panic_and_agoraphobia.pptx Psychology dep.

panic_and_agoraphobia.pptx Psychology dep.

• 1.
  .
• 2.
  DSM-5 Anxiety Disorders •Specific phobias • Social anxiety disorder • Panic disorder • Agoraphobia • Generalized anxiety disorder Most common psychiatric disorders 28% report anxiety symptoms Most common are phobias
• 3.
  DSM-5 criteria foreach disorder: • Symptoms interfere with important areas of functioning or cause marked distress • Symptoms are not caused by a drug or a medical condition • Symptoms persist for at least 6 months or at least 1 month for panic disorder • The fears and anxieties are distinct from the symptoms of another anxiety disorder
• 4.
   Frequent panicattacks unrelated to specific situations  Panic attack • Sudden, intense episode of apprehension, terror, feelings of impending doom  Intense urge to flee  Symptoms reach peak intensity within 10 minutes • Physical symptoms can include:  Labored breathing, heart palpitations, nausea, upset stomach, chest pain, feelings of choking and smothering, dizziness, sweating, lightheadedness, chills, heat sensations, and trembling • Other symptoms may include:  Depersonalization  Derealization  Fears of going crazy, losing control, or dying  25% of people will experience a single panic attack (not the same as panic disorder)
• 5.
  Uncued panic attacks •Occur unexpectedly without warning • Panic disorder diagnosis requires recurrent uncued attacks • Causes worry about future attacks Cued panic attacks • Triggered by specific situations (e.g., seeing a snake)  More likely a specific phobia
• 6.
  Recurrent unexpected panicattacks At least 1 month of concern about the possibility of more attacks, worry about the consequences of an attack, or maladaptive behavioral changes because of the attacks
• 7.
  From the Greekword “agora” or marketplace Anxiety about inability to flee anxiety- provoking situations • E.g., crowds, stores, malls, churches, trains, bridges, tunnels, etc. • Causes significant impairment In DSM-IV-TR, was a subtype of Panic Disorder • At least half of agoraphobics do not suffer panic attacks
• 8.
   Disproportionate andmarked fear or anxiety about at least 2 situations where it would be difficult to escape or receive help in the event of incapacitation or panic- like symptoms, such as: • being outside of the home alone; traveling on public transportation; open spaces such as parking lots and marketplaces; being in shops, theaters, or cinemas; standing in line or being in a crowd  These situations consistently provoke fear or anxiety  These situations are avoided, require the presence of a companion, or are endured with intense fear or anxiety  Symptoms last at least 6 months
• 9.
   Women aretwice as likely as men to have anxiety disorder • Possible explanations  Women may be more likely to report symptoms  Men more likely to be encouraged to face fears  Women more likely to experience childhood sexual abuse  Women show more biological stress reactivity  Cultural factors • Culture can shape anxieties and fears • Culturally specific syndromes  Taijin kyofusho  Japanese fear of offending or embarrassing others  Kayak-angst  Inuit disorder in seal hunters at sea similar to panic • Rate of anxiety disorders varies by culture, but ratio of somatic to psychological symptoms appears similar (Kirmayer, 2001)
• 10.
   Neurobiological factors •Locus coeruleus  Major source of norepinephrine  A trigger for nervous system activity  People with panic disorder more sensitive to drugs that trigger the release of norepinephrine
• 11.
   Behavioral factors: •Interoceptive conditioning  Classical conditioning of panic in response to internal bodily sensations
• 12.
   Cognitive factors •Catastrophic misinterpretations of somatic changes  Interpreted as impending doom  I must be having a heart attack!  Beliefs increase anxiety and arousal  Creates vicious cycle  Anxiety Sensitivity Index • High scores predict development of panic  “Unusual body sensations scare me.”  “When I notice that my heart is beating rapidly, I worry that I might have a heart attack.”
• 13.
  Genetic risk • Polymorphismin a gene guiding neuropeptide S function, the NPSR1 gene, has been tied to an increased risk of panic disorder and is associated with:  Amygdala response to threat  Cortisol response  Higher anxiety sensitivity scores • Genetic risk shapes stress responses and hypersensitivity to somatic changes, and this may then increase the risk for panic disorder.
• 14.
  Fear-of-fear hypothesis (Goldstein& Chambless, 1978) • Expectations about the catastrophic consequences of having a public panic attack  What will people think of me?!?!
• 15.
   Psychological treatmentsemphasize Exposure • Face the situation or object that triggers anxiety  Should include as many features of the trigger as possible  Should be conducted in as many settings as possible  70-90% effective  Systematic desensitization • Relaxation plus imaginal exposure  Cognitive approaches • Increase belief in ability to cope with the anxiety trigger • Challenge expectations about negative outcomes
• 16.
  Panic Control Therapy(PCT; Craske & Barlow, 2001) • Exposure to somatic sensations associated with panic attack in a safe setting  Increased heart rate, rapid breathing, dizziness • Use of coping strategies to control symptoms  Relaxation  Deep breathing • PCT benefits maintained after treatment ends
• 17.
  Cognitive Behavioral Therapy(CBT) • Systematic exposure to feared situations • Self-guided treatment effective
• 18.
   Anxiolytics: drugsthat reduce anxiety • Benzodiazepenes  Valium  Xanax • Antidepressants  Tricyclics  Selective Serotonin Reuptake Inhibitors (SSRIs)  Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) • Side effects can be problematic with continuing medication  D-cycloserine (DCS)  Enhances learning and can bolstered treatment effectiveness