Chapter 3: Panic Disorder

What is a panic attack in terms of possible symptoms, as well as the number of symptoms needed to meet DSM criteria for a full-blown panic attack?

a. a panic attack is an abrupt surge of intense fear or discomfort that is diagnosed in the presence of 4 or more of 13 physical and cognitive symptoms: palpitations, pounding heart, or accelerated heart rate, sweating, trembling or shaking, sensations of shortness of breath or smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, lightheaded or faint, chills or heart sensations, paresthesias, derealization, depersonalization, fear of losing control or going crazy, and fear of dying.
b. a full blown panic attack is defined as four or more symptoms

How is a panic attack different than panic disorder? In other words, what else needs to be present other than a panic attack for someone to be diagnosed with panic disorder?

panic disorder is characterized by repeated and unexpected panic attacks, i.e attacks that occur without an obvious trigger, "out of the blue," plus at least 1 month of persistent worry or concern about the recurrence of panic or its consequences, or a significant, maladaptive behavioral change related to the attacks.

What is agoraphobia and how does it relate to panic disorder?

panic attacks often, but not always, occur within the context of agoraphobia- 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.

In general, does panic disorder occur more or less frequently in the US than in other countries? Other than reflecting true differences in occurrence, what else might account for the different rates of diagnosed cases across countries?

a. occur more frequently in the US
b. the data from other counties raise the possibility that the range in prevalence rates reflects differences in diagnostic methodology as well as variations in diagnosis criteria.

Although panic attacks tend to be similar for children and adolescents, what is the primary differentiating factor and what may explain this difference?

children are more likely to apply external explanations for panic and adolescents are more likely to apply external explanations, such as "I'm going crazy."

Panic disorder can lead to agoraphobia in many cases, but this phenomenon is more prevalent in women and those who are unemployed. What might account for this epidemiological difference?

socialized sex role expectations and behaviors may contribute to these effects, as socialization may reinforce activity, independence, and confrontation of feared stimuli and situations to a greater extent in boys than girls.

What is interoceptive avoidance?

strong sensitivity to and avoidance of the internal bodily symptoms associated with anxiety and panic;nclude avoiding exercise, sex, caffeine, alcohol, saunas, wearing a necktie, watching arousing or scary movies, or situations that may produce anger

What are safety behaviors and how can they be differentiated from adaptive coping strategies? Why might safety behaviors decrease anxiety initially but lead to more chronic anxiety in the long run?

a. safety behaviors are behaviors which are intended to avoid disaster
b. safety behaviors can be differentiated from adaptive coping by both the situation in which they occur, a situation of overrated or no real threat," and by their function, "preventing feared outcomes that are unlikely to happen"

What is experiential avoidance and how does it relate to panic disorder?

a. Experiential avoidance occurs when a person is "unwilling to remain in contact with particular private experiences [e.g., 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;watching TV, playing video games, and eating,
b. any distraction from anxiety and panic related symptoms falls into the category of experiential avoidance

What are the "cognitive features" associated with panic disorder?

Cognitive features associated with panic disorder include strong beliefs and fear of physical or mental harm arising from bodily sensations that are associated with panic attacks, interpreting bodily sensations in catastrophic fashion, and attend more to words that represent physical threat. Also, they show greater anxiety responses to panic words relative to adults with mixed anxiety disorders and healthy controls, and are more likely to fear procedures that elicit bodily sensations similar to the ones experienced during panic attacks. They also fear signals that ostensibly reflect heightened arousal and false physiological feedback. Also, individuals with panic disorder sometimes demonstrate memory abnormalities.

What is neuroticism/negative affectivity and how do they relate to panic disorder? Are these emotional features exclusive to panic? Do you notice a pattern regarding which anxiety disorders seem more or less related to neuroticism/negative affectivity?

-Neuroticism is the proneness to experience negative emotions in response to stressors, and -negative affectivity is the tendency to experience an array of negative emotions across a variety of situations, even in the absence of objective stressors. They relate to panic disorders because they are the most common temperaments variable associated with anxiety disorders, including panic disorder. These emotional features are not exclusive to panic. Pervasive anxiety disorders such as GAD tend to load more heavily on negative affectivity, while panic disorder loads at an intermediate level, and social anxiety disorder loads the least;neuroticism was found to predict the onset of panic attacks

Why do you think prediction and control relate to proneness towards anxiety? How are early childhood relationships with caregivers relevant to the development of one' sense of prediction and control? What was Mineka, Gunnar, and Champoux 's (1986) findings regarding this phenomenon?

