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Chapter VII.docx

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University of Toronto St. George
Martha Mc Kay

Chapter VII: Anxiety Disorders Anxiety: - Harry (Case study): experiencing four types of symptoms that make up anxiety Physiological/Somatic Emotional Cognitive Behavioural Muscle tension, heart Terror, Unrealistic Avoidance palpitations, stomach restlessness worries pain, need to urinate Physiological and behavioural symptoms are similar to fight-or flight response Adaptive Fear Maladaptive Anxiety Realistic concerns Unrealistic concerns Fear: Harmin of proportion Fear: Harmout of proportion Fear subsides when threat ends 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 ones 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 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 anxiety Increases in anxiety symptoms during premenstrual periods for some women progesterone affect the activity of serotonin and GABA Gormans 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 consequences 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 aloneTreatment Function Side Effects Tricyclic Antidepressants Increase levels of blurred vision, dry mouth, norepinephrine and a difficulty urinating, number of other constipation, weight gain, neurotransmitters sexual dysfunction (including serotonin) Selective Serotonin Increase functional levels gastrointestinal upset and Reuptake Inhibitors of serotonin irritability, agitation, (SSRIs) insomnia, drowsiness, tremor, sexual dysfunction Benzodiazepines Suppress the central (1) Physically and nervous system and psychologically influence functioning in addictive the GABA, (2) Interfere with norepinephrine, and cognitive and motor serotonin functioning neurotransmitter systems (3) high relapse rate Cognitive-Behavioural (1) Irrational thoughts can be challenged and changed Therapy (CBT) (2) Anxious behaviours can be extinguished 1. Clients are taught relaxation and breathing exercisescontrol
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