A CONTEMPORARY LEARNING THEORY PERSPECTIVE OF THE ETIOLOGY OF ANXIETY DISORDERS:IT’S NOT WHAT YOU THOUGHT IT WAS

By Susan Mineka & Richard Zinbarg

Presented by Katie Kriegshauser

WHY A NEW THEORY?

First…let’s take a look at the old theory: http://www.youtube.com/watch?v=lvOV7g3osfM

Too simple in general No consideration of individual differences The old theories can’t always account for the

many possible origins of anxiety

SPECIFIC PHOBIA

Central Features: Intense and irrational fear of a certain object or

situation Usually go to great lengths to avoid

object/situation The traditional view is that a phobia develops

when a neutral stimulus is paired with a traumatic event Too simplistic!

SPECIFIC PHOBIA: POSSIBLE SOURCES

Vicarious Conditioning Based on animals models we know that simple

observation can be a particularly strong pathway towards developing a specific phobia

Individual Differences Individual differences, such as a genetic

vulnerability, an inhibited personality, or simply different life experiences can impact whether or not someone develops a specific phobia

Unlike animals, humans aren't "blank slates" and our past experiences play a big role in how events affect us

SPECIFIC PHOBIAIMPACT OF INDIVIDUAL DIFFERENCES: PAST, PRESENT & FUTURE

Prior Experiences: Latent Inhibition: exposure to the CS before it is

paired with the US makes it very difficult for an association to form later

Sense of mastery in one's environment in the past is also a protective factor

Context during Conditioning: When a traumatic event is escapable, it is less

likely to trigger the development of a phobia Post-Event Experiences:

Inflation Effect: experiencing another traumatic event can strengthen fear of CS, even if it is completely unrelated

SPECIFIC PHOBIA: SELECTIVE ASSOCIATIONS

The objects of phobias are not completely random, but instead are often fear-relevant stimuli For example, it is more likely that someone will

develop a phobia of a snake than of a flower This makes evolutionary sense!

YES!Hmm…probably

not.

SOCIAL PHOBIA

Central features: Excessive fears of situations in which they might

be evaluated or judged by others Either avoid these situations or endure them with

great distress Often a result of traumatic conditioning like

teasing in childhood

SOCIAL PHOBIA & SOCIAL LEARNING

Vicarious Conditioning Modeling Social Reinforcement/Verbal Instruction Cultural Factors

MORE FACTORS IN SOCIAL PHOBIA

Preparedness We are programmed to be more vigilant for

negative faces Behavioral Inhibition

An inhibited personality is a risk factor for social phobia, as well as many other anxiety disorders

Uncontrollability Repeated social defeat can lead someone to

perceive social situations as uncontrollable, which may make someone more susceptible to social anxiety

PANIC DISORDERWITH AND WITHOUT AGORAPHOBIA

Central Features: Recurrent unexpected panic attacks that occur

without their being aware of any cues or triggers Worry, anxiety or behavioral change related to

having another attack This can lead to agoraphobic avoidance, but more on

this later!

EXTEROCEPTIVE AND INTEROCEPTIVE CONDITIONING IN PANIC DISORDER

Exteroceptive: External triggers (or CSs) for panic

Interoceptive: Internal triggers for panic

Even weak CSs can elicit stronger responses over time

DEVELOPMENT OF AGORAPHOBIA

Avoidance not only of exteroceptive cues such as certain locations, but also activities that may cause an interoceptive cue

Major risk factors are: Gender: Women more at risk than men Employment: Working from home These are socially acceptable reasons to stay

home and act as reinforcement for the avoidance behavior

VULNERABILITY FACTORS FOR PANIC DISORDER

Baseline anxiety Genetic and temperamental factors Perceptions of lack of control/helplessness Encouragement to engage in “sick roles” or

exposure to chronic illness in the household

PTSD: PRE-TRAUMA PHASE

Sensitization: previous trauma makes a person more vulnerable to developing PTSD after a new trauma There are suggested genetic components to

