Behavioral Interpretations
CONCLUDING REMARKS
The emphasis in this chapter has been on behavioral factors involved in the etiology and maintenance of anxiety disorders. As discussed, learning theories are inadequate as a uniform theory for the development of anxiety disorders. Even in the case of phobias and post-traumatic stress disorder, centered around clear stimuli that trigger the anxiety, simple learning theories are inadequate in explaining the acquisition and maintenance. In other anxiety disorders like obsessive-compulsive disorder, generalized anxiety, and social phobia, there is even less evidence that conditioning plays a crucial role. Recent developments have stressed cognitive representations and cognitive schemata as important determinants of anxiety disorders. For
example, Beck, Emery, and Greenberg (1985) hold that cognitive schemata and automatic thoughts that are typical of anxiety play a central role in the etiology and maintenance of anxiety disorders. Other research has shown that biological factors may be involved in the etiology of anxiety disorders.
Although discussion of these developments was outside the scope of this chapter, we wholeheartedly agree with an interactional perspective, in which biological, cognitive, and behavioral factors all play an important role. There are likely to be several factors operating at different levels and influencing each other in the etiology and maintenance of anxiety disorders. A comprehensive account of the acquisition and maintenance of fears and anxiety disorders is much more complex than once thought and needs to integrate biological, behavioral, and cognitive factors.
REFERENCES
American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed. rev.). Washington, DC: Author.
Amies, P. L., Gelder. M. G., & Shaw, P. M. (1983). Social phobia: A comparative clinical study.
British Journal of Psychiatry, 142, 174-179.
Arkowitz, H. (1977). The measurement and modification of minimal dating behavior. In M.
Hersen. R. M. Eisler, & P. M. Miller (Eds.), Progress in behavior modification, Vol. 5.
New York: Academic Press.
Arrindell, W. A., Emmelkamp, P. M. G., Monsma, A., & Brilman, E. (1983). The role of perceived parental rearing practices in the aetiology of phobic disorders: A controlled study.
British Journal of Psychiatry, 143, 183-187.
Baeyens, F., Eelen, P., Crombez, G., & Van den Bergh, O. (1992). Human evaluative conditioning:
Acquisition trials, presentation schedule, evaluative style and contingency awareness. Behaviour Research and Therapy, 30, 133-142.
Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic.
New York: Guilford.
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Beidel, D. C., Turner, S. M., & Dancu, C. V. (1985) Psychological, cognitive and behavioral aspects of social anxiety. Behaviour Research and Therapy, 23, 109-117.
Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder.: A predominance of thought activity. Behaviour Research and Therapy, 28, 153-158.
Bowen, R. C., & Kohout, J. (1979). The relationship between agoraphobia and primary affective disorders. Canadian Journal of Psychiatry, 24, 317-322.
Bregman, E. (1934). An attempt to modify the emotional attitudes of infants by the conditioned response technique. Journal of Genetic Psychology, 45, 169-196.
Bruch, M. A. (1989) Familial and developmental antecedents of social phobia: Issues and findings.
Clinical Psychology Review, 9, 1, 37-47.
Bruch, M. A., Heimberg, R. G., Berger, P., & Collins, T. M. (1989). Social phobia and perception of early parental and personal characteristics. Anxiety Research, 2, 57-65.
Buglass, D., Clarke, J., Henderson, A. S., Kreitman, N., & Presley, A. S. (1977). A study of agoraphobic housewives. Psychological Medicine, 7, 73-86.
Buss, A. H. (1980). Self-consciousness and social anxiety. San Francisco: Freeman.
Chambless, D. L. (1989). Gender and phobias. In P. M. G. Emmelkamp, W. T. A. M. Everaerd, F.
Kraaimaat. & M. J. M. Van Son (Eds.), Fresh perspectives on anxiety disorders (pp.
133-142). Amsterdam/Berwyn: Swets.
Chemtob, C., Roitblat, H. C., Hamada, R. S., Carlson, J. G., & Twentyman, C. T.(1988). A cognitive action theory of post-traumatic stress disorder. Journal of Anxiety Disorders, 2, 253-275.
