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01:830:340 (47)
Chapter 4


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Sara Campbell

1 Chapter 4: ANXIETY DISORDERS I. Definitions anxiety: negative mood state characterized by marked negative affect and bodily symptoms of tension in which a person apprehensively anticipates future danger or misfortune. may involve feelings, behaviors, and physiological responses fear: emotion of an immediate alarm reaction to present danger or life threatening emergencies panic: sudden overwhelming fright or terror panic attack: abrupt experience of intense fear or discomfort accompanied by several physical symptoms such as dizziness or heart palpitations Relationship between fear, anxiety and panic attacks: II. Causes of Anxiety Disorders A. biological contributions ■ we can inherit the tendency to be anxious and collection of genes that make a person more susceptible when the right psychological and social factors are in place (genetic vulnerability) ■ no gene causes anxiety directly ■ GABA is associated with increased anxiety ■ corticotropin releasing factor (CRF)- system linked to the expression of anxiety and group of genes that causes it to be turned on ■ limbic system is the area of the brain most often associated with anxiety ○ acts as a mediator between the brainstem and cortex ■ Jeffrey Gray- studied the limbic system ○ behavioral inhibition system (BIS)- brain circuit that responds to danger/ threat signals inhibiting activity and causing anxiety. brain stem and cortex ○ flight or flight system (FFS)- brain circuit in animals that when stimulated causes an immediate alarm and escape response resembling human panic, brain stem and midbrain (amygdala and hypothalamus) ○ environmental factors affect the sensitivity of these brain circuits B. psychological contributions ■ in early childhood we acquire an understanding that events are not under our control ■ role of a parent to respond to their child’s needs in a positive and predicting way (food, attention) plays an important role ○ teaches children that they have a control over the environment ○ people who “secure home base” versus “clear the way” for their children- want to develop a healthy sense/level of control ■ panic is associated with conditioning to external or internal cues from the environment C. social contributions ■ stressful life events trigger our biological and physiological vulnerabilities to anxiety ■ most stressors are interpersonal D. triple vulnerability theory- integrated model describing a theory of development of anxiety 1. generalized biological vulnerability- heritable contribution to negative affect, uptight person ○ “glass is half empty” type, irritable, driven 2. generalized psychological vulnerability- perception of control developed in early experiences ○ sense that events are uncontrollable and unpredictable 2 ○ usually lack self confidence ○ inability to cope 3. specific psychological vulnerability- during early experiences learn that specific objects or events are to be associated with danger or fraught II. Comorbidity of Anxiety Disorders ■ comorbidity- co-occurrence of two or more disorders in a single individual ■ high rates of comorbidity among anxiety disorders possibly bc they vary only in what triggers them ■ common between anxiety and mood disorders III. Generalized Anxiety Disorder generalized anxiety disorder- characterized by intense, uncontrollable, unfocused, chronic, and continuous worry that is distressing and unproductive, accompanied by physical symptoms of tenseness, irritability, and restlessness A. statistics ■ approx 3.1% of individuals meet criteria for GAD in a one year period and 5.7% of people at some point in their lifetime ■ higher percent of people with panic disorder but this may only be to lack of GAD people seeking help ■ median age of onset is 31 usually because of a life stressor and is typically younger age of onset than other disorders ■ more common in women than men ■ higher percent of GAD is found in adults bc of more life stressors such as failing health and loss of meaningfulness B. causes ■ found that vulnerability is largely inherited ■ autonomic restrictors- individuals with GAD tend to show less responsiveness on most physiological measures than individuals with other anxiety disorders ○ exception is muscle tension which has a strong influence ■ highly sensitive to threat especially if it has personal relevance ■ studies of cognition found: ○ intense frantic thought processes and worry regarding upcoming events ○ avoidance of images associated with threat C. treatment ■ GAD is common and available treatments both drug and psychological are effective ■ in short term psychological and drug treatments work about the same but in long term psychological is more effective ■ cognitive behavioral treatment (CBT)- patients evoke the worry process during therapy sessions and confront anxiety provoking images and thought head on ○ individuals with GAD typically avoid feelings of anxiety and the threatening images associated with them ○ focusses on acceptance rather than avoidance of distressing thoughts IV. Panic Disorder with and without Agoraphobia panic disorder with agoraphobia (PDA)- fear