Panic Disorder

• Anxiety that turns the corner into terror• Bouts of panic that come on suddenly, often

with little or no warning• Include some of the following: heart

palpitations; tingling in hands, feet; shortness of breath, sweating, hot & cold flashes; trembling; chest pains; faintness; dizziness; feeling of unreality.

Panic Disorder

• Recurring bouts of panic dysfunctional changes in thinking & behavior

• Fears of “losing my mind”

• Avoidance of increasing # of places/things

• Panic Disorder can lead to agoraphobia

Panic Disorder

• What Causes Panic Disorder? – We don’t really know; many factors.

• But: Strong evidence that norepinephrine is involved.

• Norepinephrine: neurotransmitter especially active in Locus ceruleus part of the brain.

• Digression….

Models of Abnormality

Biological model

How the brain’s anatomy & physiology affect emotions, cognitions & behavior

Models of Abnormality

Biological model: Anatomy (structures)

Neo-Cortex

Corpus callosum

Amygdala

Locus ceruleus

Models of Abnormality

Biological model: Physiology (processes)

Nerve impulse

Panic Disorder

• Anti-depressant drugs that regulate norepinephrine successful in treating panic

• When Locus ceruleus stimulated in monkeys panic like behavior

• Locus ceruleus rich in norepinephrine carrying neurons

• Hypothesis: Norepinephrine dysregulation may well be implicated in Panic Disorder

Panic Disorder

• Anti-depressant drugs

• Exposure-based treatment

• Support groups to venture out & gradually reduce avoidance behaviors

• Cognitive treatments to reduce focus on, and misinterpretation of bodily signals

Treatment

Obsessive-Compulsive Disorder

Obsession: Uncontrollable thoughts, ideas, impulses

Compulsion: Rigid, repetitive acts used to reduce anxiety

Example: “Germs are everywhere. I know they are. I better go wash my hands 53 times one more time.”

Obsessive-Compulsive Disorder

• We all harbor some O-C behaviors – can you think of any?

• O-C Disorder: When they become excessive and interfere with daily functioning.

• Equally common in men and women.

• Often associated with depression.

Obsessive-Compulsive Disorder

Obsessions: Can take the form of wishes, impulses, images, ideas, or doubts.

Common Obsessions: Dirt & germs; violence; inappropriate vocalizations; sexuality.

Obsessive-Compulsive Disorder

Compulsions: Usually recognized as unreasonable; yet cannot be ignored or avoided.

Suffer dreads horrible consequences if they abandon the compulsive behavior.

Common Compulsions: Hand washing; cleaning; “checking”; “ordering”; my friend & his backpack.

Obsessive-Compulsive Disorder

• Anxiety rooted in repressed ID impulses• Impulses = obsessive thoughts• Compulsions = ego defenses against them• E.g.: Lady Macbeth: Anxiety/guilt over

her part in a murder compulsive hand washing to get rid of the imagined blood.

• How would you treat Lady Macbeth?

Psychodynamic Perspective

Obsessive-Compulsive Disorder

• Focus on compulsions, not obsessions• Theory: association forms randomly between

fear/anxiety reduction and the compulsive behavior

• Compulsive behavior becomes reinforcing because it reduces anxiety

• Therefore compulsion increases in frequency

Behavioral Perspective

Obsessive-Compulsive Disorder

• Behavioral treatment: break the link between anxiety & compulsive behavior

• Induce anxiety, prevent the compulsive behavior

• Eventually, the link is broken• However, treatment does not address the

underlying obsessions

Behavioral Perspective

Obsessive-Compulsive Disorder

• Focus on OCD as a mental phenomenon

• Compulsive thoughts/acts are those that reduce “bad” thoughts & are therefore reinforced, becoming compulsions

• CBT researchers have demonstrated strong link between OCD & depression

Cognitive Perspective

Obsessive-Compulsive Disorder

• CBT Treatment: Habituation Training, a form of exposure

• Elicit anxiety-provoking thoughts repeatedly to diminish their power

• Then, use distraction to prevent use of compulsions to alleviate anxiety

Cognitive Perspective

Obsessive-Compulsive Disorder

• Drugs that increase Serotonin activity are somewhat effective in treating OCD

• Serotonin is also active in 2 brain areas that have been associated with OCD: the orbital region of the frontal cortex and caudate nucleus

Biological Perspective

Caudate nucleus

Orbital frontal cortex