Summary of ALL literature - Anxiety and related disorders ()
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Course
Anxiety and related disorders (201600817)
Institution
Universiteit Utrecht (UU)
This is a summary of all of the literature for the course Anxiety and Related disorders. Every week includes the three articles with theoretical framework, maintaining factors and treatment of the specific disorders.
Anxiety and Related
disorders
Summary period 3 2024 201600817
Week 1 – Emotion Theory
Theoretical framework: Mineka & Zinbarg (2006). A contemporary
learning theory perspective on the etiology of anxiety disorders
Maintaining factors: Clark (1999). Anxiety disorders: why they persist
and how to treat them
Treatment: Abramowitz, 2019. Exposure Therapy for Anxiety:
Principles and Practice.
Theoretical framework; Mineka & Zinbarg (2006)
29% of the U.S. population is estimated to have an anxiety disorder at some
point. A contemporary learning theory approach can account for complexity,
and they have advantages; learning approaches are better grounded in
theories and methods of experimental psychology, have more
comprehensive formulations of the etiology of anxiety disorders and more
explicit analysis of factors promoting or inhibiting development. Article
summarizes available research illustrating these points for 6 primary anxiety
disorders.
Specific phobia: Intense and irrational fears of certain objects or situations.
Some think it is just an intense classically conditioned fear, and many people
with phobias can recall a traumatic conditioning event. However, it reflects
ignorance of vulnerability and invulnerability factors that are predicted by
learning theory to influence who develops phobias.
Conditioning of fears and phobias: many people with phobias do not have a
significant history of classical conditioning. How do phobias develop with
them? Vicarious conditioning, which assumes that we can develop fear from
watching someone else experience a traumatic event/extreme fear.
Individual differences: why do many people with traumatic experiences not
develop phobias? There is a modest genetic vulnerability, which is mediated
through fear conditioning/personality variables. Timid children have a higher
risk of developing phobias.
1
,Impact of prior experiences: latent inhibition is where exposure to stimulus
with no consequence, makes it harder to learn new associations with that
stimulus. You are less likely to notice something you have ignored before.
So, if you have a lot of neutral experiences with the dentist, and something
bad happens, you are less likely to develop a phobia. A persons history of
control over environment is also important. When children have a sense of
control over their environment, they are less frightened by novel and fearful
events.
Impact of postevent variables. If someone experiences a mild fear and then a
traumatic event, they are more likely to develop a phobia.
Selective Associations in the Conditioning of Fears and Phobias. People are
more likely to develop phobia of snakes, water, heights, and enclosed spaces
than cars, guns and bicycles. We are evolutionary prepared to fear these
things. Prepared fears are not innate, but rather easily acquired/resistant to
extinction.
Social phobia
Social phobia is excessive fear of situations in which people might be
evaluated or judged by others and avoid or endure them. Theorists say that
is a result of direct traumatic conditioning and studies have provided.
Social learning and social phobia: vicarious conditioning, seeing someone
else be humiliated, is a form of social learning which may cause social
phobia. Modelling behavior also plays a part, parents of people with social
phobia were more likely to be avoidant. There are cultural factors which play
a role, the social phobia in Japan is directed towards not offending others.
Preparedness and social phobia: Ohmans extension of preparedness theory:
social anxiety might be linked to evolutionary factors related to dominance
hierarchies. Angry facial expressions, associated with dominance conflicts,
can trigger automatic anxiety responses even if a person consciously knows
that a social situation is safe. This implies that subtle cues, not consciously
processed, can still activate anxiety in social situations.
Behavioral inhibition as a temperamental diathesis for social phobia: 20% of
the socially phobic people never experienced something traumatic.
Behavioral inhibition may influence the outcome of exposure to traumatic
experiences. It predicts the onset of social problems.
Uncontrollability and social phobia
Uncontrollability increases submissiveness. Repeated social defeat increases
helplessness. Perceptions of uncontrollability play a role in the origins of
social anxiety.
