Lecture 6 
      
                             Anxiety Disorders: Etiology
                                Psycho-Social Factors
      
      
      Lecture Outline
      
      I. Introduction
      II. Learning
           A. Learning Theory
           B. Socio-cultural factors
      III. Cognition
           A. Attribution and related theories
           B. Network Theories
      IV. Conclusions
      
                     -------------------------------------------
      
      I. Introduction
      
           To understand the etiology of Anxiety Disorders, we must look at a
      complex interaction of factors:  Learning, Physiology, Neurobiology,
      Cognition, and more.  There is still much to learn about the causes of
      these disorders - many questions remain.  
           As we shall see throughout this course, the manner in which one
      conceptualizes the etiology of a disorder has direct and important
      implications for how one carries out research and how one conceptualizes
      and conducts the treatment of that disorder (discuss Handout 6-1).
           In today's lecture we will examine a number of possible
      explanations for the Anxiety Disorders: learning theories and cognitive
      theories.
      
      II. Learning
      
           A. Learning Theory
      
           Learning Theories of the Anxiety Disorders have a relatively long
      history in modern psychology, especially in the branch of psychology
      known as behaviorism.  John B. Watson, often known as the "father of
      behaviorism", was one of the first to demonstrate that fears can be
      learned, and in precisely the same manner that other things are learned
      in our lives.  The important point is that fears, even irrational ones,
      are learned - there is nothing mysterious about them. 
      
      There are two related issues when we talk about the etiology of the
      Anxiety Disorders:  1. What was the initial cause of the learned fear?
      and 2. Why does the fear persist once it's learned?  
      
      1. Acquisition:  Classical Conditioning Model
      
      The idea here is that phobias are learned through "traumatic
      conditioning" (Wolpe, 1958) - the person learns to associate a
      threatening stimulus with a nonthreatening stimulus, so that
      the latter by itself can trigger anxiety.  
      
      Some definitions:
      
             US  = unconditioned ("unlearned") stimulus (a threatening       
                   stimulus)
             UR  = unconditioned response (the anxiety response to the US
             CS  = conditioned ("learned") stimulus  (initially a nonthreatening
                   stimulus, but comes to be threatening)
             CR = conditioned response (the learned response to the CS)
                                                                 
      If the US is paired with a CS enough times, the CS will     
      eventually be able to elicit the response that originally
      happened just with the US.  Here is a diagram to show how this
      works...
      
      
      The Process of Learning:
      
      Stage         Process        Example (a dog phobia)
      -----------------------------------------------------------
      Prior to      US ---> UR     Pain ---> Anxiety
      Learning                  
                                                                     
      Learning      US ---> UR     Pain ---> Anxiety                 
                    +               +                                 
                    CS             Dog (eg: dog bites me - pain         
                                        associated with sight of the
                                        dog)
      Successful    CS ---> CR     Dog ---> Anxiety
      Learning                  
                               
                              
      
      
      According to this model, the fear can be "unlearned"  by
      simply reversing the process.  That is, by repeatedly
      presenting the CS without the US, eventually the fear will no
      longer be elicited by the CS.  This is known as the process of
      extinction.
      
      2. Maintenance:  Avoidance model
      
      The behavioral model of fear acquisition emphasizes the
      association of two stimuli: the CS and the US.  It follows
      from this model that if that association can be broken the
      fear will be extinguished.  However, for many people, once a
      phobia is learned, it is often very resistent to extinction:
      Once I learned to be afraid of dogs, I remained afraid for
      years.  To account for this, we need to look at more than one
      factor of learning.
      
      Factor 1:  Fear is initially learned through classical conditioning.
      Factor 2:  Fear is then maintained through avoidance - because the
                 individual avoids the thing he/she is afraid of, there are no
                 opportunities for "reality testing" and new learning. As a
                 consequence, the fear does not extinguish.  (eg: I never
                 learn that most dogs are OK because I never get near enough
                 to find out).
      
      3. Social Learning
      
      Acquisition and Maintenance of fears is undoubtedly more
      complex than mere traumatic conditioning.  People learn by
      watching others, they don't necessarily need to directly
      experience something to learn it.  Thus, people also learn
      fears by watching what happens to other people.  If you grow
      up with a father who is deathly afraid of dogs, and you
      repeatedly observe his fear reactions when dogs are present,
      then it is likely that you too will learn to be afraid of dogs
      - this is known as modeling (your father modeled the fear, and
      you "picked it up" from him).  Similarly, it is likely that an
      overanxious parent, say, will subtly communicate fearfulness
      to his/her child, thereby planting the seeds of an anxiety
      disorder.
      
