This document contains all notes for lectures 1 to 8 of Anxiety and Related Disorders at Utrecht University. Sample pages are representative of the rest of the document.
Lecture 1: Emotion Theory
Lecture 2: Specific Phobias
Lecture 3: Panic Disorders
Lecture 4: Generalized Anxiety Disorders
Le...
Lecture 1 Emotion Theory
People are also able to inhibit some aspects of
What is an emotion? emotion; feeling angry but not reacting to it
Emotions are essential to a healthy human existence,
and it is for that reason that their malfunction is so Emotional reactions are sometimes very intense
serious (fight/flight reaction) – Intense emotions we don’t have
easy access to
The study of emotions used to be related to the study
of ethics: Aristoteles’ study of ethics and vices Related concepts: mood, attitude & temperament
concerned a lot of emotion theoretical approaches
The right amount of emotion is the key of showing
virtuous behavior
o First emotion was a philosophical
approach
o Later there was more focus on the
functions of emotions
Emotion is a phenomenon or psychological state that
goes together with physiological arousal, thoughts and
behavioral responses
Higher versus lower emotions 1. Emotions and moods are current states; quick in
Currently there is some consensus that all humans are time
able to experience all five emotions 2. Attitudes and temperaments are chronic
= basic emotion theory dispositions; last longer in time
Happy 3. Emotions and mood salient objects; not discrete
Anxious 4. Mood and temperament are not salient objects;
Sad discrete/unvisible
Angry
Ashamed Emotion: clear object that provokes a short and acute
state of an emotion, time-limited state
More complicated emotions: love and faith Attitude: negative or positive, more chronically and
If you unpeel more complex emotions -> one of the present in behavior and what you experience
basic emotions is the center of complex emotions Mood: few days, changes due to experiences or
Example: overwhelmed -> comes down to these events, less current and obvious
five basic emotions – can be changed with Temperament: chronic disposition which is
therapy) independent of certain objects (ex. general disposition
how you react to situations in a certain way), enduring
Anxiety versus anxiety disorders characteristic
1. Emotion Theory and Anxiety
Anxiety is useful for humans and other species as well 1. Normally distributed
2. Anxiety Disorders 2. Personality trait important in anxiety: tendency to
Anxiety disorders have a specific kind of content of the experience negative emotions concerning future
anxiety (panic attack, does not tell the disorder) happenings and events = neuroticism
- Patients coming for treatment often score high
General function: Stimulus – (anxiety) reaction on neuroticism
3. Panic disorder is also more like a mood or even
Anxiety is an emotion and emotion is more than a temperamental state
feeling, because it consists of three components:
a. Physiological aspects (sweety hands, trembling) Distinction between mood and emotion is not always
b. Cognitive aspects very clear – can be intertwined
Conscious (experience/feeling)
Unconscious Two dimensions
c. Motoric aspects 1. Low arousal/high arousal
2. Positive/negative (valence) of emotions
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.
Heart racing when seeing a loved one +
Heart racing when being angry or anxious -
The cognitive appraisal is different, while experiencing
the same physiological arousal
1
,Positive emotion, high arousal: Excitement Theory that consists of three central propositions
Negative emotion, high arousal: Anger 1. A stimulus causes physical arousal (something
Negative emotion, low arousal: Sadness you see like a bear)
Positive emotion, low arousal: Contentment 2. We cognitively label the physical response and
associate it with an emotion
The higher the arousal, the more impact it has on the 3. We feel the emotion
individual
Stimulus Physiological arousal Cognitive label
Emotions are important because they are functional Emotional experience
(language – to communicate, memory – highly
adaptive learning from experiences, attention, etc.)
What functions do emotions serve?
1. Survival of self and offspring
2. Common denominator in emotions is when
surviving is involved (for yourself and loved ones)
3. Frijda: emotions as ‘action tendencies’ (prepare us
for action to survive)
When do emotions occur?
4. When vital interests are at sake
Cause, experience, action tendency and function
Cognitive appraisal Theory
Stimulus Cognitive label Physiological reaction
Emotional experience
Theoretical background
1. Evolutionary Theory
Richard Lazarus was a pioneer in this area of emotion,
2. James-Lange Theory
and this theory is often referred to as the Lazarus
3. Cannon-Bard Theory
theory of emotion.
4. Schachter-Singer Theory
5. Cognitive appraisal Theory
Important for clinical working field:
Focus on 4 and 5 = most recently used
Emotions are clear for patients. We know that
behaviour and thoughts influence how we feel.
Schachter-Singer Theory
We have to explain that behaviour and thoughts are
Two-factor theory of emotions
the tools that we will work with.
It’s about:
According to this theory, emotions are a result of two
- Cognitions; the appraisal of stimuli
factors (two-factor theory of emotions):
Physiological arousal. - Behavior that emotion provokes
A cognitive process, in which people try to We think appraisal is rational and behavioral builds up
interpret/label this physiological response by on that, but appraisal is not rational or realistic in
looking at their surrounding environment to see anxiety disorders!
what could be causing them to feel this way.
