Anxiety and related disorders lectures
Lecture 1: Emotion Theory
What is emotion?
- ‘On virtue and vices’ – Aristoteles, philosophical approach
Higher versus lower emotions
5 basic emotions: happy, anxious, sad, angry, and ashamed
Often one of these emotions lies behind complex emotions
1. Emotion theory and anxiety
2. Anxiety disorders
Emotion I more than a feeling:
- Physiological aspects/arousal (sweaty hands, heart pounding, trembling)
- Cognitive aspects
o Conscious (experience/feelings)
o Unconscious
- Motoric aspects
Loosely coupled systems: concordant/discordant
Related concepts: Mood, attitude, and temperament
Patients score often very high on neuroticism: good to keep in mind
Two dimensions:
Low arousal negative: sadness
Low arousal positive: contentness
High arousal negative: anger
,High arousal positive: excitement
Emotion has functions:
What functions do emotions serve:
Q: when do emotions occur? Greatest common denominator?
A: when vital interests are at stake. Survival of self and offspring
Emotions prepare us for actions, it has an alarming function
Frijda: emotions as ‘action tendencies’
Theoretical background
- Schachter-Singer theory / Two-factor theory of emotions
1. A stimulus causes physical arousal
2. We cognitively label the physical response and associate it with an emotion
3. We feel the emotion
- Cognitive appraisal theory
1. Stimulus appears
2. Thoughts, labeling the stimulus + immediate experience of physiological response
3. Fight or flight or freeze
Fight or flight response = fight, freeze or flight
Emotion requires ‘interpretation’ of stimulus: sometimes (very) fast and preconscious
Neuroticism: trait anxiety/negative affectivity
- Genetically transmitted
- Neuroticism is fundamental personality trait (cf Big V)
- Neuroticism is closely associated with various disorders
- Neuroticism appears to be a ‘higher order trait’
- Related to anxiety disorders, OCD, depression, trauma
Neuroticism as a vulnerability factor:
- So certain individuals are more susceptible to anxiety disorders
- But also: some stimuli are more often the object of anxiety (disorder) than others
o Arachnophobia, mysophobia, astraphobia, social phobia
Mineka’s experiment: there is a tendency to learn fear for spider or snakes (evolutionary)
Anxiety disorders:
, 1. Abnormal is not: the nature of the anxiety response itself
2. Abnormal is: the intensity of the response disproportionate to the seriousness of the threat.
Cf. cognitive nucleus of anxiety disorders
Question yourself: what is the CS/US?
- Panic disorder: catastrophic misinterpretation of bodily sensations
- Social phobia: fear of disapproval from others because others see signs of social anxiety
(blushing, trembling, etc.)
- OCD: fear of guilt from behaving irresponsibly
- PTSD: catastrophic misinterpretations of the consequences of trauma and the significance of
trauma
- Other event related phobias: depending on nature of phobia
- Phobias: dog will attack, plane will crash, lighting will strike
- GAD: alternating (worrying is annoying, but actually good)
Classical conditioning and operant conditioning
Extinction:
- Clinical implication
- Not: habituation (‘getting used to’ CS)
- But: extinction (CS X US)
Avoidance behavior prevents us from learning that catastrophe does not happen!
Lecture 2: Specific phobias
Two sides of fear:
- Fear is useful for survival
- However: some fears are not rational and are excessive
Objects of phobia
- Animal (e.g., spiders, insects, dogs).
- Natural environment (e.g., heights, storms, water).
- Blood-injection-injury (e.g., needles, invasive medical procedures)
- Situational (e.g., airplanes, elevators, enclosed places).
- Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or
costumed characters).
Diagnostic criteria (key ones)
- Marked fear or anxiety about a specific object or situation
- The phobic object or situation almost always provokes immediate fear or anxiety
- The phobic object or situation is actively avoided or endured with intense fear or anxiety
- The fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
Phobia’s prevalence
- 7-9% US
- 6% Europe
- 2-4% Asia, Africa, Latin America
Lecture 1: Emotion Theory
What is emotion?
