10B- evidence based interventions and their use for specific phobia

Question 1

evidence based interventions

Answer 1

a treatment shown to be effective in valid and reliable research studies

Question 2

biological intervention

Answer 2

a treatment targeting physiological mechanisms believed to contribute to a condition

Question 3

benzodiazepine

Answer 3

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

Question 4

agonist

Answer 4

a type of drug that mimics the action of a neurotransmitter that binds to the same receptor by stopping the presynaptic neuron from firing

Question 5

hyperventilation

Answer 5

rapid, shallow breathing

Commonly followed by change in blood oxygen.

Can lead to further distress.

Question 6

breathing retraining

Answer 6

an anxiety management technique that involves teaching someone with a specific phobia how to control their breathing in the presence of their phobic stimulus

Question 7

psychological intervention

Answer 7

treatment that uses activities such as psychotherapy to modify thoughts, feelings and behaviours

Question 8

psychotherapy

Answer 8

any talking therapy designed to help people with a broad range of mental health issues

Question 9

cognitive behavioural therapy

Answer 9

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

Question 10

systematic desensitisation

Answer 10

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

Question 11

relaxation technique

Answer 11

any method or procedure that helps to induce a physiological and psychological relaxation response

Question 12

fear hierarchy

Answer 12

a list of anxiety- inducing experiences relating to the patient’s phobia, in order from easiest to confront, to the most difficult to confront

Question 13

social intervention

Answer 13

an intervention designed to increase social support for people with a mental illness

Question 14

psycho-education

Answer 14

educating people diagnosed with mental health conditions and their family members about the disorder
and possible treatment options

Question 15

what are some biological treatments for phobias

Answer 15

GABA agonists
breathing retraining

Question 16

what are some social treatments for phobias

Answer 16

psychoeducation

Question 17

what are some psychological treatments for phobias

Answer 17

systematic desensitisation
CBT

Question 18

how can GABA agonists assist in reducing a phobia

Answer 18

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

Question 19

what are some side effects of benzodiazepine

Answer 19

reduce alertness
reduce coordination and reaction time
increase risk of accidents
lower inhibitions so they can make some people more impulsive
addictive

Question 20

why are benzodiazepines prescribed for a short period of time

Answer 20

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

Question 21

what is the impact of hyperventilation on the experience of anxiety

Answer 21

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.

Question 22

what is a biological occurence during encountering a phobic stimulus

Answer 22

individuals may experience abnormal breathing patterns, with rapid, small, shallow breaths- hyperventilation resulting in CO2 and O2 imbalances in the blood.

Question 23

what happens when carbon dioxide levels become too low?

Answer 23

dizziness, light headedness, blurred vision, pins and needles.
these turn into heightened anxiety

Question 24

what is breathing retraining

Answer 24

an anxiety management technique where individuals learn how to control their breathing in the presence of their phobic stimulus

Question 25

what occurs when a person can control their breathing again

Answer 25

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

Question 26

why must breathing retraining be well practiced

Answer 26

it must be practiced in the absence of the phobic stimulus too, to make it a habit that can be used when experiencing anxiety

Question 27

what is a limitation of GABA agonists

Answer 27

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

Question 28

what is a limitation to breathing retraining

Answer 28

changing something as automatic as a breathing pattern requires much effort and patience.

Question 29

what are the 2 main steps of breathing retraining

Answer 29

1. a therapist or doctor will teach a person with a specific phobia how to consciously control their breathing
2. 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

Question 30

what are some cognitions that can contribute to and perpetuate a phobia

Answer 30

memory bias
catastrophic thinking
a belief that the phobia cannot be overcome and will only get worse
embarrassment
extreme fear

Question 31

what are some behaviours that contribute to and perpetuate a phobia

Answer 31

avoidance behaviours
biological stress response
not seeking help
avoiding social activities

Question 32

what does the cognitive component of CBT relate to

Answer 32

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

Question 33

what does the behavioural component of CBT relate to

Answer 33

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.

Question 34

what does CBT centre around

Answer 34

our thoughts affect how we feel and behave
behaviours affect how we think and feel
feelings affect how we think and behave

Question 35

what are some limitations of CBT

Answer 35

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

Question 36

what is systematic desensitisation

Answer 36

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.

Question 37

what are the 4 main steps of systematic desensitisation

Answer 37

learning relaxation techniques
development of a fear hierarchy
gradual exposure to fear stimulation
continuation of this systematic exposure

Question 38

what is the aim of systematic desensitisation

Answer 38

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.

Question 39

how can relaxation techniques be used

Answer 39

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

Question 40

what is the aim of fear hierarchies

Answer 40

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

Question 41

how can gradual exposure to a fear stimulus be beneficial

Answer 41

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

Question 42

why is it important to continue systematic exposure

Answer 42

it is important to list items on the fear hierarchy until the most fear inducing stimulus can be faced without producing the phobic response

Question 43

what are some limitations to systematic desensitisation

Answer 43

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.

Question 44

how can psychoeducation be used to reduce specific phobia

Answer 44

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

Question 45

what are the main goals of psychoeducation

Answer 45

challenging unrealistic or anxious thoughts and not encouraging avoidance behaviours

Question 46

why is it important to challenge unrealistic and anxious thoughts

Answer 46

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

Question 47

how can we discouraged avoidance behaviours

Answer 47

through modelling approach behaviours
explicitly teach the patient that their fear is irrational

Question 48

what are some limitations of psychoeducation

Answer 48

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

Question 49

What are the underlying assumptions of cognitive behavioural therapy?

Answer 49

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.

Question 50

Outline how cognitive behavioural therapy can be used to overcome a phobia.

Answer 50

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.

Question 51

What is systematic desensitisation?

Answer 51

Systematic desensitisation involves progressively introducing a person to their phobic stimulus while using relaxation techniques until their fear is replaced by a relaxation response.

Question 52

Explain why systematic desensitisation is effective in managing a specific phobia.

Answer 52

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.

Question 53

Provide an example of a fear hierarchy that might be used in systematic desensitisation.

Answer 53

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.

Question 54

Outline how systematic desensitisation can be used to overcome a phobia.

Answer 54

1. Relaxation is taught before the individual is exposed to any stimuli. This may include breathing retraining, progressive muscle relaxation and/or visual imagery.
2. 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.
3. 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.

Question 55

What is psychoeducation?

Answer 55

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.

Question 56

What are the underlying assumptions of psychoeducation?

Answer 56

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.

Question 57

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.

Answer 57

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.

Question 58

What are benzodiazepines?

Answer 58

Benzodiazepines are GABA agonist drugs that enhance the action of the neurotransmitter GABA when it binds to its receptor on the post-synaptic neuron.

Question 59

Explain how benzodiazepines are used to manage the symptoms of a phobia.

Answer 59

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.

Question 60

Outline two limitations of using benzodiazepines to treat phobic anxiety.

Answer 60

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

Question 61

Explain why breathing retraining is a useful intervention for specific phobia.

Answer 61

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.

Question 62

Outline how breathing retraining is used to manage specific phobia.

Answer 62

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.

Question 63

Compare and contrast cognitive behavioural therapy and psychoeducation.

Answer 63

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.