The Fear Factor: A Functional Perspective on Anxiety
Chapter 16: The Fear Factor: A Functional Perspective on Anxiety
Authors and Affiliations
Patrick C. Friman
Center for Behavioral Health, Boys Town, NE, United States
Simon Dymond
Department of Psychology, Swansea University, Swansea, Wales, United Kingdom
Reykjavík University, Reykjavík, Iceland
Introduction
This chapter serves as an updated version of a previous chapter on anxiety from the first edition of this book.
Noteworthy is the observation that advancements in the functional perspective on anxiety have been minimal since the first edition.
Despite hundreds of new papers published, the majority continue with a formal rather than functional perspective.
Many refer to anxiety as an entity rather than a category.
The authors acknowledge they will also make this categorization mistake.
Anxiety is often treated as something individuals 'have' rather than something they 'do'.
While feelings consistent with anxiety (like fear) exist, the actions taken in response to these feelings are of greater concern.
Normal anxiety or feelings of apprehension are part of human experience with little psychological significance, unlike clinically significant behaviors exhibited by some individuals in the presence of anxiety.
Novel Contributions in Understanding Anxiety
Anxiety and Autism Spectrum Disorder (ASD):
There has been a growing discussion concerning anxiety disorders in the ASD population, which exhibits substantially higher prevalence rates of anxiety disorders.
Derived Relational Responding:
An area that has been expanding rapidly and is covered in more depth in this chapter than in the preceding one.
Ubiquity of Fear
Fear is described as a universal human emotion extending beyond true danger to various human experiences.
Examples of common fears include:
Fear of social situations, affection/lack of affection, flying, being alone, etc.
Many individuals experience chronic fear without knowing the cause.
The term 'anxiety' has been used synonymously with fear since Freud, but represents fear not resulting from true danger.
Defining Anxiety
Anxiety disorders occupy the largest segment in the DSM-V, with 75 pages dedicated to defining them.
No functional definition of anxiety exists, only vague assertions.
Multiple definitions of anxiety restate its similarity to fear, contributing to confusion.
The DSM lacks precision regarding its construct, merely linking anxiety with excess fear.
Key features defining anxiety disorders include perceptions of danger, physiological activation (like increased heart rate), and avoidance behaviors that mirror fear responses.
Attempts to Differentiate Anxiety from Fear
Efforts to distinguish anxiety (non-specific responses) from fear (specific stimuli) do not withstand scrutiny, as:
Specific phobias are classified as anxiety disorders despite triggering immediate fear responses.
The idea that different responses classify anxiety and fear results in arbitrary categorizations, which fail to consider functional aspects of behavior.
Understanding reactions to phobias can benefit from applying functional concepts, extending to generalized anxiety disorders like PTSD (Post-Traumatic Stress Disorder).
Prevalence of Anxiety Disorders
Anxiety disorders are prevalent, with lifetime occurrence at about 25% for typically developing individuals.
The specific disorder prevalence rates range, e.g., 3.5% for panic disorders to 13.3% for social phobia.
For those on the autism spectrum, prevalence rates can be as high as 40-45%.
Functional Relevance of Fear
The concept of 'fear' is more functional for understanding anxiety as it:
Provides clearer definition and context than the ambiguous term 'anxiety'.
Directs inquiry towards observable stimuli and behaviors rather than elusive internal constructs.
Fear implies a relationship between individuals and their environment, linking anxiety responses to recognizable triggers.
Theoretical Concepts
Derived Relational Responding:
It explains why fear responses generalize from perilous to non-perilous events, providing complexity to anxiety disorders.
Experiential Avoidance:
Involves strategies to avoid unpleasant events and is foundational for understanding anxiety.
Connection Between Anxiety, Fear and Autism
High rates of anxiety in ASD are theorized to derive from low tolerance for benign stimuli and failures in early social developmental milestones.
Key aspects impacted include securing attachment and mastering interactive play, both pivotal for future social confidence.
Interpretation of Derived Relational Responding
Explains how behavioral patterns emerge in response to direct and indirect stimuli, including fears that manifest from learned experiences of trauma or pain.
Example: Painful experiences with pets can lead to fear towards images or even the idea of those pets deriving from initial associations.
Understanding PTSD through a Functional Lens
PTSD is identified by a clear and persistent reaction to trauma, with symptoms involving:
Re-experience of the trauma, avoidance behaviors, and heightened physiological arousal.
