Taak 2 Learning theories of anxiety
Leerdoelen:
1. Wat is een specifieke fobie?
a. Klinisch beeld
b. Epidemiologie
c. Differentiaaldiagnose
d. Etiologie
e. Behandeling
2. Welke typen zijn er?
3. Welke verschillende pathways to fear zijn er?
4. Wat is het verschil tussen een angst en een fobie?
Bron: Adams et Al
Specific phobias
● Definition
○ Criterion
■ Specific phobias are defined as a marked fear of certain objects, stimuli,
or situations (Criterion A).
■ The full intensity of the fear is experienced upon actual exposure to the
phobic trigger, specific phobias may also be characterized by a similarly
intense reaction even in anticipation of coming into contact with the
feared object or situation. Actual or anticipated exposure invariably
provokes an immediate, intense anxiety reaction, which can be similar to
a full-blown or limited-symptom panic attack (Criterion B) (= verwachten)
■ Although the dominant response tendency is avoidance (Criterion C),
phobic individuals may also engage in excessive safety behaviors or
remain in phobic situations in an effort to endure their anxiety.
■ The clinical diagnosis of a specific phobia also requires that the fear or
anxiety is out of proportion to the actual danger posed by the object or
situation (Criterion D)
■ It is persistent (Criterion E)
■ It leads to functional impairment in either personal, social, or occupational
domains (Criterion F)
■ Not due to or better explained by other anxiety/mood disorders,
substances, or organic pathology (Criterion G).
● Types → examples in the book to better understand cases of these types of
anxiety
○ Animal
■ Snakes, rodents, insects
○ Natural environment
■ Thunderstorms, tornados, heights, dark
○ Blood-injection-injury (BII)
, ■ Needles, blood draws, open wounds
○ Situational
■ Driving, flying, enclosed spaces
○ Overige
■ Bijvoorbeeld clowns, speelgoed etc.
■ Minst voorkomend
● Epidemiology
○ Lifetime prevalence: 41-50% of general population
■ Although, these symptoms are rarely “good enough” to justify a phobia
diagnosis
○ One of the most prevalent psychological disorders
○ Prevalence estimates have varied widely across studies → 0.9-0.54% (Italian
study), ~12% lifetime, ~9% 12 month (US study)
○ Types (most common to less)
■ Situational phobia, natural environment, animal, and BII
○ Fear of height most common specific phobia
○ Significant age and sex effects in prevalence
■ More common among adolescents and less common among older adult
populations
● 18-22% → ages 13 - 18
● 13-14% → ages 18 - 59
● 4-9% → ages 55 - 84
■ Also higher rates among females compared to males
● Onderrapportage → “ik ga hier zitten en ik doe het wel alleen en
niemand gaat het merken”
● Course
○ Many phobias begin in childhood or adolescence
○ Animal and BII tend to onset earlier than natural environment and situational
○ Specific fears appear even earlier than the specific phobias itself
● Impairment
○ Less research → functional impairments and quality of life
○ Linear relation found between the number of specific fears and the degree of
social and occupational impairment
○ Weinig aanwezig op het werk → gevolg: vasthouden van baan wordt lastiger,
lager inkomen etc.
● Differential diagnosis
○ Additional questions to recognise phobias during clinical interviews
■ Do you feel intense anxiety or fear when confronted by certain animals,
objects, or situations?
■ Do you think this fear is excessive or unreasonable?
■ Are you avoiding these animals, objects, or situations because of your
fear?
■ In what ways has this anxiety or fear interfered with your life?
, ■ How would you react if you were exposed to the animal, object, or
situation right now?
■ Have you ever fainted or almost fainted around blood, injuries, or
needles?
○ Self-report measures
■ Self-report questionnaires are already available
● Can be efficient means for gathering specific information on the
range of phobic cues and triggers
○ Especially when interview time is limited
● Recall biases are common!
○ Behavioral assesment
■ Highly efficient & informative → for severity of phobias
■ Allows the clinician to directly observe the patient’s reaction to various
representations of phobic cues in “real life”
■ Limitations
● Potential for retrospective recall biases!
