specific phobia Flashcards
what is anxiety?
state of physiological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or unpleasant is about to happen
what is a phobia?
characterised by a persistent intense and irrational fear of a specific event or situation that impairs functioning
what are similarities between stress and anxiety?
- common, normal experiences in certain situations
- everyone experiences this at some time
- tend to be adaptive in the short-term in threatening situations
- mild-moderate levels= more alert and improve ability to cope
- severe or exaggerated stress and anxiety can be counterproductive and disabling (potential contributory factor to mental health disorder)
what are similarities between stress, anxiety and phobias?
- can impact on a person’s functioning if not managed
- influenced by biological, psychological and social factors
- accompanied by physiological changes➝ may involve fight-flight-freeze response
what are the distinguishing features of stress?
- may be eustress or distress
- source/cause of response is usually known
- can be experienced in response to a wide range of stimuli
what are the distinguishing features of anxiety?
- source/cause of response is not always apparent
- feelings of something in the future
what are the distinguishing features of phobias?
- fear response is out of proportion to the actual danger passed by the object or situation
- people have compelling desire to avoid the phobic stimulus
- significantly impacts a person’s functioning
- source/cause of a response is usually known➝ typically in response to specific stimuli
- diagnosable mental disorder
- not considered adaptive or helpful
- not considered a ‘normal’ experience
what is stress, anxiety and phobia on a mental health continuum?
used to describe how stress, anxiety and phobia can vary independently and collectively in relation to each other
what is a specific phobia?
a disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation usually leading to avoidance behaviour
eg. animals, situations, blood, injections and injury, natural environments and other phobias
what happens when someone is exposed to a specific phobia?
- usually triggers an acute stress response➝ physio changes similar to the fight-flight-freeze response
- may experience a panic attack➝ period of sudden onset of intense fear often associated with feelings of impending doom
- may experience anticipatory anxiety➝ thinking they will be exposed to the phobic stimulus= gradual rise in anxiety levels
what are the 3 biological contributing actors to the development of a specific phobia?
- GABA dysfunction
- (role of the) stress response
- long-term potentiation
what is GABA dysfunction?
low levels of GABA in the brain due to failure to produce, release and receive adequate amounts of GABA
how does GABA dysfunction contribute to a specific phobia?
predisposing:
- GABA counterbalances the excitatory action of glutamate to regulate neuronal activity in the brain➝ calming agent to the excitatory neurotransmitters
- not enough GABA= not enough inhibitory effects to counteract the excitatory effects= anxiety/fear response more easily triggered
what is a stress response?
appraised as a threat that is unable to cope with
- activation of the sympathetic nervous system when presented with a phobic stimulus (F-F-F)= heightened arousal, including [physiological change]
how does stress response contribute to a specific phobia?
precipitating:
- physical stress response is triggered in the absence of any real threat
- The experience of stress/fear becomes associated with the phobic stimulus.
- anxiety is excessive➝ perception of threat is out of proportion to the danger it poses
- stress response is severe and prolonged
how does long-term potentiation contribute to the development of a specific phobia?
perpetuating:
- connections between phobic stimulus and fear response is strengthened due to repeated stimulation= enhanced/more effective synaptic transmission along the neural pathway of fear information
- decreases likelihood of forgetting
what are the psychological factors contributing to a specific phobia?
- behavioural models: precipitation by classical conditioning & perpetuation by operant conditioning
- cognitive bias: memory bias & catastrophic thinking
what are behavioural models and what does it propose?
phobias are learned through experience: can be acquired through CC and OC
- CC pays a role in the development (precipitating)
- OC plays a role in the maintenance (perpetuating)
how does precipitation by classical conditioning contribute to a specific phobia?
- development of a specific phobia occurs when a stimulus with no particular significance (NS) becomes a sign of impending threat, danger or other unpleasant events (CS) by association.
- naturally occurring fear response (UCR) eventually becomes a conditioned fear response
- CR is disproportional to any actual risk
how does perpetuation by operant conditioning contribute to specific phobias?
- consequence of avoidance behaviours of the phobic stimulus= reduction of anxiety and fear acts as negative reinforcement➝ strengthens or increases the likelihood of the avoidance behaviours occurring again= helps maintain the phobia
what are the focus of cognitive models?
- focuses on how the individual processes info about the phobic stimulus and related events
what does the cognitive model emphasise?
how and why people with a phobia have an unreasonable and excessive fear of phobic stimulus
what is the key assumption of cognitive models?
- people can create their own problems and symptoms by the way they interpret objects/situations
what are cognitive biases (cognitive distortions)?
