Basic mechanisms of anxiety, and fear acquisition, maintenance and remittance

Small group exercise: What is ANXIETY?

Split into pairs Briefly discuss what you think exemplifies anxiety
Create a definition and/or a description of the phenomenon
When does it happen? Is it normal/abnormal?

Is anxiety and fear the same thing? Come back as larger group and share ideas

Anxiety: Survival value, and/or a curse?

Survival value: This behavior (anxiety) and the overwhelming emotion associated with it represent the organisms reaction to potentially life-threatening emergencies.
What determines what/why/when/how something is threatening?

This almost reflexive urge to escape or, alternatively, to stand and engage the threat (fight or flight) seems clearly a behavioral tendency that has been selectively favored in an evolutionary sense.
The Four Fs

In the face of a predator, it makes (primitive) sense; on the other hand, in the modern world, is this response useful? Is it a curse?
Is there modern survival value to anxiety? In the modern world, are there still primitive needs being met by this behavior?

Anxiety, the behavior

Organisms with the capacity for anxiety were able to respond quickly and efficiently to life-threatening situations and thereby lived to procreate another day
What got evolutionarily passed forward?

Biological activation improves odds of survival:

Blood pressure + heart rate go up Respiration rate go up + become shallow and rapid (panting) Extremities tingle + skin lacks color Pupils dilate Digestion seizes + spontaneous discharges Dissociation / fainting

Brains and bodies: Good listeners (alarms), but are poor judges about what is real, benign, imagined (accuracy sucks)

Frontal lobes: The curse?

People (alone?) can plan for the distant future and can experience the retrospective pleasures of achievement
Do we plan for the average experience? Why might extremes become perceived as more average?

People can be happy People can be worried and anxious Anxiety (as a construct beyond automation/fear) appears to follow closely the capacity for intellectual thought/planning We can remember the past
Questions to accuracy abound --- fear attends to a portion of spectrum Anxiety and depression shade memories towards the negative and the catastrophic

We can recall threats

Modern threats vs. primitive threats Dissimilar results

Fear, the emotion

Affect/emotion is a variety of rich and diverse feeling states
Happiness, sadness, anger, surprise, joy, melancholy, fear

Emotion is considered to be fundamentally a set of expressive behaviors, an integrated neurobiological response, and a cognitive perception or appraisal Emotions (innate patterns of reaction and responding) have functional significance
Modifiable by learning and maturation

Adaptive value is in preparation for action and communication The emotion of FEAR seems clearly to function to prepare the animal for immediate and decisive action (run/fight) Expression of FEAR communicates danger to others

Large group exercise: Fear acquisition and conditioning

Who has ever experienced a threatening situation?

S What did you feel during the presence of that S ? STATE 1 What did you feel driven to do? DO SOMETHING
Stay in the situation? Prolong the situation? Do nothing?

What did you feel after engaging this strategy? STATE 2

Provided the strategy (eventually) was successful

What did you learn?

Two principal means of coping (E&A) Negative reinforcement

Mowrers (1947) two-stage theory of fear

The basis for most anxiety disorders, and the basis for most anxiety disorder treatment approaches Definition: Classically conditioned acquisition of fear is followed by operantly conditioned avoidance of fear cues, resulting in fear maintenance due to a lack of unreinforced exposure to those conditioned stimuli In a nutshell: People develop anxiety as a response set to nonthreatening situations because we have been punished in the past in the presence of those situations
Why is negative reinforcement so strong and important?

Emotional reactivity promotes conditioning

we do not wish to re-experience the punishment, and this desire to E&A conditions fear

HOWEVER: What does escape and avoidance PREVENT?

Vomiting: The classic 2-stage model

Who has ever had a bit too much to drink, or perhaps eaten something bad/spoiled? What do you feel?
State 1: YUCK! (Nausea: signals?)

Ever been struck by the thought / line of thinking that suggests you want to vomit?
How did you discover this?

What do you feel after you vomit?

State 2: Less YUCK (better)

Future?
Perhaps you wont go out and drink hard the next day, or when/if it happens again you have a strategy for relief I avoid a certain Caf in the Grove! What is this a functional / protective behavior for? Serves adaptive, protective function Selection by consequence (Skinner!)