● Pervasive avoidance → lack of contact with feared object or
situation
○ Distinctions from other anxiety disorders
■ Specific phobias: distinctive in their “focal” nature
● Social phobia also “focal”, but content of fear netword is
interpersonal in nature
■ 3 components of anxiety process:
● Motoric escape and avoidance
● Physiologic activation of the sympathetic branch of the autonomic
nervous system
● Cognitive appraisals of threat and harm
● Comorbidity
○ Andere specifieke fobieën
Leerdoelen:
1. Wat is een specifieke fobie?
a. Klinisch beeld
b. Epidemiologie
c. Differentiaaldiagnose
d. Etiologie
e. Behandeling
2. Welke typen zijn er?
3. Welke verschillende pathways to fear zijn er?
4. Wat is het verschil tussen een angst en een fobie?
Bron: Adams et Al
Specific phobias
● Definition
○ Criterion
■ Specific phobias are defined as a marked fear of certain objects, stimuli,
or situations (Criterion A).
■ The full intensity of the fear is experienced upon actual exposure to the
phobic trigger, specific phobias may also be characterized by a similarly
intense reaction even in anticipation of coming into contact with the
feared object or situation. Actual or anticipated exposure invariably
provokes an immediate, intense anxiety reaction, which can be similar to
a full-blown or limited-symptom panic attack (Criterion B) (= verwachten)
■ Although the dominant response tendency is avoidance (Criterion C),
phobic individuals may also engage in excessive safety behaviors or
remain in phobic situations in an effort to endure their anxiety.
■ The clinical diagnosis of a specific phobia also requires that the fear or
anxiety is out of proportion to the actual danger posed by the object or
situation (Criterion D)
■ It is persistent (Criterion E)
■ It leads to functional impairment in either personal, social, or occupational
domains (Criterion F)
■ Not due to or better explained by other anxiety/mood disorders,
substances, or organic pathology (Criterion G).
● Types → examples in the book to better understand cases of these types of
anxiety
○ Animal
■ Snakes, rodents, insects
○ Natural environment
■ Thunderstorms, tornados, heights, dark
○ Blood-injection-injury (BII)
, ■ Needles, blood draws, open wounds
○ Situational
■ Driving, flying, enclosed spaces
○ Overige
■ Bijvoorbeeld clowns, speelgoed etc.
■ Minst voorkomend
● Epidemiology
○ Lifetime prevalence: 41-50% of general population
■ Although, these symptoms are rarely “good enough” to justify a phobia
diagnosis
○ One of the most prevalent psychological disorders
○ Prevalence estimates have varied widely across studies → 0.9-0.54% (Italian
study), ~12% lifetime, ~9% 12 month (US study)
○ Types (most common to less)
■ Situational phobia, natural environment, animal, and BII
○ Fear of height most common specific phobia
○ Significant age and sex effects in prevalence
■ More common among adolescents and less common among older adult
populations
● 18-22% → ages 13 - 18
● 13-14% → ages 18 - 59
● 4-9% → ages 55 - 84
■ Also higher rates among females compared to males
● Onderrapportage → “ik ga hier zitten en ik doe het wel alleen en
niemand gaat het merken”
● Course
○ Many phobias begin in childhood or adolescence
○ Animal and BII tend to onset earlier than natural environment and situational
○ Specific fears appear even earlier than the specific phobias itself
● Impairment
○ Less research → functional impairments and quality of life
○ Linear relation found between the number of specific fears and the degree of
social and occupational impairment
○ Weinig aanwezig op het werk → gevolg: vasthouden van baan wordt lastiger,
lager inkomen etc.
● Differential diagnosis
○ Additional questions to recognise phobias during clinical interviews
■ Do you feel intense anxiety or fear when confronted by certain animals,
objects, or situations?
■ Do you think this fear is excessive or unreasonable?
■ Are you avoiding these animals, objects, or situations because of your
fear?
■ In what ways has this anxiety or fear interfered with your life?
, ■ How would you react if you were exposed to the animal, object, or
situation right now?
■ Have you ever fainted or almost fainted around blood, injuries, or
needles?
○ Self-report measures
■ Self-report questionnaires are already available
● Can be efficient means for gathering specific information on the
range of phobic cues and triggers
○ Especially when interview time is limited
● Recall biases are common!
○ Behavioral assesment
■ Highly efficient & informative → for severity of phobias
■ Allows the clinician to directly observe the patient’s reaction to various
representations of phobic cues in “real life”
■ Limitations
● Potential for retrospective recall biases!
● Pervasive avoidance → lack of contact with feared object or
situation
○ Distinctions from other anxiety disorders
■ Specific phobias: distinctive in their “focal” nature
● Social phobia also “focal”, but content of fear netword is
interpersonal in nature
■ 3 components of anxiety process:
● Motoric escape and avoidance
● Physiologic activation of the sympathetic branch of the autonomic
nervous system
● Cognitive appraisals of threat and harm
● Comorbidity
○ Andere specifieke fobieën
