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Summary of the lectures of the course Anxiety and related disorders
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Summary of the lectures of the course Anxiety and related disorders, Master Clinical Psychology at Utrecht University
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Lectures Anxiety & related disordersWeek 1: emotion theory
Emotion:
People experience Higher versus lower emotion. Basic emotions universally: Happy Anxious Sad Angry Ashamed. Every complex emotion has 1
basic emotion underlying them. In therapy you search for this emotion so you can change it.
Anxiety versus anxiety disorders:
1) Emotion Theory and Anxiety 2) Anxiety disorders (specific anxiety disorders have different underlying cognitive mechanisms,
however they don’t have their own theories)
Anxiety is an emotion:
Emotion is more than a feeling:
A) Physiological aspects (sweaty hands, heart pumping, etc)
B) Cognitive aspects (the physiological experience/motoric aspects can be the same for multiple emotions, not the cognitive aspects)
• Conscious (experience/feeling)
• Unconscious
C) Motoric aspects
‘Loosely coupled systems’: concordant/discordant in what goes together.
Related concepts: mood, attitude and temperament:
It has 2 dimensions
Pos/low = contentment
Neg/low = sadness
Pos/high= excitement
Neg/hig= anger
Emotions are functions (Cf. language, memory, attention, etc).
What functions do emotions serve?
Question:
- When do emotions occur?
- Greatest common denominator?
Answer:
- When ‘vital interests’ are at stake.
Survival of self and offspring
Frijda: Emotions as ‘action tendencies’
emotions: Cause stimulus, experience, action tendency and, function. (in a table)
Theoretical background:
1) Evolutionary Theory 2) James-Lange Theory 3) Cannon-Bard Theory 4) Schachter-Singer Theory 5) Cognitive appraisal Theory.
Schachter Singer the two-factor theory of emotions:
A stimulus causes physical arousal we cognitively label the physical response and associate it with an emotion we feel the emotion.
The cognitive appraisal theory: (we work with this one the most)
Stimulus appears thought, labeling the stimulus (emotion) + immediate experience of physiological response fight or flight or freeze.
(you need to explain this to the client, because behavior us build up on the cognitive appraisal)
Cognitive Appraisal:
Emotion requires ‘interpretation’ of stimulus: sometimes (very) fast and preconscious
Cf. Primary (preconscious) and secondary appraisal
Neuroticism (trait anxiety / negative affectivity)
Twin study: neuroticism is highly heritable (same as intelligence and processing
speed). And this is important because neuroticism is related to different
disorders
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 as a vulnerability factor:
• So certain individuals are more susceptible to anxiety disorders
• But also: some stimuli are more often the object of anxiety (disorder) than others.
Common objects of anxiety: Arachnophobia, Musophobia, Astraphobia, Social phobia, Hypochondria, Etc.
Less common objects of anxiety: Fear of oak leaves, Fear of bathrobes, Fear of lorries, Hoplophobia (fear of firearms), Fear of plug sockets, Etc.
Where does selectivity of anxiety come from? Experiment with apes and a wooden snake. The
monkeys could observe and one monkey was calm the other fearful. It showed that the monkeys
reacted the same way in which they observed the other monkey, for the snake. It is to learn a fear
for snakes.
,Anxiety disorders:
1) Abnormal is not: the nature of the anxiety response itself
2) Abnormal is: the intensity of the response disproportionate to the seriousness of the threat:
Cf. Cognitive nuceleus of anxiety disorders
The nature of the CS and US are different in the different anxiety disorders:
Panic disorder: catastrophic misinterpretation of bodily sensations
Social phobia: fear of disapproval from others because others see signs of social anxiety (blushing, trembling, etc.)
OCD: fear of guilt from behaving irresponsibly (CS= seeing a gasstove and US= its my fault if someone dies due to explosion)
PTSD: catastrophic misinterpretation of the consequences of trauma and the significance of 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)
DSM-5/ICD-11 are categorical, but Co-morbidity (50% rule)
Aetiology and persistence:
Avoidance behavior does not learn you that the CS does not have to lead to US.
