Kardinia International CollegeUnit 4 Psychology Final Review Series

AOS 2: Applications of a Biopsychosocial framework

2. Simple Phobia as an Example of an Anxiety Disorder

A state of physiological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or that something unpleasant is about to happen.

Anxiety Disorder Defined• Anxiety disorder is a group of disorders characterised by chronic

feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect.

• Anxiety disorders are distinguished from ‘normal’, everyday anxiety in

that anxiety disorders involve anxiety that:

• is more severe (intense)

• lasts longer (anxiety may persist for months instead of going away after the anxiety-provoking situation has

passed), and

• significantly interferes with a person’s daily life and stops them doing what they want to do.

Phobia• A phobia is an excessive or unreasonable fear directed

towards a particular object, situation or event that causes significant distress or interferes with everyday functioning.

Key characteristics are:

• anxiety: exposure to the phobic stimulus almost invariably induces an immediate anxiety response;

• awareness: the person recognizes that their fear is excessive or unreasonable;

• avoidance: the phobic situation is avoided or else is endured with intense anxiety or distress.

Phobias and DSM-IV-TR

• As with all other disorders in the DSM-IV-TR, the person’s anxiety and avoidance behavior significantly interfere with their everyday life and causes them great distress.

• According to the DSM, a person’s fear of a specific object or situation must have persisted for at least six months for them to be diagnosed as having specific phobia.

• 3% of the Australian Population suffer from Phobias• More women than men suffer Phobias

Forms of Phobias• DSM-IV-TR divides phobias into three categories: Agoraphobia, Social Phobia and

Specific Phobia. In the study design is states that we focus on Simple (specific) phobia.

• Simple (specific) phobias involve an intense fear that is restricted, or confined, to a single ‘specific’ stimulus such as fear of heights, ladders, frogs, enclosed places, etc.

• Complex phobias involve a non-specific, more ‘general’ fear that usually involves a ‘number of anxieties’ so it is more ‘complex’,

• Complex Phobias - ExamplesIn fear of flying, the person may be afraid of crashing, being enclosed in the plane, and losing self-control

With agoraphobia, the person may be afraid of entering shops, crowds and public places, travelling in trains, buses and planes and is also anxious about being unable to escape to a place of safety.

DSM phobia categories

1. Animals

2. Situations

3. Blood / injections

4. Natural environments

5. Other (choking, dying, illness, falling etc)

Biological Contributing Factors to a Fear-Anxiety Response :

Amygdala: a region in the brain which is involved in processing emotions – in this context – fear. Noradrenaline: mediates the physiological symptoms of fear / anxiety through the sympathetic nervous system. The HPA Axis and Adrenaline are involved with the stress response.

HPA Axis activity results in the release of Cortisol from the Adrenal Gland above each kidney.

Adrenaline hormone and subsequent adrenaline neurotransmitter activity results in the wide range of physical changes discussed in the sympathetic nervous system fight or flight response.

Role of the Stress Response:

• A phobic reaction is an exaggerated fear response.• From a physiological perspective, an extreme fight

–flight response occurs when the individual encounters the phobic stimulus or anticipates such an encounter.

• The terror experienced is marked by physical anxiety symptoms, cognitive symptoms of fear of the object or situation (fright/fight response), and an intense desire to escape (flight response).

Role of the neurotransmitter Gamma-amino butyric acid (GABA)

in the management of Phobic Anxiety

• GABA (gamma-amino butyric acid) is the major inhibitory neurotransmitter that makes presynaptic neurons less likely to fire in the brain.

• GABA inhibitory action counterbalances the excitatory action of glutamate (that makes presynaptic neurons more likely to fire).

• It is found in the CNS (brain and spinal cord).

Not enough GABA makes me anxious!

GABA – Primary Function

• Gamma-amino butyric acid is the primary inhibitory neurotransmitter in the CNS.

