phobias Flashcards
What are phobias?
A type of anxiety disorder, characterised by:
‘Uncontrollable, extreme, irrational and enduring fears and involve anxiety levels that are out of proportion to any actual risk.’
What is the DSM and ICD?
the International Classification of Diseases (ICD)
the Diagnostic and Statistical Manual of Mental Disorders (DSM)
What are specific phobias?
A marked and persistent fear of specific things/environments
e.g .Animal phobias e.g. arachnophobia (fear of spiders)
What are social phobias?
A fear of social situations – a fear of negative judgement by others and feeling inadequate.
e.g. Performance phobias: being anxious about performing in public e.g. playing at a concert.
What is Agoraphobia?
Anxiety about being in open spaces or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an situationally predisposed panic attack or panic like symptoms.
What are emotional characteristics of phobias?
Anxiety and emotional responses are unreasonable
What is the definition of anxiety?
Fear is marked and persistent, and is likely to be excessive, due to the presence of or anticipation of the phobic object/situation.
What is meant by emotional responses are unreasonable?
The emotional response is wildly disproportionate to the danger posed by the phobic object/situation
i.e. it goes beyond what is reasonable
What are behavioural characteristics of phobias?
Avoidance and Panic.
What is meant be avoidance?
Efforts are made to avoid coming into contact with the phobic stimulus in order to reduce the chances of an anxious response occurring e.g. avoid flying/social situations.
What is meant by panic?
Panic may involve a range of behaviours such as crying, screaming, freezing, running away, fainting, collapsing
What are cognitive characteristics of phobias?
Irrational beliefs:
A phobic may hold irrational beliefs in relation to the phobic stimuli e.g. if I get on that plane it will crash and I will die
Selective attention to the phobic stimulus:
A phobic will focus on the feared stimulus finding it difficult to concentrate on or think about anything else.
What is the two-process model?
Assumes that phobias are learned through experience.
The Two-Process Model (Orval Hobart Mowrer, 1947)
i) Acquisition (how the phobia was learnt initially)
- Through Classical Conditioning
ii) Maintenance (why the phobia persists) - Through Operant Conditioning
the acquisition of phobias is through…
Classical Conditioning: learning by association
- a stimulus becomes associated with a response
What is the process of classical conditioning in a phobia?
The feared stimulus/situation is originally a neutral stimulus.
It is paired/associated with an anxiety-provoking unconditioned stimulus (e.g. a traumatic event that triggers a fear response).
The feared [conditioned] stimulus/situation then triggers a conditioned response.
What is the case of little Albert (Watson & Rayner, 1920)?
Little Albert (9 month old infant) was shown a white rat (neutral stimulus) no fearful response.
Little Albert cried when a hammer (unconditioned stimulus = loud noise) was struck against a steel bar behind his head.
Over 7 weeks, the white rat (NS) was presented and immediately followed by a hammer being struck against a metal bar close to Albert’s ear (UCS).
Little Albert began only to see the rat (CS) and immediately showed signs of fear (CR).
Little Albert’s phobia generalised to other white furry objects
e.g. a fur coat and a Santa Claus beard.
How are phobias maintained?
Operant Conditioning:
Learning through the consequences of behaviour.
If a behaviour is reinforced then that increases the chances of the behaviour being repeated.
What are the two types of reinforcement?
Positive Reinforcement:
An outcome of a behaviour that is pleasant
(results in a reward – the addition of a positive stimulus)
Negative Reinforcement:
An outcome of a behaviour that results in avoiding
something unpleasant (the removal of a negative stimulus)
How does positive reinforcement maintain phobias?
Positive Reinforcement:
The attention/comfort generated by the phobia positive reinforcer, increasing the likelihood that the behaviour (i.e. fear response) will occur again in the future.
How does negative reinforcement maintain phobias?
Negative Reinforcement:
The avoidance response means the individual can escape the fear and anxiety they would have otherwise suffered if they had encountered the feared stimulus/ situation negative reinforcer.
The reduction in fear reinforces the avoidance behaviour, maintaining the phobia.
