KKP4: Evidence-based interventions for specific phobias

define evidence-based intervention

a treatment shown to be effective in valid and reliable research studies

What are the two biological evidence-based interventions

• benzodiazepine

• breathing retraining

What are the two pscyholgocial evidence-based interventions

• systematic desensitisation

• cognitive behavioural therapy

What is the social evidence-based intervention

• Psychoeducation

Define benzodiazepines

a type of medication that depresses the central nerved system activity and is often used as a short acting anxiety medication

benzo is an ______ drug meaning …

agonist drug: a drug that binds to the receptors of a neuron and causes the same action as the neurotransmitter that usually binds to that receptor (initiating or exciting a response)

How is benzodiazepine described?

short acting anti-anxiety GABA agonist

What does benzodiazepine do?

Slows down activity in the CNS: reduces physiological arousal and promotes relaxation

Describe how benzodiazepine functions as an agonist

when it binds to the GABA receptor site, it increases the inhibitory effects of GABA making the post synaptic neuron less likely to fire.

• Reduces the feelings off anxiety

Benzo ______ the effectiveness of GABA

enhanced

Side effects of benzo

• reduced alertness

• reduced coordination

• reduced reaction time

• lower inhibitions

• increased impulsivity

What occurs if an individual has low levels of GABA?

If GABA levels are low or it cannot be received normally across the synapse, stress response can be activated more easily and they may find it harder to calm down

Define breathing retraining

a method used to teach breathing control techniques that may reduce physiological arousal when confronted with a phobic stimulus

Describe what may happen to our breathing when encountering a phobic stimulus

• individual’s may experience abnormal breathing eg. hyperventilation

• Abnormal breathing patterns lead to oxygen and carbon dioxide imbalance in the bloodstream— carbon dioxide levels become low

What is having oxygen and carbon dioxide balance in bloodstream important

carbon dioxide helps to regulate the body’s reaction to anxiety, hyperventilation makes carbon dioxide levels low

• symptoms of low carbon dioxide such as dizziness, pins and needles ect may heighten anxiety levels

What are some advantages of breathing retaining?

• can be taught in a session with a therapist

• Can be used in a public setting without drawing attention to individual using it

What is the aim of breathing retraining

• slow breathing and practice maintaining regular breathing rhythms

• Rebalance oxygen and carbon dioxide

What needs to occur for breathing retraining to be effective?

Must be well practices, especially in absence of phobic stimulus to make it a habit

define systematic desensitisation

a therapeutic technique used to overcome phobias that involves a patient being exposed incrementally to increasingly anxiety inducing stimuli, combined with the use of relaxation techniques

define biological intervention

a treatment targeting physiological mechanisms believed to contribute to a condition

define psychological intervention

treatment that uses activities such as psychotherapy to modify thoughts, feelings and behaviours

Identify and detail the three steps of systematic desensitisation

1. Learning a relaxation technique:

   • any method or procedure that helps to induce a physiological and psychological relaxation response

   • occurs before stimulus exposure and aims to reduce physiological arousal involved in fear response

2. Forming a fear hierarchy:

   • a list of anxiety-inducing experiences relating to the patient’s phobia in order form easiest to most difficult to confront

3. Gradual exposure to fear stimulus:

   • patient its progressively exposed too each of the fear-producing situations from least to most frightening on the hierarchy while using relaxation techniques to control the fear response

   • done until the stimulus not longer produces a fear response

define social intervention

an intervention designed to increase social support for people with a mental illness

Strengths of systematic desensitisation

• Because phobia source is used to desensitise, patients are believes to be responsive to treatment

• can be done over time

Weaknesses of systematic desensitisation

• Not a quick fix

• if done too fats more stimulus generalisation may occur

define psychoeducation

educating people diagnosed with mental conditions and their families and loved ones about the disorder and possible treatment options

Detail what psychoeducation involves

• can decrease stigma that may be associated with the disorder

• May discuss symptoms, causes, treatment options, support services, effects on family, work related issues ect

What are the two key focuses of pscyhoeducation, detail these

1. Challenging unrealistic or anxious thoughts

   • unrealistic thoughts perpetuate phobias and make individuals less likely to confront the stimulus

2. Not encouraging avoidance behaviour

   • makes an individual feel good in the short term but perpetuated the phobia

   • person needs to be able to see the phobia is not as dangerous as they believe.

define cognitive behavioural therapy

a form of psychotherapy that encourages individuals to substitute dysfunctional cognitions and behaviours with more adaptive ones

explain how thoughts, feelings and behaviours interlink as part of a phobic cycle

when a person is exposed to a phobic stimulus:

• negative thoughts (memory bias, catastrophic thinking) occurs which leads to

• an emotional response (distress, shame, embarrassment)and then leads to

• a biological response (FFF activation)

• The person then alters their behaviour (avoiding the object or behaviour)

What is the main purpose of cognitive behavioural therapy?

to help identify, challenge and change unhelpful thoughts, processes, feelings and behaviours to helpful ones

Cognitive behaviour therapy is comprise of two components, these are

• cognitive therapy

• Behavioural therapy

Describe the process and purpose of cognitive therapy

• focuses on the role of thoughts, beliefs and attitudes in determining emotions and behaviours

• client is encouraged to identify thoughts and feelings relating to the phobic stimulus (which may be cognitive biases) and gather evidence that supports and refutes their fear

  • once an individual identifies and challenged their cognitive distortion they are more likely to change poor behaviours and thoughts for better ones

Describe the process and purpose of behavioural therapy

• deal directly with maladaptive behaviours that can maintain or worsen a person’s psychological problems

• Could include teaching them relaxation techniques eg. breathing retraining or progressive muscle relaxation

• allows dysfunctional ways of responding to be replaced with new more functional ones

Are benzodiazepine’s effects permanent? Justify

• No, they only make the receptors of GABA more sensitive, increasing the inhibitory effects of GABA neurotransmitters and making the post-synaptic neuron less likely to fire.

• As such, only the anxious symptoms of phobia are being treated with benzodiazepines, rather than the root cause of the phobia.

Therefore when a person stops taking benzodiazepines, the anxiety response will return.

Are benzodiazepines recommended for prolonged use? Justify

• No is it not

• Benzodiazepine can be quite addictive and thus is only typically prescribed short term

• They can have quite intense side effects such as impaired memory, reduced alertness, reduced coordination etc.

Describe how CBT is linked to operant conditioning

• Cognitive-behavioural therapy (CBT) involves preventing the maladaptive, avoidance behaviours that people engage in to prevent confrontation with their phobic stimulus, this results in negative reinforcement (removal of undesirable feelings of anxiety through avoidance).

• Through encouraging more functional, approach behaviours in CBT, individuals stop the perpetuation of their phobia through operant conditioning.

Describe how systematic desensitisation is linked to classical conditioning

Systematic desensitisation operates on the principles of classical conditioning, aiming to de-condition the association between the phobic stimulus and fear, by associating the phobic stimulus instead with relaxation.