Term
Panic Disorder
(+Agoraphobia) |
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Definition
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Term
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Definition
-Recurrent, unexpected, intense attacks of anxiety; in beginning attacks seem to come out of the blue
-peak within 10 min.
-At least 1 attack is followed by a month (or more) of either of the following:
-fearing another attack
-a change in behavior related to the attacks
-Note: early attacks are "unexpected“
-but tend to occur following anything physically arousing
--most symptoms are somatic (physical): up to 90% first show up at physician or emergency room- also related to ‘fear of dying…’ |
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Term
associated symptoms
(4 or more) |
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Definition
| shortness of breath, dizziness, trembling, sweating, choking, nausea, numbness/tingling sensations, hot flashes or chills, chest pain, derealization, depersonalization, *fear of dying, losing control, going crazy* |
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Term
(associated symptoms)
derealization |
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Definition
| things/surroundings don't seem real; world seems distorted in color/shape/size |
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Term
(associated symptoms)
depersonalization |
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Definition
person’s body seems distorted in color/shape/size
-fear of dying is usually related to respiratory/heart (heart attack, suddenly stop breathing and suffocate); losing control/going crazy – person is worried they’ll have an emotional meltdown and often accompanied by extreme embarrassment, so person tends to avoid open/public places |
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Term
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Definition
(fear of open spaces) avoid open places where you could embarrassed yourself or where you can’t get help
-about 50% of panic pts develop it (Amering et al., 1997)
-at least 75% of pts who have AgP have prior hx of panic attacks
-factors associated with development of AgP (Amering 97- pts w/ and w/o agp and interviewed about first panic attack- pts w/ agp had first panic attack occurred in public and was accompanied by embarrassment) |
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Term
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Definition
-pts also develop
- avoid situations that produce arousal that resembles beginnings of attack (aerobics, watching horror movies, arguments, sex) (avoidance of internal sensations, arousal avoidance) |
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Term
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Definition
-specific phobia (hundreds...)
-social phobia (fear of being negatively evaluated by other people)
--because pts with these two sometimes have panic attacks when confronted with thing they’re most scared of (specific situations)while panic attacks in panic disorder are random/unpredictable and are not tied to a specific situation |
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Term
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Definition
lifetime prevalence: 3%
F:M : for PD 2:1; for PD w/ AgP 4:1
-more social pressure on males to not act like they’re afraid?confronting scary situations with help of alcohol (because they have higher rates of alcohol abuse)
mean age of onset: late teens- mid 30s
-(wide range b/c panic disorder more likely to occur during stressful periods of life (marriage, job promotion, leaving home and going to college/living on one’s own))
social consequences: marital discord, depression, alcohol abuse, job absence |
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Term
etiology
(just an intro card) |
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Definition
| genetics, biological factors, cognitive factors |
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Term
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Definition
| concordance: 31% for MZ and 11% for DZ |
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Term
biological factors
(etiology) |
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Definition
-lactate (lactic acid) theory (original theory is dead)
-panic attacks can be induced chemically using sodium lactate infusion (injection…) (lactate is natural byproduct of exercise- heart rate, breathing increases, more aroused)
-occurs for 70% of people with prior hx of panic attacks; 10% without hx
-perhaps problem is body's inability to metabolize lactate?- no, no problem with body metabolizing lactate (however CO2, hyperventilating, noradrenalin also trigger panic attacks in those with hx- 50/60% compared to 10%...)
-apparently anything that alters bodily sensations or produces arousal precipitates panic attacks (lactate itself is not the problem…) |
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Term
cognitive factors
Clark's cognitive model
(etiology) |
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Definition
Clark's cognitive model (1986)
-“anxiety sensitivity”- fearing that bodily sxs are potentially harmful (measured with anx sensitivity index); plays key role in Clark’s model… (this one theory explains everything)
-panic attacks result from catastophic misinterpretations of normal anxiety responses (e.g., palpitations, dizziness)
-palpitations
-breathlessness
-dizziness
-Clark's cognitive loop... |
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Term
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Definition
trigger stimulus --> perceived threat --> apprehension --> body sensations --> interpretation of sensations as catastrophic --> perceived threat...
