CH9 The Biopsychosocial Approach to Explain Specific Phobia

Question 1

Social anxiety disorder (i.e. social phobia)

Answer 1

• Marked fear or anxiety about a social situation in which the individual is exposed to possible scrutiny by others

Question 2

Agoraphobia

Answer 2

• Marked fear about being in a situation in which it is believed something bad may happen and that escape might be difficult or help might not be available if needed.

Question 3

Specific phobia

Answer 3

• An anxiety disorder characterised by a marked and persistent fear/anxiety about a specific stimulus
• Symptoms are…
  
  • Present for at least 6 months
  • Disrupt one’s life
  • Cause serious distress

Question 4

33

Characteristics of specific phobia

Answer 4

• The fear
  
  • Is excessive
  • Is disproportionate to the threat posed by the phobic stimulus
  • Causes distress or impairment to daily functioning
  • Is persistent for ≥6 months
• The sympathetic nervous system is dominant
• The phobic stimulus is actively avoided or endured with intense fear
• The response is to a known stimulus
• Stimulus may not be present – can cause anticipatory anxiety
• Possible panic attacks – sudden onset of intense fear; feelings of impending doom and shortness of breath

Question 5

The biopsychosocial approach

Answer 5

• A way of describing and explaining how biological, psychological and social factors combine and interact to influence a person’s mental health and wellbeing.
  
  • I.e. how these factors lead to the precipitation and perpetuation of specific phobia

Question 6

Biopsychosocial contributing factors to specific phobia

Answer 6

• Biological
  
  • GABA dysfunction
  • Long-term potentiation
• Psychological
  
  • Classical conditioning
  • Operant conditioning
  • Cognitive biases – i.e. memory bias and catastrophic thinking
• Social
  
  • Specific environmental triggers
  • Stigma around seeking treatment

Question 7

GABA

Answer 7

• Inhibitory neurotransmitter
• GABA’s inhibitory effects keep activation of the post-synaptic neuron in control (and thereby, regulates anxiety symptoms).

Question 8

GABA dysfunction

As a biological factor contributing to specific phobia

Answer 8

• Insufficient production, neural transmission or reception of GABA in the body.
  
  • F-f-f (i.e. anxiety) response activated more easily
  • Recurrent stress responses to specific stimuli can lead to the development of a phobia.

Question 9

Long-term potentiation

As a biological factor contributing to specific phobia

Answer 9

• Long-lasting & experience-dependent strengthening of synaptic connections that are regularly coactivated.
• Synaptic connections that link the phobic stimulus and fear response are strengthened each time the pathway is activated during contact or anticipated contact
  
  • Fear response is more readily activated
  • Memories are more easily recalled
  • What has been learnt is not likely to be forgotten

Question 10

Agonists v antagonists

Answer 10

• Drugs that imitate the activity of neurotransmitters when it binds to the receptor sites of a postsynaptic neuron
• Agonists – stimulate the activity of a neurotransmitter
• Antagonists – inhibit the activity of a neurotransmitter

Question 11

Benzodiazepines

As a biological intervention

Answer 11

• GABA agonists that mimic the activity of GABA to increase GABA’s inhibitory effects
• Consequences:
  
  • Reduces anxiety symptoms
  • Short-term → only decreases the phobic response, not the association
  • Reduced alertness (i.e. dangerous on a ladder)
  • Addictive is it can cause reliance on the drug, which is maladaptive

Question 12

Breathing retraining

As a biological intervention

Answer 12

• Is an anxiety management technique that involves teaching breathing control techniques that may reduce physiological arousal
  
  • Physiological arousal: those experiencing a phobic reaction may hyperventilate → breathe faster and deeper than necessary
• Can help people feel as if they have more control of their fear or anxiety
• E.g. Slow, regular breaths in through the nose and out the mouth at a controlled rate

Question 13

Precipitating v perpetuating factors

According to the two-factor theory

Answer 13

• According to the two-factor theory
  
  • Specific phobia may be acquired through classical conditioning (CC) and maintained by operant conditioning (OC).
• CC is precipitating – contributes to the development of specific phobia
• OC is perpetuating – maintains the symptoms of specific phobia or causes it to get progressively worse

Question 14

Classical conditioning (CC)

Answer 14

• Before conditioning
  
  • NS (e.g. dark cinema) → no response
  • UCS (e.g. scary advertisement) → UCR (e.g. fear response)
• During conditioning
  