      There is some interesting animal research on this (see Agras,
      1985): in one study, young monkeys who had been raised in a
      laboratory (and therefore had no fear of snakes) were allowed
      to watch their parents (who had been raised in the wild and
      had normal a fear of snakes) react fearfully to toy and real
      snakes.  After only eight minutes, the young monkeys had
      developed a strong fear of snakes.
      
      B. Socio-cultural factors
      
      1. Acquisition: Socialization/Internalization
      
      Another possible explanation for the learning of fears and
      phobias is the effect of sex-role stereotyping.  Women are
      taught to be helpless and dependent which leads them to be
      more vulnerable to learn phobic responses (Fodor, 1974).  Men,
      although they may be fearful, have been taught that "real men"
      face their fears.  
      
      2. Maintenance: Social Sanctions
      
      Sex-role stereotyping may also explain why phobias maintain
      themselves, at least for women (and as we have seen, the
      prevalence of anxiety disorders is greater in women).  A woman
      who tries to break out of the helpless and dependent role and
      confront her fears and act assertively may be met by social
      sanctions: implicit and explicit disapproval or punishment
      from others.
      
      As I list these theories separately I do not mean to imply that either
      one or another might someday be found to be the true and correct
      explanation of Anxiety Disorders.  Although these theories and those we
      turn to next are presented in succession, the best explanation of
      Anxiety Disorders will undoubtedly combine aspects of each of the
      separate theories.
      
      III. Cognition
      
      A. Attribution and related theories
      
      1. Mistaken beliefs:  The basic idea here is that our fear is
      caused by the things we say to ourselves about the world and
      about ourselves.  Anxiety arises because we interpret a
      stimulus as threatening - the interpretation is more important
      than the actual stimulus.  There are many theories that are
      variations and elaborations on this theme (eg: Beck & Emery,
      1985; Ellis & Harper, 1976).  They include as the crucial
      cognitive variable:  irrational thoughts, misinterpretations,
      misattributions, and mistaken appraisals.  This type of
      thinking is characterized by the tendency to catastrophize,
      overgeneralize, and magnify the significance of an event. 
      Ellis and Beck both note that such thinking is often
      absolutistic in nature:  The person sees things way out of
      proportion and only in black or white  (a situation is either
      Very Bad or Very Good).  One of the major anxiety producing
      cognitions seems to be the belief that one has lost control
      over the situation and one's own reactions (Barlow, 1988).  
      This diagram illustrates the chain of events:
      
            Stimulus ---->  Interpretation  ---->  Anxiety
      
      
      Some researchers (eg: Lazarus, 1984) suggest that the
      interpretive/attribution/appraisal process may occur
      unconsciously or automatically in certain situations, making
      this process all the more complex (certainly more difficult to
      study, not to mention treat!).  Such unconscious/automatic
      processing would explain why irrational beliefs persist - they
      never really make themselves available for rational, conscious
      scrutiny and correction.
      
      2. Generalized Arousal:  Attribution theories and their
      variants first became popular with the work of Stanley
      Schachter in the 60's (eg: Schachter, 1964).  Schachter's
      theory of anxiety (actually, of emotion in general) includes a
      biological component:  An event will trigger a generalized,
      undifferentiated state of physiological arousal ("a kind of
      bubbling physiological soup"! [Lang, 1979, p. 507]).  Which
      emotion is experienced depends on how you then appraise the
      arousal (dangerous, good, bad, loving...).  So, the process
      looks like this:
      
      S ----> Generalized Arousal ----> Appraisal ----> Emotion      
                                                       (anxiety...)
      
      The concept of Generalized Arousal, although initially a
      promising attempt at bringing cognition and biology together,
      has not in fact been supported by research evidence (even
      though many textbook fail to mention this).  Rarely is there a
      generalized arousal; rather, the various indices of arousal
      (sweating, heart rate, blood pressure, etc) can vary in
      independent ways (Schwartz, 1986).  In addition, there is now
      quite reliable evidence that the emotions are in fact
      physiologically differentiated.  Variables such as heart rate,
      facial EMG (measures of muscle activity) and blood pressure
      differ across the various emotions.  For example, diastolic 
      blood pressure (ie: as the heart fills with blood) is higher
      in anger than in fear (Schwartz, 1986).  Even within the
      category of anxiety, there are differences:  skin conductance
      (sweating) and blood pressure indices are highest in panic and
      agoraphobia, whereas these indices are not particularly high
      in simple phobias (Zahn, 1986).  In addition, the concept of
      generalized arousal doesn't make sense given the evidence that
      people will sometimes say that they are anxious and even act
      anxious, yet not be physiologically aroused (Lang, 1968).  
      
