Anxiety and related disorders
Week 1: A contemporary learning theory perspective on the etiology of anxiety
disorders
Main idea
Anxiety disorders do not develop only because someone experiences a scary or
stressful event.
The same event can lead to an anxiety disorder in one person, but not in another.
The authors argue that modern learning theory explains these di<erences better than
old, simple conditioning models.
Why older learning theories were criticized
Older models said: fear/phobia happens when a neutral thing gets paired with a trauma
(classical conditioning).
Problem: many people with fears cannot remember a direct traumatic event.
Also: many people do experience trauma but do not develop an anxiety disorder.
Contemporary learning theory (modern view)
Anxiety disorders are influenced by a combination of:
- Learning history (what happened earlier in life).
- Temperament / genetics (e.g., trait anxiety, behavioral inhibition).
- Context (what happens during and after the stressful event).
This is basically a diathesis-stress model: vulnerability + stressor -> higher risk.
Key learning pathways
Direct conditioning:
- Fear can be learned when an object/situation becomes linked to pain, danger or
panic.
- But whether this fear becomes strong depends on many factors (not just the
trauma itself).
Vicarious (observational) learning:
- People can learn fear by watching others being afraid or being harmed.
- Evidence: experiments with monkeys showed they learned strong snake fear just
by observing fearful models (even via video).
Verbal learning / instruction:
- Fear can also grow through information (e.g., warnings, scary stories, cultural
rules).
Why people di<er (vulnerability vs. protection)
Temperamental / genetic risk: some people have higher vulnerability due to
- Trait anxiety / neuroticism.
- Behavioral inhibition (shy, timid temperament early in life).
These traits can make conditioning faster and fear stronger.
Important ‘protective’ factors:
- Prior safe exposure (latent inhibition): if you had many normal experiences with
something (e.g., dogs, dentists), later trauma is less likely to create a phobia.
- Sense of control / mastery: growing up with more control over your environment
can reduce later anxiety vulnerability.
,Time matters: before, during and after the event
Before the event:
- Past experiences can:
o Sensitize: make you more vulnerable after repeated uncontrollable
stress/trauma.
o Immunize: protect you if you learned mastery/control.
During the event:
- Controllability and escapability are crucial: if the trauma feels uncontrollable or
you cannot escape, fear learning is stronger.
After the event:
- Fear can become stronger through:
o Inflation: later severe stress increases fear linked to earlier mild fear.
o Re-evaluation: later information makes the original danger feel worse.
o Mental rehearsal: replaying the event strengthens the fear association.
Preparedness (evolutionary influence)
People more easily have fears for certain things (e.g., snakes, spiders, heights).
These fears are not ‘born fears’, but they are easier to acquire and harder to
unlearn.
Similar idea for social fear: angry faces/dominance cues can be ‘fear-relevant’.
Applications to anxiety disorders
Specific phobias:
- Can come from direct trauma, observing others or warnings.
- Strongly shaped by temperament and prior exposure.
Social phobia:
- Can come from humiliation/teasing, observing social embarrassment, family
modeling and culture.
- Behavioral inhibition and uncontrollability increase risk.
Panic disorder & agoraphobia:
- Panic attacks can condition fear to:
o Internal cues (heart racing, dizziness = interoceptive cues).
o External cues (malls, escalators = exteroceptive cues).
- Avoidance maintains fear and can lead to agoraphobia.
- Agoraphobia: fear about being in places or situations where escape might be
di<icult or help might not be available if they experience panic-like symptoms
(public transport, crowded places, being home alone).
Post-Traumatic Stress Disorder (PTSD):
- Not only ‘how much trauma’, but how uncontrollable/unpredictable it felt.
- ‘Mental defeat’ during trauma is an important risk factor.
- Re-experiencing symptoms (triggers/reminders) can keep PTSD going.
General Anxiety Disorder (GAD):
- Linked to a history of uncontrollable stress and low tolerance for uncertainty.
- Worry functions as cognitive avoidance: it reduces emotional activation short-
term, but prevents learning that things are safe.
Obsessive-Compulsive Disorder (OCD):
, - Less evidence for direct trauma as a cause.
- More focus on:
o Verbal learning and beliefs (responsibility, thought-action fusion).
o Compulsions as avoidance behaviors (hard to extinguish).
o Evolutionarily common themes (contamination, danger, checking).
Conclusion
Anxiety disorders are best explained by modern learning theory + vulnerability factors +
context.
This approach is more realistic than old simple models and helps explain:
- Why trauma sometimes leads to anxiety disorders and sometimes not.
