Ch 6: Panic, Anxiety, Obsessions, and their disorders

• Fear: alarm reaction is response to immediate danger
• Anxiety: general emotion of apprehension about possible future danger
• Body reacts differently to percieved danger and actual in the moment fear
• Fear response activates sympathetic nervous system. Fight, flight, or freeze response. Response to immediate danger. Take care of danger, evolutionarily beneficial to keep us alive
• Parasympathetic nervous system returns body to resting state
• Emotions, like fear and anxiety have 3 parts to them: physiological response, cognitive symptoms/emotional distress, Behavioral (avoidance and escape)
• Worry: negative expectations about the future that are excessive in relation to actual solution. It becomes a problem when it takes up too much time
• Metacognition: thinking about thinking
• Negative reinforcement increases the likelihood of escape/avoidance in the future by removing adverse stimulus
• How do we distinguish between normal and abnormal anxiety?

  Functional impairment (is it getting in the way of life), Developmental age (6 and 20 will show different symptoms), Sociodemographic factors (women are more likely to be diagnosed)
• Two Factor theory of condition anxiety: Acquired by classical conditioning (unvoluntary, begin to associate neutral stimulus with conditioned response, how fear is developed) Maintained by operant conditioning (Voluntary, negative reinforcement by removing stress through escape/avoidance alleviates anxiety, how fear is maintained)
• Vicarious: learn by observing others (type of classical conditioning)
• Anxiety disorders: group of disorders characterized by heightened physical arousal, cognitive distress, and behavioral avoidance of fear, objects, situations, or events
• Anxiety disorders are highly comorbid with other anxiety disorders and mood disorders
• In anxiety disorders: half people that will develop do so by 11 (very young onset) and there is a 31% lifetime prevalence
• Panic attack: discrete period of intense fear and physical arousal. Common in individuals with and without anxiety disorders
• Expected panic attacks are when there is an identifiable stressor to cause the arousal (normal)
• Unexpected panic attacks are when there is no reason/event to cause attack (this is not normal)
• Panic disorder: recurrent, unexpected panic attacks AND either persistent concern of future attacks or behavior changes related to attacks
• Panic disorders have very physical symptoms and 94% of people seek treatment normally in an emergency room
• Panic disorders are cross culturally prevalent and more common in women
• Agoraphobia: fear of situations where escape might be difficult, fear incapacitating/embarrassing symptoms. "fear of the marketplace" Usually associated with panic disorders very rare to stand alone
• Etiology of Panic disorders/ agoraphobia: cognitive- automatic thoughts related to physiological symptoms
• Etiology of Panic disorders/ agoraphobia: Fear of fear- hypersensitive to bodily sensations
• Etiology of Panic disorders/ agoraphobia: Anxiety sensitivity- trait-like characteristic, fear of negative consequences of anxiety
• Etiology of Panic disorders/ agoraphobia: behavioral- avoidance of internal physiological (interceptive) experiences
• Treatment for panic disorder/agoraphobia is PCT, panic control treatment: learn about the disorder, work on thought patterns, and break negative reinforcement of avoidance. MOST effective method
• Can treat panic disorders/agoraphobia with benzodiazepines (Xanax): doesn't work great since you can grow tolerance and withdrawal, negative reinforcement by suppressing anxiety
• Treatment of panic disorder/ agoraphobia with SSRI (selective serotonin reuptake inhibitors) antidepressants that are not fast acting and are a more long term solution
• Specific phobias: often no diagnosis since not functionally impairing. Excessive fear/anxiety about specific object/situation
• 4 types of specific phobias are animal, natural environment, situational, and blood-injection-injury. The first three heighten the sympathetic nervous system
• Blood injection injury increases activation of parasympathetic nervous system. Higher heritability. When injured passing out drops heart rate so lose less blood, evolutionary beneficial
• Treatment of specific phobias: exposure therapy- gradual imaginal/real life exposure to feared stimulus, sometimes only need 1 appointment
• Classical conditioning associates fear and operant conditioning is negative reinforcement
• Social Anxiety Disorders is characterized by excessive fear of social situations that could involve evaluation. Fear that others will detect anxiety/ behave embarrassingly. Has developmental trajectory (shows up in adolescence and becomes more severe older)
• Social anxiety disorder biopsychosocial factors: associated with history of criticism/negative social experiences, or behavioral inhibition, decreased state of control, and distorted interpretations.
• Treatment of SAD: antidepressants (MAOI/SSRI) or CBT (cognitive behavioral therapy) which consists of psychoeducation, cognitive restructuring and exposure
• Generalized anxiety disorder is characterized by excessive anxiety/worry across many different domains. Must include psychological symptoms. Persistent and uncontrollable worry all day (metacognition), more common in women
• Biopsychosocial factors of GAD: worry reinforces worry (worry to cope/prepare for future), sensitive to threat, genetic predisposition (overlap with MDD), disruptions in neurotransmitter systems of serotonin (Amygdala is working too hard)
• Treatment of GAD: medication (antidepressants; SSRI)/ CBT, cognitive behavioral therapy: psychoeducation (talk about worry), cognitive restructuring (reframe mind), exposure (imaginal)/ and ACT, action and commitment therapy: Acceptance (anxiety is part of life, resist fight) and commitment (identify core values and stick with them even if you have anxiety)