Anxiety, Affective Anxiety, Affective Disturbance and Disturbance and

BehaviorBehavior

Art Maerlender, Ph.D.Dartmouth Medical

SchoolClinical School Services and Learning Disorders Program

Section of Child and Adolescent Psychiatry

Concept:Concept:

In children, affect dysregulation is displayed through behavior

o It is an important signal

Question:Question:

How should adults understand and respond to behavioral displays?

Application:Application:

Assume the behavior displayed is a signal about the child, not about the adult or relationship

o I.e., that the behavior is “manipulation”o While in the end, this might be true, it

is safest and best for the child (as in respectful) to start by assuming otherwise.

Primary Assumptions

Our hypothesis is that children’s behavior is a reflection of their internal physiological and affective states NOT their cognitions. 

Further, assuming this, it becomes helpful to read their behavior as signals reflecting mood and/or health.

   In short, anxiety reflects difficulty resolving internal

conflicts, both of which typically involve a ‘desire’ (need, interest) in achieving incompatible goals.

Caveat

 the neurology of behavior is EXTREMELY complex

Interactions among many levels of influence Biology & genetics Reinforcement histories Environmental stimulation, enrichment,

deprivation 20 minutes does not do service to this

complexity

AnxietyAnxiety

Is a necessary biological process used by the organism to help it monitor the environment and attend to appropriate stimuli in effective ways

Anxiety

The anxiety system is related to attention, as “attention” to stimuli is the first stage of the anxiety system

Anxiety

What we term clinical anxiety is the ineffective response to stimuli (which may be appropriate or inappropriate)

But the ‘clinical’ aspect of anxiety arises when the system responsible is activated to a degree that behavior becomes dysfunctional.

Anxiety

is a RED FLAG that something is amiss Either in the external environment Or the internal environment

Anxiety is a signal

Physiological Behavioral Cognitive  

Anxiety Warns of:

Punishment Non-reward Novelty Innate anxiety

  These are stimuli that are warnings of potential negative affective events

 

The function of anxiety & the function of the anxiety

‘system’ Response to stimuli that warn of potential negative affective events

Response to stimuli that Warn of punishment Warn of non-reward Are novel Innately anxiety provoking

Anxiety Engages the Anxiety Engages the Behavioral Inhibition Behavioral Inhibition

SystemSystem

Inhibits ongoing behavior

Increases attention to environmental stimuli

Increases levels of arousal

The Behavioral Inhibition System:The Behavioral Inhibition System:mediates responses to any stimuli that

generates competing goals

BIS

Conflict Generation Conflict Resolution

Signals of punishment

Signals of non-reward

Novel stimuli

Innate fear stimuli

Behavioral inhibition

Increased arousal

Increased attention

In addition…

These are signals related to events or objects in which the organism has some

reason to approach.

Fear Vs AnxietyForms of behavior, not stimuliDifferent forms are appropriate at different

distances (cat & rat studies)Actual or potential presence as the

distinguishing factor Does the behavior remove the animal from or

facilitate entry into a dangerous situation? Active or passive avoidance Fear is active avoidance Anxiety is passive avoidance and related to

approach needs

Thus, it is evaluation of stimuli that becomes critical-

In humans this suggests a high level of cognitive appraisal

  

Ambiguity

The ambiguity of the situation makes evaluation difficult

And results in anxiety.

Behavioral Inhibition System (BIS)

Outputs of BIS  Inhibit ongoing behavior Increase attention to the environment Increase arousal level

Relation of neurology to behavioral responses related

to anxiety

Brainstem > panic

Limbic system > anxiety

Frontal > cognitions/behaviors

(obsessions/compulsions)

 

The Septo-Hippocampal System

A comparator system Compares currently primed goals

with each other And with ‘expectations’

‘‘Individual goals’Individual goals’ are defined as comprising:

stimuli to a which a response can be addressed;

the responses are available and expected

and there are motor programs (plans) which

can achieve the goal.

 

When no conflict is present, the S-H system is monitoring and receiving info

Processed sensory info Programming responses Comparator – just checking –

status Single cell recording show much

activity

 

When conflict between goals

Either Unpredicted events occur predicted events don’t occur equal incompatible tendencies:

approach – avoidance approach – approach avoid – avoid

 

Conflict causes the system to enter ‘control mode’

BIS interrupts behavior addressed to current prepotent goal

Stimuli associated with goal are tagged as ‘faulty’ and inspected

 Feedback in the system:

The S-H system sends feedback to other systems about the tagged stimuli that allow the other systems to increase the affective valence and take control of behavior when the signal next occurs

 

S-H reduces conflict within the organism

Amygdala becomes involved in situations of specific defensive conflict

  Panic, phobias, obsessions and

compulsions are not properly anxiety, but reactions to anxiety.

Features of human anxietyFeatures of human anxiety

Apprehension of possibility failure or loss of reward (not anticipation of pain)

Conflict between 2 goal states Avoid and approach

The role of the hippocampus

Gray (00) posits that it is suppressor of undesirable computations in other structures.

It serves as a ‘comparator’ based on: assessment of current state of the world

based on perceptual input current motor programs memory stores

Computes a prediction as to next likely state of the world

Hippocampus

The role of the septum

The septum is a nucleus in the limbic system which regulates anger and pleasure. Experiments with rats show that when the septum is activated, reactions can be extremely strong

Controls theta rhythm Has role in seratonin discharge

Septum

Septum

Limbic Structures: Septum, Amygdala, Hippocampus

Role of the hierarchical defense system in anxiety disorders

All parts receive both fast, poorly digested sensory info: “dirty” Slow, well digested sensory info: “sophisticated” Lowest level is most basic response:

o Panic Progressively higher levels - more

anticipatory reaction Activity is distributed across parts

simultaneously

Hierarchical defense system and anxiety

Anterior OCDCingulate

Amygdal Phobia-avoid GAD- arousal

Medial Hyp. Phobia- escape

Periaq. Gray Panic- escape

Active avoidance Passive avoidanceDefensive distance

Septo-Hipp. GAD Sys. cognition

Post. Cingulate GAD cognition

Prefrontal- OCD?.Ventral

Post. Cingulate GAD drug resistant

dirty sophisticated

Threat Stimuli p295

actual potential

avoidable unavoidable

flee fight freeze

fear anger panic

Phobiaamygdala medial

hyp.

Panicperiaq gray

avoidable unavoidable

assessdetectable

anticipateundetectable

conserve

anxiety obsession depression

GADSHS

OCDcingulate

DepressionNA/5HT

*

*

*nature of stimuli, relation to fx , emotion , psychological disorder, principal neural system

Take home messages

Children’s behavior is more likely due to internal processes than overt cognitive planning;

Anxiety is produced in approach situations (kid’s want to do well)

Anxiety is based on the internal perception of the threat, based on the learning history and available resources

Problem behavior is often a signal that tasks are too difficult

When in doubt, ask.