- And why symptoms persist in some people.
Is also supports treatment ideas like exposure therapy and prevention via mastery
experiences and non-anxious modeling.
, Week 1: Anxiety disorders: why they persist and how to treat them
Anxiety disorders involve distorted beliefs about danger:
- Danger in situations (e.g., social situations).
- Danger in bodily sensations (e.g., panic symptoms).
- Danger in mental events (e.g., intrusive thoughts).
Main question: if these beliefs are wrong, why don’t they correct themselves over time?
There are 6 maintenance processes that keep anxiety beliefs alive.
1. Safety-seeking behaviors: actions people do to prevent a feared disaster.
a. Problem: when nothing bad happens, the person thinks: ‘Nothing bad
happened because I did my safety behavior.’
b. Evidence: experiments show that dropping safety behaviors during
exposure leads to:
i. Bigger reductions in fear beliefs.
ii. Better improvement than exposure while keeping safety behaviors.
2. Attentional deployment: where attention goes.
a. Anxiety can be maintained by biased attention, 2 patterns:
i. Attention towards threat:
1. Spider phobia: attention drawn to spiders.
2. Panic disorder / hypochondriasis: attention focuses on body
sensations.
a. Evidence: panic/hypochondriasis patients detect
body changes more accurately; predicts relapse risk.
ii. Attention away from threat:
1. Social phobia: often avoid looking at faces -> they miss
positive social feedback -> beliefs don’t get corrected.
a. Evidence: dot-probe studies show socially anxious
people attend away from faces.
3. Spontaneous imagery:
a. Many anxious people have sudden mental images where the fear ‘comes
true’.
i. Example social phobia: people see themselves from an observer
perspective, the image shows their feared self (I look like an idot).
b. These images are often old and repetitive, linked to early
bullying/embarrassment.
c. Reduced attention to real external cues prevents the image from being
updated.
4. Emotional reasoning:
a. People use feelings as evidence: ‘I feel anxious, so I must look anxious / be
in danger’.
b. Social anxiety finding: high socially anxious people link bodily sensations
to ‘how anxious I looked’ but observers do not rate them as looking that
anxious.
c. So internal feelings -> wrong conclusions -> beliefs persist.
5. Memory processes (2 types)
a. Selective recall:
i. Under threat, socially anxious people recall:
Week 1: A contemporary learning theory perspective on the etiology of anxiety
disorders
Main idea
Anxiety disorders do not develop only because someone experiences a scary or
stressful event.
The same event can lead to an anxiety disorder in one person, but not in another.
The authors argue that modern learning theory explains these di<erences better than
old, simple conditioning models.
Why older learning theories were criticized
Older models said: fear/phobia happens when a neutral thing gets paired with a trauma
(classical conditioning).
Problem: many people with fears cannot remember a direct traumatic event.
Also: many people do experience trauma but do not develop an anxiety disorder.
Contemporary learning theory (modern view)
Anxiety disorders are influenced by a combination of:
- Learning history (what happened earlier in life).
- Temperament / genetics (e.g., trait anxiety, behavioral inhibition).
- Context (what happens during and after the stressful event).
This is basically a diathesis-stress model: vulnerability + stressor -> higher risk.
Key learning pathways
Direct conditioning:
- Fear can be learned when an object/situation becomes linked to pain, danger or
panic.
- But whether this fear becomes strong depends on many factors (not just the
trauma itself).
Vicarious (observational) learning:
- People can learn fear by watching others being afraid or being harmed.
- Evidence: experiments with monkeys showed they learned strong snake fear just
by observing fearful models (even via video).
Verbal learning / instruction:
- Fear can also grow through information (e.g., warnings, scary stories, cultural
rules).
Why people di<er (vulnerability vs. protection)
Temperamental / genetic risk: some people have higher vulnerability due to
- Trait anxiety / neuroticism.
- Behavioral inhibition (shy, timid temperament early in life).
These traits can make conditioning faster and fear stronger.
Important ‘protective’ factors:
- Prior safe exposure (latent inhibition): if you had many normal experiences with
something (e.g., dogs, dentists), later trauma is less likely to create a phobia.
- Sense of control / mastery: growing up with more control over your environment
can reduce later anxiety vulnerability.
,Time matters: before, during and after the event
Before the event:
- Past experiences can:
o Sensitize: make you more vulnerable after repeated uncontrollable
stress/trauma.
o Immunize: protect you if you learned mastery/control.
During the event:
- Controllability and escapability are crucial: if the trauma feels uncontrollable or
you cannot escape, fear learning is stronger.
