Specific Phobias…

Anxiety heightened physiological arousal, feel apprehension/ unease/ worry that something bad is about to happen
Anxiety Disorder group of MD characterised of chronic feelings of anxiety, distress, nervousness, apprehension

STRESS, ANXIETY, PHOBIA_________________________________________________________________________

Stress: Physio/psychological Anxiety: Physiological arousal Phobia: Anxiety disorder involves
arousal produced by internal with feelings of apprehension, excessive/ unreasonable fear of
external stressors that are worry or uneasiness that object or situation that causes
perceived as challenging or something is wrong/unpleasant is distress or interferes with
exceed ability/resources to cope about to happen everyday functioning
• Eustress or distress • Only distress • Only distress
• ‘Normal’ in certain situations • ‘Normal’ in certain situations • Not considered ‘normal’
• Potential contributor to MHD • Potential contributor to MHD • Diagnosable mental disorder
• Mild amounts adaptive/ helpful • Mild amounts adaptive/ helpful • Not adaptive or helpful

Similarities
• Influenced by biological, psychological and social factors
• Accompanied by physiological changes; may involve fight–flight–freeze
• May be associated with avoidance behaviour/ impact functioning if not managed

PHOBIA________________________________________________________________________________________
Phobia: Anxiety disorder involving excessive or Effects of Phobias:
unreason able fear of an object/situation that causes • Undergo a stress response with physiological
distress or interferes with everyday functioning changes very similar to the fight-flight-freeze response
• Persistent/intense/irrational • When aware may encounter phobic stimulus they
• Phobic stimulus: thing they are afraid of develop anticipatory anxiety/ phobic anxiety

SPECIFIC PHOBIA_________________________________________________________________________________
Specific phobia: Extreme anxiety produced by exposure to a specific feared object/situation, leading to avoidance
• Excessive, persistent and unreasonable fear of a specific object or situation
• Phobic object or situation almost always triggers fear or anxiety and is intentionally avoided
• Level of fear or anxiety is out of proportion to the actual danger posed and causes significant distress
★ Spiders, flying, heights, dental treatment, receiving an injection and seeing blood

FACTORS CONTRIBUTING TO THE DEVELOPMENT OF A SPECIFIC PHOBIA___________________________________

BIOLOGICAL CONTRIBUTING FACTORS_______________________________________________________________
Gaba dysfunction
Significantly low levels of GABA (failure to produce, release, receive correct amount of GABA)
→ Primary inhibitory neurotransmitter in the CNS
→ Without inhibitory effect of GABA, activation of postsynaptic neurons might get out of control (constantly firing)
→ Increased neural activation causing overthinking and leading to easily triggered fight-flight-freeze response
→ Linked to anxiety because it acts like a calming agent to excitatory neurotransmitters that lead to anxiety

Levels of GABA negatively influenced by: These factors have been found to:
• Genetic inheritance 1. Inhibit GABA release
• Exposure to prolonged Stress 2. Inhibit GABA capacity to bind to post-synaptic n
• Nutritional deficiencies (B6 & Citric Acid) 3. To stimulate over-production of Glutamate

Glutamate
→ Primary excitatory NT in the CNS (learning and memory by strengthening synaptic connections)
→ Excites/ activates post-synaptic neurons –more likely to fire/ pass on neural message
→ Inhibitory action of GABA counterbalances the excitatory activity of glutamate and vice versa

Role of the stress response

→ Anxiety involves feelings of apprehension, worry or uneasiness that something is wrong (psych component)
→ Perceived threat/ impending harm at the sight/thought of a phobic stimulus activates fight-flight-freeze response

Effects of stress → Anxiety combined with specific phobia lead to level

• Heart rate and strength of heartbeat increases of anxiety tends to be inflated or excessive because
• Blood is redirected from places not needed their perception of threat out of proportion
• Speed and depth of breathing increase → Physiological stress response often very severe and
• Adrenal hormones surge into the bloodstream can persist at this high level for extended time periods