-trigger stimulus- often an ordinary change in bodily sensations that are perceived as threatening
-apprehension- person starts to feel scared, increased self-focus and hyperventalation (getting anxious)
-body sensations- focus on body sensations with often amplfies them
-interpretation- an explosive thought, the beginning of the panic attack |
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Term
experiemental support for Clark's model
(air vs CO2) |
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Definition
| -Telch et al., in print: two groups of subjects (high and low anxiety sensitivity); put in room and breath either room air or CO2, then they manipulate expectations (as/before put in room tells half that it’s difficult to breathe in this room and other half is told to sit back and relax) [deadly combo is high anx breathing CO2 and relaxing- because others have ready explanation for why they can’t breathe) |
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Term
Clark's model is integrative
(accounts for everything...) |
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Definition
-genetics – inherit tendency to experience fluctuations in bodily arousal (over reactive ANS) (super sensitive nervous system)
-lactate – induces sensations (palpitations) that get misinterpreted
-excitation (caffeine, exercise, stress) – also induces sensations that get misinterpreted
-why antianxiety drugs work – damped the ANS(autonomic nervous system) and thus reduce bodily sensations [that could get misinterpreted]
-why panic attacks more common during stressful times- more sensations present to get misinterpreted |
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Term
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Definition
| -pharmacotherapy, cognitive restructuring, relaxation training |
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Term
pharmacotherapy
(treatments) |
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Definition
-antidepressants (tricyclics) - implicates serotonin (in general more effective)
-benzodiazapines (e.g., Xanax, Valium):
-side effects, addictive
-high relapse rates (esp without psychotherapy) |
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Term
cognitive restructuring
(treatments) |
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Definition
(via interoceptive exposure/exposure therapy- show that as you are exposed, nothing will happen to you)- try and correct the catastrophic misinterpretation
-induce sensations (via hyperventilation, spinning chair)
-teach client that these sensations are normal phys. responses (reattribution- attribute the sensations to normal responses…) |
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Term
relaxation training
(treatments) |
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Definition
| (breathing from diaphragm) to control attacks |
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Term
drugs VS CBT
[in PD treatment] |
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Definition
-after 12 wks of tx - 87% of CBT were panic free vs. 50% of drug treated clients; one year later – 87% mostly held up (still a lot better than drug-treated)
-in general, CBT > drug tx (higher success, lower dropout, and relapse rates) |
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Term
| Posttraumatic Stress Disorder (PTSD) |
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Definition
| arises from trauma that is outside the range of normal human experience (natural disaster, accident, deliberately caused (insulted, terrorist attack, concentration…) (also secondary ptsd- don’t have to be involved, but you watch it happen to someone (esp loved one)) |
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Term
four classes of sypmtoms
(associated with occurrence of trauma) |
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Definition
-traumatic event is repeatedly experienced (reliving…)
-memories (flashbacks)
-dreams
-distress when exposed to event that resembles trauma
-avoidance of stimuli assoc. with trauma
-psychogenic amnesia- (Freud’s theory-) repression (can’t remember certain parts of trauma)
-emotional numbing
-feeling detached from people (not feeling involved with people)
-restricted affect (not able to feel emotions)
-increased anxiety and arousal
-difficulty falling asleep
-irritability/outbursts of anger
-trouble concentrating
-hypervigilance- always being on guard
-startle response (war veteran- when car backfires, associate with explosion…)
-associated sxs
-drug abuse (self-med)- attempting to blunt the pain (alcohol…)
-depression
-survivor guilt (if only I did something differently they wouldn’t have died…)
-"delayed onset PTSD" – sxs begin > 6 mos after trauma (about 1/3rd of ptsd pts don’t experience ptsd until 6 mos after…) –usually triggered by mass media (tv, documentary, book, magazine…) |
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Term
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Definition
-Acute Stress Disorder
-sxs begin within a month of stressor and last less than a month (sxs essentially same as PTSD), about 80% who qualify have sxs that last long enough to get diagnosis of PTSD
--specific phobia (dog phobia)- also show avoidance; in some ways act like people who have PTSD (also show avoidance with stimuli associated with trauma)
-50% of specific phobics never directly experienced a trauma (vicarmious (CHECK!!) conditioning- observing/listening to others experiencing trauma
-specific phobics don’t meet additional criteria for PTSD (only avoidance in common) |
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Term
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Definition
