10B- evidence based interventions and their use for specific phobia Flashcards
evidence based interventions
a treatment shown to be effective in valid and reliable research studies
biological intervention
a treatment targeting physiological mechanisms believed to contribute to a condition
benzodiazepine
a type of agonist drug that works on the central nervous system to make the post-synaptic neuron less likely to fire, which regulates anxiety
A GABA agonist, i.e., mimicking GABA
agonist
a type of drug that mimics the action of a neurotransmitter that binds to the same receptor by stopping the presynaptic neuron from firing
hyperventilation
rapid, shallow breathing
Commonly followed by change in blood oxygen.
Can lead to further distress.
breathing retraining
an anxiety management technique that involves teaching someone with a specific phobia how to control their breathing in the presence of their phobic stimulus
psychological intervention
treatment that uses activities such as psychotherapy to modify thoughts, feelings and behaviours
psychotherapy
any talking therapy designed to help people with a broad range of mental health issues
cognitive behavioural therapy
a common intervention consisting of a range of cognitive and behavioural therapies and learning principles to help people identify and change unhelpful thought processes, feelings and behaviours to more helpful ones
systematic desensitisation
a method for treating phobias in which the phobic stimulus is progressively introduced while the person uses relaxation techniques
until their fear is replaced by
a relaxation response
relaxation technique
any method or procedure that helps to induce a physiological and psychological relaxation response
fear hierarchy
a list of anxiety- inducing experiences relating to the patient’s phobia, in order from easiest to confront, to the most difficult to confront
social intervention
an intervention designed to increase social support for people with a mental illness
psycho-education
educating people diagnosed with mental health conditions and their family members about the disorder
and possible treatment options
what are some biological treatments for phobias
GABA agonists
breathing retraining
what are some social treatments for phobias
psychoeducation
what are some psychological treatments for phobias
systematic desensitisation
CBT
how can GABA agonists assist in reducing a phobia
benzodiazepine mimics GABA function and increases its inhibitory effects. this makes the post synaptic neuron less likely to fire, reducing feelings of anxiety making them effective
what are some side effects of benzodiazepine
reduce alertness
reduce coordination and reaction time
increase risk of accidents
lower inhibitions so they can make some people more impulsive
addictive
why are benzodiazepines prescribed for a short period of time
they can be addictive over long periods of time, and if people suddenly stop taking them, anxiety, agitation and insomnia may return, with sensory disturbances and sometimes seizures
what is the impact of hyperventilation on the experience of anxiety
facing a phobic → hyperventilation → oxygen and carbon dioxide imbalances in the blood → dizziness, light headedness, blurred vision and pins and needles → heightened anxiety → facing a phobic stimulus
While hyperventilation is associated with a change in blood pressure, whether it increases or decreases is subjective. Either way, dizziness, lightheadedness etc. will still follow.
what is a biological occurence during encountering a phobic stimulus
individuals may experience abnormal breathing patterns, with rapid, small, shallow breaths- hyperventilation resulting in CO2 and O2 imbalances in the blood.
what happens when carbon dioxide levels become too low?
dizziness, light headedness, blurred vision, pins and needles.
these turn into heightened anxiety
what is breathing retraining
an anxiety management technique where individuals learn how to control their breathing in the presence of their phobic stimulus
what occurs when a person can control their breathing again
the balance of oxygen and carbon dioxide restabilises, helping to control heart rate and respiration, lower stress hormones and increase feelings of calm and control
why must breathing retraining be well practiced
it must be practiced in the absence of the phobic stimulus too, to make it a habit that can be used when experiencing anxiety
what is a limitation of GABA agonists
they have side effects, dependency and drowsiness can occur. furthermore, it cannot be taken by pregnant women or women who want to become pregnant, limiting treatment options
what is a limitation to breathing retraining
changing something as automatic as a breathing pattern requires much effort and patience.
what are the 2 main steps of breathing retraining
- a therapist or doctor will teach a person with a specific phobia how to consciously control their breathing
- the learner applies the learned breathing techniques when in the presence of the phobic stimulus. this restores the amount of oxygen in the body to an optimal level through parasympathetic responses, reducing sympathetic responses and anxiety
what are some cognitions that can contribute to and perpetuate a phobia
memory bias
catastrophic thinking
a belief that the phobia cannot be overcome and will only get worse
embarrassment
extreme fear
what are some behaviours that contribute to and perpetuate a phobia
avoidance behaviours
biological stress response
not seeking help
avoiding social activities
what does the cognitive component of CBT relate to
Aims to change a person’s irrational or negative way of thinking so they can better cope with the way they process information about their phobic stimulus.
