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Articles of Anxiety and Related Disorders ()
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Voorbeeld van de inhoud
Mineka & Zinbarg (2006) – A contemporaryLearning Theory Perspective on the Etiology of
Anxiety Disorders. week 1 – 1/3
Research on:
- How contemporary learning theory and research provide the basis for perspectives on the
etiology and maintenance of anxiety disorders.
- How considerations of early learning histories and temperamental vulnerabilities affect the
short- and long-term outcomes of experiences with stressful events
- How contextual variables during and following stressful learning events affect the course of
anxiety disorder symptoms once they develop
Introducti on
Anxiety disorders are the most common category of diagnoses.
Criticism on behavioral/learning approaches because of the inability to account for diverse factors
involved in the origin of people’s anxiety. Now; these models incorporated some of the complexity.
Advantage of contemporary learning approach over cognitive and psychodynamic:
Better grounded in the theories and methods of experimental psychologies
Provide more comprehensive formulations of the etiology of anxiety disorders
Provide a more explicit analysis of factors promoting or inhibiting the development of different
anxiety disorders.
Specifi c Phobia
- Intense and irrational fears of certain objects or situations that they usually go to great lengths
to avoid
- Watson & Rayner (1920): phobias are simply intense classically conditioned fear that develop
when a neutral stimulus is paired with a traumatic event.
o Has been criticized
- There’s a wide variety of vulnerability (factors) that influence who develops phobias.
Vicarious Conditi oning
Simply observing others experiencing trauma or behaving fearfully can be sufficient for developing
phobias.
Mineka & Cook (1985): Experiment with rhesus monkeys
o Watched unrelated wild-reared model monkeys react very fearfully in the presence of live and
toy snakes
o This lead to intense phobic like fear of snakes that didn’t diminish over 3 months
This suggests that humans are also susceptible to acquiring fears through watching movies and TV.
Individual Diff erences in the Acquisiti on of Fears and Phobias
Modest genetic vulnerability
o Could be mediated through genetic contributions to fear conditioning
o Which in turn may be mediated through personality variables (neuroticism), affecting the speed
and strength of conditioning
, Behavioral inhibition
Adverse life experiences
o May occur before, during or after a fear-conditioning experience
o Can act singly or in combination to affect how much fear is experiences, acquired or
maintained over time.
Impact of prior Experiences
Latent inhibition:
Simple prior exposure to a conditioned stimulus (CS) (without being followed by fear), before the
conditioned and unconditioned stimulus (UCS) are ever paired reduces the amount of subsequent
conditioning to the CS when paired with the UCS.
o Could lead to immunity against acquiring fear
Sense of control over environment
o Humans and monkeys raised with sense of control are less frightened by (and better able to cope
with) novel and frightening events
Impact of Contextual Variables during Conditi oning
Having control over a traumatic event has a major impact on how much fear is conditioned to
CSs paired with that trauma
o Being able to escape it
Impact of Post-event Variables
Different kinds of experiences that people can have following conditioning also affect the strength of
the conditioned fear that is maintained over time.
Inflation effect
Exposure to a more intense traumatic experience (not paired with the CS) after conditioning of
a mile fear is likely to show an increase of the fear for the CS
US re-evalution process
Receiving verbally or socially transmitted information about the US being more dangerous than
when she or he originally experienced it paired with the UCS inflation effect
Simple mental rehearsal of CS-US relationship can lead to enhanced strength of the
conditioned fear response.
Selecti ve Associati ons in the Conditi oning of Fears and Phobias
Seligman (1971) and Öhman (1985):
Evolutionary preparedness to rapidly associate certain kind of objects (snakes, spiders, water,
heights) with aversive events.
due to selective advantage in the course of evolution for primates who rapidly acquired
fears of certain objects or situations that posed threat to humans’ early ancestors.
Fear-relevant CSs can be conditioned unconsciously
Fear learning with fear-relevant CSs is more impenetrable to conscious cognitive control than
is fear learning with fear irrelevant CSs.
,In both monkeys and humans evolutionary fear-relevant stimuli more readily enter into selective
associations with aversive events, and these same stimuli seem more likely than others to become the
objects of human phobias.
The acquisition of phobias involves a primitive basic emotional level of learning that humans share with
many other mammalian species.
Evolutionary pressures seem to have affected the kinds of objects and situations that humans are most
prone to learn to fear.
Social Phobia
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.
