Psychology

1. .

2. DSM-5 Anxiety Disorders
• Specific phobias
• Social anxiety disorder
• Panic disorder
• Agoraphobia
• Generalized anxiety disorder
Most common psychiatric disorders
28% report anxiety symptoms
Most common are phobias

3. DSM-5 criteria for each disorder:
• Symptoms interfere with important areas of
functioning or cause marked distress
• Symptoms are not caused by a drug or a medical
condition
• Symptoms persist for at least 6 months or at least 1
month for panic disorder
• The fears and anxieties are distinct from the
symptoms of another anxiety disorder

4.  Frequent panic attacks unrelated to specific situations
 Panic attack
• Sudden, intense episode of apprehension, terror, feelings of
impending doom
 Intense urge to flee
 Symptoms reach peak intensity within 10 minutes
• Physical symptoms can include:
 Labored breathing, heart palpitations, nausea, upset stomach, chest
pain, feelings of choking and smothering, dizziness, sweating,
lightheadedness, chills, heat sensations, and trembling
• Other symptoms may include:
 Depersonalization
 Derealization
 Fears of going crazy, losing control, or dying
 25% of people will experience a single panic
attack (not the same as panic disorder)

5. Uncued panic attacks
• Occur unexpectedly without warning
• Panic disorder diagnosis requires recurrent uncued
attacks
• Causes worry about future attacks
Cued panic attacks
• Triggered by specific situations (e.g., seeing a snake)
 More likely a specific phobia

6. Recurrent unexpected panic attacks
At least 1 month of concern about the
possibility of more attacks, worry about the
consequences of an attack, or maladaptive
behavioral changes because of the attacks

7. From the Greek word “agora” or marketplace
Anxiety about inability to flee anxiety-
provoking situations
• E.g., crowds, stores, malls, churches, trains, bridges,
tunnels, etc.
• Causes significant impairment
In DSM-IV-TR, was a subtype of Panic Disorder
• At least half of agoraphobics do not suffer panic attacks

8.  Disproportionate and marked fear or anxiety about at
least 2 situations where it would be difficult to escape
or receive help in the event of incapacitation or panic-
like symptoms, such as:
• being outside of the home alone; traveling on public
transportation; open spaces such as parking lots and
marketplaces; being in shops, theaters, or cinemas; standing
in line or being in a crowd
 These situations consistently provoke fear or anxiety
 These situations are avoided, require the presence of
a companion, or are endured with intense fear or
anxiety
 Symptoms last at least 6 months

9.  Women are twice as likely as men to have anxiety disorder
• Possible explanations
 Women may be more likely to report symptoms
 Men more likely to be encouraged to face fears
 Women more likely to experience childhood sexual abuse
 Women show more biological stress reactivity
 Cultural factors
• Culture can shape anxieties and fears
• Culturally specific syndromes
 Taijin kyofusho
 Japanese fear of offending or embarrassing others
 Kayak-angst
 Inuit disorder in seal hunters at sea similar to panic
• Rate of anxiety disorders varies by culture, but ratio of somatic to
psychological symptoms appears similar (Kirmayer, 2001)

10.  Neurobiological factors
• Locus coeruleus
 Major source of
norepinephrine
 A trigger for nervous system
activity
 People with panic disorder
more sensitive to drugs that
trigger the release of
norepinephrine

11.  Behavioral factors:
• Interoceptive conditioning
 Classical conditioning of panic in
response to internal bodily
sensations

12.  Cognitive factors
• Catastrophic
misinterpretations of somatic
changes
 Interpreted as impending doom
 I must be having a heart attack!
 Beliefs increase anxiety and arousal
 Creates vicious cycle
 Anxiety Sensitivity Index
• High scores predict development of panic
 “Unusual body sensations scare me.”
 “When I notice that my heart is beating rapidly, I
worry that I might have a heart attack.”

13. Genetic risk
• Polymorphism in a gene guiding neuropeptide S
function, the NPSR1 gene, has been tied to an
increased risk of panic disorder and is associated
with:
 Amygdala response to threat
 Cortisol response
 Higher anxiety sensitivity scores
• Genetic risk shapes stress responses and
hypersensitivity to somatic changes, and this may
then increase the risk for panic disorder.

14. Fear-of-fear hypothesis (Goldstein & Chambless,
1978)
• Expectations about the catastrophic consequences
of having a public panic attack
 What will people think of me?!?!

15.  Psychological treatments emphasize
Exposure
• Face the situation or object that triggers anxiety
 Should include as many features of the trigger as possible
 Should be conducted in as many settings as possible
 70-90% effective
 Systematic desensitization
• Relaxation plus imaginal exposure
 Cognitive approaches
• Increase belief in ability to cope with the anxiety trigger
• Challenge expectations about negative outcomes

16. Panic Control Therapy (PCT; Craske &
Barlow, 2001)
• Exposure to somatic sensations associated with
panic attack in a safe setting
 Increased heart rate, rapid breathing, dizziness
• Use of coping strategies to control symptoms
 Relaxation
 Deep breathing
• PCT benefits maintained after treatment ends

17. Cognitive Behavioral Therapy (CBT)
• Systematic exposure to feared situations
• Self-guided treatment effective

18.  Anxiolytics: drugs that reduce anxiety
• Benzodiazepenes
 Valium
 Xanax
• Antidepressants
 Tricyclics
 Selective Serotonin Reuptake Inhibitors (SSRIs)
 Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
• Side effects can be problematic with continuing
medication
 D-cycloserine (DCS)
 Enhances learning and can bolstered treatment effectiveness