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Chapter Seven.docx

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Department
Psychology
Course
PSYC 3140
Professor
Joel Goldberg
Semester
Winter

Description
Chapter Seven  Anxiety: physiological, or somatic, symptoms, including muscle tension, heart palpitations, stomach pain, and the need to urinate. Second, emotional symptoms—primarily a sense of fearfulness and watchfulness. Third, cognitive symptoms, including unrealistic worries that something bad is happening or is about to happen. Finally, behavioural symptoms—avoids situations because of fears  adaptive fear, and a maladaptive anxiety response, although these distinctions are often not sharp: o In adaptive fear, people's concerns are realistic, given the circumstances; in maladaptive anxiety, their concerns are unrealistic. What they are anxious about cannot hurt them or is very unlikely to come about o In adaptive fear, the amount of fear people experience is in proportion to the reality of the threat; in maladaptive anxiety, the amount of fear experienced is out of proportion to the harm the threat could cause o In adaptive fear, people's fear response subsides when the threat ends; in maladaptive anxiety, people's concern is persistent when a threat passes, and they may have a great deal of anticipatory anxiety about the future.  Anxiety disorders co-occur a lot  Fred: Neurosis: refer to disorders in which the anciety aroused by unconscious conlficts could not be quelled or channeled by defence mechanisms, DSM no longer uses this term  Neuroticism: to have a general tendency towards anxiety from an early age. These people become anxious or depressed easily  Parents of anxious kids: overprotective, less accepting, overinvolved, controlling, anxious themselves  Panic attacks characterized by: o Dizziness related symptoms o Cardio respiratory distress o Cognitive factors  Some panic attacks are triggered by specific events  40% of adults have occasional panic attacks, most think it’s a life-threatening illness.  Panic disorder: if they becoming common and unprovoked  Some suffer chronic generalized anxiety, depression and alcohol use, increase risk of suicide  Panic attacks: o Run in families o Biological vulnerability, transmitted through genes o Norepinephrine that is poorly regulated in locus coeruleus. Same with GABA and cholecystokinin o Drugs that alter the function of serotonin systems are helpful in reducing panic attack, because they may be caused by excess serotonin(especially in amygdala, periaqueductal grey) o Increase in progesterone can induce mild panic o Poorly regulated fight-or-flight system  Anxiety sensitivity: belief that symptoms of anxiety have harmful consequences  a kindling model of panic disorder, which suggests that the anticipatory anxiety that many people with the disorder have chronically kindles, or sets the stage for, the experience of panic attacks (see Figure 7.4). This link has to do with two parts of the brain: the locus ceruleus and the limbic system, which have well- defined pathways between them. Gorman and colleagues argue that, whereas the locus ceruleus is involved in the production of panic attacks, the limbic system is involved in diffuse, anticipatory anxiety. Poor regulation in the locus ceruleus causes panic attacks, which then stimulate and kindle the limbic system, lowering the threshold for the activation of diffuse and chronic anxiety. This anticipatory anxiety, in turn, may increase the likelihood of dysregulation of the locus ceruleus and thereby induce a new panic attack.  Introspective awareness: heightened awareness of bodily cues that a panic attack may happen soon. People prone to panic attacks have this.  If with a “safe” person, less likely to have an attack  Treatment: SSRIs, benzodiazepines. The latter and antidepressants cause relapse  Tricyclic antidepressants, can induce panic attacks, improve functioning of norepinephrine. Effect levels of serotonin. Side effects: mild.  SSRI: Paxil, Prozac, Zoloft. Increase functional levels of serotonin. Side effects: mild  Benzodiazepines: supress CNS and influence function in GABA, norepinephrine, serotonin. Work quickly. Side effects: addictive, relapse, cognitive interference. Withdrawal symptoms  Cognitive-behavioural therapy (CBT) for all the anxiety disorders, including panic disorder, involves getting clients to confront the situations or thoughts that arouse anxiety in them. Confrontation seems to help in two ways: Irrational thoughts about these situations can be challenged and changed, and anxious behaviours can be extinguished. More effective in preventing relapse. o Taught relaxation o Second, the clinician guides clients in identifying the catastrophizing cognitions they have about changes in bodily sensations.  therapist may try to induce panic symptoms in clients during therapy sessions by having them exercise to elevate their heart rates, spin to get dizzy, or put their heads between their knees and then stand up quickly to get lightheaded (because of sudden changes in blood pressure). This clinical procedure is called interceptive exposure. o Third, clients practise using their relaxation and breathing exercises while experiencing panic symptoms in the therapy session. o Fourth, the therapist challenges clients' catastrophizing thoughts about their bodily sensations and teaches them to challenge their thoughts for themselves by using the cognitive techniques o Fifth, the therapist uses systematic desensitization therapy to expose clients gradually to the situations they most fear, while helping them maintain control over their panic symptoms  Combination of CBT and antidepressants result in higher relapse rate than CBT alone  Agoraphobia: fear of crowded places  Adults recognize that their phobias are illogical  Specific phobias conform more to popular conceptions of pho
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