Find out the latest news and topics of interest from Dr. James G. Hood, D.D.S., M.A.!
Archive for the ‘Child Abuse’ Category
Playing the Psychologist: The Importance of Cultural Competence
Friday, May 28, 2010
Society has struggled throughout history to explain and manage individuals with abnormal mental states, and as a result of society’s quest for understanding, three major explanations have developed: the supernatural, biological, and psychological. More recently, psychologists have argued that the combination of biological and psychological factors are the most likely causal factors of psychopathology (Barlow & Durand, 2005). Realizing that psychological disorders are caused by psychological and biological factors is important for the implementation of effective treatment; however, clinicians and researchers must also be aware of and sensitive to a particular individual’s culture in order to properly diagnose a psychological disorder. Additionally, cultural knowledge is necessary to off set the negative stigma that society may be attributing to a particular psychological disorder or psychological abnormalities in general.
Taking a step back and looking through a cultural perspective at the actions of a particular individual acting in his/her respective culture is extremely important. A culture deems what behaviors are normal (acceptable) in its own culture. What is normal in one culture, therefore, could be deemed completely unacceptable or could even be classified as a psychological disorder in another culture. A careful mental health practitioner would therefore be sure to understand the cultural nuances of a patient’s culture in order to avoid an inappropriate diagnose and respective treatment for a patient which could result in a patient being hurt rather than helped. For instance, a patient may develop symptoms of a particular mental disorder even though the initial diagnosis was incorrect because the patient could experience the self fulfilling prophecy.
After determining that a patient actually has a psychological disorder based on the guidelines for behavior in the patient’s particular culture, then a responsible mental health practitioner must be aware of society’s feelings toward that particular disorder and act accordingly. In the past, psychological disorders were viewed in a variety of negative ways that greatly marginalized or even physically inflicted harm on individuals with psychological disorders. For the most part, the negative perception of individuals with psychological disorders continues to this day.
The negative perception of psychological disorders is harsher towards individuals on the “extreme” end of the psychological spectrum. Pop culture points out and/or creates examples of schizophrenic or individuals with some sort of personality disorder that exhibit wild behaviors. These behaviors are often exaggerated for dramatic effect and cast in a clearly negative light.
Individuals in a different subset of psychological disorders, however, are often viewed as people with small problems that can easily be remedied. The show, Monk, depicts a detective with Obsessive Compulsive Disorder. However, the detective’s disorder is not viewed as a detriment, but rather as an interesting quirk that provides comic relief and ingenious insight into his profession. Furthermore, with the rising popularity of pharmeceutical drugs, more and more people are taking medications for depression or certain anxiety disorders. More people being treated in a more public setting means that the norm for these treatments and their corresponding ailments is becoming more widely accepted. The new emphasis on the biological factors contributing to these disorders also helps alleviate the previous stigma because now the problem is more like a headache being treated with pills instead of an inexplicable problem of a particular individual’s human nature.
Knowing society’s particular viewpoint towards a specific mental malady is essential for beneficial treatment. By realizing society’s perspective a mental health practitioner will realize the obstacles that a patient may be facing. The realization will allow the mental health practitioner to outline an effective coping strategy for the patient.
Cultural competence is something that a clinician and/or reseracher must posess in order to best help an individual suffering from a psychological disorder. Realizing the dual nature of the psychological disorder involving both psychological and biological factor is important, but the cultural perspective must be explored to find its definition of normal behaviors and to determine the positive and/or negative attributions given to each respective psychological disorder.
References
Barlow, D. & Durand, M. (2005). Abnormal Psychology. Belmont: Thomson Wadsworth.
Playing the Psychologist: Causes of Anxiety Disorders
Friday, May 28, 2010
Running head: THE ETIOLOGY OF ANXIETY DISORDERS
The Etiology of Anxiety Disorders: A Biological, Cognitive, and Experiential Perspective
Kyler Hood
Abstract
This paper explains the diagnosis of anxiety disorders and examines biological, cognitive, and experiential studies pertinent to the exploration of anxiety disorders. Genetic predisposition, increased brain activation to nonthreatening situations, negative interpretation bias, positive bias, bullying, and lack of social support are all aspects related to the formation of anxiety disorders. Research suggests that increased brain activation to nonthreatening social stimuli along with a prevalent negative interpretation bias, reduced positive interpretation bias, a genetic predisposition, increased bullying in childhood, and lack of social support all contribute to the formation of anxiety disorders. Future studies on the role of these multiple factors in anxiety disorders will need to be conducted concurrently (if possible) and individually, so interactions can be assessed for causality and correlation more confidently.
