Phobias (chp9)

Specific phobia

An intense and irrational fear of a specific object or event, which is consequently either strenuously avoided or endured with marked distress.

Predisposing (Biopsychosocial (int/ext) – Phobias)

Precipitating (Biopsychosocial (int/ext) – Phobias)

Perpetuating (Biopsychosocial (int/ext) – Phobias)

Protective (Biopsychosocial (int/ext) – Phobias)

Biological factors that contribute to specific phobia

1.GABA dysfunction

2.Long-term potentiation (LTP)

GABA dysfunction

uGABA dysfunction refers to the insufficient neural transmission or reception of GABA in the body.

uThis can be due to a low level or production of GABA, or an insufficient reception or transmission of GABA across the synapse.

uGABA dysfunction can contribute to the development of phobia because:

uIt may cause someone’s flight-or-fight-or-freeze response to be activated more easily than someone with adequate GABA levels. This means that the stress response may be more easily triggered by certain stimuli.

uRecurrent stress responses to specific stimuli can lead to the development of a phobia.

GABA dysfunction and phobia template

GABA (gamma-amino butyric acid) is an inhibitory neurotransmitter, therefore making postsynaptic neurons less likely to fire.

GABA dysfunction refers to the insufficient neural transmission or reception of GABA in the brain, causing heightened levels of neural activity on the post-synaptic neuron.

GABA dysfunction can contribute to the development of phobia because it may cause someone’s anxiety response to be activated more easily than someone with adequate GABA levels that would normally inhibit the anxiety response. Recurrent stress responses to specific stimuli can precipitate a phobia

Long-term potentiation

Long-term potentiation (LTP) refers to the long-lasting and experience-dependent strengthening of synaptic connections that are regularly coactivated.

LTP can strengthen the association between a phobic stimulus and a fear/anxiety response through repeated activation of the same neural pathways.

LTP and phobia template

Long term potentiation (LTP) is the long-lasting strengthening of synaptic connections due to repeated co-activation

The neural pathways for (PHOBIC STIMULUS) and fear are repeatedly co-activated and strengthened.

This can lead to adaptive changes in the brain, including sprouting that lead to learning and memory formation between the (PHOBIC STIMULUS) and the fear response, which strengthens and perpetuates the phobia.

Psychological factors that contribute to specific phobia

1.Classical conditioning

2.Operant conditioning

3.Cognitive biases

Psychological factors that contribute to specific phobia

1.CLASSICAL CONDITIONING – PRECIPITATES

2.OPERANT CONDITIONING – PERPETUATES

1.Classical conditioning

Classical conditioning can precipitate specific phobia as phobias can be learned, and therefore developed, through classical conditioning.

The development of a specific phobia through classical conditioning is essentially the process by which a stimulus with no particular significance becomes, by association, a sign of impending threat, danger or some other unpleasant event . The innate, naturally occurring fear response (UCR) eventually becomes a conditioned fear response (CR).

CC and phobia template

Before conditioning stage – the neutral stimulus (phobic stimulus) elicits no relevant response and the unconditioned stimulus (specific environmental trigger) elicits the unconditioned response (fear)

During conditioning stage – where the NS (phobic stimulus) is repeatedly presented before the UCS (specific environmental trigger) eliciting the UCR (fear)

After conditioning stage – the previous NS (phobic stimulus) becomes a conditioned stimulus (phobic stimulus) which, alone produces the learned conditioned response (fear)

This can lead to the precipitation of a specific phobia where the phobic stimulus produces an intense and irrational fear

2. Operant conditioning

The role of operant conditioning in phobias can be thought about largely in terms of the consequence stage.

an individual with a phobia will generally avoid contact with their phobic stimulus at all costs.

by avoiding confrontation with the phobic stimulus, a person is negatively reinforced through this avoidance in not having to deal with their fear response.

over time, this reinforcement strengthens or maintains the phobic response, making avoidance behaviours more likely to be repeated and preventing recovery through this cycle.

OC and phobia template

The antecedent is (PHOBIC STIMULUS)

The behaviour is the avoidance of the (phobic stimulus)

The consequence is the removal of the fear response. This acts as negative reinforcement, which is the removal of an undesirable stimulus, which in turn increases the likelihood of continued avoidance behaviour.

This perpetuates and reinforces the intense and irrational fear of the phobia.

3.Cognitive biases

Memory bias (past)

a type of cognitive bias caused by inaccurate or exaggerated memory

for example, people with arachnophobia (fear of spiders) may recall the size of a spider they encountered as much bigger than it was in reality.

