Anxiety & Fear Related Disorder

Diagnostic Criteria

According to the ICD-11, anxiety disorders such as Generalised Anxiety Disorder (GAD), agoraphobia, and specific phobias exhibit symptoms that lead to significant distress or impair one or more essential areas of functioning, like family, social, or work life. The symptoms of anxiety disorders are typically severe enough to result in significant distress, including muscle tension, heart palpitations, sweating, and sleep disturbances.

Key Measures of Anxiety Disorders

1. Generalised Anxiety Disorder-7 (GAD-7): A self-report screening tool that measures the severity of anxiety through seven items scored from 0 to 3. Items include feeling nervous, restless, and afraid that something awful might happen.

2. Blood Injection Phobia Inventory (BIPI): A self-report questionnaire designed to evaluate the cognitive, physiological, and behavioural responses to phobic stimuli involving blood and injections.

Chapman and DeLap (2013) on Blood-Injection Phobia

Aim: To examine the effectiveness of Cognitive Behavioural Therapy (CBT) in treating individuals with blood-injection phobia.

Procedure: Participants underwent a structured program of CBT, focusing on gradual exposure to anxiety-inducing stimuli and cognitive restructuring of negative thoughts associated with blood and injections.

Findings: Post-treatment assessments indicated a significant reduction in phobia severity and improved coping mechanisms when exposed to phobic stimuli.

Conclusion: CBT is an effective treatment for blood-injection phobia, proving to reduce symptoms and aid in desensitisation.

Mas et al (2010) on the BIPI

Aim: To determine the BIPI's discriminatory ability between individuals with blood-injury-injection phobia and a control group.

Procedure: 39 participants diagnosed with blood-injury phobia responded to both the BIPI and a Fear Questionnaire.

Findings: The BIPI showed excellent reliability and was sensitive in detecting changes in phobia severity post-treatment.

Conclusion: The BIPI effectively distinguishes between those with and without the phobia, indicating strong psychometric properties.

Evaluations of Measures

• Strengths: The GAD-7 and BIPI demonstrate high reliability and validity, making them effective screening tools for identifying individuals who require further assessment.

• Weaknesses: Both measures depend on accurate self-reporting; hence the data may not reflect the true severity of the conditions if patients under-report symptoms based on situational factors.

Explanations of Anxiety Disorders

Biological Explanation

Genetic predisposition is believed to play a role in the development of anxiety and fear disorders. Öst (1992) found familial patterns in blood phobia, suggesting a genetic basis for these fears.

• Aim:To investigate the genetic predisposition in the development of anxiety and fear disorders.

• Procedure: 81 individuals with blood phobia and 59 with injection phobia the compare them to others with specific phobias like animal, dental, and claustrophobia.

  • Participants underwent a screening interview and completed a self-report questionnaire on their phobia's history and nature.

  • Participants discussed how their phobia affected daily life and rated fear-triggering situations before undergoing a behavioural test.

  • For blood phobia, they watched a 30-minute silent surgery video, instructed to watch as long as possible. Gaze direction was tracked, and the test ended if they looked away or stopped the video.

  • The injection phobia test was a live, 20-step process, from fingertip cleaning to a fingertip prick. Each step was described, and participants decided if it could proceed. Saying ‘no’ ended the test.

• Findings: 50% of blood phobia and 27% of injection phobia participants had a parent with the same phobia.

  • 21% of blood phobia participants had a sibling with the same disorder.

  • Fainting occurred in 70% of blood phobia and 56% of injection phobia cases, higher than other phobias

• Conclusion:Genetic predisposition plays a role in the development of anxiety disorders, highlighting the importance of considering biological factors when understanding these conditions.

• Evaluation:Found higher familial occurrence of blood and injection
  phobias, suggesting a genetic link.

  • Explains unexplained phobias – Accounts for cases where phobias develop without direct trauma.

  • Phobias may be learned through observation, not just inherited.

  • Limited explanation; stronger for some phobias (e.g., blood phobia) but weaker for others (e.g., social phobia)

Psychological Explanation

The two-process model proposed by Mowrer posits that phobias are acquired via classical conditioning and maintained through operant conditioning. Watson and Rayner’s (1920) study with Little Albert illustrated how fear can be conditioned.

• Aim: To explain how phobias are acquired and maintained from a psychological perspective.

• Procedure:

  • At 9 months, Little Albert showed no fear of various stimuli (rat,
    rabbit, dog, monkey).

  • At 11 months, he experienced the loud noise and rat together seven times. Eventually, when shown the rat alone, he cried and crawled away—his first fearful response in the study.

  • Over the next month, he remained fearful of the rat and showed negative reactions to a rabbit, fur coat, and Santa mask.

  • During conditioning, Watson struck an iron bar as Albert reached for the rat, causing him to jump and bury his face.

• Findings: Little Albert exhibited fear response to a white rat after it was paired with a frightening sound, demonstrating classical conditioning of phobia.

• Conclusion: Phobias are acquired through learned associations and maintained via reinforcement, indicating that psychological processes are integral in understanding anxiety disorders.

• Evaluation:

  • Not all phobias come from negative experiences; some
    develop without any prior traumatic event.

  • Not everyone develops a phobia; many may have
    negative experiences but do not develop a lasting fear

  • Counterconditioning Can Reduce Phobias

Two process model of Phobias (Mowrer)

According to the two-process model, phobias are initiated through classical conditioning (learning through association) and maintained through operant conditioning (negative reinforcement).

1. Acquisition: Phobias are acquired initially by classical conditioning (learning by association). If an unpleasant emotion is paired with a stimulus, then the two become associated with each other through conditioning.

2. Maintenance: Phobias are maintained through operant conditioning (learning through rewards/punishments)- the person avoids the phobic stimulus and gains a reward for doing so. This maintains the phobia because the feared association is never ‘unlearned’.
   

Psychodynamic Explanation

Freud suggested that anxiety and fear arise from the impulses of the ID, particularly when these urges are denied or repressed. He believed that phobias reflect an internal conflict that manifests in behaviour, with the phobic object symbolising the conflict associated with various developmental stages. Consequently, the sources of these conflicts typically occur at different times throughout a person's development.

• Freud (1909) examined the case of Little Hans, a five-year-old boy with a phobia of horses, to illustrate the Oedipus complex.

• Little Hans developed an intense interest in his penis at three years old, angering his mother who threatened castration, leading to fear of castration.

• Concurrently, he experienced trauma with the birth of his sister, separation from his mother, and witnessing a horse die, which triggered his horse phobia, particularly fear of being bitten by a white horse.

• Conflict arose when his father prevented him from sleeping with his parents, and his phobia faded by age five.

• Hans had two key fantasies: one involving having children with his mother and perceiving his father as his grandfather, and another of a plumber replacing his penis with a larger one.

• Findings:

  • Freud interpreted Hans' fear of white horses with black nosebands as a symbol of his father, linking the anxiety to the fear of castration and exclusion from the bed, viewing the fantasies as evidence of the Oedipus complex.

• Evaluation:

  • This study used longitudinal research, examining his fears, dreams, and fantasies over several years.

  • Longitudinal research helps build a deeper understanding of causal factors in phenomena, such as the development of phobias.

  • This study lacked objectivity due to his friendship with Hans’ father, leading to potential bias in aligning with Freud’s theories.