phobias

Question 1

What are phobias?

Answer 1

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.’

Question 2

What is the DSM and ICD?

Answer 2

the International Classification of Diseases (ICD)
the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Question 3

What are specific phobias?

Answer 3

A marked and persistent fear of specific things/environments
e.g .Animal phobias e.g. arachnophobia (fear of spiders)

Question 4

What are social phobias?

Answer 4

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.

Question 5

What is Agoraphobia?

Answer 5

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.

Question 6

What are emotional characteristics of phobias?

Answer 6

Anxiety and emotional responses are unreasonable

Question 7

What is the definition of anxiety?

Answer 7

Fear is marked and persistent, and is likely to be excessive, due to the presence of or anticipation of the phobic object/situation.

Question 8

What is meant by emotional responses are unreasonable?

Answer 8

The emotional response is wildly disproportionate to the danger posed by the phobic object/situation
i.e. it goes beyond what is reasonable

Question 9

What are behavioural characteristics of phobias?

Answer 9

Avoidance and Panic.

Question 10

What is meant be avoidance?

Answer 10

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.

Question 11

What is meant by panic?

Answer 11

Panic may involve a range of behaviours such as crying, screaming, freezing, running away, fainting, collapsing

Question 12

What are cognitive characteristics of phobias?

Answer 12

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.

Question 13

What is the two-process model?

Answer 13

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

Question 14

the acquisition of phobias is through…

Answer 14

Classical Conditioning: learning by association
- a stimulus becomes associated with a response

Question 15

What is the process of classical conditioning in a phobia?

Answer 15

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.

Question 16

What is the case of little Albert (Watson & Rayner, 1920)?

Answer 16

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.

Question 17

How are phobias maintained?

Answer 17

Operant Conditioning:
Learning through the consequences of behaviour.
If a behaviour is reinforced then that increases the chances of the behaviour being repeated.

Question 18

What are the two types of reinforcement?

Answer 18

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)

Question 19

How does positive reinforcement maintain phobias?

Answer 19

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.

Question 20

How does negative reinforcement maintain phobias?

Answer 20

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.

Question 21

What is the supporting evidence of the two-process model?

Answer 21

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.

Question 22

Evaluation of the Behavioural Approach to Explaining Phobias:
P: Effective treatments based on behaviourist principles have been developed to treat phobias.

Answer 22

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.

Question 23

Evaluation of the Behavioural Approach to Explaining Phobias. P: There is research support for the role of classical conditioning in acquiring phobias.

Answer 23

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…

Question 24

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.

Answer 24

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.

Question 25

Limitations of the behavioural approach to explaining phobias: P: it cannot explain why we seem to fear certain stimuli e.g. heights, spiders

Answer 25

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.

Question 26

How might the Cognitive Approach Explain Phobias?

Answer 26

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.

Question 27

What are behavioural therapies based on?

Answer 27

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.

Question 28

What do behavioural therapiesinvolve?

Answer 28

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.

Question 29

What is systematic desensitisation Wolpe (1958)?

Answer 29

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.

Question 30

What is in vitro desensitisation?

Answer 30

Imagined exposure to the phobic stimulus.

Question 31

What is in vivo desensitisation?

Answer 31

Actual exposure to the phobic stimulus

Question 32

What are the steps of systematic desensitisation?

Answer 32

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

Question 33

What is counterconditioning?

Answer 33

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.

Question 34

What is reciprocal inhibition?

Answer 34

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.

Question 35

what is desensitisation?

Answer 35

A list of situations related to the phobic stimulus that provoke anxiety, arranged in order from least to most feared.

Question 36

Evaluation of Systematic Desensitisation.
SD is successful for treating a range of phobic disorders:

Answer 36

• 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.

Question 37

What are limitations of systematic desensitisation?

Answer 37

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.

Question 38

What is Flooding?

Answer 38

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.

Question 39

What are the steps of flooding?

Answer 39

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.

Question 40

strengths of flooding:

Answer 40

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).

Question 41

Limitation of flooding: Individual Differences:

Answer 41

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.

Question 42

strengths of behavioural therapies:

Answer 42

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.

Question 43

limitations of behavioural therapies?

Answer 43

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.