chapter 10 Flashcards
what is a phobia?
-Anxiety belongs to a group of mental
health disorders characterised by worry, fear and anxiety strong enough to interfere with daily activities, specific phobia being one of the most common
specific phobia
- a persistent, intense, irrational fear of a specific object or event (often leads to avoidance behaviour)
- fear is out of proportion to the actual danger
- for diagnosis of specific phobia, symptoms must be present for 6 months or longer and disrupt the persons life, especially work and social relationships, or cause them serious distress
phobias can generally be placed in four categories that relate to:
- the natural environment (e.g. water, storms)
- animals (e.g. snakes, spiders, dogs)
- potential bodily pain or injury (e.g. needles, dental and medical procedures, sight of blood)
- situations (e.g. heights, confined or open spaces, aeroplanes, tunnels).
TYPES OF ANXIETY DISORDER
-generalised anxiety disorder (GAD)
-specific phobia
generalised anxiety disorder (GAD):
-Persistent and excessive worry, often about daily situations like work, family or health.
-This worry is difficult to control and interferes with the person’s day-to-day life and relationships
specific phobia:
- Extreme anxiety and fear of particular objects or situations.
-Common phobias include fear of flying, fear of spiders and other animals, and
fear of injections
TYPES OF ANXIETY DISORDER
-panic disorder
-agoraphobia
panic disorder:
- The experience of repeated and unexpected panic attacks – sudden
surges of overwhelming fear and anxiety accompanied by physical symptoms such as chest pain, heart palpitations, dizziness and breathlessness.
-In panic disorder, these panic attacks come ‘out of the blue’ with no apparent trigger.
agoraphobia:
- Involves intense anxiety in situations and places where the person feels it would be difficult for them to get out quickly or get help if needed.
-This includes situations such as using public transport, being in a lift or a cinema, standing in a queue, being in a crowd, or being outside of the home alone
TYPES OF ANXIETY DISORDER
-obsessive-compulsive disorder (OCD)
-social anxiety disorder
obsessive-compulsive disorder (OCD):
-Recurring, persistent and distressing thoughts, images or impulses known as obsessions (e.g. a fear of catching germs), or feeling compelled to carry out certain repetitive behaviours, rituals or mental acts, known as compulsions (e.g. handwashing).
-Some people with OCD have both obsessions and compulsions.
-These thoughts and behaviours can take over a person’s life and, while people with OCD usually know that their obsessions and compulsions are an overreaction, they feel they are unable to stop them.
social anxiety disorder:
-Severe anxiety about being criticised or viewed negatively by others.
-This leads the person to avoid social events and other social situations for fear of doing something that leads to embarrassment or humiliation.
development of specific phobia and the biopsychosocial model
BIOLOGICAL FACTORS:
-dysfunctional GABA system
-long-term potentiation
PSYCHOLOGICAL FACTORS:
-classical conditioning (precipitates)
-operant condition (perpetuates)
- cognitive bias ( memory bias and catastrophic thinking)
SOCIAL FACTORS:
-specific environmental trigger
-stigma
*two people may have the same diagnosis, the same factors will not necessarily interact in the same way in the development of their illnesses
BIOLOGICAL FACTORS
- relates to the physiological functioning of the body
-Genetics is an example of a biological factor that contributes to the development, progression or perpetuation of a specific
phobia.
-other biological factors include, gamma-aminobutyric acid (GABA) dysfunction,
the role of the stress response and the impact of long-term potentiation, and how they contribute to the development of a phobia
GABA
-the main inhibitory neurotransmitter in the nervous system, associated with
anxiety, specific phobias and Parkinson’s disease
-GABA is considered an inhibitory neurotransmitter because it blocks, or inhibits, certain neural signals and decreases activity in the nervous system.
-When GABA activates its receptors, it makes post-synaptic neurons less likely to fire an action potential, producing a calming effect.
-This reduces feelings of anxiety, stress and fear.
GLUTAMATE
the main excitatory neurotransmitter in the nervous system, involved with learning and
memory
BIOLOGICAL FACTORS
1. Gamma-aminobutyric acid (GABA) dysfunction
- Dysfunctional GABA system refers to a failure to produce, release or receive the correct amount of gamma-aminobutyric
acid
-people diagnosed with a specific phobia are predisposed to anxiety because they have a dysfunctional GABA system
- Excessive anxiety is due to an elevated stress response caused by the release of glutamate during a flight-or-fight-or-freeze response.
-If there is a failure to produce, release or receive the correct GABA signal, then there is an insufficient inhibitory signal to adequately regulate heightened arousal levels that are caused by excitatory neurons being too active.
-Therefore, people with a phobia have an
insufficient GABA signal to inhibit this neural activation, resulting in exaggerated feelings of fear or anxiety.
*-People with a low GABA signal are more vulnerable to anxiety. Furthermore, their flightor-fight-or-freeze response may be more easily activated when they encounter or believe they will encounter a phobic stimulus, and they become more anxious to stimuli.
BIOLOGICAL FACTORS
2. long-term potentiation (LTP)
-the relatively permanent strengthening of synaptic connections as a result of repeated activation of a neural pathway
-LTP can strengthen the association between a phobic stimulus and a fear/anxiety response through repeated
activation of the same neural pathways.
-When these connections are activated through different encounters with the phobic stimulus or thinking about a past or future encounter, the connections are further strengthened.