PTSD, so sensitivity to uncontrollable and unpredictable stress would mediate this relationship

Habituation: sense of control in past trauma could immunize someone against developing PTSD after a new trauma This is associated with “psychological readiness”

PTSD: TRAUMA PHASE

Animal models give us a lot of information about what is going on during a trauma

Traumas that are perceived to be uncontrollable and unpredictable are more likely to result in PTSD

The amount of trauma is not as predictive of PTSD as the victim's resistance to an attack A sense of mental defeat during a trauma is

more predictive of PTSD in comparison to more resistance to an attack

This also predicts symptom severity

PTSD: POST-TRAUMA PHASE

More early re-experiencing symptoms predict PTSD better than early numbing/avoidance symptoms This results in a strengthening of the CS

Reevaluation of the trauma could lead to full-blown PTSD

Reinstatement of fear: a separate trauma could trigger PTSD after recovery Also called the inflation effect

GENERALIZED ANXIETY DISORDER (GAD)

Central Features: Chronic, excessive worry about a number of

events or activities for at least six months Worry must be experienced as difficult to control

Those with GAD are more likely to have experienced childhood trauma

Especially vulnerable to unpredictable events due to less tolerance for uncertainty and fewer "safety signals“

Animal model evidence shows us that those who are used to controlling their environment are less likely to have GAD

THE ROLE OF WORRY IN GAD

The central feature of GAD Suppresses emotional and physiological

responses and serves as a cognitive avoidance response

Worry keeps us from fully processing our anxiety, so our anxious response can't be extinguished

Worry creates a vicious cycle:

Worry leads to intrusive thoughts, which lead to worrying about the intrusive thoughts, which often ends up feeling uncontrollable, therefore leading to even more anxiety and worry.

OBSESSIVE-COMPULSIVE DISORDER

Central features: Unwanted and intrusive thoughts, impulses, or

images that cause marked anxiety or distress Usually accompanied by compulsive behaviors or

mental rituals to minimize anxiety http://www.youtube.com/watch?v=SH0r44qn6pI

&NR=1

VERBAL CONDITIONING AND SOCIAL LEARNING IN OCD

Rules and expectations from parents and teachers can create a vulnerability in children for OCD and lead to an acquisition of beliefs that could lead to obsessions What do you think about how believable this is?

Thought-action fusion: when thoughts become equated with action in one's mind; believing that thinking about something is the same as doing it or is more likely to make it happen This is highly correlated with religiosity

OTHER FACTORS IN OCD

The role of avoidance in the maintenance of OCD The compulsions present in OCD serve as

avoidance techniques, making the anxiety difficult to extinguish

Preparedness and OCD Obsessions are generally not random, but

evolutionarily based or based on social learning Video clip about compulsions:

http://www.youtube.com/watch?v=44DCWslbsNM&feature=related

SUMMARY: ETIOLOGICAL FACTORS IN ANXIETY DISORDERS

Evolution / Preparedness of Stimulus Genetic diathesis Personality Unpredictability, Uncontrollability Past experiences

Childhood/Past Trauma Sensitization, Habituation

Variables during conditioning Escapability, response to stimulus

Experiences after conditioning Re-evaluation of trauma Reinstatement of fear/inflation effect

CASE STUDY Mary is a 19 year old female who has been

diagnosed with Panic Disorder with Agoraphobia. After her parents divorced when she was young

she lived with her mother and grandmother, who suffered from rheumatoid arthritis.

Throughout school she was very shy. One day in gym class, Mary had a panic attack in the middle of running laps. She began having panic attacks whenever she walked into her school gym and started to miss school because her mother let her stay home on days that she had gym class, because she “felt sick.”

When she graduated from high school, Mary decided to pursue her college degree online.

CONCLUSIONS

Contemporary learning theory tells us more about etiology

Also informs treatments: "What can be learned can be unlearned, and perhaps also prevented”

Treatment methods such as exposure therapy are based on this premise

Prevention: Identify who is at risk