Summary Week 1 Emotion theory and anxiety-related disorders Literature Summaries
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Course
Anxiety and related disorders (201600817)
Institution
Universiteit Utrecht (UU)
The document contains detailed notes of all four articles that are part of the obligatory literature for the exam of the course Anxiety and related disorders in the academic year 2021/2022.
1. MENTAL DISORDERS AS NETWORKS OF PROBLEMS: A REVIEW (Fried et al., 2017)
Approach that treats mental disorders as networks of interacting symptoms using network psychometrics
a causal interplay between symptoms constitutes mental disorders (we can draw causal links between
symptoms of a disorder, realize what came first and hence what should be treated first).
1. Time-series allow to look at these causal relationships (are directional).
2. Whereas cross-sectional data is an undirected network.
1) Comorbidity
o People with more disorders have a poorer prognosis, worse treatment outcomes, and higher suicide
rates.
o The approach hypothesizes disorders co-occur due to mutual interactions among symptoms (and
hence, aren’t totally unrelated as has been traditionally believed). Comorbidity arises when
symptoms bridge two disorders bridge symptoms can spread activation from one disorder to
another.
o For example, one such symptom, common to most disorders, is emotional pain = a promising target
for psychotherapeutic interventions.
o There are no sharp boundaries between many disorders due to a substantial symptom overlap.
diagnoses may co-occur as a function of their number of shared symptoms. Disorders that share more
symptoms are more likely to co-occur (a ni to po definiciji sicer?), but only if they share common
underlying causes (if the causes are independent, this isn’t a predictor of comorbidity, such as in
physical illnesses, even if symptoms are the same, but the cause different,
o Empirical comorbidity rates were related to distances between disorders in an analysis of symptom
overlap in the DSM.
o However, the way comorbidity arises may very well be different for different people with the same
comorbid diagnoses and different for different types of comorbid diagnoses.
2) Prediction
o While many people experience single symptoms, only part of them develop a mental disorder.
o Prediction of psychopathology onset is thus crucial for intervention, it allows us to know when a
transition happens between healthy and disordered states, when a tipping point is reached.
o Such knowledge (of early warning signs and of centrality degree of each symptom) also helps predict
such tipping points.
o For weakly connected symptom networks, negative external conditions (i.e., stressful events) lead to
a gradual increase in symptoms, whereas for strongly connected networks, external stress leads to a
sudden shift from a healthy to depressed state. Knowledge of such networks sheds new light on a
long-standing discussion whether psychopathology is dimensional or categorical: for those with a
strong connectivity of symptoms, it’s categorical, for those with a weaker symptom connectivity, it’s
dimensional.
3) Clinical intervention of the concept of centrality
o Network analysis may provide promising leads towards improving clinical prevention and
intervention strategies by investigating which symptoms are more strongly connected or more central
than others.
o If a symptom (e.g., depressed mood) has many connections to other symptoms in a
psychopathological system, it may cause the development of these symptom, hence, it should be the
first to treat.
, o However, the problems are that different studies use:
1) different questionnaires
2) different time frames
3) different samples
4) different network estimation methods
Network models of psychopathology help:
1) predict onset / tipping points / transition from healthy to disordered time interventions
2) determine the most central symptoms to a disorder target interventions to people with those
symptoms
2. ANXIETY DISORDERS: WHY THEY PERSIST AND HOW TO TREAT THEM (Clark, 1999)
But isn’t the idea of exposure therapy precisely that enough disconfirming evidence helps tackle anxiety
disorders? But the article says exactly the opposite: DESPITE a ton of disconfirming experience, people
with anxiety disorders still engage in their negative maladaptive thinking patterns, so exposure didn’t
work? exactly, this works is a direct critique of the behavioral conditioning theories of anxiety!
