By Susan Mineka & Richard Zinbarg Presented by Katie Kriegshauser

1. 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

2. 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

3. 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!

4. 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

5. 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

6. 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! Hmm…probably not. YES!

7. 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

8. Social Phobia & Social Learning • Vicarious Conditioning • Modeling • Social Reinforcement/Verbal Instruction • Cultural Factors

9. 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

10. 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!

11. 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

12. 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

13. 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

14. 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”

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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.

24. 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