5. WHO WHAT WHY HOW ? An example of John’s typical panic attack
6. WHO WHAT WHY HOW ? Symptoms of panic attack Intense apprehension and terror Impending doom Labored breathing Heart palpitations Nausea, chest pain Choking and smothering Dizziness Sweating Trembling Depersonalization Derealization Fears of losing control, going crazy Panic Disorder with Agoraphobia “ Anxiety about situations which would be embarrassing or difficult to escape if panic symptoms occurred” What are his symptoms Diagnosis? Symptoms of panic attack Intense apprehension and terror Impending doom Labored breathing Heart palpitations Nausea, chest pain Choking and smothering Dizziness Sweating Trembling Depersonalization Derealization Fears of losing control , going crazy Do John’s symptoms fit the disorder? recurrent unexpected panic attacks at least 1 of attacks followed by month of concern about having another attack concern about consequences of attack change in behavior because of attacks
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8. WHO WHAT WHY HOW ? Integrative Model of Causes and Maintenance of Panic Disorder Genetic factors Social Factors Physiological Factors Cognition (personality) Life Events Why did he develop this disorder? Etiology of Panic Disorder with Agoraphobia “ Fear of Fear” Hypothesis
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11. WHO WHAT WHY HOW ? Why did he develop this disorder? cognition Safety behaviors and safety signals 24 access to anti anxiety medication driving to side of road holding onto stationary objects remaining near walls Safety behaviors serve to maintain beliefs about the consequences of panic Lack of control over environment More attentive to signs of threat
12. WHO WHAT WHY HOW ? Negative life event Anxiety Somatic symptoms First panic attack Fear symptoms Panic disorder Psychological and biological vulnerability Belief that symptoms dangerous Why did he develop this disorder? The big picture GENETIC SOCIAL/ENVIRONMENTAL BEHAVIORAL COGNITIVE
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15. WHO WHAT WHY HOW ? How do we treat it? Course of treatment OUTCOME: panic and medication free 6 months after final session
