A Contemporary Learning Theory Perspective on the Etiology of Anxiety Disorders

Its Not What You Thought It Was

The authors describe how contemporary learning theory and research provide the basis for perspectives on the etiology and maintenance of anxiety disorders that capture the complexity associated with individual differences in the development and course of these disorders. These insights from modern research on learning overcome the shortcomings of earlier overly simplistic behavioral approaches, which sometimes have been justifiably criticized. The authors show how considerations of early learning histories and temperamental vulnerabilities affect the short- and long term outcomes of experiences with stressful events. They also demonstrate how contextual variables during and following stressful learning events affect the course of anxiety disorder symptoms once they develop. This range of variables can lead to a rich and nuanced understanding of the etiology and course of anxiety disorders.

Approximately 29% of the U.S. population is estimated to have or to have had one or more diagnosable anxiety disorders at some point in their lives, making anxiety disorders the most common category of diagnoses in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV; A merican Psychiatric Association, 1994; see Kessler, Berglund, Demler, Jin, &Walters, 2005). Most of us might intuitively guess that anxiety disorders would typically develop during or following a frightening or traumatic event or during a period of significant stress when many of us experience some anxiety. Yet it is also obvious that not everyone undergoing traumas or highly stressful periods develops an anxiety disorder. Any good etiological theory must be able to account for this and many other apparent mysteries involved in who does and who does not develop an anxiety disorder. Consider the following examples, which illustrate the kinds of issues we address in this article:

"Emily and Marian both had had traumatic experiences with dogs. Emily was hiking with her own dog when another dog attacked her and bit her on the wrist. She was terrified. The wound became badly infected and very painful, requiring medical treatment. Marian was walking in the fields when she became terrified by three large, growling dogs that chased her to a fence. One began tearing at her pant legs, but their owner fortunately intervened before she was physically injured. Why did Marian but not Emily go on to develop dog phobia when only Emily was actually bitten by a dog? Ahmet and Hasan were both male Turkish citizens in their 30s who were arrested, imprisoned, and tortured. Ahmet was imprisoned for several years and experienced a great deal of torture; Hasan was imprisoned for several weeks and experienced far less torture (M. Başoğlu, personal communication, 1997).

Why did Hasan but not Ahmet develop posttraumatic stress disorder? What accounts for such individual differences?"

Although behavioral/learning approaches were the dominant empirical perspective on anxiety disorders from the 1920s until the 1970s, these approaches have been widely criticized since the early 1970s (for reviews, see Mineka, 1985; Rachman, 1978, 1990). Many of these criticisms stemmed from the inability of early learning approaches to account for the diverse factors involved in the origins of people's anxieties, such as the individual differences illustrated in the cases cited above. More recently, however, a resurgence of interest in learning approaches has occurred, as these approaches have incorporated some of the complexity predicted by contemporary learning theory and research (e.g., Barlow, 1988, 2002; Craske, 1999).

In this article we discuss how prior criticisms of earlier learning approaches are addressed by contemporary approaches grounded in modern research on learning (e.g., see Rescorla, 1988, for one classic review). 2 Unfortunately, however, these advances have not been adequately communicated to clinical scientists who advance the theories of etiology and maintenance. Therefore, we attempt to advance such communication by describing how certain insights from this area of research overcome the shortcomings of earlier, overly simplistic behavioral approaches. Weshow how early learning histories serve as vulnerability (or invulnerability) factors that can dramatically affect the emotional consequences of traumatic and stressful life events often implicated in the origins of anxiety disorders. Such early learning histories, when considered together with temperamental vulnerabilities, can serve as diatheses that make certain individuals more susceptible to adverse and stressful experiences that sometimes lead to the development of anxiety disorders. Consideration of these diatheses, as well as of various contextual variables during and following traumatic learning events, can lead to a rich and nuanced understanding of the etiology and course of anxiety disorders (Mineka & Zinbarg, 1996).

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Taken from: Mineka, S. & Zinbarg, R. (2006). A Contemporary Learning Theory Perspective on the Etiology of Anxiety Disorders: It's Not What You Thought It Was. American Psychologist, 61(1), pp. 10-26