Chapter 9: Phobia

Question 1

Panic attack

Answer 1

• 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)

Question 2

Anticipatory anxiety

Answer 2

• Worrying abt being exposed to a phobic stim in future
• Often accompanied by somatic symptoms of tension

Question 3

Biopsychosocial approach

Answer 3

• Describes how biological, psychological & social factors interact to influence behaviour & mental processes
• Holistic (considers individuals & the wider social setting)

Question 4

Difference between biological, psychological and social factors

Answer 4

• Biological (in) – genetic, physiological, innate
  
  • E.g. GABA dysfunction and LTP
• Psychological (in) – mental processes, cognition, emotions, thoughts, beliefs, and attitudes
  
  • E.g. CC, OC and cognitive bias
• Social (ex) – relos, interactions, comm involvement
  
  • E.g. stigma and specific environmental triggers

Question 5

GABA dysfunction

Biological factor that contributes to specific phobia

Answer 5

• 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

REMEMBER: GABA is an inhibitory NT that makes postsynaptic neurons less likely to fire.

Question 6

Factors that can affect GABA levels in the brain

Answer 6

• 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).

Question 7

Long-term potentiation

Biological factor that contributes to specific phobia

Answer 7

• 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).

Question 8

Precipitation (development) by classical conditioning

Psychological factor that contributes to specific phobia

Answer 8

• Before conditioning
  
  • NS (e.g. white rat) produces no response
  • UCS (e.g. loud noise) elicits UCR of fear
• 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
• 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.

Question 9

Precipitating factors

In relation to specific phobia

Answer 9

• Increases susceptibility and contributes to the development of specific phobia

Question 10

Perpetuation (maintenance) by operant conditioning

Psychological factor that contributes to specific phobia

Answer 10

• 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

Question 11

Example of how operant conditioning can contribute to the acquisition of phobia

Answer 11

• 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

Question 12

Cognitive bias

Psychological factor that contributes to specific phobia

Answer 12

• 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

Question 13

Memory bias

Type of cognitive bias

Answer 13

• 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 likely to be recalled

Question 14

Catastrophic thinking

Type of cognitive bias

Answer 14

• 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

Question 15

Specific environmental triggers

Social factor that contributes to specific phobia

Answer 15

• 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)

Question 16

Stigma around seeking treatment

Social factor that contributes to specific phobia

Answer 16

• Feelings of shame can prevent one from seeking help which exacerbates phobia

Question 17

Social vs self stigma

Answer 17

• 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

Question 18

Benzodiazepine

Biological intervention

Answer 18

• 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.

Question 19

Short vs long lasting benzodiazepines

Answer 19

• Short – addresses phobic stimulus
• Long – used when GABA levels are significantly low and is affecting a large range of bodily functions

Question 20

How do benzodiazepines work as GABA agonists?

Answer 20

• 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.

Question 21

Benzodiazepine limitations

Answer 21

• 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

Question 22

Breathing patterns associated with specific phobia

Answer 22

• Rapid, shallow breathing bc of sympathetic NS dom
• Over-breathing (↑ respiration due to perceived threat)
• Can lead to hyperventilation and increased anxiety

Question 23

Breath retraining

Biological intervention

Answer 23

• Breathing techniques that can ↓ physiological arousal
• Promotes regular breathing patterns
• Restores optimal levels of O2 in the body
• Initiates parasympathetic NS dominance

Question 24

Steps of breath retraining

Answer 24

• 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

Question 25

Steps of systematic desensitisation

Answer 25

• Patient learns relaxation techniques
  
  • E.g. breath retraining
• 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
• Gradual step-by-step exposure
  
  • Paired with learnt relaxation techniques
  • Starting with the least fear inducing stimulus
  • When fear resp stops, patient moves ↑ hierarchy
• Continuation of systematic exposure
  
  • Until most fear inducing exp doesn’t cause fear

Question 26

Systematic desensitisation

Psychological intervention

Answer 26

• Incremental exp to increasingly anx inducing stimuli
• Exposure is combined with relaxation techniques
• Involves CC principles (de-conditioning association between phobic stim and fear)

Question 27

Systematic desensitisation advantage

Answer 27

• Long-term solution that targets the cause of phobia

Question 28

Cognitive behavioural therapy (CBT)

Psychological intervention

Answer 28

• 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
• Cognitions – memory bias, catastrophic thinking
  
  • Challenged via hypotheses (e.g. reminding ppl who fear flying that a plane crash is statistically unlikely)
• Behaviours – avoidance behaviours, not seeking help
  
  • Challenged via exposure and relaxation techniques

Question 29

Psychoeducation

Social intervention

Answer 29

• Teaching families / supporters of those w phobia how to better understand, manage and treat their condition
• Challenging unrealistic / anxious thoughts
  
  • In a supportive, non-judgemental manner
  • Helps person recognise their dysfunctional thoughts
• Not encouraging avoidance behaviours
  
  • Avoidance is not a long-term solution
  • Learning that avoidance perpetuates phobia