Panic Disorder

Question 1

why do we have anxiety?

Answer 1

it’s our inbuilt threat system - designed to alert us

Question 2

What is the physiology of anxiety?

Answer 2

Fight or flight response e.g. palpitations, shaking, sweating, nausea, dizziness etc

Question 3

What behavioural consequences are there of anxiety?

Answer 3

desire to avoid or escape

Question 4

What emotional consequences are there of anxiety?

Answer 4

Stress, worry, afraid, nervous, on edge

Question 5

What cognitive consequences are there of anxiety?

Answer 5

• Inflated sense of danger
• Worry ‘what if…’
• Cognitive biases - attention to threat, interpretation of threat, inflated sense of danger (catastrophising - lots of different unhelpful thinking styles will creep in)

Question 6

How are anxiety disorders characterised?

Answer 6

• fears out of proportion to the threat posed by the current situation
• recurrent or persistent
• limiting in terms of activities, goals, occupation or relationships

Question 7

What are the DSM-5 criteria for panic disorder?

Answer 7

• Panic Attacks
• Worry/anxiety about panic attacks or avoidance
• not due to drugs/medical condition
• not another anxiety disorder

Question 8

How does the DSM-5 define a panic attack?

Answer 8

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time 4 more symptoms occur.
The abrupt surge can occur from a calm state or an anxious state

Question 9

What is the lifetime prevalence of panic disorder?

Answer 9

1.5-3.5%

Question 10

What is the UK prevalence of panic disorder?

Answer 10

1.7%

Question 11

What distinct feature is there of panic attacks that separates it from other anxiety disorders with panic attacks?

Answer 11

Intense fear of experiencing panic attacks

Question 12

What biological theories are there of panic disorder?

Answer 12

• Hyperventilation
• Noradrenergic overactivity

Question 13

What psychological theories are there of panic disorder?

Answer 13

• Classical conditioning
• Anxiety sensitivity
• Catastrophic misinterpretation of bodily sensations
• psychodynamic theory of panic

Question 14

What is hyperventilation?

Answer 14

a rapid form of breathing that results in ventilation exceeding metabolic demand and has an end result of raising blood pH levels. a common feature of panic attacks

Question 15

What did Ley (1987) suggest about hyperventilation theory?

Answer 15

That shortness of breath & heart palpitations are the cause of panic attacks rathe than the effect.
- affects CO2 levels, resulting in a rise in pH levels producing mild symptoms
- continues to rise and passes a critical point where tolerance gives way to alarm and fear
- sympathetic nervous system takes over, further exacerbating panic symptoms

Question 16

What evidence is there for Ley’s hyperventilation theory?

Answer 16

• Biological challenge tests
• panic attacks induced by hyperventilation
• however. they’re only generated in individuals with a history of panic attacks

Question 17

What did Klein (1993) suggest about hyperventilation theory?

Answer 17

Suffocation Alarm Theories
- panic attacks are due to a ‘suffocation monitor’ in the brain that mistakenly signals a lack of useful air, triggering the suffocation alarm system
- CO2 acts as a panic stimulus, suggesting suffocation may be imminent
- People prone to panic attacks have an oversensitive suffocation alarm system

Question 18

What evidence is there for Klein’s suffocation alarm theory?

Answer 18

• People with panic disorder report more shortness of breath when anxious & greater fear of suffocation
• people without panic disorder focus on heart palpitations rather than respiratory symptoms
• however, whilst panic patients are hypersensitive to alterations in breathing, this is not specific to CO2
• cognitive symptoms, such as fear of dying or loss of control, were the most highly associated with a clinical panic attack

Question 19

What is the noradrenergic overactivity theory?

Answer 19

People with panic disorder may have overactivity in the noradrenergic neurotransmitter system

Question 20

What evidence is there for the noradrenergic overactivity theory?

Answer 20

• Drugs which increase noradrenergic function induce anxiety
• greater levels of norepinephrine have been shown to occur with anxiety conditions
• mechanism of action in some antidepressants maybe due to their ability to reduce central noradrenergic function
• people with panic may also be deficient in the GABA neurons that inhibit noradrenergic activity

Question 21

What is the issue with the noradrenergic overactivity theory?

Answer 21

Is it a cause or effect?

Question 22

How does classical conditioning explain panic disorder?

Answer 22

When stimuli, events or situations are paired with a panic attack, these conditioned stimuli then trigger panic when they are encountered again

Question 23

Explain Clark’s Model of Panic Disorder

Answer 23

Trigger stimulus (internal or external) lead to perceived threats (e.g. i’m going to faint)
These perceived threats cause apprehensions (e.g. anxiety) and/or interpretations of physical sensations (e.g. thinking they’re having a heart attack).
These lead to physiological sensations (e.g. palpitations, sweating)

Question 24

What is catastrophic misinterpretation?

Answer 24

• an appraisal that bodily sensations mean something terrible
• anxiety symptoms misinterpreted as being catastrophic

Question 25

What evidence is there for catastrophic misinterpretations?

Answer 25

- Phobia patients with panic attacks have more anticipation of illness, death or loss of control - bodily sensations are perceived first in panic attacks - patients are more likely to have a panic attack when bodily sensations are induced by sodium lactate (increased heart rate and BP) - CBT focused on catastrophic misinterpretation is effective in reducing panic attack frequency - people with panic report catastrophic misinterpretation

Question 26

What are safety behaviours?

Answer 26

activities intended to avoid the feared outcome may lead to short term decrease in anxiety but maintain unhelpful beliefs in the long run

Question 27

What should we do in CBT Assessment in Panic?

