PROBLEM 1: FEAR AND PHOBIAS
Learning objectives
Case 1:
What is a phobia?
What is the difference between normal anxiety and a phobia?
Which phobias are distinguished in DSM-V? (criteria/clinical views/epidemiology)
What causes a phobia? How is a phobia developed? (etiological models)
Case 2:
How are phobias treated?
What is exposure and how does it work?
What types of therapies are used to treat specific phobias, social phobias and agoraphobias?
Fear
Clear source of danger
- Basic emotion that involves fight-or-flight response
- Instantaneous reaction to any imminent threat
- Adaptive value is primitive alarm response
- Autonomic nervous system
Fear and panic have 3 distinct components:
1. Cognitive/subjective components (I feel afraid)I am going to die)
2. Physiological components (increased heartrate, heavy breathing)
3. Behavioural components (strong urge to escape or flee)
Loosely coupled: someone might show some indications of fear or panic but not all of them
Anxiety
Frequently cannot specify clearly what the danger is
Complex blend of unpleasant emotions and cognitions
- More oriented to the future
Cognitive/subjective:
- Involves negative mood, worry about possible future threats or danger, self-preoccupation
and the sense of being unable to predict the future threat or to control it
Physiological level:
- Creates a state of tension and chronic over arousal which reflect risk assessment and
readiness for dealing with danger
, - No activation of fight-or-flight
- May create a strong tendency to avoid situations where danger might be encountered
(behavioural) adaptive value:
- Wouldn’t even get into the situation. Helps to plan and prepare for possible threat
- In mind-moderate degrees: enhances learning and performance
Anxiety disorders
Specific phobia : anxiety symptoms about the possibility of encountering their phobic situation and
when actually encountering their phobic situation
Social anxiety disorder (social phobia) : anxiety symptoms about the possibility of encountering their
phobic situation and when actually encountering their phobic situation
Agoraphobia : go to greater lengths to avoid a variety of feared situations
Brain structures involved in disorders
- Limbic system
- Parts of the cortex
- Neurotransmitter substances: aminobutyric acid (GABA), norepinephrine and serotonin
Factors influencing vulnerability:
• People who have perceptions of a lack of control over their environment/ emotions are more
vulnerable
• Classical conditioning
• Perception depends on social environment (parenting styles)
• Faulty or distorted patterns of cognition may play a role
• Sociocultural environment in which people are raised effects on the kinds of objects and
experiences people become anxious about or come to fear
Treatment:
- Graduated exposure to feared cues, objects, situations
- Cognitive restructuring technique
o Help the individual understand their distorted patterns of thinking about anxiety-
related situations and how these patterns can be changed
- Medication
o Useful for treating all disorders (except phobias)
o Antianxiety medication (anxiolytics) and antidepressant medication
,Phobia: persistent and disproportionate fear of some specific object of situation that presents little
or no actual danger and yet leads to a great deal of avoidance of these feared situations
Specific phobia
Criteria:
- Marked fear or anxiety about a specific object or situation
- The phobic object almost always provokes fear or anxiety and is therefore avoided or
endured with intense fear
- The fear/anxiety is out of proportion to the actual danger posed by the object
- Fear/anxiety/avoidance is persistent, lasting for 6 months or more
- Fear/anxiety/avoidance causes distress or impairment in social, occupational or other areas
of functioning
Subtypes in DSM- 5
Phobia type Example
Animal Spider, snake, insects
Natural environment Storms, heights, water
Blood-injection-injury Seeing blood or an injury, receiving
injections
Situational Public transportation, tunnels, bridges,
elevators, flying, driving
Other Choking, vomiting, space phobia
Blood-injection- injury phobia
- Experience disgust and fear
- Unique physiological response when confronted with the sight of blood or injury
o Initial acceleration in heart rate and blood pressure followed by a dramatic drop in
both heart rate and blood pressure
o Accompanied by nausea, dizziness or fainting (does not occur with other specific
phobias)
o These people show more typical physiological response pattern characteristic of the
fight-or-flight response to their other feared objects.
