chapter 10

Question 1

what is a phobia?

Answer 1

-Anxiety belongs to a group of mental
health disorders characterised by worry, fear and anxiety strong enough to interfere with daily activities, specific phobia being one of the most common

Question 2

specific phobia

Answer 2

• a persistent, intense, irrational fear of a specific object or event (often leads to avoidance behaviour)
• fear is out of proportion to the actual danger
• for diagnosis of specific phobia, symptoms must be present for 6 months or longer and disrupt the persons life, especially work and social relationships, or cause them serious distress

Question 3

phobias can generally be placed in four categories that relate to:

Answer 3

• the natural environment (e.g. water, storms)
• animals (e.g. snakes, spiders, dogs)
• potential bodily pain or injury (e.g. needles, dental and medical procedures, sight of blood)
• situations (e.g. heights, confined or open spaces, aeroplanes, tunnels).

Question 4

TYPES OF ANXIETY DISORDER
-generalised anxiety disorder (GAD)
-specific phobia

Answer 4

generalised anxiety disorder (GAD):
-Persistent and excessive worry, often about daily situations like work, family or health.
-This worry is difficult to control and interferes with the person’s day-to-day life and relationships

specific phobia:
- Extreme anxiety and fear of particular objects or situations.
-Common phobias include fear of flying, fear of spiders and other animals, and
fear of injections

Question 5

TYPES OF ANXIETY DISORDER
-panic disorder
-agoraphobia

Answer 5

panic disorder:
- The experience of repeated and unexpected panic attacks – sudden
surges of overwhelming fear and anxiety accompanied by physical symptoms such as chest pain, heart palpitations, dizziness and breathlessness.
-In panic disorder, these panic attacks come ‘out of the blue’ with no apparent trigger.

agoraphobia:
- Involves intense anxiety in situations and places where the person feels it would be difficult for them to get out quickly or get help if needed.
-This includes situations such as using public transport, being in a lift or a cinema, standing in a queue, being in a crowd, or being outside of the home alone

Question 6

TYPES OF ANXIETY DISORDER
-obsessive-compulsive disorder (OCD)
-social anxiety disorder

Answer 6

obsessive-compulsive disorder (OCD):
-Recurring, persistent and distressing thoughts, images or impulses known as obsessions (e.g. a fear of catching germs), or feeling compelled to carry out certain repetitive behaviours, rituals or mental acts, known as compulsions (e.g. handwashing).
-Some people with OCD have both obsessions and compulsions.
-These thoughts and behaviours can take over a person’s life and, while people with OCD usually know that their obsessions and compulsions are an overreaction, they feel they are unable to stop them.

social anxiety disorder:
-Severe anxiety about being criticised or viewed negatively by others.
-This leads the person to avoid social events and other social situations for fear of doing something that leads to embarrassment or humiliation.

Question 7

development of specific phobia and the biopsychosocial model

Answer 7

BIOLOGICAL FACTORS:
-dysfunctional GABA system
-long-term potentiation

PSYCHOLOGICAL FACTORS:
-classical conditioning (precipitates)
-operant condition (perpetuates)
- cognitive bias ( memory bias and catastrophic thinking)

SOCIAL FACTORS:
-specific environmental trigger
-stigma

*two people may have the same diagnosis, the same factors will not necessarily interact in the same way in the development of their illnesses

Question 8

BIOLOGICAL FACTORS

Answer 8

• relates to the physiological functioning of the body
  -Genetics is an example of a biological factor that contributes to the development, progression or perpetuation of a specific
  phobia.
  -other biological factors include, gamma-aminobutyric acid (GABA) dysfunction,
  the role of the stress response and the impact of long-term potentiation, and how they contribute to the development of a phobia

Question 9

GABA

Answer 9

-the main inhibitory neurotransmitter in the nervous system, associated with
anxiety, specific phobias and Parkinson’s disease

-GABA is considered an inhibitory neurotransmitter because it blocks, or inhibits, certain neural signals and decreases activity in the nervous system.
-When GABA activates its receptors, it makes post-synaptic neurons less likely to fire an action potential, producing a calming effect.
-This reduces feelings of anxiety, stress and fear.

