xxiv Preface
rarely—if ever—is the only one affected by the therapy.) For instance, below is the icon
we use to note when treatment that directly targets a psychological factor in turn can
affect neurological factors and create feedback loops between the two kinds of factors.- At the end of the “Understanding” and the “Treating” sections, we typically
have concluding sections that explicitly call attention to interactions among the
three factors and that walk students through a description of how the three types
of factors affect one another via feedback loops. Examples of these sections are
Feedback Loops in Action: Understanding Panic Disorder and Feedback Loops in
Treatment: Panic Disorder. - At the end of most Feedback Loops in Action and Feedback Loops in Treatment
sections, we include a neuropsychosocial “Feedback Loops” fi gure; this fi gure
illustrates the feedback loops among the neurological, psychological, and social
factors. - The Feedback Loops in Action fi gures serve several purposes: (1) They provide a
visual summary of the most important neuropsychosocial factors that contribute
to the various disorders; (2) they illustrate the interactive nature of the factors;
(3) their overall structure is the same for each disorder, which allows students to
compare and contrast the specifi cs of the feedback loops across disorders.
pgggp ,
were afraid of touching dirt, she would touch dirt but would not then wash her hands.
Through exposure and response prevention, patients learn that nothing bad happens if
they don’t perform their compulsive behavior; the anxiety is lessened without resorting
to the compulsion, their fear and arousal subside, and they experience mastery. They
survived the anxiety and exerted control over the compulsion. When patients success-
fully respond differently to a feared stimulus, this mastery over the compulsion gives
them hope and motivates them to continue to perform the new behaviors.P SNFEEDBACK LOOPS IN ACTION: Understanding Panic Disorder
Cognitive explanations of panic disorder can help show how a few panic attacks can
progress to panic disorder, but not everyone who has panic attacks develops panic
disorder. It is only when neurological, biological, and psychological factors interact
that panic disorder develops (Bouton, Mineka, & Barlow, 2001). Cognitive processes
such as catastrophic thinking and anxiety sensitivity (psychological factors) are trig-
gered, in part, by environmental and social stressors (social factors). Indeed, such
stressors may lead an individual to be aroused (neurological factor), but he or she
then misinterprets the cause of this arousal (psychological factor). This misinterpre-
tation may increase the arousal (Wilkinson et al., 1998), making it more likely that
symptoms of panic—rapid heartbeat or shallow breathing—will follow.
For example, a man’s argument with his wife might arouse his anger and in-
crease his breathing rate. Breathing faster results in a lower carbon dioxide levelP SNFEEDBACK LOOPS IN TREATMENT: Panic Disorder
Invariably, medication—which changes neurological functioning—stops exerting its
benefi cial effect when the patient stops taking it. The positive changes in neural
communication and brain activity, and the associated changes in thoughts, feelings,
and behaviors do not endure. Eventually, the symptoms of panic disorder return.
For some patients, though, medication is a valuable fi rst step, providing enough
relief from symptoms that they are motivated to obtain CBT, which can change
their reactions (psychological factor) to perceived bodily sensations (neurological
factor). When a patient receives both medication and CBT, however, the medication
should be at a low enough dose that the patient can still feel the sensations that led
to panic in the past (Taylor, 2000). In fact, the dose should be gradually decreased
so that the patient can experience enough anxiety to be increasingly able to make
use of cognitive-behavioral methods. It is the CBT that leads to enduring changes:
Researchers have found that adding medication to CBT doesn’t provide an advan-
tage over CBT alone (de Beurs et al., 1999). This fi nding has led to CBT’s being
recommended even for those who prefer medication (Ellison & McCarter, 2002).
Whether it involves medication or CBT or both, successful treatment will probably
lead the patient especially if he or she also has agoraphobia to become moreP SN