- Evolutionary and functional reason behind their response:
o Fainting: person being attacked might inhibit further attack, if attack did not occur,
the drop in blood pressure might minimize blood loss
o Highly heritable
, Prevalence, age of onset and gender differences
Epidemiology- 12 % lifetime prevalence
70% of people have another fear
- Gender ratio: vary considerably according to the type of phobia
o More common in women than men
o 90-95% of people with animal phobias are women
o Gender ratio is less than 2:1 for blood-injection-injury phobia.
- Age of onset: vary for different phobias
o Animal phobias: childhood
o Blood-injection-injury: childhood
o Claustrophobia: adolescence or early adulthood
o Driving phobia: adolescence or early adulthood
Psychological causal factors
Psychoanalytical viewpoint:
- Phobias represent a defence against anxiety that stems from repressed impulses from the id
- Repressed impulse is too dangerous to “know” so the anxiety is displaced onto some external
object or situation that has some symbolic relationship to the real object of anxiety
- Criticism:
o Too speculative & alternative
Phobias as learned behaviour:
Classical conditioning:
- Fear response is readily conditioned to previously neutral stimuli when these stimuli are
paired with traumatic or painful events.
o E.g. Fear started because she used to be put in closets and now being in an elevator
triggers claustrophobia
Vicarious conditioning:
- Watching a phobic person behaving fearfully with his/her phobic object can be distressing to
the observer and can result in fear being transmitted from one person to another
- Watching non fearful person undergoing a frightening experience can also lead to vicarious
conditioning
Individual differences in learning:
- Differences in life experiences among individuals strongly affect whether or not conditioned
fears/phobias actually develop
o E.g. Years of positive experiences with friendly dogs before being bitten by one will
probably keep a dog bite victim from developing a full blown dog phobia
- Some experiences serve as risk factors = make people more vulnerable to phobias
Learning objectives
Case 1:
What is a phobia?
What is the difference between normal anxiety and a phobia?
Which phobias are distinguished in DSM-V? (criteria/clinical views/epidemiology)
What causes a phobia? How is a phobia developed? (etiological models)
Case 2:
How are phobias treated?
What is exposure and how does it work?
What types of therapies are used to treat specific phobias, social phobias and agoraphobias?
Fear
Clear source of danger
- Basic emotion that involves fight-or-flight response
- Instantaneous reaction to any imminent threat
- Adaptive value is primitive alarm response
- Autonomic nervous system
Fear and panic have 3 distinct components:
1. Cognitive/subjective components (I feel afraid)I am going to die)
2. Physiological components (increased heartrate, heavy breathing)
3. Behavioural components (strong urge to escape or flee)
Loosely coupled: someone might show some indications of fear or panic but not all of them
Anxiety
Frequently cannot specify clearly what the danger is
Complex blend of unpleasant emotions and cognitions
- More oriented to the future
Cognitive/subjective:
- Involves negative mood, worry about possible future threats or danger, self-preoccupation
and the sense of being unable to predict the future threat or to control it
Physiological level:
- Creates a state of tension and chronic over arousal which reflect risk assessment and
readiness for dealing with danger
, - No activation of fight-or-flight
- May create a strong tendency to avoid situations where danger might be encountered
(behavioural) adaptive value:
- Wouldn’t even get into the situation. Helps to plan and prepare for possible threat
- In mind-moderate degrees: enhances learning and performance
Anxiety disorders
Specific phobia : anxiety symptoms about the possibility of encountering their phobic situation and
when actually encountering their phobic situation
Social anxiety disorder (social phobia) : anxiety symptoms about the possibility of encountering their
phobic situation and when actually encountering their phobic situation
Agoraphobia : go to greater lengths to avoid a variety of feared situations
Brain structures involved in disorders
- Limbic system
- Parts of the cortex
- Neurotransmitter substances: aminobutyric acid (GABA), norepinephrine and serotonin