  • NS (i.e. to-be phobic stimulus) + UCS → UCR of fear
  • E.g. dark cinema presented before scary advertisement → fear response
• After conditioning
  
  • Phobic stimulus (CS) → fear response (CR)
  • E.g. dark cinema → fear response

N(S) comes before U(CS) in the alphabet; determine brackets 1st

Question 15

Operant conditioning (OC)

In terms of specific phobia

Answer 15

• Is a perpetuating factor of specific phobia
• Antecedent
  
  • Any environmental stimulus that triggers avoidance
  • E.g. needing to go to the dentist
• Behaviour
  
  • Avoidance of the phobic stimulus
  • E.g. not going to the dentist
• Consequence
  
  • Negative reinforcement – feelings of anxiety are taken away
  • Strengthens the avoidance behaviour
  • E.g. relief

Neg. UNLESS scenario specifically adds a stimulus (i.e. comforting hugs)

Question 16

Cognitive bias

Answer 16

• Is a systematic error of thinking that affects decision-making and judgments, usually leading to inaccurate conclusions.
  
  • Occurs without conscious awareness
  • Occurs constantly and predictably under certain circumstances → is thereby considered systematic
• Two kinds: memory bias and catastrophic thinking

Question 17

Memory bias

Answer 17

• A kind of cognitive bias
• Refers to when present knowledge, beliefs and feelings distort the recollection of previous experiences
  
  • Exaggerating memory of phobia → recalling the phobic stimulus as more dangerous than it actually was
  • More likely to recall neg. experience with phobic stimulus and forget pos./neutral experience

Question 18

Catastrophic thinking

Answer 18

• A kind of cognitive bias
• Involves overestimating and exaggerating the threat of an object or situation and predicting the worst possible outcome.

Question 19

Cognitive behavioural therapy (CBT)

As a psychological intervention

Answer 19

• A form of psychotherapy that is based on the assumption that thoughts can influence emotions and behaviour and that subsequent behaviours and emotions can influence thoughts.
  
  • Aims to identify, assess and correct current dysfunctional cognitions (i.e. memory bias, catastrophic thinking) and behaviours
  • Improves long-term functioning
  • Requires active participation.

Question 20

Process of CBT: Phobia of bird (example)

Answer 20

• Cognitive component:
  
  • 1. Client identifies fear-related thoughts about birds → ‘All birds are going to attack me’.
  • 2. Psychologist encourages client to challenge + replace unhelpful thoughts → ‘It is unlikely that all birds are going to attack me’.
• Behavioural component:
  
  • 3. Psychologist helps client modify their avoidance of birds
  • 4. Client is taught relaxation techniques (i.e. deep breathing) to reduce their anxiety when confronting birds.

Question 21

Systematic desensitisation

Answer 21

• A therapeutic technique used to overcome phobia
• Involves incremental exposure to increasingly anxiety-inducing stimuli, combined with the use of relaxation techniques.

Question 22

Process of systematic desensitisation

Answer 22

1. Relaxation technique is taught, such as deep breathing
2. Fear hierarchy is established → bottom level is least anxiety-producing situation; top is most anxiety-producing situation.
3. Work up the fear hierarchy, starting from the bottom, through systematic, graduated pairing with the relaxation technique.
4. Continue process until calm in highest level

Question 23

Specific environmental triggers

Answer 23

• When a specific phobia is developed after a direct negative and traumatic experience with an object or situation that produces extreme fear
  
  • Initial extreme fear response may become a conditioned fear response through CC.

Question 24

Stigma around seeking treatment

Answer 24

• Embarrassment / shame about symptoms
• Concerns about negative judgement by others (due to negative stereotypes
• Discourages people with a phobia from seeking treatment.

Question 25

Psychoeducation

As a social intervention

Answer 25

• Educating support networks about the mental disorder’s characteristics and possible treatment options
  
  • Enables more and better support if they understand it
  • I.e. challenging anxious thoughts, discouraging avoidance behaviours

Question 26

Challenging anxious thoughts

Answer 26

• Taught through psychoeducation
• Pointing out & challenging unrealistic, neg. thoughts enables individuals to replace it with realistic ones

Question 27

Not encouraging avoidance behaviours

As a social intervention

Answer 27

• Taught through psychoeducation
• Avoidance behaviours are a perpetuating factor
  
  • Removal of anxiety acts as negative reinforcement