Phobias

1. Diagnostic features

   Nota:

   • - Persistent fear of a specific object or situation - Recognition that the fear is irrational and excessive - Attempts to avoid the phobia-inducing situation - The phobia interferes with the person's life
2. Types of phobias
   1. Specific phobias
      1. Animals

         Nota:

         • - Spiders (arachnophobia), insects, snakes, etc.
      2. Blood - injuries - injections
      3. Situations

         Nota:

         • - Planes, elevators, enclosed spaces (claustrophobia), etc.
      4. Natural environment

         Nota:

         • - Heights, thunderstorms, etc.
   2. Social phobia

      Nota:

      • - This is the fear of social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others - Fear of acting in a humiliating or embarrassing way (or show anxiety symptoms) 
      1. Examples

         Nota:

         • - Speaking in public - Eating in restaurants - Using public toilets - Writing in public
      2. Generalized social phobia

         Nota:

         • - This involves the person being shy in most social situations such as initiating or maintaining conversations, dating, speaking to authority figures, etc.
   3. Agoraphobia (Panic disorder with Agoraphobia)

      Nota:

      • "fear of the marketplace" - It is the fear of having a panic attack in a place where they don't feel safe and where there may be nobody around to help. - Many agoraphobics are confined to their houses for years
      1. Comparison

         Nota:

         • - Social phobia is when a person is afraid of others watching them while Agoraphobia is when the person is afraid for themselves - People with social phobia are concerned about being embarrassed while Agoraphobics are concerned about their own safety.
      2. Development

         Nota:

         • - It begins with a series of panic attacks in public places - Panic attack symptoms:  - Sweating  - Rapid heart rate  - Increased respiration  - Feeling of impending doom  - Fear of dying, going mad, or losing control

1. Classical conditioning (Watson, 1920)

   Nota:

   • This was the study on Little Albert. Albert was conditioned for 10 days to fear rats by classical conditioning
   1. Evaluation

      Nota:

      • - Ethics: Albert may have had long term effects (emotional) - Ecological validity: Does not apply to real life as this is not how phobias are formed - Attempts to replicate the findings have been unsuccessful - Many people have phobias but no unpleasant experiences. Hence vicarious learning may play a part
   2. Mowrer's 2 factor approach

      Nota:

      • - The fear is acquired through classical conditioning and maintained by operant conditioning
2. Operant conditioning

   Nota:

   • - The fear is maintained by operant conditioning  - When avoiding a the feared stimuli, relief is felt - Avoidance behavior is reinforced, which maintains the fear

Nota:

• The phobia in some way, represents the source of original anxiety. By avoiding the phobic object or situation, the person avoids having to face up to and deal with the repressed conflict

1. Little Hans (Freud, 1909)

   Nota:

   • - Hans, due to the unresolved Oedipus complex, he feared his father (castration anxiety included). He displaced his repressed fear onto horses as they resembled his father.
   1. Evaluation

      Nota:

      • - No scientific proof - Observer bias from observer (Han's father) - The fear may have been caused by other variables (he saw a horse falling over)

Nota:

• - People who are negatively affected by stress have a biological abnormality that predisposes them to develop a phobia following a stressful event.

1. Autonomic Nervous System (ANS)

   Nota:

   • - According to research, the ANS of some are more easily aroused that those of others. Hence making them more sensitive to environmental stimuli. - The ANS is involved in fear as well.
   1. Evaluation

      Nota:

      • - It is difficult to show if the heightened sensitivity is caused by the hypersensitive ANS or if the anxiety disorder has affected the ANS - The sensitivity may be genetically determined
2. Genetics

   Nota:

   • - Phobias tend to run in families - Prevalence rate is higher for social and specific phobias in first rate relatives
   1. Ost (1992)

      Nota:

      • - Family studies were conducted to find out the prevalence rate of blood-injection phobias in first degree relatives - 64% phobics have a cousin with the same phobia
   2. Evaluation

      Nota:

      • - Is the phobia learned or inherited? - It is too reductionist as life events, environmental factors, etc. are also relevant

Nota:

• - The way people think about, judge and appraise situations affects the likelihood of a fear response

1. Schemas

   Nota:

