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Chapter 7:. Anxiety Disorders: Specific Phobia, Panic Disorder, Panic Disorder with Agoraphobia. What is anxiety?. Activation of the “fight or flight” response. Associated with a variety of internal sensations. An adaptive and future-oriented process.

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Chapter 7:

Anxiety Disorders: Specific Phobia, Panic Disorder, Panic Disorder with Agoraphobia


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What is anxiety?

  • Activation of the “fight or flight” response.

  • Associated with a variety of internal sensations.

  • An adaptive and future-oriented process.

  • More appropriately described as “anxious apprehension”


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Panic Attacks

  • A discrete period of intense fear or discomfort, associated with four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes.

    • Accelerated heart rate*

    • Sweating

    • Trembling

    • Shortness of breath*

    • Choking

    • Chest pain*

    • Nausea

    • Dizziness

    • Derealization

    • Fear of losing control/Fear of dying*

    • Numbness

    • Chills/Hot flashes


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Panic Attacks

  • Very common in the general population (around 20% past year prevalence). Higher rates have been found in college student populations.

  • May be limited symptom (< 4 symptoms), full symptom (< 4 symptoms), nocturnal, cued, or uncued.

  • Seen across the anxiety disorders.


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Specific Phobia

  • Fear of a specific object, place, or situation.

  • Four types: Animal type, Environment type (e.g., water, heights), Situational type (tunnels, bridges), Blood-injection-injury (BII) type.

  • Very common.

  • Very treatable with strictly exposure-based behavioral treatments (e.g., systematic desensitization, flooding).


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Panic Disorder

  • Uncued (spontaneous, “out of the blue”) panic attacks are the defining feature of panic disorder.

  • 3-4% of the general population will develop panic disorder in their lifetime.

  • Late adolescent to mid-thirties is when we are at the greatest risk to develop this disorder.

  • Associated with heightened risk for depression, suicide, and, of course, agoraphobia.


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Theories of Panic Disorder

  • Psychodynamic

    • Unconscious, repressed anxiety being released.

  • Biological

    • Genetic component

    • Poor regulation of norepinephrine or serotonin

    • Carbon dioxide sensitivity

      In general, the physiological response of panic vs. non-panic individuals is about the same – suggesting that PD may be influenced by how we respond to our internal experience.


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    Theories of Panic Disorder

    • Fear of Fear

      • Behavioral: Classical conditioning

      • Panic is a conditioned response to internal stimuli (CS) associated with anxiety and fear

      • Not entirely clear about how PD develops.

      • Problem with this is that the CS and the CR are essentially the same, as are the US and UR. They are all panic/fear/anxiety.


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    Theories of Panic Disorder

    • Catastrophic Misinterpretation

      • Cognitive theory

      • Fear is not necessary for a panic attack to occur.

      • Individuals can misinterpret any bodily sensation.

      • Not a conscious process – automatic, becomes a habit (i.e., a bodily sensation is detected immediately followed by a catastrophic thought).

      • Engaging in “safety behaviors” in response to a catastrophic thought prevent the refutation of a catastrophic thought.

      • Gambler’s fallacy


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    Theories of Panic Disorder

    • Anxiety Sensitivity

      • Cognitive

      • Long-standing beliefs that the experience of anxious arousal will have negative physical (e.g., heart attack), social (embarrassment), or cognitive (“going crazy”) consequences.

      • These beliefs develop early in childhood.

      • High AS predicts the later development of panic.

      • Differs from catastrophic misinterpretation in that consequences are not necessarily immediate and anxiety sensitivity is considered to be learned (develops early in childhood).


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    Theories of Panic Disorder

    • False alarm theory

      • Panic attacks are “false alarms” – the misfiring of the body’s fight or flight response due to increased stress and dysregulation.

      • As a result of this first false alarm, individuals learn to fear low level bodily sensations because these are “signals” that a panic attack may occur.

      • “Seek to avoid” process is reinforced.

      • However, anxiety about having these bodily sensations further increases the intensity of those sensations to the point that individuals may actually have a panic attack.


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    Vulnerability

    • Genetics

    • Childhood environment (endorsement of sick-role behavior).

    • High levels of stress.

    • Poor coping (emotional avoidance).

    • Substance use (tobacco, marijuana).


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    Treatment

    • Psychopharmacology

    • Cognitive Restructuring

    • Relaxation (diaphragmatic breathing)

    • Interoceptive Exposure


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    Interoceptive Exposure

    • Induce bodily sensations associated with panic.

      • Head spinning (dizziness, disorientation)

      • Running in place (increased heart rate, sweating)

      • Hyperventilation (dizziness, increased heart rate, shortness of breath)

      • Chair spinning (dizziness, disorientation)

      • Breath holding (shortness of breath, choking)

      • Straw breathing (shortness of breath, dizziness)

      • Gag (feeling of nausea, vomiting)


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