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Chapter 5 - Anxiety Disorders. PANIC DISORDER Description - with &without Agoraphobia PD w/o Agora - panic attacks - feeling of imminent death - numerous symptoms (racing heart, sweating, dizziness) - “out of blue” - fear another attack. PD w/Agora - avoid certain situations

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Chapter 5 - Anxiety Disorders

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Chapter 5 anxiety disorders l.jpg

Chapter 5 - Anxiety Disorders

PANIC DISORDER

  • Description - with &without Agoraphobia

  • PD w/o Agora - panic attacks

    - feeling of imminent death

    - numerous symptoms

    (racing heart, sweating, dizziness)

    - “out of blue”

    - fear another attack


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  • PD w/Agora - avoid certain situations

    - embarrassment, lack of help

    - Rare

    - More in women

    Tx implications?

    involve spouse, decrease aid


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Possible Causes

  • Psychodynamic:

    - anxiety from sexual/aggressive impulses leaking

  • Cognitive:

    - Hypersensitive to internal states

    - Misinterpret symptoms

    - Perceive danger


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Behavioral: Classical conditioning

  • Panic attack (US) -> fear (UR)

  • Associate place (CS) with panic attack

  • Public place (CS) -> fear (CR)

    (embarrassment, lack of assistance)

    Agoraphobia = stimulus generalization (all places like 1st place)


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Biological

  • genetic sensitivity– overactive BAS

  • hyperventilation causes symptoms


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Panic Treatment

Psychodynamic

  • Uncover conflict

    Cognitive

  • Breathing retraining & relaxation

  • Self-statements & reappraisal of fears

    Biological

  • Mild tranquilizers (Xanax)


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Behavioral

  • Systematic desensitization

  • Barlow: gradual exposure to panic symptoms until fear decreases


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Phobias

Description

  • Fear specific object or situation

  • No threat or threat is exaggerated

  • Common fears, but heightened

  • Phobia = impairs your life


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Specific Phobias

  • fear of specific situation/object

  • animal, nature (childhood)

  • blood-injection-injury

  • ~11%


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Social Phobia

  • fear of being judged/embarrassed in social situations

  • 3-13%


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Agoraphobia

  • fear situations/public places

  • something bad might happen

  • fear panic but no actual attacks

  • avoid situation


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Possible Causes

Psychodynamic

  • Projection of own impulses onto object

  • Avoid object to reduce anxiety& keep impulse out of awareness

    Cognitive

  • Catastrophize


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Behavioral: Mowrer’s 2-Factor Theory

  • 1st = fear is classically conditioned

  • 2nd = fear maintained by operant conditioning

    - avoid situation = avoid punishment

    (negative reinforcement)


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  • Preparedness

    - biologically prepared to fear certain stimuli harmful to ancestors

    - harder to unlearn these phobias


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Treatment

  • Best is behavioral (esp. specific phobia)

    - Exposure to feared situation/object

    - Learn that it is not so frightening

    - Extinguish link of CS -> CR

    - Imaginal vs. in vivo exposure

    - Gradual (systematic) or flooding

    - Relax vs. not during exposure


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Obsessive-Compulsive Disorder(OCD)

Description

  • Anxiety if do not perform certain actions

    Anxiety from certain thoughts

  • Actions are pointless, often embarrassing


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  • Obsessions

    - meaningless, troublesome thoughts that cannot stop

  • Compulsions

    - meaningless acts person feels forced to repeat


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Possible Causes

Psychodynamic

  • Obsessions = unconscious impulses

  • Compulsions = behaviors that keep impulses unconscious

    Cognitive

  • Irrational beliefs: perfectionism & seeking approval of others


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Behavioral

  • Obsessions -> anxietycompulsions reduce anxiety

  • Modeling


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Treatment

  • Systematic desensitization + response prevention

    - Expose to thoughts and prevent behavior

    - Tolerate thoughts until anxiety decreases

  • Medication — SSRIs


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Post-Traumatic Stress Disorder(PTSD)

Description

  • Extreme anxiety related to specific trauma

  • Trauma is “outside the normal range of human experience”


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Symptoms

  • Intrusive thoughts: reliving event

  • Avoid reminders

  • Emotional numbness

  • Hypervigilance

  • Dissociation - detachment from self & surroundings


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1.Acute Stress Disorder

- lasts a few weeks

2.Post-Traumatic Stress Disorder

>1 month


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Possible Causes

Cognitive

  • Appraising threat as extremely traumatic

    Biological

  • Sympathetic NS


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Behavioral

  • Classical conditioning - environment becomes conditioned stimuli for PTSD response

  • Stimulus generalization - cues that resemble original situation trigger PTSD


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Treatment

  • Systematic Desensitization

    - progressive exposure, imaginal or in vivo

  • Flooding

    - imagine worst-case scene

    - multiple times until anxiety decreases

  • Disagreement about flooding for trauma


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Generalized Anxiety Disorder (GAD)

Description

  • continual anxiety over everything

  • “catch-all” vs. true disorder


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Possible Causes

Cognitive

  • General tendency to catastrophize, perceive threat

    Behavioral

  • Worrying modeled/reinforced


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Biological

Genetic predisposition + decreased GABA

  • GABA = inhibits firing

  • Less GABA=more firing


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Treatment

Behavioral

  • Relaxation exercises (deep breathing, progressive muscle)

    Cognitive

  • Discover & retrain automatic thoughts

    Biological

  • Medications to stimulate GABA


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