Analyzing Adult Psychopathology - Essay Example

?Adult Psychopatology: Scenario 1. Diagnosis John presents with some of the most popular ic symptoms of panic disorder: frequent and unpredictable episodes of anxiety accompanied by some of the most frequently reported somatic symptoms necessary for satisfying the criteria for panic disorder. John’s somatic symptoms are chest pains, palpitations, sweating and shortness of breath and he even reports that there have been times when he thought he would have a heart attack (Katon, 1984). John does not know when the attacks will occur and can only say that they appear to occur out the home, although he has trouble sleeping. The sleeping problems do not appear to be linked to nocturnal panic attacks since John does not report waking up with panic attacks (Ley, 1993). John’s symptoms also appear to lack situational or social specific cues. However, there is a danger that John will develop situational panic disorders as he reports increasingly avoiding social activities and feels stressed at work. At this point John’s avoidance tendencies are not serious enough to be considered panic disorder with agoraphobia, however, given his avoidance tendencies, he may eventually develop panic disorder with agoraphobia if he is not treated. Since there is no history of substance abuse and John’s physical examination was normal, John’s symptoms can only be linked to panic disorder (Nutt, Ballenger, & Lepine, 1999). 2. Clinical Conceptualization The three main theories that help in a clinical conceptualization of John’s acquisition and maintenance of his panic disorder without agoraphobia and the risk of developing and maintaining panic disorder with agoraphobia are cognitive, anxiety sensitivity and conditioning theories (Bouton, Mineka, & Barlow, 2001). Of the three theories, cognitive theory of panic disorder appears to be the most relevant. Cognitive theory of panic disorder takes the position that panic attacks typically occur as a reaction to an enduring vulnerability to exaggerate physical (Salkovskis, Clark, Gelder, 1996). In John’s case, he reports that there have been times when he was experiencing chest pains, shortness of breath, sweating and palpitations that he feared he was going to have a heart attack. However, these fears are not substantiated by his physical examination. Khawaja and Oei (1998) explain that the tendency to “misinterpret external or internal cues in a catastrophic manner” is referred to as “catastrophic cognitions” and it is these “catastrophic cognitions” that result in the maintenance of panic disorders (p. 341). Moreover, Salkvskis, et. al. (1996) conducted a study of 147 patients with panic disorders and reported that when patients exhibit catastrophic cognitions, they will usually gravitate toward or away from situations to avoid experiencing panic attacks. This is known as the “within-situation safety seeking behaviours” attack (Salkovskis, et. al., 1996, p. 453). According to Salkovskis, et. al., (1996) catastrophic cognitions not only contribute to the acquisition of panic disorder, but also contribute toward the maintenance of panic disorders. John is definitely a candidate for treatment as he is already reporting an increasing proclivity to avoid social activities and it can be assumed that his catastrophic cognitions are resulting in this type of within-situation safety seeking behaviours” which will likely lead to panic disorder with agoraphobia. Anxiety sensitivity models of panic disorder refer to the “fear of anxiety-related sensations” which are linked to “beliefs about their harmful consequences” (Deacon & Abramowitz, 2006, p. 837). Anxiety sensitivity is comprised of fear of the “somatic, social, and cognitive” spheres of anxiety (Deacon & Abramowitz, 2006, p. 837). As previously noted, John has demonstrated fears of both the somatic and social spheres of his anxiety. For instance he has feared having a heart attack and he avoids social activities which indicate a fear of the social aspects of his anxiety. Conditioning theory takes the position that individuals are vulnerable to acquire or maintain panic disorders when they develop the tendency to associate specific stimuli with the onset of anxiety or panic attacks. Thus “conditioned fear acts as a drive that motivates and reinforces avoidance” (Lissek, et. al., 2005, p. 