U4AOS2B - Phobia

Question 1

Explain what is meant by a biopsychosocial framework as an approach to understanding mental health

Answer 1

• A framework is a scientific model or approach used to describe and explain how various internal and external factors interact to affect a person’s mental health
• Biological → Physiologically based factors
  
  • Genes, hormones, brain function, genetic vulnerability, poor sleep and substance use
• Psychological → Internal factors
  
  • How a person thinks, learns, solves problems, perceives, experiences emotions, manages stress and stores information, and self-efficacy
• Social → External Factors
  
  • Forming relationships, the support from friends and family, family upbringing, attachment, cultural values, income level, and educational and employment history

Question 2

Describe biological factors that contribute to specific phobia

Answer 2

• GABA dysfunction
  
  • ★ GABA → Inhibitory and calms stress response
  • Low levels/ cannot be transmitted or received normally → Stress response activated more easily + Harder to calm down
  • More susceptible
• Long-term potentiation
  
  • ★ Repeated stimulation of 2 neurons; strengthen response
  • Continued costimulation (connection for fear + perception of phobic stimulus) = Phobia strengthens over time
  • High activity in amygdala → Fear

Question 3

What is a GABA agonist?

Biological Intervention

Answer 3

• Drug that binds to receptor of neuron to mimic effect of GABA
• Benzodiazepines
  
  • Medication/ drug that binds to GABA receptor and increases GABA effects
  • Slow down CNS activity
  • Change shape of receptor to make it more receptive to GABA and more resistant to excitation
  • Can be short acting → Cleared from body quickly
  • Long lasting → Accumulate in bloodstream, longer time to clear

Question 4

How do you determine whether short/long acting benzodiazepines are appropriate?

Biological Intervention

Answer 4

• Short
  
  • Phobia → Address specific stimulus
  • Immediate
• Long
  
  • GABA is incredibly low and affecting a range of functions
  • Long term

Question 5

What are advantages of benzodiazepines?

Biological Intervention

Answer 5

• Highly effective in minimising symptoms
• Alleviate symptoms → Root causes of phobia can be more effectively treated

Question 6

What are limitations of benzodiazepines?

Biological Intervention

Answer 6

• Body can become dependent → Addictive
• Only treats symptoms, not underlying causes (not long-term solution)
• Causes reduced alertness, drowsiness & slower reaction times → Dangerous
• Lower inhibitions → Increase risk-taking
• Dangerous when mixed with alcohol or other depressants

Question 7

How can a benzodiazepine agent help manage a phobia?

Answer 7

• Acts as a GABA agonist in the brain by promoting GABA’s inhibitory effect
  
  • Helps to calm physiological arousal
• People with a phobia may have dysfunctional levels of GABA
• Prescribing a benzodiazepine helps reduce the extreme anxiety experienced because of the phobia → Reducing intensity of stress response
  
  • Less likely to avoid (perpetuate) phobia via neg. reinforcement

Question 8

What is breathing retraining?

Biological Intervention

Answer 8

• Method that teaches breathing control techniques that may reduce physiological arousal
• Reduce sympathetic nervous system activity + Increase parasympathetic
• Slow breathing → Calm stress response
  
  • Shortness of breath isn’t associated with phobic stimulus
  • Make individuals feel like they have control over their fear
• Needs to be practiced when not anxious in order to make it habitual
  
  • Ensure that individual can implement technique even when not thinking clearly

Question 9

What are abnormal breathing patterns that can be developed by people with specific phobia?

Biological Symptom

Answer 9

• Shallow ‘chest breathing’ → Not taking in sufficient volume of air
• Rapid breathing → Number of breaths is unnecessarily increased
• Deep breathing → Deeper, larger breaths = Too much oxygen
  
  • Upset balance between oxygen and carbon dioxide
  • Low level of carbon dioxide in blood
• Symptoms
  
  • Dizziness
  • Light-headedness
  • Blurred vision
  • All associated with panic attack → Heighten fear and anxiety
• Solution
  
  • All require breathing retraining to normalise breathing
  • Maintain correct oxygen and carbon dioxide balance in blood

Question 10

What are potential benefits of breathing retraining?

Answer 10

• When encountering/ anticipating phobic stimulus…
  
  • Maintain correct breathing
  • Correct abnormal breathing patterns
  • Enhanced ability to remain calm
• Minimise likelihood of hyperventilation or panic attack

Question 11

Describe psychological factors that contribute to specific phobia

Answer 11

• Precipitation - Classical
  
  • Increase susceptibility and contribute to development of phobia
  • Phobia caused by NS + UCS pairing with NS just before UCS
  • Non-extinguished (without intervention)
• Perpetuation - Operant
  
  • Inhibit person’s ability to recover → Continue phobia
  • Avoidance of phobic stimulus = Negative reinforcer (calm)
  • Increase likelihood of behaviour
• Cognitive Bias
  
  • Tendency to think in a way that involves errors + faulty decision making
  • Are not factual
  • Fixate on negative

PCPOCB - Pineapples Can’t Possibly Obtain Carbonara Beautifully

Question 12

Describe the two types of cognitive biases

Answer 12

• Memory Bias
  
  • Distorting influence of present on the recollection of previous experiences → Selective Memory, only remembering negatives thus forgetting positives that challenge
  • Consistency Bias → Distorted to fit in what is presently known/believed
    
    • Fear something currently, reflect back and conclude that they feared it in the past as well
    • Similar memories to cause are strengthened & more likely to be retrieved
• Catastrophic Thinking
  
  • Predicting worst possible outcome
  • Heightened feelings of helplessness
  • Underestimate ability to cope with situation

Question 13

What is systematic desensitisation?

