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1
Q

Define simple phobias

A

Marked, persistent and excessive fear of particular objects or situations. Exposure to the phobic stimulus almost always provokes an immediate anxiety response involving extreme fear and panic. Thus, the phobic situation is avoided or else is endured with intense anxiety or distress.

2
Q

What is the diagnostic criteria for simple phobias

A
  1. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response
  2. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.
  3. Symptoms interfere significantly with the person’s normal routine, occupational (or academic) or social functioning
  4. Lasts for at least 6 months or more
  5. Not better explained by another diagnosis
3
Q

What are some examples of simple phobias

A

Arachnophobia (Spiders)
Ophidiophobia (Snakes)
Acrophobia (Heights)
Achluophobia (The Dark)

4
Q

What are phobic beliefs

A

Individuals who suffer from phobias have beliefs about the phobic stimuli that maintain and control the phobics fear and avoidance of that stimuli
These beliefs contain info about why they think the phobia is threatening and how to react when they are in the situation
These beliefs are also rarely challenged as the individual avoids all circumstances where such beliefs may be disconfirmed so the beliefs are maintained

5
Q

Describe the prevalence of simple phobias

A

A very common disorder, surveys of the general population such that approximately 60% experience ‘unreasonable fears’: CHAPMAN 1997

  1. 3 times as common in women than in men.
  2. Different types have different mean ages of onset
  3. Immediate fear response may resemble a panic attack, except for the presence of a trigger.
  4. Tend to persist without treatment
6
Q

Evaluation of specific phobia research

A
  1. There are cultural differences in the diagnosis of phobias: different kinds of stimuli and events are the focus of phobias in various cultures. For example, Taijin-Kyofusho is a common japanese syndrome characterised by a fear of embarrassing or offending other people but the western syndrome of social phobia is different where the fear is based on the public embarrassment experienced by the phobic individual.
7
Q

Why has an evolutionary theory of phobias been developed

A

Researchers decided to explore this theory as it would appear that many of the phobias that exist tend to be focused on a limited set of fears that have evolutionary significance and thus we are biologically pre-wired to acquire certain phobias that have been present for years which are adaptive and aid our survival. Whereas, we rarely develop phobias to life threatening stimuli that are recent such as guns.
So evolutionary theory explains the high prevalence of certain phobias such as spiders or heights

8
Q

Describe the first evolutionary theory of phobias

A

SELIGMAN (1971) Preparedness Theory:
The preparedness theory of phobias was designed to explain certain facts about phobias that seemed inconsistent with the traditional learning model.
Suggests that evolutionary “Preparedness” explains phobias where we have evolved a tendency to fear certain things/situations and a biological predisposition to learn to associate fear with stimuli that have been hazardous for our ancestors.

Biological preparedness is postulated to be responsible for the rapid acquisition, irrationality, belongingness, and high resistance to extinction considered characteristic of phobias (‘fear relevant’ stimuli are more easily conditioned, resistant to extinction)

Many phobia objects involve things that potentially pose a threat to safety and well-being. Snakes, spiders, and dangerous heights are all things that can potentially be deadly. Biological preparedness makes it so that people tend to form fear associations with these threatening options. Because of that fear, people tend to avoid those possible dangers, making it more likely that they will survive. Since these people are more likely to survive, they are also more likely to have children and pass down the genes that contribute to such fear responses.

9
Q

Strengths of the first evolutionary theory of phobias

A

+ RESEARCH SUPPORT
1. EXPERIMENTAL STUDIES: Ohman et al. 1975 - Fear conditioning research provides evidence that we more readily associate harm with certain stimuli than with others. Showed that ppts in a classical conditioning study, when shown pictures of fear-relevant stimuli (CS) paired with electric shocks (UCS) they develop a fear of the CS more quickly and show a greater resistance to extinction than if pictures of fear irrelevant stimuli were shown. Thus, supporting that we associate fear more readily with dangers of our evolutionary past than modern day dangers.

