6 - Anxiety, Phobias, Social Phobia

Neuroticism

Proneness or disposition to experience negative mood states (a common risk factor for both anxiety and mood disorders)

Anxiety

general fear about possible future danger

Fear

alarm response that occurs due to immediate danger

Preparedness Theory (survival purposes)

suggests that humans and animals are biologically prepared to learn certain fears more easily than others because those fears helped our ancestors survive.

✅ Example:

• People easily develop fears of snakes, spiders, or heights—things that could have been dangerous in the past—

Anxiety

• General feeling of apprehension about possible danger

• Future-oriented and diffuse

• Cognitive/subjective, physiological, and behavioral components

• Cognitive/subjective

• Physiological

• Behavioral

Components of Fear and Anxiety:

• "I am in danger!"

• "I am worried about what might happen."

Cognitive/subjective (Fear & Anxiety):

• Increased heart rate, sweating

• Tension, chronic overarousal

Physiological (Fear & Anxiety):

• Desire to escape or run

• General avoidance

Behavioral (Fear & Anxiety):

fear or anxiety

For example,

• A girl named Angela sometimes saw and heard her father physically abuse her mother in the evening. After this happened four or five times, Angela started to become anxious as soon as she heard her father's car arrive in the driveway at the end of the day.

• In such situations a wide variety of initially neutral stimuli may come to serve as cues that something threatening and unpleasant is about to happen—and thereby come to elicit ______ themselves.

• Our thoughts and images can also serve as conditioned stimuli capable of eliciting the fear or anxiety response pattern.

• For example, Angela came to feel anxious even when thinking about her father.

Anxiety Disorders

Include disorders that share features of excessive fear and anxiety and related behavioral disturbances. (excessive and persistent fear and anxiety,)

• Disabling Function

Disabling Function

The pain is so severe that it restricts a person's ability to perform their usual daily activities, such as working, exercising, or even simple movements like walking. 

• Specific phobia

• Social Anxiety disorder (social phobia)

• Panic disorder

• Agoraphobia

• Generalized Anxiety disorder

5 Primary Types of Anxiety Disorders:

Anxiety Disorders

People with these disorders are all high in neuroticism

High Neuroticism

emotional instability, a tendency to experience negative emotions like anxiety, depression, and anger, and increased reactivity to stress

Specific Phobia

• Strong and Persistent fear recognized as excessive and unreasonable

  • Triggered by a specific object or situation

• Animal

• Natural environment

• Blood-injection-injury

• Situational

• Other

Specific Phobia Subtypes: (5)

Animal

Snakes, spiders, dogs, insects, birds

Natural environment

Storms, heights, water

Blood-injection-injury

Seeing blood or an injury, receiving an injection, seeing a person in a wheelchair

Situational

Public transportation, tunnels, bridges, elevators, flying, driving, enclosed spaces

Social Phobia

common mental disorder

• More common in women (60%) than men

• Psychoanalytic viewpoint

• Learned behavior/classical conditioning

• Vicarious conditioning

• Individual differences in learning

• Evolutionary preparedness

Psychological Causal Factors (specific phobia):

• Monozygotic twins

• Behaviorally inhibited temperament

Biological Causal Factors (specific phobia):

• Genetics: __________ are more likely to share phobias than dizygotic twins

• Temperament: ______________ is linked to higher vulnerability to phobias

• Exposure therapy

• Participant modeling

• Virtual Reality components

• Cognitive Techniques combinations

Treatments for Specific phobia: (4)

Exposure therapy

The person is slowly and safely exposed to what they fear until their fear lessens.

Participant modeling

The therapist shows how to calmly face the feared object or situation, then helps the person try it themselves.

Virtual reality components

Uses VR technology to simulate the feared situation (like flying or heights) for safe exposure practice.

Cognitive techniques combinations

Helps the person change negative thoughts about their fear while doing exposure therapy to make it more effective.

Medication treatments

________ are ineffective by themselves when dealing with any of the specific phobias

d-cycloserine

may enhance the effectiveness of small amounts of exposure therapy for fear of heights in a virtual reality environments.

• By itself, it has no effect.

