1
Hoorcolleges Fear, Anxiety and Related Disorders
Lecture 1 – From anxiety to anxiety disorders
8 april 2026
Fear = a state of immediate alarm in response to a serious, known threat to one’s well-being, more
localized.
Anxiety = a state of alarm in response to a vague sense of threat or danger
Both have the same physiological features: increase in respiration, perspiration, muscle tension, etc
Fear
- An emotional response to perceived threat
- Adaptive and has evolutionary value
- Humans are predisposed biologically
- Involves activation of the sympathetic nervous system
- “Fight or flight” phenomenon
- These automatic responses aren’t helpful now, not weird that we have anxiety disorde
When does anxiety develop into a disorder?
- Normal anxiety is adaptive. It is an inborn response to threat or to the absence of people or
objects that signify safety can result in cognitive (worry) and somatic (racing heart, sweating,
shaking, freezing, etc.) symptoms.
- Pathologic anxiety is anxiety that is excessive, impairs function.
DSM-Definition
- Unreasonably strong or permanent,
- Arises without sufficient reason,
- Cannot be controlled or endured,
- Causes suffering and constrains life AND
- Typical symptom patterns are present!
Avoidance means creating physical or psychological
distance from something you perceive as threatening
→ Like a situation, object, thought, feeling, or memory.
Miss nog even terugkijken, wordt veel bij vertelt
Adaptive vs. Maladaptive
- Adaptive: Avoiding real threats (e.g., not walking into traffic)
- Maladaptive: Avoiding perceived threats when there’s no real danger (e.g., avoiding public
transport due to fear of panic)
Key idea: Avoidance prevents learning that the feared thing might not be dangerous — which keeps
the fear going.
Example: The Supermarket
- Overt avoidance – leaving the supermarket during a panic attack
- Pre-encounter avoidance – Not going to the supermarket at all
- Safety behaviour – only going when someone else comes along
- Covert / Experiential avoidance – doing mental arithmetic to distract from bodily sensations
, 2
Epidemiology
Lifetime prevalence for any anxiety disorder ranges from
10% to 29%; higher for females (40-50%)
12-month prevalence 18%
Each age has got its typical fears!
In infancy and early childhood, children are fearful of
immediate, concrete threats
Later: fears begin to incorporate anticipatory events and stimuli of an imaginary or
abstract nature.
Diversity in Anxiety Disorders
Expression varies across cultures
- Somatic focus (e.g., headaches, dizziness) more
prominent in some groups
→ Example: In some Latin American communities,
panic symptoms may be described as "nerves in the
chest" leading to visits to the GP or emergency room
rather than mental health care.
Risk is not evenly distributed
- Higher prevalence in women, LGBTQ+ individuals, and
marginalized communities
- Linked to chronic stress, discrimination, and reduced
access to resources
- Meyer’s Minority Stress Model (2003)
Susceptibility, vulnerability and predisposition
Biological Causes
Genetic Influences
- There is increasing evidence that we inherit a tendency
to be tense or uptight
- No single gene has been identified to cause anxiety
- A tendency to panic also seems to run in families
BUT:
- Anxiety and fear states are highly heterogeneous
High risk studies
- There seem to be underlying psychological or biological vulnerability factors for anxiety
disorders in general, which may already manifest in children
- Possible risk factors:
o Behavioral Inhibition
o Higher autonomic reactivity
▪ Enhanced startle reflex
▪ Respiratory sensitivity
, 3
Epigenetics refers to changes in gene expression that don’t involve changes to the DNA sequence
itself, influenced by environmental factors, (stress, trauma, lifestyle). These changes may increase
vulnerability to anxiety disorders by affecting brain function,
Brain Areas Affected
- Amygdala: Responsible for processing fear
- Prefrontal cortex: Regulates emotional responses
- Hippocampus: Memory and stress response
regulation
Studies show that early life stress can lead to long-term-
changes in gene expression related to stress response
systems.