Can arise as a result of direct traumatic conditioning
o 92% history of severe teasing in childhood (50 % in PD / 35% OCD)
o 65% recalled direct traumatic conditioning experiences
Social learning and social phobia
All kinds of social learning forms can lead to developing or enhancing social phobia.
Vicarious learning = a form of social learning
o Modeling of social anxiety in families of those with social phobia
Direct social reinforcement and verbal instructions
o Reciprocation of children’s proposal of avoidant situations
o Discussion of potentially threatening situations strengthens the anxious children’s avoidance
tendencies
Culturally transmitted display rules and norms
o Japan: taijin kyofusho. Fear of doing something that will offend others.
Japan reinforces interdependence and social affiliation
Great deal of emphasis on implicit communication
Preparedness and Social Phobia
Öhman et al. (1985)
- Social anxiety is a byproduct of the evolution of dominance hierarchies.
- Social stimuli signaling dominance and intraspecific threat should be fear-relevant or prepared
CSs for social anxiety.
- This can also happen unconsciously: knowing that a situation is safe, but experiencing anxiety
that is automatically activated in response to subtle cues that are not consciously processed.
Behavioral Inhibiti on as a Temperamental Diathesis for Social Phobia
Behavioral inhibition
predicts the onset of many specific phobias in childhood but also social phobias in adolescence.
Influences the outcome of exposure to socially traumatic experiences or socially anxious
models.
,Uncontrollability and Social Phobia
Perceptions of uncontrollability is a vulnerability
o Uncontrollable (but not controllable) electric shock increases submissiveness
o Repeated social defeat leads to increased submissiveness to any other conspecific
behaving in an aggressive manner
o Repeated social defeat produces learned helplessness.
Moderate to strong associations between perceptions of uncontrollability and social phobia
Summary
In sum, complexities involved in etiology of social phobias:
Temperamental diathesis such as behavioral inhibition
Experiental diathesis such as learning histories, including those that lead
to perceptions of uncontrollability.
The preparedness of certain cues to become CSs for social anxiety
learning experiences.
Panic Disorder with and without Agoraphobia
Recurrent unexpected panic attacks that occur without their being aware of any cues or triggers. Many
also experience worry, anxiety of behavioral change related to having another attack.
Sometimes also agoraphobic avoidance of situations in which escape is difficult or embarrassing
if they were to have a panic attack.
Exteroceptive Conditioning
Central to the development of agoraphobia.
CSs (mall, escalator) impinge on the external sensory receptors (eyes and ears)
Interoceptive conditioning
“fear of fear” developing (being afraid that raised heart is causing heart attack)
CSs (dizziness, heart palpitations) are the body’s own internal sensations
Anxiety and Panic are unique / distinct emotional experiences:
1. Two separable factors:
o Panic is accompanied by strong autonomic arousal, extreme fear and fight-or-flight
action tendencies
o Anxiety is accompanied by apprehension, worry, and tension
2. Neurobiological research supports the existence of these two partially distinct emotional states
of panic and anxiety.
Both panic and anxiety are central to PD and PDA!
,Exterocepti ve and Interocepti ve Conditi oning In PD
Conditioning during panic attacks sets the stage for the development of PD and PDA.
The initial attack becomes associated with initial neutral interoceptive and exteroceptive CSs through
conditioning.
Prototypic CSs: malls / escalators (extero) and heart palpitations / dizziness (intero)
Primary effect of this conditioning is that anxiety becomes conditioned to these CSs
Another effect: panic attacks themselves are also likely to be conditioned to certain stimuli.
Different CSs paired with the very same US often result in qualitatively different CRs to the different CSs.
Shock (US) + flower (CS) heart decelerating vs. shock (US) + snake (CS) heart accelarating
Thus: some internal and external cues present before and during panick attacks may become
conditioned to elicit anxiety and other may become conditioned to elicit panick.
Interoceptive conditioning is robust and stable:
- Various internal sensations like intestinal contractions (interoceptive CSs) might be paired with
sensations of hyperventilation (interoceptive US); later the contractions might come to elicit
hyperventilation or even panic themselves.
The development of Agoraphobia
Many people with PD develop agoraphobia; avoidance of situations in which they fear or expect they
may have a panic attack in the future.
- Long been thought avoidance happened as a result of exteroceptive conditioning of anxiety to
these situations when panic attacks happened there in the past, followed by learned avoidance
of these situations to minimize anxiety
- Agoraphobic fears and anxiety often generalize to other similar situations
- Numerous everyday activities also become avoided because the interoceptive cues created by
these activities resemble those experienced at the beginning of a panic attack
Major risk factors
Gender
Employment
Explanation
- learning theory approach: In each case the person is allowed to avoid his or her feared
situations rather than be exposed to them.
