GAD, Panic Disorder, & Agoraphobia

Prevalence of Specific Phobia

7-9% (12-month), is similar in the EU and lower in Asia, Africa, Latin America

Specific Phobia development

Traumatic experience (direct or observed) OR unexpected panic attack in to-be-feared situation OR “Informational transmission”

Treatment for Specific Phobia

CBT (esp. exposure therapy) which alters neural circuitry (amygdala, insula, cingulate cortex)

Statistics of Panic Disorder

A. 2-3% 12-month prevalence (adults & adolescents)
B. <0.4% in children < 14 y.o.
C. Primarily identified in non-Latino whites
D. 2:1 Female-to-male ratio
E. Prevalence rates gradually increase, adolescence➔
F. ...But rates decrease in older folks (0.7% @ >64 y.o.)

Risk Factors for Panic Disorder

❖Neuroticism (“negative affectivity”) + anxiety sensitivity*
❖History of childhood abuse
❖Smoking (who knew???)
❖Prodromal interpersonal/environmental stressors
❖Heredity--Multiple genes (specifics still unknown)
❖Respiratory disturbance (e.g. asthma)

Pharmacotherapy treatment of Panic Disorder

❖ Benzodiazepines
--e.g. clonazepam [Klonopin], lorazepam [Ativan],
alprazolam [Xanax]
--Drawbacks = short half-life + addictive
❖ SSRI + SNRI Antidepressants
--e.g. fluoxetine (Prozac), paroxetine [Paxil],
venlafaxine [Effexor, a SNRI]
--Assets = systemic + not addictive

Psychotherapy treatment of Panic Disorder

Preferred: Cognitive-Behavioral Therapy (CBT) that targets perceived lack of control. Techniques include gradual exposure, progressive
relaxation, etc.

True or False: Pharmacotherapy alone seems to be best first-line (initial) intervention for panic disorder (& agoraphobia).

False: Psychotherapy alone seems to be best first-line (initial) intervention for panic disorder (& agoraphobia). If nec., it should be augmented w/ medication

Agoraphobia

A. 1.7% annually among adolescents & adults
B. 2:1 Female-Male Ratio
C. Incidence peaks in late adol./early adult.
D. 0.4% prev. in older adults
E. No notable cultural variance in prevalence

Risk factors of Agoraphobia

Behavioral inhibition + neuroticism + anxiety
sensitive OR Negative childhood events (e.g. emotionally cold family, overprotective family, parental separation or death) AND 61% heritability (the strongest & most specific of all
phobias)

GAD

Generalized Anxiety Disorder

Generalized Anxiety Disorder Statistics

A. Approx. 3.1% of population during a one-year period
B. Approx. 5.7% of pop. lifetime
C. Approx. 2/3 (66%) female
D. Seems to develop earlier & more gradually in life
E. Esp. prevalent in older adults (up to 10%)

Risk Factors for GAD

Generalized Biological Vulnerability and Psychosocial Vulnerability

Generalized Biological Vulnerability to Anxiety

Genetic predisposition to anxiety AND ”autonomic restrictors” (less responsive on most physiological measures) AND chronic physical tension

Psychosocial Vulnerability to Anxiety

Highly sensitive to threat (esp. personally relevant) and it seems to be automatic or unconscious

Treatment of GAD

Pharmacotherapy and Psychotherapy

Pharmacotherapy and treatment of GAD

❖ Benzodiazepines
--Drawbacks = short half-life + addictive
❖ SSRI + SNRI Antidepressants
--Assets = systemic + not addictive

Psychotherapy treatments of GAD

Preferred: Cognitive-Behavioral Therapy (CBT) as it targets perceived lack of control. Techniques involve exposure, cognitive reframing, etc.