LONG-TERM POTENTIATION
Long-lasting increase in strength of synaptic transmission
process of learning in brain which leads to memory consolidation:
1. Strengthened neural connections between neurons
(where it is believed memories are stored)
2. Increased dendritic branching (increasing connections between neurons)
3. Increased NT levels/speed of processing of neural info (between neurons)

→ Phobias developed and enhanced through learning by experience

→ Demonstrated in Watson’s ‘Little Albert’ experiment
→ Learning has specific regions of Brain linked with the process of LTP
(Thalamus, Hippocampus and Hypothalamus)
→ Amygdala is main structure in establishing a learnt fear response, stores
emotional memory and LTP has long term effects

PSYCHOLOGICAL CONTRIBUTING FACTORS____________________________________________________________

Behavioural models
→ Phobias are learned through
experience and acquired, maintained or
modified by enviro consequences such
as rewards and punishments

2-FACTOR’ THEORY
Factor 1: Establishing (Precipitating) a
phobia using Classical Conditioning
Factor 2: Maintaining (Perpetuating) a
phobia using Operant Conditioning
PRECIPITATION BY CLASSICAL CONDITIONING (CC) PERPETUATION BY OPERANT CONDITIONING (OC)
• Can be used to explain acquisition of all phobias • Phobia can be maintained and therefore
• Pairing CS and UCS to produce CR perpetuated through operant conditioning
• Stimulus generalisation may occur • Negative reinforcement contributes to persistence
• Conditioned fear response can last long time, of avoidance behaviour and therefore phobia
unlikely forgotten (extinguished) without intervention • OC can also contribute to the acquisition of a phobia

Cognitive models
Cognitive bias; tendency to think in a way that involves errors of judgment and faulty decision-making
→ Used to determine how a person’s thinking processes evaluate the phobic stimuli

MEMORY BIAS CATASTROPHIC THINKING

Distorting influences of present knowledge, beliefs and Thinking style involve overestimating, exaggerating,
feelings on the recollection of previous experiences magnifying object/ situation, predict worst outcome

• Uses ‘selective memory’ to identify certain features • Occurs in phobias when believe that exposure to the
of memory that have been enhanced or modified phobic stimulus will result in death or extreme
Consistency bias: Past mem are distorted through suffering (unlikely as thoughts are irrational)
reconstruction to fit in with current beliefs about • Person underestimates their coping capacity
event or experience • Phobia of driving: “If I was to drive a car, I would
Change bias: Exaggerating features of mem to focus definitely crash, probably kill a innocent person and
on most fearful aspects of the phobic stimulus end up with my car bursting into flames”

SOCIAL CONTRIBUTING FACTORS____________________________________________________________________

Specific Environmental Triggers: Stigma around seeking treatment:

Development of a specific phobia after one single Shame and embarrassment of symptoms as well as
experience that is negative fear of judgement preventing seeking treatment
→ Two people may be in a traumatic event which may → Particularly prevalent for individuals with specific
lead to development of a phobia for one but not other phobias of everyday items (balloons, pens)
→ Initial fear response to a specific environmental → Failing to seek treatment perpetuate the phobia
trigger becomes a conditioned fear response with CC → Specific phobias are based on irrational fears, thus
→ More severe trauma, more likely develop phobia difficult to understand/empathise with these people

INTERVENTIONS IN THE TREATMENT OF A SPECIFIC PHOBIA______________________________________________

BIOLOGICAL INTERVENTIONS
A specific targeting of bodily processes to assist in reducing or minimising symptoms / experience of a phobia.

