A C ONTEMPORARY L EARNING T HEORY P ERSPECTIVE OF THE E TIOLOGY OF A NXIETY D ISORDERS : I T ’ S N...
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Transcript of A C ONTEMPORARY L EARNING T HEORY P ERSPECTIVE OF THE E TIOLOGY OF A NXIETY D ISORDERS : I T ’ S N...
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.