2
,Panic disorder with and without agoraphobia
People with PD experience panic attacks without knowing triggers or cues.
Many with PD develop a degree of agoraphobic avoidance of situations
perceived as difficult or embarrassing to have an attack. First, they thought
that panic disorder consisted of exteroceptive and interoceptive
conditioning. The learning perspective proposes that anxiety and panic are
at least partially unique. Panic is with arousal, extreme fear, fight, or flight
tendencies. Anxiety is with apprehension, worry and tension.
Exteroceptive and interoceptive conditioning in panic disorder: Initial panic
attacks come with initially neutral interoceptive and exteroceptive CSs. They
become conditioned.
The development of agoraphobia: many people with PD go on to develop
agoraphobia of situations where they fear they might have a panic attack.
The avoidance of these situations tends to become generalized to other
situation where someone never even had a panic attack. Even sexual
activities may create interoceptive cues and are thus avoided. Women are
more likely to develop agoraphobia as well as people who do not work or
work from home. According to learning theory, these people can avoid their
feared objects.
Further complexities:
The CSs in anxiety lower the threshold for, or exaggerate, panic reactions.
Baselevel anxiety is a precursor for panic attacks. Personality traits such as
neuroticism and trait anxiety cause a vulnerability for PD and PDA. As well
are early stressful life events which were uncontrollable (death or divorce). A
lot of physical suffering may contribute to viewing somatic symptoms as
dangerous.
PTSD
Reexperiencing the trauma, passively avoiding reminders, numbing affect
heightened arousal. Why do some people develop PTSD? The contemporary
learning theory on the effects of uncontrollable and unpredictable stress.
Trauma that are perceived to be uncontrollable and unpredictable are more
likely to cause PTSD. Feeling helpless and giving up during traumatic events
correlates with PTSD. A history of prior trauma increases the risk of PTSD, a
prior history of control over stressful events can immunize against the
harmful effects of uncontrolled stress, thus PTSD. Psychological readiness
(knowing torture, having had training etc.) decreases risk.
A greater severity of reexperiencing symptoms after traumas influence the
course of PTSD. The inflation and US reevaluation effects can also affect the
course of PTSD (finding out that your attacker is a convicted murderer weeks
later).
3
, Generalized Anxiety Disorder
Chronic and excessive worry about events or activities for at least six
months, and the worry must be experienced as difficult to control.
Uncontrollable and unpredictable aversive events may play a role in the
development of GAD. People with GAD may be more likely to have a history
of childhood trauma than are people with several other anxiety disorders.
They have less tolerance of uncertainty, disturbed by not being able to
predict future threats. people high on neuroticism or trait anxiety may be
especially susceptible to the effects of uncontrollable and unpredictable
aversive events. Worry suppresses physiological responding; this also
prevents the person from fully experiencing or processing the topic that is
being worried about; such processing is necessary if extinction of anxiety is
to occur. According to learning theory, worry serves as a cognitive avoidance
response. Thought-action fusion is thinking of thoughts and actions as having
the same consequences, which increases the risk of anxiety.
OCD
Most patients with OCD engage in either behavioral or mental rituals
intended to neutralize or prevent their obsessions, and it is therefore not
surprising that rituals have long been construed as avoidance responses.
Learned avoidance responses are very resistant to extinction. Prolonged
exposure causes the avoidance responses to not occur. OCD has
evolutionary roots, they do not typically obsess about random or scary
thoughts. Verbal and social learning contribute to distress-related beliefs,
often centered around evolutionarily relevant themes. Once compulsive
rituals develop as methods to neutralize or prevent obsessive thoughts, they
exhibit high resistance to extinction, similar to learned avoidance responses
in animals.
Clark (1999). Anxiety disorders: why they persist and how to treat
them
There are six maintaining processes in anxiety disorders: safety seeking
behavior, attentional deployment, spontaneous imagery, emotional
reasoning, certain types of memory processes and the nature of threat
representations.
Safety seeking behavior
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