1
Q
What is a panic attack?
A
abrupt surge of intense fear or discomfort that is diagnosed by presence of 4 or more of 13 physical and cognitive symptoms
2
Q
Name 4 of the 13 physical/cognitive symptoms
A
- Palpitations
- Pounding/accelerating heart
- Sweating
- Trembling and shaking
3
Q
What is the difference between a full-blown panic attack and a limited symptom attack?
A
- Full-blown defined as four or more symptoms
- Limited symptom defined as fewer than four symptoms
4
Q
How is panic disorder characterized?
A
- repeated unexpected panic attacks (no obvious trigger)
- at least 1 month of persistent worry or concern about the recurrence of panic and its consequences OR significant maladaptive behavioral change related to the attacks
5
Q
When does the surge of fear in a panic attack peak?
A
- within minutes, generally around 10 minutes
6
Q
At what baseline state do panic attacks occur?
A
- anxious or calm (either one)
7
Q
What are examples of maladaptive behavioral change related to panic disorder?
A
- avoidance of activities where panic attacks are expected to occur
- safety behaviors (going to medical facilities frequently)
8
Q
With what specific phobia are panic attacks highly comorbid?
A
- agoraphobia
9
Q
How is agoraphobia characterized?
A
- marked fear or anxiety about situations from which escape might be difficult or in which help might be unavailable in the event of panic-like or other incapacitating symptoms
10
Q
The diagnosis of agoraphobia requires fear of at least two of the following symptoms:
A
- Public transport
- Open spaces
- Enclosed spaces
- Standing in line or being in a crowd
- Being outside of home alone
11
Q
Panic attacks are often seen as a specifier in other disorders. What makes panic attacks in these cases different from panic disorder?
A
- they only occur in the context of that disorder (panic attacks occur only when recovering from effects of alcohol in AUD, etc.)
12
Q
What are the two unique action tendencies seen in panic disorder?
A
- urges to escape
- urges to fight
13
Q
What is non-cognitive panic?
A
when perceptions of loss of control, dying, or going crazy are refuted, despite reports of intense fear and arousal
14
Q
What is nocturnal panic?
A
- found mainly in those with panic disorder that wake from sleep in a state of panic w/symptoms similar to panic attacks that occur during wakeful states, though it is separate from night terrors, sleep apnea, etc
15
Q
What is the estimated prevalence for panic disorder based on National Comorbidity Survey Replication?
A
- 2.4% (12 month)
- 4.7% (lifetime)
- 6.8% (lifetime morbid risk)
16
Q
Agoraphobia without history of panic disorder occurs at roughly what rate?
A
one third of the rate of panic disorder
17
Q
What percent of individuals with panic disorder have at least one other mental or chronic physical disorder?
A
93.7% - extremely high! (typically a specific phobia, GAD, social phobia, MDD, SUD)
18
Q
What percent of people w/panic disorder meet criteria for a current comorbid personality disorder?
A
- 25-60%
19
Q
What is the ratio of female to men with panic disorder?
A
2F : 1M
20
Q
How early is the onset of panic disorder in children? Is it typically comorbid with other disorders in children?
A
- onset can be as early as 6 years old
- tend to be chronic and comorbid w/other anxiety, mood, and disruptive disorders
21
Q
What kinds of explanations are children more likely to apply in relation to their panic, in contrast to adolescents?
A
- Children more likely to apply external explanations for panic and adolescents more likely to apply internal explanations (I’m going crazy)
22
Q
Do people with panic disorder report more identifiable stressors than those without panic disorder?
A
- not necessarily, but they find these stressors far more distressing than someone without panic disorder
23
Q
Is panic disorder typically chronic? Does it have a more positive or negative prognosis than GAD and SAD?
A
- tends to be highly chronic (especially comorbid w/agoraphobia), only modest decreases in severity over a 14 year follow-up
- more positive prognosis
24
Q
What is interoceptive avoidance?
A
strong sensitivity to and avoidance of the internal bodily symptoms associated with anxiety and panic
25
What are behavioral manifestations of interoceptive avoidance?
- actions intended to minimize exposure to situations, substances, or activities that reproduce bodily sensations associated w/symptoms of anxiety and /or panic attacks (ie avoiding exercise, sex, caffeine, wearing a necktie, etc.)
26
What are safety behaviors?
behaviors which are intended to avoid disaster
27
What are some examples of safety behaviors?
making sure a bathroom or hospital is close by, carrying antianxiety medication, bringing along a safe person
28
Why are safety behaviors not necessarily beneficial to someone with panic disordder?
- reduce anxiety in short term but serve to maintain panic disorder in the long term by preventing disconfirmation of the patient’s catastrophic predictions about panic and/or extinction of conditioned responses
29
What is experiential avoidance?
occurs when a person is “unwilling to remain in contact with particular private experiences [eg. bodily sensations, emotions, thoughts, memories, behavioral predispositions] and takes steps to alter the form or frequency of these events and the contexts” in which they occur
30
What are some examples of experiential avoidance?
