Anxiety Disorders: Specific and Social Phobia

Question 1

1. Prevalence of Anxiety disorders
2. True/False: a) consistent across cultures, b) learning principles are seen here
3. cost of anxiety disorders
4. comorbidities

Answer 1

1. -most common for women, second most for men
   - 18% one year prevalence US (22% of these are severe)
2. a) true b) true
3. costly: $15 billion/year
4. lots of comorbidities:
   - depression, substance abuse, eating disorders, other anxiety disorders
   - diseases such as cancer, heart disease, high IBS, thyroid, high blood pressure, migraines

Question 2

Fear vs. Anxiety

Answer 2

Fear

• basic emotion
• flight or fight response
• specific imminent threat

Anxiety

• complex blend of unpleasant emotions and thoughts
• more general, future oriented

Both can be adaptive - fear causes us to be active. anxiety causes us to be proactive

Question 3

Specific Phobia

Answer 3

• marked by fear or anxiety about a specific object or situation
• the phobic object or situation almost always provokes immediate fear or anxiety
• the phobic object or situation is actively avoided or endured with intense fear or anxiety
• the fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
• the fear, anxiety, or avoidance is persistent, >6 months
• fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• disturbance is not better explained by another disorder

Question 4

Subtypes of Phobias

Answer 4

• animal
• natural environment
• blood/injection/injury
• situational (ex claustrophobia, flying, bridges)
• other (ex choking, vomiting)

Question 5

Behaviors in Relation to Phobia

Answer 5

=often avoid thinking about or being around the feared stimuli
=anxiety causes you to feel as if you are going to pass out, but you don’t
-except in blood-injection-injury subtype where people do faint
=phobic behavior is reinforced after avoidance reduces anxiety - operant conditioning
-reduction of anxiety reinforces the avoidance response

Question 6

Prevalence and Age of Onset for Specific Phobias

Answer 6

-12% lifetime prevalence
-more common in women
=age of onset varies
-animal subtype - onset in childhood

Question 7

Etiology of Specific Phobias

Answer 7

=Freud/psychodynamic theory has been largely discounted for phobias
=phobias as learned behavior
-classical conditioning
-vicarious conditioning

Question 8

Classical Conditioning of a Phobia Example

Answer 8

• US: pain
• UR: anxiety
• CS: dentist office
• CR: anxiety
• Result: Phobia (BII type)

Question 9

Vicarious Conditioning of a Phobia

Answer 9

=seeing someone else who is fearful
=happens in animals
- rhesus monkeys raised in captivity learned fear of snakes from watching a video of a monkey afraid of snakes - influence of media on people?
=don’t want to have to learn after you get bitten that snakes bite and you should fear them

Question 10

Protective Factors for Phobia

Answer 10

• observed non fearful behaviors from others - a parent is smiling and saying its ok
• multiple preceding positive experiences will prevent a phobia from occurring after a negative experience

Question 11

Risk Factors for Phobia

Answer 11

=escaped and uncontrollable stress
- could not get out of a bad situation
- ex claustrophobia from being stuck in a well as a child
=later information saying that the situation was much worse than you originally believed
-ex “you are lucky to be alive!”
=cognitive bias to be on the look out for threatening stimuli and to perceived feared events as being more likely than they are

Question 12

Biological Risk Factors for Phobias

Answer 12

=there is a modest genetic component to phobia
=serotonin transporter gene - carry the allele for heightened neuroticism, show superior fear conditioning
=behaviorally inhibited temperament - excessively timid and distressed

Question 13

Treatment for Specific Phobias

Answer 13

=Exposure therapy
-gradually expose yourself to the feared stimuli
-may include participant modeling or virtual reality
-hierarchy of feared stimuli - start with tolerable activity and work up - stay at a stage until that stimuli does not evoke anxiety - if you avoid stimuli you reinforce avoidance by anxiety reduction and will continue to get anxious
=medication does not work

Question 14

example of conditioning in phobia treatment

Answer 14

US: dog bite
UR: fear and anxiety
CS: see dog
CR: fear and anxiety

-exposure to dog and increasingly scarey stimuli without the bite breaks the association between the US and CS –> CR is extinguished, fear naturally subsides

Question 15

why meds don’t work for phobia

Answer 15

prevent physiological response –> will interfere with exposure therapy –> disrupts desensitization process

Question 16

Social Phobia

Answer 16

• fear of going to a social setting where they are judged
• can include worry about showing anxiety
• severe impairment, persistent course without treatment

Question 17

Prevalence of Social Phobia and age of onset

Answer 17

• lifetime prevalence: 12%
• more common in women than in men
• onset in adolescence and early adulthood

Question 18

Etiology of Social Phobia

Answer 18

• witnessing a perceived social defect or humiliation
• socially traumatic experience
• parents who are overly socially selective/avoidant
• biased attention to negative facial expressions
• uncontrollable and unpredictable stressors
• self attention and expectation of negative evaluation in social settings
• behavioral inhibition
• genetics ~30%

Question 19

Treatment for Social Phobia

Answer 19

=cognitive restructuring 
-identify automatic negative thoughts 
-decatastrophizing 
=medications
-sometimes uses 
-antidepressants don't work right away and have side effects