• Inhibits postsynaptic neurons – stops them passing on the neural impulse

• Gets in the synapse to block transmission• Helps fine tune brain activity, keeps neural

transmission from getting out of control

• Without GABA neural activation could spread like fire throughout the brain causing seizures

Management of Anxiety Biologically: Use of Pharmaceutical Medication

• Lack of the neurotransmitter GABA might lead to over stimulation, and thus heightened anxiety

1. Benzodiazepines – a class of drugs that ‘calm down’ neural activity. Valiam, Xzanax, Rohypnol, Serepax etc.

• All drugs are either Agonists – mimic the activity of a neurotransmitter• Or Antagonists – inhibit the activity of a neurotransmitter

2. GABA Supplements can also be prescribed, however their effectiveness is yet to be proven medically as the synthetic GABA has difficulty crossing the blood-brain barrier.

GABA

Stop the message!

GLUTIMATE

Get the message going!

Psychological Contributing Factors: • Psychodynamic Model

• Behavioral and Cognitive Models

Freud’s psychodynamic model• Mental disorders are caused by unresolved conflicts that occur in

the subconscious• ‘skeletons in the closet’• Memories that are too distressing are pushed out of conscious

awareness

• As we grow up we progress through different psychosexual stages• oral 0 – 2• Anal 2 -3• Phalic 4 -5• Latency 6 – puberty

Freud’s psychodynamic model

• As we progress through these stages different parts of the body become the focus of attention and pleasure

• Each stage has a critical developmental conflict that must be resolved to move onto the next stage

• Unresolved conflicts cause anxiety

• Freud’s anxiety refers to unpleasant feeling when our instincts make us do something that we will be punished for

Freud’s psychodynamic model

• We use defence mechanisms to protect ourselves from this anxiety

• The ego (conscious part of the mind) distorts, denies or falsifies reality unconsciously

• We can then ‘believe’ that there is no reason to be anxious

• We lie to ourselves to be happy

Freud’s psychodynamic model – oedepal complex

• Phallic stage 0 – 3• Male child develops sexual attraction to his mother• Below conscious awareness• Fears father who is bigger and stronger, believes

punishment will involve castration• Repression used as defence mechanism• Child identifies with father – being like dad will mean

dad will be less inclined to punish me• Displacement can also be used• Anxiety directed onto another irrelevant object, then

the child can avoid this stimulus and thus solve the conflict

Freud’s psychodynamic model – Pseudoscience?

• Based on very small (unhealthy) samples• Very subjective• Can easily shift the facts to fit the theory

• Some useful ideas

• Not used in its original form today by the majority of practicing psychologists

• Remember recovered memory syndrome from Unit 3?

Behavioural model

• Phobias are learned

• Learned through classical conditioning or observational learning

• Maintained through operant conditioning

Behavioural model:Watson and Little Albert

Classical Conditioning of Arachnophobia

• UCS– spider in sandpit• UCR– fear• NS– spiders• CS– spiders• CR – fear

• Avoidance of spiders or spider related places, images etc is negatively reinforcing, avoiding the bad stimulus.

• This strengthens further avoidance behaviours

Role of Operant Conditioning

• Acquisition: Phobias can be acquired by operant conditioning processes through positive reinforcement.

• Maintenance: Phobias can be maintained by operant conditioning processes through negative reinforcement.

• When a person is confronted with their feared object or situation, the person experiences intense, almost unbearable, anxiety but their fear/anxiety is reduced by avoiding the object or situation.

• The avoidance behaviour is therefore negatively reinforced (more likely to occur again in the future) and the phobia is maintained.

LITTLE ALBERT OPERANT CONDITIONING:

• Little Albert’s specific phobia of white rats (and all things white and furry) was then maintained through operant conditioning, specifically, through negative reinforcement.

