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Lectures Anxiety and Related Disorders ()
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Lecture 1 Emotion TheoryWHAT IS AN EMOTION?
Emotions are essential to a healthy human existence, and it is for that reason that their malfunction
is so serious.
The study of emotions used to be related to the study of ethics:
Aristoteles’ study of ethics and vices concerned a lot of emotion theoretical approaches. Why?
The right amount of emotion is one of the keys to being/showing virtues behaviour.
o First emotion was a philosophical approach
o Later there was more focus on the functions of emotions.
Emotion:
A phenomenon or psychological state, which goes together with a physiological arousal, thoughts,
feelings, and a behavioural response.
There is no consensus yet about the definition.
HIGHER VS LOWER EMOTIONS
Basic emotion theory:
There are 5 basic emotions:
Happy
Anxious
Sad
Angry
Ashamed
There is some consensus on this and is quite influential for interventions and psychopathology.
Higher emotions: Complex emotions are faith, love (St. Thomas Aquinas, c. 1224-74).
If you unpeel them, you get one of the basis emotions.
Theories about basic emotions originated from ancient Greece and China (source…). Current basic emotion
theory started with Darwin (1872) and Ekman (2003), later (Tomkins, 1962), subsequently followed by Ekman
(1984), and Izard (1977), then by many current psychologists (Ortony and Turner, 1990;… etc.). Basic emotion
theory proposes that human beings have a limited number of emotions that are biologically and psychologically
“basic”, each manifested in an organized recurring pattern of associated behavioural components.
ANXIETY VS ANXIETY DISORDERS
1. Emotion theory and anxiety
2. Anxiety disorders
Anxiety is a human as well as an animal emotion and it is quite useful.
There are some general basic function in anxiety disorders; stimulus + anxiety (reaction)
,ANXIETY IS AN EMOTION
Emotion is more than a feeling, because it consists of three aspects:
a. Physiological arousal (sweety hands, hart pounding, trembling)
b. Cognitive aspects
We have a cognitive appraisal before it comes to our consciousness
a. Conscious (experience/feeling)
b. Unconscious
c. Motoric aspect
These aspects are loosely coupled systems, and can be either concordant or discordant.
They occur together, but are not always present and are not concordant for all situations or
emotions. For example;
Heart racing when seeing a loved one positive
Heart racing when being angry of anxious is negative
The cognitive appraisal is different, while experiencing the same physiological arousal.
People are also able to inhibit some aspects of emotion; feeling angry but not reacting to it.
Emotional reactions are sometimes very intense, think of fight or flight reaction. We don’t have easy
access to them:
Sometimes it takes us a second to realize what’s happening.
RELATED CONCEPTS: MOOD, ATTITUDE & TEMPERAMENT
Current state Chronic
disposition
Salient Emotion Attitude
object
No salient Mood Temperament
object
Mood, attitude and temperament are different from emotion.
Emotions and moods are current states; quick in time
Attitudes and Temperament are chronic dispositions; last longer in time.
Emotions and mood salient objects; not discrete
Mood and temperament are not salient objects: discrete / unvisible
Distinction between mood and emotion is not always clear and they are entangled.
Mood is more constant, a dimension from positive to negative. Can last for a few days.
,Temperament
A general disposition on how you react to situations in a certain effective way. A chronic disposition
which is independent from certain objects.
- Normally distributed.
- One important personality trait: tendency to experience negative emotions or interpret
everything in a negative way = neuroticism.
Patients coming for treatment often score high on neuroticism.
- Panic disorder is also more like a mood or even temperamental state.
TWO DIMENSIONS
Emotions happen on two dimensions; arousal against valence (of an emotion).
Very positive and high in arousal: Excitement about something pleasantly.
High arousal in the negative side: Anger.
Negative emotion, low arousal: Sadness.
Positive emotion, low arousal: Contentment.
The higher the arousal, the more impact it has on the individual.
,EMOTIONS HAVE FUNCTIONS
(CF. LANGUAGE, MEMORY, ATTENTION, ETC.)
Emotions (and other abovementioned things) are important because they are functional.
What functions do emotions serve?
Survival of self and offspring
o Emotions prepare us for action; fight or flight
Emotions occur when vital interests are at stake.
This is the most important greatest common denominator of emotions.
Same holds for memory. Memory is highly adaptive:
Learn from your experience. If you would not learn from your experience, you would have been
dead by now.
Frijda; great emotion theorist:
Emotions as ‘action tendencies’ They prepare you for survival, to take the right action.
