01 14 19 Behavior Therapy Class 1 Treatment of Panic Disorder Lecture Overview Nature and epidemiology Etiology Empirically supported treatments Efficacy data Moderator variables Class discussion 01 14 19 Behavior Therapy Class 2 Epidemiology of Panic Disorder Defining features Unexpected panic attacks 01 14 19 Behavior Therapy Class 3 Distinguishing Features of Panic Attacks Intensity Sudden onset Unexpected nature Urge to flee Feeling of impending doom Four or more key symptoms 01 14 19 Behavior Therapy Class 4 Panic Attack Symptoms Shortness of breath or smothering sensations Dizziness or unsteadiness Heart racing or pounding Trembling or shaking Sweating Feelings of choking feeling throat constrict 01 14 19 Behavior Therapy Class 5 Panic Attack Symptoms Cont Nausea or abdominal distress Numbness or tingling sensations Chest pain or discomfort Feelings of unreality Feeling of dying Feeling of going crazy or losing control 01 14 19 Behavior Therapy Class 6 Epidemiology of Panic Disorder Defining features Panic related apprehension Persistent worry about having more attacks Unrealistic concern about the consequences of panic attacks Changes in behavior to cope with fear of mpanic safety behaviors 01 14 19 Behavior Therapy Class 7 Panic Related Appraisals Telch et al 1989 Perceived negative consequences of panic attacks 01 14 19 Physical Social Loss of control mental illness Functional incapacitation Behavior Therapy Class 8 Panic Related Appraisals Telch et al 1989 Overestimate the likelihood of panic occurrence Underestimate one s ability to cope with panic Exaggerate the negative consequences of panic attacks 01 14 19 Behavior Therapy Class 9 Epidemiology of Panic Disorder Prevalence General population 3 5 Primary care Cardiologists 6 10 30 50 Gender Distribution 2 to 1 Women for PD uncomplicated 4 to 1 Women for PD with agoraphobia Data from the National Comorbidity Study Kessler et al 1994 01 14 19 Behavior Therapy Class 10 Epidemiology of Panic Disorder Onset and course Onset occurs early to mid 20s Course is chronic 01 14 19 Behavior Therapy Class 11 Consequences of Panic Disorder Over utilization of medical services Work social and family disability Substance abuse Depression Agoraphobia 01 14 19 Behavior Therapy Class 12 What Causes Panic Disorder 01 14 19 Behavior Therapy Class 13 Factors Associated With First Panic Attack Stress Drugs Exercise Hyperventilation Relaxation Meditation Physical Medical Conditions 01 14 19 Behavior Therapy Class 14 01 14 19 Behavior Therapy Class 15 Men are disturbed not by things but by the views which they take of them Epictetus 60 A D Meanings are not determined by situations but we determine ourselves by the meanings we give to situations Adler 1931 01 14 19 Behavior Therapy Class 16 Cognitive Model of Panic Clarke 1986 Panic stems from a catastrophic misinterpretation of benign bodily sensations Treatment is aimed at correcting the patient s tendency to misperceive benign bodily sensations as threatening 01 14 19 Behavior Therapy Class 17 Examples of Somatic Misinterpretation Heart racing Lightheadedness Breathlessness Dissociation Stomach distress Sweating Muscle tightness 01 14 19 Heart Attack Faint Suffocation Insanity Vomit Faint Choking Behavior Therapy Class 18 Anxiety Sensitivity Construct Fear of Anxiety Petersen Reiss 1987 Perceived Negative Consequences of Anxiety Telch et al 1989 01 14 19 Behavior Therapy Class 19 Evidence Implicating Anxiety Sensitivity As a Risk Factor in Panic Elevated AS in panic disorder patients relative to normal and psychiatric controls 01 14 19 Behavior Therapy Class 20 Anxiety Sensitivity Across the Anxiety Disorders 40 35 30 25 20 15 10 5 PD GAD OCD Social Phobia Simple Phobia Data from Taylor et al 1992 Journal of Anxiety Disorders 6 249 259 01 14 19 Behavior Therapy Class 21 Evidence Implicating Anxiety Sensitivity As a Risk Factor in Panic Elevated AS increases panicogenic response to biologic challenge 01 14 19 Behavior Therapy Class 22 Effects of Anxiety Sensitivity and Expectancy of Arousal on Nonclinical Subjects Emotional Response to 35 Carbon Dioxide Inhalation Michael J Telch Patrick J Harrington University of Texas atAustin 01 14 19 Behavior Therapy Class 23 Expected Arousal Instructions This This study study investigates investigates the the ef effects fects of of carbon carbon dioxide dioxide inhalation inhalation on on mood mood You You will will be be taking taking aa single single vital vital capacity capacity breath breath containing containing either either 35 35 carbon carbon dioxide dioxide and and 65 65 oxygen oxygen or or normal normal room room air air Breathing Breathing the the carbon carbon dioxide dioxide mixture mixture may may result result in in various various physical physical feelings feelings of of arousal arousal such such as as rapid rapid breathing breathing heart heart rate rate acceleration acceleration sweating sweating and and dizziness dizziness or or lightheadedness lightheadedness Breathing Breathing in in the the room room air air will will not not result result in in any any different different physical physical feelings feelings besides besides those those you you might might normally normally experience experience after after taking taking aa full full breath breath You You will will need need to to exhale exhale completely completely hold hold your your nose nose tightly tightly closed closed and and then then take take aa full full and and complete complete inhalation inhalation from from the the mouthpiece mouthpiece connected connected to to the the bag bag of of gas gas Please Please hold hold this this breath breath for for five five seconds seconds after after you you finish finish the the inhalation inhalation II will will count count to to five five for for you you Let s Let s do do aa practice practice trial trial to to make make sure sure you you understand understand the the procedure procedure After After you you hold hold the the breath breath for for the the five five seconds seconds and and then then exhale exhale II will will hand hand you you aa form form to to fill fill out out Do Do you you have have any any questions questions 01 14 19 Behavior Therapy Class 24 Expected Relaxation Instructions This fects of This study study investigates investigates the the ef effects of carbon carbon dioxide dioxide inhalation on mood You will be taking a single inhalation on mood You will be taking a single vital vital capacity capacity
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