      3. Self-Fulfilling Prophecies:  It may seem strange that
      someone would so tenaciously hold onto and continue making
      misattributions that cause so much distress.  We've noted that
      one reason for this may be that the whole process goes on
      automatically and unconsciously.  An additional reason may be
      that it is our beliefs that allow us to make sense out of the
      world.  They're part of our self-concept and our world view,
      and to change them means changing all that.  As long as we
      stick with our beliefs, no matter how distressing they may be,
      they provide us with a sense of stability:  They bias what we
      see in such a way as to make what we see consistent with our
      self-concept and world view - a self fulfilling prophecy.  To
      do away with these beliefs would mean jeopardizing that
      stability for an unknown and unpredictable world (Wegner &
      Vallancher, 1977).
      
      B. Network Theories
           
           Much of what we are discussing has been elaborated by
      associative network models of emotion (eg: Bower, 1981; Foa &
      Kozak, 1985; Lang, 1979).  The basic idea: Fear is a network of
      concepts, tendencies, or informational nodes stored in memory that
      represent stimuli, responses, and their meanings.  Think of what a
      network is: a bunch of things all connected, somehow related. 
           Human memory can be modeled in terms of a network (see, for
      example, Bower, 1981).  Each event and experience (including
      emotions) is represented in memory as a cluster of descriptive
      thoughts, beliefs, ideas, or what we can call "nodes".   Now, what
      is important is that each of these nodes are connected to other
      related nodes.  So, "school" node is connected to "exams" node in
      my mental network.  If I think of "school", it is much more likely
      that I will think of "exams" than if I didn't think of "school". 
      When one of these thoughts, feelings (or other nodes) comes to
      consciousness, it is said to be activated.  And once activated,
      other nodes nearby in the network are likely to be activated. 
      Handout 6-2 illustrates a possible network for an emotion. 
      "Emotion 3" is connected to various other nodes: nodes representing
      thoughts, behaviors, physiological patterns, events, and so on that
      have to do with "emotion 3".  
           From this network perspective, fear is seen as residing in a
      network, made up of nodes which are all associated or connected, so
      activation of one node makes others more likely to be activated. 
      Fear isn't a simple process where one thing leads to another, but
      rather a complex network of things.  The more of the network
      activated, the more likely fear will occur.  And fear can begin at
      various places - beliefs, physiology, response patterns - all parts
      of the network.  
           This network then is like a computer program that, when run,
      outputs fear behavior.  
           The network is generally thought to be learned, bit by bit,
      although some aspects of it may be innate (Barlow, 1988) [and as we
      shall see in our discussion next time of "preparedness"].
           Abnormal fear networks differ from normal ones in a number of
      important ways (Steketee & Foa, 1985):
      1. Re: the stimulus:  erroneous attributions/appraisals of     
                           threat 
      2. Re: meaning:  unusually high fearfulness associated with an 
                       event
      3. Re: responses:  excessive response elements, such as        
                        avoidance behaviors
      4. Re: treatment:  resistent to modification
      Why resistant?:
      a) processing is unconscious
      b) impairment of physiological, neurological or
      cognitive processes
      c) failure to access the fear network, or only
      incomplete access - eg: access just cognitions, not
      physiological components.  Such incomplete accessing
      has been argued to lead to incomplete "emotional
      processing" - ie: the fear doesn't subside or become
      absorbed, but persists unduly long (Rachman, 1980).
      
      IV. Conclusions
      
           As is becoming clear, there are "multiple pathways" (Barlow, 1988)
      to Anxiety Disorders.  Today we have discussed some of these paths: 
           1. Learning
           2. Social Factors
           3. Attributions
           4. Network Theories
           
           A question to begin pondering:  "Are patients and nonpatients
      qualitatively different from one another, or just quantitatively
      different?"  We often think of an abnormal person as somehow
      qualitatively different than us.  It may, in fact be simply a matter of
      degree.
           In the next lecture, we will continue our discussion of the
      etiology of anxiety.