Anxiety disorder: specific phobia. Lesson objectives Learn what an anxiety disorder is, focusing on Specific Phobia Understand the biological contributing.

Anxiety disorder: specific phobia

Lesson objectives

• Learn what an anxiety disorder is, focusing on Specific Phobia• Understand the biological

contributing factors to phobias and the ways to manage phobias

Study design dot point

• application of a biopsychosocial framework to understanding ONE of the following four types of mental disorder and its management:

Anxiety disorder: specific phobia- biological contributing factors: role of the

stress response; role of the neurotransmitter gamma aminobutyric acid (GABA) in the management of phobic anxiety

Anxiety definition

• A state of physiological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or that something unpleasant is about to happen.

Anxiety disorder definition

• Describes a group of disorders that are characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect.

DSM-IV-TR anxiety disorders

• Agoraphobia without history of panic disorder• Panic disorder with/without agoraphobia• Specific phobia• Social phobia• Obsessive compulsive disorder• Post-traumatic stress disorder• Generalised anxiety disorder• Acute stress disorder• Anxiety disorder due to a general medical condition• Substance-induced anxiety disorder

Phobia definition

• An excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning.

Specific phobia definition

• A disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.

• The specific object/situation producing the fear is called the phobic stimulus.

Phobia activity

• Anunptaphobia: fear of staying single• Arachibutyrophobia: fear of peanut butter

sticking to the roof of the mouth• Hippopotomonstrosesquipped-aphiliophobia:

fear of long words• Keraunophobia: fear of lighting• Ornithophobia: fear of birds• Papaphobia: fear of the Pope• Pentheraphobia: fear of mother-in-laws• Quadrataphobia: fear of quadratic equations• Vuteuthindon: fear of picnics

http://www.youtube.com/watch?v=9rl7Lr6eDLc

• People with a specific phobia know that their level of fear is excessive or unreasonable.

• The fear is in excess of any real danger posed by the phobic stimulus.

Symptoms

• Elevated heart rate & blood pressure

• Hand tremors• Diarrhoea• Sweating• Shortness of breath• Dizziness• Feel like they have no

control over the situation

Exposure to phobic stimulus

Triggers involuntary anxiety response (similar to stress

response)

Can lead to panic attacks (unexpected

onset of intense anxiety that can last a few mins

> an hour)

DSM specific phobia categories

Categories Examples

Animal type

Situation type

Blood, injections and injury type

Natural environments type

Other phobias Choking, vomiting, loud noises, dying, costumed characters

Biopsychosocial framework applied to specific phobia and its management

Biological

factors

Psychological factors

Social factors

Biological factors

Contributing factors:• Role of stress

response• Dysfunctional

GABA system

Management:• Benzodiazepines• GABA supplement• Relaxation

response

Specific

phobia

Biological contributing factors

• Genetic predisposition – moderate level of heritability of anxiety disorders• Role of the stress response• Role of the brain’s neurochemistry

How does the stress response contribute to phobic anxiety?

• Fight-fight response activated• Accounts for phobic

symptoms such as sweating & palpitations• Dizziness due to increase

in ANS arousal then sudden drop in blood pressure

• Becomes problematic when the anxiety response is triggered when there is no real threat or danger

• For example, objects/situations that have little potential for harm • flowers (anthophobia) or clouds

(nephophobia)

• Anxiety remains until the exposure to the phobic stimulus is gone

Role of GABA

• Gamma-amino butyric acid (GABA)• = Primary inhibitory neurotransmitter• Inhibits firing of neurons• Maintains optimal level of

neurotransmission• Low levels of GABA leads to higher

levels of anxiety • Neurons are not stopped from

firingNOT THAT

GABBA…

Role of glutamate(GABA’s mate)

• Glutamate = primary excitatory neurotransmitter

• Makes neurons more likely to fire

• Both GABA and glutamate have important roles in arousal and therefore anxiety

Management of phobias

• Benzodiazepines: a group of drugs which are referred to as minor tranquillisers

• ADVANTAGE: Calm down the body by reducing physiological arousal and promoting relaxation

• DISADVANTAGE: induce drowsiness and are addictive

• Eg: Valium, Temazepam, Xanax etc

How do ‘benzos’ work?

Agonists• Imitate therefore

stimulate a neurotransmitter’s activity

• Benzos are GABA agonists

• Benzos have inhibitory effects on neurons which reduce the symptoms of anxiety

Antagonists

• Inhibit a neurotransmitter’s activity

• Reduce GABA function and increase anxiety symptoms

GABA/anxiety connection

• Researchers believe that some people develop anxiety because they have a dysfunctional GABA system • The result of failure to produce,

release or receive the correct amount of GABA that is needed to regulate neuronal transmission in the brain

GABA may be affected by:

• Genetic inheritance• Socio-cultural factors• Exposure to

prolonged stress• Exposure to

environmental toxins• Nutritional

deficiencies (vitamin B6 and citric acid, and high caffeine intake)

What can you do?• Proposals that GABA

levels can be increased “naturally” by:

• Drinking green tea• Eating foods “high in

GABA” (e.g. beans, dairy foods, eggs, seafoods and wholegrains)

• GABA supplements (although there is no significant research evidence that this works)

Review!

• Draw a flow chart to describe and explain how the stress response contributes to a phobic reaction