Catastrophic thinking (future)

a type of cognitive bias in which a stimulus or event is predicted to be far worse than it actually is

for example, people with arachnophobia (fear of spiders) may think that if they encounter any type of spider, they will get bitten and die.

Social factors that contribute to specific phobia

1.Specific environmental triggers

2.Stigma around seeking treatment

1.Specific environmental triggers

are stimuli or experiences in a person’s environment that evoke an extreme stress response, leading to the development of a phobia

2.Stigma around seeking treatment

Stigma can inhibit people from seeing a mental health professional for assessment and diagnosis, or from seeking any type of help, due to feeling of shame and negative stereotypes, thereby increasing the troublesome impact of their phobia by increasing the duration of the untreated affects

Evidence-based interventions

treatments that were effective in valid and reliable research studies.

Biological interventions for phobias

1.GABA agonists

2.Breathing retraining

1.GABA agonists

-Benzodiazepines are a group of drugs that work on the central nervous system, binding to GABA receptors in the brain to increase GABA’s inhibitory effects and make postsynaptic neurons less likely to fire.

-By inducing inhibitory responses, excitatory communication between neurons in the fear response is reduced, reducing anxiety.

Benzodiazepines and phobia template

People with specific phobia often have a GABA dysfunction, predisposing them to anxiety.

Benzodiazepines work as an agonist for GABA by binding to the GABA receptor sites on the post synaptic neuron to mimic the effects of GABA.

This increases the effectiveness of GABA, thereby allowing GABA to have its inhibitory effects.

By making the neuron less likely to fire, the over-excitation of neurons that causes anxiety is reduced, providing a temporary relief of the stress response, which can reduce specific phobia response

2.Breathing retraining

Breathing retraining is a method used to teach breathing control techniques that may reduce physiological arousal

Breathing retraining and phobia template

Phobic anxiety involves fast-paced and often shallow breathing, sometimes causing hyperventilation and activation of other sympathetic nervous system responses.

Breathing retraining involves teaching someone to control their breath and work on reducing fast-breathing through deep, slow breaths e.g. box breathing.

When someone has phobic anxiety, they can apply this technique to induce physiological relaxation to reduce phobic anxiety through parasympathetic responses.

Psychological interventions for phobias

1.Cognitive behavioural therapy (CBT)

2.Systematic desensitisation

1.Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a form of psychotherapy (‘talking therapy’) that encourages individuals to substitute dysfunctional cognitions and behaviours with more adaptive ones.

CBT template

Cognitive behavioural therapy (CBT) involves identifying problematic cognitions and behaviours and replacing them with positive ones to improve mental wellbeing/phobia

The psychologist would help identify and challenge unhelpful thoughts and behaviours. For example, the psychologist might address cognitions (MEMORY BIAS/CATSTROPHIC THINKING) and behaviours (AVOIDANCE)

The psychologist would then help to change or replace thoughts and behaviours with more helpful ones. For example, by (INSERT A POSTIVE THOUGHT) and (INSERT A POSITIVE BEHAVIOUR CHANGE)

E.g. positive thought – clowns can’t hurt me

E.g. behaviour change – use of breathing retraining

2.Systematic desensitisation

Systematic desensitisation is a behaviour therapy used to overcome phobias that involves a patient being exposed incrementally to increasingly anxiety inducing stimuli, combined with the use of relaxation techniques.

2. Systematic desensitisation steps

1.Learning a relaxation technique

2.Forming a fear hierarchy

3.Gradual exposure to the fear stimulus

Systematic desensitisation and phobia template

The therapist/professional may teach a relaxation technique, such as breathing retraining to reduce physiological arousal.

A fear hierarchy is then developed, ranking experiences from least anxiety-inducing interactions, to most anxiety-inducing interaction.

This fear hierarchy is gradually worked through, starting with the least anxiety-inducing stimulus, pairing fearful stimuli with relaxation technique until anxiety response has been extinguished.

This systematic exposure of items in the hierarchy should be continued until the most anxiety-producing stimulus can be faced without phobic response

Social interventions for phobias

1.Psychoeducation

1.Psychoeducation

Psychoeducation is educating people diagnosed with mental health conditions and their family members about the disorder and possible treatment options

Psychoeducation template

Psychoeducation is the social protective factor that could be used.

Psychoeducation involves educating people diagnosed with mental health conditions and their family members about the disorder and possible treatment options.

Family/friends/supporters could assist by

challenging unrealistic thoughts (memory bias/catastrophic thinking) about phobic stimulus (insert scenario)

discouraging avoidance behaviours (operant conditioning)

and reminding him of his breathing retraining (biological)