Psychological Intervention

Answer 13

• Graded experience where patient with phobia is gradually exposed to phobic stimuli using relaxation techniques to calm response
• Pair CS (phobic stimulus) with pleasant UCS (relaxation technique) → new UCR
• Replace anxiety response with relaxation
• Steps
  
  • Learn relaxation technique
  • Patient establishes fear hierarchy (what is the scariest to least)
  • Patient exposed to fear hierarchy going up
  • Can only continue up the stages when they are willing and relaxed, fear response is eliminated
  • Continues until extinguished

Treats CC and OC
AKA Exposure Therapy

Question 14

What are the advantages of systematic desensitisation?

Psychological Intervention

Answer 14

• Use same thing that developed phobia to undevelop it
  
  • More responsive
• Can be done over time
• Address root cause

Question 15

What are disadvantages of systematic desensitisation?

Psychological Intervention

Answer 15

• Take a lot of time
• Too fast → Can cause stimulus generalisation
  
  • Intended pleasant UCS becomes feared

Question 16

What is cognitive behavioural therapy (CBT)?

Psychological Intervention

Answer 16

• Identifying and replacing negative cognitions & behaviours for more positive, helpful ones
  
  • Change in thinking supports changed behaviour → No more avoidance + removal of negative feelings
  • Thoughts → Feelings → Behaviour
• New understanding that phobic stimulus is not (or unlikely to be) dangerous

Assume that reason for behaviour is caused by thought processes (Thoughts-Feelings-Behaviour)
Treats cognitive biases

Question 17

What are the goals of a CBT treatment plan?

Answer 17

• Changing thoughts and behaviour that perpetuate the phobia
  
  • New understanding that their feared stimuli is not/ not likely to be dangerous
  • Introduces the idea that avoidance and safety behaviours are unnecessary and maladaptive in the long-term
• New understanding (T) = Change in feeling (F) and Behaviour (B)

Must mention change in thoughts, feelings and behaviour

Question 18

Describe social factors that contribute to specific phobia

Answer 18

• Environmental Triggers
  
  • Stimuli that evoke an extreme stress response
  • Can be generalised (not just initial stimulus)
  • Direct confrontation, observation, learning (parents and peers)
  • Lead to development of phobia
  • Doesn’t need to be repeated if intense
• Stigma - Maintains
  
  • Shame/embarrassment about something that makes one different from others
  • Prevent from seeking treatment → Getting a label
  • Worried about perception from others → Makes phobia worse

Question 19

What is psychoeducation?

Social Intervention

Answer 19

• Teaching families and supporters of individuals with mental health disorders how to…
  
  • Better understand
  • Deal with disorder
  • Treat disorder
• Components
  
  • Challenging unrealistic/ anxious thoughts of the individual
  • Not encouraging avoidance behaviours

BDT - Butter Dog Town
Explicitly mention components in responses

Question 20

State examples of how to effectively + ineffectively challenge phobic thoughts

Social Intervention - Psychoeducation

Answer 20

• Effective
  
  • Calmly acknowledge + Reassure about lack of danger
    
    • What is making you feel scared?
    • Is there any evidence that contradicts your thoughts?
• Ineffective
  
  • No acknowledgement or reassurance - Stigmatising comments
    
    • Don’t be stupid
    • You’re crazy

Question 21

State examples of how to effectively + ineffectively discourage avoidance

Social Intervention - Psychoeducation

Answer 21

• Effective
  
  • Encourage not to engage in avoidance behavior
  • Support to not engage
  • Praise/ positive reinforcement
• Ineffective
  
  • Forced exposure
  • Ridicule
  • Impatience
  • Sarcasm
  • Belitting

Question 22

Why are families/ supporters advised not to encourage avoidance behaviour (phobia)?

Answer 22

• It perpetuates the phobia
  
  • Important that the individual has the opportunity to face what is feared → Learn that their phobic stimuli isn’t dangerous
• Exposure provides opportunity to learn to cope with fears + Experience control
• Comforting rather than challenging may unintentionally reinforce avoidance behaviour

Question 23

How can attention in observational learning lead to someone developing a phobia?

Answer 23

• Individual actively focuses on model’s responses to the phobic stimulus
• Proceed to…
  
  • Storing/ encoding/ retaining the antecedent-behaviour-consequence relationship
  • NOT just imitating fear response
  • For example → Model is relieved when avoiding phobic stimulus so learner learns vicariously that avoidance of it is negatively reinforced

Question 24

Why are evidence-based interventions preferred in the treatment of a phobia?

Answer 24

• Based on peer-reviewed scientific studies → Increase likelihood of treatment to…
  
  • Be effective/ maximise chance of benefit
  • Tailored to individual’s specific phobia and their specific symptoms
  • Minimise risk of harm (unlikely to be dangerous)
  • Be of an acceptable cost

Question 25

What is the relationship between GABA and the stress response in the development of a phobia?

Answer 25

• Individuals with a phobia have low levels of GABA
• Results in neurons firing excessively
• Individual’s FFF response may activate more easily for a prolonged period when exposed to the phobic stimulus

Question 26

Why is it important to challenge unrealistic thoughts about a phobic stimulus?

Answer 26

• People with specific phobias have cognitive biases → Avoidance behaviours
• Challenging = Assist person in developing a new understanding that the feared stimulus is not dangerous
  
  • Avoidance not necessary

Question 27

Why is systematic desensitisation more effective than benzodiazepines?

Answer 27

• Benzodiazepines are a short-term solution that only reduce the phobic response
  
  • Do not change association between PS and fear
• Systematic desensitisation is more long-term because it works to change the association between the PS and fear