control over panic
Agoraphobia: fear of crowded, bustling places (malls), enclosed spaces
(elevators, buses) and wide open spaces (fields); wide variety of situations; worry
they might not be able to escape or help might not be available in case of
emergency; can occur in people who don’t have panic attacks but most people
who seek treatment do experience panic attacks or severe social phobia (panic
like symptoms in social situations); typically begins within one year after a person
begins experiencing frequent anxiety symptoms; strikes during youth
Specific phobias: fear of specific objects, places or situations; anxiety is
immediate and intense when encounter feared object and may even have panic
attacks; go to great lengths to avoid object; most develop during childhood; adults
realize anxieties are illogical and unreasonable; 90% don’t seek treatment
oAnimal type phobias: focused on specific animals or insects, like spiders;
most common is snakes in North America