Functional approaches suggest that avoidance and derived relational contexts contribute significantly to PTSD symptoms.
Assessment in Functional Analysis
Assessment focuses on understanding behavior through the lens of physiological, cognitive, and behavioral activities.
The investigation includes exploring potential secondary gains from anxiety behaviors leading to reinforced avoidance or escape patterns.
Chapter 16: The Fear Factor: A Functional Perspective on Anxiety
Patrick C. Friman from the Center for Behavioral Health in Boys Town, NE, and Simon Dymond from Swansea University and Reykjavík University authored this chapter. It serves as an updated take on a previous chapter on anxiety in the first edition of this book. Notably, the advancements in understanding anxiety from a functional perspective have been minimal despite numerous new publications. The majority continue to adopt a formal view rather than a functional one, treating anxiety as something individuals 'have' rather than 'do'. While anxiety-related feelings, such as fear, exist, the actions taken in response to these feelings are of greater concern. Normal anxiety, which includes feelings of apprehension, is part of human experience and holds little psychological significance when compared to clinically significant behaviors exhibited by individuals experiencing anxiety.
In understanding anxiety, the chapter highlights concerns regarding anxiety and Autism Spectrum Disorder (ASD), noting that this population experiences significantly higher prevalence rates of anxiety disorders. Additionally, Derived Relational Responding is discussed as an area of rapid expansion, which is covered more extensively in this chapter than the previous one.
Fear is identified as a universal human emotion that transcends true danger and emerges in various human experiences, such as fear of social situations, affection/lack of affection, flying, or being alone. Many individuals experience chronic fear without an identifiable cause, and the term 'anxiety' has been synonymous with fear since Freud, although it represents fear that does not arise from true danger.
Anxiety disorders occupy the largest segment of the DSM-V, with 75 pages dedicated to defining these disorders. However, no functional definition exists for anxiety; only vague assertions are made. Multiple definitions of anxiety reiterate its similarity to fear, raising confusion, and the DSM fails to provide precision in its constructs, merely linking anxiety with excessive fear. Key features that define anxiety disorders include perceptions of danger, physiological activation (like increased heart rate), and avoidance behaviors mirroring fear responses.
Attempts to differentiate anxiety, defined as non-specific responses, from fear, which is typically triggered by specific stimuli, fall short upon scrutiny. Specific phobias are classified as anxiety disorders, leading to immediate fear responses. The belief that responses delineate anxiety from fear results in arbitrary categorizations, overlooking functional behavioral aspects. A functional perspective can enhance the understanding of reactions to phobias and extend its application to generalized anxiety disorders, including PTSD.
Anxiety disorders are prevalent, occurring in approximately 25% of typically developing individuals, with specific disorder prevalence rates ranging from 3.5% for panic disorders to 13.3% for social phobia. In the autism spectrum population, prevalence rates can be as high as 40-45%. The chapter argues for the functional relevance of fear in understanding anxiety, as it provides clearer definitions and context compared to the ambiguous term 'anxiety'. This focus directs inquiry toward observable stimuli and behaviors instead of elusive internal constructs, highlighting the relationship between individuals and their environment and linking anxiety responses to recognizable triggers.
Key theoretical concepts discussed include Derived Relational Responding, which explains why fear responses may generalize from harmless to dangerous events, adding complexity to anxiety disorders, and Experiential Avoidance, which involves strategies to evade unpleasant experiences and is foundational to understanding anxiety.
The chapter further explores the connection between anxiety, fear, and autism, suggesting that high anxiety rates in ASD may arise from low tolerance to benign stimuli and failures in early social development milestones, thereby impacting attachment and interactive play crucial for social confidence.
Finally, Derived Relational Responding is interpreted as a mechanism through which behavioral patterns emerge in response to direct and indirect stimuli. For instance, painful experiences with pets may lead to fear associated with images or concepts related to those pets. The understanding of PTSD through a functional lens reveals persistent reactions to trauma involving re-experience, avoidance, and heightened physiological arousal. Functional approaches suggest avoidance and derived relational contexts significantly contribute to PTSD symptoms, emphasizing the necessity of a thorough assessment focusing on behavior through physiological, cognitive, and behavioral activities, and exploring potential secondary gains from anxiety behaviors that reinforce avoidance or escape patterns.