Chapter 9: Phobia Flashcards
Panic attack
- Sudden onset of intense fear
- Can occur when calm / anxious
- Either expected (i.e. obvious cue or trigger) / unexpected
- Involves physiological & psychological changes (e.g. shortness of breath, nausea & feelings of losing control)
Anticipatory anxiety
- Worrying abt being exposed to a phobic stim in future
- Often accompanied by somatic symptoms of tension
Biopsychosocial approach
- Describes how biological, psychological & social factors interact to influence behaviour & mental processes
- Holistic (considers individuals & the wider social setting)
Difference between biological, psychological and social factors
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Biological (in) – genetic, physiological, innate
- E.g. GABA dysfunction and LTP
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Psychological (in) – mental processes, cognition, emotions, thoughts, beliefs, and attitudes
- E.g. CC, OC and cognitive bias
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Social (ex) – relos, interactions, comm involvement
- E.g. stigma and specific environmental triggers
GABA dysfunction
Biological factor that contributes to specific phobia
- Involves insufficient GABA transmission / reception
- Occurs due to ↓ GABA production & unsuccessful binding
- FFF / anxiety response is more easily activated
- Phobia can develop due to recurrent SR to specific stimuli
- People with phobia may have lower levels of GABA
REMEMBER: GABA is an inhibitory NT that makes postsynaptic neurons less likely to fire.
Factors that can affect GABA levels in the brain
- Genetic inheritance and CNS damage
- Prolonged stress
- Nutritional deficiencies and high caffeine intake
NOTE: These influences can inhibit GABA release and binding or stimulate the overproduction of glutamate (excitatory NT).
Long-term potentiation
Biological factor that contributes to specific phobia
- During exposure to the phobic stimulus:
- Synaptic connection between neuron perceiving the PS and neuron activating the fear response is activated
- Repeated coactivation = strengthened neural connection
- Fear response & memories of PS are more readily recalled and activated (unlikely to forget what has been learnt)
REMEMBER: Phobic response is learned and therefore involves LTP (long-lasting strengthening of synaptic connections).
Precipitation (development) by classical conditioning
Psychological factor that contributes to specific phobia
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Before conditioning
- NS (e.g. white rat) produces no response
- UCS (e.g. loud noise) elicits UCR of fear
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During conditioning
- NS presented before UCS to produce UCR of fear
- E.g. white rat + loud noise → fear
- Association is possible after only 1 pairing if the UCS is very traumatic
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After conditioning
- NS becomes a CS to produce CR of fear
- E.g. white rat → fear
REMEMBER: CC involves the involuntary association of two or more stimuli.
Precipitating factors
In relation to specific phobia
- Increases susceptibility and contributes to the development of specific phobia
Perpetuation (maintenance) by operant conditioning
Psychological factor that contributes to specific phobia
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Avoidance = neg reinforcement (prevents recovery)
- Negative – avoidance removes feelings of fear
- Reinforcement – ↑ likelihood of avoidance in future
- Antecedent, behaviour, consequence
- A – phobic stimulus (e.g. spider)
- B – avoiding the phobic stimulus
- C – fear response is avoided, providing relief
Example of how operant conditioning can contribute to the acquisition of phobia
- Parents take a walk w their son. Their son sees something move in the lake and cries. The parents reassure him, hug him and buy him ice cream to help him ‘feel better’.
- Hugs & ice cream = positive reinforcement
- ↑ likelihood of behaving fearfully when he sees a lake
Cognitive bias
Psychological factor that contributes to specific phobia
- Flawed thinking that results in systematic errors of judgment and faulty decision-making
- ↑ vulnerability to being fearful in response to phobic stim
- Includes memory bias and catastrophic thinking
Memory bias
Type of cognitive bias
- Distorting influence of present thinking on recollection of previous experiences (inaccurate / exaggerated mem)
- Results in selective memory (recalling 👎🏻 experiences with PS more than than 👍🏻 / neutral memories associated w it)
- Fear response is strengthened & more readily recalled
Catastrophic thinking
Type of cognitive bias
- Stim / event is predicted to be far worse than reality
- Individuals experience heightened feelings of helplessness and underestimate their ability to cope with the situation
- E.g. assuming that one will die if exposed to their PS
Specific environmental triggers
Social factor that contributes to specific phobia
- Stimuli / experiences in enviro that evoke stress
- Direct confrontation (e.g. being bitten by a snake)
- Observing direct confrontation (e.g. see smo be bitten)
- Indirect learning (e.g. reading about danger of snakes)
Stigma around seeking treatment
Social factor that contributes to specific phobia
- Feelings of shame can prevent one from seeking help which exacerbates phobia
Social vs self stigma
- Shame / disgrace experienced by someone due to a characteristic that makes them different from others
- Social – negative attitudes / beliefs held by community
- Self – occurs when an individual accepts, internalises and applies the negative views of others to themselves
Benzodiazepine
Biological intervention
- Group of drugs that work on the CNS
- Have both anti-anxiety and sleep-inducing properties
- Act on GABA receptors to ↑ GABA’s inhibitory effects, making postsynaptic neurons more resistant to excitation
- Helps calm physiological arousal
NOTE: Benzodiazepines are commonly called sedatives or mild tranquilisers.
