Friday, 9 September 2011

Threat Avoidance and Fear of Fear

When I was a undergrad student of psychology at University College Cork, my future PhD supervisor, Dermot Barnes-Holmes, I think, assigned me a paper to read as part of one of my classes in "abnormal" psychology. It was A Re-Analysis of Agoraphobia by Goldstein and Chambless, which was published in Behavior Therapy, 1978.

In it, the authors introduced the concept of "fear of fear" in which people diagnosed with agoraphobia become fearful, and show avoidance of, the very thought of going outside. That is, it's not the actual going outside that is fearful, it's the thought of it. As a result, people with this diagnosis develop elaborate ways of reducing the impact of this fear, largely through cognitive avoidance and distraction. What becomes a priority for such individuals is the removal of fear, or the avoidance of fear; hence, fear of fear.

That paper made quite an impact on me, but it wasn't until many years later that I was able to undertake an experimental investigation of some of these fear and avoidance processes. 

My colleagues and students and I have just published a paper in Behaviour Research & Therapy that, we believe, gets at some of these processes. In it, we showed how a relatively simple response that avoids or prevents something bad from happening may spread or transfer through indirectly related stimuli. 

This, we argue, resembles a lot of what goes on when we avoid things, people and events that we have never previously had anything bad happen in the presence of. I say "we" because such processes are the staple diet of language-able humans; no diagnosis is needed to show this behaviour. We all do it, so much so that one leading account of human psychopathology, one of the "third wave" behaviour therapies, Acceptance & Commitment Therapy (ACT), claims that it is an integral part of being human.

Here's the Abstract:
Symbolic generalization of avoidance may underlie the aetiology and maintenance of anxiety disorders. The aim of the present study was to demonstrate inferred threat-avoidance and safety (non-avoidance) behaviours that occur in the presence of stimuli indirectly related to learned threat and safety cues. A laboratory experiment was conducted involving two symbolic stimulus equivalence relations consisting of three physically dissimilar stimuli (avoidance cues: AV1-AV2-AV3 and neutral cues: N1-N2-N3). During avoidance learning involving aversive images and sounds, a key-press avoidance response was trained for one member of one of the relations (AV2) and non-avoidance for another (N2). Inferred threat and safety behaviour and ratings of the likelihood of aversive events were tested with presentations of all remaining stimuli. Findings showed a significantly high percentage of avoidance to both the learned and inferred threat cues and less avoidance to both the learned and inferred safety cues. Ratings in the absence of avoidance were high during training and testing to threat cues and low to safety cues and were generally lower in the presence of avoidance. Implications for associative and behavioural accounts of avoidance, and modern therapies for anxiety disorders are discussed.

You can read the pdf here.

Dymond, S., Schlund, M. W., Roche, B., Whelan, R., Richards, J., & Davies, C. (2011). Inferred threat and safety: Symbolic generalization of human avoidance learning. Behaviour Research and Therapy, 49, 614-621. doi:10.1016/j.brat.2011.06.007