The Etiology of Anxiety Disorders: A Biological, Cognitive, and Experiential Perspective
People suffering from anxiety disorders typically exhibit symptoms of anxiety and/or excessive worrying that negatively affects all levels of everyday interactions (Friedman, 2001). Greenberg et al. (1999) found that millions of adults have been diagnosed with some sort of anxiety disorder, which costs the United States over 42 billion dollars annually . Anxiety disorders clearly present a problem to the American populace, so understanding the nature and cause of anxiety disorders is crucial for preventing and treating anxiety disorders. Numerous empirical studies explain the biological, cognitive, and experiential factors that contribute to the creation of anxiety disorders, but few have been able to examine all three as concurrent contributing factors (Mineka & Zinbarg, 2006). In this article, the biological, cognitive, and experiential causes/correlated factors of anxiety disorders will be discussed. When the different types of causes or correlations coexist then an anxiety disorder is more likely to develop. This article also addresses the multiple causal factors in the hope that a greater understanding of the contributing factors that lead to the development of anxiety disorders will lead to greater prevention and treatment for anxiety disorders.
Biological Causal Factors
By comparing participants’ neural responses to facial images showing either anger or no emotion, investigators determined that the amygdala plays a role in the expression of emotions
(Morris, Frith, Perrett, Rowland, Young, Calder, et al., 1996; Straube, Kolassa, Glauer, Mentzel, & Miltner, 2004). More specifically, the amygdala, right insula, and superior temporal sulcus for the most part exhibit a stronger response in participants with anxiety disorder especially in response to angry facial expressions (Morris et al.; Straube et al.). Straube et al. showed that participants with anxiety disorder consistently exhibited pronounced activations in the amygdala, right insula, and superior temporal sulcus, but more replications with a greater sample size are needed to determine how the range and complex interactions affect each of these regions of the brain in participants with an anxiety disorder.
Genetic Factors
Hettema, Prescott, Myers, Neale, and Kendler (2005) found that two genetic components make individuals more likely to develop an anxiety disorder from the category of generalized and panic anxiety (including agoraphobia) not phobias. These genetic factors do not differ as causal factors between men and women. Correlations exist between specific environmental factors to a specific anxiety disorder and some general correlations exist between environmental factors across several disorders (Hettema et al.).
Psychophysiological Factors
Hermann, Ziegler, Birbaumer, and Flor (2002) compared people suffering from social phobia to healthy control participants by examining each group’s different responses to unpleasant conditioning with two expressionless faces being conditioned stimuli and an unpleasant smell as an unconditioned stimulus. The investigators analyzed various physiological responses of the social phobics versus the healthy control participants in order to ascertain each individual’s conditioned responses to the stimuli. Researchers predicted that people diagnosed with social phobia would show a more pronounced response to the stimuli than the control participants. During habituation to the stimulus, people with social phobia demonstrated higher arousal ratings than the control participants and those people with social phobia did not make a distinction between the positive and negative conditioned stimuli. People suffering from social phobia also exhibited higher arousal ratings to the stimulus and showed a greater corrugator muscle response. The researchers concluded that people afflicted with social phobia are more apt to negatively interpret neutral stimuli (Hermann et al.).
Cognitive Factors
Certain people have a different way of processing events cognitively that seems to contribute to the development of anxiety disorders. Amin, Foa, and Coles (1998) examined negative interpretation bias in participants with generalized social phobia (GSPs) and obsessive compulsive disorder (OCD). The researchers hypothesized that the participants with social phobia or OCD would interpret ambiguous experimental scenarios more negatively than the control participants would in the same scenarios. The investigators determined the disorder or phobia groups by having incoming participants take the depression inventory and anxiety depression scales. Amin et al. then had each group fill out questionnaires that asked each group questions concerning how they would respond to various social and nonsocial scenarios. Sample questions like the ones used in the questionnaire were provided with the study and the questions may have a problem with social acceptability bias. The reader can easily see the positive, negative, or neutral mood that is evoked from each response and he/she may want to give a positive response instead of a true to life response. By examining the evidence people with GSPS, Amin et al. found that the data supported the hypothesis that people with anxiety tend to interpret scenarios more negatively especially in social scenarios. The researchers found that OCD participants did not perceive the outcomes of social scenarios as negatively as GSPS participants, but both GSPs and OCD participants interpreted social events more negatively than the control group did as a whole. The GSPs and OCD participants’ negative interpretations serve a microcosm for the negative interpretation bias found within the broader category of anxiety disorders.
