Application Of A Biopsychosocial Approach To Explain Specific Phobia - Chapter 9

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Contributing Factors To Specific Phobia

Biological, Psychological and Social

Biological Factors Examples

GABA Dysfunction, Long-term potentiation (LTP)

Psychological Factors Examples

Classical Conditioning, Operant Conditioning and Cognitive Biases

Cognitive Biases Examples

Memory Bias, Catastrosphic thinking

Social Factors Examples

Specific environmental triggers, Stigma

Biological Contributing Factors

The factors that relate to the physiology of an individuals brain and body. They can be abnormalities in neurotransmitter function (GABA dysfunction), and the role in long-term potentiation

GABA (Gamma-Amino Butyric Acid)

Regulates postsynaptic activation in neural pathways, preventing over excitation and uncontrolled firing. This is important in regulating the fight-or-flight-or-freeze response, as well as anxiety.

* Slows or halts the excitatory neural impulse responsible for these reactions

GABA Dysfunction

May cause someone’s fight-or-flight-or-freeze or anxiety response to be activated easier than someone with adequate levels. Stress response may be more easily triggered by certain stimuli

Reasons For Levels Of GABA

Can be impacted by a plethora of things, including:

* Genetic inheritance, central nervous system damage, exposure to prolonged stress, nutritional deficiencies in vitamin B6 and citric acid and high caffeine intake

These things can inhibit release or binding to post-synaptic neurons, or may even stimulate over production of glutamate

Long-Term Potentiation

The long-lasting and experience-dependant strengthening of synaptic connections that are regularly coactivated. Development of phobias is influenced by these strengthened neural signals involved in perceiving a stimulus and in activating the fear response.

Psychological Contributing Factors

Relate to the individuals mental capacities, abilities and mindsets. They can be precipitation by classical conditioning, perpetuation by operant conditioning and the role of cognitive biases, including memory bias and catastrophic thinking

Precipitation By Classical Conditioning

Contributes to the development of phobias by increasing susceptibility to and contributing to their occurrence.

* Precipitating Factors

Precipitating Factors

Factors that increase the susceptibility to and contribute to the occurrence of developing a specific phobia

Perpetuation By Operant Conditioning

After Acquisition, the phobia can be maintained through operant conditioning (learning through the association of a behaviour and the consequence it receives)

Any response that reduces fear will be negatively reinforced. Avoidance response to any phobic stimulus will continue to be reinforced through operant conditioning

* Perpetuating Factors

Perpetuating Factors

Factors that inhibit a person’s ability to recover from a specific phobia

Antecent In Phobia

Phobia stimulus

Behaviour In Phobia

Individual avoids phobic stimulus (Interchanging with behaviour)

Consequence In Phobia

Individual avoids fear response (Interchanging with consequence)

Negative Reinforcement In Phobia

behaviour is negatively reinforced due to the avoidance of an aversive stimulus (Fear response)

Cognitive Biases

A predisposition to think about and process information in a certain way. May cause errors in people’s judgement and thoughts, and contribute to phobias because some people consider certain stimuli as particularly negative

Memory Bias

Refers to the distorting influences of present knowledge, beliefs and feelings on the recollection of previous experiences. Commonly called “selective memory”

• Consistency Bias

• Change Bias

Consistency Bias

Memories of past experiences are distorted through reconstruction to fit in with what is presently known or believed

Change Bias

Whenever we recall a past experience we exaggerate the difference between what we knew or felt then and what we currently know or feel, which can lead to out phobic fears to grow over time, disproportionately from what they are in reality

Catastrophic Thinking

A type of cognitive bias in which a stimulus or event is predicted to be far worse than it actually is. Individuals heightened feelings of helpless and grossly underestimate their ability to cope with the situation

Social Contributing Factors

Includes factors that are of the \[people around you and the communities and support people are surrounded by . Includes specific environmental triggers and stigma around seeking treatment

Specific Environmental Triggers

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

• Direct Confrontation

• Observation

• Learning/Indirect Confrontation

Direct Confrontation

When something extremely distressing and upsetting happens, direct experience and contact with the specific stimulus would cause fear

Observation

When something extremely distressing and upsetting is seen, it causes deep fear when being in contact with said thing again

Learning/Indirect Confrontation

When something is learnt or talked about that is distressing or upsetting, it causes fear to that discussed topic

Stigma Around Seeking Treatment

The feeling of shame or disgrace experienced by an individual for a characteristic that differentiates them from others. Leaving a phobia untreated contributes to the development and maintenance of specific phobia

Evidence-Based Interventions In The Treatment Of Specific Phobia

Treatments have been found to be effective on the basis of valid and reliable studies. DIfferent for different people.