  1. ANIMAL STUDIES: Cook+Mineka 1990 - found that rhesus monkeys that had never seen a snake before rapidly acquired fear reactions to snakes after being shown a demonstration of another monkey being frightened in the presence of a snake. But they did not get fear reactions after watching a demonstration of another monkey being frightened in the presence of a stimulus such as a rabbit - Thus suggests that humans and primates both has a biological predisposition to rapidly acquire fear responses to certain stimuli

+ Arguably the best explanation offered so far for the non-random quality of fears is the concept of preparedness proposed by Seligman (1971). Human phobias are ‘largely restricted’ to situations that threaten survival, potential predators, unfamiliar places, the dark, deformities etc. It may also provide the best basis for an explanation of why people fail to acquire fears despite exposure to considerable stress. RANCHMAN 1976

10
Q

Weaknesses of the first evolutionary theory of phobias

A
  • There appear to be contradictions in the research that reduces the certainty of the explanation provided. Specific phobias treated by therapists include non-prepared phobias, i.e. have no connection to our evolutionary past. For example we do fear modern dangers, e.g. public transport and driving (BARLOW 1995). Of those with a phobia of driving about 50% had been involved in a car accident Nor are prepared phobias harder to treat than non-prepared ones, which we would expect if innate preparedness was valid as we would not be able to cure such a biological predisposition
  • Traditional behavioural explanations alone may fully account for phobias and so contradict an evolutionary basis because phobias may be solely learned (i.e. through classical and operant conditioning) rather than learned preparedness. A breakdown in cognitive processing has been linked to phobias—interpretations of the fear-provoking stimulus, bodily response, and emotions are maladaptive given that the fear is disproportionate to the threat. Thus, counter-perspectives provide insights that may have more relevance to the individual’s current experience than explanations based on our evolutionary past.
  • Evolutionary theories are reductionist as they focus on one factor only (the gene) when other emotional, social, cognitive, behavioural, and developmental factors are highly relevant to the aetiology of mental disorders. They are oversimplified accounts at best. This s exemplified by the significant differences in the kind of phobias reported by different cultural groups. BROWN et al 1990 found that phobic disorders are more common amount African American than white American even when socioecominc factors were controlled for. Thus showing that environmental/social factors are important in determining aspects of phobias.
  • Two important concepts are 1) that we learn certain fears more rapidly and 2) such fears are harder to unlearn. However, McNally (1987) concluded that although there is firm evidence that enhanced resistance to extinction of fear responses conditioned by prepared stimuli, there is very little experimental support for the ease of acquisition hypothesis. Thus, Davey (1995) proposed a simpler explanation - expectancy biases. An expectancy bias is an expectation that fear
  • Deciding what was dangerous in our evolutionary past is highly speculative. Such explanations are post hoc (made up after the event) and so cannot be verified or falsified, and given that falsification is a key criterion of science, according to Popper, then the theory lacks scientific validity.
11
Q

Describe the behavioural theory of phobias

A

This approach proposes that phobias are acquired through conditioning processes. Classical conditioning explains phobias by suggesting fears are acquired when an individual associates a neutral stimulus e.g a fluffy bunny with a fear response.

This was demonstrated by Watson & Rayner (1921) who experimented on an 11-month-old infant ‘Little Albert’. The goal was to condition Albert to fear a white rat by pairing the white rat (NS) with a loud bang (UCS). Initially, Albert showed no fear of rats, but once the rat was repeatedly paired with the loud noise (UCS), Albert developed a fear of rats (CS). The noise (UCS) induced fear (UCR). After pairings between the loud noise (UCS) and the rat (NS), Albert started to fear (CR) the rat (CS). Watson showed that classical conditioning could cause phobia.

Phobia responses can be permanent unless we go through the extinction process, where one must confront the fear without the presence of the UCS. Little Albert’s phobia could have been extinguished by repeatedly exposing him to the white rat without the loud bang. Another way to extinguish a phobia is through counter-conditioning where the CS is paired with a pleasant stimulus.

12
Q

Strengths of behavioural theory of phobias

A

+ EMPIRICAL SUPPORT
Phobia responses can be permanent unless we go through the extinction process, where one must confront the fear without the presence of the UCS. Little Albert’s phobia could have been extinguished by repeatedly exposing him to the white rat without the loud bang. Another way to extinguish a phobia is through counter-conditioning where the CS is paired with a pleasant stimulus.

13
Q

Weaknesses of behavioural theory of phobias

A
  • A simple fear conditioning model remains inconclusive as it fails to account for the common clinical phenomenon of incubation. This is where fear increases in magnitude over successive enouncters with the phobic stimulus even when not followed by a traumatic experience (EYSENCK, 1979).