- Interoceptive avoidance and any type of distractive behaviors count
- Unwillingness to experience anxiety and fear-related thoughts and emotions through distraction
- Thought suppression
31
People with panic disorder have strong beliefs and fears of physical or mental harm arising from ... sensations that are associated with panic attacks (give example)
- bodily
- ex: cardiovascular exercise
32
Adults with panic disorder showed increased activation in what part of the brain (according to an EEG study)?
- right frontal hemisphere (could reflect a more acute emotional response in response to fear stimuli)
33
Many studies of cognitive tasks and EEGs have found associations of panic disorder and deficits in ----, but none have been entirely consistent?
memory (typically autonomic memory processes)
34
What area is most activated in those with panic disorder when threat words are presented (according to fMRI studies)? What does this imply?
- left posterior cingulate and dorsolateral prefrontal cortex
- greater processing of threat-related words in those with panic disorder
35
What is neuroticism? How is it associated with panic disorder?
- proneness to experience negative emotions in response to stressors
- temperament variable most associated w/anxiety disorders
36
What is negative affectivity?
- tendency to experience an array of negative emotions across a variety of situations, even in the absence of objective stressors
37
How is negative affectivity useful?
- higher-order factor that distinguishes individuals w/anxiety and/or depressive disorders from controls with no mental disorder (lower-order factors further discriminate among anxiety disorders, fear of fear being factor that disc. panic disorder from other anx. disorders)
38
What type of parenting & attachment style (in an infant) may predict anxiety disorders later in childhood and adolescence?
- early insecure attachment caused by unpredictability and unresponsiveness of parents
39
What did the hyperventilation study demonstrate?
- adolescents who witnessed their parents escape a voluntary 3-minute hyperventilation (fear of panic-like symptoms) were more likely to escape themselves than those whose parents stayed the full 3 minutes without panicking
40
What other illness or physical abnormality has been associated with anxiety/panic disorder?
- respiratory disturbances/abnormalities
41
What childhood experiences could predict panic disorder (though it may also predict several others and lacks specificity)?
- physical and/or sexual abuse
42
Why is there often a relationship between stressful events and panic disorder?
1. higher neuroticism may contribute to more frequent/potent stressful events
2. stressful life events may precipitate initial panic attacks and contribute to repeated occurence over time
3. more stressful life events can lead to increased risk for anxiety disorder
43
What would a stress-diathesis perspective look like?
- hypothesizes that stressful life events interact with preexisting vulnerabilities to produce panic attacks and panic disorder
44
Heritability accounts for what percentage of the variance in panic disorder?
- 30-40%
45
Which gene has been a target of investigation across mood and anxiety disorders?
- polymorphism 5-HTTLPR, a promoter region on the serotonin transporter gene
46
There are strong associations between the 5-HTTLPR gene and what trait (often seen in higher levels in panic disorder)?
- neuroticism
47
Why is the 5-HTTLPR gene complex?
- many contradicting studies, with several finding clear links to panic disorder, and several disputing it - either way there is likely some genotypic association
48
What role does the amygdala play in panic disorder?
amygdala serves as mediator of input from the environment and stored experience which then triggers anxiety and panic response by activating brain regions involved in panic symptoms like the hypothalamus, locus coeruleus, and parabrachial nucleus
49
How does the ventromedial prefrontal cortex play a role in panic disorder?
Evidence suggests that the vmPFC may be underactive in panic disorder, resulting in diminished inhibitory inputs to the amygdala and further brain regions
50
What is the role that the prefrontal cortex plays in relation to panic disorder?
- those with panic disorder may experience inhibiting deficits of prefrontal cortex when modulating amygdala activity
51
other neurocircuitry hypotheses relating to those w/panic disorder (5)
| lower levels of? dysregulated? lower volume of? higher variability of?
## Footnote
impaired neuronal...?
- lower baseline GABA levels / blunted sensitivity to benzodiazepine -- could be seen in many psychological disorders
- dysregulated HPA axis and autonomic nervous system -- elevated HPA reactivity to specific environmental cues but no difference in baseline levels
- lower pituitary gland volume
- high cardiac vagal tone and heart rate variability -- could be seen across anxiety disorders
- impaired neuronal uptake of noradrenaline
52
Etiology (causes) of panic disorder (4)
- neuroticism
- anxiety sensitivity - acquired through lifetime of direct aversive experiences including vicarious observation (watching parents)
- impaired discriminative learning between safety and danger cues which create a context in which fear conditioning more readily occurs and generalizes
- catastrophic misappraisals/misinterpretations of bodily sensations (not necessarily a cause but accompanies PD)
53
Why is anxiety sensitivity a risk factor for panic disorder? (2)
- primes reactivity to bodily sensations
- predicts subjective distress and reported symptoms in response to procedures that induce strong physical sensations
54
Different types of assessment of panic disorder
- interviews
- clinical rating scales
- self-report and behavioral measures
- behavioral tests
- ongoing assessment
- neurobiological assessment
55
Why is an in-depth interview valuable (1) and what types of interviews are there (3)? (4)
- differential diagnosis and interrater reliability
- Schedule for Schizophrenia and Affective Disorders-- Lifetime Version
- Structured Clinical Interview for DSM-IV
- Anxiety Disorders for Interview Schedule (DSM-5)
56
What does the ADIS-5 do (1) and why is it the most valuable interview (3)?
