Phobias & SAD and GAD & PD
Phobias & SAD and GAD & PD
Phobias & SAD and GAD & PD
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Flashcards
Suffocation false alarm theory
Person is hypersensitive to carbon dioxide levels ⇒ Minor drops in Oxygen result in false alarm "person is suffocating" ⇒ Panic Attack
Pharmacological treatment for panic disorder
First line treatments
• SSRI (Selective Serotonin Reuptake Inhibitors)
effective in many controlled studies ( e.g. Wade et al. 1997; Michelson et al 1998, 2000)
anxiolytic effect latency of 2-4 weeks
• Serotonin Norepinephrine Reuptake Inhibitors
effective in double blind placebo controlled studies (Bradwejn et al. 2005; Pollack et al. 1996)
Second line treatments
• Tricyclic antidepressants
frequency of adverse events is higher than for SSRI (Amore et al. 1999)
Third line treatments
• Benzodiazepines
anxiolytic effects immediately after oral intake, risk of dependency (Bradwejn 1993)
Psychological treatment for panic disorder
Cognitive behavioral therapy
“Panic control treatment”
(PCT, Craske et al., 2000, Hofmann & Spiegel, 1999)
Elements
• Education about anxiety and panic development
• Cognitive restructuration: identification and correction of thoughts /
false cognitions about anxiety and its consequences
• Training (reduction arousal, hyperventilation)
• Exposition, controlled hyperventilation
11-12 sessions, 3-4 months
Psychological treatment for panic disorder
Classical CBT Methods
• Hyperventilation
• Triggering bodily symptoms
• Deep breathing
• External focus
• mindfulness
Learning safety in panic
Interoceptive exposure
Feared sensations become safe sensations:
• in the office with the therapist
• at home
• independent of the treatment context
Dizziness
Panic Cycle
Uh oh!
What if:
• This gets worse?
• I lose control?
• This is a stroke?
I have to control
this!
Relative Comfort
• Notice the sensation
• Do nothing to control it.
• Relax WITH
the sensation
Exposure procedures
Head rolling – 30 seconds - dizziness, disorientation
Hyperventilation – 1 minute - produces dizziness
lightheadedness, numbness, tingling, hot flushes, visual
distortion
Stair running – a few flights – produces breathlessness, a
pounding heart, heavy legs, trembling
Full body tension – 1 minute – produces trembling, heavy
muscles, numbness
Chair spinning – several times around – produces strong
dizziness, disorientation
Mirror (or hand) staring – 1 minute – produces derealization
Psychological treatment for panic disorder
Cognitive behavioral therapy
• Efficacy between 87% and 75%
• Greater efficacy than relaxation therapy or control groups
• Greater efficacy than certain medicaments (e.g. alprazolam) and
similar to imipramine
• Long-term treatment with PCT is more effective than pharmacological
treatment
• Evidence of superiority from combined approach towards single treatment
not conclusive
• New developments: combination with self-help modules, therapy via
internet, electronic auto-observation
