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
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
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