- evaluates anxiety disorders, mood disorders and somatoform disorders, screens for psychotic and drug conditions
- facilitates a reliable method of gathering info to make differential diagnoses among anxiety disorders
- provides info to distinguish between clinical & subclinical presentations of a disorder
- interrater reliability ranges from satisfactory to excellent
57
Panic Disorder Severity Scale
| what is it? what is the cutoff score to identify those w/panic disorder?
- seven-item clinical rating sclae measure
- provides a dimensional severity rating, cutoff score of 8 on PDSS identifies patients w/panic disorder w/high sensitivity (83%) and acceptable specificity (64%)
58
CSRs
| what are they? more or less commonly used than PDSS?
## Footnote
based on info gathered from what...? what rating indicates indv. meets diagnostic criteria for given disorder?
- clinical severity ratings of distress and disablement scale
- more commonly used than PDSS as dimensional ratings for panic disorder and other anxiety disorders
- based on info gathered from diagnostic interview
- rating of 4 or higher indicates individual meets diagnostic criteria for a given disorder
59
DSM-5 Anxiety Disorders Subgroup preliminary scale
| what type of measure & how many items
- 10-item dimensional rating sclae for panic disorder and separate scale for agoraphobia
60
Anxiety Sensitivity Index and multidimensional Anxiety Sensitivity Index-3
| type of measure? measures what? why is it good/bad (2)?
- self-report measures
- trait measures of threatening beliefs about bodily sensations (Body Sensations Questionnaire & Agoraphobic Cognitions Questionnarie - will tell more about particular bodily sensations feared most)
- good psychometric properties, discriminates panic disorder from anxiety disorders
61
Albany Panic and Phobia Questionnaire
| type of measure? measures what? is good/bad why?
- self-report measure
- measures fear of interoceptive stimuli
- shows good internal validity & test-retest reliability
62
Panic Disorder Self-Report (PDSR)
| measure based on what? why is it good/bad (4)?
- self-report measure based on DSM-IV panic disorder criteria
- demonstrates excellent sensitivity and specificity in diagnosing panic disorder, strong agreement with a structured diagnostic interview, good retest reliability, convergent and discriminant validity
63
Panic Disorder Screener (PADIS)
| type of measure? why was it developed (2)? why is it good/bad?
- self-report measure
- developed as a way to identify panic disorder in community settings and to assess symptom severity
- adequate validity and reliability as a measurement tool
64
behavioral test
- useful measure of degree of avoidance of specific situations
- can be standardized or individually tailored
65
1) Standardized behavioral test examples for panic disorder
2) what is measured (in addition) in those with agoraphobia
- target interoceptive sensations and typically include exercises such as spinning, running in place, hyperventilating
- anxiety levels recorded continuously along w/duration for which client continued each exercise
66
Pros & cons of behavioral tests
- con: susceptible to demand biases for fear and avoidance prior to treatment and for improvement after treatment
- pros: important supplement to self-report of agoraphobic avoidance because clients tend to underestimate what they can actually achieve, often reveal info if which the individual is not fully aware but is important
67
self-monitoring pros
- yields more accurate, less inflated estimates of panic attacks
- contributes to increased objective self-awareness (helps in CBT)
68
What is ongoing assessment? What are examples (names) of ongoing assessment?
- can be administered to patients at regular intervals during treatment to assess changes in panic symptomology
- Anxiety Sensitivity Index
- QQL (quality of life) measures capture wider impact of panic disorder treatment
69
Why might it be recommended to receive a medical evaluation (in addition to psychological eval) for panic disorder?
- medical eval rules out several conditions before assigning panic disorder and agoraphobia (ie thyroid conditions, caffeine or amphetamine intoxication, drug withdrawal, etc.)
- certain medical conditions can exacerbate panic disorder and agoraphobia (asthma, etc.)
70
What is the difference between fear, panic, and anxiety (broadly)?
- fear is our friend! - short-term response by a perceived threat
- panic very similar to fear, physiologically, but a false alarm (does not necessarily occur in the presence of a perceived threat)
- anxiety is future oriented, absence of perceived threat
71
What is a phobia, as described in the DSM?
