Transcript A Contemporary Learning Theory Perspective of the Etiology of

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?
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First…let’s take a look at the old theory:
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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
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SPECIFIC PHOBIA
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Central Features:
Intense and irrational fear of a certain object or
situation
 Usually go to great lengths to avoid object/situation
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The traditional view is that a phobia develops
when a neutral stimulus is paired with a
traumatic event
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Too simplistic!
SPECIFIC PHOBIA: POSSIBLE SOURCES
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Vicarious Conditioning
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Based on animals models we know that simple
observation can be a particularly strong pathway
towards developing a specific phobia
Individual Differences
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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 PHOBIA
IMPACT OF INDIVIDUAL DIFFERENCES:
PAST, PRESENT & FUTURE
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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
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Context during Conditioning:
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When a traumatic event is escapable, it is less likely
to trigger the development of a phobia
Post-Event Experiences:
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Inflation Effect: experiencing another traumatic
event can strengthen fear of CS, even if it is
completely unrelated
SPECIFIC PHOBIA:
SELECTIVE ASSOCIATIONS
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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!
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YES!
Hmm…probably
not.
SOCIAL PHOBIA
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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
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Often a result of traumatic conditioning like
teasing in childhood
SOCIAL PHOBIA & SOCIAL LEARNING
Vicarious Conditioning
 Modeling
 Social Reinforcement/Verbal Instruction
 Cultural Factors
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MORE FACTORS IN SOCIAL PHOBIA
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Preparedness
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Behavioral Inhibition
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We are programmed to be more vigilant for negative
faces
An inhibited personality is a risk factor for social
phobia, as well as many other anxiety disorders
Uncontrollability
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Repeated social defeat can lead someone to perceive
social situations as uncontrollable, which may make
someone more susceptible to social anxiety
PANIC DISORDER
WITH AND WITHOUT AGORAPHOBIA
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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
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This can lead to agoraphobic avoidance, but more on this
later!
EXTEROCEPTIVE AND INTEROCEPTIVE
CONDITIONING IN PANIC DISORDER
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Exteroceptive: External triggers (or CSs) for
panic
Interoceptive: Internal triggers for panic
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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:
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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
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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
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PTSD: PRE-TRAUMA PHASE
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Sensitization: previous trauma makes a person
more vulnerable to developing PTSD after a new
trauma
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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
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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
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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
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PTSD: POST-TRAUMA PHASE
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More early re-experiencing symptoms predict
PTSD better than early numbing/avoidance
symptoms
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This results in a strengthening of the CS
Reevaluation of the trauma could lead to fullblown PTSD
 Reinstatement of fear: a separate trauma could
trigger PTSD after recovery
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Also called the inflation effect
GENERALIZED ANXIETY DISORDER (GAD)
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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
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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
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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:
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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
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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
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VERBAL CONDITIONING AND SOCIAL
LEARNING IN OCD
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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
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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
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This is highly correlated with religiosity
OTHER FACTORS IN OCD
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The role of avoidance in the maintenance of OCD
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Preparedness and OCD
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The compulsions present in OCD serve as avoidance
techniques, making the anxiety difficult to extinguish
Obsessions are generally not random, but
evolutionarily based or based on social learning
Video clip about compulsions:
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http://www.youtube.com/watch?v=44DCWslbsNM&fe
ature=related
SUMMARY: ETIOLOGICAL FACTORS IN
ANXIETY DISORDERS
Evolution / Preparedness of Stimulus
 Genetic diathesis
 Personality
 Unpredictability, Uncontrollability
 Past experiences
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Variables during conditioning
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Childhood/Past Trauma  Sensitization, Habituation
Escapability, response to stimulus
Experiences after conditioning
Re-evaluation of trauma
 Reinstatement of fear/inflation effect
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CASE STUDY
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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
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