   • - The emotions we feel are the result of our interpretations of our experiences according to our existing schemas. Phobics will:  - Over exaggerate the negative consequences - Under estimate their ability to cope - Show "Catastrophic Misinterpretation"
   1. DiNardo (1988)

      Nota:

      • - Self report on people with traumatic experience with dogs - the 50% that developed phobias was more likely to believe that they would have another negative experience
      1. Discussion

         Nota:

         • - Believing in another occurrence may be a cognitive diathesis to developing a phobia - Phobias can be maintained or made worse by how people think
2. Evaluation

   Nota:

   • - It is better at explaining the maintenance and not the initiation - It can also explain social phobias and agoraphobia (It's useful)

1. Behavioral therapies
   1. Classical conditioning

      Nota:

      • Carried out under the assumptions that: - Phobias are learned by classical conditioning - They can also be unlearned similarly - They can be counter conditioned - learning a new response
   2. Systematic desensitization (Wolpe, 1958)

      Nota:

      • - Relaxation - Fear Hierarchy - Go through hierarchy with therapist while deeply relaxed  - Relaxation is now associated with the once fear stimuli not fear
      1. Evaluation

         Nota:

         • - It is useful as it is very effective and "better" than other therapies and hence is the main treatment for phobias. 75% of people with specific phobias have shown improvement after treatment. - Ethical issue: protection from harm should be carefully considered
   3. Flooding (exposure therapy)

      Nota:

      • - Patient is put in inescapable space with feared object/situation until the fear response disappears - It is assumed that the high levels of fear/anxiety cannot be sustained and will eventually drop
      1. Evaluation

         Nota:

         • - It can be incredibly frightening and discomforting and hence is the last resort for therapists - It is incredibly effective as 3 sessions are usually enough
   4. Applied tension

      Nota:

      • - Blood and injection phobics are different in that relaxation makes it worse for them (they can faint due to the blood pressure drop) - They are encouraged to tense their muscles instead when encountering the feared object/situation
      1. Ost et al. (1989)

         Nota:

         • - 30 patients with the phobia were treated individually with applied tension (5 sessions), applied relaxation (9 sessions), or the combination of both (10 sessions). - Assessed on self report, behavioral and physiological measures before and after treatment and at a 6 month follow up
         1. Evaluation

            Nota:

            • - Useful - Qualitative and quantitative data - Individual measures - Reliable - Valid - Not generalisable to all phobics - Valid? The cognitions may have been influenced
         2. Findings

            Nota:

            • - All groups improved greatly  (73% of patients) and the improvements were maintained (77% of patients) - Applied tension was favored. And it should be the clinical treatment
2. Cognitive-behavioral treatment

   Nota:

   • - Cognitive Behavioral Therapy (CBT) vs Applied Tension as therapies for panic disorder
   1. Details

      Nota:

      • Method: Longditudinal study Design: Independent design with random assignment of patients Participants: - 38 with panic disorder with/without agoraphobia - 26 females and 12 males. Mean age of 33 years. Variety of occupations
   2. Procedure

      Nota:

      • - Pre-treatment: Agoraphobic Cognitions Questionnaire used to assess panic attacks - Patients recorded details of panic attacks in a diary - Each patient was given 12 weeks of treatment
   3. Applied relaxation group

      Nota:

      • - Applied relaxation was used to identify what cause panic attacks, then relaxation training started with tension-release of muscles - It was gradually increased so that the patients could use the techniques in stressful situations
   4. CBT group

      Nota:

      • - CBT was used to identify the misinterpretation of physical symptoms and then generate an alternative cognition in response - Cognitions were tested in panic situations that patients could not avoid, so that the restructured thoughts had to be accepted - Patients were then reassessed on the questionnaires - After one year a follow up assessment was carried out
   5. Findings

      Nota:

      • Applied relaxation: - Showed 65% panic free patients after treatment - 82% panic free after one year CBT: - Showed 74% panic free patients after treatment - 89% panic free after one year
   6. Evaluation

      Nota:

      • - Validity: it's difficult to rule out the cognitive changes that may have occurred in the applied relaxation group - Generalisability: Good range of age, diagnoses, gender, etc. but not generalisable to other phobias - The questionnaire is not objective (scientific) and can yield faulty results as patients looked back a full year and may have been optimistic - Good mixture of quantitative and qualitative results