Introduction to Anxiety
Fear
Immediate, present-oriented
Sympathetic nervous system activation
Anxiety
Apprehensive, future-oriented
Somatic symptoms: muscle tension, restlessness, elevated heart rate
Panic attack: abrupt experience of intense fear
Physical symptoms: heart palpitations, chest pain, dizziness, sweating, chills or heat sensations, etc.
Cognitive symptoms: Fear of losing control, dying, or going crazy
Two types of panic attacks: expected and unexpected
The DSM – 5 diagnostic criteria for panic attack — 4 (or more) of the following symptoms occur:
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations
Paresthesias
Derealization
Fear of losing control or going crazy
Fear of dying
Increased physiological vulnerability
Polygenetic influences
Corticotropin releasing factor (CRF)
Affects the HPA axis
Brain circuits and neurotransmitters
GABA
Noradrenergic
Serotonergic systems
Limbic system
Behavioral inhibition system (BIS)
Received danger signals from:
Brain stem
Septal-hippocampal system
Fight/flight (FFS) system
Panic circuit
Alarm and escape response
Brain circuits are shaped by environment
Example: teenage cigarette smoking – teenage smoking is linked to increased risk for developing anxiety and panic
Interactive relationship with somatic symptoms
Freud
Anxiety = psychic reaction to danger
Reactivation of infantile fear situation
Behaviorists
Classical and operant conditioning: symptoms are a result of learned associations
Modeling: anxious behavior
Beliefs about control over environment
Biological vulnerabilities triggered by stressful life events
Family
Interpersonal
Occupational
Educational
Triple vulnerability
Generalized biological vulnerability
Diathesis
Generalized psychological vulnerability
Beliefs/perceptions
Specific psychological vulnerability
Learning/modeling
High rates of comorbidity
55% to 76%
Commonalities
Features
Vulnerabilities
Links with physical disorders
Suicide attempt rates
Similar to major depression
20% of panic patients attempt suicide
Increases for all anxiety disorders
Fear
Immediate, present-oriented
Sympathetic nervous system activation
Anxiety
Apprehensive, future-oriented
Somatic symptoms: muscle tension, restlessness, elevated heart rate
Panic attack: abrupt experience of intense fear
Physical symptoms: heart palpitations, chest pain, dizziness, sweating, chills or heat sensations, etc.
Cognitive symptoms: Fear of losing control, dying, or going crazy
Two types of panic attacks: expected and unexpected
The DSM – 5 diagnostic criteria for panic attack — 4 (or more) of the following symptoms occur:
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations
Paresthesias
Derealization
Fear of losing control or going crazy
Fear of dying
Increased physiological vulnerability
Polygenetic influences
Corticotropin releasing factor (CRF)
Affects the HPA axis
Brain circuits and neurotransmitters
GABA
Noradrenergic
Serotonergic systems
Limbic system
Behavioral inhibition system (BIS)
Received danger signals from:
Brain stem
Septal-hippocampal system
Fight/flight (FFS) system
Panic circuit
Alarm and escape response
Brain circuits are shaped by environment
Example: teenage cigarette smoking – teenage smoking is linked to increased risk for developing anxiety and panic
Interactive relationship with somatic symptoms
Freud
Anxiety = psychic reaction to danger
Reactivation of infantile fear situation
Behaviorists
Classical and operant conditioning: symptoms are a result of learned associations
Modeling: anxious behavior
Beliefs about control over environment
Biological vulnerabilities triggered by stressful life events
Family
Interpersonal
Occupational
Educational
Triple vulnerability
Generalized biological vulnerability
Diathesis
Generalized psychological vulnerability
Beliefs/perceptions
Specific psychological vulnerability
Learning/modeling
High rates of comorbidity
55% to 76%
Commonalities
Features
Vulnerabilities
Links with physical disorders
Suicide attempt rates
Similar to major depression
20% of panic patients attempt suicide
Increases for all anxiety disorders