What is the supporting evidence of the two-process model?
Di Gallo (1996)
Reported that around 20% of people who had experienced traumatic car accidents developed a phobia of travelling in cars, especially of travelling at speed, which can be explained by classical conditioning.
The neutral stimulus of a car became associated with the naturally occurring fear response (UCR) to the crash (UCS).
It was found that they tended to make avoidance responses (behavioural characteristic) e.g. staying at home rather than making car journeys to see friends – the maintenance of the phobia can therefore be explained by operant conditioning.
The avoidance response of saying at home was negatively reinforcing and therefore repeated, making the phobia resistant to extinction.
Evaluation of the Behavioural Approach to Explaining Phobias:
P: Effective treatments based on behaviourist principles have been developed to treat phobias.
E: Systematic Desensitisation and Flooding are based on the idea of counter-conditioning, breaking down the negative association between the stimulus and fear, replacing it with a more positive association. they also prevent the individual from practicing their avoidance behaviour, preventing reinforcement.
C: The fact that these treatments are successful suggests that phobias are maladaptive behaviours acquired by learning i.e. they can be unlearned by replacing them with more adaptive behaviours.
Evaluation of the Behavioural Approach to Explaining Phobias. P: There is research support for the role of classical conditioning in acquiring phobias.
E: The case of Little Albert (Watson and Raynor, 1920) supports the two-process model as they were able to condition Albert to develop a fear of white fluffy objects by pairing a previously neutral stimulus , a white rate, with a loud noise.
C: However it is difficult to generalise these findings because…
Limitations of the behavioural approach to explaining phobias:
P: however, the model is deterministic as not everyone who has a traumatic experience develops a phobia.
E: Di Nardo et al (1988): not everyone who is bitten by a dog develops a phobia of dogs - the behavioural approach cannot explain these individual differences. C: However, according to the diathesis model, a dog bite would only lead to a phobia in those people with a genetic vunerability i.e they carry a specific gene that codes for phobic/anxiety disorders.
Limitations of the behavioural approach to explaining phobias: P: it cannot explain why we seem to fear certain stimuli e.g. heights, spiders
E: ‘ Biological preparedness’ offers an alternative explanation (Seligman, 1970): proposes that animals (including humans), are genetically programmes to rapidly learn an association between potentially life-threatening stimuli and fear. These stimuli are known as ancient fears - thing that would have been dangerous in our evolutionary past i.e. snakes, heights. It would have been adaptive to rapidly learn to avoid such stimuli that posed a threat to survival.
C: Biological preparedness explains why people are less likely to develop fears of modern objects i.e. cars, which are more of a threat than spiders. Such items were not a danger in our evolutionary past, suggesting that behavioural explanations alone cannot be used to explain the development of phobias.
How might the Cognitive Approach Explain Phobias?
Irrational Thinking: the individual develops faulty thought processes in relation to a particular stimulus or situation
Attentional Bias: phobics focus more upon anxiety generating stimuli i.e. the teeth of a dog rather than its other features.
What are behavioural therapies based on?
Behavioural therapies are based on the principles of classical conditioning.
Treating the phobia requires breaking the association between the phobic stimulus and the anxiety/avoidance response.
What do behavioural therapiesinvolve?
Behavioural therapies involve exposure to the feared stimulus or situation through counter-conditioning:
A patient is taught (through classical conditioning) to associate the phobic stimulus with a new response
i.e. relaxation instead of fear.
What is systematic desensitisation Wolpe (1958)?
A behavioural therapy for treating anxiety disorders involving gradual exposure to a feared stimulus or situation over several sessions through counter-conditioning:
- the sufferer learns relaxation techniques and then faces a progressive hierarchy of exposure to the objects and situations that cause anxiety.
What is in vitro desensitisation?
Imagined exposure to the phobic stimulus.
What is in vivo desensitisation?
Actual exposure to the phobic stimulus
What are the steps of systematic desensitisation?