- tendency to think in a way that involves errors of judgement and faulty decision making
- can become habitual= make a person more prone to fear/anxiety in response to a phobic stimulus
how are cognitive biases perpetuating risk factors?
perpetuating: strengthens phobic response in that stimulus becomes associated with a traumatic experience (memory bias)/very bad consequences (catastrophic thinking)
what is memory bias?
tendency for recall of the phobic stimulus to be better for negative/threatening info than for positive/neutral info
- distorting influences of present knowledge, beliefs and feelings on the recollection of previous experiences
what are the 2 types of memory bias?
- consistency bias
- change bias
what is consistency bias?
- memories of past experiences are distorted through reconstruction to fit in with what is presently known or believed
what is change bias?
- when we recall a past experience we exaggerate the difference between what we knew or felt then and what we know or feel now= phobic fears grow over time, disproportionately from what they are in reality
what is catastrophic thinking?
thinking style which involves over-estimating, exaggerating or magnifying an object or situation and predicting the worst possible outcome
eg. may assume they will lose control or die if exposed to phobic stimulus
how does catastrophic thinking contribute to a specific phobia?
- experience heightened feelings of helplessness and severely underestimate their capacity to cope with the situation
- think they will be unable to deal with the anxiety symptoms they might experience
what are the social contributing factors to a specific phobia?
- specific environmental triggers
- stigma around seeking treatment
what is specific environmental triggers?
traumatic experience with the particular phobic stimulus in their past
how may specific environmental triggers contribute to specific phobias?
precipitating: traumatic experience is attributed to cause of phobia
- initial fear response to specific environmental trigger= conditioned fear response
- fear response is produced each time the specific stimulus is encountered (NS➝CS)
- more severe the trauma experience= phobia more likely to develop
eg. specific environmental trigger was witnessing brother being bitten and going to hospital when he was a child= shows spiders as dangerous and something to fear
why are do people not seek treatment for their phobias?
- specific phobia involving an object or situation that is apparently harmless to others= particularly vulnerable to stigma
- can be difficult for people to understand or empathise with
- sharing fear may result is ridicule, belittlement or not being taken seriously
how does stigma around seeking treatment contribute to specific phobia?
perpetuating:
- people believe specific phobias are ‘less severe’ than other anxiety disorders
- due to negative reactions= many disguise the reality of the disorder
- personal or cultural beliefs may also inhibit treatment
What are the biological evidence based interventions for specific phobia?
- use of benzodiazepine agents (GABA agonist)
- relaxation technique: breathing retraining
- relaxation technique: exercise
what are benzodiazepines (type of GABA agonists)?
group of drugs that reduce the activity of the CNS acting on GABA receptors in the brain to increase GABA’s inhibitory effects
what are GABA agonists?
drugs that stimulate a neurotransmitter’s activity
- stimulates inhibitory effects
how may benzodiazepine be effective?
- benzo attaches to GABA receptor= mimics neurotransmitter
- changes receptor’s shape= makes it more receptive to GABA activity
- amplifies GABA’s inhibitory effects on post-synaptic neuron
= reduces physiological arousal/anxiety & promote relaxation
how does short-acting benzodiazepines help with a specific phobia?
- use occasionally to cope with an encounter with a phobic stimulus
- reduces anxiety in the short-term
- treats the symptoms, not the cause➝ once medication stops, anxiety may return
what is breathing retraining?
teaching correct breathing habits
why do people over-breathe during encounter with phobic stimulus and why is it bad?
breathing is often fast and shallow during a phobic/anxiety response= can lead to hyperventilation
- upsets balance between O2 and CO2
= associated with panic attack= increase anxiety
how may breathing retraining be effective?
- consciously control/slow his breath = restore the balance of O2 & CO2
- activate parasympathetic response➝ inhibits fight-flight= lowers arousal and reduces anxiety and stress= promotes relaxation
what is exercise?
physical activity undertaken to improve or maintain one’s physical condition
how may exercise be effective at managing a phobia?
- promotes relaxation by relieving anxiety
- provide distraction
- uses up stress hormones in the blood-stream
- experiences the fear/anxiety symptoms (fight-flight) in non-threatening way= may improve coping ability through repeated exposure
- releases endorphins= enhances mood
What are the psychological evidence based interventions for specific phobia?
- psychotherapeutic treatments: cognitive behavioural therapy (CBT)
- psychotherapeutic treatments: systematic desensitisation
what is the aim of cognitive behavioural therapy (CBT)?
