Blog details

Modern learning theory models of anxiety disorders

The summary of an article, originally published in the American Psychologist is primarily intended for therapists with a substantial knowledge of learning models of anxiety disorders. It assumes a psychologically-educated reader, but is not beyond comprehension for a lay person. It highlights how vital scienctific research is to continually refine our knowledge and better understand these persistent human problems.

Mineka, S & Zinbarg, R.  (2006). A contemporary learning theory perspective on the eitiology of anxiety disorders. American Psychologist , 61, 10-26.

Background

Until the 1970's, behavioral and learning theories were the dominant scientific models advanced to explain the development and maintenance of anxiety problems.  Since then those models have been criticized because they could not adequately explain the less classic routes by which anxiety problems might emerge.  In this review article, Mineka and Zinbarg explain how contemporary learning theory better accounts for the origins of anxiety problems for each of the six primary anxiety disorders.  They show how both early learning history and temperament act as vulnerability factors that make a person more or less susceptible to anxiety when faced with adverse and stressful life experiences.  Further, they show how traumatic events, being powerful learning events, are greatly influenced by the context of the event before, during and after the occurrence of the triggering event.  Their review concludes that contemporary learning theory models are more comprehensive, better explain the origin and maintenance of anxiety, and are more grounded in scientific research. 

Some background for non-psychologists 
The older behavioral/learning models generally proposed that anxiety problems were based on two conditioning (learning) processes. As an example, consider a specific phobia, like fear of water.  Early models hypothesized that when a traumatic events became associated with a normally harmless object or situation an anxiety response became associated with the object.  "Classical conditioning" was the explanation for the beginning of the phobia.  Following that initial association, the individual would tend to experience anxiety at the next presentation of the object and would frequently escape that anxious feeling by escaping the object.  That would result in a reduction of anxiety.  Hence, by his/her own response, the person learned to reduce anxiety through escape or avoidance, but that unfortunately strengthened the association between the object and the anxiety (close= anxious; far away = not anxious).  The fear, therefore, was maintained through "respondent conditioning" (also know as operant, instrumental or Skinnerian conditioning).

Nice models ...a neutral stimulus becomes associated with a traumatic event and that association is maintained by way of avoidance/escape behavior over time.  But those models don't always explain the variety of ways that anxiety problems develop.

Discussion

Looking at the primary anxiety disorders, Mineka and Zinbarg describe the how the old models fall short and review the evidence that supports contemporary learning theory (CLT) models.

Specific phobias: Many people with phobias can't recall any traumatic event connected with their specific phobia.  CLT emphasizes the importance of several factors not contained in previous models. 1) observational learning in the development of fear.  Simply observing others' traumas or observing other people behaving fearfully can create the conditioned fear.  2) Individual differences:   Not everyone exposed to a traumatic stressor develops a phobia.  CLT recognizes that individuals differ in their susceptibility to anxiety based on a) their previous experience,  such as previous exposure to the stimulus, b) extensive exposure to non-fearful parents, c) a previous history of experiencing control of their environments, d) having the ability for control/escape the situation, and e) the effects of accumulated or subsequent, post-event stress even if unrelated to the trauma. 3) Selective associations: Fears of some things are simply more readily developed because we are more 'prepared' to find them dangerous even with only minimal negative associations.

Social phobia: In the absence of traumatic conditioning, vicarious conditioning and social learning, direct reinforcement, and explicit verbal instruction or even discussions of threatening social situations are alternate routes that may play a large role in the development of the disorder .  In addition, selective attention to subtle cues associated with anxiety (e.g., facial expressions) appear to ignite a 'prepared' vulnerability to fear of socially dominant individuals.  Individuals with a temperament characterized by behavioral inhibition seem to be more vulnerable perhaps due to perceptions of how controllable the social situation may be.

Panic Disorder: Since far more people experience panic attacks than develop a panic disorder, what determines who will develop the disorder?  The authors cite several vulnerability factors that contribute: 1) a genetic temperament that accelerates the speed of conditioning, 2) prior learning experiences that lead to a lack of perceived control and helplessness, and 3) the witnessing of physical suffering  that contributes to the evaluation of physical symptoms as dangerous.

Posttraumatic Stress Disorder: In answer to the question of why some who are exposed to traumatic events develop PTSD and some do not, CLT points to the potency of stress that is either uncontrollable and/or unpredictable.  One's pre- trauma history of uncontrollable stress can have the effect to sensitize a person to an actual trauma just as a prior history of perceived control over stressors can have the effect of insulating a person from the development of symptoms following a trauma.  Similarly, being psychologically ready or prepared for some identifiable stressor renders the stress more predictable and so has the effect of immunizing the person from a post-trauma anxiety disorder.  Even after the stressor is past, if the dangerousness of the event is subsequently reevaluated, symptoms may appear due to the reappraisal.

Generalized Anxiety Disorder: Those who suffer the seemingly uncontrollable worry that characterizes the disorder are also influenced by perceptions of controllability and predictability of dreaded events.  Those with histories of aversive events beyond their prediction and control adopt mental vigilance against future imaginable and unimaginable catastrophes.  The worry process  attempts to ward off the occurrence of the event through mental preparation and actually temporarily decreases the physical arousal piece of the anxiety.  Both of those processes act as a kind of mental avoidance of the feared event and so become a form of avoidance, which in turn reinforces the need to worry. Further, attempts to control negative thoughts has the counterproductive effect of increasing negative intrusive thoughts which also contributes to the perception that the worry process is itself uncontrollable.

Obsessive Compulsive Disorder: Existing research has failed to find much evidence to support the idea of traumatic conditioning in OCD.  The process of symptom development is more akin to a verbal conditioning whereby certain thoughts have acquired the potency of actual aversive events via mental associations.   In addition, certain societal/cultural beliefs acquired early on may actually be dysfunctional and come to fuel the misinterpretation of intrusive thoughts and situations producing elevated levels of distress.  Subsequent compulsive behavior has the effect of removing or avoiding the disturbing ideas and situations.

How can this help me?

This review is intended to build on already strong scientifically-tested models of anxiety disorders.  It presses researchers to more closely examine the complexity of factors that contribute to all anxiety disorders via a more complex understanding of learning.  In a beautiful flowchart  (I wish I could reproduce it here) the authors  display the major elements incorporated into the Contemporary Learning Theory models.  The ultimate benefit of the models is to guide treatment and prevention.  Treatment based on learning principles (cognitive and behavioral therapies) can take sharper aim at those aspects that are more likely influencing the development of the disorder and help patients to unlearn what they unfortunately "learned" in the process of developing the disorder. Appropriate steps to prevent or remove anxiety problems would include identifying people at greater risk for anxiety disorders, developing a "strong sense of mastery", inoculating people against anxiety via social modeling, direct instruction, and promoting regular contact with (to not avoid !)- stimuli that could easily stir anxiety . 

Citation
Mineka, S & Zinbarg, R.  (2006). A contemporary learning theory perspective on the etiology of anxiety disorders. American Psychologist, 61, 10-26.

Posted by: James Dod, Ph.D.May 31st, 2016 Share