Anxiety Wrap up

Introduction

• Greeting and check-in on students' experiences with the recent 50-day mark.

Today’s Agenda

• Wrap-up of anxiety disorders.

• Discussion of the upcoming exam on Thursday.

  • In-class exam; students must bring a laptop or tablet.

  • The exam is not cumulative and will cover three chapters.

  • More details about the exam will be provided at the end of the lecture.

Review of Panic Attacks and Panic Disorder

• Previous lecture emphasis on:

  • Interoceptive conditioning.

  • Interoceptive awareness, referring to hyperactivity and reactivity in awareness of internal bodily sensations.

  • Varying levels of somatic experiences in daily life.

• Individuals with panic disorder often have:

  • Heightened awareness and sensitivity to their physiological sensations.

  • Example experiences:

    • Focused on an activity and suddenly realizing bodily needs (e.g., needing to urinate).

    • Losing track of hunger—opposite of interoceptive awareness.

• Impact of hypersensitivity:

  • Chronic monitoring of physiological changes can lead to conditioned responses.

  • Classical conditioning explanation:

  • Learning an association between stimuli (e.g., bodily cues that signal an impending panic attack).

  • Example: Advertising leading to drooling (conditioned response).

• Treatment approaches:

  • Working with clients to down-train interoceptive awareness and reactivity.

  • Not all bodily sensations correlate directly with panic attacks.

Complex Interplay of Factors in Panic Disorder

• Biopsychosocial factors involved include:

  • Biological:

  • Genetic vulnerability for anxiety disorders.

  • Heritability of anxiety conditions varies by diagnosis.

  • Cognitive vulnerability and dysregulation:

  • Dysregulation of neurotransmitters like GABA and serotonin.

  • Catastrophizing bodily sensations is prevalent among users experiencing panic attacks.

  • Example of catastrophizing: Being late to class leads to a belief of failing college (overshooting the situation).

  • Anticipatory anxiety regarding potential future attacks enhances overall anxiety levels.

  • Situational context and panic disorder with agoraphobia:

  • Impacts of being in open spaces on anxious individuals.

Treatment Options for Panic Disorder

• Biological interventions include:

  • Medications:

  • SSRIs (Selective Serotonin Reuptake Inhibitors).

  • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).

  • Tricyclic antidepressants.

  • Common theme: Relapse occurs after discontinuation of medication.

• Cognitive-Behavioral Therapy (CBT) includes:

  • Relaxation and breathing exercises as vital tools during rising anxiety levels.

  • Cognitive restructuring addressing catastrophizing thoughts:

  • Challenging validity and utility of anxious thoughts.

  • Example: Assessing the validity of the belief that being late to class means failing out of college.

• Systematic desensitization:

  • Creating a fear hierarchy to manage sensations associated with panic attacks.

  • Importance of exposures without the paired stimuli to break classical conditioning.

  • Classical conditioning vs. operant conditioning clarification:

    • Classical: Involuntary responses (e.g., anxiety); operant: Voluntary behaviors (e.g., using a vending machine).

Selective Mutism Overview

• Definition and Characteristics:

  • Diagnosed typically before age five.

  • Rare condition often linked to:

  • Social anxiety.

  • Experiences of neglect or abuse.

  • Poor family relationships or speech issues.

  • A child can speak but fails to do so in certain social contexts, signaling anxiety.

• Therapeutic Approaches for Selective Mutism:

  • Cognitive-Behavioral Therapy (CBT) with stimulus fading:

  • Gradually introducing new people into the setting where the child is comfortable speaking.

  • Stress-free communication styles allowed, including gestures instead of enforced verbal communication.

  • Family therapy to guide parents not to worsen the issue by pressuring the child to speak.

  • Potential use of SSRIs to manage symptoms.

Importance of Exposure in Treatment

• Need for exposure to reduce symptoms efficiently:

  • Clients with selective mutism may overly rely on nonverbal communication methods.

  • Importance of implementing exposure opportunities to facilitate verbal communication capabilities.

• Early communication development importance:

  • Children can learn sign language effectively before verbal communication.

  • Communication tools develop language skills and reduce frustration (example given about sign language usage in infants).

  • Emphasizing the need for both functional communication and the development of coping strategies.

Addressing Untreated Selective Mutism

• Possible outcomes of untreated selective mutism:

  • Functional communication capabilities may become limited or develop around nonverbal strategies.

  • Relevance of exposure to ensure verbal interaction where possible.

  • All developmental issues require facilitation of communication without obstruction.

• Parallel discussions with broader developmental issues such as PTSD:

  • Focus on symptom management while working toward comprehensive communication capabilities.

Exam Preparation

• Details of the upcoming exam:

  • Date: Thursday.

  • Format: 30 multiple-choice questions covering PTSD, trauma disorders, and anxiety disorders.

  • Opportunities for collaboration before the exam, review predictions about question complexity.

Group Activity

• Students to work together in groups to analyze a case and determine a diagnosis.

  • Document group participants' names, date, and diagnosis with explanations for clarity.

  • Engage in discussions and critical thinking about diagnostic processes.