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A contemporary learning theory
perspective on the etiology of anxiety disorders.
American Psychologist, Volume 61, Number 1, 2006, Pages
10-26.
Susan Mineka, Northwestern University
Richard Zinbarg, Northwestern University
Summary:
The authors review literature
suggesting that personality and prior learning experiences
make a person vulnerable to developing anxiety disorders
including panic disorder and agoraphobia.
Since the 1920's, the principles of behaviorism have been
used to explain the development of anxiety disorders. It is
widely accepted that people develop panic disorder and
agoraphobia, specifically through a process called
"conditioning."
Conditioning exists in two basic forms:
1)
Exteroceptive conditioning: learning to associate external
cues (sights, sounds, smells, etc.) with anxiety and panic.
2)
Interoceptive conditioning: learning to associate internal
cues
(mild bodily sensations caused by anxiety) with higher
levels of
anxiety and panic.
With regard
to explaining the development of panic disorder and
agoraphobia by conditioning alone, the authors pose this
question:
"If simple conditioning explains the cause of panic disorder
and agoraphobia then why do
some people who experience panic attacks go on to develop
panic disorder and agoraphobia and some don't?"
The authors address this question by reviewing literature on
"contemporary learning theory." This literature suggests
that genetics and prior
learning history can make a person vulnerable to developing
full-on panic disorder or agoraphobia if they
experience a single panic attack.
Here are the factors related to genetics and prior learning
history that might put someone at risk for developing panic
disorder and agoraphobia:
1) Hereditary personality traits (neuroticism and trait
anxiety).
2) History of learning experiences in which one learns to
perceive oneself as being helpless or lacking control.
3) A history of being rewarded for engaging in sick role
behavior when experiencing anxiety or panic. (The article
says that adults who experience panic attacks are more
likely to have grown up in households where they witnessed
chronic illness and learned to perceive any unusual bodily
sensations as dangerous).
To summarize the author's points, initial panic attacks set
the stage for the internal and external conditioning that
leads to panic disorder and agoraphobia but.......
People with the risk factors just discussed are predisposed
to this conditioning process.
The authors suggest that "contemporary learning theory"
offers a more complete explanation for the development of
panic disorder and agoraphobia. Also, assessment of
individual's learning histories could be used to identify
people who are most at risk for these disorders, allowing
intervention (or re-learning) to take place before they
develop panic disorder and agoraphobia.
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