and avoidance of situations the person believes might induce a dreaded panic attack agoraphobia- anxiety about being in places or situations from which escape might be difficult in the event of a panic attack, in severe cases person may be unable to leave the house 3 phobic avoidance- in PDA anxiety and panic are combined with this panic disorder without agoraphobia (PD)- panic attacks experienced without the development of agoraphobia A. the development of agoraphobia ■ characterized by unexpected panic attacks ■ their anxiety increases when feel they are in an unsafe location if a panic attack were to occur and always plan for rapid escape ■ agoraphobic avoidance can be experienced by someone who has never had a panic attack just need to fear the possibility of having one ■ DSM-says person either avoids situations or endures them with marked distress ■ interoceptive avoidance- avoidance of internal physical sensations, avoid situations that may be physiological arousing and can induce a panic attack B. statistics ■ fairly common 2.7% people experience in one year and 4.7 in a lifetime ■ agoraphobia without the history of a panic disorder is fairly common ■ more common in women (more acceptable for women to report fear, culturally disproving form men) ■ onset in early adulthood C. cultural influences ■ ataques de nervios- anxiety related culturally defined syndrome prominent among hispanic americans similar to panic attacks ■ cambodian and vietnamese refugees in the US suffer from high rates of panic disorder ○ attacks are associated with orthostatic dizziness (when stand up too quickly) D. nocturnal panic ■ 60% of people with panic disorder have experienced an attack while asleep ■ attacks starts when entering deepest stages of sleep (delta waves) ■ hypothesize that cause is the physical sensation of “letting go” when entering deep sleep ■ similar to sleep terrors in children ■ isolated sleep paralysis- when a person is about to fall asleep or wake up their body is temporarily paralyzed which causes panic ○ feature in REM sleep is lack of body movement E. causes ■ biological vulnerability ○ people who are more likely to be stressed or more likely to have an emergency alarm reaction (unexpected panic attack) during stressful events ○ particular internal and external cues in persons mind is associated to having a panic attack ○ learned alarms- cues associated with internal and external stimuli during a panic attack though a learning process ■ psychological vulnerability ○ person must be susceptible to developing anxiety over having another panic attack ○ associates bodily sensations they experience with possibility that they are having a panic attack ■ David Clark- cognitive theories state that the psychological vulnerability of people causes them to interpret normal physical sensations in a catastrophic way and biological predisposal to anxiety will cause additional sensations F. treatment 4 ■ medication ○ drugs that affect the noradrenergic, serotonergic, or GABA NT systems are effective in treating panic disorder ○ SSRI’s are currently the indicated drug ■ side effects include sexual dysfunctioning ○ benzodiazepines (xanax) work quickly but are hard to stop taking bc of psychological and physical dependence ■ adverse effects on cognitive and motor fx ○ drugs are effective if they continue to take them but if stop has a high relapse rate ■ psychological intervention ○ proven effective for panic disorder but doesn't cure ○ concentrated on reducing agoraphobic avoidance through exposure therapy ○ exposure therapy- patient gradually faces feared situations so that they can learn there is nothing to fear ○ combined with anxiety reducing coping mechanisms such as relaxation and breathing panic control treatment (PCT)- cognitive behavioral treatment for panic attacks, involving gradual exposure to feared somatic sensations and modifying patient’s perceptions about them, most people remain better after two years ■ combined ○ patients often see a clinician first before psychologists so often they are already on medication ○ National Institution of Mental Health looked at separate and combined effects of these two methods ■ all treatment groups were significantly better than the placebo ■ drug alone responded better than CBT alone ■ combined groups were the same (no better than individual treatments) ■ psych treatment was more effective long term a. effects of meds or combo deteriorated after 6 months effects of CBT alone lasted b. found drugs may interfere with the effects of psych treatment ○ “stepped care” approach in which is administered first followed by a second treatment is better than combining treatments from the beginning ○ D-cycloserine (DCS)- antibiotic drug that enhances the effects of psychological treatment ■ helps extinguish anxiety triggered by physical sensations V. specific phobia specific phobia- unreasonable fear of a specific object or situation that significantly interfered with daily life functioning A. clinical description ■ surveys indicate that the majority of the pop has a specific phobia ■ for most they are inconvenient and they can adapt to life by avoiding them B. Four major types blood inj
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