-identifying and changing negative thoughts
-develop a new understanding that their feared stimuli are not/unlikely to be dangerous
-to change maladaptive behaviours with more balanced and realistic ones
what is aim of cognitive behavioural therapy as an intervention for specific phobias?
- used to change thoughts (cognitive biases) and behaviours (avoidance) that perpetuate the phobia and improve coping skills
cognitive: help a person develop a new understanding that their feared stimuli are not/unlikely to be dangerous
behavioural: avoidance (staying away) and safety (precautions taken if contact with the phobic stimulus occurs) behaviours are unnecessary and unhelpful in the long-term
why are avoidance and safety behaviours not helpful with a person with a specific phobia?
- perpetuates a behaviour
- They prevent a person from disconfirming their unrealistic beliefs about the amount of danger
posed by the phobic stimulus. - they think the feared outcome hasn’t occurred due to their avoidance of it ➝ aren’t able to verify that their feared outcome will not occur
- They have not experienced a decrease in anxiety in the presence of their phobic stimulus (anxiety
levels cannot keep rising indefinitely)
how may the cognitive component of cognitive behavioural therapy (CBT) as an intervention for specific phobias be effective?
- client identifies their fear-related thoughts and cognitive biases
= finds accurate and reliable evidence that supports/doesn’t their fear cognitions, thinks of their thoughts as hypotheses to allow for questioning - more balanced and objective thinking allows people to approach their fears more rationally
- change in thoughts= change in feelings and behaviours
how may the behavioural component of cognitive behavioural therapy (CBT) as an intervention to specific phobia be effective?
- To change any behaviours which are maladaptive about the phobic
stimulus – especially avoidance - includes use of relaxation techniques
- gradual and repeated exposure to the phobic stimulus in safe and controlled way
what is systematic desensitisation?
behaviours therapy that aims to replace an anxiety response with a relaxation response when person encounters a fear stimulus
how may systematic desensitisation be effective in reducing anxiety?
4 step process:
- learn relaxation technique
- break down the phobia into a fear/anxiety hierarchy
- pairing of items in the hierarchy with relaxation technique
- continue until the person can face the most anxiety producing step in a relaxed state
how may step 1 of systematic desensitisation be effective?
- learning breathing retraining, progressive muscle relaxation, visual imagery
- decrease physiological arousal when faced with the phobic stimulus
how may step 2 of systematic desensitisation be effective?
- fear hierarchy: list of feared objects/situations ranked from the least to most anxiety producing
how may step 3 of systematic desensitisation be effective?
- each step is exposed to the client using real life visual imerage/virtual reality and paired with relaxation technique
- do not progress to the next step unless relaxation is achieved
CC principles: - unlerning connection between anxiety and a specific object/situation
- reassociating feelings of relaxation (safety) with the object or situation
What are the social evidence based interventions for specific phobia?
Psychoeducation for families and supporters
- challenging unrealistic or anxious thoughts
- not encouraging avoidance behaviours
what is psychoeducation for families/supporters?
- info, explanation of how it is triggered & how to assist management of a phobia to diagnosed individuals & their friends/family/social networks to increase knowledge and understanding of their phobia and its treatments
how may psychoeducation for families/supporters be effective?
- assumes increased understanding of symptoms, treatment options, services available and recovery patterns enables individuals with a mental disorder to cope more effectively
- the more educated a person is, the more self-control a person tends to have (self-management of a disorder
what is psychoeducation for families/supporters: challenging unrealistic or anxious thoughts?
- tendency to overestimate the threat the phobic stimulus poses while underestimating the ability to cope
- goal: to realise thoughts have no real basis
how may psychoeducation for families/supporters: challenging unrealistic or anxious thoughts be effective?
- family/supporters can help by encouraging a person to test or evaluate unrealistic or anxious thoughts when not exposed to a phobic stimulus and support them through this process
- can acknowledge their worries but challenge or question distorted thinking
- remind people that their anxious thoughts are not facts
- encourage people to consider alternative possibilities
- suggest people to write down negative thoughts and help in evaluating them
what is psychoeducation for families/supporters: not encouraging avoidance behaviours ?
- important to face phobic stimulus to learn the phobic stimulus is not threatening
- avoidance encouraged= unintentionally perpetuate phobia
- family/supporters can learn about the importance of gently and calmly encouraging a person not to engage in avoidance behaviour, possibly challenging behaviour
how may psychoeducation for families/supporters: not encouraging avoidance behaviours be effective?
- helps person realise through repeated experiences of facing their fearm they will begin to realise that the worst is not going to happen
- positive reinforcement could be provided if a person doesn’t use avoidance behaviour
