#1 PHOBIAS
Anxiety
=> involves a general feeling of apprehension about possible future danger
-> complex blend of unpleasant emotions & cognitions that is both more oriented to the future & much more
diffuse than fear
1) anxiety involves negative mood, worry about possible future threats/danger;
self-preoccupation; sense of being unable to predict future threat or to control it if it occurs
2) state of tension & chronic over arousal, which may reflect risk assessment & readiness for
dealing with danger should it occur
3) may create a strong tendency to avoid situations where danger might be encountered, but
no immediate behavioural urge to flee
-> highly conditional
-> create enormous personal, economic, and health care problems
-> 25-29% U.S. population
-> also associated with an increased prevalence of a number of medical conditions (asthma, chronic pain,
hypertension, arthritis etc.)
-> source not present / not obvious, more diffused
Fear
=> basic emotion, that involves activation of the “fight-or-flight” response of the autonomic nervous system
-> an almost instantaneous reaction to any imminent threat
-> fear responses in absence of any obvious external danger -> panic attack
1) cognitive/subjective components (“I feel afraid”)
2) physiological component (increased heartrate, heavy breathing)
3) behavioural component (strong urge to escape)
Neuroticism
=> a proneness/disposition to experience negative mood states, which is a common risk factor for anxiety and
mood disorders
- Brain Structures involved:
-> limbic system (“emotional brain”)
-> certain parts of the cortex
-> neurotransmitter substances (GABA, norepinephrine, serotonin)
Phobia
=> a persistent & disproportionate fear of some specific object/situation that presents little or no actual dangers
& yet leads to a great deal of avoidance of these feared situations
-> irrational, persistent fear which causes avoidance
-> sufferer is aware that his phobia is irrational
SPECIFIC PHOBIAS
=> a phobia towards a specific object/situation
-> phobic behaviour gets reinforced – when you escape – anxiety decreases => reinforcement
-> secondary benefits ??? (e.g.: attention) the secondary benefits derived from being disabled, such as increased
attention, sympathy, and some control over the behaviour of others, may also sometimes reinforce a phobia
Subtypes
-> animals
,-> natural environment
-> blood-injection injury -> irrational arousal; evolutionary (adaptive) -> leads to low blood pressure & then to
lose less blood; phobia is about disgust & fear + highly inheritable
-> situational
-> others …
Prevalence, Age of Onset, Gender Differences
-> 12% lifetime prevalence rate
-> have at least one or more specific phobias (comorbidity) -> 75% & often have depression
-> more common in females (60% are female) than in males
-> animal phobias start in childhood (+ blood-injection + dental phobias)
-> claustrophobia, driving etc. -> late adolescence, early adulthood
-> highly cultural dependence
PSYCHOLOGICAL CAUSAL FACTORS
-> psychoanalytic:
- phobias represent a defence against anxiety that stems from repressed impulses from the
Id impulse
- anxiety is displaced onto some external objects/situations that has some symbolic
relationship to the real object of the anxiety
// far too speculative
-> learned behaviour:
- classical conditioning:
-> fear response can readily be conditioned to previously neutral stimuli when these stimuli
are paired with traumatic/painful events
-> once acquired -> generalization to other similar objects/situations
- vicarious conditioning:
=> simply watching a phobic person behaving fearfully with his/her object -> can distress
observer -> results in fear being transmitted from one person to another
+ seeing/observing a non-fearful person undergoing a frightening experience -> vicarious conditioning
++ lots of support
- operant conditioning
-> escaping the fearful situation/object -> decreased arousal/anxiety -> reinforcement
// not everyone with traumatic experiences have phobias & vice versa
-> evolutionary aspect:
, - evolutionary history has affected which stimuli we’re most likely to come to fear
-> evolutionary prepared for certain objects
prepared learning
=> occurs because humans who rapidly acquired fears of certain objects -> selective advantage
(fear of actually harmful objects helped them to survive)
-> not inborn/innate but easily acquired & resistant to extinction
// can’t be traced back + not provable
BIOLOGICAL CAUSAL FACTORS
-> genetic & temperamental variables affect speed & strength of conditioning a fear
-> carriers of serotonin-transporter gene -> superior fear conditioning
-> same kind of phobias for monozygotic twins
-> predisposition & inheritable
Brain
-> amygdala: emotional centre -> overreactive to stimuli, neuropathways strengthen
-> hypothalamus
TREATMENTS
-> exposure therapy
1) systematic desensitization
2) flooding
-> best treatment for specific phobias
-> involves controlled exposure to the stimuli/situations that elicit phobic fear
-> gradually placed in those situation they find most frightening (or direct exposure)
- in vivo (real life exposure) / in vitro (virtual reality)
3) participant modelling
=> therapist calmly models way of interacting with the phobic stimulus/situation
-> enables to learn that a situation isn’t as frightening/harmful
-> is probably mediated by changes in brain activation in amygdala
4) counter conditioning
-> applied tension technique
-> for blood-injection phobia
=> is a strategy developed to help prevent fainting or help people recover faster if they do faint. The
technique involves tensing muscles in the body, which then raises blood pressure. If your blood pressure
increases, you are less likely to faint.
