Task 3 - Anxiety & Panic Disorder

Question 1

Panic Attack

Answer 1

Discrete period of intense fear or discomfort;
-symptoms develop abruptly and peak within 10 minutes
in absence of triggers
-> certain situations but not every time

Question 2

Panic Attack Symptoms

Answer 2

Heart Palpitations
Sweating
Trembling, shaking
Shortness of breath or choking
Chest pain, discomfort
Nausea
Dizziness
Derealization/depersonalization

Question 3

Panic Disorder DSM criteria

Answer 3

A. Recurrent unexpected panic attacks
B. at least one attacks followed by one month or more of:
1. persistent concern about additional attacks
2. worry about implications of attack or consequences
3. clinically significant change in behavior related to attacks

Question 4

Panic Disorder Characteristics

Answer 4

• diagnosis when panics attacks become common occurrence
• can go with many episodes in a short time and then some time without panic attack
• fear of possessing life threatening illness
• tends to be chronic
• many show generalized anxiety, depression, alcohol abuse

Question 5

Panic Disorder Prevalence

Answer 5

3-5% lifetime prevalence

• more common in women
• onset usually between late adolescence and mid-thirties

Question 6

Agoraphobia

Answer 6

Fear of places where there might be trouble escaping or getting help if they become anxious or have panic attack
-> frequently developed by people with panic disorder

Question 7

Panic Disorder Genetic correlates

Answer 7

10% of first-degree relatives also have it

• twin studies: 30-40% due to genetics (transmitted vulnerability)
• Agoraphobia: attributable in part due to genetics

Question 8

Panic Disorder Neurobiological Contributors

Answer 8

Different functioning in limbic system (amygdala, hippocampus, hypothalamus)

• dysregulation of norepinephrine in locus ceruleus in brain stem
• > poorly regulated fight-or-flight response

Question 9

Panic Disorder Cognitive Model

Answer 9

Psychological Factors associated with disorder;

• anxiety sensitivity: belief that bodily symptoms have harmful consequences
• > interoceptive awareness: heightened awareness of bodily cues
• > interoceptive conditioning: slight increases in anxiety elicit conditioned fear

Question 10

Panic Disorder Integrated Model

Answer 10

Genetic vulnerability leads to vulnerability to dysreguulation of neurotransmitters involved in anxiety

• > lead to cognitive vulnerability: hyperattentive and misinterpretation of bodily sensations
• > anticipatory anxiety (panic disorder) and sometimes conditioned avoidance response (panic disorder + agoraphobia)

Question 11

Biological Treatments for Panic Disorder

Answer 11

Trycyclic Antidepressants
SSRIs & SNRIs
Benzodiazepines

Question 12

Tricyclic Antidepressants

Answer 12

Can reduce panic attacks and improve functioning of norepinephrine system & influence serotonin levels
-disadvantages: side effects and relapse upon discontinuation

Question 13

SSRIs & SNRIs

Answer 13

• effective in anxiety relief
• better tolerated than tricyclic antidepressants
• side effects as well (not as severe as trcyclic)

Question 14

Benzodiazepines

Answer 14

Suppress CNS by influencing GABA, norepinephrine, and serotonin

• effective at reducing panic attacks
• physically and psychologically addictive: withdrawal symptoms, can interfere with cognitive and motor functioning

Question 15

Cognitive Behavioral Therapy & Panic Disorder

Answer 15

• Confrontation with situations and thoughts causing anxiety: changing and challenging thoughts to extinguish behaviors
• components:
  1. teaching of relaxation and breathing techniques
  2. clinician guides in identifying catastrophic cognitions
  3. practicing relaxation & breathing techniques while experiencing panic symptoms
  4. Therapist challenges catastrophizing thoughts and teaches to challenge them
• > relief of panic attacks of 85-90% within 12 wweeks
• > better at preventing relapse

Question 16

Social Anxiety Disorder DSM criteria

Answer 16

A. marked and persistent fear of one or more social or performance situations; exposed to unfamiliar people or possible scrutiny by others
B. exposure to feared social situation provokes anxiety
C. person recognizes that fear is excessive or unreasonable
D. feared social or performance situations are avoided
E. avoidance/anticipation or distress in situations interferes with normal routine/functioning
F. under 18: duration at least 6 months
G. not due to effects of substance or medication
H. Criterion A is unrelated to another present medical condition