- Marked, persistent, and excessive or unreasonable fear when in the presence of or anticipating encountering an object
72
What are the types of phobias (5)?
- animal-type
- natural environment-type
- Blood/injection/injury type
- Situational type (tunnels, bridges, elevators, flying)
- Residual “other” category
- Very common = choking, vomiting, illness, loud noises, falling down
73
According to the DSM, exposures to the [---] almost invariably produces a(n) [---] (in relation to specific phobias)
stimulus, anxiety response
74
According to DSM, a phobia situation is [...] or [...] with intense [...]
avoided, endured, distress
75
Some aspect of the phobia interferes with...
the person's normal functioning
76
Is fear of the object itself in specific phobias?
- no, fear is of the outcome of an interaction w/stimulus
77
How can the fear of airplanes be diagnosed as 2 different phobias?
- depends on reasoning behind the fear:
- Anna is afraid of airplanes because she fears falling from the sky and dying
- Sam is afraid of airplanes because he fears he will be trapped and unable to escape if he suddenly starts to feel dizzy or nauseated (agoraphobia)
78
How common are phobias? What is the percentage of prevalence of specific phobias? Agoraphobia?
- Phobias relatively common
- Specific: 12.5%
- Agoraphobia: 1.5%
79
What is the ratio of women to men developing phobias?
2 F : 1 M
80
Is comorbidity high or low with phobias? Can people outgrow phobias?
- Comorbidity very high- very often comorbid with other anxieties and depression
- Most children outgrow specific fears
- not true of other anxiety disorders
81
How are both classical and operant conditioning representative of potential etiological explanations for anxiety disorders (phobia, specifically)?
- Classical example: if we get struck by lightning (US), it will provoke fear in us (UR), over time the sound that we associated with lightning (thunder - NS), can provoke fear in us and becomes the CS
- Operant example: pulling candy machine lever, do i get candy bar or electric shock, would i then want to repeat the task
82
What is the two-factor theory (Orval Hobart Mowrer)?
- classical conditioning model of acquisition of phobia which are then maintained through operant conditioning
- ex: people begin to avoid things they are afraid of, makes anxiety go away which is negatively enforcing behavior, but has consequence of person never getting exposed leading the fear to be maintained
83
What is the evolutionary preparedness theory?
- It is adaptive to be afraid of some types of animals or environments - at some point, having a fear of snakes, for example, might help you to live longer
84
What did the Cook & Mineka (1990) study of evolutionary preparedness conclude?
- Some fears are easier to condition or easier to acquire because of some evolutionary processes (harder to condition a fear of flowers than a fear of snakes in monkeys)
85
How does life experience affect our fears/phobias of things?
- more exposure we have to things, the less likely we are to be afraid of them (tend to be much more afraid of sharks than outlets simply bc we interact w/sharks far less, even though outlets are much more dangerous)
86
Are monozygotic or dizygotic twins more likely to be consistent in their fears?
- Mz twins
87
What type of genetic temperament may make it easier to condition a fear in someone?
- high in neuroticism
88
How is a phobia different than panic disorder? Agoraphobia?
- panic disorder is spontaneous, phobias are stimulus-bound -- agoraphobia is situationally-bound panic
89
Why is avoidance a negative reinforcement of panic?
- When we avoid, we don’t learn any new information
- Exposure to the things that we’re afraid of
- Have to approach the thing that you’re afraid of to have a fulfilling life
90
What is the median age of onset of panic disorder?
- 24 years old
91
What is the range of age of onset in panic disorder? Is it relatively narrow or wide?
- narrow, rarely before adolescence or after middle age (between 14-34)
92
David Clark's theory of panic
- Panic attacks occur due to catastrophic misinterpretations of certain bodily sensations (ex: heart starts beating a little faster, the more we start thinking about that the more we get anxious and into a downward spiral that your body cannot regulate at all)
- Vicious cycle
- Symptoms usually internally-generated, though if you have too much caffeine or cocaine it can trigger a panic attack as well
93
What is anxiety sensitivity?
- trait-like differences in how fearful one is about physiological sensations of anxiety
94
Reiss & McNally theory of panic
- People high on anxiety-sensitivity trait more likely to panic when they experience anxiety – anxiety-sensitivity at baseline can predict how likely one is to experience a panic attack
PSYC 337
flashcards
Decks in class (9)
# Cards
-
chapter 114
-
chapter 2 - social anxiety disorder85
-
chapter 3 - panic disorder / specific phobias94
-
chapter 6 - posttraumatic stress disorder33
-
chapter 4 - generalized anxiety disorder57
-
chapter 7 - depressive disorders53
-
chapter 5 - obsessive compulsive disorder48
-
chapter 8 - bipolar disorder25
-
eating disorders1
