Chapter 9: Phobias

The biopsychosocial approach

a way of describing and explaining how biological, psychological and social factors combine and interact to influence an individual's behaviour and mental processes, including mental wellbeing.

specific phobia

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

Biological predisposing (phobia)

GABA dysfunction

Biological perpetuating (phobia)

Long Term Potentiation (LTP)

Biological Protective (phobia)

GABA agonists

Breathing retraining

Psychological precipitating (phobia)

Classical conditioning

Psychological protective (phobia)

CBT

Systematic Desensitisation

Psychological perpetuating (phobia)

Operant Conditioning

Cognitive Bias (memory and catastrophic thinking)

Social precipitating (phobia)

Specific Environmental Trigger

Social perpetuating (phobia)

stigma around treatment

Social protective (phobia)

Psychoeducation

GABA dysfunction

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

GABA dysfunction and phobia

it 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.

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

long-term potentiation (LTP)

refers to the long-lasting and experience-dependent strengthening of synaptic connections that are regularly coactivated. Can strengthen the association between a phobic stimulus and a fear/anxiety response through repeated activation of the same neural pathways

Classical Conditioning of Phobia

process by which a stimulus with no particular significance (i.e. a neutral or unconditioned stimulus) becomes, by association, a sign of impending threat, danger or some other unpleasant event (i.e. a conditioned stimulus). The innate, naturally occurring fear response (UCR) eventually becomes a conditioned fear response (CR).

operant conditioning (phobia)

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.

Antecedent

phobic stimulus

behaviour

the avoidance of the (phobic stimulus)

consequence

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.

cognitive bias

tendency to think in a way that involves errors of judgement and faulty decision-making.

memory bias (past)

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)

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.

specific environmental triggers

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

stigma

the feeling of shame or disgrace experienced by an individual for a characteristic that differentiates them from others.

stigma (around seeking treatment)

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.

GABA agonists (benzodiazepines)

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

Breathing retraining

a method used to teach breathing control techniques that may reduce physiological arousal.

cognitive behavioral therapy (CBT)

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

Systematic desensitisation

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.

steps of systematic desensitisation

1.Learning a relaxation technique

2.Forming a fear hierarchy

3.Gradual exposure to the fear stimulus + using relaxation

Psychoeducation

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

Psychoeducation Component 1: challenging unrealistic or anxious thoughts of the individual

Family and supporters are encouraged to actively challenge these thoughts in order to help a person with a specific phobia to understand that some cognitive components of their fears are potentially unfounded and irrational. This should be done in a supportive, non-judgemental fashion.

Psychoeducation Component 2: not encouraging avoidance behaviours

families and supporters are taught that they should not encourage avoidance behaviours, as they do not solve and only perpetuate the phobic anxiety