Some Examples:
THEORETICAL BACKGROUND
1. Evolutionary Theory
2. James-Lange Theory
3. Cannon-Bard Theory
4. Schachter-Singer Theory
Stimulus Physiological arousal Cognitive label Emotion
5. Cognitive appraisal Theory
Stimulus Cognitive label Physiological arousal Emotion
,SCHACHTER-SINGER: THE TWO-FACTOR THEORY OF EMOTIONS
Stimulus Physiological arousal Cognitive label Emotion
According to the Schachter-Singer theory, emotions are a result of two factors:
1. Physiological arousal.
2. A cognitive process, in which people try to interpret / label this physiological response by
looking at their surrounding environment to see what could be causing them to feel this way.
Examples:
Strange man run toward me heart racing, trembling caused by anxiety thus I am frightened
Stimulusphysical arousalcognitive labelconscious experience of the emotion
COGNITIVE APPRAISAL THEORY
Stimulus Cognitive label Physiological arousal Emotion
Richard Lazarus was a pioneer in this area of emotion, and this theory is often referred to as the
Lazarus theory of emotion.
Important for clinical working field:
Emotions are clear for patients. Wé know that behavior and thoughts influence how we feel.
We have to explain that behavior and thoughts are the tools that we will work with.
It’s about:
- Our cognitions; the appraisal of stimuli
- The behavior that emotion provokes
This is important because we think appraisal is rational, but it’s not. Behavior builds up on that.
In anxiety this appraisal is often not realistic. This leads to..
,FIGHT, FREEZE OR FLIGHT REACTION
Walter Cannon (1920): first to describe the fight-or-flight response.
- Later the FREEZE response has been officially added.
- Present in a lot of animals – also often in victims of sexual assault.
COGNITIVE APPRAISAL THEORY
Emotion requires ‘interpretation’ of stimulus:
o Often very fast, sometimes even preconscious
Primary = preconscious vs secondary appraisal = conscious
The interpretation of the stimulus determines which emotion you feel.
Primary interpretation takes place in a split of a second and is often unconscious.
Secondary interpretation takes longer and is conscious (cognitive reappraisal)
Example: Breaking vase in the room besides your bedroom while sleeping:
- Vase breaking (neutral stimulus) + cognitive appraisal ‘it’s a burglar’ = anxiety
- Vase breaking (neutral stimulus) + cognitive appraisal ‘it’s my cat’ = neutral feeling
NEUROTICISM
(TRAIT ANXIETY/NEGATIVE AFFECTIVITY)
ON PERSONALITY
1. Neuroticism is fundamental personality trait (cf Big V)
2. Neuroticism is genetically transmitted
3. Neuroticism is closely associated with various symptom disorders
4. Neuroticism appears to be a ‘higher order trait’
Neuroticism
Trauma and OCD
Depr.Diso Anxiety +related
Stress Related
rders Disorders Disorders Disorders
,Neuroticism as a vulnerability factor
Certain individuals are more susceptible to anxiety disorders
Some stimuli are more anxiety provoking than others.
Common objects of anxiety: Less common objects of anxiety
Arachnophobia Fear of oak leaves
Musophobia Fear of bathrobes
Astraphobia Fear of lorries
Social phobia Hoplophobia (fear of firearms)
Hypochondria Fear of plug sockets
Etc. Etc.
WHERE DOES SELECTIVITY OF ANXIETY COME FROM?
See also article of Mineka & Zinbarg (2006); this comes from evolution.
According to evolution theory there were certain objects / things that promote survival if
you are afraid of them; snake can kill you. Flower not, f.e.
Monkey experiment:
- Monkeys from Africa to colleague in Chicago – afraid of wooden snake.
- Monkeys from Chicago – offspring from the monkeys in Africa – born and raised in Chicago.
They were not afraid of the wooden snake contradicts inherited fear.
- Conclusion: Interaction effect between model and stimuli.
- Also: Vicarious learning;
Although fear can be inherited, this can be influenced by just observing others being fearful.
Or in this experiment, not being fearful.
,ANXIETY DISORDERS
Why is this so important in anxiety disorders?
Fear might not be irrational, but the response to the stimulus !
Typical in anxiety disorders is the following assumption:
CS (neutral stimulus) provokes an anxiety response, how?
CS is somehow associated with potential danger Called US (consequence)
CS activates a memory of a US (nasty event) which causes the emotion.