Clum, G. A., & Knowless, S. L. (1991). Why do some people with panic disorders become avoidant?
A review. Clinical Psychology Review, II, 295-313.
Cook, M., & Mineka, S. (1991). Selective associations in the origins of phobic fears and their implications for behavior therapy. In P. R. Martin (Ed.). Handbook of behavior therapy and psychological science: An integrative approach (pp. 413-434). New York: Pergamon.
Davey, G. C. L. (1992). Classical conditioning and the acquisition of human fears and phobias: A review and synthesis of the literature. Advances in Behavior Research & Therapy, 14, 29-66.
De Silva, P. (1988). Phobias and preparedness: Replication and extension. Behaviour Research and Therapy, 26, 97-98.
De Silva, P., Rachman, J., & Seligman, M. E. A. (1977). Prepared phobias and obsessions:
Therapeutic outcome. Behaviour Research and Therapy, 15, 65-77.
DiNardo, P. A., Guzy, L. T., & Bak, R. M. (1988). Anxiety response patterns and etiological factors in dog-fearful and nonfearful subjects. Behaviour Research & Therapy, 26, 245-252.
DiNardo, P. A., Guzy, T., Jenkins, J. A., Bak, R. M., Tomasi, S. F., & Copland, M. (1988). Etiology and maintenance of dog fears. Behaviour Research and Therapy, 26, 3, 241-244.
Dow, M. G., Biglan, A., & Glaser, S. R. (1985). Multimethod assessment of socially anxious and socially unanxious women. Behavioral Assessment, 7, 273-282.
Edelmann, R. J. (1985). Dealing with embarrassing events: Socially anxious and non-socially anxious groups compared. British Journal of Clinical Psychology, 24, 281-288.
Ehlers, A., & Margraf, J. (1989). The psychophysiological model of panic attacks. In P. M. G.
Emmelkamp. W. T. A. M. Everaerd, F. Kraaimaat, & M. J. M. Van Son (Eds.), Fresh
perspectives on anxiety disorders (pp. 1-29). Amsterdam/Berwyn: Swets.
Eifert, G. H., & Evans, I. M. (Eds.). (1990). Unifying behavior therapy: Contributions of paradigmatic behaviorism. New York: Springer.
Emmelkamp, P. M. G. (1982). Phobic and obsessive-compulsive disorders: Theory, research and practice. New York: Plenum.
Emmelkamp, P. M. G., & Rabbie, D. (1982) Parental rearing styles and sex-role differences in obsessive-compulsive disorders. Unpublished manuscript. University of Groningen.
English, H. B. (1929). Three cases of the “conditioned fear response.” Journal of Abnormal and Social Psychology, 34, 221-225.
Eysenck, H. J., & Rachman, S. (1965). The causes and cures of neurosis. London: Routledge &
Kegan Paul.
Eysenck, M. W., & Mathews, A. (1987). Trait anxiety and cognition. In H. J. Eysenck & I. Martin (Eds.), Theoretical foundations of behavior therapy. New York: Plenum.
Faravelli, C. (1985). Life events preceding the onset of panic disorder. Journal of Affective Disorders, 9, 103-105.
Fazio, F. (1972). Implosive therapy with semiclinical phobias. Journal of Abnormal Psychology, 50, 183-188.
Foa, E. B., Steketee, G., & Olasov Rothbaum, B. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy, 20, 155-176.
Foa, E. B., Steketee, G., & Young, M. C. (1984). Agoraphobia: Phenomenological aspects, associated characteristics, and theoretical considerations. Clinical Psychological Review, 4, 431-457.
Goldstein, A. J., & Chambless, D. L. (1978). A reanalysis of agoraphobia. Behavior Therapy, 9, 47-59.
Gray, J. A. (1975). Elements of a two-process theory of learning. New York: Academic Press.
Hartman, L. M. (1983). A metacognitive model of social anxiety: Implications for treatment.
Clinical Psychology Review, 3, 435-456.
Hekmat, H. (1987). Origins and development of human fear reactions. Journal of Anxiety Disorders, I, 197-218.
Herrnstein, R. J. (1969). Method and theory in the study of avoidance. Psychological Review, 76, 49-69.