• Biological Intervention

• Psychological Interventions

• Social Interventions

Biological Intervention Examples

GABA Agonists, Breathing Retraining, Benzodiazepine

Psychological Intervention Examples

Cognitive Behavioural Therapy, Systematic Desensitisation

Social Interventions Examples

Psychoeducation for families and supporters, challenging unrealistic or anxious thoughts and not encouraging avoidance behaviours

Bioloigcal Interventions

GABA dysfunction is an example of this intervention that contributes to specific phobia. The lack of inhibitory neural transmission in the body leads to over-excitation at the synapses, and this decreased ability to regulate neural firing can lead to feelings of anxieties

Benzodiazepine

Group of drugs that work on the CNS, acting selectively on GABA receptor in the brain to increase GABA’s inhibitory effects and most post synaptic neurons resistant to excitation

• Both anti-anxiety and sleep-inducing properties

• Referred to as sedatives, mild tranquillisers or depressants

Side Effects Of Benzodiazepine

Drowsiness, Highly addictive and long term use is not recommended

How Do Benzodiazepines Work

Are GABA Agonists, so they stimulate at the site of a postsynaptic neuron where GABA is recieved from a presynaptic neuron

* Inhibitory effect

What Benzodiazepine Does To A Receptor

It attaches to a GABA receptor, and changes the shape of the receptor to make it more receptive to the activity of the GABA and consequently more resistant to excitation. Reducing excitability of neurons reduces communication between neurons and had a calming effect

* If no GABA at receptor site, it has little effect. If it has some, it will amplify the effect

Breathing Excessively

People experiencing a phobic reaction may over breathe (Hyperventilate)

Problem With Breathing Excessively

Take more air in than th body needs, upsetting the balance of O2 and CO2, resulting in low levels of CO2 in blood. Causes dizziness, light headedness, blurred vision and pins and needles (associated with panic attack), or causing feeling of breathlessness

Breathing Retraining

An anxiety management technique that involves teaching correct breathing habits to people with specific phobia’s.

* Helps maintain breathing patterns and correct abnormal breathing patterns, as its main goal is to slow breathing

Why Breathing Retraining Is Done

To promote relaxation and to correct abnormal breathing patterns as well as to slow down breathing when exposed to specific phobias

Psychological Interventions

Typically people only seek treatment specific phobia is when it is frequently encountered and is therefore constantly intruding on everyday life

• Cognitive Behavioural Therapy

• Exposure Therapy (Systematic Desensitisation)

Cognitive Behavioural Therapy

Focusses on addressing the through pattern underlying a specific phobia. Aims to assist the individual to develop a new understanding that their feared stimuli are not dangerous so that their avoidance is unnecessary

During Cognitive behavioural Therapy

• Individual encouraged to identify their fear-and-anxiety related thoughts (cognitive biases)

• Use range of techniques to help someone identify their cognitive distortions and other unhelpful thinking patterns

• Encouraged to look for evidence that support their fear cognitions and evidence that does not support them

• Armed with objective thinking, they are able to better counter cognitive distortion

Behaviour Therapy

Major component of CBT. Involves teaching a relaxation technique (breathing retraining, promoting exercise, and/or encouraging activities that are rewarding, pleasant or give a sense of satisfaction)

* Can help distract from or reduce fear and anxiety

System Desensitisation

Involves gradual exposure. Aims to replace anxiety with a relaxation response. This technique applies classically conditioning principles.

Fear/Anxiety Hierarchy

Breaking down the anxiety-arousing object or situation into a sequence arranged from least to most anxiety-producing.(fear/anxiety hierarchy)

Three Step Process For System Desensitisation

1. Teaching an individual a relaxation technique to decrease physiological symptoms

2. Breaking down the anxiety object or situation into a sequence arranged from least to most anxiety-producing

3. graduated pairing of items in hierarchy with relaxation by working upwards through items in the hierarchy (one step at a time). Encouragement as well as patience

Social Interventions

Generally used to complement one or more biological and psychological interventions. Includes psychoeducation

Psychoeducation

Involves the provision and explanation of info about mental disorder to individuals diagnosed with the disorder to increase knowledge and understanding of their disorder and its treatment

Challenging Unrealistic Or Anxious Thoughts

Getting families and other social support to challenge unrealistic or anxious thoughts of the person

* Is their any evidence to this thought?

Not Encouraging Avoidance Behaviours

Making family and other support understand what avoidance is and the role it plays in perpetuating a phobia and how it can impact on daily functioning

* Avoidance behaviour usually encouraged, however is counterproductive. Doesn’t mean they should force them towards phobic stimulus but gently calmly encourage to not engage in avoidance behaviour