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Chapter 5

Psychology 2030A/B Chapter Notes - Chapter 5: Generalized Anxiety Disorder, Panic Attack, Panic Disorder

Course Code
David Vollick

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Chapter 5 Anxiety disorders
Anxiety and fear
- Anxiety:
o Future-oriented: mood state with marked negave aect & somac 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 negave aect (something just happens,
normal response, helps us to get ready)
o Immediate ght or ight emoonal response to danger or threat
o Strong avoidance/escapist tendencies
o Abrupt acvaon of the sympathec nervous system
- Anxiety and fear are normal emoonal states
From normal to disordered anxiety and fear
- Characteriscs of anxiety disorders
o Pervasive (embedded our all life) and persistent symptoms of anxiety and fear
(always present, connue). Apparently anxiety damaging the immune system
o Excessive avoidance and escapist tendencies
o Symptoms and avoidance cause clinically signicant distress and impairment (e.g. I
have a phobia about ying, I can y 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)
- Panic aack: people vicms of panic aacks think they are going to die (palpitaon, dizzy,
nausea, chest pain… heart aack disease!)
The phenomenology of Panic aacks
- What is panic aack?
o Emoonal 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 aacks:
o Situaonally bound (cued) panic: expected and bound some situaons (the person is
actually expected to have it)
o Unexpected (uncued) panic: unexpected “out of the blue” without warning
o Situaonally predisposed panic: may or may not occur in some situaon (somemes
you get a panic aack and somemes you don’t! you don’t know whats going on,
you are not expecng anything)
Biological contribuons to anxiety and panic
- Diathesis-stress: I have a genec base (previous genec posion) that leads me to response
with stress to situaon. Maybe young I was traumase and know I am predisposed.
o Inherit vulnerabilies for anxiety and panic, not for anxiety disorders (is not a
disorder is a genec previous posion, I most likely to suer of anxiety)
o Stress and life circumstances acvate the vulnerability
- Biology and inherent vulnerabilies:
o Anxiety and brain circuits (GABA, noradrenergic and serotonergic systems)
o Corcotropin releasing factor (CRF) and the hypothalamic-pituitary-adrenocorcal
(HYPAC) axis (really important!!)
o Limbic system (amygdala) and septal-hippocampal systems
o Behavioural inhibion (BIS) ((really inuence by the environment)) & ght/ight (FF)
systems (develop fear, eyes dilated…)
o Circuits are shaped by the environment
Psychological contribuons
- Began with Freud
o Anxiety involves reacvaon of an infanle fear situaon
- Behaviourisc views
o Anxiety and fear result from direct classical and operant condioning and modeling
(if parent afraid the baby of the re for example, the baby could keep this fear all his
life, its a learned behaviour)
- Other psychological views
o Early experiences with uncontrollability, unpredictability, and dangerousness
o Stressful life events as triggers of biological/psychological vulnerabilies (e.g. exercise
producing similar physical sensaons = an internal cue, some people cannot exercise
because they almost panic)
Toward an integrated model
- Integrave view:
o Biological vulnerability interacts with psychological, experienal, 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 paents 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 relaon between anxiety and depression
Textbook e.g.: panic disorders with agoraphobia (Lan, fear of the market place, afraid to go out of
open places because you might suer of the panic aack).
Panic disorder with and without agoraphobia
- Features overview and dening:
o Experience of unexpected panic aack (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 aack or its implicaons
o Agoraphobia: fear or avoidance of situaons/events associated with panic
o Symptoms and concern about another aack persists for 1 month or more
- Facts and stascs:
o 3,5% of the meet diagnosc criteria for panic disorder
o 75% or more with panic disorder are female
o Onset is oen acute, beginning between 25 and 29
- Causes:
o Genec neurobiological vulnerability to stress
o Expect worse from physical symptom
Interocepve avoidance can lead to catastrophic misinterpretaon of
o Parents modeling (we could learn from them the way to handle situaons)
o Genec basis
- Associated features:
o Nocturnal panic aacks: 60% experience panic during sleep, during deep non-REM
sleep (= not a dream who causes that, its something else)
- Medicaon 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 aack following medicaon disconnuaon
- Psychological and combined treatments of panic disorder
o Panic control treatments are highly eecve
o Combined treatments which do well in the short term
o Relaxaon for example
o Best long-term outcome is with cognive-behaviour therapy alone
- Panic disorder treatment: diagram for short term treatment
o Cognive behaviour therapy, andepressant is given to the paent versus placebo.
o Cognive therapy by herself, really good results! Much beer than a placebo
o The combinaon has the best results
Diagnosis criteria from generalized anxiety disorder: worry, anxiety but there are no reasons for!
Tired, fague, irritable and so long. Has to cause clinical impairment and distress.
Generalized anxiety disorder: the basic anxiety disorder
- Overview and dening features
o Excessive uncontrollable anxious apprehension and worry about life events, problems
sleeping, inaenve
o Coupled with strong (very strong anxiety), persistent anxiety
o GADs (generalized anxiety disorder) experience muscle tension, fague, irritability,
are autonomic restrictors (fail to process emoonal part of thoughts and images)
versus autonomic arousal of panic.
o Persists for 6 months or more!
- Fact and stascs:
o 3,5% of the general populaon meet diagnosc criteria
o Females outnumber males approximately 2:1
o Onset is oen insidious, beginning in early adulthood
o Tendency to be anxious runs in families