- ‘On virtue and vices’ – Aristoteles, philosophical approach
Higher versus lower emotions
5 basic emotions: happy, anxious, sad, angry, and ashamed
Often one of these emotions lies behind complex emotions
1. Emotion theory and anxiety
2. Anxiety disorders
Emotion I more than a feeling:
- Physiological aspects/arousal (sweaty hands, heart pounding, trembling)
- Cognitive aspects
o Conscious (experience/feelings)
o Unconscious
- Motoric aspects
Loosely coupled systems: concordant/discordant
Related concepts: Mood, attitude, and temperament
Patients score often very high on neuroticism: good to keep in mind
Two dimensions:
Low arousal negative: sadness
Low arousal positive: contentness
High arousal negative: anger
,High arousal positive: excitement
Emotion has functions:
What functions do emotions serve:
Q: when do emotions occur? Greatest common denominator?
A: when vital interests are at stake. Survival of self and offspring
Emotions prepare us for actions, it has an alarming function
Frijda: emotions as ‘action tendencies’
Theoretical background
- Schachter-Singer theory / Two-factor theory of emotions
1. A stimulus causes physical arousal
2. We cognitively label the physical response and associate it with an emotion
3. We feel the emotion
- Cognitive appraisal theory
1. Stimulus appears
2. Thoughts, labeling the stimulus + immediate experience of physiological response
3. Fight or flight or freeze
Fight or flight response = fight, freeze or flight
Emotion requires ‘interpretation’ of stimulus: sometimes (very) fast and preconscious
Neuroticism: trait anxiety/negative affectivity
- Genetically transmitted
- Neuroticism is fundamental personality trait (cf Big V)
- Neuroticism is closely associated with various disorders
- Neuroticism appears to be a ‘higher order trait’
- Related to anxiety disorders, OCD, depression, trauma
Neuroticism as a vulnerability factor:
- So certain individuals are more susceptible to anxiety disorders
- But also: some stimuli are more often the object of anxiety (disorder) than others
o Arachnophobia, mysophobia, astraphobia, social phobia
Mineka’s experiment: there is a tendency to learn fear for spider or snakes (evolutionary)
Anxiety disorders:
, 1. Abnormal is not: the nature of the anxiety response itself
2. Abnormal is: the intensity of the response disproportionate to the seriousness of the threat.
Cf. cognitive nucleus of anxiety disorders
Question yourself: what is the CS/US?
- Panic disorder: catastrophic misinterpretation of bodily sensations
- Social phobia: fear of disapproval from others because others see signs of social anxiety
(blushing, trembling, etc.)
- OCD: fear of guilt from behaving irresponsibly
- PTSD: catastrophic misinterpretations of the consequences of trauma and the significance of
trauma
- Other event related phobias: depending on nature of phobia
- Phobias: dog will attack, plane will crash, lighting will strike
- GAD: alternating (worrying is annoying, but actually good)
Classical conditioning and operant conditioning
Extinction:
- Clinical implication
- Not: habituation (‘getting used to’ CS)
- But: extinction (CS X US)
Avoidance behavior prevents us from learning that catastrophe does not happen!
Lecture 2: Specific phobias
Two sides of fear:
- Fear is useful for survival
- However: some fears are not rational and are excessive
Objects of phobia
- Animal (e.g., spiders, insects, dogs).
- Natural environment (e.g., heights, storms, water).
- Blood-injection-injury (e.g., needles, invasive medical procedures)
- Situational (e.g., airplanes, elevators, enclosed places).
- Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or
costumed characters).
Diagnostic criteria (key ones)
- Marked fear or anxiety about a specific object or situation
- The phobic object or situation almost always provokes immediate fear or anxiety
- The phobic object or situation is actively avoided or endured with intense fear or anxiety
- The fear or anxiety is out of proportion to the actual danger posed by the specific object or
situation and to the sociocultural context
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
Phobia’s prevalence
- 7-9% US
- 6% Europe
- 2-4% Asia, Africa, Latin America