In the midway of this our mortal life, I found me in a gloomy wood, astray, Gone from the path direct. Dantes Inferno

Ockhams Latin principle lex parsimoniae

 In order to reason well, its absolutely necessary to possess such virtues as intellectual honesty and sincerity and a real love of truth

We must presume, on the part of those who follow any scientific vocation, a sort of tacit oath never to subordinate the motive of objective truth-seeking to any subjective preference or inclination or any expediency or opportunistic consideration
philisophizers, and the like, reveal a startling failure, or perhaps refusal, to grasp what intellectual integrity is, or why it is important. Why does truth-seeking matter?

Where patients might believe anxiety will go: Intolerably high 100 90
SUDs / Anxiety Ratings

T1

T2

Anxiety naturally begins to decline, without escape: Parasympathetic nervous system reduces activation in response to a lack feared outcomes occurring

50 First exposure exercise produces worst arousal Subsequent exposures become easier because of repeated habituation ~ 10

T3

Exposure can be discontinued after 50% reduction (e.g., 90 to 45), but lower is still preferable; 50% reduction = habituation

Escape leads to rapid decline in autonomic arousal and stress, but maintains future anxiety

Possible floor effect or base arousal

0 Time Exposure start ~ 60 Min ~ 90 Min Exposure stops

Fig. 2.2. The normal, natural habituation curve, and maladaptive escape curve

Meaning-making and interpretation of threat

Bi-Directional reasoning: The plague of anxiety disorders
The cow example and illustration of reasoning Ex-Consequentia reasoning: Reasoning with how it feels

Most people do (and should!) reason danger in the presence of immediate, real threat
Lions, tigers, bears, the mugger, the oncoming buss, etc.

People who do not experience chronic fear and anxiety, do not normally (typically) reason there is danger on occasion when their bodies are behaving in an aroused / activated fashion People who suffer with anxiety disorders, reason there is danger if they feel anxious
If it feels like a cow (4 legs), then there must be a cow (confirmatory bias) If it feels bad, it is bad (it becomes reified)

Small group exercise: The maintenance of anxiety

Break into small groups Discuss what you believe contributes to the maintenance of anxiety, fear, and their accompanying emotional states Remember (or be informed now) that ALL BEHAVIOR IS FUNCTIONAL
The person who continues a behavioral set is either:
Getting something Getting away/out of something (positive reinforcement) (negative reinforcement) (punishment)

Or they would stop doing it

If a behavior is punished, it will seize

Be creative --- consider 2ndary gain issues, too

Come back as larger group and discuss findings

Main problem: Acting in the absence of evidence

In the absence of actual experience, we anticipate or predict
Probability (i.e., how likely will an event / outcome be) Cost (i.e., how personally painful / damaging will outcome be, if it actually occurred)

Accuracy is a significant problem

Engaging in emotional reasoning overestimation & underestimation

Probability of event & capacity to handle it

Not scientific approach to understanding likelihood

How is probability calculated? ( X X = ?)

Dont have the actual evidence of reality

People are by design hedonistic; therefore, operate on principles of maximize what feels good and minimize what feels bad
Actively trying to reduce chances of bad happening Reason extreme experiences more average, and if it occurred again it would be intolerable

Large group exercise: A walk in the woods

Close your eyes Listen to description What kinds of reactions do you have? Share with your peers your own experience of the walk you just took Close your eyes again Continue the walk Share with group
Lessons learned? Anything new discovered?

An Illustration: African Savanna & Smoke Jumpers

Running away from the roar vs .

Unless the patient decides to run towards the roar (which will, inherently, seem counter-intuitive), they will not have unreinforced encounters with the stimulus To survive the certain death, the smoke jumper has to somehow make it through the fire to emerge on the side without the fuel, superheated air and poisonous gases People have to discover the evidence (experiences) that refutes their beliefs that say/feel bad, in order to learn that what they predict does not occur at the frequency they predict, and neither is it as intolerable as imagined should it actually occur They have to play scientist, and treat all assumptions, beliefs and positions as hypotheses (not as absolutes or truths), and they cannot act until the findings (data) is in

Repeated habituation produces extinction!

Repeated experiences refuting former beliefs form the foundation of new, alternative (more reasonable --- not Polly Ann-ish) beliefs What does normal, natural habituation do to the peaks of arousal / activation / anxiety? Exposure vs. Experiment Habituation vs. Refuting faulty assumptions / beliefs

Soooooo, how do we treat ANXIETY???? Like fear of heights, snakes, and the dark?????