PSYC1024 Essay PDF

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The core assessment of PSYC1024. Was given a HD mark....

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Course ID: PSYC1024 Course Name: Clinical Perspectives on Anxiety, Mood and Stress I declare that: This assessment item is entirely my own original work, except where I have acknowledged use of source material such as books, journal articles, other published material, the Internet, and the work of other student/s or any other person/s. This assessment item has not been submitted for assessment for academic credit in this, or any other course, at UNSW or elsewhere. I understand that: The assessor of this assessment item may, for the purpose of assessing this item, reproduce this assessment item and provide a copy to another member of the University. The assessor may communicate a copy of this assessment item to a plagiarism checking service (which may then retain a copy of the assessment item on its database for the purpose of future plagiarism checking).

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Using the CBT model of panic disorder, compare the relative roles of fear and anxiety in driving the disorder

In order to completely understand the characteristics of panic disorder, one must understand what a panic attack involves. A panic attack is a debilitating surge of fear and intensified anxiety that may occur within minutes, during which a plethora of uncomfortable physiological (i.e. severe palpitations, tachycardia) and fear-provoking (loss of mental stability and control, fear of death) responses manifest (Pilecki, Arentoft, & McKay, 2011). Panic disorder, defined by the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), is the state in which a person experiences recurrent unexpected panic attacks and begins to develop anxious responses over the thought of undergoing another episode, or the underlying implications that may incur from another attack (American Psychiatric Association, 2016). The repetitive nature of these attacks become disabling to those who experience them, as patients begin to significantly alter their current behaviour in order to avoid experiencing another attack. Often confused with the phobic disorder agoraphobia, panic disorder is only diagnosed when an individual has experienced minimum 3 panic attacks in the previous month, and these attacks did not occur in cluster, phobic-type environments (Landon & Barlow, 2004). Clark (1986) proposed that panic attacks occur as a result of the catastrophic misinterpretation of bodily sensations that are often associated with anxiety attacks, but are perceived much more life-threatening than they actually are (Clark, 1986). This gives rise to the cognitive behavioural therapy (CBT) model of panic disorder.

Originally, pharmacotherapy and drug therapy were perceived to be the most efficacious of treatments for panic disorder. Antidepressant drugs, such as benzodiazepines, were used in order to suppress feelings of anxiety, phobic avoidance and in turn were able to limit the recurrence of panic attacks (Roy-Byrne, Craske, & Stein, 2006). Albeit these drugs effectively managed symptoms of panic disorder, patients run the risk of addiction and abuse, and are likely to become physiologically dependent on these suppressants. CBT model of panic disorder encourages the psychoeducation of the symptoms associated with panic and aid the patient with identification and correction of distortions of normal thinking. This behavioural change model deals with behaviours often associated with panic disorders such as the avoidance of situations and the escape of situations that may provoke panic. Salkovskis et al. (1996) utilised exposure of

these uncomfortable situations that initiate fear and panic in order to eliminate the “safety net” and safety-seeking behaviours that patients seek when experiencing panic symptoms (Salkovskis, Clark, & Gelder, 1996). This method develops the means to reconstruct the patient’s perception of the feared disaster in order to deny the fearful interpretations manifested and to reduce fear responding (Roy-Byrne et al., 2006). This mode reduces anxiety-exacerbating thoughts by implementing breathing strategies to control the intensity of the symptoms. Altering the cognitive bias set upon themselves is a critical component for symptom reduction for patients with panic disorder, it shifts the interpretation of the sensation rather than deterring the sensation itself (Hofmann et al., 2007). As patients begin to become desensitised to the exposed stimulus, they become less fearful of the normal physiological sensations and are thus more inclined to return to naturalistic activities (Reinecke & Clark, 2004). There is a considerable amount of evidence supporting the CBT model of panic disorder (Teachman, Marker, & Clerkin, 2010), however there are two important components of emotion that are relevant to determining the efficacy of the CBT model: anxiety and fear.

Often used interchangeably, anxiety and fear are both intense emotions felt when experiencing a panic attack. It must be recognized however, that they are not the same, particularly with reference to panic disorders. Both fear and anxiety play an equal role in the development of panic disorders, but the emotions themselves are stemmed from alternative feelings.