Classical conditioning theory functioned upon the supposition that any predictor should be able to enter into an association with any outcome. This is called the equipotentiality premise. Equipotentiality implies that a phobia of anything can develop provided that it is experienced in close association with a trauma (Field, 2006). However, not everyone who have pain or trauma paired with a situation develop a phobia. For example, Di Nardo (1998) suggests that not everyone who is bitten by a dog develops a phobia of dogs. It could be that only those with a genetic vulnerability for phobias would be affected by such events (diathesis-stress model). So, behavioural approach cannot explain all phobias, only some. Therefore this reduces the support for classical conditioning as an explanation for phobias which reduces the credibility of it overall because it doesn’t offer a full explanation.

Although the addition of the informative and vicariate learning pathways improved the robustness of the classical conditioning model, certain researchers (e.g., Mineka & Zinbarg, 2006 stressed the need to also recognize the concept of preparedness to answer some of the questions that classical conditioning was unable to answer. This perspective proposed that some individuals may be more or less biologically prepared to acquire some disorders. (Mineka & Zinbarg, 2006).

  • Arguably a reductionist argument; it reduces the acquisition of phobias down to conditioning and fails to consider the individual as a whole person. Under classical conditioning, fears are said to be acquired purely when an individual associates a neutral stimulus with a fear response. It fails to recognise other factors which could cause phobic disorders such as abnormal levels of neurotransmitters in the body. By being reductionist, this element of the individual – along with many others is ignored and the whole person is not considered. A more useful explanation would include the background of the individual, their genetics and their unconscious thoughts – a more interactionist approach, when explaining phobias.
14
Q

A new approach for phobias

A

Mineka and Zinbarg (2006) used learning theories and preparedness to describe a contemporary learning perspective on the etiology and maintenance of anxiety disorders.
Introduced vicarious learning to expand and combat the criticism of early classical conditioning theories. Evidence for the role of vicarious conditioning in phobia acquisition stems from a primate model showing that strong and persistent phobic- like fears can indeed be learned rapidly through observa- tion alone. Lab-reared rhesus monkeys who initially were not afraid of snakes served as observers who watched unrelated wild-reared model monkeys reacting very fearfully in the presence of live and toy snakes. These lab-reared observer monkeys showed rapid acquisition of an intense phobic- like fear of snakes that did not diminish over a three-month follow-up period. This vicarious conditioning also occurred simply through watching videotapes of models behaving fearfully (Cook & Mineka, 1990), suggesting that humans are also susceptible to acquiring fears vicariously.

They also acknowledge evolutionary perspectives to explain phobias. Early conditioning models predicted that fears and phobias would occur to any random group of objects associated with trauma. However, clinical observations show that people are much more likely to have phobias of snakes, water, heights, and enclosed spaces than of bicycles, guns, or cars, even though today the latter objects (not present in our early evolutionary history) may be at least as likely to be associated with trauma.

So, contemporary learning theory provides a foundation for the development of models of the anxiety disorders that can capture the richness and complexity associated with the development and course of phobias.

15
Q

General consensus regarding aetiology of phobias

A

There are multiple pathways to phobias where the acquisition of all phobias can occur through different processes depending on the type of phobia. Phobias such as dog or dental is suggested to be caused by traumatic experiences and conditioning however other common phobias such as animal phobias are not seen to be caused by this as people often cannot recall the exact onset of it suggesting it is a gradual process for the individual.

So treatments need to be tailored to the type of phobia experienced in order for it too be effective.

16
Q

What are the different treatments for phobias

A
  1. Exposure Therapy

2. One session Treatments (exposure+modelling)

17
Q

Describe exposure therapy

A

An important aspect of therapy for phobias is that the sufferer must be exposed to the stimulus that they fear. If the person were to be exposed to the non-dangerous stimulus time after time without any harm being experienced, the phobic response would gradually extinguish itself. However this is not likely to occur naturally, so behavior therapy sets up phobic treatment involving exposure to the phobic stimulus in a safe and controlled setting.

Exposure therapy involves having the client repeatedly confront the feared object or situation in a systematic and controlled manner while preventing behavioural and cognitive avoidance.