Step 1: Patient is taught progressive muscle relaxation and breathing techniques
(Reciprocal Inhibition: a relaxed state is incompatible with anxiety)
Step 2: Therapist and patient together construct a hierarchy of anxiety-provoking situations
Step 3: Patient gradually works their way through the fear/desensitisation hierarchy, practicing relaxation at each stage
Step 4: Once the patient has mastered their anxiety at one step in the hierarchy (i.e. completely relaxed in the presence of the phobic stimulus), they are ready to move onto the next.
Step 5: Patient masters the feared situation, once they can stay relaxed in situations at the top of the fear hierarchy
What is counterconditioning?
The learning of a different response to the phobic stimulus – the phobic stimulus is paired with relaxation/calm, breaking down the previous association between the phobic stimulus and fear/anxiety.
What is reciprocal inhibition?
One emotion prevents the other; they are incapable of co-existing simultaneously i.e. it is impossible to be both afraid and relaxed at the same time as they are opposing emotions.
what is desensitisation?
A list of situations related to the phobic stimulus that provoke anxiety, arranged in order from least to most feared.
Evaluation of Systematic Desensitisation.
SD is successful for treating a range of phobic disorders:
- McGrath et al (1990): 75% of patients with phobias respond to SD.
- Jones (1924) used SD to eradicate ‘Little Peter’s’ phobia of white fluffy animals/objects i.e. rabbits:
- The rabbit was presented at closer distances each time his anxiety levels subsided.
- Peter was rewarded with food to develop a positive association towards the rabbit.
- He developed affection for the rabbit, which generalised onto similar animals/objects.
Unlike drug therapy e.g. BZs, there are no side effects from SD and no risk of addiction or dependency. BZs are highly addictive and can result in aggression and long-term memory impairments.
What are limitations of systematic desensitisation?
Risk of symptom substitution: Systematic Desensitisation only deals with the symptoms and not the root cause of the phobia, so there is a risk that the symptoms will resurface, possibly in another form e.g. another phobia/disorder will develop in its place.
However, there is a lack of evidence for symptom substitution.
In vivo (actual exposure) techniques have been found to be more effective and longer-lasting than in vitro (imagined exposure), as some individuals lack the ability to imagine the feared situation, so might still experience a fear response when they confront the actual objects/situations.
What is Flooding?
A behavioural therapy, where instead of a step-by-step approach, patients go straight to the top of the hierarchy and imagine (in vitro), or have direct contact with (in vivo), their most feared scenarios, while at the same time practicing relaxation.
Through forced and prolonged exposure, the idea is that patients cannot make their usual avoidance response; anxiety peaks at such high levels it cannot be maintained and eventually subsides.
What are the steps of flooding?
Step 1: Patient is taught progressive muscle relaxation and breathing techniques
(Reciprocal Inhibition: a relaxed state is incompatible with anxiety)
Step 2: Relaxation techniques are applied in one session in the presence of the most feared situation, which usually lasts 2-3 hours
Step 3: A person’s fear response (and the release of adrenaline underlying this) has a time limit.
As adrenaline levels naturally decrease, a new stimulus-response link can be learned between the feared stimulus and relaxation.
Step 4: Patient masters the feared situation.
strengths of flooding:
For those patients who choose flooding as a treatment and do stick with it, it appears to be an effective treatment (equally as effective as SD) and is relatively quick (compared to Systematic Desensitisation and CBT).
Limitation of flooding: Individual Differences:
Individual Differences: Flooding can be highly traumatic (unethical – psychologically harmful) and patients may quit during treatment, which reduces the effectiveness of the therapy for some people.
strengths of behavioural therapies:
Behavioural therapies are relatively fast and require less effort than CBT: CBT requires a lot of motivation and willpower from the patient in trying to understand their behaviour and apply these insights e.g. homework tasks.
limitations of behavioural therapies?
Not appropriate for treating all phobias: Researchers have suggested that SD and Flooding may not be as effective in treating phobias that have an underlying evolutionary component (e.g. fear of the dark, fear of heights or fear of dangerous animals), than in treating phobias that have been acquired as a result of personal experience.
It also appears to be less effective for treating more complex phobias like social phobias, which may be because they have more cognitive aspects.