Question 17

Social Anxiety Disorder Characteristics

Answer 17

• fear of being judged or embarrassed in front of others
• causes disruptions in daily life
• onset as early as preschool
• > often related to bullying or high expectations of parents

Question 18

Social Anxiety Disorder Symptoms

Answer 18

in social situations:

• trembling
• feelings of confusion and dizziness
• heart palpitations
• full panic attacks
• think others see nervousness and judge them negatively

Question 19

Social Anxiety Disorder Prevalence

Answer 19

3-7% lifetime prevalence worldwide (US: 12%)

• more common in women
• tends to develop in early preschool or adolescence
• tends to be chronics once developing and if it remains untreated

Question 20

Biological Theory of SAD

Answer 20

-smaller amygdala

Question 21

Behavioral Treatments SAD

Answer 21

Exposure in absence of negative consequences to extinguish fear of object or situation

• > systematic desensitization
• Modelling
• flooding

Question 22

Modeling

Answer 22

Method used in treatment of SAD

• therapist may model (perform) each behavior before asking client to perform it
• > association with calm response of therapist reduces anxiety

Question 23

Flooding

Answer 23

Intense exposure to feared object until anxiety is extinguished
-> therapist prepares patient with relaxation techniques

Question 24

Cognitive Behavioral Treatments of SAD

Answer 24

Combination of behavioral with cognitive techniques

• > helps patient identify and challenge negative, catastrophizing thoughts when they’re anxious
• good at preventing relapse

Question 25

Biological Treatment of SAD

Answer 25

- e.g. Benzodiazepines - temporary relief but phobia remains - Antidepressants (monoamine oxidase inhibitors, SSRIs): effective but relapse prone

Question 26

Generalized Anxiety Disorder DSM Criteria

Answer 26

A. excessive anxiety & worry more days than not for at least 6 months about a number of events or activities B. person finds it difficult to control worry C. anxiety & worry associated with 3 or more symptoms (only one required for children D. focus of anxiety and worry not due to another disorder E. anxiety causes clinically significant distress or impairment in functioning F. disturbance not due to effects of substance or medication

Question 27

Symptoms of generalized anxiety disorder

Answer 27

1. Restlessness or feeling keyed up or on edge 2. easily fatigued 3. concentration problems 4. irritability 5. muscle tension 6. Sleep disturbance

Question 28

Cognitive Mediation Hypothesis for Panic Attacks

Answer 28

panic disorder patients have a stronger tendency to misinterpret certain bodily sensations -> more likely to interpret them as signs of impending physical or mental disorder

Question 29

Panic Disorder & Perceived Control

Answer 29

Interpretation believed to be most influential manipulation in inducing panic attacks as it facilitates expected affect and perceived control

Question 30

Catastrophic Cognitions in Panic Disorder and Agoraphobia

Answer 30

Hypervigilance to bodily sensations and tendency to focus on autonomic arousal - > misinterpretation of bodily sensations - cognitive constructs play role in misinterpretation: information, perceived, control, safety - attentional and memory bias in favor of physical threat cues

Question 31

Memory Bias in SAD

Answer 31

People high in Social Anxiety rated negative words as more descriptive than positive words (people low in SAD vice versa) - recalled significantly less positive words about public selves when anticipating giving a speech - > bias occurs at retrieval rather than encoding

Question 32

Social Performance Deficits in SAD

Answer 32

- people with SAD underestimate social performance primarily during speech and to lesser extent during conversation - actual performance problems during conversation but not during speech

Question 33

Interpretation and judgmental biases in social phobia

Answer 33

Negative interpretation of all social events irrespective of valence: ambiguous, positive, and negative events rated negatively by SAD patients -> judgment bias

Question 34

Clark & Wells cognitive model of SAD

Answer 34

1. Social situations interpreted as threatening due to dysfunctional beliefs (high standards for social performance, conditioned beliefs about evaluation) 2. Negative Evaluation expected because of dysfunctional beliefs - > cognitive, somatic, affective, and behavioral responses

Question 35

Rapee & Heimberg Model of SAD

Answer 35

SAD patients attach importance to receiving positive appraisal by others (assume others to be critical) - > form prediction about standard of performance they believe others expect & compare it to own mental representations - > negative evaluation anticipated if discrepancy is dected - > results in behavioral, cognitive and physical symptoms