Herrnstein, R. J., & Hineline, P. N. (1966). Negative reinforcement as shock-frequency reduction.
Journal of Experimental Analysis of Behavior, 9, 421-430.
Hibbert, G. A. (1984). Ideational components of anxiety: Their origin and content. British Journal of Psychiatry, 144, 618-624.
Hoekstra, R. J., Visser, S., & Emmelkamp, P. M. G. (1989). Social learning formulation of the etiology of obsessive-compulsive disorders. In P. M. G. Emmelkamp, W. T. A. M.
Everaerd, F. Kraaimaat, & M. J. M. Van Son (Eds.), Fresh perspectives on anxiety disorders (pp. 115-124). Amsterdam/ Berwyn: Swets.
Keane, T. M., Zimmerling, R. T., & Caddell, J. M. (1985). A behavioral formulation of post-traumatic stress disorder in Vietnam veterans. The Behavior Therapist, 8, 9-12.
Kilpatrick, D. G„ Veronen, L. J., & Best, C. L. (1985). Factors predicting psychological distress among rape victims. In C. R. Figley (Ed.), Trauma and its wake. New York:
Brunner/Mazel.
Kipper, D. A. (1977). Behavior therapy for fears brought on by war experiences. Journal of Consulting and Clinical Psychology, 45, 216-221.
Klein, D. F. (1981). Anxiety reconceptualized. In D. F. Klein, J. G. Rabkin (Eds.), Anxiety: New research and changing concepts. New York: Raven Press.
Kleiner, L., & Marshall, W. L. (1987). The role of interpersonal problems in the development of
agoraphobia with panic attacks. Journal of Anxiety Disorders, 1, 313-323.
Last, C. G., Barlow, D., & O’Brien, G. T. (1984). Precipitants of agoraphobia: Role of stressful life-events. Psychological Reports, 54, 567-570.
Lautch, H. (1971). Dental phobia. British Journal of Psychiatry, 119, 151-158.
Leary, M. R. (1988). A comprehensive approach to the treatment of social anxieties: The self-presentation model. Phobia Practice and Research Journal, I, 1,48-57.
Lelliott, P., Marks, I., McNamer, G., & Tobema, A. (1989). Onset of panic disorder with agoraphobica: Toward an integrated model. Archives of General Psychiatry, 46, 100-104.
Levey, A. B., & Martin, I. (1983). Cognitions, evaluations and conditioning. Rules of sequence and rules of consequence. Advances in Behaviour Research & Therapy, 4, 181-195.
Litz, B. T., & Keane, T. M. (1989). Information processing in anxiety disorders: Application to the understanding of post-traumatic stress disorder. Clinical Psychological Review, 9, 243-257.
Lucock, M. R, & Salkovskis, P. M. (1988). Cognitive factors in social anxiety and its treatment.
Behaviour Research and Therapy. 26, 297-302.
Marks, I. M. (1969). Fears and phobias. London: Heinemann.
Marks, I. M., & Gelder, M. G. (1966). Different ages of onset in varieties of phobias. American Journal of Psychiatry, 123, 218-221.
Martin, I., & Levey, A. B. (1985). Conditioning, evaluations and cognitions: An axis of integration.
Behaviour Research and Therapy, 23, 167-175.
Marzillier, J. S., Lambert, C., & Kellett, J. (1976). A controlled evaluation of systematic desensitization and social skills training for socially inadequate psychiatric patients. Behaviour Research and Therapy, 14, 225-238.
Mathews, A. (1989). Cognitive aspects of the etiology and phenomenology of anxiety disorders of panic attacks. In P. M. G. Emmelkamp. W. T. A. M. Everaerd, F. Kraaimaat, & M. J. M.
Van Son (Eds.), Fresh perspectives on anxiety disorders (pp. 1225-1232).
Amsterdam/Berwyn: Swets.
McNally, R. J. (1987). Preparedness and phobias: A review. Psychological Bulletin, 101, 283-303.
McNally, R. J. (1990). Psychological approaches to panic disorder: A review. Psychological Bulletin, 108, 403-419.
McNally, R. J., & Steketee, G. S. (1985). The etiology and maintenance of severe animal phobias.