Look at the covid measurements. Better safe than sorry or is there a negative side to safety behavior/ avoidance behavior? Avoidance behavior
is not going into the feared situation, safety behavior is about entering the feared situation however doing something that gets them through
it.
- Classical conditioning
- Operant conditioning https://www.youtube.com/watch?v=H6LEcM0E0io
Is threat in the eye of the beholder? Mental imagery that can be so strong that they don’t go into the situation
What to do when you’re anxious?
Do we need a theory?
Week 2: specific phobias
Everyone knows fear and fear has a function for survival, it is a adaptive reaction.
Objects of phobia:
- Animal (e.g., spiders, insects, dogs).
- Natural environment (e.g., heights, storms, water).
- Blood-injection-injury (e.g., needles, invasive medical procedures) Situational (e.g., airplanes, elevators, enclosed places).
- Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or costumed characters).
Diagnostic criteria (key ones):
o Marked fear or anxiety about a specific object or situation.
o The phobic object or situation almost always provokes immediate fear or anxiety.
o The phobic object or situation is actively avoided or endured with intense fear or anxiety.
o The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
o The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
o The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
Fear is ubiquitous, phobias not:
Phobias prevalence: 7-9% in US, 6% in Europe, 2-4% in Asia, Africa, Latin America.
Etiology:
- Ivan Pavlov (+ Friends)
- BF Watson + Little Albert + Rosalie Rayner
First, behaviourists didn’t say anything about the CS-US, only the relationship was important not the expectancies etc, because this was
something you couldn’t observe.
Fear conditioning and anxiety phobias:
- Fear conditioning — Laboratory parallel for the acquisition of anxiety psychopathology
- Elevated acquisition scores among anxiety and phobia patients
- Better understanding of fear acquisition could lead to better therapies
, What’s wrong with fear conditioning as a model for phobias?
- Neither necessary nor sufficient
- No individual differences
- Assumption that all stimuli can be similarly conditioned
- No direct experience needed
Contemporary Cognitive Model
Latent inhibition: prior experience influences your response because your previous experiences were
not scary.
Prior beliefs:
- Prior beliefs influence subsequent learning!
- Threat situations
It matters what kind of stimuli is presented. Some stimuli are easier to develop a phobia over, because
of evolution for example spiders and snakes. We are more prepared to associate the spider with
something negative.
If you see the square (CS) often alone, so without the US, your fear will diminish, also if you only see the US without the CS, after pairing.
How can you use these models to reduce phobias?
Treatment:
The fault in fear extinction: fear extinction does not prevent the return of the fear (CS).
Return of fear phenomena:
- Fear is not erased, but you created a new memory.
- Fear acquisition memory vs. fear extinction memory; these memories fight with each other for dominance.
- Return of fear phenomena parallel to relapse
• Exposure
• In vivo exposure
• Virtual reality
• Imaginary
Steps of exposure treatment:
1. Intake
2. Establish fear hierarchy
3. Flooding or systematic desensitization n km
4. Response prevention
5. Pharmacological enhancement as an addition
So here are the problems with exposure…
•Not everyone likes it
- 75-85% of phobic patients do not seek treatment
- 25% of patients who seeks treatment refuse exposure therapy
• Drop-outs are high (0-45%)
• Relapse
- High relapse rates (19-62%)
What shall we do? Can we erase fear memories?
Memory reconsolidation: Idea
Memory reconsolidation literature:
- Memories may not be forever
- Nader et al., (2000)
- Misanin et al., (1968); Lewis et al., (1973)
Study about animals.
Some notes:
Effect not always there (Bos et al., 2014)
Overall effect for fear responses in humans (g = .56- small to moderate)
(Lonergan et al., 2013)
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