This irrational thought may be helped by helping the person identify their negative or unhelpful thoughts, carefully examine each thought and then to evaluate how realistic or helpful it is
what does the behavioural component of CBT relate to
The behavioural component of CBT commonly involves using behavioural strategies that will help to reduce the anxiety that the patient has regarding the phobic stimulus.
what does CBT centre around
our thoughts affect how we feel and behave
behaviours affect how we think and feel
feelings affect how we think and behave
what are some limitations of CBT
it can be difficult to practically address as avoidance behaviours tend to perpetuate specific phobias, negatively reinforcing their behaviour. as such, these behaviours are so strongly entrenched in patients that undoing the connection can be difficult, and may take longer than expected to start showing progression
what is systematic desensitisation
Systematic Desensitisation involves progressively exposing the client to increasingly similar stimuli (as the CS) to gradually desensitise them to the CS itself, such that the CS no longer produces the phobic fear response.
what are the 4 main steps of systematic desensitisation
learning relaxation techniques
development of a fear hierarchy
gradual exposure to fear stimulation
continuation of this systematic exposure
what is the aim of systematic desensitisation
The aim is to disassociate the phobic stimulus from the fear response, or associate the phobic CS with a response of relaxation rather than fear.
how can relaxation techniques be used
a therapist may treat a patient a technique they can apply to reduce the physiological arousal and anxiety involved in a fear response. this may involve breathing retraining, progressive muscle relaxation or visual imagery
what is the aim of fear hierarchies
in breaking down and creating a list of anxiety inducing experiences relating to the patients phobia and listing them in order of easiest to hardest to confront. they can slowly make their way through the hierarchy
how can gradual exposure to a fear stimulus be beneficial
They are exposed to the least-frightening fear on the fear hierarchy while using a relaxation technique to control the fear response. This is repeated until the stimulus no longer produces a fear response, but instead produces a relaxation response. best results occur through real life exposure
why is it important to continue systematic exposure
it is important to list items on the fear hierarchy until the most fear inducing stimulus can be faced without producing the phobic response
what are some limitations to systematic desensitisation
even an approximation of their phobic stimulus is enough to cause them distress and negative emotions - particularly as the nature of their fear is intense and irrational.
time consuming as different patients may show progress on varying timeframes - depending on the severity of their specific phobia.
frustrated with the slow progressing nature of this treatment and choose to withdraw or give up half-way.
how can psychoeducation be used to reduce specific phobia
psychoeducation is based on the idea that patients who are well informed about their condition can cope more effectively, improving awareness and coping more effectively
what are the main goals of psychoeducation
challenging unrealistic or anxious thoughts and not encouraging avoidance behaviours
why is it important to challenge unrealistic and anxious thoughts
members of the community can help the patient deal with the actual nature of their automatically negative and catastrophic thinking. practically breaking them down and increasing the reasoning behind the can help them to understand there is no major danger
how can we discouraged avoidance behaviours
through modelling approach behaviours
explicitly teach the patient that their fear is irrational
what are some limitations of psychoeducation
relies on support provided from community members and supporters. they need to be on board for it to work
if they have a deep stigma, it can be difficult to change their views and the struggle in transforming their mindsets can cause more stress and worry
individuals have low levels of control or influence regarding how well psychoeducation works due to limited evidence based intervention
What are the underlying assumptions of cognitive behavioural therapy?
Most people with a specific phobia have cognitive biases and excessive behavioural reactions to fear or anxiety producing stimuli. Cognitive behavioural therapy (CBT) is a type of psychotherapy that combines cognitive and behavioural therapies to help people change unhealthy thought processes, feelings and behaviours. CBT is used to change thoughts and behaviours that perpetuate the phobia and to improve coping skills.
Outline how cognitive behavioural therapy can be used to overcome a phobia.
For example, a person has a phobia of birds.
In the cognitive component of the intervention, the psychologist would have the person identify their fear-related (unhelpful/unreasonable) thoughts about birds, e.g. ‘All birds are going to attack me’. The psychologist would then encourage the person to challenge these thoughts, which should help them to replace their unhelpful thoughts with more reasonable ones, e.g. ‘It is unlikely that all birds are going to attack me’.
In the behavioural component, the psychologist would help the person modify their maladaptive behaviour (avoiding birds) by introducing behavioural strategies, e.g. teaching them to use relaxation techniques such as deep breathing to reduce their anxiety when in a situation where birds are present.
What is systematic desensitisation?