- Panic attacks are perceived as incontrollable and unpredictable association with greater
conditioning of anxiety
Further complexiti es of the Role of Conditi oning in PD and agoraphobia
Conditioned stimuli also facilitate or inhibit responses controlled by other events.
- CSs for safety (bringing companion) can attenuate panic symptoms
- CSs for anxiety (warning about stressful day) can strengthen ongoing avoidance behavior
Conditioned anxiety increases startle response; so it could lower threshold for panic:
, Baseline levels of anxiety strongly predict who will experience panic in response to various panic
provocations as USs.
Anxiety is very often a precursor to panic attacks
The same CR elicited from two different sources can summate, so baseline anxiety could
potentiate agoraphobic anxiety and avoidance
Vulnerability Factors for PD
1. Nonspecific genetic vulnerability
a. Could be mediated by temperamental or personality vulnerability
2. Perceived lack of control through prior learning experiences
a. Early experiences with uncontrollable situations: death, divorce
3. Specific learning experiences
a. Having been encouraged to engage in sick role behavior when experiencing panic symptoms (but
not cold symptoms)
b. Having had a lot of physical suffering
Summary
Initial panic attacks set the stage for conditioning of anxiety to external and internal cues
associated with panic
The process of interoceptive conditioning also allows bodily sensations to become conditioned
to elicit panic itself
People with certain genetic/temperamental and/or experiental vulnerabilities will show
stronger conditioning of anxiety and panic
This explains why only a subset of those who have panic attacks develop PD or PDA
Post-traumatic Stress Disorder
Symptoms:
Reexperiencing the trauma
Passively avoiding temindes of the trauma
Numbing of affect
Heightened general arousal
Why does one person develop PTSD and the other not?
Perceiving uncontrollable and unpredictability
Similariti es between symptoms of PTSD and eff ects of uncontrollable and unpredictable
stress
Heightened GAD and enhanced passive avoidance in animals exposed to uncontrollable and
unpredictable stress
Relative insensitivity to pain produced by cues associated with uncontrollable stress may
resemble numbing in PTSD
, Reexperiencing symptoms of PTSD include fear and distress at exposure to reminders of the
trauma and these emotional reactions can be seen as conditioned emotional responses elicited
by reminder cues.
Intense physical stressors used in animals resemble to forms of human trauma in PTSD.
Symptom similarities and resemblance of the physical stressors used to produce them lead us to believe
that the uncontrollable, unpredictable stress animal model is highly relevant for understanding PTSD.
Trauma Phase
- Traumas that are perceived to be uncontrollable and unpredictable are more likely to result in
PTSD
- Individual differences in experiencing uncontrollability
- Perceived mental defeat predicted PTSD symptom severity
o The amount of trauma is less predictable then the perceived incontrollability
Pre-trauma Phase
Sensitization through prior uncontrollable stress to the harmful effects of subsequent exposure
to such trauma
History of prior trauma increased risk of developing PTSD after recent trauma
Moderate genetic contribution. Can be mediated by sensitivity
Prior history of Controllability can immunize
o Psychological readiness prior to being tortured is associated with decreased likelihood
of subsequently developing PTSD despite very high levels of torture.
o Protective effects probably mediated by rendering the subsequent torturing more
predictable
o Stoicism training more perceived controllability of torture
Post-trauma Phase
Effects of uncontrollable, unpredictable stress is short-lived, but this may be more apparent than real
- Only small number of individuals who develop initial signs of PTSD develop chronic PTSD
- In exposure of rats to where they had previously experienced uncontrollable stress, the time
course of the uncontrollable stress is prolonged “indefinitely”.
Greater re-experiencing associated with a more persistent course
Inflation and reevaluation can affect course of PTSD
Reinstatement of fear: phenomenon in which after a CS has extinguished, the CS can regain its
ability to elicit a CR by simply exposing the animal to the US.
Summary
Compelling parallels between the literature on uncontrollable, unpredictable stress in animals
and human PTSD
Perceptions of uncontrollability and unpredictability play a role in the development and course
of PTSD
Parallels between trauma and pre- and post-trauma variables affecting the outcome of
exposure to unpredictable, uncontrollable stress in animals and several forms of human trauma
associated with PTSD.
