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Panic, Anxiety, and
Their Disorders
Allyn & Bacon copyright 2000
1
The Fear and Anxiety Response Patterns
 Fear & Panic
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A basic emotion that involves the activation of the
“fight or flight” response of the SNS.
 Anxiety
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A general feeling of apprehension about possible
danger; much more diffuse than fear.
Anxiety Disorder
 Any mental disorder characterized by unrealistic,
irrational fear or anxiety of disabling intensity.
 DSM-IV-TR (Seven Types)
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Specific Phobia
Social Phobia
Panic Disorder with Agoraphobia
Panic without Agoraphobia
Generalized Anxiety
Obsessive Compulsive Disorder
Post-Traumatic Disorder
Overview of Anxiety Disorders
 Anxiety Disorders as a group are the most
common diagnosis for women.
 Phobias in females are second in prevalence
to Depression
 Phobias are the fourth most common
diagnosis for men (etoh abuse, etoh
dependency, major depression, phobias)
Phobic Disorders
 Phobias
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Specific phobias
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Social phobia
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Fears of other species or environment
Fear of social situations in which a person is
exposed to the scrutiny of others and is afraid of
acting in a humiliating or embarrassing way.
Agoraphobia
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Anxiety about having a panic attack in situations
where escape might prove difficult or
embarrassing.
Specific Phobia
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Marked and persistent fear that is excessive or unreasonable,
cued by the presence or anticipation of a specific object or
situation. (e.g., flying, seeing blood).
Exposure to the phobic stimulus almost invariably provokes an
immediate anxiety response, which may take the form of a
situationally bound or situationally predisposed
The person recognizes that the fear is excessive or
unreasonable. The phobic situation(s) is avoided or else is
endured with intense anxiety or distress.
The avoidance, anxious anticipation, or distress in the feared
situation(s) interferes significantly with the person's normal
routine, occupational (or academic) functioning, or social
activities or relationships, or there is marked distress about
having the phobia.
In individuals under age 18 years, the duration is at least 6
months.
Specific Phobias
 Five Subtypes
 Animal
 Natural Environment
 Blood-injection
 Situational (flying)
 Atypical (choking)
Phobias (cont.)
 Most common fears include in order: snakes, being in
high exposed places, mice, flying on an airplane, being
closed in a small place, spiders and insects, thunder and
lightning, being alone in a house at night, and dogs.
 Blood-Injection-Injury Phobia has unique physiological
response
 Age of onset and gender differences in specific phobias:
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Lifetime Prevalence: Women 16% Men 7%
Onset typically in childhood.
Animal phobias are equal in boys and girls but boys tend to
outgrow them
In adulthood 90-95% of people with animal phobias are
women.
Sex ratio is less than 2 to 1 for blood-injection.
Specific Phobias:
Psychosocial Causal Factors
 Symbolic displacement of repressed id impulse
 Learned (classical conditioning-generalized)
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Vicarious / Observational Classical Conditioning
Experiences before, during, and after exposure are
determinants of the strength of the phobia
 Cognitive Bias Maintain and Strengthen Phobia
 Availability Heuristic
 Genetic and temperamental causal factors
 Temperament and Personality (Behaviorally
Inhibited; shy & timid)
 Evolutionary Factors
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Selective Advantage
Treatment of Specific Phobias
 Exposure
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Controlled with Gradual Exposure
Expose for long enough time that fear begins to
subside
 Participant Modeling
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Therapist models interacting with the feared
situation or object in a calm and non-fearful
manner.
Social Phobia
 General characteristics
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Lifetime Prevalence
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Women 15% Men 11% during their lifetime
Over 50% suffer from another anxiety disorder.
Approximately 40% suffer from a depressive disorder
at some point.
Approximately 1/3 abuse etoh at one point
Onset
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Adolescence and Early Adulthood
Social Phobia: Psychosocial and
Biological Causal Factors
 Learned Behavior
 Direct and Vicarious Classical Conditioning)
 Social Fears and Phobias: Evolutionary Context
 Dominance and Aggression)
 Genetic and Temperamental factors
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Behavioral Inhibition (shy)
 Perceptions of Uncontrollability
 Cognitive variables (vicious cycle)
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Experience Fear- Avoidant or Odd Behavior ResultsOthers Avoid or Become Less Friendly-Confirmation of
Expectations and Beliefs
Treatment for Social Phobia
 Medications
 Beta-Blockers (used for high blood pressure)
 Anti-depressants and Anxiolytics
 High relapse rates with discontinuation of meds
 Behavioral Therapy
 Social Skills Training
 Counter-Conditioning
 Cognitive Therapy
 Challenge Negative Automatic Thoughts
 Cognitive-Behavioral Therapy
Panic Disorder and Agoraphobia
 Panic Disorder
 Unexpected panic attacks that occur
suddenly
 Panic versus Anxiety
 Distinguished by Brevity and Intensity
 Reach peek in 10 min. Subside at 20-30 min.