Pavlog dog experiment: US (food) + CS (bell) = CR
Abnormal is not: the nature of the anxiety response itself
Abnormal is: the intensity of the response (disproportionate)
to the seriousness of the threat:
Cf. Cognitive nucleus of anxiety disorders
Nature of CS and US in anxiety disorders are different
--------------------------------------------------------------------------------------------------------------------------------------
Panic disorder: Catastrophic misinterpretation of bodily sensations
CS: physical sensation; US: Heart-attack
Social phobia: fear of disapproval from others because others see signs of social anxiety
(blushing, trembling, etc.)
CS: others see signs of social anxiety (trembling); US: others will reject me
OCD: fear of guilt from behaving irresponsibly
CS: boils down to being guilty: seeing gas stove; US: neighbour will die from
explosion my fault I will be guilty
PTSD: catastrophic misinterpretation of the consequences of trauma and the
significance of trauma
CS: memory; US: fear of ‘whatever happened during trauma’
Other event-related Depending on nature of phobia
phobias: (Dog will attack, plane will crash, lightning will strike, etc.)
GAD: alternating (‘worrying is annoying, but actually good’)
OCD / PTSD distinct disorders because there are other prominent emotions. Often shame, disgust
and guilt which is different from anxiety disorders.
FEAR OF HEIGHTS?
Important aspect in anxiety disorders is that they provoke malfunctioning in daily life!
Being afraid of spiders – Jumping out of a boat – Maladaptive, limited in functioning
,DSM-5/ICD-11 ARE CATEGORICAL, BUT
Co-morbidity (50% rule)
Fuzzy boundaries and co-morbidity is rather the rule than the exception.
Symptoms are not specific for one anxiety disorder – certainly in many anxiety disorders you
can e.g. experience panic attacks. Importantly it is more the specific for an anxiety disorder.
In this course we will work with the DSM-5 as it is the general classification system in the
Netherlands. In other countries the ICD-11 is used. A classification system of the World Health
Organization (WHO).
AETIOLOGY & PERSISTENCE
Aetiology: we simply don’t know why some people develop anxiety disorders and other not.
Yes, life events make us more susceptible to develop a disorder.
Maintenance:
Avoidance behavior prevents from learning that CS does not prevent US.
o Target safety behavior! CS is not predictive of US!
BETTER SAFE THAN SORRY?
Difference avoidance behaviour and safety behaviour:
Avoidance: not getting into feared situation
Safety behaviour: Confronting feared situation, but doing something to “help you get
through it.
Safety behaviour prevents you from learning when you face your fear!
REMEMBER EXTINCTION?
Habituation: Decrease of anxiety.
Extinction: Learning that the association CS US does not occur.
o Based on conditioning models; behaviour will decline if it is not rewarded (Pavlov,
1927).
IS THREAT IN THE EYE OF THE BEHOLDER?
Mental imagery can be very strong.
o In social phobia these can be pictures of yourself trembling and others really laughing at you.
Pictures are so strong and clear cut that people often refuse exposure.
DO WE NEED A THEORY ?
Yes, it helps us to know how and why anxiety starts and persists.
It brings us something we can test and helps us to treat our patients and know what to target.
, Lecture 2: Specific Phobias
The two sides of fear:
Fear is useful for survival
Too much fear or fear for things that are not dangerous can
o Excessive avoidance
o Excessive fear
Objects of Phobias:
- Animal
- Natural environment (heights, storms, water)
- Blood-injection-injury
- Situational
- Other
Common characteristics in DSM-V
Marked fear or anxiety about specific object or situation
Phobic object is almost provokes immediate fear of anxiety
The phobic object or situation is actively avoided or endured with intense fear
The fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation to the sociocultural context.
The fear, anxiety or avoidance causes clinically significant distress or impairment in social,
occupational or other important areas of functioning
Persistent, typically lasting for 6 months or longer
Excessive reactions: running away for your life when seeing a big dog which is on the leash.
Fear is ubiquitous, phobias not!
Prevalence phobias:
- 7-9% US
- 6 % Europe
- 2-4 % Asia, Africa, Latin America
“prevalence is important when we’re going to talk about the models, especially when talking about
individual differences”
Aetiology
Ivan Pavlov (+ friends): classical conditioning
BF Watson + Little Albert + Rosalie Rayner
o Happened 101 years ago, it has many methodological problems
o If it would be done today, it wouldn’t be something recalled as giving good evidence
o It’s useful because of aversive conditioning
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