panic

Question 1

what is panic disorder?

Answer 1

• recurrent, unexpected panic attacks
• a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of different symptoms occur
• at least one of the attacks has been followed by 1 month (or more) of one or both of the following: (persistent concern/worry about additional panic attacks OR significant maladaptive change in behaviour related to attacks)

Question 1

what is agoraphobia?

Answer 1

• marked fear or anxiety about 2+ of following situations (using public transport, being in open space, being outside or home alone)
• the individual fears or avoids these situations because of thoughts that escape because it might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
• almost always provoke fear or anxiety
• actively avoided, require the presence of a companion

Question 2

what are the features of PD and agoraphobia - gender?

Answer 2

• 80-90% panic attacks develop after negative life event
• more prevalent in women
• female prevalence increases with higher avoidance
• expression of fear more acceptable in women
• men cope by drinking, smoking & enduring panic attack
• women cope by increasing avoidance > agoraphobia

Question 3

behavioural perspective on PD: interoceptive conditioning?

Answer 3

• initial panic attack
• linked by continuous pairings
• leads to recurrent panic attacks
• INTERNAL STIMULUS: physical/cognitive symptoms

Question 4

behavioural perspective on PD: exteroceptive conditioning?

Answer 4

• initial panic attack
• linked by continuous pairings
• leads to recurrent panic attacks
• EXTERNAL STIMULUS: specific situation

Question 5

what does the behavioural perspective say about PD?

Answer 5

• generalisation of conditioning to all places/situations where PA occurred and internal stimulus/symptoms experienced
• people with PD have a greater generalisation of conditioned response and slower extinction of conditioned anxiety

Question 6

what are the effects of behavioural therapy on PD?

Answer 6

• prolonged exposure to feared situations
• useful for 60-75% of people with agoraphobia & effects maintained at 2 & 4 year follow ups
• interoceptive exposure to feared internal sensations (e.g., breath control versus hyperventilation)

Question 7

what does the cognitive perspective say about PD?

Answer 7

• trigger stimulus (external/internal)
• leads to apprehensions
• leads to bodily sensations
• leads to interpretation of sensations as catastrophic
• we get automatic thoughts about the meanings of these bodily sensations and factors that influence these thoughts = maintenance and vulnerability factors

Question 8

who did a study on cognitive distortions in PD?

Answer 8

Teachman et al., (2007)

Question 9

who did a study on safety behaviours in PD?

Answer 9

Rachman et al., (2008)

Question 10

do people with PD frequently engage in safety behaviours (e.g., breathing slowly)?

Answer 10

YES

Question 11

are safety behaviours in PD good?

Answer 11

• yes as provide short=term anxiety relief
• but reinforce avoidance behaviours
• prevent disconfirmation of catastrophic beliefs

Question 12

is eliminating safety behaviours central in CBT?

Answer 12

YES

Question 13

what are nocturnal panic attacks?

Answer 13

• 50-60% experience a panic attack during sleep
• different from nightmares & other night terrors
• can’t be explained by cognitive theory – hard to understand how catastrophic cognitions may develop during sleep
• explained by interoceptive conditioning

Question 14

how does CBT help PD people?

Answer 14

recognise that catastrophic thoughts help maintain panic attacks & begin to challenge and restructure cognitions

Question 15

how does psycho-education help people with PD during CBT?

Answer 15

• adaptive value of anxiety
• function of fight-or-flight response
• panic cycle

Question 24

what techniques are used during BT for people with PD?

Answer 24

• psych-education
• self-monitoring of panic attacks
• identification of automatic thoughts and cognitive distortions (ABC model)
• interoceptive exposure
• exposure to feared situations and bodily sensations (without safety behaviours)