Lecture 3: Specific phobias

Fear responses and phobias look very similar on the outside. What is the difference?

Fear is a response to a danger. A phobia is triggered even when there is no danger present

What are common phobic objects?

•Animal (e.g., spiders, insects, dogs).

•Natural environment (e.g., heights, storms, water).

•Blood-injection-injury (e.g., needles, invasive medical

procedures)

•Situational (e.g., airplanes, elevators, enclosed places).

•Other (e.g., situations that may lead to choking or vomiting; in

children, e.g., loud sounds or costumed characters)

Conditioning (classical)

US (bite) = UR (fear)

CS (dog) = CR (fear)

What types of conditioned responses exist?

Physiological responses

Electromyography (EMG)

Skin conductance (SCR)

Subjective responses

Fear ratings

Expectancy Ratings

Behaviour

Avoidance/Freezing

Fear generalization

the spread of fear to

objects similar to the phobic object (e.g. all dogs)

What is a problem with conditioning models?

Neither necessary nor sufficient to explain phobias

No individual differences

Assumption that all stimuli can be

similarly conditioned

No direct experience needed

How can fear conditioning be a procedure, an effect and a mechanism?

Procedure (What is happening?)

Effect (What do we find?)

Mechanism (Why it is happening

What types of exposure therapy are there?

• In vivo exposure

• Virtual reality exposure

  • Imaginary exposure

  • (Interoceptive exposure - more used in treating PD)

Explain this

In a phobia, the CS is associated with the US and thus there is an expectancy that the US will occur. The fear is caused by the expectation that the US will occur as well as the evaluation of the US as dangerous

What are the steps in exposure therapy?

(I) Intake

(II) Fear hierarchy

(III) Flooding (start with most fearful component) or desensitization (start with least

fearful component)

(IV) Behavioral Approach Task (With Response Prevention)

(V)Duration: Typically one long session (3h) or 3-5 shorter sessions (1h) are

sufficient

(VI) Pharmacological enhancement/support can be considered (e.g., when patients

is highly distress) (Maybe safety cue)

What are problems with in-vivo exposure therapy?

1.Treatment acceptance (e.g., Garcia-Palacios et al., 2001)

•75-85% of phobic patients do not seek treatment

•25% of patients who seeks treatment refuse exposure therapy

2.Drop-out

•0-45% drop-out rates (Choy et al., 2007)

3.Relapse

•19-62% of patients relapse after exposure therapy (Craske & Mystkowski, 2006)

What is

• Spontaneous recovery

• Reinstatement

• Renewal

• Rapid reaquisition

Spontaneous recovery: fear just coming back after a while

Reinstatement: Fear coming back after another encounter with the US

Renewal:the return of conditioned fear observed when the threat cue is encountered outside the extinction context

Rapid reaquisition: The phobia coming back quickly when CS and US are paired together

What did the study with propanolol find?

That providing people with a propanolol pill erased the behavioural activation of the fear memory 24 hours later, e.g. the fear memory was not remembered as being fearful

This could potentially be a factor in relapse rates

What did another study on propanolol find?

That the reconsolidation process was only disrupted if the patients who took propanolol encountered the feared stimulus 2 days (rather than 4 weeks) after the intervention