Question 10

GLUTAMATE

Answer 10

the main excitatory neurotransmitter in the nervous system, involved with learning and
memory

Question 11

BIOLOGICAL FACTORS
1. Gamma-aminobutyric acid (GABA) dysfunction

Answer 11

• Dysfunctional GABA system refers to a failure to produce, release or receive the correct amount of gamma-aminobutyric
  acid

-people diagnosed with a specific phobia are predisposed to anxiety because they have a dysfunctional GABA system
- Excessive anxiety is due to an elevated stress response caused by the release of glutamate during a flight-or-fight-or-freeze response.
-If there is a failure to produce, release or receive the correct GABA signal, then there is an insufficient inhibitory signal to adequately regulate heightened arousal levels that are caused by excitatory neurons being too active.
-Therefore, people with a phobia have an
insufficient GABA signal to inhibit this neural activation, resulting in exaggerated feelings of fear or anxiety.

*-People with a low GABA signal are more vulnerable to anxiety. Furthermore, their flightor-fight-or-freeze response may be more easily activated when they encounter or believe they will encounter a phobic stimulus, and they become more anxious to stimuli.

Question 12

BIOLOGICAL FACTORS
2. long-term potentiation (LTP)

Answer 12

-the relatively permanent strengthening of synaptic connections as a result of repeated activation of a neural pathway

-LTP can strengthen the association between a phobic stimulus and a fear/anxiety response through repeated
activation of the same neural pathways.
-When these connections are activated through different encounters with the phobic stimulus or thinking about a past or future encounter, the connections are further strengthened.
-Subsequently, the associated fear response to the phobic stimulus strengthens, and it is much less likely that what is learned will be forgotten.

Question 13

PSYCHOLOGICAL FACTORS

Answer 13

-a factor that relates to the functioning of the brain and the mind, including cognitive
and affective processes such as thought patterns and memory.
-internal influences associated with mental processes

Question 14

PSYCHOLOGICAL FACTORS
behavioural models of phobia development:

Answer 14

-Behaviourism is a theory of learning based on the idea that all behaviours are acquired
through an interaction with the environment.
-Therefore, behavioural models suggest that phobias are learned through experience and may be developed, sustained or modified by environmental consequences such as rewards or punishments.

• eg. classical conditioning and operant conditioning

Question 15

PSYCHOLOGICAL FACTORS
behavioural models of phobia development:

1. precipitated by classical conditioning

Answer 15

-a simple form of learning that occurs through the repeated association between a neutral stimulus and an unconditioned stimulus to produce a conditioned response.

CLASSICAL CONDITIONING APPLIED TO PHOBIAS, EXAMPLE:
(before conditioning):
- a magpie (NS) produces no relevant response. Being swooped by magpie (UCS) produces shock and fear (UCR)

(during conditioning):
- the magpie (NS) is presented immediately before being swooped (UCS) multiple times and the UCS produces shock and fear (UCR)

(after conditioning):
- the magpie (CS) on its own now produces shock and fear (CR)

• as a result of the shock and fear of being swooped, they now fear magpies.

Question 16

PSYCHOLOGICAL FACTORS
behavioural models of phobia development:

2. perpetuation by operant conditioning

Answer 16

-a type of learning process in which the likelihood of a voluntary behaviour occurring is determined by its consequences

-The feeling of relief at avoiding a stressful experience is an example of operant
conditioning
-Once a phobia has developed, it can be perpetuated by operant conditioning, more specifically by negative reinforcement.
-When a person is confronted by, or thinks they might be confronted by, a phobic stimulus, using avoidance behaviour reduces or removes the unpleasant feelings of fear or anxiety associated with the stimulus.
-This makes the person more likely to avoid the phobic stimulus in future, effectively continuing the cycle of fear.