• • •

Cognitive modelMaladaptive (Negative) Cognition: • A cognitive theory of phobia, that says that a person may experience shame

or embarrassment at the thought that he or she may become frightened in public and may avoid such a risk (further negatively reinforcing the avoidance behaviour).

Key Assumptions:• The focus or emphasis of cognitive models in explaining the development

and persistence of a specific phobia:

• Focus: how the individual processes information and thinks about the phobic stimulus and related events (e.g. their perceptions, memories, beliefs, attitudes, appraisals and expectations).

• Emphasis: how and why people with a specific phobia have an unreasonable and excessive fear of a particular phobic stimulus.

Cognitive model – Attentional Bias• Seek out and notice threatening stimuli over

normal stimuli• Eg. Arachnophobias might notice a spider web

in the corner while everyone else is looking at the painting on the wall

• Tend to be hyper vigilant – always looking out for the phobic stimulus

Cognitive biases:

• Cognitive biases are tendencies to think in some kind of erroneous/mistaken or distorted way that involves an error(s) of judgment and faulty decision-making (and therefore also referred to as ‘mistakes in thinking’ or cognitive distortions).

• Note: In relation to phobias, cognitive biases make individuals more prone or vulnerable to experiencing fear and anxiety in response to a phobic stimulus.

Cognitive model – memory bias• Remember the bad things more readily• Eg. Only remember being dumped by a big

wave, not the hundreds of small waves that were enjoyable to jump over

• Memories reconstructed to be worse than the actual event

Cognitive model – interpretive bias • Neutral situations or stimuli interpreted as

threatening• Eg. Fluff on the carpet is a spider, a dog

running over happily is going to attack

Cognitive model:Catastrophic Thinking

• Negative thinking in which things are percieved in the ‘worst possible’ light

• Often underestimate their ability to cope with the situation

• What can go wrong will go wrong, and in a big way

e.g. a person with a phobia of beesmay think that any bee they encounter will attack and kill them.

The Use of Psychotherapies in the Treatment of Anxiety:

• Cognitive Behavioural Therapy (CBT)

• Systematic Desensitisation

• Flooding

Cognitive Behavioural Therapy (CBT)• CBT helps people with phobias face up to their fears by teaching

them new skills to help them react differently to the situations that trigger their phobia.

• Patients also learn to understand how their thinking patterns contribute to the:

– Situations that trigger their phobia– Symptoms

• How to Change their beliefs to reduce or stop these symptoms and, in time, accept whatever was causing their extreme anxiety.

Systematic Desensitisation• A process where individuals extinguish the

association between the phobic stimulus and anxiety through a series of graded steps – known as a fear hierarchy.

Systematic Desensitisation

• Incremental exposure allows the patient to gradually face the phobic stimulus and replace the fear response with the specific relaxed response.

Flooding

• Flooding involves exposing a phobic person repeatedly to the object of fear either in vivo (real life/natural setting) or indirectly by imagination or virtual reality. – The technique initially creates significant distress in the patient.

Flooding

• It is not suggested for most individuals because it can trigger a higher level of sensitisation or fear reinforcement.

• It works well when the individual is highly motivated and given appropriate support through the process.

• Eventually through sustained contact the patient learns to relax in the presence of the phobic stimulus.

Socio-cultural Contributing Factors• Specific Environmental Triggers such as being

bitten by a dog

Where something in the environment triggers the anxiety-fear response.

All Specific Phobias have a direct relationship to the person’s environment or their knowledge of it.

Parental Modelling

• Modelling bravery can help children cope with fears

• Reference to Bandura’s stages of Observational Learning are relevant here:

• Attention, retention, reproduction, motivation- reinforcement.

Where parental influences have shaped the development of anxiety disorders of their children, particularly relevant in social anxiety.

Transmission of threat information

• Delivery of information from others about potential threat

• Children might develop a phobia if constantly warned about the dangers of going outside alone

• Research suggests that fears develop largely due to negative information about a specific event, object or situation being communicated often enough

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