Dishabituation processes in height fear and dental fear: an indirect test of the non-associative model of fear acquisition

Fear and anxiety: Lessons learned from the Dunedin longitudinal study

Four related lines of research on anxiety were reviewed from the 'Dunedin Study', an investigation of a representative longitudinal birth cohort of 50-years duration, with 94% retention at the last follow-up. Findings include: (i) Childhood fears deemed evolutionarily-relevant may have different pathways and/or mechanisms underlying their emergence when compared to evolutionarilyneutral fears. (ii) Sequential comorbidity both inside and external to the family of disorders is the rule not the exception, highlighting the importance of developmental history. (iii) The developmental relationship between GAD and MDE is more symmetric that previously assumed, with equal numbers of persons having GAD preceding MDE and MDE preceding GAD. (iv) PTSD in adulthood is influenced by a broad range of childhood risk factors, sequential comorbidity is near universal, and both high-stress life events and mental-disorder history influence the development of PTSD. The implications for epidemiology, nosology, the importance of developmental history, and prevention/treatment options are considered.

Children's risky play from an evolutionary perspective: the anti-phobic effects of thrilling experiences

This theoretical article views children's risky play from an evolutionary perspective, addressing specific evolutionary functions and especially the anti-phobic effects of risky play. According to the non-associative theory, a contemporary approach to the etiology of anxiety, children develop fears of certain stimuli (e.g., heights and strangers) that protect them from situations they are not mature enough to cope with, naturally through infancy. Risky play is a set of motivated behaviors that both provide the child with an exhilarating positive emotion and expose the child to the stimuli they previously have feared. As the child's coping skills improve, these situations and stimuli may be mastered and no longer be feared. Thus fear caused by maturational and age relevant natural inhibition is reduced as the child experiences a motivating thrilling activation, while learning to master age adequate challenges. It is concluded that risky play may have evolved due to this anti-phobic effect in normal child development, and it is suggested that we may observe an increased neuroticism or psychopathology in society if children are hindered from partaking in age adequate risky play.

Social anxiety disorder in older adults: evidence from the National Epidemiologic Survey on alcohol and related conditions

OBJECTIVE

This study aims to investigate the following: 1) the association of social anxiety disorder with childhood parental loss and recent stressful life events; 2) the coexistence of social anxiety disorder and major depressive disorders (MDD); and 3) the impact of social anxiety disorder on medical conditions, obesity, health service utilization, and health-related quality of life.

DESIGN

Cross-sectional observational study.

SETTING

The National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a national representative survey of the U.S. noninstitutionalized household population.

PARTICIPANTS

13,420 respondents aged 55 and above.

MEASUREMENTS

Social anxiety disorder was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Demographic characteristics, psychosocial risk factors, psychiatric disorders, health-related quality of life, obesity, medical conditions, and health service utilization were measured.

RESULTS

The current and lifetime prevalence rates of specific phobia were found to be 1.83% and 3.50%, respectively. Multivariate analyses revealed that social anxiety disorder was more common among the younger age groups and those who reported stressful life events. In addition, MDD, specific phobia, and personality disorder were significantly related to social anxiety disorder. Lastly, after adjusting for other psychiatric comorbidities, the association of social anxiety disorder with health-related quality of life, medical condition, and health care service utilization became insignificant.

CONCLUSION

The correlation between social anxiety disorder and MDD raises further questions about the nature of social anxiety disorder among older adults, but this study does not support the notion that this disorder has a strong impact on the quality of life in old age independent of other psychiatric comorbidities.

Specific phobia in older adults: evidence from the national epidemiologic survey on alcohol and related conditions

OBJECTIVE

This study aims to investigate: 1) the association of specific phobia with childhood parental loss and recent stressful life events; 2) the coexistence of specific phobia and major depressive disorders (MDDs); and 3) the impact of specific phobia on medical conditions, obesity, health service utilization, and health-related quality of life.

DESIGN

Cross-sectional observational study.

SETTING

The National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a national representative survey of the noninstitutionized U.S. household population.

PARTICIPANTS

The 8,205 respondents aged 65 and above.

MEASUREMENTS

Specific phobia was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition version. Demographic characteristics, psychosocial risk factors, psychiatric disorders, health-related quality of life, obesity, medical conditions, and health service utilization were measured.

RESULTS

The current and lifetime prevalence of specific phobia were 4.51% and 6.05%, respectively. Multivariate analyses revealed that specific phobia was more common among younger age groups, women, and those who reported stressful life events but less common among foreign-born individuals. In addition, MDD was significantly related to lifetime specific phobia. Specific phobia was also significantly related to a lower health-related quality of life and two medical conditions.