Fight or flight response = fight, freeze or flight
Examples: response
Strange man run toward me heart racing, trembling
caused by anxiety thus I am frightened The freeze response – mostly in sexual assault
Stimulusphysical arousalcognitive So anxious that you are numbed/paralyzed. The body
labelconscious experience of the emotion does not respond – physiological reaction that occurs
when we are in de presence of something
terrifying/threatening
2
,- Leads to tonic immobility (also seen in animals) afraid of them (example; snake can kill you, a
Cognitive appraisal theory flower not)
An emotion requires ‘interpretation’ of the stimulus
– often really fast primary = preconscious (helps us
survive) – first appraisal in an unconscious level
Secondary appraisal takes longer = conscious
(cognitive reappraisal)
Example: breaking vase in the room besides your
bedroom while sleeping
Interpretation of the sound you hear provokes the
emotion
Vase breaking (Neutral Stimulus) + cognitive
appraisal “It’s a burglar” = Anxiety
Vase breaking (Neutral Stimulus) + cognitive Monkey experiment:
appraisal “It’s my cat” = Neutral feeling Monkeys from Africa to Chicago
Different situation with a wooden snake – monkeys
Neuroticism (trait anxiety/negative affectivity) were afraid (evolutionary learned a snake might be
Makes it more prone to experience anxiety/depression dangerous)
Experience more negative emotions (looking back Monkeys offspring Africa, but born and raised in
at the past + the future) Chicago – were not afraid of the wooden snake ->
Is highly heritable contradicts inherited fear
Conclusion: interaction effect between model and
Neuroticism on personality stimuli
Neuroticism is fundamental personality trait (Big Vicarious learning: although fear can be inherited,
Five) this can be influenced by just observing others
Neuroticism is genetically transmitted being fearful (in this experiment, not being fearful)
Neuroticism is closely associated with various
symptom disorders Why is this so important in anxiety disorders?
Neuroticism appears to be a ‘higher order trait’ The fear might not be irrational, but the response
to the stimulus
Neuroticism vulnerability high score The nature of the anxiety response itself = normal
But the intensity of the response disproportionate
to the seriousness of the threat (cognitive nucleus
of anxiety disorders) = abnormal (irrational)
Typical in anxiety disorders is the following assumption
CS -> provokes and anxiety response
CS is associated with potential danger (= US)
CS activates the memory of the US (dangerous
event), which causes the emotion
US (food) + CS (bell) = CR
Nature of CS and US in anxiety disorders are different:
Neuroticism as a vulnerability factor
So certain individuals are more susceptible to
develop anxiety disorders Panic disorder Catastrophic misinterpretation of
But also: some stimuli are more often the object of badly sensations
anxiety (disorder) than others CS = physical sensation
US = experiencing a heart attack
Social phobia Fear of disapproval from others
CS = signs of social anxiety like
blushing, trembling, sweating
US = others will see these and
reject me
OCD Fear of guilt from behaving
Where does selectivity of anxiety come from?
irresponsibly
See also article of Mineka & Zinbarg (2006): this
CS = situation (seeing a gas
comes from evolution
stove)
According to evolution theory there were certain
US = irrational thoughts (If I don’t
objects/things that promote survival if you are
turn of the gas stove, there will be
an explosion and the neighbor
3
, will die. So it will be my fault)
PTSD Catastrophic misinterpretation of
the consequences of trauma and Better safe than sorry?
the significance of trauma Difference avoidance behavior and safety behavior
CS = reexperiencing the Avoidance behavior: not going into the feared
traumatic event (B criteria) situation
US = avoid remembering the Safety behavior: confronting the feared situation,
trauma and intrusive memories but doing something that helps you getting through
Other event- Depending on nature of phobia it (example, carrying a bottle of water if feeling
related phobias (dog will attack, plane will crash, dizzy drinking water)
lightning will strike, etc.)
GAD Alternating (worrying is annoying, Safety behavior provokes a positive feeling in that
but actually good) moment, but prevents you from learning when you
actually face your fear!
Why OCD and PTSD have their own DSM-Criteria
Other prominent emotions between OCD and Habituation = “getting used to” CS
PTSD
Often shame, disgust and guilt (really central Based on conditioning models:
feelings) which is different from anxiety disorders Extinction = CS US
Learning that CS does not automatically lead to the US
Being afraid of spiders – Jumping out of a boat =
maladaptive behavior, limited in functioning
Fear of heights
People can still experience a limitation in functioning,
denying a job promotion if you must work on the 10 th
floor, or crossing a bridge that is going up high.
Important aspect in anxiety disorders is that they
provoke malfunctioning in daily life! Is threat in the eye of the beholder?
Mental imagery (images of what will happen when
you take a certain action) can be very strong!
DSM-5/ICD-11 are categorical, but:
In social phobia for example pictures of seeing
High comorbidity (50% change) with one AD
yourself trembling or seeing others laughing at
Fuzzy boundaries and comorbidity is rather the
you
rule than the exception
Pictures are so strong and clear cut that people
Symptoms are not specific for one anxiety disorder
often refuse exposure.
– certainly in many anxiety disorders, you can for
example experience panic attacks. Importantly it is
What to do when you are anxious?
more the specific for an anxiety disorder
It is human avoiding things we are afraid of. Also
depends on the steps you take (first fluffy tiny dog)
In this course we will work with DSM-5, as it is the
general classification system in the NL. In other
Conclusions
countries ICD-11 is used. a classification system of the
Avoidance behavior is really important, because it
World Health Organization (WHO)
helps us in the moment itself, but in the long time it
prevents us from learning
Critical question: Why does anxiety continue, even
Theories helps us to know how and why anxiety
when patient know it is irrational or unrealistic?
persist and how we can treat them (and what to
target)
Aetiology: We simply do not know why some people
develop anxiety disorders and others not. Life events
makes you more prone to develop disorders, but some
people are more resilient than others, and we do not
know why.
Persistence: Classical conditioning experiments, rat
learns with buzzer (CS) getting a shock (US), and
sitting getting no shock -> learns to avoid shocks.
Avoidance is helpful to survive.
Avoidance behavior prevents us from learning that
CS does not prevent US
Target safety behavior (if patients do not learn that
CS is not predictive of US, they can always
attribute to what did not happen was according to
the safety behavior)
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