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PSY240H1 Chapter Notes -Locus Coeruleus, Panic Attack, Posttraumatic Stress Disorder

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Martha Mc Kay

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Chapter VII: Anxiety Disorders
- Harry (Case study): experiencing four types of symptoms that make up anxiety
Muscle tension, heart
palpitations, stomach
pain, need to urinate
Physiological and behavioural symptoms are similar to fight-or flight response
Adaptive Fear
Maladaptive Anxiety
Realistic concerns
Fear: Harmin of proportion
Fear subsides when threat ends
Unrealistic concerns
Fear: Harmout of proportion
Concern persistent after threat ends,
great deal of anticipatory anxiety
Prominent feature in many psychological disorders (Ex. depression)
Freud: anxiety is the underlying cause of most forms of psychopathology
Neurosis: disorders in which the anxiety aroused by unconscious conflicts
could not be quelled or channeled by defense mechanisms (Ex. depression,
hypochondriasis (unrealistic worry about one’s health))
DSM no longer assumed anxiety underlies these disorders
Tendency toward anxiety from early ageneuroticism, negative affectivity,
behavioural inhibitionoverprotective, controlling, intrusive parents
Panic Disorder:
Panic attacks: short but intense periods in which one experiences many symptoms
of anxiety (heart palpitations, pounding heartbeat, numbness, shaking, etc.)
Three core themes: dizziness-related symptoms, cardio-respiratory distress,
cognitive factors
Most commonly related to certain situations: likely to have them in certain
situations but not always
Panic disorder: when panic attacks become common, unprovoked, and the person
begins to worry about having attacks and changes their behaviours accordingly;
4± symptoms occur frequently and interfere with functioning
Often fear they have life-threatening illnesses, believe that they are going
crazy or losing control
Usually developed between late adolescence and mif-30s, tends to be chronic
Theories of Panic Disorder:
1. Genetics:
30% - 40% due to genetics
Biological vulnerability predisposes a person transmitted through genes
2. Neurotransmitters and the Brain:
Donald Klein: anti-depressant reduce panic attacks by affecting norepinephrine
Norepinephrine may be poorly regulated in locus ceruleus (part of the brain

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stem)in monkeys, stimulation produces panic-like responses, destruction
renders fear responses
Altering activity of norepinephrine in LC induces/reduces panic attacks
Other neurotransmitters: serotonin, GABA, CCK
Increases in serotonin in periaqueductal grey of the brain stem reduce panic-like
responses, increases in serotonin in the amygdala increase anxiety/anticipatory
Increases in anxiety symptoms during premenstrual periods for some women
progesterone affect the activity of serotonin and GABA
Gorman’s Kindling Model: anticipatory anxiety set the stage for panic attacks
poor regulation in the locus ceruleus initiatespanic attacks lower
threshold for chronic anxiety in limbic systemincreases likelihood of
deregulation in the locus ceruleusmore frequent panic attacks
procedures that initiate the physiological changes of the flight-or-flight response
induce panic attacks in those with the disorderpoor flight-or-fight regulation
3. The Cognitive Model:
(1) pay very close attention to their bodily sensations, (2) misinterpret bodily
sensations in a negative way, and (3) engage in snowballing catastrophic thinking
Higher anxiety sensitivity: the belief that symptoms of anxiety have harmful
Taylor and Cox found that anxiety sensitivity is highest in panic disorder and
post-traumatic stress disorder
Stewart found that females score higher on the anxiety sensitivity indexsex role
socialization processes, women receives greater rewards for expressing symptoms
Higher interoceptive awareness: an awareness of bodily cues that a panic attack
may soon happen
Study: only 20% of those that believed they have control of the inhalation of
carbon dioxide experienced panic attack compared to 80% of those that believed
that have no control (both groups had no control) belief of uncontrollability
Study: those with panic attack did not experience significantly more anxiety than
control group after inhaling carbon dioxide when they have a safe person nearby
The Integrated Model:
The vulnerability-Stress Model of Panic Disorder: biological vulnerability to a
hypersensitive fight-or-flight response X tendency to engage in catastrophizing
cognitions about physiological symptoms panic attacks, panic disorder, hyper
vigilance for signs of panic
Beck & Clark: increases in anxiety hijacks the cognitive processes that allow the
person to evaluate and determine the absence of threat/dangerstuck in an
automatic threat mode
Treatments for Panic Disorder:
CBT is as effective as drug therapies and better at preventing relapse
Brief CBT treatment is as effective as longer treatments
Antidepressants + CBT has higher relapse rate than CBT alone

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Tricyclic Antidepressants
Increase levels of
norepinephrine and a
number of other
(including serotonin)
Selective Serotonin
Reuptake Inhibitors
Increase functional levels
of serotonin
Suppress the central
nervous system and
influence functioning in
the GABA,
norepinephrine, and
neurotransmitter systems
Therapy (CBT)
(1) Irrational thoughts can be challenged and changed
(2) Anxious behaviours can be extinguished
1. Clients are taught relaxation and breathing
2. Guide client to identify catastrophizing cognitions of
bodily sensations interoceptive exposure (induces
panic symptoms)
3. Client practice relaxation and breathing exercises
4. Therapist challenges the clients catastrophizing
thoughts of bodily sensations reinterpret
5. Systematic desensitization to expose clients
gradually to feared situations as they use new skills
to quell anxiety symptoms (list most feared to least)
Fear of places where help may not be
available in case of emergency (house
Strikes people in their youth
Specific Phobias
Develop during childhood
I. Animal Type
Specific animals or insects (dogs, cats)
II. Natural Environment Type
Events or situations in the natural
environment (storms, heights, water)
III. Situational Type
Public transits, tunnels, bridges,
elevators, driving (claustrophobic)
IV. Blood-injection-injury Type
Blood, injury, injections
Social Phobia
Fear of being judged or embarrassed
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