CONCLUSION

Our prevalence rates of specific phobia in the elderly are at the lower end of the ranges identified in the previous studies. The correlation between specific phobia and MDD raises further questions about the nature of specific phobia in the elderly. This study supports the notion that specific phobia has a strong impact on the quality of life in old age.

Exposure to heights in a theme park: fear, dizziness, and body sway

Fear of heights results in the experience of dizziness and measurable body sway. We investigated the relationship between fear, dizziness, and body sway during height exposure 16 m above ground. Thirty five healthy participants stood on a force-plate to measure sway before, during, and after exposure and an ECG was recorded. Self-report measures were anticipated fear and dizziness before exposure, as well as actual fear and dizziness during the three situations. For all participants, fear, dizziness, and body sway were increased during exposure. Anticipated fear most reliably predicted body sway during exposure. In addition, persons scoring high on trait fear of heights anticipated and experienced more fear during exposure, but this relationship was not found for any objective measure. There was no evidence that vestibular function moderates the relationship between sub-clinical fear and body sway. The results underline the importance of cognitive factors, like anticipatory anxiety and overestimation of bodily symptoms, in fear of heights.

Psychophysiological reactions in dental phobic patients with direct vs. indirect fear acquisition

Dental phobic patients with reported traumatic experiences at onset of dental anxiety were compared to subjects with an indirect fear acquisition in their psychophysiological responses to video scenes showing dental procedures. It has been suggested that individuals with conditioned fear would respond with higher levels of physiological arousal in response to threat compared to subjects with indirect fear acquisition. Although the overall pattern indicates support for this hypothesis, subjects grouped on the basis of their reported fear-etiology did not statistically differ in recorded muscle tension, heart rate or skin conductance reactions to fear-provoking conditions.

Non-associative fear acquisition: a review of the evidence from retrospective and longitudinal research

It is axiomatic that the capacity to experience fear is adaptive, enabling rapid and energetic response to imminent threat or danger. Despite the generally accepted utility of functional fear, the nature of maladaptive fear remains controversial. There is still no consensus about how specific fears and phobias are acquired and modulated. Two major schools of thought are apparent: those suggesting dysfunctional fear arises largely as the result of associative-conditioning processes versus those who favour more biologically based etiological explanations. In this regard, the non-associative model of fear acquisition postulates the existence of a limited number of innate, evolutionary-relevant fears, while emphasising conditioning modes of onset for evolutionary-neutral fears. Recent retrospective and longitudinal studies have tested predictions from the non-associative model. In general, findings support non-associative hypotheses and are difficult to reconcile with neo-conditioning explanations of fear acquisition. These data suggest that four pathways to fear may provide the most parsimonious theory of fear etiology. The theoretical and practical implications of adding a fourth, non-associative path to Rachman's (Behav. Res. Ther. (1977) 15, 375-387) three 'associative' pathways are discussed. Unresolved issues requiring further investigation are considered.

Fears born and bred: toward a more inclusive theory of fear acquisition

Alleged differences between associative and non-associative perspectives are sometimes more apparent than real. The non-associative model describes a pathway to fear that is complementary to associative pathways. It does not seek to usurp conditioning models as applied to evolutionary-neutral fear. We discuss vexing definitional issues surrounding what qualifies as a conditioning event and what characterises the non-associative pathway. Genetic findings are shown to be consistent with the non-associative model of fear. Following discussion of the relation between stress-diathesis models and the non-associative position we conclude by urging a developmental, life-course approach to the understanding of fear acquisition.

Determinants of early- vs late-onset dental fear in a longitudinal-epidemiological study

A longitudinal investigation of risk factors for early- and late-onset dental fear was conducted. Early-onset dental fear was related to conditioning experiences (indexed via caries level and tooth loss), service use patterns, stress reactive personality and specific beliefs about health professionals. Late-onset dental fear was related to aversive conditioning experiences, irregular service use and an external locus of control. In contrast to recent findings for dental anxiety, personality factors were not strongly related to the onset of dental fear in young adulthood. The key role played by conditioning events in the development of both early- and late-onset dental fear was confirmed. Conditioning events appear to play a different role in the development of dental fear vs dental anxiety. This may reflect important, but largely ignored differences between these two closely-related constructs. Interventions for early-onset dental fear should aim to modify both the dental fear and the personality vulnerabilities that may contribute to the development of dental fear early in the life-course.