-> medication
-> d-cycloserin -> facilitates extinction of conditioned fear
-> not that effective, but facilitates behavioural therapy
-> addictive? + has to be taken for a long time
, SOCIAL PHOBIAS
=> characterized by disabling fears of one/more specific social situations
1) performance situations -> e.g.: public speaking (most common), performing in front of others
2) non-performance situations
-> rigid postures, shy, can’t hold eye contact, submissive
Prevalence, Age of Onset, Gender Differences
-> 12%
-> more common in females, but for dating situations more for males
onset: emerges later – during early/middle adolescence, early adulthood
comorbidity: 2/3 also suffer from other anxiety disorders, 50% from depressive disorders
-> also abuse alcohol to reduce their anxiety (e.g. before fearful situations)
-> lower employment rates, lower SES
prognosis: disorder is very persistent, only 37% recovered over a 12 year period + high relapse rate
cultural differences: different expression in different countries
PSYCHOLOGICAL CAUSES
- learned behaviour
-> originates from simple instances of direct or vicarious classical conditioning (experiencing, witnessing
a perceived social defeat)
-> 92% reported history of severe teasing in childhood
-> more likely to have emotionally cold parents + being socially isolated & avoidant
-> never learned how to behave in social situations
- evolutionary context
-> social phobias evolved as a byproduct of dominance hierarchies
-> are established through aggressive encounters between members of a social group, and a
defeated individual typically displays fear & submissive behaviour
- uncontrollability
-> being exposed to uncontrollable + unpredictable stressful events -> important role
-> leads to submissive, unassertive behaviour
-> reduced sense of personal control over events
Anxiety
=> involves a general feeling of apprehension about possible future danger
-> complex blend of unpleasant emotions & cognitions that is both more oriented to the future & much more
diffuse than fear
1) anxiety involves negative mood, worry about possible future threats/danger;
self-preoccupation; sense of being unable to predict future threat or to control it if it occurs
2) state of tension & chronic over arousal, which may reflect risk assessment & readiness for
dealing with danger should it occur
3) may create a strong tendency to avoid situations where danger might be encountered, but
no immediate behavioural urge to flee
-> highly conditional
-> create enormous personal, economic, and health care problems
-> 25-29% U.S. population
-> also associated with an increased prevalence of a number of medical conditions (asthma, chronic pain,
hypertension, arthritis etc.)
-> source not present / not obvious, more diffused
Fear
=> basic emotion, that involves activation of the “fight-or-flight” response of the autonomic nervous system
-> an almost instantaneous reaction to any imminent threat
-> fear responses in absence of any obvious external danger -> panic attack
1) cognitive/subjective components (“I feel afraid”)
2) physiological component (increased heartrate, heavy breathing)
3) behavioural component (strong urge to escape)
Neuroticism
=> a proneness/disposition to experience negative mood states, which is a common risk factor for anxiety and
mood disorders
- Brain Structures involved:
-> limbic system (“emotional brain”)
-> certain parts of the cortex
-> neurotransmitter substances (GABA, norepinephrine, serotonin)
Phobia
=> a persistent & disproportionate fear of some specific object/situation that presents little or no actual dangers
& yet leads to a great deal of avoidance of these feared situations
-> irrational, persistent fear which causes avoidance
-> sufferer is aware that his phobia is irrational
SPECIFIC PHOBIAS
=> a phobia towards a specific object/situation
-> phobic behaviour gets reinforced – when you escape – anxiety decreases => reinforcement
-> secondary benefits ??? (e.g.: attention) the secondary benefits derived from being disabled, such as increased
attention, sympathy, and some control over the behaviour of others, may also sometimes reinforce a phobia
Subtypes
-> animals
,-> natural environment
-> blood-injection injury -> irrational arousal; evolutionary (adaptive) -> leads to low blood pressure & then to
lose less blood; phobia is about disgust & fear + highly inheritable
-> situational
-> others …
Prevalence, Age of Onset, Gender Differences
-> 12% lifetime prevalence rate
-> have at least one or more specific phobias (comorbidity) -> 75% & often have depression
-> more common in females (60% are female) than in males
-> animal phobias start in childhood (+ blood-injection + dental phobias)