,Conclusion
Contemporary learning theories and research:
provide a foundation for the development of anxiety disorder models that capture the richness
and complexity associated with the development and course.
Have a great deal of explanatory power
Are testable
Although overlap with models emanating from other theoretical perspectives,
learning models are being more comprehensive
o F.e. cognitive model and learning theory perspective. The cognitive model does not:
- distinguish clearly between panic and anxiety, learning theory does
- outline the exact processes as thorough as learning theory model does
- discuss the different vulnerability factors;
o Address different vulnerabilities, learning theory models explicitly addresses which
individuals with panic attacks are most likely to develop PD or PDA
Contemporary learning models have important implications for treatment and prevention
Behavioral/learning research sowed the seed for the development of exposure therapy – a
central component of treatment packages for anxiety disorders
Regarding prevention; contemporary learning models can help identify which individuals are at
highest risk for the development of anxiety disorders
,Clark (1999) – Anxiety Disorders: why they persist
and how to treat them. Lecture 1 – 2/3
Abstract
Anxiety disorders are characterized by distorted beliefs about the dangerousness of certain situations
and / or internal stimuli.
Six processes could maintain anxiety-related beliefs
Safety-seeking behavior
Attentional deployment
Spontaneous imagery
Emotional reasoning
Memory processes
Nature of the threat representation
Knowledge about maintenance processes have been used to develop focused cognitive therapy
programs and evaluation of the effectiveness is discussed.
Ways of identifying the effective ingredients in cognitive therapy is discussed.
Introduction
Anxiety disorders result from distorted beliefs about the dangerousness of certain situations,
sensations and/or mental events.
Such over-estimates are disorder specific; each anxiety disorder has a specific type of negative
belief
Something appears to prevent self-correction from occurring
The persistence of the fear seems irrational
despite what might appear to an outsider to be stunning disconfirmation of their fears,
their thinking has not changed.
6 maintaining processes:
Safety-seeking behavior, attentional deployment, spontaneous imagery, emotional reasoning,
certain types of memory processes, the nature of threat representations
1. Safety-seeking behavior
A behavior which is performed in order to prevent or minimize a feared catastrophe.
- Safety behavior prevents disconfirmation
- This maintains negative beliefs
Other interesting features of safety behavior:
- Although they’re termed behaviors, many are internal mental processes
- It is common for patients to engage in a large number of different safety behaviors while in
feared situation
- Safety behaviors can create some of the symptoms that social phobics fear
- Some safety behaviors can draw other people’s attention to the patient
- Some safety behaviors influence other people in a way which partially confirms social phobic’s
fear.
, 2. Attentional Deployment
Selective attention towards & away from threat cues maintains anxiety by enhancing perception of
threat.
Attention towards threat cues
Panic disorders (PD) and hypochondriasis obvious candidates for attentional bias towards threat
cues
Their fears lead them to focus attention on their bodies and, as a consequence of this
attentional deployment, they become aware of benign bodily sensations that other people
don’t notice.
Enhanced awareness of bodily sensations contributes to maintenance of PD and
hypochondriasis.
Patients wo report a re-occurrence of their panic attacks demonstrate significantly better heart
rate perception than patients who don’t experience re-occurrence.
Attention away from threat cues
- Especially in social phobia; attention away from faces and towards objects.
- Socially anxious individuals tend to avoid looking at other people when in a feared social
situation
- In line with model of Clark and Wells (1995) which state that people with social phobia tend to
reduce attention to external social cues
Leads to less chance to observe other people’s response in detail
would therefore be unlikely to help them see that they generally come across more
positively than they think (no disconfirmation of CS-US)
Why would people with spider phobia, PD and hypochondriasis show attentional bias towards threat
and people with social phobia attentional bias away from threat?
- Consideration of the functional consequences
o Looking away from spider can increase fear because of not knowing where it is
o Looking away from other’s faces and avoiding eye contact it’s more difficult for people
to ask social phobics questions or engage them in conversation (which takes away the
threat of giving inappropriate answers)
Psychological escape
3. Spontaneously Occurring Images
In which people ‘see’ their fears are common in anxiety disorders and play an important role in
enhancing the perception of threat.
- In PD, hypochondriasis and social phobia
- Observer-perspective
Spontaneously occurring images in which social phobia see themselves as if viewed from
outside.
o They don’t see what the observer actually sees, but rather their feared image
- 77% of social phobics have spontaneously occurring images
- There’s a lack of updating
- They are recurrent: appear in similar form in many different social situations
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