In addition to having a negative interpretation bias, participants that later develop anxiety disorders have a dysfunctional positive bias. This conclusion makes the reader wonder if researchers looked at negative interpretation bias with a new perspective and renamed it impaired positive inferential bias. However, Hirsch and Matthews (2000) predicted that participants with social phobia will either continuously construe neutral encounters negatively at the moment of the encounter, or participants with social phobia only judge encounters looking back with a negative viewpoint. Using these hypotheses, the researchers tested for bias by giving the participants from the control and experimental groups lexical word puzzles that gave them information on the biases because of the way each group responded. The investigators found that individuals without anxiety make positive impressions constantly in their mind while people with anxiety disorders do not. Anxious participants also did not process external cues in encounters and typically had early social failures; both of which contributed to later anxiety. Experimenters will need to conduct more replications of this experiment, and other modified forms, however, because the extensive reading tasks required for this experiment may have caused undue stress which would significantly hinder the results of the experiment (Hirsch & Matthews).
Hirsch and Matthews found that positive bias is impaired in people with anxiety disorders, and other researchers found a complex correlation between explicit memory and anxiety disorders. Becker, Roth, Andrich, and Margraf (1999) conducted 2 experiments. In the first experiment, researchers gave participants from three groups words to examine (people came from the generalized anxiety disorder group, the control group or the social phobia group). The investigators gave the participants words related to generalized anxiety disorder, and phobia along with neutral and positive words. The participants rated each word they received according to three categories: personal relevance, excitingness, and pleasantness. Becker et al. found that the participants with generalized anxiety disorder scored the highest (when compared to the social phobia and control group) in psychopathology and also had higher levels of depression. Becker et al. then performed a free recall test that assesses the number of words a participant can remember from a neutral, positive, or disorder specific word category. Becker et al. found that explicit memory for generalized anxiety disorder or social phobia participants did not occur for words associated with anxiety or emotional words indicating that anxious people do not exhibit selective memory.
In experiment two, however, the researchers found evidence supporting the claim that anxious individuals demonstrate a negative selective memory. Becker et al. tested if participants with panic disorder and agoraphobia would selectively recall anxiety related words. The researchers conducted the experiment in a similar fashion as experiment one. Becker et al. found that participants showed a selective memory for disorder specific words. The results of both experiments seem irreconcilable because the first experiment rejected the hypothesis that people with anxiety disorders selectively remember negative stimuli while the second experiment supported it. These concurrent experiments support the idea that selective memory in anxiety disorders may only be related to certain anxiety disorders. However, several replications of these experiments and modified versions of them will need to be conducted to provide more conclusive results.
Although support for a negative selective memory is unclear, researchers found clear support indicating that people with anxiety disorders often avoid social encounters because they view themselves extremely negatively. Voncken, Alden, and Bogels (2006) conducted an experiment in which participants read different vignettes with a main character interacted in 1 of 3 different ways: admitting that he/she is anxious, hiding the anxiety, or continuing indifferently. The participants rated the character’s social interactions positively or negatively and then the participants rated each scenario again as if they were put in as the main character. The researchers found that people with anxiety disorders live by a double standard in which they view others’ behavior more leniently while their own behavior is viewed much stricter and more negatively. Voncken et al. determined that anxious individuals often avoid people in small ways such as no eye contact, or any behavior that will hide their own anxious behavior. This avoidance behavior often leads to more negative outcomes than if the anxious individual would try not to avoid the social situation. People with anxiety disorders believe that stating that they have an anxiety disorder will draw out a negative response from others; however, people usually view being open to discussion about personal issues positively.
Despite the compelling data, the experiment conducted by Voncken et al. contained several limiting factors. The tests for a participant’s response in a particular social assessed the interaction with a written vignette. A written vignette may not accurately describe how an anxious person would actually respond in a real life situation. Furthermore, investigators only studied a small portion of the population of anxious individuals which may not accurately reflect population trends. Only women participated in the experiment, so researchers did not assess gender differences in anxious individuals (Voncken et al.).
Experiential Factors
Social support in adolescence weakly correlates with social anxiety later in life. Casyln, Winter, and Burger (2005) conducted a study using college students and comparing socially anxious individuals with a control group. Students completed a questionnaire assessing past childhood experiences. The investigators found that only a weak correlation between social anxiety and social support in adolescence exists. The directionality of causality between social anxiety and social support was impossible to determine. The sample came only from college students which limited the ability to generalize the results.