Question 17

PSYCHOLOGICAL FACTORS
cognitive models and cognitive biases:

Answer 17

-Cognitive model refers to a model that describes how people’s perceptions of situations influence their emotional and behavioural reactions
-When we are distressed, our perceptions are often distorted.
- It focuses on how a person processes information about the phobic stimulus and related events, including their perceptions, memories, attitudes and biases.
-The underlying assumption of the cognitive model is that people with a specific phobia often have one or more cognitive biases.

• cognitive bias refers to the tendency to think in a way that involves errors of judgment and faulty decision-making
  -cognitive biases are memory bias and catastrophic thinking

Question 18

PSYCHOLOGICAL FACTORS
cognitive models and cognitive biases:

3. memory bias

Answer 18

-distorted thinking that either enhances or impairs the recall of a memory or alters its content

-completely distorts and exaggerates fears relating to phobias by focusing more on the fearful or negative experiences.

Question 19

PSYCHOLOGICAL FACTORS
cognitive models and cognitive biases:

4. catastrophic thinking

Answer 19

-a cognitive bias that involves overestimating and exaggerating the worst
possible outcomes to situations even though they are unlikely to occur
- perpetuates fear by heightening levels of anxiety and distress

Question 20

SOCIAL FACTORS

Answer 20

-a factor that relates to the social components of a person’s environment

(specific environmental trigger and stigma)

Question 21

SOCIAL FACTORS

1. specific environmental trigger

Answer 21

-an object, situation or circumstance
that probably caused a direct, negative
traumatic experience associated with extreme fear or discomfort, which then acts as a cue for future phobic fear responses

-Many people diagnosed with a specific phobia report that they had a negative and traumatic experience with the object of their phobia in the past. These people generally attribute this specific encounter as the cause of their phobia.
e.g. fear of injections ➡️ phobia developed from pain experienced when being immunised at the doctors

-even observing a frightening event can result in phobia. e.g. witnessing a car accident and blood ➡️ blood phobia

-the more traumatic the event the more likely it is that a phobia will develop, even if the event or situation occurs only once.
e.g. almost drowning ➡️phobia of water

-not everyone who is exposed to similar traumatic events develops a phobia.
-If a person is exposed to a positive experience soon after the traumatic one, they are less likely to form an association
between the fear object and a fear response. e.g. after injection receiving a lollipop ➡️ may not develop a phobia

Question 22

SOCIAL FACTORS

2. stigma around seeking treatment

Answer 22

-the feeling of shame or disgrace associated with a personal characteristic that indicates you belong to a culturally devalued group in society – this can be real or imagined.
-people with a specific phobia are
vulnerable to stigmatisation because phobias are irrational fears and it is difficult for others to empathise with people who have them.
-Stigma brings with it feelings of shame, poor self-esteem and hopelessness.
-Distress and symptoms may be worsened
by a lack of understanding by family, friends and others, and may be a barrier to seeking treatment.

Question 23

evidence-based interventions for specific phobia

Answer 23

BIOLOGICAL TREATMENTS:
-GABA agonists
-breathing retraining

PSYCHOLOGICAL TREATMENTS:
-systematic desensitization
-CBT

SOCIAL TREATMENT:
-psychoeducation

Question 24

BIOLOGICAL INTERVENTIONS

Answer 24

• a treatment targeting physiological mechanisms believed to contribute to a condition
• target physiological mechanisms believed to contribute to a phobia, and may focus on
  eliminating or alleviating symptoms of disorders rather than dealing with the underlying
  causes.
  -Biological management tools for specific phobia include short-acting anti-anxiety benzodiazepine agents (GABA agonists) and breathing retraining.

Question 25

BIOLOGICAL INTERVENTIONS
1. short-acting anti-anxiety benzodiazepine agents (GABA agonists)

Answer 25

-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.

