Phobias

DSM-5 Categories of Phobia

All phobias are characterised by excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus.

• Specific phobia - phobia of an object, such as an animal or body part, or a situation such as flying or having an injection.

• Social anxiety (social phobia) - phobia of a social situation such as public speaking or using a public toilet.

• Agoraphobia - phobia of being outside or in a public place.

Characteristics of Phobias

• Definition

  • An irrational fear of an object or a situation

  • Behavioral

    • Panic

    • Crying

    • Freezing

    • Screaming

    • Sweating

  • Avoidance

• Emotional

  • Anxiety:

  • Unable to relax

  • Hard to have any positive emotion from the experience

  • Fear

  • Fight or Flight Response

  • Heart/Breathing rate increases

• Cognitive

  • Irrational Beliefs

    • Unreasonable and illogical

  • Selective Attention

    • Interferes with other tasks

The Two-Process Model (Classical Conditioning) - Orval Hobart Mowrer (1960)

1. Acquisition of Phobias

   • Phobias are acquired through classical conditioning.

2. Maintenance of Phobias

   • Phobias are maintained through operant conditioning, specifically negative reinforcement.

   • Negative reinforcement leads to avoidance of phobic stimuli, resulting in reduced fear and anxiety.

   • Avoidance behavior is reinforced by the absence of fear, perpetuating the phobia.

The Two-Process Model - Evaluation

Practical Application: Systematic Desensitization

• Patients are taught relaxation techniques to counter anxiety.

• Exposure to phobic stimuli is gradual, following a hierarchy.

Biological Explanation Comparison

• Not all phobias may be solely learned and maintained through conditioning.

• Genetic predispositions and biological preparedness can influence phobia development.

• Behaviourist explanation- “All phobias are learned”

• Doesn't take into account biological explanations

• Some people experience the same incident but they don't all develop a phobia,Why?

• Seligman (1971) argued that sometimes humans are genetically predisposed to learn an association with something that could be highly fearful

• This is because in the past we've evolved to understand that snakes loud noises or the dark are potentially dangerous

• Seligman called this biological preparedness, this means that we may have an increased likelihood of developing certain phobias because of a specific variation in our DNA which predisposes us to this fear

Cognitive Explanation Comparison

• Behaviorist model lacks consideration of cognitive aspects in phobia development.

• Irrational thoughts and anxiety play a significant role in triggering and maintaining phobias.

Outline: Behavioral Treatment for Phobias

Positive Factors

• Ad de Jongh et al (2006)

  • 73% of individuals fearing dental treatment had a traumatic dental experience

• Real-world Application

  • Treatment: Exposure therapy

• Little Albert (1920)

Negative Factors

• Does not explain how all phobias are acquired

  • Biological factors

  • Cognitive factors

• Vicarious reinforcement

Phobias: Treatment

• Behavioral treatment for phobias

• Systematic Desensitization (SD)

  • Aims to reduce phobic anxiety through classical conditioning principles

  • Cure: If a person can relax in the presence of the phobic stimulus

  • Counter conditioning: Replacing fear/anxiety with relaxation

  • Reciprocal Inhibition: Fear and relaxation cannot co-exist

Systematic Desensitization Processes

1. Relaxation Techniques

   • Breathing exercises

   • Mental imagery techniques

   • Meditation

   • Medication (e.g., valium)

2. Anxiety Hierarchy

   • Creating a hierarchy of situations related to the phobic stimulus

3. Gradual Exposure

   • Exposing the client to the phobic stimulus in a relaxed state

   • Sessions progress from least to most frightening situations

   • Success: Patient can stay relaxed in high-anxiety situations

   • Virtual Reality Exposure Therapy (VRET): In vitro form of SD

Behavioural Treatments for Phobias

Flooding:

Immediate and direct exposure to the phobic stimulus

• Pavlov on phobias:

We have associated the feared object or situation with a negative outcome or experience

If a person cannot avoid the feared object or situation, they will learn that the phobic stimulus is not as harmful as they believe, and therefore their anxiety will subside(become extinct)

Extinction in CC-The gradual weakening of a conditioned response

If the conditioned(phobic) stimulus continues to be present, but the unconditioned stimulus never appears, the association between the 2 weakens and eventually become extinct

Flooding sessions typically takes longer than SD session(2-3 hours), but sometimes only one session is enough to be cured

Evaluation(AO3)

Evidence of effectiveness

Lisa Gilroy et al. (2003) followed up 42 people who had SD for spider phobia in three 45-minute sessions. At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. In a recent review Theresa Wechsler et al. (2019) concluded that SD is effective for specific phobia, social phobia and agoraphobia.

People with learning disabilities

Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require complex rational thought. They may also feel confused and distressed by the traumatic experience of flooding.

This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias.

SD in virtual reality

Traditional SD involves exposure to the phobic stimulus in a real-world setting. However there are advantages to conducting the exposure part of SD in virtual reality (VR). Exposure through VR can be used to avoid dangerous situations (e.g. heights) and is cost-effective because the psychologist and client need not leave the consulting room.

On the other hand there is some evidence to suggest that VR exposure may be less effective than real exposure for social phobias because it lacks realism (Wechsler et al. 2019).

-Less traumatic

-Patients are in control of the process

Cost-effective

One strength of flooding is that it is highly cost-effective.

Clinical effectiveness means how effective a therapy is at tackling symptoms. However when we provide therapies in health systems like the NHS we also need to think about how much they cost. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session (perhaps three hours) this makes flooding more cost-effective.

This means that more people can be treated at the same cost with flooding than with SD or other therapies.

Traumatic

One limitation of flooding is that it is a highly unpleasant experience.

Confronting one's phobic stimulus in an extreme form provokes tremendous anxiety. Sarah Schumacher et al. (2015) found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed

consent. More seriously, the traumatic nature of flooding means that attrition (dropout) rates are higher than for SD.

This suggests that, overall, therapists may avoid using this treatment.

-Flooding could reinforce the phobia is ended too soon or the procedure not carried out properly

-May do the opposite and it will become a lifetime fear that cannot be fixed

-Less expensive that SD

vs Biological Treatments

• Beta-blockers

• Benzodiazepines

Reduce the physiological response that people have to a fear.

But not dealing with the cause of the phobia, therefore perhaps not a long-term solution.

Also serious side-effects (Benzodiazepine)

Pros of Flooding:

1. Highly cost-effective compared to other therapies like systematic desensitization (SD).

2. Can work in as little as one session, making it more time-efficient.

3. Treats more people at the same cost due to its efficiency.Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result.

4. Less expensive than SD.

Cons of Flooding:

1. Highly unpleasant and stressful experience for individuals.

2. Raises ethical concerns about causing stress to clients.

3. Higher attrition rates compared to SD due to its traumatic nature.

4. Risk of reinforcing the phobia if not conducted properly.

5. Possibility of creating a lifetime fear if not ended appropriately.