Short vs long lasting benzodiazepines
- Short – addresses phobic stimulus
- Long – used when GABA levels are significantly low and is affecting a large range of bodily functions
How do benzodiazepines work as GABA agonists?
- They bind to GABA receptors on postsynaptic neurons
- Benzos ↑ effectiveness of GABA (mimics its effects)
- ↑ inhibitory effects ↓ the likelihood that neurons will fire
- Neural comm and therefore anxiety is temporarily ↓
NOTE: Agonists are drugs that imitate NTs and initiate neural responses (excitatory or inhibitory) after binding to specific receptor sites.
Benzodiazepine limitations
- Can be addictive (body can become dependent)
- Only treat symptoms and not the cause of anxiety (association between the PS and fear does not change)
- Pose negative consequences when used long term
- E.g. ↓ alertness, concentration, reaction time
Breathing patterns associated with specific phobia
- Rapid, shallow breathing bc of sympathetic NS dom
- Over-breathing (↑ respiration due to perceived threat)
- Can lead to hyperventilation and increased anxiety
Breath retraining
Biological intervention
- Breathing techniques that can ↓ physiological arousal
- Promotes regular breathing patterns
- Restores optimal levels of O2 in the body
- Initiates parasympathetic NS dominance
Steps of breath retraining
- In the presence of the PS, patient is likely to have abnormal breathing patterns (likely to ↑ fear response)
- Patient is taught how to consciously control breathing
- Slow, deep inhales followed by controlled exhales
- Inhaling through nose and exhaling through mouth
- Techniques are applied in presence of phobic stim
- Sympathetic NS activity ↓ and parasympathetic NS ↑
- Patient feels calmer during exposure to PS
Steps of systematic desensitisation
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Patient learns relaxation techniques
- E.g. breath retraining
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Fear hierarchy is developed
- List of experiences from least to most fear inducing
- E.g. looking at a picture of PS then touching a PS
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Gradual step-by-step exposure
- Paired with learnt relaxation techniques
- Starting with the least fear inducing stimulus
- When fear resp stops, patient moves ↑ hierarchy
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Continuation of systematic exposure
- Until most fear inducing exp doesn’t cause fear
Systematic desensitisation
Psychological intervention
- Incremental exp to increasingly anx inducing stimuli
- Exposure is combined with relaxation techniques
- Involves CC principles (de-conditioning association between phobic stim and fear)
Systematic desensitisation advantage
- Long-term solution that targets the cause of phobia
Cognitive behavioural therapy (CBT)
Psychological intervention
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Replacing negative cognitions (thoughts / feelings) and behaviours with positive ones
- Change in thinking supports change in behaviour
- Thoughts create feelings
- Feelings create behaviours
- Behaviours reinforce thoughts
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Cognitions – memory bias, catastrophic thinking
- Challenged via hypotheses (e.g. reminding ppl who fear flying that a plane crash is statistically unlikely)
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Behaviours – avoidance behaviours, not seeking help
- Challenged via exposure and relaxation techniques
NOTE: Only need to apply to phobia.
Psychoeducation
Social intervention
- Teaching families / supporters of those w phobia how to better understand, manage and treat their condition
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Challenging unrealistic / anxious thoughts
- In a supportive, non-judgemental manner
- Helps person recognise their dysfunctional thoughts
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Not encouraging avoidance behaviours
- Avoidance is not a long-term solution
- Learning that avoidance perpetuates phobia