-There is a plethora of research that supports the idea that early experiences related to infant care may play an important role in facilitating later proneness towards anxiety. -Prediction and control may be associated with the development of adaptive emotion regulatory capacities in the face of negative stressors. -Caregiver responses that are characterized by unpredictability and unresponsiveness may lead to anxious attachment in which the child is chronically insecure and apprehensive. ----Mineka, Gunnar, and Champoux demonstrated that infant rhesus monkeys who were granted control over toys and food habituated more quickly to novel stimuli, demonstrated more exploratory behavior in a novel playroom, and demonstrated enhanced coping responses during separation from peers compared to infants without control-concluded that experiences with mastery and control buffer the effects of stressful experiences.

Identify how parental overprotectiveness might be a causal factor in the development of panic disorder?

If a parent is constantly on their child's butt, watching over their shoulder every move, it may make the child feel anxious and like nothing they do is good enough. This can cause high anxiety in the child. Generally, children of anxious parents view their families as more conflictual, less independent, less cohesive, and more controlling than children with healthy, nonanxious parents do; In addition, children with anxiety disorders view their families as less independence promoting than nonanxious children do

Assume that there is no causal relationship between panic and overprotective parenting, what might explain why these two variables are correlated with each other?

found that the presence of child behavior symptoms accounted for the relationship between parental protectiveness and child anxiety symptoms, suggesting that parental overprotectiveness may stem from other child symptoms. These studies, however, are limited by reliance on self-report measures and cross-sectional designs

How did Schwartz et al.'s (2012) findings suggest that certain parental behavior may not be a precursor specific to anxiety?

Schwartz demonstrated that greater prenatal aggression predicted high adolescent anxiety and depression symptoms over the course of 2.5 years. Thus, maladaptive parental behaviors such as aggression may characterize parents of children with significant psychopathology or distress rather than children with anxiety disorders or panic disorder in particular. This was done in a longitudinal investigation which used observational coding.

How did Schneider et al.'s (2009) study demonstrate that certain behaviors by mothers with panic disorder might be specific to their children's anxiety status?

Schneider used observational coding to compare mothers with panic disorder to non anxious mothers and found that mothers with panic disorder were more verbally controlling and more conflictual with their children, regardless of the children's anxiety status.

It is notable that respiratory disease in childhood may be a specific risk for panic disorder over other anxiety disorders (e.g., obsessive-compulsive disorder); why might this be the case? That is, what is it about respiratory problems that might link with panic attacks?

They may fear the disease or illness during childhood will come back, which could cause a lot of stress and may put them at risk for anxiety disorders. During panic attacks, many patients report feeling as if their chest is tightening, shortness of breath, or that they cannot breathe. This links respiratory problems to panic attacks.

The stress-diathesis model posits that neither a life stressor or a pre-existing vulnerability for a disorder is sufficient cause for a disorder, but rather both need to be present for problems to develop. How has this model been applied to explain the fact that stressful life events tend to precede panic disorder?

According to the model, high anxiety can elevate the likelihood of panic attacks. Stressful life events may elevate levels of anxiety, particularly in vulnerable individuals, therefore increasing the risk for panic. Additionally, high levels of stressful life events interacted with a subscale of anxiety sensitivity.

The experience of panic symptoms in relatively common, yet only a small portion of the population develop panic disorder. Describe why this might be the case with reference to the concept of anxiety sensitivity. How might parental behavior influence anxiety sensitivity and, in turn, the development of panic?

Anxiety sensitivity is the tendency to interpret anxiety symptoms as dangerous and threatening. Considering some people may have less intense life stressors, and people handle stress differently, some individuals may be more prone to develop panic disorder, while symptoms of panic are more common among the general population.

Briefly describe Eysenk's (1960) model of interoceptive conditioning and what evidence is there to suggest that it overcomes problems with Clark's (1986, 1988, 1996) cognitive model for panic disorder?

Clark argued that catastrophic mis appraisals of bodily sensations, including misinterpretation of panic and anxiety related bodily sensations as signs of imminent death, craziness, and loss of control, are central to the development and maintenance of panic disorder. Eysenck's model emphasizes interoceptive fear conditioning, or the process by which low-level somatic sensations of arousal or anxiety (elevated heart rate, perspiration) become conditioned stimuli due to their association with intense fear, pain, or distress. Eysenks accounted for unconscious or nocturnal panic attack