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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
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

slide2
PD w/Agora - avoid certain situations

- embarrassment, lack of help

- Rare

- More in women

Tx implications?

involve spouse, decrease aid

slide3
Possible Causes
  • Psychodynamic:

- anxiety from sexual/aggressive impulses leaking

  • Cognitive:

- Hypersensitive to internal states

- Misinterpret symptoms

- Perceive danger

slide4
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)

slide5
Biological
  • genetic sensitivity – overactive BAS
  • hyperventilation causes symptoms
panic treatment
Panic Treatment

Psychodynamic

  • Uncover conflict

Cognitive

  • Breathing retraining & relaxation
  • Self-statements & reappraisal of fears

Biological

  • Mild tranquilizers (Xanax)
slide7
Behavioral
  • Systematic desensitization
  • Barlow: gradual exposure to panic symptoms until fear decreases
phobias
Phobias

Description

  • Fear specific object or situation
  • No threat or threat is exaggerated
  • Common fears, but heightened
  • Phobia = impairs your life
slide9
Specific Phobias
  • fear of specific situation/object
  • animal, nature (childhood)
  • blood-injection-injury
  • ~11%
slide10
Social Phobia
  • fear of being judged/embarrassed in social situations
  • 3-13%
slide11
Agoraphobia
  • fear situations/public places
  • something bad might happen
  • fear panic but no actual attacks
  • avoid situation
possible causes
Possible Causes

Psychodynamic

  • Projection of own impulses onto object
  • Avoid object to reduce anxiety & keep impulse out of awareness

Cognitive

  • Catastrophize
slide13
Behavioral: Mowrer’s 2-Factor Theory
  • 1st = fear is classically conditioned
  • 2nd = fear maintained by operant conditioning

- avoid situation = avoid punishment

(negative reinforcement)

slide14
Preparedness

- biologically prepared to fear certain stimuli harmful to ancestors

- harder to unlearn these phobias

slide15
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

obsessive compulsive disorder ocd
Obsessive-Compulsive Disorder(OCD)

Description

  • Anxiety if do not perform certain actions

Anxiety from certain thoughts

  • Actions are pointless, often embarrassing
slide17
Obsessions

- meaningless, troublesome thoughts that cannot stop

  • Compulsions

- meaningless acts person feels forced to repeat

possible causes18
Possible Causes

Psychodynamic

  • Obsessions = unconscious impulses
  • Compulsions = behaviors that keep impulses unconscious

Cognitive

  • Irrational beliefs: perfectionism & seeking approval of others
slide19
Behavioral
  • Obsessions -> anxietycompulsions reduce anxiety
  • Modeling
treatment
Treatment
  • Systematic desensitization + response prevention

- Expose to thoughts and prevent behavior

- Tolerate thoughts until anxiety decreases

  • Medication — SSRIs
post traumatic stress disorder ptsd
Post-Traumatic Stress Disorder(PTSD)

Description

  • Extreme anxiety related to specific trauma
  • Trauma is “outside the normal range of human experience”
slide22
Symptoms
  • Intrusive thoughts: reliving event
  • Avoid reminders
  • Emotional numbness
  • Hypervigilance
  • Dissociation - detachment from self & surroundings
slide23
1. Acute Stress Disorder

- lasts a few weeks

2. Post-Traumatic Stress Disorder

>1 month

possible causes24
Possible Causes

Cognitive

  • Appraising threat as extremely traumatic

Biological

  • Sympathetic NS
slide25
Behavioral
  • Classical conditioning - environment becomes conditioned stimuli for PTSD response
  • Stimulus generalization - cues that resemble original situation trigger PTSD
treatment26
Treatment
  • Systematic Desensitization

- progressive exposure, imaginal or in vivo

  • Flooding

- imagine worst-case scene

- multiple times until anxiety decreases

  • Disagreement about flooding for trauma
generalized anxiety disorder gad
Generalized Anxiety Disorder (GAD)

Description

  • continual anxiety over everything
  • “catch-all” vs. true disorder
possible causes28
Possible Causes

Cognitive

  • General tendency to catastrophize, perceive threat

Behavioral

  • Worrying modeled/reinforced
slide29
Biological

Genetic predisposition + decreased GABA

  • GABA = inhibits firing
  • Less GABA=more firing
treatment30
Treatment

Behavioral

  • Relaxation exercises (deep breathing, progressive muscle)

Cognitive

  • Discover & retrain automatic thoughts

Biological

  • Medications to stimulate GABA
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