A Contemporary Learning Theory A Contemporary Learning Theory Perspective on the Etiology of Anxiety Perspective on the Etiology of Anxiety Disorders: Disorders: Its Not What You Thought It WasIts Not What You Thought It Was

Mineka & ZinbargMineka & Zinbarg

20062006

Why Care?Why Care?

Lifetime prevalence in the U.S. of Lifetime prevalence in the U.S. of approximately 29%.approximately 29%.

Classical learning theory does not account Classical learning theory does not account for why some people develop anxiety for why some people develop anxiety disorders while others do not.disorders while others do not.

Specific PhobiaSpecific Phobia

Intense and irrational fears of certain Intense and irrational fears of certain objects or situations they actively avoid.objects or situations they actively avoid.

Watson & Rayner (1920)Watson & Rayner (1920)– Little AlbertLittle Albert

Other Factors with Specific PhobiasOther Factors with Specific Phobias

Vicarious ConditioningVicarious ConditioningIndividual DifferencesIndividual Differences– Personality Variables (High Trait Anxiety, Behaviorally Inhibited)Personality Variables (High Trait Anxiety, Behaviorally Inhibited)– Genetically based vulnerabilitiesGenetically based vulnerabilities– Latent Inhibition: Prior exposure to the CS before paired with the Latent Inhibition: Prior exposure to the CS before paired with the

US US ↓ later conditioning to CS paired w/ US.↓ later conditioning to CS paired w/ US.– Perceived Control of the SituationPerceived Control of the Situation– Postevent inflation (another experience, more information, Postevent inflation (another experience, more information,

mental rehearsal of CS-US relationship)mental rehearsal of CS-US relationship)

Evolutionary selection of Phobias – more preparedEvolutionary selection of Phobias – more prepared– Fear Relevant vs. Fear Irrelevant StimuliFear Relevant vs. Fear Irrelevant Stimuli

Social PhobiaSocial Phobia

Excessive fear of situations in which they Excessive fear of situations in which they might be evaluated or judged.might be evaluated or judged.

Direct traumatic conditioning – 92% report Direct traumatic conditioning – 92% report history of severe teasing in childhood; history of severe teasing in childhood; 50% in panic disorder; 35% in OCD50% in panic disorder; 35% in OCD

56% of those with social phobia recalled 56% of those with social phobia recalled direct traumatic conditioning experiencesdirect traumatic conditioning experiences

Factors with Social PhobiasFactors with Social Phobias

Vicarious learning (13%)Vicarious learning (13%)Modeling – parents fearsModeling – parents fearsCultural Norms (Taijin Kyofusho)Cultural Norms (Taijin Kyofusho)Preparedness (Social Dominance)Preparedness (Social Dominance)Behavioral InhibitionBehavioral InhibitionControllabilityControllability

Notice any patterns?Notice any patterns?

Panic Disorder With and Panic Disorder With and Without AgoraphobiaWithout Agoraphobia

Recurrent unexpected panic attacks without Recurrent unexpected panic attacks without explicit knowledge of cues or triggers; explicit knowledge of cues or triggers; experience worry anxiety or behavioral change experience worry anxiety or behavioral change related to having another attack.*related to having another attack.*Some develop avoidance of situations in which Some develop avoidance of situations in which they feel escape might be difficult or they feel escape might be difficult or embarrassing if they had a panic attack.embarrassing if they had a panic attack.Risk Factors:Risk Factors:– GenderGender– EmploymentEmployment

Panic vs. AnxietyPanic vs. Anxiety

Panic: strong autonomic arousal, extreme Panic: strong autonomic arousal, extreme fear, and fight or flight actionsfear, and fight or flight actions

Anxiety: apprehension, worry and tensionAnxiety: apprehension, worry and tension

TheoryTheory

Exteroceptive ConditioningExteroceptive Conditioning– CSs interact with external sensory receptorsCSs interact with external sensory receptors

Central to development of agoraphobiaCentral to development of agoraphobia

Interoceptive ConditioningInteroceptive Conditioning– CSs are bodies own internal sensationsCSs are bodies own internal sensations

Heart palpitations and dizzinessHeart palpitations and dizziness

Panic Attacks can occur due to the presence of Panic Attacks can occur due to the presence of exteroceptive CSs or interoceptive CSsexteroceptive CSs or interoceptive CSsMay cause generalization of agoraphobia due to May cause generalization of agoraphobia due to interoceptive CSs generalizations (caffeine, interoceptive CSs generalizations (caffeine, scary movies, exercise, etc.)scary movies, exercise, etc.)