Factors influencing vulnerability:
• People who have perceptions of a lack of control over their environment/ emotions are more
vulnerable
• Classical conditioning
• Perception depends on social environment (parenting styles)
• Faulty or distorted patterns of cognition may play a role
• Sociocultural environment in which people are raised effects on the kinds of objects and
experiences people become anxious about or come to fear
Treatment:
- Graduated exposure to feared cues, objects, situations
- Cognitive restructuring technique
o Help the individual understand their distorted patterns of thinking about anxiety-
related situations and how these patterns can be changed
- Medication
o Useful for treating all disorders (except phobias)
o Antianxiety medication (anxiolytics) and antidepressant medication
,Phobia: persistent and disproportionate fear of some specific object of situation that presents little
or no actual danger and yet leads to a great deal of avoidance of these feared situations
Specific phobia
Criteria:
- Marked fear or anxiety about a specific object or situation
- The phobic object almost always provokes fear or anxiety and is therefore avoided or
endured with intense fear
- The fear/anxiety is out of proportion to the actual danger posed by the object
- Fear/anxiety/avoidance is persistent, lasting for 6 months or more
- Fear/anxiety/avoidance causes distress or impairment in social, occupational or other areas
of functioning
Subtypes in DSM- 5
Phobia type Example
Animal Spider, snake, insects
Natural environment Storms, heights, water
Blood-injection-injury Seeing blood or an injury, receiving
injections
Situational Public transportation, tunnels, bridges,
elevators, flying, driving
Other Choking, vomiting, space phobia
Blood-injection- injury phobia
- Experience disgust and fear
- Unique physiological response when confronted with the sight of blood or injury
o Initial acceleration in heart rate and blood pressure followed by a dramatic drop in
both heart rate and blood pressure
o Accompanied by nausea, dizziness or fainting (does not occur with other specific
phobias)
o These people show more typical physiological response pattern characteristic of the
fight-or-flight response to their other feared objects.
- Evolutionary and functional reason behind their response:
o Fainting: person being attacked might inhibit further attack, if attack did not occur,
the drop in blood pressure might minimize blood loss
o Highly heritable
, Prevalence, age of onset and gender differences
Epidemiology- 12 % lifetime prevalence
70% of people have another fear
- Gender ratio: vary considerably according to the type of phobia
o More common in women than men
o 90-95% of people with animal phobias are women
o Gender ratio is less than 2:1 for blood-injection-injury phobia.
- Age of onset: vary for different phobias
o Animal phobias: childhood
o Blood-injection-injury: childhood
o Claustrophobia: adolescence or early adulthood
o Driving phobia: adolescence or early adulthood
Psychological causal factors
Psychoanalytical viewpoint:
- Phobias represent a defence against anxiety that stems from repressed impulses from the id
- Repressed impulse is too dangerous to “know” so the anxiety is displaced onto some external
object or situation that has some symbolic relationship to the real object of anxiety
- Criticism:
o Too speculative & alternative
Phobias as learned behaviour:
Classical conditioning:
- Fear response is readily conditioned to previously neutral stimuli when these stimuli are
paired with traumatic or painful events.
o E.g. Fear started because she used to be put in closets and now being in an elevator
triggers claustrophobia
Vicarious conditioning:
- Watching a phobic person behaving fearfully with his/her phobic object can be distressing to
the observer and can result in fear being transmitted from one person to another
- Watching non fearful person undergoing a frightening experience can also lead to vicarious
conditioning
Individual differences in learning:
- Differences in life experiences among individuals strongly affect whether or not conditioned
fears/phobias actually develop
o E.g. Years of positive experiences with friendly dogs before being bitten by one will
probably keep a dog bite victim from developing a full blown dog phobia
- Some experiences serve as risk factors = make people more vulnerable to phobias
