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Complete summary of all MAPD articles for interim exam 2!
I personally summarised all articles necessary for the second interim exam of MAPD. It is very complete and includes all important information to pass the exam.
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MAPD Article Notes Midterm 2A contemporary learning theory perspective on the etiology of anxiety disorders
Early learning histories, together with temperamental vulnerabilities, can serve as a diathesis that make
certain individuals more susceptible to adverse and stressful experiences that sometimes lead to the
development of anxiety disorders.
Specific phobia
- Vicarious conditioning: observing others in a traumatic event can be enough to induce a phobia, this
is why many people don’t have a conditioning history when it comes to their phobia.
- Sources in the individual differences in the acquisition of fears and phobias: genetically based
vulnerability for phobias, behavioral inhibition,
- Differences in prior experiences: latent inhibition prior exposure to CS without US leads to
decrease in conditioning when CS and US are paired, mastery of the environment,
- Impact of contextual variables during conditioning (e.g., being able to escape from the traumatic
event)
- Impact of post-event variables: mild CS-US pairing followed by more extreme no-CS-US exposure
leads to increase in phobia.
- Selective associations in the conditioning of fears and phobias (evolution)
Social phobia
- Social learning: observing another being ridiculed or humiliated or behaving in a very anxious way
in some social situation, social reinforcement of avoidance behaviour, culturally transmitted rules
and norms.
- Preparedness: social stimuli signaling dominance and intraspecific threat should be fear-relevant of
prepared CSs for social anxiety.
- Behavioral inhibition as a vulnerability factor.
- Uncontrollability of the CS-US pairing.
Exteroceptive and interoceptive conditioning in panic disorder and agoraphobia
- Panic attacks become conditioned to external cues (agoraphobic cues) but also to internal cues.
- A panic attack (UR) is not similar to anxiety about the panic attack (CR) different CSs paired with
the same US can lead to very different CRs.
- Influenced by both exteroceptive and interoceptive conditioning.
- Having to leave the house makes it less likely for a person to develop agoraphobia (lack of
avoidance).
- Conditioned anxiety serves to increase startle responses: CSs for anxiety lower the threshold for, or
exaggerate panic reactions.
- Genetic and temperamental variables seem to serve as nonspecific vulnerability factors that increase
the likelihood of developing panic.
- Prior learning experiences that lead to perceptions of lack of control and helplessness pose a
vulnerability factor for panic disorder, agoraphobia, and emotional disorders.
PTSD
- Uncontrollable and unpredictable stress.
- Allowing animals to express aggression during uncontrollable stress attenuated the effects of the
stress.
o The amount of trauma seems to be less important than the perceived ability of the victim to
fight back for the attenuation of stress effects.
o Mental defeat
- Prior uncontrollable stress can sensitize an organism to the harmful effects of subsequent exposure to
such trauma.
- Prior history of control over trauma can immunize the person for trauma.
- Possible genetic influence.
, o Psychological readiness decreasing the ‘unexpected’ part.
- Severity and earliness of reexperiencing leads to an increase in PTSD and avoidance.
- Reevaluation of the danger posed by the original trauma can increase the chance of PTSD.
Generalized anxiety disorder
- Possibly connected to childhood trauma.
- Less tolerance for uncertainty.
o Connected to neuroticism and trait anxiety (possibly).
- Effective use of worry for avoidance causes negative reinforcement.
- Worry becomes uncontrollable and intrusions increase vicious cycle.
- Uncontrollable and unpredictable life stress.
OCD
- Verbal transmission of dangerous thoughts may influence OCD symptoms.
- Rigid rules and responsibility in children may cause a vulnerability factor.
- Thought-action fusion: thoughts are equal to actions (which makes intrusions extra distressing) and
thoughts will increase probability of action.
- Culturally transmitted beliefs and norms.
- Evolutional preparedness.
Aversive learning and generalization predict subclinical levels of anxiety: a six-month longitudinal study
Aversive learning: a form of associated learning where an originally neutral stimulus comes to evoke fear
reactions after pairings with an aversive stimulus.
- Impaired discrimination learning between safety signals and danger signals may contribute to the
development of anxiety symptoms (panic attack vs heart attack).
- Maladaptive consequences of irrational fears are greatly multiplied by the generalization of aversive
learning.