Behaviour Research and Therapy, 23, 4, 431-435.
Merkelbach, H., Van den Hout, M. A., Hoekstra, R., & Van Oppen, P. (1988). Are prepared fears less severe, but more resistant to treatment? Behaviour Research and Therapy, 25, 527-530.
Merkelbach, H., de Ruiter, C., Van den Hout, M. A., & Hoekstra, R. (1989). Conditioning experiences and phobias. Behaviour Research and Therapy. 27, 657-662.
Mineka, S. (1979). The role of fear in theories of avoidance learning, flooding, and extinction.
Psychological Bulletin, 86, 985-1010.
Mineka, S., & Kihlstrom, J. F. (1978). Unpredictable and uncontrollable events: A new perspective on experimental neurosis. Journal of Abnormal Psychology, 87, 256-271.
Mowrer, O. H. (1960). Learning theory and behavior. New York: Wiley.
Murray, E. J., & Foote, F. (1979). The origins of fear of snakes. Behaviour Research and Therapy, 17, 489-493.
Newton, A., Kindness, K., & MeFudyen, M. (1983). Patients and social skills groups: Do they lack social skills? Behavioural Psychotherapy, II, 116-128.
Ohman, A. (1987). Evolution, learning, and phobias: An interactional analysis. In D. Magnusson &
A. Ohman (Eds.), Psychopathology: An interactional perspective (pp. 143-158). New
York: Academic Press.
Ollendick, T. H., & King, N. J. (1991). Origins of childhood fears: An evaluation of Rachman's theory of fear acquisition. Behaviour Research and Therapy, 29, 117-123.
Ost, L-G. (1985). Ways of acquiring phobias and outcome of behavioural treatments. Behaviour Research and Therapy, 23, 683-689.
Ost, L-G. (1987). Age of onset in different phobias. Journal of Abnormal Psychology, 96, 3, 223-229.
Ost. L-G., & Hugdahl, K (1981). Acquisition of phobias and anxiety response patterns in clinical patients. Behaviour Research and Therapy, 19, 439-447.
Ost, L-G., & Hugdahl, K. (1983). Acquisition of agoraphobia, mode of onset and anxiety response patterns. Behaviour Research and Therapy, 21, 623-631.
Ost, L-G., & Hugdahl, K. (1985). Acquisition of blood and dental phobia and anxiety response patterns in clinical patients. Behaviour Research and Therapy, 23, 27-34.
Ottaviani, R., & Beck, A. T. (1987). Cognitive aspects of panic disorders. Journal of Anxiety Disorders, I, 15-28.
Parker, G. (1979). Reported parental characteristics of agoraphobics and social phobics. British Journal of Psychiatry, 135, 555-560.
Perris, C., Jacobsson, L., Lindstrom, H., Van Knorring, L., & Perris, H. (1980). Development of a new inventory for assessing memories of parental rearing behaviour. Acta Psychiatrica Scandinavia, 61, 265-274.
Persson, G., & Nordlund, C. L. (1985). Agoraphobics and social phobics: Difference in background factors, syndrome profiles and therapeutic response. Acta Psychiatrica Scandinavica, 71, 148-162.
Rachman, S. (1976). Obsessive-compulsive checking. Behaviour Research and Therapy, 14, 269-277.
Rachman, S. (1978). Fear and courage. San Francisco: Freeman & Co.
Rachman, S. (1991a). Neo-conditioning and the classical theory of fear acquisition. Clinical Psychology Review, II, 155-173.
Rachman, S. (1991b). The consequences of panic. Journal of Cognitive Psychotherapy: An International Quarterly, 5, 187-197.
Rachman, S., & Hodgson, R. J. (1980). Obsessions and compulsions. Englewood Cliffs, NJ: Prentice-Hall.
Rapee, R. M. (1991). Generalized anxiety disorder: A review of clinical features and theoretical concepts. Clinical Psychology Review, II, 419-440.
Rapee, R. M., & Murrell, E. (1988). Predictors of agoraphobic avoidance. Journal of Anxiety Disorders, 2, 203-218.
