PHOBIAS – AN EXAMPLE OF AN ANXIETY DISORDER Health.

PHOBIAS – AN EXAMPLE OF AN ANXIETY DISORDER

Health

What is fear? What is anxiety? Fear - unpleasant feeling of anxiety or

apprehension caused by the presence or anticipation of danger

Anxiety -- feeling of worry: nervousness or

agitation, often about something that is going to happen

- PSYCHIATRY extreme apprehension: a medical condition marked by intense apprehension or fear of real or imagined danger

When does anxiety become a problem?

All people experience anxiety at some time.

It is a normal element of human existence.

However, anxiety can become a major problem with disturbing consequences.

What axis in DSM-IV-TR do anxiety disorders come under?

Anxiety disorders

Come under Axis 1 and are characterised by extreme apprehension, fear, stress and unease.

5 main types of anxiety disorder

1. Generalised

anxiety disorder

2. Post-traumatic

stress

3. Panic disorder

4.Obsessive-

compulsive disorder

5. Phobic disorder

OUR FOCU

S

What is a phobia?

A phobia is a persistent, irrational and intense fear of a particular object or event.

persistent - existing for an unpleasantly long

irrational - lacking in reason or logic intense - extreme in a way that can be felt

What cause simple phobias? After many years of extensive research into

the origin and maintenance of simple phobias, scientists came to an important conclusion - there is no simple explanation

Main factors are:- Biological- Genetic tendencies- Brain chemistry- Psychological- Sociocultural- Environmental

Subcategories of phobias

• Fear of other people• Fear of social

situation

Social Phobia

• Fear of leaving a familiar placeAgoraphobia

• One specific object/event

• e.g. – fear of heights

Simple phobia or Specific phobia

Four main types of simple phobia:

AnimalNatural

Environment

Situation PhobiasBlood - injection-injury phobia

Simple Phobias

Symptoms of phobic anxiety elevated heart rate & blood pressure tremor (shaking in hands) palpitations (abnormally fast heartbeats

that a person is aware of) diarrhoea sweating shortness of breath dizziness

Fear of clowns- symptoms

Watch the following You Tube video that explains the symptoms by someone suffering from a simple phobia.

http://www.youtube.com/watch?v=W2nK_qmvJ7A&feature=related

At what age to phobias start? Age of onset of simple phobias:- Animal 7 years- Blood 9 years- Dental 12 years- Claustrophobia 20 years- Social Before 20 years- Agoraphobia Late adolescence

early adulthoodMost simple phobias first appear at anytime, but particularly during

adolescence.

Biological factors & phobiasStress Response

• flight –or-flight response will occur when a person is frightened or highly stressed

GABA- found in 40% of all synaptic junctions.

•Low levels of the neurotransmitter GABA leads to higher levels of anxiety• Anti-anxiety drugs that mimic GABA’s inhibitory effects can help manage anxiety

Genetic predisposition and inherited vulnerabilities

• genetic vulnerability is expressed in a person’s personality; people who are nervous and apprehensive about objects and events are more likely to develop simple phobias and anxiety disorders

a substance that stops or slows a chemical reactionMicrosoft® Encarta® 2008. © 1993-2007 Microsoft Corporation. All rights reserved.

Inhibitory or agonist - a substance that stops or slows a chemical reaction.

Agonist is the opposite to antagonist

Theoretical approaches

Psychodynamic model

Behavioural model: classical conditioning and operant conditioning

Cognitive model

Psychodynamic model – p479 Oxford

Is based on the work of Freud.

States that the development of phobias is due to unresolved conflicts that arise during the phallic stage of a child’s development.

If a person is unable to deal with this conflict, their anxiety is displaced to a situation or object that is less relevant – e.g. in the case of Hans (see Oxford p480) a fear of horses.