1. Safety-seeking behavior
o Safety behaviors = behavior which is performed in order to prevent or minimize a feared catastrophe.
o This explains why the non-occurrence of a feared event fails to change patients' negative beliefs: if
the person uses safety behaviors, their beliefs aren’t really disconfirmed, since they can attribute the
absence of the US to their safety behaviors.
o In an experiment that manipulated safety seeking behaviors, dropping-safety behaviors condition led
to a significantly larger decrease in negative beliefs and produced a significantly greater
improvement in anxiety in a subsequent behavior test.
o Several additional interesting features of safety behaviors:
1) many safety “behaviors” are internal mental processes (worrying, memorizing, rehearsing,
reassuring, checking) making their basic fear to persist
2) patients often engage in a large number of different safety behaviors in a feared situation
3) safety behaviors can create some of the symptoms that those with anxiety disorders fear
4) some safety behaviours can draw other people's attention to the patient
5) some safety behaviours influence other people in a way which partially confirms the patient’s
fears
2. Attentional deployment
o Selective attention towards threat cues may play a role in the maintenance of anxiety disorders by
enhancing the perception of threat.
o Attention towards threat cues
In an experiment, patients with spider phobia showed an attentional bias towards the spider
pictures more than non-patient controls.
Panic disorder patients were more accurate at counting their heart beats than infrequent
panickers, simple phobics and non-patient controls.
Yeah, but still, this is a defining characteristic of anxiety disorders, it doesn’t explain WHY
people develop an anxiety disorder. These traits are merely symptoms one developed after
already having a disorder.
o Attention away from threat cues
, Socially anxious individuals tend to avoid looking at other people when in a feared social
situation, but it’s precisely the eye contact that gives information about how others react towards
us. The high socially anxious students showed an attentional bias away from faces and towards
objects. In this way, attentional avoidance would maintain their fears.
There’s a difference though: patients with spider phobia, panic disorder and hypochondriasis
show an attentional bias towards threat cues, whereas patients with social phobia show some
evidence of an attentional bias away from others' facial expressions.
If a spider phobic is presented with a spider, looking away does not remove the threat
hence, it doesn’t help to look away.
On the other hand, looking away from others' faces and avoiding eye contact is likely to
reduce some aspects of threat for a social phobic (less likely to engage them in conversation)
provides a psychological escape.
3. Spontaneously occurring images
o Spontaneously occurring mental images in which patients `see' their fears realized are common in
anxiety disorders and enhance the perception of threat.
o One particularly potent source of information is self-imagery, which serves as “evidence” even in the
absence of any real empirical evidence.
o In these images, patients see they see their fears visualized, which to them, confirms these fears.
o In an experiment, the majority (77%) of patients with social phobia reported spontaneously
occurring, negative, observer-perspective images, and only 10% of non-patient controls reported
such images and their images were in general less negative.
o Also, these images lack updating in social phobia, there are recurrent images which appear in
similar form in various social situations, are often outdated, from times when the person was
humiliated etc. from a time when a mental model of the patient’s social self was laid down after a
traumatic experience., and then this model is reactivated in subsequent social encounters. Reduced
attention to social situations prevents the model from being updated.
4. Emotional reasoning
o Patients with social phobia use self-images and other anxiety-related interoceptive information, to
make erroneous inferences about how they appear to others.
o In an experiment, within the high social anxiety group, perceived body sensations were significantly
correlated with self-ratings, but not observer-ratings, of anxious appearance.
o Social anxiety may be partly maintained by patients using perceived body sensations to make
erroneous inferences about how anxious they appear and how poorly they come across an
instance of emotional reasoning.
5. Memory processes
1) selective retrieval of negative memories and impressions of the observable self
Anxious individuals selectively retrieve information which appears to confirm their worst fears.
They recall fewer positive words and recall more negative ones, but only when anticipating a speech,
and only for those terms referring to how they would appear to others.
2) dissociation between explicit and implicit memory (recall and priming)
Those with PTSD have difficulty in intentionally retrieving a complete memory of the traumatic
event.
However, they also often they involuntarily re-experience aspects of the trauma vividly and
emotionally.
3) affect without recollection
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