 Agoraphobia
 Fear of being in a place or situation from
which escape would be physically difficult or
psychologically embarrassing, or in which
immediate help would be unavailable
 Usually develops as a result of panic attacks
Panic Disorder
 An anxiety disorder marked by a minutes-long episode of intense
dread in which a person experiences terror and accompanying chest
pain, choking, or other frightening sensations.
 The person must have experienced recurrent unexpected attacks
and must have been consistently concerned about having another
attack or worried about the consequences of having another attack
for at least one month.
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To be considered a full blown panic attack the episode must
involve the abrupt onset of at least 4 of 13 symptoms e.g.:
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Shortness of breath
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Heart palpitations
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Sweating
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Dizziness
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Depersonalization (feeling detached from ones body)
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Derealization (feeling that the outside world is unreal)
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Fear of dying, going crazy, losing control
Panic Disorder
 Prevalence and age of onset
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Age 15-24 but also in 30’s & 40’s (Women)
Typically follows a chronic course
More prevalent in women (2-4 x)
 Comorbidity with other disorders
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GAD, Depression, Alcohol Abuse
 Timing of a first panic attack
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Frequently follows a distressing event
Panic: Biological Causal Factors
 High Noripinephrine
activity in the Locus
Coeruleus
 Altering Serotonin levels
also decreases panic.
Panic Disorder: Cognitive &
Behavioral Causal Factors
 1) Interoceptive Conditioning Model
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Interoceptive Fears
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Fears focused on various internal bodily functions
Introreceptive Conditioning (bodily sensations
become associated with panic attacks and then
acquire the capacity to invoke panic)
 2) Cognitive Model
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Focuses on the meaning placed on physiological
sensations.
See next slide>
Panic Circle
 Hypersensitivity to bodily
sensations
 Dire Thought with
Catastrophizing
 Thought fuels increase in
bodily response
 Vicious out-of-control
cycle
Panic Disorder: Cognitive Theory II.
 Perceived Control as a blocker to panic
 Pre-existing Anxiety Sensitivity
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High level of belief that certain bodily symptoms
may have harmful consequences
Treating Panic Disorder and Agoraphobia
 Medications
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Benzodiazepine (Xanax)
 Behavioral and CBT
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Exteroceptive Exposure
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Interoceptive Exposure
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Exposure to external situations
Exposure to internal bodily sensations
Relapse greater with combination with
Meds. (likely due to attribution to med.)
Generalized Anxiety Disorder
 Prevalence and age of onset
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Two-thirds diagnosed are women
60-80% Report having had anxiety since
childhood.
Unlike phobias, generalized anxiety disorder
involves the person not being able to identify the
cause of the anxiety.
Smokers have a fourfold risk of a first-time panic
attack.
Generalized Anxiety Disorder
 DSM-IV Criteria are as Follows:
 Includes chronic excessive worry about a
number of events and activities (not identified)
 Must occur more days than not for at least 6
months
 Worry must be accompanied by at least 3 of the
following
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Restlessness or feelings of being keyed up or on edge
A sense of being easily fatigued
Difficulty concentrating or mentally going blank
Irritability
Muscle tension
Sleep disturbance
Generalized Anxiety Disorder:
Psychosocial Causal Factors
 Psychoanalytic Viewpoint
 Classical Conditioning (many stimuli)
 History of Unpredictable & Uncontrollable Events
 Content of Anxious Thoughts
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Maladaptive Negative and Automatic Thoughts
 Focus on the Positive Function of Worry
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Worry for them suppresses their emotional and
physiological responses to aversive stimuli. This
reinforces worrying.
 Cognitive Biases for Threatening Iinformation
Generalized Anxiety Disorder:
Biological Causal Factors
 Genetic Factors
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Scientists have identified a specific gene
related to anxiety and neuroticism
 A functional deficiency of GABA
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Xanax, Valium, and Librium stimulate the
action of gaba.
Obsessive Compulsive Disorder
 Obsessions- persistent and recurrent intrusive thoughts,
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images, or impulses that are experienced as disturbing
and inappropriate.
Compulsions- overt repetitive behaviors (such as hand
washing, checking or ordering) or covert mental acts (such
as counting, praying, or saying certain words silently).
The person feels driven to perform the compulsive
behavior in response to an obsession.
The person must recognize that the obsession is a product
of their own mind rather than from external sources
The involuntary behavior must cause marked distress,
consume excessive time, or interfere with occupational or
social functioning.
Obsessive-Compulsive Disorder
 Prevalence and age of onset
 Characteristics of OCD
 Types of compulsions
 Consistent themes
 Comorbidity with other disorders
Obsessive-Compulsive Disorder:
Psychosocial Causal Factors
 Psychoanalytic viewpoint
 Behavioral viewpoint
 OCD and preparedness
 The role of memory
 Attempting to suppress obsessive thoughts
Obsessive-Compulsive Disorder:
Biological Causal Factors
 Genetic influences
 Abnormalities in brain
function
 The role of serotonin
General Sociocultural Causal
Factors For All Anxiety Disorders
 Cultural differences in sources of worry
 Taijin Kyofusho
UNRESOLVED ISSUES
 Interdisciplinary research on the anxiety
disorders