Factors in Panic DisorderFactors in Panic Disorder

Anxiety- may be a precursor to panic Anxiety- may be a precursor to panic attacksattacks– Can be additive (general level of anxiety and Can be additive (general level of anxiety and

CS)CS)

Genetic & Personality factorsGenetic & Personality factorsPrior learningPrior learning– Perceptions of lack of control and Perceptions of lack of control and

helplessnesshelplessness– Engaging in sick role behavior, observing Engaging in sick role behavior, observing

physical suffering as childrenphysical suffering as children

PTSDPTSDReexperiencing the trauma, passively avoiding Reexperiencing the trauma, passively avoiding remingers, numbing of affect, heightened remingers, numbing of affect, heightened general arousal.general arousal.Trauma Phase Trauma Phase – ControllabilityControllability– Mental defeatMental defeat

Pretrauma Phase Pretrauma Phase – Prior trauma (especially interpersonal trauma)Prior trauma (especially interpersonal trauma)– History of control/readiness - predictableHistory of control/readiness - predictable– Genetic liabilityGenetic liability

Posttrauma PhasePosttrauma Phase– Exposure to contexts related to the traumaExposure to contexts related to the trauma– Reevaluation inflationReevaluation inflation– Reinstatement of fearReinstatement of fear

GADGAD

Chronic excessive worry about several Chronic excessive worry about several events and/or activities for 6+ months, events and/or activities for 6+ months, worry must be difficult to control.worry must be difficult to control.

Less tolerance for uncertainty than Less tolerance for uncertainty than nonanxious controls – need to predict the nonanxious controls – need to predict the futurefuture

Anxiety-Worry-Intrusive thoughts Cycle; Anxiety-Worry-Intrusive thoughts Cycle; Cognitive avoidanceCognitive avoidance

GAD FactorsGAD Factors

Benefits:Benefits:– Avoid catastropheAvoid catastrophe– Avoid deeper emotional topicsAvoid deeper emotional topics

CostsCosts– Greater sense of danger and anxietyGreater sense of danger and anxiety– Negative intrusive thoughtsNegative intrusive thoughts– Suppresses emotional and physiological responses to Suppresses emotional and physiological responses to

aversive imageryaversive imagery

FactorsFactors– Uncontrollable/Unpredictable events (though not as Uncontrollable/Unpredictable events (though not as

severe as those in PTSD)severe as those in PTSD)– Childhood traumaChildhood trauma

OCDOCD

Unwanted and intrusive thoughts, Unwanted and intrusive thoughts, impulses, or images causing marked impulses, or images causing marked anxiety or distress; usually accompanied anxiety or distress; usually accompanied by compulsive behaviors or mental ritualsby compulsive behaviors or mental rituals

Factors in OCDFactors in OCD

Verbal ConditioningVerbal Conditioning

Responsibility and DutyResponsibility and Duty

Thought-action fusionThought-action fusion– Moral equivalentMoral equivalent– Probability increaseProbability increase

Cultural NormsCultural Norms

Avoidance Avoidance → Maintenance→ Maintenance

Evolutionarily relevant themesEvolutionarily relevant themes

ConclusionsConclusions

From this perspective we can identify risk From this perspective we can identify risk factors associated with future development factors associated with future development of anxiety disorders.of anxiety disorders.

Strong sense of mastery and exposure to Strong sense of mastery and exposure to nonanxious models from early agenonanxious models from early age

Exposure therapyExposure therapy