In addition to the weak correlation between social support and anxiety, bullying in childhood strongly correlates with depression and anxiety in adulthood. Gladstone, Parker, and Malhi (2006) conducted an experiment in which participants filled out a questionnaire and underwent an interview that asked about past childhood experiences. Gladstone et al. found that several factors contributed to being victims of bullying: shy temperament, sickness, and parents being extremely authoritarian. Bullied children often exhibited high levels of depression and anxiety, but the direction of causality between these factors was impossible to determine. Investigators found a strong relationship between ill-treatment by parents including indifference, being extremely controlling, sexual mistreatment, and bullying in childhood. People with anxiety disorders often exhibited feelings of isolation, sadness, confusion of who they are as a person, and a tendency to leave social situations that could cause or be caused by bullying (Gladstone et al.). The investigators’ experiment may have been limited because participants did not say if they ever acted as bullies themselves and the experiment rested solely on parents’ recall of past events in their child’s bullying experiences (Gladstone et al.).
Conclusions
Anxiety disorders are not caused by any single factor. Anxiety disorders are caused and/or correlated with factors on the biological, cognitive, and experiential levels. On the biological level certain genes predispose people to increased levels of anxiety and depression. The amygdala, right insula, and superior temporal sulcus respond more strongly in people that exhibit anxious symptoms. At the cognitive level, anxious individuals typically interpret situations negatively and they cannot give a situation a positive impression. Anxious individuals seem to selectively remember negative experiences, but the experimental results are mixed and more replications are necessary to confirm that assumption. People with anxiety disorders often avoid social encounters because they are overly self critical and afraid of making an embarrassing mistake. Lack of social support and bullying are strongly related to the development of an anxiety disorder. However, most researchers agree anxiety disorders are not well researched and many more replications examining negative selective memory will need to be conducted to establish if that is a true phenomenon. Many experiments are also needed to explore the causes and correlations of anxiety disorders such as examining participants with past bullying experiences and a negative interpretation bias in comparison with those who have past bullying experiences and no negative interpretation bias (both could develop anxiety disorders or each only a respective group, but either way the results of this study would provide useful data).
References
Amin, N., Foa, E.B., & Coles, M.E. (1998). Negative interpretation bias in social phobia. Behavior Research and Therapy, 36, 945-957.
Becker, E.S., Roth, W.T., Andrich, M., & Margraf, J. (1999). Explicit memory in anxiety disorders. Journal of Abnormal Psychology, 108, 153-163.
Casyln, R. J., Winter, J. P., & Burger, G. K. (2005). The relationship between social anxiety and social support in adolescents: A test of competing causal models. Adolescence 40, 103-113.
Friedman, S. (2001). Anxiety and anxiety disorders. Mental Health, 1-5. Retrieved October 15, 2006 from http://healthyplace.healthology.com/mental-health/article83.htm
Gladstone, G.L., Parker, G.B., & Malhi, G.S. (2006). Do bullied children become anxious and depressed adults? The Journal of Nervous and Mental Disease, 3, 201-208.
Greenberg, P.E., Sisitsky, T., Kessler, R.C., Finkelstein, S. N., Berndt, E.R., Davidson, J.R.T., Ballenger, J.C., & Fyer, A.J. (1999). The economic burden of anxiety disorders in the 1990s . Journal of Clinical Psychiatry, 60, 427-435.
Hermann, C., Ziegler, S., Birbaumer, N., & Flor, H. (2002). Psychophysiological and subjective indicators of pavlovian conditioning in generalized social phobia. Society of Biological Psychiatry, 328-337.
Hettema, J.R., Prescott, C.A., Myers, J. M., Neale, M.C., & Kendler, K. S. (2005). The Structure of genetic and environmental risk factors for anxiety disorders in men and women. Archive of General Psychiatry, 62, 182-189.
Hirsch, C. R., & Mathews A. (2000). Impaired positive inferential bias in social phobia. Journal of Abnormal Psychology, 4, 705-712.
Mineka, S. & Zinbarg, R. (2006). A contemporary learning theory perspective on the etiology of anxiety disorders. American Psychological Association, 61, 10-26.
Morris, J.S., Frith, C.D., Perrett, D.I., Rowland, D., Young, A.W., Calder, A.J. et al. (1996). Nature, 383, 812-814.
Straube, T., Kolassa, I., Glauer, M., Mentzel, H., & Miltner, W. (2004). Effect of task conditions on brain responses to threatening faces in social phobics: An event-related functional magnetic resonance imaging study. Society of Biologic Psychiatry, 56, 921-930.
Voncken, M.J., Alden, L.E., & Bogels S.M. (2006). Hiding anxiety versus acknowledgment of anxiety in social interaction: Relationship with social anxiety. Behavior Research and Therapy, 44, 1673-1679.
Latest Comments