Answer 27

- Build relationship - Gather information - Socialise into the model (thoughts and feelings)

Question 28

What kind of assessments can we do specific to panic?

Answer 28

- Diary measures of panic attacks - Symptom-specific questionnaires e.g. panic disorder severity scale

Question 29

What should we do in CBT Formulation of Panic?

Answer 29

- formulate collaboratively with the client - use clark's model - help the client to understand the role of catastrophic misinterpretations - work through the model with personalised examples for the individual

Question 30

What should we do in CBT Intervention of Panic?

Answer 30

- test out the validity of cognitions - focus on catastrophic misinterpretations - review evidence for and against these cognitions - behavioural experiments - developing alternative cognitions - maybe to a thought record with them

Question 31

What common behavioural experiments are used in panic intervention?

Answer 31

- Reproduce symptoms of panic attacks (e.g. hyperventilation) - ask clients to stay in the feared situation rather than avoid them or engage in safety behaviours - make predictions and rate beliefs in this - then rate again afterwards - usually involved exposure to the feared situation

Question 32

What should we do in CBT Evaluation for Panic?

Answer 32

- evaluate treatment as you go along - may include idiosyncratic measures (panic attack diary, fear of panic attack subjective units of distress) - ask if they feel more capable to cope

Question 33

What are the 6 processes involved in a maintaining negative beliefs in an anxiety disorder?

Answer 33

- safety-seeking behaviours - attentional deployment - spontaneous imagery - emotional reasoning - memory processes - nature of the threat representations

Question 34

explain attentional deployment.

Answer 34

- selective attention towards threat cues may play a role in the maintenance of anxiety disorders by enhancing the perception of threat - attention towards threat cues and away from threat cues may both play a role in the maintenance of anxiety disorders

Question 35

explain spontaneous imagery.

Answer 35

- spontaneously occurring mental images in which patients see their fears realised -enhancing the perception of threat - images of physical and mental catastrophes

Question 36

explain emotional reasoning

Answer 36

- creating an 'emotional truth' which creates feelings of anxiety, fear and apprehension in existing stressful situations - patients use self-images and other anxiety-related interoceptive information to make erroneous inferences about how they appear to others

Question 37

explain memory processes

Answer 37

2 types: - Selective retrieval of negative memories and impressions of the observable self - Apparent dissociation between explicit and implicit memory, specifically between recall and priming

Question 38

explain the nature of the perceived threat

Answer 38

- out of the blue intense affect may be maintained because the threat cue that triggers the problem is out of awareness and so patients have difficulty recognising the inappropriateness of their reaction at the time it occurs - affected by the way you interpret your initial normal intrusive recollections and other symptoms - may engage in dysfunctional strategies that could prolong the intrusions

Question 39

what is an empirically derived treatment?

Answer 39

- targeting maintenance processes will make therapy more effective and efficient - developing with patients an idiosyncratic version of the cognitive model - examining and modifying negative beliefs

Question 40

what does cognitive therapy aim to do for anxiety disorders?

Answer 40

- educate - verbal discussion techniques - imagery modification - attentional manipulations - exposure to feared stimuli - manipulation of safety behaviours - behavioural experiments

Question 41

What are the different types of safety-seeking behaviours?

Answer 41

- direct avoidance - escape - subtle avoidance

Question 42

what are adaptive coping strategies?

Answer 42

something that individuals do in order to reduce anxiety, and does not maintain or worsen future responses to the same stimulus or stimuli - lack of negative impact compared to safety-seeking behaviours

Question 43

What 3 dimensions are used to distinguish between SS-Behaviours and helpful coping strategies?

Answer 43

- topology of the behaviour - intention behind the behaviour - consequences of the behaviour

Question 44

what are direct avoidance behaviours?

Answer 44

- most obvious - avoiding situations that have particular characteristics

Question 45

what are escape behaviours?

Answer 45

- similar to direct avoidance - includes leaving a particular room, building or area, or having to return to a perceived place of safety

Question 46

what are subtle ss-behaviours?

Answer 46

- harder to distinguish from adaptive coping strategies - include planned in advance or performed once the anxiety is experiences - don't seem to be safety behaviours but they are easier to identify based on the frequency with which they are reported by panic patients - e.g. carrying a bottle of water or meds

Question 47

what is an anxiety disorder?

Answer 47

a psychological disorder characterised by an excessive or aroused state and feelings of apprehension, uncertainty, and fear

Question 48

what are the 6 main anxiety and stress-related disorders?

Answer 48

- specific phobias - social anxiety disorder - panic disorder - generalised anxiety disorder (GAD) - obsessive-compulsive disorder (OCD) - post-traumatic stress disorder (PTSD)

Question 49

what is panic?

Answer 49

a sudden uncontrollable fear or anxiety

Question 50

what are biological challenge tests?

Answer 50

research in which panic attacks are induced by administering carbon dioxide enriched air or by encouraging hyperventilation

Question 51

what is anxiety sensitivity?

Answer 51

fears or anxiety symptoms based on beliefs that such symptoms have harmful consequences (e.g. that a rapid heartbeat predicts an impending heart attack0

Question 52

what is the Anxiety Sensitivity Index (ASI)?

Answer 52

a measure developed to measure anxiety sensitivity

Question 53

What are the 3 common treatments for panic disorder?

Answer 53

- Structured Exposure Therapy - CBT - Drug Treatment

Question 54

What drug treatments are effective?

Answer 54

Tricyclic antidepressants and benzodiazepines are an effective first-line treatment, but structured exposure therapy or CBT is as effective if not superior