Aversive learning task
- CS+ was followed by an aversive picture. CS- was not. GS was a size in-between the two, to check
for generalization.
- Hypothesis: impaired differentiation in US expectancy between the two circles (CS+ and CS-) would
predict higher levels of anxiety after 6 months based on increased generalization.
- Afterwards, depression and anxiety were measured using a scale.
Results
- Impaired discrimination learning did not predict state anxiety at baseline, but it did predict state
anxiety after 6 months impaired discrimination precedes anxiety.
o Elevated responding to CS- resulted in higher anxiety scores after 6 months.
- Responding to the generalization stimuli (GS) added significantly to the explained variance in the
regression analysis for anxiety after 6 months, but not for baseline anxiety generalization precedes
anxiety symptoms.
Maximizing exposure therapy: an inhibitory learning approach
Learning model of extinction
- Pavlovian model: a neutral stimulus is followed by an aversive stimulus. After a number of pairings,
the neutral CS will come to elicit anticipatory fear reactions.
o An association is posited between the memory representations of the CS and the US such that
presentations of the CS will indirectly activate the memory of the US.
- Systematic desensitization was derived from early models of extinction learning.
- Inhibitory learning: the original CS-US association is not erased during extinction, but rather left
intact as new, secondary inhibitory learning about the CS-US develops.
, o Explanation for spontaneous recovery of the fear, renewal (surrounding context is changes
between extinction and retest), reinstatement (new exposure to CS-US), and reacquisition.
Inhibition and anxiety disorders
- Substantial number of individuals fail to achieve symptom relief from exposure-therapy, or
experience a return of fear.
o May derive from deficits in extinction learning and inhibition learning.
o Deficits in mechanisms that are believed to be central to extinction learning.
Inhibitory learning vs habituation and behavioral testing approaches to exposure
- Habituation-based model: fear reduction during exposure trials as a critical index of therapeutic
change.
- Inhibitory learning: not about the fear reduction during the exposure, because the fear
habituation/extinction during the sessions is not a good predictor for the real world.
o More overlap with behavioral testing, where beliefs and assumptions are disconfirmed.
Therapeutic strategies for enhancing inhibitory learning and its retrieval
1. Expectancy violation: violation of expectancies regarding the frequency and intensity of aversive
outcomes.
a. It is important that the client identifies the US when predicting the expectancy to be violated
(the mismatch needs to very concrete for the patient, which is why distraction is such a bad
avoidance mechanism).
b. The end of an exposure trial is determined by conditions that violate the expectancies and not
by fear reduction.
c. Graduated exposure is possible, but graduation lies in level of mismatch and not in level of
fear.
d. Do not use cognitive challenging beforehand, as this may reduce the mismatch.
2. Deepened extinction: either multiple fear CS are first extinguished separately before being combined
during extinction, or a previously extinguished CS is paired with a novel CS.
a. Has been associated with reduction in spontaneous recovery and reinstatement of fear in
animals and humans.
b. Both CS need to represent the same US.
3. Occasional reinforced extinction: occasional CS-US pairings during extinction.
a. The patient is less likely to expect the next CS-US because the CS is both associated with US
and no US.
b. Attenuates the reacquisition of fear because you don’t expect the CS-US to never appear.
4. Removal of safety signals: fear returns when the avoided safety signals are removed.
a. Safety signals should gradually be phased out.
5. Variability: stimulus variability throughout exposure since varying the to-be-learned task enhances
the retention of learned non-emotional material.
a. May offset context renewal effects after exposure.
b. Variability in duration between exposure treatments has a positive effect on outcomes.
c. Do not consider the fear level per stimulus, and use random selection of feared stimuli
(except for the first).
6. Retrieval cues: CS-no US reminders during extinction training to be used in other contexts once
extinction is over.
a. May become a safety signal.
b. (Mentally) carrying cues with you that remind you if what was learned during the exposure.
c. Not early in treatment, as this can reduce the expectancy of averse events.
7. Multiple contexts: use in vivo exposure in multiple contexts to reduce renewal.
8. Reconsolidation: retrieving already stored memories induces a process of reconsolidation. The
memory is written into long-term memory again.
a. Introduce the phobic stimulus for a brief period of 30 minutes before repeated exposure
memory will be restored as less fear-inducing because of new learned association.
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