1391). John appears to be exhibiting early signs of conditioned fear as he is increasingly avoiding social activities and although he continues to work, complains that he finds his work quite stressful. It would appear that John finds his job stressful because he has a fear of having anxiety attacks. The evidence therefore suggests that unless John receives treatment, he will develop panic disorder with agoraphobia and will eventually avoid leaving his home altogether. As it is his home is the only place where he apparently does not have panic attacks and therefore has no fear of having an attack at home. 3. Treatment Cognitive behavioural therapy will be recommended for treating John’s panic disorder. Cognitive behavioural therapy uses techniques calculated to reduce the patient’s tendency to exaggerate or misinterpret physical sensations. In this regard, the cognitive behavioural approaches will encourage John to expose himself to those situations that he currently avoids for a fear that they will bring on panic attacks, palpitations, chest pains, shortness of breath and so on. By taking his approach it is believed that John will become desensitized to the panic attacks and it will eventually become a lot easier for him to participate in activities that he avoids or has extreme difficulty dealing with (Schmidt & Kelly, 2000). Beck (1988) conducted a study in which 25 patients with panic disorder were treated by cognitive behavioural therapy and were involved in “graded exposure”(p. 91). The cognitive behavioural therapy also involved the induction of “minipanic attacks” (Beck, 1988, p. 91). The results of the study indicated that the methods employed significantly reduced the “frequency of the panic attacks” and in many cases totally eliminated the panic attacks (Beck, 1988). Since John does not state when or where his panic attacks occur, but will only say that his attacks occur away from the home and that he avoids social activities, it can be assumed that John is vulnerable to panic attacks in any social setting away from the home. Therefore the cognitive behaviour therapy will involve John consciously engaging in social activities away from the home. It may also be helpful to have John learn to adapt distracting techniques. In this regard, John may learn to focus his thought elsewhere when he feels an attack coming on. In other words, if John deliberately thinks about something else rather than the somatic symptoms when they occur, he may reduce the level of fear and anticipation that usually accompanies those symptoms. This kind of learning behaviour may also help John to eventually rid himself of his panic disorder (Beck, 1988). Bibliography Beck, A. T. (1988). “Cognitive Approaches to Panic Disorder: Theory and Therapy”. In Rachman, S. and Maser, J. D. (Eds.) Panic: Psychological Perspectives. Hillsdale, NJ: Lawrence Eribaum Associates, Inc. 91-109. Bouton, M. E.; Mineka, S. and Barlow, D. H. (2001). “A Modern Learning Theory Perspective on the Etiology of Panic Disorder.” Psychological Review, Vol. 108(1): 4-32. Deacon, B. and Abramowitz, J. (2006). “Anxiety Sensitivity and its Dimensions Across the Anxiety Disorders.” Anxiety Disorders, Vol. 20: 837-857. Katon, W. (July 1984). “Panic Disorder and Somatization: Review of 55 Cases.” The American Journal of Medicine, Vol. 77(1): 101-106. Khawaja, N.G. and Oei, T. P. (April 1998). “Catastrophic Cognitions in Panic Disorder with and without Agoraphobia.” Clin Psychol Rev. Vol. 18(3): 341-365. Ley, R. (July 1992). “The Many Faces of Pan: Psychological and Physiological Differences Among Three Types of Panic Attacks.” Behaviour Research and Therapy, Vol. 30(4): 347-367. Lissek, S. et. al., (2005). “Classical Fear Conditioning in the Anxiety Disorders: A Meta-Analysis.” Behaviour Research and Therapy, Vol. 43: 1391-1424. Nutt, D. J.; Ballenger, J. C. and Lepine, J. (1999). Panic Disorder: Clininal Diagnosis and Management. London, UK: Martin Dunitz, Ltd. Salkovskis, P. M.; Clark, D.M. and Gelder, M. G. (May-June 1996). “Cognition-Behaviour Links in the Persistence of Panic.” Behav. Res. Ther. Vol. 34(5-6): 453-458. Schmidt, N. B. and Kelly, W. (Feb. 2000). “The Effects of Treatment Compliance on Outcome in Cognitive-Behavioral Therapy for Panic Disorder: Quality versus Quantity.” Journal of Counseling and Clinical Psychology, Vol. 68(1): 23-18. Read More