Chapter 5 - Anxiety Disorders PANIC DISORDER Description - with &without Agoraphobia PD w/o Agora -...
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Transcript of Chapter 5 - Anxiety Disorders PANIC DISORDER Description - with &without Agoraphobia PD w/o Agora -...
Chapter 5 - Anxiety DisordersPANIC DISORDER• Description - with &without Agoraphobia• PD w/o Agora - panic attacks
- feeling of imminent death- numerous symptoms
(racing heart, sweating, dizziness)- “out of blue”- fear another attack
• PD w/Agora - avoid certain situations
- embarrassment, lack of help
- Rare
- More in women
Tx implications?
involve spouse, decrease aid
Possible Causes • Psychodynamic:
- anxiety from sexual/aggressive impulses leaking• Cognitive:
- Hypersensitive to internal states
- Misinterpret symptoms
- Perceive danger
Behavioral: Classical conditioning
• Panic attack (US) -> fear (UR)
• Associate place (CS) with panic attack
• Public place (CS) -> fear (CR)
(embarrassment, lack of assistance)
Agoraphobia = stimulus generalization (all places like 1st place)
Panic Treatment
Psychodynamic
• Uncover conflict
Cognitive
• Breathing retraining & relaxation
• Self-statements & reappraisal of fears
Biological
• Mild tranquilizers (Xanax)
Behavioral
• Systematic desensitization
• Barlow: gradual exposure to panic symptoms until fear decreases
Phobias
Description
• Fear specific object or situation
• No threat or threat is exaggerated
• Common fears, but heightened
• Phobia = impairs your life
Specific Phobias
• fear of specific situation/object
• animal, nature (childhood)
• blood-injection-injury
• ~11%
Agoraphobia
• fear situations/public places
• something bad might happen
• fear panic but no actual attacks
• avoid situation
Possible Causes
Psychodynamic
• Projection of own impulses onto object
• Avoid object to reduce anxiety& keep impulse out of awareness
Cognitive
• Catastrophize
Behavioral: Mowrer’s 2-Factor Theory
• 1st = fear is classically conditioned
• 2nd = fear maintained by operant conditioning
- avoid situation = avoid punishment
(negative reinforcement)
• Preparedness
- biologically prepared to fear certain stimuli harmful to ancestors
- harder to unlearn these phobias
Treatment • Best is behavioral (esp. specific phobia)
- Exposure to feared situation/object- Learn that it is not so frightening- Extinguish link of CS -> CR- Imaginal vs. in vivo exposure- Gradual (systematic) or flooding- Relax vs. not during exposure
Obsessive-Compulsive Disorder(OCD)
Description
• Anxiety if do not perform certain actions
Anxiety from certain thoughts
• Actions are pointless, often embarrassing
• Obsessions
- meaningless, troublesome thoughts that cannot stop
• Compulsions
- meaningless acts person feels forced to repeat
Possible Causes
Psychodynamic
• Obsessions = unconscious impulses
• Compulsions = behaviors that keep impulses unconscious
Cognitive
• Irrational beliefs: perfectionism & seeking approval of others
Treatment
• Systematic desensitization + response prevention
- Expose to thoughts and prevent behavior
- Tolerate thoughts until anxiety decreases
• Medication — SSRIs
Post-Traumatic Stress Disorder(PTSD)
Description
• Extreme anxiety related to specific trauma
• Trauma is “outside the normal range of human experience”
Symptoms
• Intrusive thoughts: reliving event
• Avoid reminders
• Emotional numbness
• Hypervigilance
• Dissociation - detachment from self & surroundings
Behavioral
• Classical conditioning - environment becomes conditioned stimuli for PTSD response
• Stimulus generalization - cues that resemble original situation trigger PTSD
Treatment
• Systematic Desensitization
- progressive exposure, imaginal or in vivo
• Flooding
- imagine worst-case scene
- multiple times until anxiety decreases
• Disagreement about flooding for trauma
Generalized Anxiety Disorder (GAD)
Description
• continual anxiety over everything
• “catch-all” vs. true disorder
Possible Causes
Cognitive
• General tendency to catastrophize, perceive threat
Behavioral
• Worrying modeled/reinforced