• Benzodiazepines are commonly used as sleeping pills or to reduce anxiety because they slow down activity in the CNS, which reduces physiological arousal and
  promotes relaxation.
  -Benzodiazepines are agonists – drugs that mimic or enhance the action of a neurotransmitter that binds to its receptor on the post-synaptic neuron.

*- when a benzodiazepine binds to a GABA receptor site, it mimics the inhibitory effects of GABA

-this makes the post-synaptic neuron less likely to fire, which reduces the feelings of anxiety, thus making benzodiazepines an effective treatment for a specific phobia

Question 26

BIOLOGICAL INTERVENTIONS
1. short-acting anti-anxiety benzodiazepine agents (GABA agonists)

effects of benzos:

Answer 26

-reduces alertness, coordination and reaction time
-can be addictive if taken for a long time
-if a person suddenly stops taking them, symptoms of anxiety, agitation and insomnia return

Question 27

BIOLOGICAL INTERVENTIONS
2. breathing retraining

the impact of hyperventilation on the experience of anxiety

Answer 27

-When someone with specific phobia is facing their phobic stimulus, they may experience abnormal breathing patterns.
-Their breathing might consist of rapid, small shallow breaths (hyperventilation), resulting in oxygen and carbon dioxide
imbalances in the blood.
-Carbon dioxide levels can become low.
-Carbon dioxide helps regulate the body’s reaction to anxiety, and when levels are too low this can cause reactions such as dizziness, lightheadedness, blurred vision and pins and needles, which in turn increases
already heightened anxiety

facing a phobic stimulus
⬇️
hyperventilation
⬇️
oxygen and carbon dioxide imbalances in the blood
⬇️
dizziness, light headedness, blurred vision and pins and needles
⬇️
heightened anxiety

Question 28

BIOLOGICAL INTERVENTIONS
2. breathing retraining

Answer 28

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

• can be taught in a session with a therapist and then used in a public setting without drawing much attention to the individual
  -Breathing retraining aims to slow breathing and practise maintaining regular breathing
  rhythms
  -When the person can control their breathing, this restabilises the balance of oxygen and carbon
  dioxide in the bloodstream, which in turn helps to reduce heart rate and respiration, lower stress hormones and increase feelings of calm and control.
  -needs to be well practised

Question 29

PSYCHOLOGICAL INTERVENTIONS

Answer 29

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

-psychological interventions using psychotherapy aim to unlearn the response to the phobia
-psychotherapy and biological interventions are often used together
-psychological evidence-based interventions are cognitive behavioural therapy (CBT) and systematic desensitisation

Question 30

PSYCHOLOGICAL INTERVENTIONS
1. cognitive behavioural therapy

Answer 30

-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 one.

-if a person suffering from a specific phobia can develop a new understanding of the phobic stimulus as not dangerous, then they can also reduce the instances of avoidance behaviour by using coping strategies.

Question 31

PSYCHOLOGICAL INTERVENTIONS
1. cognitive behavioural therapy

cognitive therapy:

Answer 31

-Cognitive therapy focuses on the role of thoughts, beliefs and attitudes in determining emotions and behaviour
-The therapist will encourage their client to identify which
thoughts and feelings related to the phobic stimuli might be cognitive biases or fear related
-The client is then encouraged to gather evidence that supports, as well as refutes their fear
-therapist encourages the client that their fear is unlikely (evidence helps them change their beliefs)
-Once the person has identified
and challenged their cognitive
distortions, they are more likely to be able to change their thoughts, feelings and beliefs to more realistic and positive ones

Question 32

PSYCHOLOGICAL INTERVENTIONS
1. cognitive behavioural therapy

behavioural therapy:

Answer 32

-deals directly with maladaptive behaviours that can maintain or worsen a person’s psychological problems and the thoughts and feelings associated with them
-could include teaching them relaxation techniques such as breathing retraining or progressive muscle relaxation, promoting exercise, or encouraging them to engage
in activities that are distracting
and rewarding.
- This allows dysfunctional ways of responding to be replaced with new, more functional behaviours.