Back to 3 theories

•Phallic stage - in psychoanalytic theory, relating to a stage of psychosexual development during which a young child's sexual feelings are concentrated on the genitals.•Oedipal & Electra complexes

Back

Behavioural Model: Classical and Operant Conditioning – p 481 Oxford

Focuses on observable behaviours and downplays cognition

Behaviours are learned through classical conditioning and maintained through operant conditioning

e.g. development of dentist phobia

Think about ‘Little Albert’ – draw a similar diagram to explain how his phobia developed & was maintained.Back to 3

theories

Dentist PhobiaClassical Conditioning – phobia develops

Before Conditioning

NS No ResponseUCS UCRpain from injection fear: due to pain from injection

During Conditioning

NS + UCS UCRdentist pain fear: due to pain from injection

After Conditioning

CS CRvisit to dentist fear: due to visit to dentist

Operant conditioning – phobia maintained

The avoidance of the unpleasant injection acts as a negative reinforcer the strengthens the likely hood of that behaviour being repeated.

Back

Cognitive Model

emphasises the influences of thought processes

is used to examine the distorted thinking process involved in the development

Argues that anxious individuals are more likely to exaggerate perceived threats, making then more likely to interpret some situations, objects or activities as more dangerous than the average person would

Treatments for simple phobias1. Cognitive behaviour therapy (CBT): p482 Oxford

- uses a combination of verbal and behaviour modification to help people change their thinking

- focuses on the person to change negative thoughts (flies can kill me) to more positive ones (flies are unpleasant but they won’t hurt me if I am careful).

- person is encouraged to recognise that the likelihood of their perceived events happening in real life is very small.

- often combined with relaxation to treat a wide range of phobias; click on feather to view video about CBT.

Treatments for simple phobias2. Systematic desensitisation

- based on the idea that most anxiety responses are initially required through classical conditioning, therefore getting rid of a phobia can be achieved through counter conditioning

Steps involved1. Therapist helps client build an anxiety/fear

hierarchy2. Therapist trains the client in deep muscle

relaxation3. Client tries to work through the hierarchy,

learning to remain relaxed; repeat until person can imagine situation/object with no anxiety.

Systematic desensitisation:

Click me to view a video

about systematic

desensitisation.

Treatment of phobias

3. Flooding- based on the idea that phobias are learnt

through classical conditioning- occurs when the client is exposed to feared

stimulus all at once for long periods of time- helps the client to replace feelings of

anxiety/fear with feelings of relaxation- although effective, is not suitable for

everyone and can increase rather than decrease their phobia.

- http://www.youtube.com/watch?v=DkaeVrs7-ZA&feature=relmfu

Sociocultural factors & phobias Social and cultural factors can contribute to the

type and incidence (the rate of occurrence) of simple phobia.

e.g. A child whose parents suffer a phobia of moths is more likely to develop the same or similar phobia.

Some phobias are culturally specific. e.g. taijin kyofusho, a social phobia that appears

almost exclusively in Japan. This is a fear of offending or harming others in social situations. It is different from a traditional social phobia, in which the sufferer is afraid of being personally embarrassed on humiliated.

Sociocultural factors & phobias: cont

Parental modelling can lead to the transmission of threat information which is incorporated into a child’s LTM and phobia can develop

i.e. children who are exposed to parents with phobic responses are more likely to develop comparable fears to similar stimuli

Biopsychosocial Approach

Health professionals take a holistic approach to treating simple phobias and consider the following factors- genetic vulnerability- physiological processes- psychological determinants- family history of anxiety and simple phobia- environmental influences- symptoms and whether the person can function

effectively at work, home and socially.

Example of factors considered

Biological – has the person been born with

an easily startled

personality

Sociocultural – has the

person learnt to fear

something by observing other family

members

Psychological – has the

person overestimat

ed the perceived level of danger

Combining all the factors

Biological, psychological and social-environmental factors must be considered when treating simple phobias

Step 1 - Full understanding of all the elements needed

Step 2- determine which therapy or combination of therapies is suitable (e.g. CBT, Systematic desensitisation or flooding)

Step 3 – determine if anti-anxiety medication is also needed