prevalence: 7.8%
-greatly depends on intensity, type, and timing of trauma (and location…)
-20% of wounded Vietnam War vets
-94% of rape victims (assessed 1 wk after rape)- acute stress disorder at this time
-47% of rape victims (assessed 12 wks after rape)
F:M : 2:1 |
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Term
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Definition
| genetics, biological factors, preexisting mental problems, social support |
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Term
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Definition
| after controlling for amount of combat exposure, 2000 MZ twins show higher concordance (.35) than 2000 DZ twins (.17) (True et al., 1993) – predisposes person (despite how environmentally dependent) |
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Term
biological factors
(etiology) |
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Definition
-trauma may trigger [lasting] changes in brain functioning
-may damage the noradrenergic system (involved in body’s alarm reaction) resulting in chronically elevated levels of hormones (adrenaline and noradrenaline) that mobilize person for emergencies (puts them in hyper-aroused/-vigilant state)
-this makes person more hyper-reactive in non-threatening situations |
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Term
preexisting mental problems
(etiology) |
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Definition
(especially anxiety and depression-related symptoms prior to trauma)
-e.g., those scoring high in introversion and withdrawal (soft signs of avoidance…)(on MMPI) prior to entering service were more likely to develop combat-related PTSD |
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Term
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Definition
| -those with high levels of social support are less likely to develop PTSD, or recover faster |
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Term
classical conditioning
(example of acquisition and potentially delayed-onset) |
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Definition
UCS (gunshot) -- UCR (fear/startle)
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CS(hot, humid weather, tropical setting) --- CR (fear/startle)
-supported by Blanchard
-compared Vietnam vets with and without PTSD- (had both groups listen to sounds with headphones…) PTSD vets had higher heart rate increase to combat sounds (three types of sounds- music, silence, combat sounds- spike during combat)- they’re showing conditioned response in reaction to combat sounds…
-heightened amygdala activation may underlie differences in conditioned fear reactions (CR have a bio basis?) – Shinn et al. 97: compared vets with and w/o PTSD, PTSD vets had greater blood flow in amygdale when imagining combat related scenes |
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Term
Mowrer's 2 factor model
(explaining acquisition and persistence) |
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Definition
-fear acquired via classical conditioning (f1)
-avoidance maintained by operant conditioning (relief from anxiety) (f2)
UCS (rape) -- UCR (fear)
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CS(man, car, dark...) -- CR (fear)--> avoidance/depression-relief (reinforces avoidance...) |
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Term
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Definition
-primary goal is gradual reexposure to stimuli associated with trauma (CS)
-extinction procedures
-imaginal flooding
-in vivo exposure (walking past sight of attack…)
-illustrated by Wirtz & Harrel, 1987- 165 victims; Foa & Rothbaum, 1998- treating trauma of rape)- 165 victims of violent assault and reexposed them to CSs, pts who underwent in vivo exposure had significantly less sxs than those who did not (they were much more likely to recover…) ; re-exposure therapy works
-what else is learned in exposure therapy
-anx doesn’t remain indefinitely; remembering trauma does not = re-experiencing it(less anx provoking, and safe); realization-there’s nothing I could have done; symbolically shaking hands with the enemy
EMDR (Eye Movement Desensitization and Reprocessing) Shapiro, 1989 |
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Term
eye movement desensitization and reprocessing (EMDR) - Shapiro 1989
(treatment) |
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Definition
Techniques:
1. desensitization phase:
-select memory that causes distress
-pt verbalizes negative thought about the memory (e.g., “I am unloveable”)
-therapist moves finger back and forth
-pt follows moving finger while concentrating on the disturbing image and thought
2. installation phase: (replace neg with pos)
-pt verbalizes positive thought about the memory (e.g., “I am deserving of love”)
-therapist moves finger back and forth
-pt follows moving finger while concentrating on the disturbing image and positive thought
-has undergone some changes- can use other forms of bilateral stimulation
-has been applied beyond PTSD- PD, alcohol abuse, sleep disorders, ADHD
-questions:
-Is a single session sufficient? –no
-Does EMDR provide therapeutic benefits compared to “no” treatment? –yes, effective (do significantly better than control group)
-Is EMDR more effective than other standard therapies? –no (why it’s quackery), because it’s basically exposure therapy
-Are the eye movements necessary? –no. just have to include exposure therapy
-Can patient “walk the walk”? –still questionable, probably not as much as in vivo
-overall appears to be variant of exposure therapy |
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