Allyn & Bacon copyright 2000 1 Panic, Anxiety, and Their Disorders
Transcript
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Allyn & Bacon copyright 20001 Panic, Anxiety, and Their
Disorders Panic, Anxiety, and Their Disorders
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The Fear and Anxiety Response Patterns Fear & Panic A basic
emotion that involves the activation of the fight or flight
response of the SNS. Anxiety A general feeling of apprehension
about possible danger; much more diffuse than fear.
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Anxiety Disorder Any mental disorder characterized by
unrealistic, irrational fear or anxiety of disabling intensity.
DSM-IV-TR (Seven Types) Specific Phobia Social Phobia Panic
Disorder with Agoraphobia Panic without Agoraphobia Generalized
Anxiety Obsessive Compulsive Disorder Post-Traumatic Disorder
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Overview of Anxiety Disorders Anxiety Disorders as a group are
the most common diagnosis for women. Phobias in females are second
in prevalence to Depression Phobias are the fourth most common
diagnosis for men (etoh abuse, etoh dependency, major depression,
phobias)
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Phobic Disorders Phobias Specific phobias Fears of other
species or environment Social phobia Fear of social situations in
which a person is exposed to the scrutiny of others and is afraid
of acting in a humiliating or embarrassing way. Agoraphobia Anxiety
about having a panic attack in situations where escape might prove
difficult or embarrassing.
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Specific Phobia Marked and persistent fear that is excessive or
unreasonable, cued by the presence or anticipation of a specific
object or situation. (e.g., flying, seeing blood). Exposure to the
phobic stimulus almost invariably provokes an immediate anxiety
response, which may take the form of a situationally bound or
situationally predisposed The person recognizes that the fear is
excessive or unreasonable. The phobic situation(s) is avoided or
else is endured with intense anxiety or distress. The avoidance,
anxious anticipation, or distress in the feared situation(s)
interferes significantly with the person's normal routine,
occupational (or academic) functioning, or social activities or
relationships, or there is marked distress about having the phobia.
In individuals under age 18 years, the duration is at least 6
months.
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Specific Phobias Five Subtypes Animal Natural Environment
Blood-injection Situational (flying) Atypical (choking)
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Phobias (cont.) Most common fears include in order: snakes,
being in high exposed places, mice, flying on an airplane, being
closed in a small place, spiders and insects, thunder and
lightning, being alone in a house at night, and dogs.
Blood-Injection-Injury Phobia has unique physiological response Age
of onset and gender differences in specific phobias: Lifetime
Prevalence: Women 16% Men 7% Onset typically in childhood. Animal
phobias are equal in boys and girls but boys tend to outgrow them
In adulthood 90-95% of people with animal phobias are women. Sex
ratio is less than 2 to 1 for blood-injection.
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Specific Phobias: Psychosocial Causal Factors Symbolic
displacement of repressed id impulse Learned (classical
conditioning-generalized) Vicarious / Observational Classical
Conditioning Experiences before, during, and after exposure are
determinants of the strength of the phobia Cognitive Bias Maintain
and Strengthen Phobia Availability Heuristic Genetic and
temperamental causal factors Temperament and Personality
(Behaviorally Inhibited; shy & timid) Evolutionary Factors
Selective Advantage
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Treatment of Specific Phobias Exposure Controlled with Gradual
Exposure Expose for long enough time that fear begins to subside
Participant Modeling Therapist models interacting with the feared
situation or object in a calm and non-fearful manner.
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Social Phobia General characteristics Lifetime Prevalence Women
15% Men 11% during their lifetime Over 50% suffer from another
anxiety disorder. Approximately 40% suffer from a depressive
disorder at some point. Approximately 1/3 abuse etoh at one point
Onset Adolescence and Early Adulthood
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Social Phobia: Psychosocial and Biological Causal Factors
Learned Behavior Direct and Vicarious Classical Conditioning)
Social Fears and Phobias: Evolutionary Context Dominance and
Aggression) Genetic and Temperamental factors Behavioral Inhibition
(shy) Perceptions of Uncontrollability Cognitive variables (vicious
cycle) Experience Fear- Avoidant or Odd Behavior Results- Others
Avoid or Become Less Friendly-Confirmation of Expectations and
Beliefs
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Treatment for Social Phobia Medications Beta-Blockers (used for
high blood pressure) Anti-depressants and Anxiolytics High relapse
rates with discontinuation of meds Behavioral Therapy Social Skills
Training Counter-Conditioning Cognitive Therapy Challenge Negative
Automatic Thoughts Cognitive-Behavioral Therapy
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Panic Disorder and Agoraphobia Panic Disorder Unexpected panic
attacks that occur suddenly Panic versus Anxiety Distinguished by
Brevity and Intensity Reach peek in 10 min. Subside at 20-30 min.