• Arachnophobia

• Ophidiophobia

• Cynophobia

• Entomophobia

Examples of specific phobias in ANIMALS:

• Fear of spiders.​

• Fear of snakes.

• Fear of dogs.​

• Fear of insects.​

• Acrophobia

• Astraphobia

• Aquaphobia

• Nyctophobia

Examples of specific phobias in NATURAL ENVIRONMENT: 

• Fear of heights.​

• Fear of thunder and lightning/storms.

• Fear of water.​

• Fear of the dark

• Hemophobia

• Trypanophobia

• Dentophobia

Examples of specific phobias in BLOOD-INJECTION-INJURY:

• Fear of blood.​

• Fear of needles or injections.​

• Fear of dentists/dental procedures.

• Aerophobia

• Claustrophobia

• Amaxophobia

• Scolionophobia

Examples of specific phobias in SITUATIONAL:

• Fear of flying.​

• Fear of confined or enclosed spaces.​

• Fear of driving or riding in a vehicle.

• Fear of school

Exposure therapy

Mike’s treatment:

• A few months ago, Mike was an eyewitness to a fatal car accident, in which everyone in the car died, and the bodies were mutilated and the whole area was covered in blood.

• Since then, Mike became extremely sensitive to blood-like red liquids and was also unable to enjoy most meat products.

• He participated in more than 10 sessions of graduated exposure exercises in which the clinician accompanied Mike first into mildly fear-providing situations and then gradually into more and more fear provoking situations.

• For example, during the first few sessions, Mike was asked to close his eyes and imagine raw meats, or a typical rare steak where some blood is still visible. Later in the sessions (when Mike was able to settle with mildly provoking imagery), the clinician began exposing Mike to "real-life" objects, such as uncooked meat, pieces of chicken with blood, or fresh fish.

• These in vivo exposure sessions, while initially very difficult for Mike, eventually enabled him to become desensitized to these phobic targets. Mike has mostly recovered and is able to cook for his family and enjoy meals at his favorite steak house.

Social phobia

Disabling fears of one or more specific social situations

Social phobia

Fear of exposure to scrutiny and potential negative evaluation of others and to humiliation or embarrassment

Social Anxiety disorder

Social phobia is also known as?

Social Anxiety disorder

• Common mental disorder

• More common in women

• Adolescence or Early adulthood

• Many have comorbid disorders such as other anxiety disorders or depression

• Fear of Scrutiny

• Fear of Humiliation

• Social Situations = Anxiety

• Avoidance

• Out of Proportion (Fear is excessive compared to the actual threat.)

• Lasts 6+ Months:

• Impairment

• Not Due to Substance

• Not Another Disorder

• Unrelated to Other Condition

Criteria for Social Anxiety Disorder (social phobia): (10)

alcohol

Approximately 1/3 abuse _____ to reduce anxiety and face fear

• Learned behavior

• Evolutionary factors

• Perceptions of uncontrollability and unpredictability

• Cognitive biases toward "danger schemas"

Causal Factors of Social Anxiety Disorder:

Learned behavior

Classical conditioning that is direct or vicarious in nature (56-58%)

Evolutionary factors

Predisposition based on social hierarchies

• Greater activation of the amygdala in response to negative facial expressions (angry faces)

Cognitive biases toward "danger schemas"

(expect to be rejected or being negatively evaluated) in social situations that they will behave in awkward and unacceptable fashion, resulting in rejection and loss of status

• genetic

• Behavioral inhibition

Biological Causal Factors of Social Anxiety Disorder

• Twin studies suggest about 30% of variance in liability to social phobia is due to _____ factors

• ___________ (shares characteristics with neuroticism and introversion) correlates with social phobia

• Cognitive therapy

• Behavior therapy

• Medications

Treatments for Social Anxiety Disorder (social phobia):

Cognitive therapy

Cognitive restructuring to change distorted automatic thoughts.

• More effective than medications.

Behavior therapy

Exposure to social situations that evoke fear.

• If added d-cycloserine, treatment gains occur more quickly and are more substantial

Antidepressants (MAOIs and SSRIs)

Medications for Social Phobia: