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- Choy et al. (2007) Treatment of specific phobia in adults. Clinical P...
Mineka & Zinbarg (2006) – A contemporary learning theory perspective on the
etiology of anxiety disorders
Advantages new of the new contemporary learning approach over the two other approaches:
Learning approaches are better grounded in the theories and methods of experimental
psychology
They provide more comprehensive formulations of the etiology of anxiety disorders
They provide a more explicit analysis of factors promoting or inhibiting the development of
different anxiety disorders.
Specific phobia
Individuals with specific phobias show intense and irrational fears of certain objects or situations that
they usually go to great lengths to avoid. Originally it was argued that phobias are simply intense
classical conditioned fears that develop when a neutral stimulus is paired with a traumatic event.
It was thought that people with phobias recall a traumatic conditioning event when their phobia began,
however this straightforward view of phobia acquisition was later criticized for several reasons:
1. The first criticism of early conditioning approaches centered on the observation that many
people with phobias do not appear to have any relevant history of classical conditioning.
Simply observing others experiencing a trauma or behaving fearfully could be sufficient for
some phobias to develop, this is called vicarious learning/conditioning.
2. Another criticism is on how to explain why many individuals who do undergo traumatic
experiences do not develop phobias as many non-phobic individuals reported having had
traumatic experiences in the presence of some potentially phobic object without having
acquired a fear or phobia.
Rhesus monkey experiment (Mineka & Cook)
Young adult rhesus monkeys who initially were not afraid of snakes served as observers who watched
unrelated wild-reared model monkeys reacting very fearfully in the presence of live and toy snakes.
These lab-reared observer monkeys showed rapid acquisition of an intense phobic-like fear of snakes
that did not diminish over a three-month follow-up period. This vicarious conditioning also occurred
simply through watching videotapes of models behaving fearfully, suggesting that humans are also
susceptible to acquiring fears vicariously simply through watching movies and TV.
They also showed that most monkeys who had initially simply watched a non-fearful model monkey
behaving non-fearfully with snakes were completely immunized against acquiring a fear of snakes when
subsequently exposed to fearful monkeys behaving fearfully with snakes.
Why do some develop phobias, and some don’t?
Diathesis-stress perspective: there seems to be a modest genetically based vulnerability for
phobias. This genetic vulnerability may well be mediated through genetic contributions to fear
conditioning, which may in turn be mediated through personality variables such as high trait
anxiety that also seem to serve as vulnerability factors, affecting the speed and strength of
conditioning.
, Children categorized as behaviourally inhibited (excessively timid, shy, etc.) at 21 months of
age have been found to be at higher risk for the development of multiple specific phobias (an
average of three to four per child) by 7-8 years of age than were uninhibited children.
Differences in life experiences among individuals can also strongly affect the outcome of
conditioning experiences. Such experiential factors may serve as vulnerability (or
invulnerability) factors for the development of phobias. The relevant differences in life
experiences may occur before, during, or following a fear-conditioning experience, and they can
act singly or in combination to affect how much fear is experienced, acquired, or maintained
over time.
Someone’s history of control over important aspects of his/her environment. Infants and
children raised in environments in which they gain a sense of control over their environment are
less frightened by (and better able to cope with) novel and frightening events. Such research
suggests that children reared with a stronger sense of mastery over their environments should
be more invulnerable to developing phobias following traumatic experience.
Having control over a traumatic event (such as being able to escape it) has a major impact
on how much fear is conditioned to CSs paired with that trauma. Far less fear is conditioned
when the aversive event is escapable than when it is inescapable.
The impact of post-event variables. A person who is exposed to a more intense traumatic
experience (not paired with the CS) after conditioning of a mild fear is likely to show an increase
in fear of the CS Inflation effect: this suggests that a person who, for example, acquired a
mild fear of automobiles following a minor crash might develop full-blown driving phobia if
he/she were later physically assaulted even though no automobile was present during the
assault.
Impact of prior experiences Latent inhibition: a simple prior exposure to a CS before the
CS and the US are ever paired together reduces the amount of subsequent conditioning to the
CS when paired with the US.
Example: Children who have had more previous nontraumatic encounters with a dentist are
less likely to develop dental anxiety if subsequently traumatized at the dentist’s office than are
those with fewer prior encounters when they are traumatized.
When a person receives verbally or socially transmitted information about the US being
more dangerous than when she or he originally experienced it paired with the US. This can
result in an inflated level of fear to the CS.
Simple mental rehearsal of CS–US relationships can lead to enhanced strength of the
conditioned fear response.
Why are we afraid of spiders/snakes but not so much of guns or cars?
Early conditioning models predicted that fears and phobias would occur to any random group of objects
associated with trauma. However, clinical observations show that people are much more likely to have
phobias of snakes, water, heights, and enclosed spaces than of bicycles, guns, or cars, even though
today the latter objects (not present in our early evolutionary history) may be at least as likely to be
associated with trauma.
Primates may be evolutionarily prepared to rapidly associate certain kinds of objects (such as snakes,
spiders, water, heights) with aversive events. This is because there may have been a selective
advantage in the course of evolution for primates who rapidly acquired fears of certain objects or
situations that posed threats to humans’ early ancestors. Consistent with this, studies have shown that
the content of most phobias is rated by independent raters as “prepared” in the sense that it was
,probably dangerous to pretechnological humans. Thus, prepared fears are not seen as inborn or innate
but rather as very easily acquired and/or especially resistant to extinction.
Social phobia
Individuals with social phobias show excessive fears of situations in which they might be evaluated or
judged by others, and they either avoid such situations or endure them with marked distress.
Factors in the development of social phobia:
Vicarious conditioning also plays a role in social phobia, as simply observing another being
ridiculed or humiliated or behaving in a very anxious way in some social situation is one potent
form of social learning that may be sufficient to make the observer develop social phobia of
similar situations.
Direct social reinforcement and verbal instructions are also likely to play a role in the
development of social phobia.
Culturally transmitted display rules and norms.
Example: Japanese may fear they will offend others by blushing, emitting an offensive odor, or
staring inappropriately into someone else’s eyes. By contrast, Westerners with social phobia
are afraid of other people because they believe they will be the object of scrutiny by others and
will act in ways that will be personally humiliating or embarrassing.
Preparedness theory of social anxiety proposes that social anxiety is a by-product of the
evolution of dominance hierarchies and therefore predicted that social stimuli signalling
dominance and intraspecific threat should be fear-relevant or prepared CSs for social anxiety.
Thus, a person can claim to “know” rationally that a social situation is safe and yet still
experience anxiety that is automatically activated in response to subtle cues that are not
consciously processed.
Behavioural inhibition may influence the outcome of exposure to socially traumatic
experiences and/or socially anxious models.
Perceptions of uncontrollability are also likely to play a role in the origins of social anxiety.
Positive association has been found between perceptions of uncontrollability and social phobia
in humans.
Panic disorder
People with panic disorder experience recurrent unexpected panic attacks that occur without their being
aware of any cues or triggers, and they must also experience worry, anxiety, or behavioral change
related to having another attack. Many, but not all, people with PD also go on to develop some degree
of agoraphobic avoidance of situations in which they perceive that escape might be either difficult or
embarrassing if they were to have a panic attack.
Factors in the development of PD:
Exteroceptive conditioning: CSs impinge on the external sensory receptors like eyes
and ears.
Interoceptive conditioning: The CSs are the body’s own internal sensations.
Interoceptive conditioning is robust and stable. Weak versions of some event can
become conditioned by pairing it with a strong version of the same event. Early internal
signs of panic can become conditioned when paired with full-blown panic attacks.
, Prototypic CSs during initial (as well as later) panic attacks include heart palpitations and dizziness
(interoceptive CSs), as well as escalators and malls (exteroceptive CSs). It is proposed that the primary
effect of this conditioning is that anxiety becomes conditioned to these CSs, but another effect is that
panic attacks themselves are also likely to be conditioned to certain internal cues.
Example: A man with PD, who was particularly sensitive to signs of his heart racing, surprisingly
experienced a panic attack one night when he got excited while watching an announcement that his
favourite presidential candidate had won a hotly contested state. Thus, the panic attack occurred at a
time when he was happy and excited; however, this was also a time when his heart was racing, which
probably served as an interoceptive CS.
Different CSs paired with the very same US often result in qualitatively different conditioned responses
(CR) to the different CSs.
Some internal and external cues present before and during panic attacks may become conditioned to
elicit anxiety (different from the panic unconditioned response (UR)), and others may become
conditioned to elicit panic itself. Interoceptive cues in close proximity to panic may serve as ‘prepared’ or
fear-relevant CSs and may be especially likely to elicit panic, just as other fear-relevant CSs seem
especially likely to condition CRs that strongly resemble URs.
Vulnerability factors of PD
A moderate nonspecific genetic vulnerability for PD and PDA. This overlaps with the genetic
vulnerability for phobias and may be mediated by temperamental or personality vulnerability
factors like neuroticism or trait anxiety. These personality variables serve to potentiate
conditioning of anxiety responses as well as aversive expectations.
Prior learning experiences that lead to perceptions of lack of control and helplessness.
Early experience with uncontrollable stressful life events can enhance vulnerability to PD and
depression. Early experiences with control and mastery in infancy and childhood are important
for developing the ability to cope with stress and anxiety-provoking situations.
More specific learning experiences that may play a more unique role in creating risk for
developing PD and PDA per se. Observing a lot of physical suffering may contribute to the
evaluation of somatic symptoms as dangerous.
Agoraphobia
Anxiety and avoidance of social situations have long been thought to develop as a result of
exteroceptive conditioning of anxiety to these situations when panic attacks have occurred there in the
past, followed by learned avoidance of these situations to minimize anxiety. As the disorder develops,
these agoraphobic fears and avoidance often generalize to other similar situations.
Risk factors for developing agoraphobia:
Gender: Women are more likely than men to develop agoraphobia.
Employment: People who must leave the house to work are less likely to develop agoraphobia.
than those who do not work or work from home.
The learning theory approach can explain both of these factors because in each case the person is
allowed to avoid his or her feared situations rather than be exposed to them, which would
extinguish his or her anxiety
Conditioned stimuli not only come to elicit conditioned responses but also to facilitate or inhibit
responses controlled by other events.
Conditioned anxiety serves to increase startle responses. It is likely that CSs for anxiety similarly lower
the threshold for, or exaggerate, panic reactions. Baseline levels of anxiety strongly predict who will
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