Mental health, theme 2

Anxiety disorder (phobia)

a psychological disorder characterized by an excessive or aroused state and feelings of apprehension, uncertainty and fear (most expensive to treat)

someone with anxiety —> their stress response may be:

• out of proportion to the actual threat

• something they constantly experience and may not be attributable to a specific cause

• is chronically and disabling —> causes constant emotional distress

6 main anxiety and stress-related disorders

1. specific phobias

2. social anxiety disorder

3. panic disorder

4. generalized anxiety disorder (GAD)

5. obsessive compulsive disorder (OCD)

6. post-traumatic stress disorder (PTSD)

aetiology

attributing a cause to something

specific phobia

an excessive, unreasonable & persistent fear triggered by a specific object or situation

avoidance strategies

strategies individuals with specific phobias design to minimize the possibility of contact with the trigger

phobic beliefs

beliefs about the phobic stimuli (trigger) that maintain the phobic’s fear and avoidance of that stimulus or action —> women with the fear of snakes though she would get a heart attack whenever she would see one.

exposure therapy

a big part of treating specific phobias, by exposing them to the phobic trigger and change the phobic beliefs of the patient

prevalence rate of specific phobias

20% of adults, females being twice as likely as males

DSM-5 criteria for specific phobia

1. disproportionate and immediate fear relating to a specific object or situation

2. object or situations are avoided, or tolerated with intense fear or anxiety (avoidance behavior)

3. symptoms cannot be explained by another mental disorder and persist for at least 6 months

4. phobia causes significant distress and difficulty in performing social or occupational activities

common specific phobias: (7)

• social phobia

• blood-injury-injection phobia

• animal phobias

• dental phobia

• water phobia

• height phobia

• claustrophobia

4 theories about phobia and their purpose

• psychoanalytic theory by Freud

• Classical conditioning theory by Pavlov

• Biological preparedness theory

• Non-associative fear acquisition theory

psychoanalytic theory by Freud

phobias are a defense against the anxiety that is produced by repressed id impulses

—> so, repressed id impulses causes anxiety, and the function of the phobia is then to avoid the confrontation with the real, underlying issue

(no evidence as per usual with Freud)

Classical conditioning theory by Pavlov

traumatic experiences lead to the conditioning of a specific phobia

criticism:

• not everyone who has a traumatic experience, has a specific phobia

• many people with a specific phobia can’t remember the traumatic experience

• some specific phobias are worse than others —> in conditioning models they treat everything as equal

• it doesn’t include incubation

incubation

the worsening of the fear with every encounter with the phobic stimulus

Biological preparedness theory

we have a built-in-predisposition to learn to fear things such as snakes, spiders, heights, water etc. because these have been life-threatening to our ancestors

evidence:

• with classical conditioning people will learn a fear-relevant fear (like things that can be actually dangerous to us) faster than fear-irrelevant fears (picture of houses etc)

• monkeys have shown to develop a fear of snakes if they see another monkey have a fear reaction to it —> the same did not happen when a monkey was afraid of a flower

Non-associative fear acquisition theory

a fear develops naturally and doesn’t need a traumatic experience to be elicited —> no proof of this theory

—> with exposure therapy the fear should eventually disappear

disgust

a food-rejection emotion whose purpose is to prevent the transmission of illness and disease through eating contaminated items

disease-avoidance model

the view that animal phobias are related to attempt to avoid disease or illness that might be transmitted by these animals

social anxiety

a severe and persistent fear of social or performance situations (afraid of embarrassing oneself)

DSM-5 criteria for social anxiety disorder

• distinct fear of social interactions, because someone is afraid of receiving negative judgement or giving offense to others

• social interactions are avoided, or experienced with intense fear or anxiety

• the symptoms last for at least 6 months and cause significant distress and difficulty in performing social or occupational activities

• anxiety cannot be explained by other mental/medical disorders, drug abuse or medications

prevalence rate of social anxiety disorder

between 4-13%, 3:2 with females being more likely than males (it has a genetic underlying component)

behavioral inhibition

a characteristic of children to seem quiet, isolated and anxious when confronted with social or new situations. —> not a sufficient indicator of social anxiety disorder)

self-focused attention

sufferers from social anxiety disorder tend to shift their attention inwards onto themselves

treatments for social anxiety disorder —> cognitive behavior therapy (CBT), 3 types:

• exposure therapy

• social skills training

• cognitive restructuring —> replacing their negative bias towards themselves

agoraphobia

a fear of public places (& sometimes also their own bodily experiences, like sweating, arousal etc.)

DSM-5 criteria for agoraphobia

• marked fear or anxiety about 2 or more public situations (public transport, open spaces, enclosed spaces, being in a crowd etc)

• they avoid these situations because of the idea that they can’t escape or help won’t be able to reach them when something happens

• these situations ALWAYS provoke fear

• the situations are actively avoided, require the presence of a companion or are endured with intense fear or anxiety

• the fear or anxiety is out of proportion to the actual threat

• the fear, anxiety or avoidance is persistent over at least 6 months

• causes significant distress or impairment in social, occupational or other important areas of functioning

• the symptoms are not better explained by other mental disorders

—> agoraphobia is separate of a panic disorder, if someone meets both criteria, both disorders should be assigned

prevalence of agoraphobia

4.7% of the population, usually starts in the late teenage years, but on average between 23-34 years —> twice more common in women than men

treatments of agoraphobia

• medications like anti anxiety or antidepressants (to calm them down)

• behavioral & cognitive-behavioral treatments —> exposure therapy & interoceptive exposure

—> clients who only use medication treatments are more likely to relapse

interoceptive exposure

deliberate exposure to feared internal sensations

D-cycloserine (DCS) (article)

DCS’s overall effects were extremely small in helping with overcoming phobias, same effects as a placebo —> So, DCS is unlikely to be useful for improving exposure therapy in anxiety and OCD