Question 33

PSYCHOLOGICAL INTERVENTIONS
2. systematic desensitisation

Answer 33

-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

-operates on the principles of classical conditioning, and aims
to recondition the association between the phobic stimulus and the fear response, by associating the phobic stimulus with a relaxation response instead

-involves 3 steps:
*learning a relaxation technique
*forming a fear hierarchy
*gradual exposure to the fear stimulus

Question 34

PSYCHOLOGICAL INTERVENTIONS
2. systematic desensitisation

.1. relaxation techniques

Answer 34

-Before the person is exposed
to any stimulus, they are taught a relaxation technique.
-This may include breathing
retraining, progressive muscle
relaxation or the use of visual imagery to reduce the physiological arousal involved in the fear response.

Question 35

PSYCHOLOGICAL INTERVENTIONS
2. systematic desensitisation

.2. fear heirarchies

Answer 35

-breaking down and then organising the phobic stimulus into a list of anxiety-inducing
situations from easiest to most difficult to confront.
-The therapist then arranges these situations into a hierarchical order from least frightening to most frightening

Question 36

PSYCHOLOGICAL INTERVENTIONS
2. systematic desensitisation

.3. gradual exposure to fear stimulus

Answer 36

-After creating their fear hierarchy, the person is progressively exposed to each of the fear-producing situations. -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.
-Once the first step of the fear hierarchy has been overcome,
the therapist allows the client to move on to the next ones until the phobic stimulus does not elicit a fear response, but rather a relaxation response.

Question 37

SOCIAL INTERVENTIONS

Answer 37

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

-Having social support is very important in the treatment of a phobia
-Social interventions may be used alongside biological and psychological interventions to provide support.

Question 38

SOCIAL INTERVENTIONS
1. psychoeducation for families and supporters

Answer 38

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

• assumes that sufferers and
  their social supporters cope better if they have a thorough understanding of the illness, its
  treatment and the challenges sufferers face.
  -can take place in individual or group sessions
  -It is important that friends and family are included in psychoeducation because learning more about the symptoms and difficulties associated with a specific phobia can decrease the stigma that might be associated with the disorder

Question 39

SOCIAL INTERVENTIONS
1. psychoeducation for families and supporters

what psychoeducation provides

Answer 39

-Common topics in psychoeducation sessions are symptoms, causes, treatment options, support services and networks, useful sources of
information, effects on family, work-related issues, and what constitutes improvement.
- those in the social support network are educated about two key strategies to help manage a phobia:
challenging unrealistic or anxious thoughts and not encouraging avoidance behaviours

Question 40

SOCIAL INTERVENTIONS
1. psychoeducation for families and supporters

what psychoeducation provides
STRATEGY 1: challenging unrealistic or anxious thoughts

Answer 40

-The anxious thoughts that are characteristic of a specific phobia are usually negative and unrealistic.
-Unrealistic thoughts perpetuate the phobia because they make the individual less likely to confront the stimulus.
- Members of a social support network can encourage them to
recognise and challenge these unrealistic or anxious thoughts.
-Family or friends can do this by using questions to help the person look for evidence that counters their thoughts in a calm, gentle manner.
-This will help the individual become more able to recognise when his thoughts are unrealistic and replace them with a more rational evaluation of potential exposure to the phobic stimulus.

Question 41

SOCIAL INTERVENTIONS
1. psychoeducation for families and supporters

what psychoeducation provides
STRATEGY 2: not encouraging avoidance behaviours

Answer 41

-Avoidance can make the person feel better in the short term, but perpetuates the phobia.
-Avoidance behaviour stops a person from facing the phobic stimulus.
-The person needs to see that it is not as dangerous as they believe.
- members of a support network might encourage the person to slowly expose themselves to the fear stimulus and use praise and companionship while the sufferer does this.