Raskin, M., Peek, H. V. S., Dickman, W., & Pinsker, H. (1982). Panic and generalized anxiety disorders: Developmental antecedents and precipitants. Archives of General Psychiatry, 39, 687-689.
Rimm, D. C., Janda, L. H.. Lancaster, D. W., Nahl, M., & Ditmar, K. (1977). An exploratory investigation of the origin and maintenance of phobias. Behaviour Research and Therapy, 15, 231-238.
Robinson, S., & Brichwood, M. (1991). The relationship between catastrophic cognitions and the components of panic disorder. Journal of Cognitive Psychotherapy: An International Quarterly, 5, 175-186.
Roy-Byrne, P. P., Geraci, M., & Uhole, T. W. (1986). Life events and the onset of panic disorder.
American Journal of Psychiatry, 143, 1424-1427.
Schneier, F. R., Fyer, A. J., Martin, L. Y., Ross, D., Manuzza, S., Liebowitz, M. R., Gorman, J. M., &
Klein, D. F. (1991). A comparison of phobic sub-types within panic disorder. Journal of Anxiety Disorders, 5, 66-75.
Seligman, M. E. P. (1971). Phobias and preparedness. Behavior Therapy, 2, 307-320.
Sheehan, D. V., Sheehan, K. E., & Minichiello, W. E. (1981). Age of onset of phobic disorders: A reevaluation. Comprehensive Psychiatry, 22, 544-553.
Solyom, L., Beck, P., Solyom, C., & Huger, R. (1974). Some etiological factors in phobic neurosis.
Canadian Psychiatric Association Journal, 19, 67-68.
Spielberger, C. D. (1972). Anxiety: Current trends in theory and research. New York: Academic Press.
Steketee, G. S., Grayson, J. B., & Foa, E. B. (1985). Obsessive-compulsive disorders: Differences between washers and checkers. Behaviour Research and Therapy. 23, 197-201.
Thyer, B. A., Curtis, G. C., & Fechner, S. L. (1984). Fear of criticism is not specific to obsessive-compulsive disorder. Behaviour Research and Therapy, 22, 77-80.
Thyer, B. A., & Himle, J. (1985). Temporal relationship between panic attack onset and phobic avoidance in agoraphobia. Behaviour Research and Therapy, 23, 607-608.
Thyer, B. A., Himle, J., & Fischer, D. (1988). Is parental death a selective precursor to either panic disorder or agoraphobia: A test of the separation anxiety hypothesis. Journal of Anxiety Disorders, 2, 333-338.
Thyer, B. A., Nesse, R. M., Cameron, O. G., & Curtis, G. C. (1985). Agoraphobia: A test of the separation anxiety hypothesis. Behaviour Research and Therapy, 23, 75-78.
Thyer, B. A., Nesee, R. M., Curtis, G. E., & Cameron, O. G. (1986). Panic disorder: A test of the separation anxiety hypothesis. Behaviour Research and Therapy, 24, 209-211.
Trower, P., Bryant, B. M., & Argyle, M. (1978). Social skills and mental health. London: Methuen.
Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95, 4, 389-394.
Turner, R. M., Steketee, G. S., & Foa, E. B. (1979). Fear of criticism in washers, checkers and phobics. Behaviour Research and Therapy, 17, 79-81.
Van den Hout, M. A. (1988). The explanation of experimental panic. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives. Hillsdale, NJ: Erlbaum.
Van der Molen, G. M., Van den Hout, M. A., Van Dieren, A. C., & Griez, E. (1989). Childhood separation anxiety and adult-onset panic disorders. Journal of Anxiety Disorders, 3, 97-106.
Watson. J., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3, 1-22.
Windheuser, H. J. (1977). Anxious mothers as models for coping with anxiety. Behavioural Analysis and Modification, 1, 39-58.
Wolpe, J. (1958). Psychotherapy and reciprocal inhibition. Stanford: Stanford University Press.
Wolpe, J., & Rowan, V. C. (1988). Panic disorder: A product of classical conditioning. Behaviour Research & Therapy, 26, 441-450.
Zafiropoulo, M., & McPherson, F. M. (1986). Preparedness and the severity and outcome of clinical phobias. Behaviour Research and Therapy, 24, 221-222.