Systematic desensitisation involves progressively introducing a person to their phobic stimulus while using relaxation techniques until their fear is replaced by a relaxation response.
Explain why systematic desensitisation is effective in managing a specific phobia.
Phobic associations are sometimes so strong and well established that they persist for a long time and are difficult to extinguish unless there is intervention. This has led psychologists to apply classical conditioning processes, in which an individual’s conditioned fear response is reconditioned and replaced with a relaxation response.
Provide an example of a fear hierarchy that might be used in systematic desensitisation.
View pictures of dogs.
View videos of little, fluffy dogs.
View videos of police dogs.
Go to a dog rescue centre and view dogs in pens.
Pat a dog on a leash.
Pat a small dog off leash.
Pat a large dog off leash.
Outline how systematic desensitisation can be used to overcome a phobia.
- Relaxation is taught before the individual is exposed to any stimuli. This may include breathing retraining, progressive muscle relaxation and/or visual imagery.
- The therapist will work with the client to ‘break down’ then organise the anxiety- or fear- producing situation into a hierarchy of increasingly difficult encounters. For example, if a person has a fear of flying in aeroplanes, the therapist could ask them to describe the most frightening part of flying, the second most frightening, the next most frightening and so on. The therapist then arranges these in order from least frightening to most frightening.
- The person is exposed step by step to each of the fear-producing situations, starting with the least frightening. Fear-inducing stimuli are progressively paired with relaxation techniques (breathing relaxation or progressive muscle relaxation) to control fear. Repeated associations occur until stimuli no longer elicit fear.
What is psychoeducation?
Psychoeducation involves providing and explaining information about a mental disorder to someone diagnosed with the disorder and their families and support networks to increase their understanding of the disorder and possible treatment options.
What are the underlying assumptions of psychoeducation?
Increased understanding of symptoms, treatment options, services available and recovery patterns enables people with mental disorders to cope more effectively.
Educating someone’s support network about the characteristics and symptoms of a mental disorder, reduces stigma associated with the disorder.
Explain how family members of someone with a specific phobia can challenge unrealistic or anxious thoughts and not encourage avoidance behaviours to help manage the phobia.
Members of an individual’s support network can ask questions to help highlight and challenge unhelpful thoughts, such as ‘What’s the probability of a bird attacking you happening?’
Members of an individual’s support network should not criticise the behaviour; instead they should encourage more adaptive alternatives and/or gradually expose the person to the phobic stimulus in a safe manner. For example, the support network of person who is scared of bees can calmly encourage them to go outside for a few minutes each day.
What are benzodiazepines?
Benzodiazepines are GABA agonist drugs that enhance the action of the neurotransmitter GABA when it binds to its receptor on the post-synaptic neuron.
Explain how benzodiazepines are used to manage the symptoms of a phobia.
Benzodiazepines enhance the activity of GABA and prevent the post-synaptic neurons from firing (i.e. enhance inhibitory effects of GABA). By reducing the activity of the neurons, it reduces the anxiety that a person feels when exposed to the phobic stimuli.
Outline two limitations of using benzodiazepines to treat phobic anxiety.
can promote dependency over the long term, highly addictive
only treats symptoms, not underlying causes (so is not a long-term ‘solution’)
does not teach any non-drug-dependent coping skills for the phobia
reduces alertness, causes drowsiness, slower reaction times, which can be dangerous when driving or operating machinery
can lower inhibitions and increase impulsiveness or risk-taking behaviour
is dangerous when mixed with alcohol or other depressants
Explain why breathing retraining is a useful intervention for specific phobia.
Breathing retraining is a useful intervention because the individual is taught the intervention while in therapy and then a person can use their correct breathing technique by themselves in any setting (not just the therapist’s office) when required.
Outline how breathing retraining is used to manage specific phobia.
Breathing is often fast and shallow during a phobic response, which can lead to activation of the sympathetic nervous system in anxiety, causing increase breathing/increasing heart/respiration. Breathing retraining involves teaching an individual to consciously control their breath (by taking slow, deep inhalations and exhalations through the nose/diaphragm breathing) when experiencing fear. Breathing retraining acts to reduce physiological arousal associated with the phobic response to restore the balance of oxygen and carbon dioxide.
Compare and contrast cognitive behavioural therapy and psychoeducation.
Similarity (one of):
Both work to reduce maladaptive thoughts and change them to more realistic ones.
Both work to reduce avoidance behaviours.
Difference (one of):
CBT involves the help of a therapist whereas psychoeducation involves the help of the support network.
CBT is a psychological intervention whereas psychoeducation is a social intervention.
