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From Last Class

Anxiety Disorders, Part I (Chapter 5) February 21, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. From Last Class. Phobia client video Nature of anxiety Pathways for acquiring a fear. Panic Attacks. DSM-IV panic attack symptoms (4 or more):

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From Last Class

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  1. Anxiety Disorders, Part I(Chapter 5)February 21, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

  2. From Last Class • Phobia client video • Nature of anxiety • Pathways for acquiring a fear

  3. Panic Attacks • DSM-IV panic attack symptoms (4 or more): • Palpitations, pounding heart, or accelerated heart rate • Sweating • Trembling or shaking • Sensations of shortness of breath or smothering • Feeling of choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, unsteady, lightheaded, or faint • Derealization or depersonalization • Fear of losing control or going crazy • Fear of dying • Numbness or tingling sensations • Chills or hot flushes

  4. Panic Attacks • Common in all anxiety disorders • Can occur in response to an obvious trigger or for no apparent reason (“out of the blue”) • If you experienced a full-blown panic attack for no apparent reason… • What might you conclude is happening? • What would you do to feel safe? • If nothing bad happened, why?

  5. Safety Behaviors • Intentional efforts to prevent a feared outcome • Normal and adaptive process in the presence of actual threat • Maladaptive if the behaviors occur in the absence of actual threat, or if they are out of proportion to the threat

  6. Safety Behaviors and Danger Prevention • Prediction:“People will notice and laugh at me if I blush” • SBs: wear clothes to hide face, extra make-up • Prediction:“I will make myself and others sick from germs” • SBs: use tissues to open doors, compulsive washing • Prediction:“Dogs are dangerous and I will be bitten” • SBs: avoidance, leash, muzzle • Prediction:“I am having a heart attack” • SBs: call doctor, take pulse, stay near hospitals

  7. Safety Behaviors • A person has had over 1,000 panic attacks. During each attack, the person feared having a heart attack. The person has never had a heart attack. Yet, the person continues to fear a heart attack with each new panic attack. • How can this phenomenon be understood?

  8. Harmful Effects of Safety Behaviors • The non-occurrence of catastrophe is attributed to safety behaviors rather than to the fact that the catastrophe would probably not have occurred anyway • Safety behaviors interfere with the disconfirmation of inaccurate beliefs about danger, thereby maintaining pathological anxiety

  9. Panic Disorder • DSM-IV diagnostic criteria: • Recurrent, unexpected panic attacks • At least 1 month of: • Persistent concern about additional attacks • Worry about implications of attacks • Change in behavior related to the attacks

  10. Agoraphobia • Diagnosed as either Panic Disorder With or Without Agoraphobia • Agoraphobia – nature and cause

  11. Statistics • Lifetime prevalence = 3.5% • Twice as common in women • About 1/3 also have Agoraphobia (75% of whom are women) • Typical age of onset = mid-teens through age 40

  12. Fear-Evoking Stimuli in Panic Disorder • Arousal-related body sensations • Activities/places/substances that evoke them, and situations in which, in the event of a panic attack • Help might not be available • Escape might not be possible • Embarrassment would be likely

  13. Fear-Evoking Stimuli in Panic Disorder

  14. Fear-Evoking Stimuli in Panic Disorder

  15. Fear-Evoking Stimuli in Panic Disorder

  16. Fear-Evoking Stimuli in Panic Disorder

  17. Fear-Evoking Stimuli in Panic Disorder

  18. Symptom-Outcome Associations in Panic Disorder SymptomFeared Outcome Palpitations Heart attack Dizziness Fainting Breathlessness Suffocation Nausea Vomiting Dissociation Insanity Observable symptoms Humiliation

  19. Treatment of Panic Disorder • Medications • Psychotherapy: Cognitive-Behavioral Therapy (CBT) • Combined treatment (CBT + drugs)

  20. Medications for Panic Disorder • Antidepressants and benzodiazepines • By far the most common treatments • Demonstrated short-term effectiveness • Antidepressants are about as effective as our best psychotherapies as long as they are being taken • Benzos are less effective and have serious addiction potential

  21. A Benzodiazepine Advertisement

  22. CBT for Panic Disorder • Most effective psychological treatment for panic disorder is cognitive-behavioral therapy (CBT) • Components: • Education about the anxiety/panic response • Disputing/modifying erroneous beliefs • Exposure to feared body sensations • Exposure to feared activities and places • Elimination of safety behaviors

  23. Panic Disorder Treatment Video • Intensive CBT for panic disorder with agoraphobia • http://www.youtube.com/watch?v=wE5F-FjbTRk

  24. Example Interoceptive Exposure Exercises • Exposure to feared body sensations (“interoceptive exposure”) -Shaking head -Swallowing quickly -Head between legs -Hold push-up -Running in place -Straw breathing -Holding breath -Hyperventilation -Spinning in chair -Staring at spot on wall -Gag response -Caffeine ingestion

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