Learning theories
- Classical conditioning
- Operant conditioning
- Observational learning
Learning theory
Mowrer (1947): two-factor model of avoidence learning)
1. Phase 1: Classical Conditioning
A neutral stimulus becomes associated with an aversive experience → fear response
Example: Little Albert learns to fear a white rat (Watson & Rayner, 1920)
2. Phase 2: Operant Conditioning
Avoidance = negative reinforcement
Avoiding the feared stimulus reduces fear → short-term relief → But this prevents fear
extinction and maintains anxiety
Revisiting Mowrer’s Two-Factor Theory
Operant conditioning part holds up
- Avoidance reduces fear in the short term
- → Negatively reinforced
- → Explains maintenance of anxiety
Classical conditioning part too simplistic
- Not all stimuli are equally fear-relevant
- Öhman & Mineka (2001): Fear-relevant stimuli (e.g.,
snakes, angry faces)
→ learned faster
→ more resistant to extinction
Observational Learning
- Mineka et al. demonstrated that apes learn a fear reaction by observing other apes
Watching parents, watching other apes, watching videos, watching just 2 times, immunization
, 4
Triggers/elicting environmental conditions
Dresden Predictor Study: Methods
- Prospective longitudinal study (18 months) with 2 measurements (baseline/follow-up)
- 18-25-year-old women from Dresden (Germany)
N(baseline)=2064, N(follow-up)=1569
- >Clinical diagnosis instrument: F-DIPS (ADIS)
Psychological Predictors
Longitudinal Cut
Do baseline values of:
- Psychopathology
- Cognitive Biases
- Avoidance
- Stress/Coping
- Health/Protective Factors
... predict mental disorders at follow-up???
Maintaining factors
Early vs. Late Stages of Processing Threat
Fast and Spontaneous Allocation of Attention
- Threat attracts reflexive attention
- Particular to anxiety patients
- Pronounced in the presence competing stimuli
Strategic Allocation of Attention
- Is threat attended to voluntarily over longer periods?
- Do anxiety patients avoid voluntary and maintained attention to threat?
Methods
Participants:
- 22 Spider Phobics
- 23 Non-Anxious Controls
Task:
- Study matrices of 4 pictures for 1 min for later memory test
- Each matrix shows 1 spider, 1 butterfly, 1 cat, 1 dog
Hoorcolleges Fear, Anxiety and Related Disorders
Lecture 1 – From anxiety to anxiety disorders
8 april 2026
Fear = a state of immediate alarm in response to a serious, known threat to one’s well-being, more
localized.
Anxiety = a state of alarm in response to a vague sense of threat or danger
Both have the same physiological features: increase in respiration, perspiration, muscle tension, etc
Fear
- An emotional response to perceived threat
- Adaptive and has evolutionary value
- Humans are predisposed biologically
- Involves activation of the sympathetic nervous system
- “Fight or flight” phenomenon
- These automatic responses aren’t helpful now, not weird that we have anxiety disorde
When does anxiety develop into a disorder?
- Normal anxiety is adaptive. It is an inborn response to threat or to the absence of people or
objects that signify safety can result in cognitive (worry) and somatic (racing heart, sweating,
shaking, freezing, etc.) symptoms.
- Pathologic anxiety is anxiety that is excessive, impairs function.
DSM-Definition
- Unreasonably strong or permanent,
- Arises without sufficient reason,
- Cannot be controlled or endured,
- Causes suffering and constrains life AND
- Typical symptom patterns are present!
Avoidance means creating physical or psychological
distance from something you perceive as threatening
→ Like a situation, object, thought, feeling, or memory.
Miss nog even terugkijken, wordt veel bij vertelt
Adaptive vs. Maladaptive
- Adaptive: Avoiding real threats (e.g., not walking into traffic)
- Maladaptive: Avoiding perceived threats when there’s no real danger (e.g., avoiding public
transport due to fear of panic)
Key idea: Avoidance prevents learning that the feared thing might not be dangerous — which keeps
the fear going.
Example: The Supermarket
- Overt avoidance – leaving the supermarket during a panic attack
- Pre-encounter avoidance – Not going to the supermarket at all
- Safety behaviour – only going when someone else comes along
- Covert / Experiential avoidance – doing mental arithmetic to distract from bodily sensations
, 2
Epidemiology
Lifetime prevalence for any anxiety disorder ranges from
10% to 29%; higher for females (40-50%)
12-month prevalence 18%
Each age has got its typical fears!
