Chapter 4 o Anxiety Disorders Anxiety the future oriented mood state Somatic symptoms of tension Apprehension about future danger or misfortune Characterized by marked negative affect Negative emotion that causes physical symptoms and negative Fear the present oriented mood state Immediate fight or flight response to danger or threat Involves abrupt activation or the sympathetic nervous system Strong avoidance escapist tendencies Marked negative affect Anxiety and fear are normal emotional states Make you a better human to have these things than to not When are anxiety and fear abnormal When it impairs normal functions o Ex severe test anxiety may avoid the subject and not show up to the test maladaptive because you fail Characteristics of anxiety disorders Pervasive and persistent symptoms of anxiety and fear Cause clinically significant distress and impairment Involve excessive avoidance and escape What is a panic attack Abrupt experience of intense fear or discomfort 85 90 will experience a panic attack within the next Malfunction in your endocrine thalamus amygdala 3 years regions No one has ever died from a panic attack Several physical symptoms o Breathlessness chest pain Fear as an alarm response o True alarm o False alarm Getting robbed same symptoms of panic attack but is needed Extreme thoughts of death heart attack Many end up in the ER thinking they re having a heart attack when it s actually panic attack o Learned alarm Sensitization False alarms are turning into learned alarms 4 or more symptoms at the same time and it must reach the peak anxiety within minutes and subside in 30 minutes in order to be a panic attack Sweating Sensation of shortness of breath or smothering Feelings of choking Palpations pounding heart accelerated heart rate Trembling or shaking Chest pain or discomfort Nausea or abdominal distress Chills or heat sensation Paresthesias numbness or tingling Derealization or depersonalization Fear or losing control or going crazy Fear of dying Feeling dizzy light headed o Panic attacks at biological level Genetic vulnerability Anxiety and brain circuits o GABA o Norepinepherine o Serotonin o Corticotropin releasing factor CRP Activates the HPA axis Areas of the brain Limbic system o Amygdala Behavioral inhibition system BIS Jeffrey Gray Anxiety Know where the septum and formix is Septo hippocampal system Fight Flight System FFS Gray Graeff Panic fear Brain stem to midbrain o Amygdala o Hypothalamus o Central gray matter o Periadequeductal gray Behavioral and Cognitive views Invokes conditioning and cognitive explanations Anxiety and fear are learned responses Catastrophic thinking and appraisals play a role Experiences with uncontrollability and unpredictability o The role of Negative Reinforcement in the development and maintenance of anxiety disorders o Reinforcement increase in behavior o Negative taking something away o What is the negative component o Avoidance learning Integrative view triple vulnerability model o Generalized biological vulnerability o Generalized psychological vulnerability o Specific psychological vulnerability Common processes the problem of COMORBIDITY o Comorbidity is common across the anxiety disorders o Major depression is the most common secondary diagnosis o About half of patients have two or more secondary diagnosis o Comorbidity suggests Common factors A relation between anxiety and depression Cognitive Behavioral Therapy CBT o Exposure therapy Systematic desensitization Gradual exposure Flooding ANXIETY DISORDER NEW DAY Separation anxiety disorder o Classified as a disorder of infancy childhood or adolescence o Selective mutism Classified as disorder of infancy childhood or adolescence o Panic disorder o Specific phobia o Social anxiety disorder o Agoraphobia First time its been diagnosed as a disorder in dsm5 Overview and defining features o Experience of unexpected panic attack i e a false alarm o Develop anxiety worry or fear about another attack o Many develop agoraphobia DSM 5 panic disorder and agoraphobia are separate diagnoses Recurrent unexpected panic attacks o At least one of the attacks has been followed by 1 month or more of one or both of the following their consequences Persistent concern or worry about additional panic attacks or Losing control having a heart attack going crazy A significant maladaptive change in behavior related to the Facts and statistics attacks o Affects about 3 8 of the general population 1 year prevalence is 2 3 o Onset is often acute mean onset between 20 and 24 years of age Associated features o Nocturnal panic attacks 60 Panic occurs in stages 1 4 not 5 Classical conditioning panic disorder o Two stimuli are being associated with each other o Conditioned response to a stimulus that used to be neutral Interoceptive cues heart pounding o What is being associated with what o Ex building up smaller panics heart rate means heart attack sweating leads to dehydration then to death unrealistic panics Exteroceptive setting in which the panic occurs o What is being associated with what Causes o Triple Biological Vulnerability to stress Prone to panic attacks Psychological Conditioning Catastrophizing the results of a panic attack o Generalized psychological vulnerability stress false alarm learned alarm specific psychological vulnerability anxious apprehension panic disorder o Psychological and combined treatments CBT is highly effective Key to treatment for panic disorder Exposure to interoceptive and exteroceptive cues o Medication treatments Target serotonergenic noadrenergenic and GABA systems Relapse rates are high following medication discontinuation SSRIs Prozac and paxil are preferred drugs An unrealistic fear of an object or situation o Phobia o Types of phobias Agoraphobia Fear of certain places because escape might be difficult or embarrassing o Ex phobia of going to malls buses crowded areas because escaping these places would be deemed embarrassing so they avoid going to these places o More a generalized phobia rather than specific Specific phobia Social phobia Unrealistic fear of a specific situation or object Unrealistic fear of social situation s Tied to a fear or judgment and embarrassed o Agoraphobia women Now a separate diagnosis from panic Commonly co occurring with panic disorder especially among 30 50 of individuals experienced panic attacks or panic disorder prior to the agoraphobia typically before age 35 most likely late adolescence or early adulthood tends to