  1. In vivo exposure involves having patients come into direct contact with the feared stimulus, such as a live spider.
  2. Systematic desensitisation which includes exposure to the phobic stimulus through imagination, but the goal is to suppress anxiety with deep muscle relaxation (Wolpe, 1982). This desensitization involves three steps: (1) training the patient to physically relax, (2) establishing an anxiety hierarchy of the stimuli involved, and (3) counter-conditioning relaxation as a response to each feared stimulus beginning first with the least anxiety-provoking stimulus and moving then to the next least anxiety-provoking stimulus until all of the items listed in the anxiety hierarchy have been dealt with successfully.
18
Q

Evaluation of exposure therapy

A

+ EFFECTIVE
When comparing exposure treatments to no-treatment control groups, the effects sizes were larger than those found in meta-analyses investigating exposure treatment for social anxiety disorder (Gould, Buckminster, Pollack, Otto, & Yap, 1997) and panic disorder (Gould, Otto, & Pollack, 1995)

  1. CHOY etal. 2007: The five controlled studies of systematic desensitization consistently reported improved subjective anxiety: McGrath et al (1990) found that 75% of patients with phobias respond to SD.
  2. HOWEVER, in-vivo seen to be the effacious treatment for phobias. The key to success if the physical contact with a feared stimulus over just imagination. Compared to placebo and control conditions, without exception, in vivo exposure produce significantly greater improvements in subjective anxiety, negative cognitions, and behavioral avoidance for most types of specific phobia (Choy et al. 2007). Further, in vivo exposure typically outperforms other active treatments including imaginal exposure, relaxation, and cognitive therapy (Wolitzky-Taylor et al. 2008).

+ APPROPRIATE
1. Behavioural therapies for dealing with phobias are generally fast and require less effort for the patients part compared to other cognitive therapies. Therefore they are more likely to continue with the therapy, improving their chances of removing the fear. It is also potentially self administered that has been evidenced to useful for some phobias such as social phobia (Humphrey, 1973).

19
Q

Describe one-session treatments

A

One-session therapies consists of exposure in trim, in most cases combined with modeling. These procedures are regularly used in behavioral treatments for phobias but the number of sessions is then generally considerably higher; often 4-8 for specific phobias.

Exposure can most simply be described by the following: (1) The patient makes a commitment to remain in the exposure situation until the anxiety fades away and never escape from the situation during the treatment. (2) The patient is encouraged to approach the phobic stimulus as much as possible and continue to expose him/herself until the anxiety has decreased or completely disappeared. (3) When the anxiety has been reduced the patient is instructed to approach the phobic stimulus more closely, and stay there until the anxiety is decreased, and so on until the patient is as close as is possible. (4) A therapy session is concluded only when the anxiety level has been reduced by 50% of its highest value, or completely vanished.

In modeling, the patient observes others (the “models”) in the presence of the phobic stimulus who are responding with relaxation rather than fear. In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia

20
Q

Evaluation of one-session treatments

A

+ EFFECTIVE
1. OST The results for the present group of 20 consecutive cases of specific phobia show that 90% of the patients were much improved or completely recovered after a mean of 2.1 h of therapy. These results are on a par with regular behavioral treatment where the treatment included multiple sessions. Thus, when it comes to clinical efficacy, it was not a disadvantage to reduce the number of sessions to one*.

+ Increase in cost-effectiveness

  • NOT APPROPRIATE IN THE LONG TERM: Contrary to the assertion that one session of exposure treatment is as effective as multiple sessions, the data lead us to conclude that multiple exposure sessions are more effective than one session of exposure particularly at follow-up and suggest that clinicians should deliver treatment in multiple sessions to enhance long-term treatment gains. HOROWITZ etal 2007
21
Q

Evaluation of treatments for phobias

A
  1. More individuals needs to be educated and supported for their phobias: compelling evidence suggests that those suffering from specific phobias are hesitant to seek treatment despite the availability of effective interventions. Based on data from the ECA study, only 31% of those meeting DSM-III criteria for phobia sought treatment (Regier, Narrow, & Rae, 1993), and of those, only 43.4% sought specialty mental health services (Narrow, Darrel, Rae, & Manderscheid, 1993). Many may perceive their phobia as untreatable, or are unaware of effective and available treatments despite specific phobia being among the most treatable of disorders.