In infancy and early childhood, children are fearful of
immediate, concrete threats
Later: fears begin to incorporate anticipatory events and stimuli of an imaginary or
abstract nature.
Diversity in Anxiety Disorders
Expression varies across cultures
- Somatic focus (e.g., headaches, dizziness) more
prominent in some groups
→ Example: In some Latin American communities,
panic symptoms may be described as "nerves in the
chest" leading to visits to the GP or emergency room
rather than mental health care.
Risk is not evenly distributed
- Higher prevalence in women, LGBTQ+ individuals, and
marginalized communities
- Linked to chronic stress, discrimination, and reduced
access to resources
- Meyer’s Minority Stress Model (2003)
Susceptibility, vulnerability and predisposition
Biological Causes
Genetic Influences
- There is increasing evidence that we inherit a tendency
to be tense or uptight
- No single gene has been identified to cause anxiety
- A tendency to panic also seems to run in families
BUT:
- Anxiety and fear states are highly heterogeneous
High risk studies
- There seem to be underlying psychological or biological vulnerability factors for anxiety
disorders in general, which may already manifest in children
- Possible risk factors:
o Behavioral Inhibition
o Higher autonomic reactivity
▪ Enhanced startle reflex
▪ Respiratory sensitivity
, 3
Epigenetics refers to changes in gene expression that don’t involve changes to the DNA sequence
itself, influenced by environmental factors, (stress, trauma, lifestyle). These changes may increase
vulnerability to anxiety disorders by affecting brain function,
Brain Areas Affected
- Amygdala: Responsible for processing fear
- Prefrontal cortex: Regulates emotional responses
- Hippocampus: Memory and stress response
regulation
Studies show that early life stress can lead to long-term-
changes in gene expression related to stress response
systems.
Learning theories
- Classical conditioning
- Operant conditioning
- Observational learning
Learning theory
Mowrer (1947): two-factor model of avoidence learning)
1. Phase 1: Classical Conditioning
A neutral stimulus becomes associated with an aversive experience → fear response
Example: Little Albert learns to fear a white rat (Watson & Rayner, 1920)
2. Phase 2: Operant Conditioning
Avoidance = negative reinforcement
Avoiding the feared stimulus reduces fear → short-term relief → But this prevents fear
extinction and maintains anxiety
Revisiting Mowrer’s Two-Factor Theory
Operant conditioning part holds up
- Avoidance reduces fear in the short term
- → Negatively reinforced
- → Explains maintenance of anxiety
Classical conditioning part too simplistic
- Not all stimuli are equally fear-relevant
- Öhman & Mineka (2001): Fear-relevant stimuli (e.g.,
snakes, angry faces)
→ learned faster
→ more resistant to extinction
Observational Learning
- Mineka et al. demonstrated that apes learn a fear reaction by observing other apes
Watching parents, watching other apes, watching videos, watching just 2 times, immunization
, 4
Triggers/elicting environmental conditions
Dresden Predictor Study: Methods
- Prospective longitudinal study (18 months) with 2 measurements (baseline/follow-up)
- 18-25-year-old women from Dresden (Germany)
N(baseline)=2064, N(follow-up)=1569
- >Clinical diagnosis instrument: F-DIPS (ADIS)
Psychological Predictors
Longitudinal Cut
Do baseline values of:
- Psychopathology
- Cognitive Biases
- Avoidance
- Stress/Coping
- Health/Protective Factors
... predict mental disorders at follow-up???
Maintaining factors
Early vs. Late Stages of Processing Threat
Fast and Spontaneous Allocation of Attention
- Threat attracts reflexive attention
- Particular to anxiety patients
- Pronounced in the presence competing stimuli
Strategic Allocation of Attention
- Is threat attended to voluntarily over longer periods?
- Do anxiety patients avoid voluntary and maintained attention to threat?
Methods
Participants:
- 22 Spider Phobics
- 23 Non-Anxious Controls
Task:
- Study matrices of 4 pictures for 1 min for later memory test
- Each matrix shows 1 spider, 1 butterfly, 1 cat, 1 dog
