Textbook Notes (363,516)
Canada (158,391)
Psychology (4,731)
Chapter 5

Chapter 5.docx

8 Pages
Unlock Document

Western University
Psychology 2030A/B
David Vollick

Chapter 5 Anxiety disorders Anxiety and fear - Anxiety: o Future-oriented: mood state with marked negative affect & somatic tension (we are not anxious about the past!! Just about the future) o Apprehension about future danger or misfortune - Fear: o Present-oriented: mood state with marked negative affect (something just happens, normal response, helps us to get ready) o Immediate fight or flight emotional response to danger or threat o Strong avoidance/escapist tendencies o Abrupt activation of the sympathetic nervous system - Anxiety and fear are normal emotional states From normal to disordered anxiety and fear - Characteristics of anxiety disorders o Pervasive (embedded our all life) and persistent symptoms of anxiety and fear (always present, continue). Apparently anxiety damaging the immune system o Excessive avoidance and escapist tendencies o Symptoms and avoidance cause clinically significant distress and impairment (e.g. I have a phobia about flying, I can fly but I am really anxious during the previous 3 weeks, if I want to be a business man, I will not apply for a job where I have to take the plane! And I will lose this opportunity) DSM-IV - Panic attack: people victims of panic attacks think they are going to die (palpitation, dizzy, nausea, chest pain… heart attack disease!) The phenomenology of Panic attacks - What is panic attack? o Emotional component: Abrupt experience of intense fear or discomfort (because you’re really thinking you’re dying!!) o Physical component: Accompanied by several physical symptoms (e.g. breathlessness, chest pain) - DSM-IV subtypes of panic attacks: o Situationally bound (cued) panic: expected and bound some situations (the person is actually expected to have it) o Unexpected (uncued) panic: unexpected “out of the blue” without warning o Situationally predisposed panic: may or may not occur in some situation (sometimes you get a panic attack and sometimes you don’t! you don’t know what’s going on, you are not expecting anything) Biological contributions to anxiety and panic - Diathesis-stress: I have a genetic base (previous genetic position) that leads me to response with stress to situation. Maybe young I was traumatise and know I am predisposed. o Inherit vulnerabilities for anxiety and panic, not for anxiety disorders (is not a disorder is a genetic previous position, I most likely to suffer of anxiety) o Stress and life circumstances activate the vulnerability - Biology and inherent vulnerabilities: o Anxiety and brain circuits (GABA, noradrenergic and serotonergic systems) o Corticotropin releasing factor (CRF) and the hypothalamic-pituitary-adrenocortical (HYPAC) axis (really important!!) o Limbic system (amygdala) and septal-hippocampal systems o Behavioural inhibition (BIS) ((really influence by the environment)) & fight/flight (FF) systems (develop fear, eyes dilated…) o Circuits are shaped by the environment Psychological contributions - Began with Freud o Anxiety involves reactivation of an infantile fear situation - Behaviouristic views o Anxiety and fear result from direct classical and operant conditioning and modeling (if parent afraid the baby of the fire for example, the baby could keep this fear all his life, it’s a learned behaviour) - Other psychological views o Early experiences with uncontrollability, unpredictability, and dangerousness o Stressful life events as triggers of biological/psychological vulnerabilities (e.g. exercise producing similar physical sensations = an internal cue, some people cannot exercise because they almost panic) Toward an integrated model - Integrative view: o Biological vulnerability interacts with psychological, experiential, and social variables to produce an anxiety disorder o Consistent with diasthesis-stress model - Common processes: the problem of comorbidity: one disorder plus another one, even more! o About half of anxiety patients have two or more secondary diagnoses! o Major depression is the most common secondary diagnosis o Comorbidity suggests common factors across anxiety disorders o Suggests a relation between anxiety and depression DSM-IV-TR Textbook e.g.: panic disorders with agoraphobia (Latin, fear of the market place, afraid to go out of open places because you might suffer of the panic attack). Panic disorder with and without agoraphobia - Features overview and defining: o Experience of unexpected panic attack (I had one before, it’s awful I don’t want to experience that anymore, I will not go out) o Develop anxiety about having another attack or its implications o Agoraphobia: fear or avoidance of situations/events associated with panic o Symptoms and concern about another attack persists for 1 month or more - Facts and statistics: o 3,5% of the meet diagnostic criteria for panic disorder o 75% or more with panic disorder are female o Onset is often acute, beginning between 25 and 29 - Causes: o Genetic neurobiological vulnerability to stress o Expect worse from physical symptom  Interoceptive avoidance can lead to catastrophic misinterpretation of symptoms o Parents modeling (we could learn from them the way to handle situations) o Genetic basis - Associated features: o Nocturnal panic attacks: 60% experience panic during sleep, during deep non-REM sleep (= not a dream who causes that, it’s something else) Treatment - Medication treatment of panic disorder o Target serotonergic, noradrenergic, and benzodiazepine GABA system o SSRI’s (e.g. Prozac and Paxil) can be also used too (preferred drugs) o Relapse rates are high with panic attack following medication discontinuation - Psychological and combined treatments of panic disorder o Panic control treatments are highly effective o Combined treatments which do well in the short term o Relaxation for example o Best long-term outcome is with cognitive-behaviour therapy alone - Panic disorder treatment: diagram for short term treatment o Cognitive behaviour therapy, antidepressant is given to the patient versus placebo. o Cognitive therapy by herself, really good results! Much better than a placebo o The combination has the best results DSM-IV-TR Diagnosis criteria from generalized anxiety disorder: worry, anxiety but there are no reasons for! Tired, fatigue, irritable and so long. Has to cause clinical impairment and distress. Generalized anxiety disorder: the basic anxiety disorder - Overview and defining features o Excessive uncontrollable anxious apprehension and worry about life events, problems sleeping, inattentive o Coupled with strong (very strong anxiety), persistent anxiety o GADs (generalized anxiety disorder) experience muscle tension, fatigue, irritability, are autonomic restrictors (fail to process emotional part of thoughts and images) versus autonomic arousal of panic. o Persists for 6 months or more! - Fact and statistics: o 3,5% of the general population meet diagnostic criteria o Females outnumber males approximately 2:1 o Onset is often insidious, beginning in early adulthood o Tendency to be anxious runs in families o Prevalent among elderly - Textbook diagram: Lickert scale, asking question: “do you worry excessively about little thing” for anxiety disorder yes at 100%! Generalized anxiety disorder: associated features: - Model of Quebec researchers o Intolerance of uncertainty o Erroneous beliefs about worry o Poor problem orientation (don’t seek for challenging problem!!) o Cognitive avoidance Treatment of GAD - Muscle tension is really different between anxious people and people with anxiety disorders! - Treatment of GAD: generally weak o Benzodiazapines: often prescribed o Psychological: cognitive-behavioural  Exposure to worry process (what’s going on, how is it build, how it making you anxious all the time!)  Confronting anxiety-provoking images (people have those images and we expose the people to them)  Coping strategies (they generally avoid the problem, we try to teach them how to focus on it, don’t avoid your feelings!) o Meditation o Similar benefits as meds in the short-term therapies o Better long-term therapies o Cognitive behaviour therapy with family therapy good for children (7 years old, anxious about the school, family
More Less

Related notes for Psychology 2030A/B

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.