Anxiety And Pain Essay Research Paper How — страница 3

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are strongly interdependent (Windmann, 1998 p.490). A third problem of both cognitive and PP models is that they do not explain why some people misread bodily symptoms as catastrophic whilst others do not.Cognitive models usually imply that PD sufferers have an attentional bias towards threat cues and bodily sensations (Beck, Emery & Greenberg, 1985; cited in Windmann, 1998). PD patients have been shown to have shorter response latencies to presentations of threatening words (Asmundsun, Sandler, Wilson & Walker, 1992; cited in Windmann, 1998). However it is unclear whether a cognitive bias towards threat perception in PD sufferers is a cause or a consequence of the disorder (McNally, 1994; cited in Windmann, 1998).A new model by Beck & Clark (1997) proposes a

multistage information processing model. In this model a proposed threat can be detected by an early warning system, which operates subconsciously, and is purely stimulus-driven. Processing done at this stage is "relatively undifferentiated" and classifies threats only on a rough perceptual basis. This system is argued to be evolutionary useful in that a person who is ?weighted? towards more responses to possible threats, even if some of these constitute false alarms will have a greater chance of survival. And it is these false alarms that are described as ?cognitive misinterpretations? in the clinical literature (Clark, 1986, 1988; cited in Windmann, 1998). However the false alarm rates have to be minused from the ?hit rates? to be able to come to a figure of optimum

survival value (see Windmann & Krüger, in press).Windmann (1998) suggests that the revised Beck & Clark (1997) model can be combined with neurobiological perspectives to provide a new model of PD. It is suggested that a dysfunction in the amygdala and the ascending transmitter system can lead to false alarm perceptions of threat, causing irrational fear and anxiety. This theory represents a monistic approach that unites the previously antithetical medical and psychological approaches. The new theory sheds some light on previously problematical aspects of PD. Some of these include the observation of groundless respiratory manoeuvres that occur during a panic attack. This can be accounted for in the new theory as the amygdala is connected to the central nuclei of

respiratory regulation. It is also possible to see why antidepressants and alcohol can have alleviative effects upon PD as these should also counteract the effects of the pre-attentive alarm system (Windmann, 1998). The theory is supported by other finding of the role the amygdala has in fear production (Gloor, 1992; cited in Windmann, 1998).An implication of the theory regards the assumption that anxiety reflects an enhanced propensity to give false alarm reports regardless of the stimulus (i.e. whether it is neutral or not). The implication being that PD sufferers should display an enhanced response bias to tasks requiring the discrimination between threatening and neutral stimuli (Windmann, 1998) Although the theory is based upon the assumption of a physical dysfunction,

Windmann does not go on to suggest a drug based therapeutic approach. Firstly, the problem of systemic effects that psychoactive drugs have on the whole brain often lead to unavoidable side effects, and secondly the brain?s extreme plasticity, even in adulthood offer the possibility that cognitive therapies may be useful in re-organising the structure of neuronal connections which can facilitate coping stratagies for the PD sufferer.Much research is still being done into the problem of Panic Disorder. Until recently the psychological and medical approaches have tended to avoid each other. In psychology the more successful models have tended to stress the cognitive aspects of the disorder and have proven useful in providing therapies for helping sufferers re-evaluate the symptoms

and enable them to cope to a certain extent with the debilitating effects of the disorder. Drug therapies can be effective in taking away the symptoms but often entail deleterious side effects and can also be addictive. The new monistic approach offered by Windmann (1998) seems to provide a conceptual framework for both the medical and psychological approaches to work together for a more encompassing understanding of the disorder. According to this model the underlying cause, whilst biological in nature, may well still benefit from being treated with psychological/cognitive methods. The theory?s multidisciplinary approach also avoids the crude physical/mental distinctions that have to a large extent hindered a better understanding of the disorder until this time. REFERENCESBaker,