Agoraphobia Fear of being in a place or situation from which escape
would be physically difficult or psychologically embarrassing, or
in which immediate help would be unavailable Usually develops as a
result of panic attacks
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Panic Disorder An anxiety disorder marked by a minutes-long
episode of intense dread in which a person experiences terror and
accompanying chest pain, choking, or other frightening sensations.
The person must have experienced recurrent unexpected attacks and
must have been consistently concerned about having another attack
or worried about the consequences of having another attack for at
least one month. To be considered a full blown panic attack the
episode must involve the abrupt onset of at least 4 of 13 symptoms
e.g.: Shortness of breath Heart palpitations Sweating Dizziness
Depersonalization (feeling detached from ones body) Derealization
(feeling that the outside world is unreal) Fear of dying, going
crazy, losing control
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Panic Disorder Prevalence and age of onset Age 15-24 but also
in 30s & 40s (Women) Typically follows a chronic course More
prevalent in women (2-4 x) Comorbidity with other disorders GAD,
Depression, Alcohol Abuse Timing of a first panic attack Frequently
follows a distressing event
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Panic: Biological Causal Factors High Noripinephrine activity
in the Locus Coeruleus Altering Serotonin levels also decreases
panic.
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Panic Disorder: Cognitive & Behavioral Causal Factors 1)
Interoceptive Conditioning Model Interoceptive Fears Fears focused
on various internal bodily functions Introreceptive Conditioning
(bodily sensations become associated with panic attacks and then
acquire the capacity to invoke panic) 2) Cognitive Model Focuses on
the meaning placed on physiological sensations. See next
slide>
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Panic Circle Hypersensitivity to bodily sensations Dire Thought
with Catastrophizing Thought fuels increase in bodily response
Vicious out-of-control cycle
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Panic Disorder: Cognitive Theory II. Perceived Control as a
blocker to panic Pre-existing Anxiety Sensitivity High level of
belief that certain bodily symptoms may have harmful
consequences
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Treating Panic Disorder and Agoraphobia Medications
Benzodiazepine (Xanax) Behavioral and CBT Exteroceptive Exposure
Exposure to external situations Interoceptive Exposure Exposure to
internal bodily sensations Relapse greater with combination with
Meds. (likely due to attribution to med.)
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Generalized Anxiety Disorder Prevalence and age of onset
Two-thirds diagnosed are women 60-80% Report having had anxiety
since childhood. Unlike phobias, generalized anxiety disorder
involves the person not being able to identify the cause of the
anxiety. Smokers have a fourfold risk of a first-time panic
attack.
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Generalized Anxiety Disorder DSM-IV Criteria are as Follows:
Includes chronic excessive worry about a number of events and
activities (not identified) Must occur more days than not for at
least 6 months Worry must be accompanied by at least 3 of the
following Restlessness or feelings of being keyed up or on edge A
sense of being easily fatigued Difficulty concentrating or mentally
going blank Irritability Muscle tension Sleep disturbance
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Generalized Anxiety Disorder: Psychosocial Causal Factors
Psychoanalytic Viewpoint Classical Conditioning (many stimuli)
History of Unpredictable & Uncontrollable Events Content of
Anxious Thoughts Maladaptive Negative and Automatic Thoughts Focus
on the Positive Function of Worry Worry for them suppresses their
emotional and physiological responses to aversive stimuli. This
reinforces worrying. Cognitive Biases for Threatening
Iinformation
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Generalized Anxiety Disorder: Biological Causal Factors Genetic
Factors Scientists have identified a specific gene related to
anxiety and neuroticism A functional deficiency of GABA Xanax,
Valium, and Librium stimulate the action of gaba.
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Obsessive Compulsive Disorder Obsessions- persistent and
recurrent intrusive thoughts, images, or impulses that are
experienced as disturbing and inappropriate. Compulsions- overt
repetitive behaviors (such as hand washing, checking or ordering)
or covert mental acts (such as counting, praying, or saying certain
words silently). The person feels driven to perform the compulsive
behavior in response to an obsession. The person must recognize
that the obsession is a product of their own mind rather than from
external sources The involuntary behavior must cause marked
distress, consume excessive time, or interfere with occupational or
social functioning.
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Obsessive-Compulsive Disorder Prevalence and age of onset
Characteristics of OCD Types of compulsions Consistent themes
Comorbidity with other disorders
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Obsessive-Compulsive Disorder: Psychosocial Causal Factors
Psychoanalytic viewpoint Behavioral viewpoint OCD and preparedness
The role of memory Attempting to suppress obsessive thoughts
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Obsessive-Compulsive Disorder: Biological Causal Factors
Genetic influences Abnormalities in brain function The role of
serotonin
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General Sociocultural Causal Factors For All Anxiety Disorders
Cultural differences in sources of worry Taijin Kyofusho
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UNRESOLVED ISSUES Interdisciplinary research on the anxiety
disorders