Chapter 7:

1. Chapter 7: Anxiety Disorders: Specific Phobia, Panic Disorder, Panic Disorder with Agoraphobia

2. What is anxiety? • Activation of the “fight or flight” response. • Associated with a variety of internal sensations. • An adaptive and future-oriented process. • More appropriately described as “anxious apprehension”

3. Panic Attacks • A discrete period of intense fear or discomfort, associated with four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes. • Accelerated heart rate* • Sweating • Trembling • Shortness of breath* • Choking • Chest pain* • Nausea • Dizziness • Derealization • Fear of losing control/Fear of dying* • Numbness • Chills/Hot flashes

4. Panic Attacks • Very common in the general population (around 20% past year prevalence). Higher rates have been found in college student populations. • May be limited symptom (< 4 symptoms), full symptom (< 4 symptoms), nocturnal, cued, or uncued. • Seen across the anxiety disorders.

5. Specific Phobia • Fear of a specific object, place, or situation. • Four types: Animal type, Environment type (e.g., water, heights), Situational type (tunnels, bridges), Blood-injection-injury (BII) type. • Very common. • Very treatable with strictly exposure-based behavioral treatments (e.g., systematic desensitization, flooding).

6. Panic Disorder • Uncued (spontaneous, “out of the blue”) panic attacks are the defining feature of panic disorder. • 3-4% of the general population will develop panic disorder in their lifetime. • Late adolescent to mid-thirties is when we are at the greatest risk to develop this disorder. • Associated with heightened risk for depression, suicide, and, of course, agoraphobia.

7. Theories of Panic Disorder • Psychodynamic • Unconscious, repressed anxiety being released. • Biological • Genetic component • Poor regulation of norepinephrine or serotonin • Carbon dioxide sensitivity In general, the physiological response of panic vs. non-panic individuals is about the same – suggesting that PD may be influenced by how we respond to our internal experience.

8. Theories of Panic Disorder • Fear of Fear • Behavioral: Classical conditioning • Panic is a conditioned response to internal stimuli (CS) associated with anxiety and fear • Not entirely clear about how PD develops. • Problem with this is that the CS and the CR are essentially the same, as are the US and UR. They are all panic/fear/anxiety.

9. Theories of Panic Disorder • Catastrophic Misinterpretation • Cognitive theory • Fear is not necessary for a panic attack to occur. • Individuals can misinterpret any bodily sensation. • Not a conscious process – automatic, becomes a habit (i.e., a bodily sensation is detected immediately followed by a catastrophic thought). • Engaging in “safety behaviors” in response to a catastrophic thought prevent the refutation of a catastrophic thought. • Gambler’s fallacy

10. Theories of Panic Disorder • Anxiety Sensitivity • Cognitive • Long-standing beliefs that the experience of anxious arousal will have negative physical (e.g., heart attack), social (embarrassment), or cognitive (“going crazy”) consequences. • These beliefs develop early in childhood. • High AS predicts the later development of panic. • Differs from catastrophic misinterpretation in that consequences are not necessarily immediate and anxiety sensitivity is considered to be learned (develops early in childhood).

11. Theories of Panic Disorder • False alarm theory • Panic attacks are “false alarms” – the misfiring of the body’s fight or flight response due to increased stress and dysregulation. • As a result of this first false alarm, individuals learn to fear low level bodily sensations because these are “signals” that a panic attack may occur. • “Seek to avoid” process is reinforced. • However, anxiety about having these bodily sensations further increases the intensity of those sensations to the point that individuals may actually have a panic attack.

12. Vulnerability • Genetics • Childhood environment (endorsement of sick-role behavior). • High levels of stress. • Poor coping (emotional avoidance). • Substance use (tobacco, marijuana).

13. Treatment • Psychopharmacology • Cognitive Restructuring • Relaxation (diaphragmatic breathing) • Interoceptive Exposure

14. Interoceptive Exposure • Induce bodily sensations associated with panic. • Head spinning (dizziness, disorientation) • Running in place (increased heart rate, sweating) • Hyperventilation (dizziness, increased heart rate, shortness of breath) • Chair spinning (dizziness, disorientation) • Breath holding (shortness of breath, choking) • Straw breathing (shortness of breath, dizziness) • Gag (feeling of nausea, vomiting)