Lecture 5 - Panic Disorder

What are the physical symptoms of panic disorder?

1. Palpitations, pounding heart, or

accelerated heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath or

smothering

5. Feelings of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Feeling dizzy, unsteady, light-headed,

or faint.

9. Chills or heat sensations

10. Paresthesias (numbness or tingling

sensations

11. Derealization or depersonalization

What emotional symptoms of panic disorder are there

Fear of dying (e.g. choking or having a heart

attack)

Fear of losing control or “going crazy”

Constant worrying about having another attack

Adapting behavior (avoiding busy places)

Fear that others might notice a panic attack

Anticipating with anxiety certain events

Focusing on bodily symptoms

Appraising bodily symptoms as dangerous

Always anticipating panic attacks

Always carry certain attributes to prevent PA

What is the prevalence of panic disorder?

United states and Europe: 2-3% of 12-month

prevalence

Estimated lifetime prevalence 1.7% with 2.7%

projected lifetime risk in mental health surveys

Women more likely to have it (2:1)

What is the comorbidity like for people with panic disorder?

Generally, 80% of individuals with panic

disorder have a lifetime comorbid mental

diagnosis:

 Any other anxiety or related disorder

 Major depressive disorder

 Mild alcohol use disorder

They also have comorbidity with physical disorders (Cardiac arrhythmias, hyperthyroidism,

asthma, COPD and irritable bowl syndrome)

What are risk factors for panic disorder?

Behavioural: Neuroticism, anxiety sensitivity, behavioural inhibition and harm avoidance

Environmental: Stressors in the months leading up to the panic attacks, drug use

Genetic/physiological: Hereditary, increased risk if your immediate family members have anxiety, depressive, or bipolar disorders

What different aspects of panic appraisal are there?

1. Catastrophic consequences of panic

2. Likelihood of panic in agoraphobic situation

3. Perceived self-efficacy in coping with panic

What is anxiety sensitivity?

The predisposition to believe that symptoms of anxiety are harmful (leading to increased vigilance towards physical symptoms of arousal)

Explain Clark’s cognitive model of panic?

Explain Craske’s model of panic disorder

What does exposure therapy for panic disorder aim to do?

Reduce avoidance behaviours

How do you test the idea that you will have a heart attack if your heart starts racing?

Exercise or get patient’s heart racing in another way

How can you test the idea that one is “going crazy”?

e.g. make them watch an optical illusion

What is interoceptive exposure therapy?

Exposure therapy where the thing the patient is being exposed to is their own bodily sensations

How can you test a fear of suffocation?

By making the patient hyperventilate

Why does interoceptive exposure therapy work?

Learning that CS (= feared cue) does not lead to US (= catastrophe)

What can be a problem with therapists when it comes to exposure therapy?

The therapist can be overly anxious about doing the exposure measures, which can lead to the patient not being properly “exposed”. Some therapists think, that, for example, it is unethical for a therapist to deliberately induce tension in clients. or that most clients struggle to tolerate the stress of exposure therapy.

Why is it important that therapists commit to properly doing exposure therapy?

More therapist behaviors that encourage approach—and less use of accommodation, unrelated talk, and externalizing language—predicted greater subsequent habituation during individual exposure

tasks (exposure-level), and also predicted improved patient clinical outcomes via higher “total dose”

of habituation across treatment (patient-level indirect effect)

What are some positive aspects of virtual reality therapy?

• Situations that can’t be easily simulated in vivo can be simulated there

  • Efficacy is similar to that of in vivo

CBT (including exposure therapy) is an effective treatment, but it has a relatively high percentage (10-40% of non-respondence). What treatment could potentially be used instead?

Recent studies have indicated that EMDR as a second step intervention has

potentially an additional value in panic disorder (and) agoraphobia.

Explain based on this why EMDR could be useful in treating panic disorder

There are different pathways for anxiety aquisition. CBT for example targets the expectancies that people have. However, EMDR can also help, for example by reducing the fear towards the US