Anxiety And Pain Essay Research Paper How — страница 2

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cultural characteristics, for example among the Eskimo people of west Greenland it can take the form of kayak angst where symptoms include intense fear, disorientation and fear of drowning (Davison & Neale, 1998)PD has a high comorbidity with other disorders, which can make diagnosis difficult. It often occurs with or can lead to agoraphobic disorder, especially for women (Hallam, 1985). It often co-exists with major depression (Breier et al, 1986; cited in Davison & Neale, 1998) and/or alcoholism, which may function as a coping strategy, especially for males (Hallam, 1985).Research (Rees, Richards, & Smith, 1998) has shown that PD sufferers have more medical tests, use emergency services more and are more likely to be misdiagnosed than other anxiety groups i.e.

social phobics. Sufferers have also been shown to incur health service costs 11 times higher than controls and 5 times higher than social phobics. This may be due to PD sufferers being misdiagnosed in the first place or simply unconvinced by a PD diagnosis in the face of intense feelings of bodily dysfunction, i.e. a perceived feeling of heart attack or choking etc (Rees, Richards, & Smith, 1998).The two prevalent psychological theories for PD are the cognitive model (Clark, 1986, cited in Baker, 1989) and the psychophysiological (PP) model (Ehlers, 1989, cited in Baker, 1989). Both models assume the PD arises as a result of a tendency to associate harmless bodily symptoms (Clark, 1986; cited in Windmann, 1998) or of "bodily and/or cognitive changes" (Ehlers, 1989;

cited in Windmann, 1998) with threat of immanent attack. The models consider PD as quantitatively not qualitatively different from normal panic episodes (as opposed to the more medical models which view it as more of a qualitative difference, see Baker, 1989) on a number of different dimensions. Which include the nature of the triggering event (internal vs. external), the nature (somatic vs. psychic) and time factor (sudden vs. gradual) of the dominant symptoms and also the nature of the feared outcomes of the attacks (immediate bodily/mental catastrophes vs. long term negative events, (Margraf & Ehlers; cited in Baker 1989)).Both PP and cognitive models propose that the perception of threat based upon physical symptoms create a positive feedback loop which exacerbates the

perceived feeling of panic which spirals up into a full-blown panic attack. The cognitive model refers to this process as ?cognitive misinterpretation? as sufferers erroneously take normal bodily sensations (such as increased heart rate) and catastrophically misinterpret them as signs of physical threats. The PP model extends this idea in that it also proposes that associated conditioning of fear responses can also provide panic provoking mechanisms (McNally, 1994; cited in Windmann, 1998). Any one of the features of the feedback loop could precipitate the panic attack, for instance physiological changes may occur due to activity, drug intake, situational stressors etc. The person perceives these changes though not necessarily accurately, for example heart rate may seem to

increase when lying down due to a change in posture, which increases cardiac awareness, the person may associate these bodily perceptions with danger which in turn cause further anxiety which leads to more physiological changes and so-on. PP theories consider bodily sensations to be the initial precipitator of panic attacks and the PD sufferer to have characteristics that make him/her more likely to experience bodily symptoms that are likely to trigger the attack. Such attributes can include a tendency for subtle hyperventilation, ?weak neurological signs, and cardiovascular events (Margraf & Ehlers; cited in Baker, 1989).PD has also been found to run in families (Crow et al, 1987; cited in Davison & Neale, 1998) which may reflect a genetic diathesis. Klein (1980, 1981;

cited in Baker, 1989), proposes that PD is linked to separation anxiety responses in early childhood. As such PD in this model is seen as a regression phenomenon whereas more evolutionary based approaches see PD as a normal if exaggerated adult response that performs an adaptive function in our species history (Baron-Cohen, 1997).Problems with the PP model include a lack of explanatory power as anxiety is said to be the result of perception of anxiety, which is a circular argument (Lang, 1988; cited in Windmann, 1998) and scientific theories need to avoid confounding explanans and explananda in the same account of a phenomena. A second problem is that the temporal succession of the ?presumed causes from the presumed consequences? is difficult to empirically disentangle, as they