-Subsequently, the associated fear response to the phobic stimulus strengthens, and it is much less likely that what is learned will be forgotten.
PSYCHOLOGICAL FACTORS
-a factor that relates to the functioning of the brain and the mind, including cognitive
and affective processes such as thought patterns and memory.
-internal influences associated with mental processes
PSYCHOLOGICAL FACTORS
behavioural models of phobia development:
-Behaviourism is a theory of learning based on the idea that all behaviours are acquired
through an interaction with the environment.
-Therefore, behavioural models suggest that phobias are learned through experience and may be developed, sustained or modified by environmental consequences such as rewards or punishments.
- eg. classical conditioning and operant conditioning
PSYCHOLOGICAL FACTORS
behavioural models of phobia development:
- precipitated by classical conditioning
-a simple form of learning that occurs through the repeated association between a neutral stimulus and an unconditioned stimulus to produce a conditioned response.
CLASSICAL CONDITIONING APPLIED TO PHOBIAS, EXAMPLE:
(before conditioning):
- a magpie (NS) produces no relevant response. Being swooped by magpie (UCS) produces shock and fear (UCR)
(during conditioning):
- the magpie (NS) is presented immediately before being swooped (UCS) multiple times and the UCS produces shock and fear (UCR)
(after conditioning):
- the magpie (CS) on its own now produces shock and fear (CR)
- as a result of the shock and fear of being swooped, they now fear magpies.
PSYCHOLOGICAL FACTORS
behavioural models of phobia development:
- perpetuation by operant conditioning
-a type of learning process in which the likelihood of a voluntary behaviour occurring is determined by its consequences
-The feeling of relief at avoiding a stressful experience is an example of operant
conditioning
-Once a phobia has developed, it can be perpetuated by operant conditioning, more specifically by negative reinforcement.
-When a person is confronted by, or thinks they might be confronted by, a phobic stimulus, using avoidance behaviour reduces or removes the unpleasant feelings of fear or anxiety associated with the stimulus.
-This makes the person more likely to avoid the phobic stimulus in future, effectively continuing the cycle of fear.
PSYCHOLOGICAL FACTORS
cognitive models and cognitive biases:
-Cognitive model refers to a model that describes how people’s perceptions of situations influence their emotional and behavioural reactions
-When we are distressed, our perceptions are often distorted.
- It focuses on how a person processes information about the phobic stimulus and related events, including their perceptions, memories, attitudes and biases.
-The underlying assumption of the cognitive model is that people with a specific phobia often have one or more cognitive biases.
- cognitive bias refers to the tendency to think in a way that involves errors of judgment and faulty decision-making
-cognitive biases are memory bias and catastrophic thinking
PSYCHOLOGICAL FACTORS
cognitive models and cognitive biases:
- memory bias
-distorted thinking that either enhances or impairs the recall of a memory or alters its content
-completely distorts and exaggerates fears relating to phobias by focusing more on the fearful or negative experiences.
PSYCHOLOGICAL FACTORS
cognitive models and cognitive biases:
- catastrophic thinking
-a cognitive bias that involves overestimating and exaggerating the worst
possible outcomes to situations even though they are unlikely to occur
- perpetuates fear by heightening levels of anxiety and distress
SOCIAL FACTORS
-a factor that relates to the social components of a person’s environment
(specific environmental trigger and stigma)
SOCIAL FACTORS
- specific environmental trigger
-an object, situation or circumstance
that probably caused a direct, negative
traumatic experience associated with extreme fear or discomfort, which then acts as a cue for future phobic fear responses
-Many people diagnosed with a specific phobia report that they had a negative and traumatic experience with the object of their phobia in the past. These people generally attribute this specific encounter as the cause of their phobia.
e.g. fear of injections ➡️ phobia developed from pain experienced when being immunised at the doctors
-even observing a frightening event can result in phobia. e.g. witnessing a car accident and blood ➡️ blood phobia
-the more traumatic the event the more likely it is that a phobia will develop, even if the event or situation occurs only once.
e.g. almost drowning ➡️phobia of water
-not everyone who is exposed to similar traumatic events develops a phobia.
-If a person is exposed to a positive experience soon after the traumatic one, they are less likely to form an association
between the fear object and a fear response. e.g. after injection receiving a lollipop ➡️ may not develop a phobia
SOCIAL FACTORS
- stigma around seeking treatment
-the feeling of shame or disgrace associated with a personal characteristic that indicates you belong to a culturally devalued group in society – this can be real or imagined.
-people with a specific phobia are
vulnerable to stigmatisation because phobias are irrational fears and it is difficult for others to empathise with people who have them.
-Stigma brings with it feelings of shame, poor self-esteem and hopelessness.
-Distress and symptoms may be worsened
by a lack of understanding by family, friends and others, and may be a barrier to seeking treatment.
evidence-based interventions for specific phobia
BIOLOGICAL TREATMENTS:
-GABA agonists
-breathing retraining
PSYCHOLOGICAL TREATMENTS:
-systematic desensitization
-CBT
SOCIAL TREATMENT:
-psychoeducation
BIOLOGICAL INTERVENTIONS
- a treatment targeting physiological mechanisms believed to contribute to a condition
- target physiological mechanisms believed to contribute to a phobia, and may focus on
eliminating or alleviating symptoms of disorders rather than dealing with the underlying
causes.
-Biological management tools for specific phobia include short-acting anti-anxiety benzodiazepine agents (GABA agonists) and breathing retraining.