Anxiety is defined as the anticipation of future threat (American Psychiatric Association, 2016), wherein feelings of intense arousal occur as well as physiological changes such as increased palpitations and restlessness. It is important to acknowledge that, prior to being listed as its own disorder, panic disorder was categorised as a form of generalised anxiety disorder and that anxiety in itself comes with its own symptoms. Anxiety sensitivity plays a large role in driving panic disorder as, by definition, refers to the fear of the sensations related to anxiety (McNally, 2002). This determines the fearful response to anxiety symptoms even before the life-threatening construct has even occurred. Much like the catastrophic misinterpretation of bodily sensations that occurs with panic disorder, those with higher ranges of anxiety sensitivity have the capacity to surge and exacerbate regular physiological responses and provide irrational responses to avoid any stimulus that may seem uncertain or unknown (Reiss et al. 1986). Moreover, anxiety presents the threat of the unknown; the lack of security and safe-haven may distort perception and thus

lead to symptoms of anxiety. This “unknown” is often referred to as the fear of feeling anxiety, wherein which motive is provided for avoidance behaviour, similarly to that of panic disorder (McNally, 2002). CBT model has been shown to aid in reduction of anxiety sensitivity for those who are non-responsive to pharmacological treatments (Bruce, Spiegel, Gregg, & Nuzzarello, 1995), and with the symptoms of anxiety being a major driving factor for panic disorder, it may be assumed that the management of anxiety sensitivity and anxious symptoms can aid in the management of panic disorder.

On the contrary, fear is the emotional response to which real or perceived imminent threat (American Psychiatric Association, 2016), which is more often associated to specific stimuli. Although similar in physiological responses, fear is postulated as a result of the body’s sympathetic nervous system, in which the “fight or flight” response is derivative of (Epstein, 1972). Epstein (1972) argued that fear itself requires action present in order for avoidance behaviour to arise, however when the action is obstructed that is when fear transforms into anxiety (Epstein, 1972). This correlates to the CBT model of panic disorder as physicians tend to provoke fear into the patients in order to retrain patients that the fear stimulus is not always associated with an imminent threat. They eliminate the avoidance options by eliciting circumstances that may draw on their fears (Roy-Byrne et al., 2006).

There is no concrete evidence distinguishing the differences between the two emotions: fear and anxiety. However, it can be acknowledged that, with regards to panic disorder, one acts as a precursor to the other. Fear occurs as a result of an aroused, aversive state wherein which the individual implements methods of avoidance in order to protect their state. Anxiety occurs rather internally as “the fear of the fear”, where an exaggeration is placed on the uncertainty of the potential of external threat. It must also be acknowledged that fear and anxiety are both normal reactions to impending dangers, it is the recurrence of these that become the crux of panic disorders and both are equally as important in the management of the disorder.

REFERENCES

American Psychiatric Association (2016). Anxiety Disorders: DSM-5® Selections. American Psychiatric Association. Bruce, T. J., Spiegel, D. A., Gregg, S. F., & Nuzzarello, A. (1995). Predictors of alprazolam discontinuation with and without cognitive behavior therapy in panic disorder. Am J Psychiatry, 152(8), 1156-1160. doi:10.1176/ajp.152.8.1156 Clark, D. M. (1986). A cognitive approach to panic. Behav Res Ther, 24(4), 461-470. doi:10.1016/0005-7967(86)90011-2 Epstein, S. (1972) The Nature of Anxiety with emphasis upon its relationship to expectancy. In C.D. Spielberger (Eds), Anxiety: Current trends in theory and research, (pp. 291 – 337). New York, NY: Academic Press. Hofmann, S. G., Meuret, A. E., Rosenfield, D., Suvak, M. K., Barlow, D. H., Gorman, J. M., . . . Woods, S. W. (2007). Preliminary evidence for cognitive mediation during cognitivebehavioral therapy of panic disorder. J Consult Clin Psychol, 75(3), 374-379. doi:10.1037/0022-006X.75.3.374 Landon, T. M., & Barlow, D. H. (2004). Cognitive-behavioral treatment for panic disorder: current status. J Psychiatr Pract, 10(4), 211-226. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15552543 McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biol Psychiatry, 52(10), 938-946. doi:10.1016/s0006-3223(02)01475-0 Pilecki, B., Arentoft, A., & McKay, D. (2011). An evidence-based causal model of panic disorder. J Anxiety Disord, 25(3), 381-388. doi:10.1016/j.janxdis.2010.10.013 Reinecke, M. A., & Clark, D. A. (2004). Cognitive therapy across the lifespan. Cambridge: Cambridge University Press. Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther, 24(1), 1-8. doi:10.1016/0005-7967(86)90143-9 Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic disorder. Lancet, 368(9540), 10231032. doi:10.1016/S0140-6736(06)69418-X Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behav Res Ther, 34(5-6), 453-458. doi:10.1016/00057967(95)00083-6

Teachman, B. A., Marker, C. D., & Clerkin, E. M. (2010). Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder. J Consult Clin Psychol, 78(6), 964-973. doi:10.1037/a0021067...