لایب سان

We all worry! We worry about arriving on time, not burning the food we are mak- ing for lunch, or whether we will find another job. Daily life is replete with oppor- tunities to worry. But not everyone who experiences worry develops clinical anxiety. A person can be a high worrier but still not fulfill the criteria for GAD. How can nonclinical worry be distinguished from the clinical worry symptoms of generalized anxiety disorder? Studies that compared high worriers and patients with GAD found notable differences. Compared to high worriers, people with GAD had higher scores on trait anxiety, depression, more negative beliefs about worry, a greater range of worry topics, and more frequent and severe negative thought intrusions (even when objectively assessed by a rater). In one study, clients in treatment for GAD were compared to community volun- teers who have the same propensity to worry but did not meet the criteria for GAD. Both groups had to engage in a worry task consisting of three phases: a 5-minute period where participants were instructed to focus on their breathing, 5 minutes of worrying, and a 5-minute post worry breathing focus period. Participants were interrupted several times to report if their attention was focused on their breathing or other thought intrusions. If they reported a thought intrusion, they indicated its valence—positive, negative, or benign—and provided a description. These descriptions were rated by an objective experimenter who also assessed their valence. Both groups completed many assessments such as the Generalized Anxiety Disorder Questionnaire, Penn State Worry Questionnaire (to ensure that they are similar), State-Trait Anxiety Inventory-Trait, Beck Depression Inventory, Attentional Control Questionnaire, and Metacognition Questionnaire

xi Contents 1 Generalized Anxiety Disorder (GAD): Etiological, Cognitive, and Neuroscientific Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Introduction: Worry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Etiological Aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2.1 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.2.2 Parent-Child Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.2.3 The Development of Cognitive Biases . . . . . . . . . . . . . . . . 7 1.2.4 Unexpected Adverse Events. . . . . . . . . . . . . . . . . . . . . . . . . 8 1.2.5 Childhood Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.2.6 Age of Onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.3 Cognitive Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.3.1 Avoidance Model of GAD and Worry . . . . . . . . . . . . . . . . . 10 1.3.2 The Intolerance of Uncertainty Model of GAD. . . . . . . . . . 12 1.3.3 Metacognitive Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.3.4 The Emotion Dysregulation Model (EDM) . . . . . . . . . . . . . 17 1.3.5 Acceptance-Based Model of GAD . . . . . . . . . . . . . . . . . . . 17 1.3.6 Contrast Avoidance Model of GAD . . . . . . . . . . . . . . . . . . . 18 1.3.7 Hirsch and Mathews’ Cognitive Model of Pathological Worry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1.4 Neuroscientific Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 1.4.1 Neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 1.4.2 Electrophysiological Studies . . . . . . . . . . . . . . . . . . . . . . . . 28 1.4.3 Neuroendocrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 1.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2 Social Anxiety Disorder (SAD): Etiological, Cognitive, and Neuroscientific Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 2.2 Etiological Aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 2.2.1 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 xii 2.2.2 Behavioral Inhibition Temperament . . . . . . . . . . . . . . . . . . 53 2.2.3 Parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 2.2.4 Peers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 2.3 Cognitive Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 2.3.1 Rapee and Heimberg’s Model . . . . . . . . . . . . . . . . . . . . . . . 57 2.3.2 Clark and Wells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 2.3.3 Other Cognitive Models of SAD . . . . . . . . . . . . . . . . . . . . . 60 2.3.4 Information-Processing Biases . . . . . . . . . . . . . . . . . . . . . . 62 2.4 Neurobiological Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 2.4.1 MRI Task Independent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 2.4.2 Task-Dependent fMRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 2.4.3 Electrophysiological Studies . . . . . . . . . . . . . . . . . . . . . . . . 76 2.5 Summary and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 3 Panic Disorder PD and Agoraphobia: Etiological, Cognitive, and Neuroscientific Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 3.2 Etiological Aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 3.2.1 Genetic Etiology of PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 3.2.2 Learning Theory and Etiology of PD. . . . . . . . . . . . . . . . . . 108 3.3 Cognitive Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 3.3.1 Cognitive Models of Panic Disorder . . . . . . . . . . . . . . . . . . 112 3.3.2 Cognitive Information-Processing Biases in PD . . . . . . . . . 119 3.4 Neuroscientific Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 3.4.1 Structural Neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 3.4.2 Functional Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 3.4.3 Neurochemistry of Panic Disorder. . . . . . . . . . . . . . . . . . . . 128 3.5 Conclusion and Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 4 Specific Phobia: Etiological, Cognitive, and Neuroscientific Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 4.2 Etiological Aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 4.2.1 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 4.2.2 Temperaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 4.2.3 Associative and Nonassociative Models . . . . . . . . . . . . . . . 150 4.3 Cognitive Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 4.3.1 Attentional Bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 4.3.2 Other Biases in Judgment . . . . . . . . . . . . . . . . . . . . . . . . . . 163 4.4 Neurobiological Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 4.4.1 fMRI Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 4.4.2 ERP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 4.5 Summary and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Contents xiii 5 Evidence-Based Treatments for Anxiety Disorders . . . . . . . . . . . . . . . 189 5.1 Talk Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 5.1.1 Cognitive Behavioral Therapy (CBT) . . . . . . . . . . . . . . . . . 189 5.1.2 Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Interventions (MBIs) . . . . . . . . . . . 192 5.1.3 Acceptance and Commitment Therapy (ACT) . . . . . . . . . . 193 5.2 Neurostimulation Brain Stimulation Therapeutic Approaches . . . . 201 5.2.1 Repetitive Transcranial Magnetic Stimulation (rTMS) . . . . 201 5.2.2 Transcranial Direct Current Stimulation (tDCS) . . . . . . . . . 203 5.2.3 Vagus Nerve Stimulation (VNS) . . . . . . . . . . . . . . . . . . . . . 205 5.2.4 Trigeminal Nerve Stimulation (TNS) . . . . . . . . . . . . . . . . . 206 5.3 Biofeedback and Neurofeedback . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 5.3.1 Electromyography (EMG) Biofeedback . . . . . . . . . . . . . . . 208 5.3.2 Electroencephalography (EEG) Neurofeedback . . . . . . . . . 208 5.3.3 Functional Magnetic Resonance Imaging (fMRI) Neurofeedback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 5.4 Summary and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

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