-> claustrophobia, driving etc. -> late adolescence, early adulthood
-> highly cultural dependence
PSYCHOLOGICAL CAUSAL FACTORS
-> psychoanalytic:
- phobias represent a defence against anxiety that stems from repressed impulses from the
Id impulse
- anxiety is displaced onto some external objects/situations that has some symbolic
relationship to the real object of the anxiety
// far too speculative
-> learned behaviour:
- classical conditioning:
-> fear response can readily be conditioned to previously neutral stimuli when these stimuli
are paired with traumatic/painful events
-> once acquired -> generalization to other similar objects/situations
- vicarious conditioning:
=> simply watching a phobic person behaving fearfully with his/her object -> can distress
observer -> results in fear being transmitted from one person to another
+ seeing/observing a non-fearful person undergoing a frightening experience -> vicarious conditioning
++ lots of support
- operant conditioning
-> escaping the fearful situation/object -> decreased arousal/anxiety -> reinforcement
// not everyone with traumatic experiences have phobias & vice versa
-> evolutionary aspect:
, - evolutionary history has affected which stimuli we’re most likely to come to fear
-> evolutionary prepared for certain objects
prepared learning
=> occurs because humans who rapidly acquired fears of certain objects -> selective advantage
(fear of actually harmful objects helped them to survive)
-> not inborn/innate but easily acquired & resistant to extinction
// can’t be traced back + not provable
BIOLOGICAL CAUSAL FACTORS
-> genetic & temperamental variables affect speed & strength of conditioning a fear
-> carriers of serotonin-transporter gene -> superior fear conditioning
-> same kind of phobias for monozygotic twins
-> predisposition & inheritable
Brain
-> amygdala: emotional centre -> overreactive to stimuli, neuropathways strengthen
-> hypothalamus
TREATMENTS
-> exposure therapy
1) systematic desensitization
2) flooding
-> best treatment for specific phobias
-> involves controlled exposure to the stimuli/situations that elicit phobic fear
-> gradually placed in those situation they find most frightening (or direct exposure)
- in vivo (real life exposure) / in vitro (virtual reality)
3) participant modelling
=> therapist calmly models way of interacting with the phobic stimulus/situation
-> enables to learn that a situation isn’t as frightening/harmful
-> is probably mediated by changes in brain activation in amygdala
4) counter conditioning
-> applied tension technique
-> for blood-injection phobia
=> is a strategy developed to help prevent fainting or help people recover faster if they do faint. The
technique involves tensing muscles in the body, which then raises blood pressure. If your blood pressure
increases, you are less likely to faint.
-> medication
-> d-cycloserin -> facilitates extinction of conditioned fear
-> not that effective, but facilitates behavioural therapy
-> addictive? + has to be taken for a long time
, SOCIAL PHOBIAS
=> characterized by disabling fears of one/more specific social situations
1) performance situations -> e.g.: public speaking (most common), performing in front of others
2) non-performance situations
-> rigid postures, shy, can’t hold eye contact, submissive
Prevalence, Age of Onset, Gender Differences
-> 12%
-> more common in females, but for dating situations more for males
onset: emerges later – during early/middle adolescence, early adulthood
comorbidity: 2/3 also suffer from other anxiety disorders, 50% from depressive disorders
-> also abuse alcohol to reduce their anxiety (e.g. before fearful situations)
-> lower employment rates, lower SES
prognosis: disorder is very persistent, only 37% recovered over a 12 year period + high relapse rate
cultural differences: different expression in different countries
PSYCHOLOGICAL CAUSES
- learned behaviour
-> originates from simple instances of direct or vicarious classical conditioning (experiencing, witnessing
a perceived social defeat)
-> 92% reported history of severe teasing in childhood
-> more likely to have emotionally cold parents + being socially isolated & avoidant
-> never learned how to behave in social situations
- evolutionary context
-> social phobias evolved as a byproduct of dominance hierarchies
-> are established through aggressive encounters between members of a social group, and a
defeated individual typically displays fear & submissive behaviour
- uncontrollability
-> being exposed to uncontrollable + unpredictable stressful events -> important role
-> leads to submissive, unassertive behaviour
-> reduced sense of personal control over events