Benzodiazepines: Drugs that ‘calm down’ neural activity, acting selectively on GABA receptors of post-synaptic
neuron to increase GABA’s inhibitory effects and make post-synaptic neurons resistant to excitation

AGONISTS ANTAGONISTS
Mimic activity of a neurotransmitter Inhibit activity of a neurotransmitter
SAME JOB AS A NEUROTRANSMITTER PREVENT NEUROTRANSMITTERS FROM WORKING
• Either mimic role of a NT by doing same function • Either inhibit function of a NT
• Or by stimulating production of needed NT and • Or effect receptor site of post-synaptic neuron to
increasing its overall levels prevent its reception/ processing

Side-effects can include:

• Reduced alertness and abilities dependent on alertness (concentration, reaction times)
• Addictive; reliant on meds, body not going to naturally produce it
• Can lower inhibition / increase impulsivity / take risks when mixed with alcohol
RELAXATION TECHNIQUES: Help manage anxiety-like symptoms

Breathing retraining Exercise

Anxiety-management technique that explicitly teaches Physical activity undertaken to improve or maintain
breathing patterns to people with specific phobias physical condition (aerobic/anaerobic)

• Perceived threat can increase in respiration rate • Using up stress hormones (adrenaline, cortisol)
• Either hyperventilation (b faster and deeper) or • Reduce muscle tension and promote relaxation
pattern of uncontrolled rapid/shallow b (tachypnea) • Increases efficiently of cardiovascular system/
• Can lead to low levels of CO2 and results in flexibility and stamina for dealing with future stressors
dizziness, light-headedness, blurred vision • Release of ‘feel-good’ hormone beta-endorphins
• Breathing can be a trigger for a panic attack • Distraction from phobic stimuli
• Help assert control over autonomic functions such • Similar symptoms as ‘fight-flight-freeze’, making
as heart rate, blood pressure, breathing rate etc. stress experience more common/less threatening

PSYCHOLOGICAL INTERVENTIONS
Attempt to address the cognition and behaviour around the phobic stimuli using different tactics / strategies.
aims to prevent the individual perpetuating or maintaining the phobia (reduce avoidance behaviours)

Cognitive behavioural therapy

Therapeutic technique drawn from cognitive behavioural therapy to identify, assess and correct faulty patterns of
thinking or problem behaviours that may be affecting mental health and wellbeing

Cognitive therapy – Aims to address problems in cognition that contribute to negative emotions and behaviours
• Identify unhelpful thoughts and to shift thinking to more balanced helpful thoughts
Behavioural therapy – Application of classical, operant and observational learning to address behaviours
• Address maladaptive behaviours and retrain good behaviours to become automatic

CBT and phobias

• Tries to develop a new understanding of phobic stimulus
• Identify anxiety related thoughts and cognitive biases
• Look at evidence that supports/rejects these biases
• Switch irrational thoughts to rational thoughts

Systematic desensitisation
Aims to replace an undesirable response, such as fear, with a relaxation response through classical conditioning

• CC; unlearning connection between fear/phobic 1. Patient taught relaxation techniques

stimuli and re-associating feelings of relaxation 2. Breaking down phobic stimuli into a sequence
• Gradual/repeated exposure through a series steps arranged from least to most fearful (fear hierarchy)
• Attempts to replace fear response with relaxation 3. Slowly pair items in hierarchy with relaxation by
• Gradually introduced to fear inducing stimulus working upwards through items in hierarchy

SOCIAL INTERVENTIONS
Psychoeducation for families and supporters
Psychoeducation; Form of education to explain and outline information about a mental disorder to help increase
knowledge and understanding of the disorder and its treatment
→ Aims to increase people’s understanding what is happening to them and how they can best manage phobia

Challenging unrealistic or anxious thoughts Not encouraging avoidance behaviours

• Anxious thoughts trigger and perpetuate phobias/ • Facing your fears is needed to overcome a phobia
usually negative and unrealistic • Never get the chance to learn how to cope with
• Individual tends to overestimate how bad it will be their fears and control over fearful situations
• At same time, they underestimate ability to cope • Avoidance can interfere with normal routine
• Supporters should encourage individual to recognise • Gently encourage and support individual to stop
and challenge unrealistic or anxious thoughts avoidance behaviour, possibly challenging behaviour