Notes on Anxiety Disorders: Development Perspectives, PTSD, and CBT
Diathesis-Stress Model
Genetics contribute to anxiety symptoms, but the interaction between genetics and stressful environmental influences accounts for more anxiety disorders than genetics alone.
Diathesis-Stress Hypothesis: genetic factors can place an individual at risk (diathesis), but environmental stress factors must impinge in order for the potential risk to manifest as an anxiety disorder.
Essentially: even with genetic predisposition, a very stressful environment is often required to trigger an anxiety disorder.
This model links biology with environment and helps explain why not all genetically at-risk individuals develop disorders.
Psychodynamic Perspective
Anxiety disorders are viewed as rooted in underlying psychodynamic conflict coming into consciousness.
Freud’s idea: fixation or unresolved conflict during psychosexual development contributes to later symptoms.
Example from transcript: fixation at the anal stage can lead to obsessive cleaning behaviors later in life.
Implication: uncovering unconscious conflicts and past developmental tensions may be relevant for understanding or treating anxiety.
Behavioural Perspective
Emphasizes the role of environmental factors and learning processes.
Acquisition of fear can occur through classical conditioning:
Learns to associate neutral objects with fear.
Example: painful food poisoning with a brand of chicken leads to disgust/nausea upon smell of that chicken.
Observational learning: fear can be learned by observing others’ responses (e.g., child sees parent react fearfully to spiders).
Maintenance of fear often occurs via operant conditioning, specifically negative reinforcement:
Avoidance reduces fear temporarily, reinforcing the avoidance behavior.
Example: a dog bite leads a child to avoid environments with dogs, possibly crossing the road when a dog is walked.
Link to avoidance as a core maintenance mechanism in anxiety disorders.
Cognitive Perspective
Cognitive factors contribute to anxiety by altering threat appraisal and information processing.
Key cognitive patterns:
Overestimating the likelihood or severity of threats.
Perceiving ambiguous situations as threatening.
Focusing excessive attention on perceived threats.
Examples:
People may choose stairs over a lift because they overestimate harm from potential lift failure.
Waiting for exam results induces anxiety due to uncertainty and self-doubt.
Underestimation of coping ability:
Appraising stress as overwhelming and not knowing how to respond increases risk of anxiety.
Negative selective memory: preferential recall of threat/distressing information while ignoring non-distressing events.
Vicious circle of anxiety (cognitive–emotional–physiological loop):
cognition leads to physical symptoms (e.g., increased heart rate, tummy upset), which then reinforce fear and avoidance.
Example: (Technology submission scenario)
Scenario: a technical issue when submitting an assignment leads to negative beliefs about using technology, physical symptoms (rapid heart rate, tummy upset), and avoidance behaviors (asking someone else to submit).
Consequence: avoidance reduces fear temporarily but reinforces the belief that technology cannot be trusted, maintaining anxiety.
Therapeutic implication: Cognitive Behavioral Therapy (CBT) can help manage thoughts and behaviors related to anxiety and obsessive-compulsive disorders by restructuring cognitions and reducing avoidance.
Post-Traumatic Stress Disorder (PTSD) and Related Factors
Causes of PTSD attributed to predispositional factors such as personality, coping styles, and intellectual functioning.
High-risk groups: military personnel and first responders are at heightened cumulative risk due to exposure to traumatic/violent events.
Gulf War veterans study (one-year assessment):
Best predictor of PTSD was the use of avoidant coping styles (efforts to avoid thoughts about the traumatic event).
Emotional processing and arousal patterns:
Individuals with PTSD are likely to suppress emotions, which maintains high states of implicit activation.
Implicit activation keeps individuals alert to trauma-related events and can contribute to intrusive memories
Sometimes there are breakthroughs or intrusive recollections; the underlying pattern is persistent hypervigilance to threat.
Anxiety Disorder Overview (Definitions and Classifications)
Anxiety disorders are characterized by excessive fear and threat that disrupt daily functioning.
Generalised Anxiety Disorder (GAD): a high level of anxiety present for at least
6 ext{ months}
(duration criterion is specified in the transcript as "at least six months").
Panic Disorder: recurrent and unexpected panic attacks.
Obsessive-Compulsive Disorder (OCD): combines obsessions (intrusive thoughts) and compulsions (repetitive behaviors) aimed at reducing distress from obsessions.
Post-Traumatic Stress Disorder (PTSD): in response to traumatic events; classified within trauma- and stressor-related disorders.
The lecture notes that a variety of accounts—biological, psychodynamic, behavioural, and cognitive—offer explanations for why these disorders develop.
The best predictor of PTSD, across studies, remains use of avoidant strategies, highlighting the role of coping style in trauma responses.
Links Between Theories and Treatment Implications
CBT is highlighted as a potential treatment across anxiety, OCD, and PTSD by addressing thoughts, beliefs, and avoidance behaviors.
Understanding the maintenance cycles (e.g., avoidance, negative reinforcement, selective memory, implicit activation) helps tailor CBT interventions (exposure, cognitive restructuring, behavioral experiments).
The diathesis-stress framework supports a biopsychosocial approach, combining genetic vulnerability, learning history, and current stressors in assessment and treatment planning.
Practical Examples and Scenarios (Illustrative)
Classical conditioning example: pain from food poisoning leads to aversion to the smell of that chicken; fear generalizes to related foods.
Observational learning example: seeing a parent display fear toward spiders increases a child’s spider fear even without direct harm.
Avoidance as maintenance: a child bitten by a dog grows up avoiding dogs, which prevents disconfirmation of fear, thus sustaining anxiety.
Exam anxiety scenario: uncertain exam outcomes trigger worry; cognitive appraisal leads to heightened symptoms and potential avoidance of study or test-taking behaviors.
Key Takeaways and Ethical/Clinical Implications
The interaction of biology and environment often explains anxiety disorders better than genetics alone (diathesis-stress).
Anxiety disorders arise from multiple pathways: psychodynamic conflicts, conditioning processes, cognitive appraisals, and coping styles.
Avoidant coping strategies are consistently linked to higher PTSD risk and can maintain anxiety via the loop of suppression and heightened arousal.
CBT offers a practical, evidence-based approach across anxiety disorders, OCD, and PTSD by modifying cognitions, reducing avoidance, and improving coping strategies.
For clinicians and researchers: consider predispositional factors, learning histories, environmental stressors, and coping styles when assessing risk and designing interventions.
Quick ReferenceTerms and Concepts
Diathesis-Stress Model: genetic predisposition interacts with environmental stress to produce anxiety disorders.
Psychodynamic conflict: unresolved internal conflicts manifesting as anxiety symptoms; fixation example: anal stage → obsessive cleaning.
Classical Conditioning: learning via association (fear response to previously neutral stimuli).
Observational Learning: learning by watching others’ reactions.
Operant Conditioning and Negative Reinforcement: avoidance reduces fear, reinforcing avoidance.
Cognitive Appraisal: evaluation of threat; overestimation or misinterpretation increases anxiety.
Selective Memory: preferential recall of distressing information.
Implicit Activation: non-conscious arousal maintained by suppression of emotions.
Avoidant Coping Styles: strategies aimed at avoiding thoughts/feelings about trauma, predictor of PTSD.
Generalised Anxiety Disorder (GAD): excessive anxiety for at least 6 ext{ months}.
Panic Disorder: recurrent panic attacks.
Obsessive-Compulsive Disorder (OCD): obsessions and compulsions.
Post-Traumatic Stress Disorder (PTSD): trauma- and stressor-related disorder.