After the event:
- Fear can become stronger through:
o Inflation: later severe stress increases fear linked to earlier mild fear.
o Re-evaluation: later information makes the original danger feel worse.
o Mental rehearsal: replaying the event strengthens the fear association.
Preparedness (evolutionary influence)
People more easily have fears for certain things (e.g., snakes, spiders, heights).
These fears are not ‘born fears’, but they are easier to acquire and harder to
unlearn.
Similar idea for social fear: angry faces/dominance cues can be ‘fear-relevant’.
Applications to anxiety disorders
Specific phobias:
- Can come from direct trauma, observing others or warnings.
- Strongly shaped by temperament and prior exposure.
Social phobia:
- Can come from humiliation/teasing, observing social embarrassment, family
modeling and culture.
- Behavioral inhibition and uncontrollability increase risk.
Panic disorder & agoraphobia:
- Panic attacks can condition fear to:
o Internal cues (heart racing, dizziness = interoceptive cues).
o External cues (malls, escalators = exteroceptive cues).
- Avoidance maintains fear and can lead to agoraphobia.
- Agoraphobia: fear about being in places or situations where escape might be
di<icult or help might not be available if they experience panic-like symptoms
(public transport, crowded places, being home alone).
Post-Traumatic Stress Disorder (PTSD):
- Not only ‘how much trauma’, but how uncontrollable/unpredictable it felt.
- ‘Mental defeat’ during trauma is an important risk factor.
- Re-experiencing symptoms (triggers/reminders) can keep PTSD going.
General Anxiety Disorder (GAD):
- Linked to a history of uncontrollable stress and low tolerance for uncertainty.
- Worry functions as cognitive avoidance: it reduces emotional activation short-
term, but prevents learning that things are safe.
Obsessive-Compulsive Disorder (OCD):
, - Less evidence for direct trauma as a cause.
- More focus on:
o Verbal learning and beliefs (responsibility, thought-action fusion).
o Compulsions as avoidance behaviors (hard to extinguish).
o Evolutionarily common themes (contamination, danger, checking).
Conclusion
Anxiety disorders are best explained by modern learning theory + vulnerability factors +
context.
This approach is more realistic than old simple models and helps explain:
- Why trauma sometimes leads to anxiety disorders and sometimes not.
- And why symptoms persist in some people.
Is also supports treatment ideas like exposure therapy and prevention via mastery
experiences and non-anxious modeling.
, Week 1: Anxiety disorders: why they persist and how to treat them
Anxiety disorders involve distorted beliefs about danger:
- Danger in situations (e.g., social situations).
- Danger in bodily sensations (e.g., panic symptoms).
- Danger in mental events (e.g., intrusive thoughts).
Main question: if these beliefs are wrong, why don’t they correct themselves over time?
There are 6 maintenance processes that keep anxiety beliefs alive.
1. Safety-seeking behaviors: actions people do to prevent a feared disaster.
a. Problem: when nothing bad happens, the person thinks: ‘Nothing bad
happened because I did my safety behavior.’
b. Evidence: experiments show that dropping safety behaviors during
exposure leads to:
i. Bigger reductions in fear beliefs.
ii. Better improvement than exposure while keeping safety behaviors.
2. Attentional deployment: where attention goes.
a. Anxiety can be maintained by biased attention, 2 patterns:
i. Attention towards threat:
1. Spider phobia: attention drawn to spiders.
2. Panic disorder / hypochondriasis: attention focuses on body
sensations.
a. Evidence: panic/hypochondriasis patients detect
body changes more accurately; predicts relapse risk.
ii. Attention away from threat:
1. Social phobia: often avoid looking at faces -> they miss
positive social feedback -> beliefs don’t get corrected.
a. Evidence: dot-probe studies show socially anxious
people attend away from faces.
3. Spontaneous imagery:
a. Many anxious people have sudden mental images where the fear ‘comes
true’.
i. Example social phobia: people see themselves from an observer
perspective, the image shows their feared self (I look like an idot).
b. These images are often old and repetitive, linked to early
bullying/embarrassment.
c. Reduced attention to real external cues prevents the image from being
updated.
4. Emotional reasoning:
a. People use feelings as evidence: ‘I feel anxious, so I must look anxious / be
in danger’.
b. Social anxiety finding: high socially anxious people link bodily sensations
to ‘how anxious I looked’ but observers do not rate them as looking that
anxious.
c. So internal feelings -> wrong conclusions -> beliefs persist.
5. Memory processes (2 types)
a. Selective recall:
i. Under threat, socially anxious people recall:
