Unit 4 AOS 2: Explaining specific Phobias - Application of the BPS Approach

Comparison of stress, phobia, and anxiety

Phobia

An excessive or unreasonable fear directed to a particular object, situation or event that causes significant distress or interferes with everyday functioning.

• ~10% aussies have some type of phobia

Specific Phobia

A disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation (a phobic stimulus), often leading to avoidance behaviour.

• exposure may trigger involuntary anxiety responses, which can sometimes take the form of a panic attack.

Panic Attack

The unexpected onset of intense anxiety that can last for a few minutes or up to an hour. Ther person may feel sick, dizy, short of breathm, tight in the chest, or experience disorientation.

Anticipatory anxiety

The gradual rise in anxiety as a person thinks about, or ‘anticipates’, being exposed to a phobic stimulus in the future.

What are the 5 categories of Phobias

• Animal type

• Natural environment (heights, storms, water, etc)

• Blood-injection injury (seeing or receiving blood tests)

• Situational type (driving, flying, elevators, etc)

• Other categories

DSM-IV-TR Diagnostic criteria for Specific Phobia  

• Marked and out of proportion fear within an environmental or situational context to the presence or anticipation of a specific object or situation

• Exposure to the phobic stimulus provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack.

• The person recognizes that the fear is out of proportion.

• The phobic situation(s) is avoided or else is endured with intense anxiety or distress.

• The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

•  the symptoms for all ages must have a duration of at least 6 months.

• The anxiety, panic attack, or phobic avoidance associated with the specific object or situation is not better accounted for by another mental disorder.

Influences of contributing factors to the development of Specific Phobias

Biological Factors for Development of Phobias - Biologicacl Factors (predisposing risk factors)

GABA Dysfunction - It is hypothesised that some people develop anxiety because they have a dysfunctional GABA system, which is the result of a failure to produce, release or receive the correct amount of GABA that is needed to regulate neuronal transmission in the brain.

Biological Factors for development of Phobias - Biological factors (precipitating risk factor)

Role of Stress Responses - In a Phobia the stress response is triggered in the absence of any real threat or danger, it is excessive because their perception of threat is unreasonable and out of all proportion to what it should be. The stress response can last much longer than it should.

Biological Factors for Development of Phobias - Biological Factors (perpetuating risk factors)

Long-term Potentiation - Phobias are learned through experience. The association between the phobic stimulus and the fear is strengthened each time the relevant synapses are activated together. The more the connection is strengthened, the more the relevant neural pathway is strengthened, increasing the efficiency in transferring fear information along the pathway and decreasing the likelihood that what has been learnt will be forgotten.

Psychological Factors for Development of Phobias - Psychological Factors (precipitating risk factors)

Behavioural Model (CC) - Behavioural models suggest that phobia’s (like other ways of thinking, feeling and behaving) are learned through experience. Classical conditioning plays a role in the precipitation of a phobia and operant conditioning plays a role in the perpetuation of a phobia.

Psychological Factors for Development of Phobias - Psychological Factors (perpetuating risk factors)

Behavioural Model (OC) - Operant conditioning can perpetuate (maintain) the phobia. When a person is in the presence of their phobic stimulus they feel extreme fear, anxiety, distress. In order to alleviate these feelings they remove themselves for the phobic stimuli. By avoiding the phobic stimulus they are negatively reinforcing themselves. For example someone who is afraid of spiders when in the presence of a spider may run away (negative reinforcement = removal of anxiety).

Psychological Factors for Development of Phobias - Cognitive models

Focus on how the individual processes information about the phobic stimulus and related events. According to these models, people can actually create their own problems (and symptoms) by the way they interpret objects or situations.

• Memory bias

  • Consistency bias - past memories distorted through reconstruction to fit in with what is presently known or believed

  • Change Bias - recalling a past experience leading to exaggeration of the difference between what we kne then and what we currently feel or know → phobic fear grows over time.

• Catastrophic Thinking -  Involves overestimating, exaggerating or magnifying an object or situation and predicting the worst possible outcome. → fear/anxiety responses.

Psychological Factors for Development of Phobias - Social Factors (precipitating risk factors)

Specific environmental triggers - Initial fear response to a specific environmental trigger becomes a conditioned fear response through classical conditioning processes and is produced whenever the specific stimulus (or a generalised version) is subsequently encountered.

Psychological Factors for Development of Phobias - Social Factors (perpetuating risk factors)

Stigma around seeking treatment - A sign of unacceptability or undesirability relating to seeking support for the treatment of a phobia due to Phobias being “irrational” by definition. This reduces people’s willingness to be open, likely worsening it.

Psychological Factors for Development of Phobias - Social Factors (Protective Factors)

Social interventions - Psychoeducation for families and supporters - provision and explanation of information about a mental disorder to individuals diagnosed with the disorder to increase knowledge and understanding of their disorder and its treatment.

Evidence-based BIOLOGICAL interventions for Specific Phobia

• Biological Interventions

  • drug use (agonists & antagonists),

  • Benzodiazepines - drugs that act as a GABA agonist (have calming effects)

  • Relaxation techniques (breathing retraining because phobia = abnormal breathing)

  • Exercise - promotes mental health, well-being, and reduces anxiety.

Evidence-based PSYCHOLOGICAL interventions for Specific Phobia

• Psychological Interventions

  • Cognitive behavioural therapy (CBT)

    • Cognitive therapy - assists in developing a new understanding of the feared stimulus.

    • Behaviour therapy - deals directly with maladaptive behaviours.

  • Systematic desensitisation - replaces anxiety response with relaxation response upon the encounter o f afeared stimulus