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Anxiety Disorder: Phobia. Anxiety disorders. Anxiety – physiological arousal, feelings of apprehension, unease, worry that something bad is about to happen Anxiety disorder – chronic feelings of anxiety, distress, nervousness, apprehension
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Anxiety disorders • Anxiety – physiological arousal, feelings of apprehension, unease, worry that something bad is about to happen • Anxiety disorder – chronic feelings of anxiety, distress, nervousness, apprehension • Level of anxiety is so severe that it interferes with everyday life
What is a phobia • Everyone is afraid of things, mostly these things are not classed as phobias • Phobias are INTENSE and IRRATIONAL • Characterised by an unreasonable fear directed towards a particular object, situation or event • Phobias effect the lives of sufferers • Specific phobia specific situation object or event • The ‘thing’ they are afraid of is referred to as the phobic stimulus
DSM phobia categories • Animals • Situations • Blood / injections • Natural environments • Other (choking, dying, illness, falling etc)
How many phobias? • Traditional phobia names use a Greek prefix • Most specific phobias are not listed in the DSM as there are literally too many to list • Simply classified as ‘specific phobias’ • ICD -10 uses the term ‘specific’ interchangeably with ‘isolated’ • Some phobias are less specific eg. Agoraphobia • These are referred to as ‘complex phobias’
Specific phobia • Exposure to the phobic stimulus causes a significant anxiety response • Panic attack can occur – intense anxiety, dizziness, short of breath, tight chest, disorientation, feeling of no control. • Sufferers know that the fear is irrational but feel compelled to avoid the phobic stimulus • Anticipatory anxiety can also occur if they think about encountering the phobic stimulus
Biological factors • Some evidence for genetic inheritance – predisposition, not a guarantee of a disorder • Sympathetic arousal closely related to stress response, and thus also to phobic response • Problem is that stress response is being elicited with no real threat to the organism
GABA • 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
glutamate • 2nd most common neurotransmitter in the brain • Excitatory neurotransmitter • Makes postsynaptic neurons more likely to pass on the neural impulse • Gets the post synaptic neuron excited so it requires less stimulation to make it fire • Also plays a role in learning and memory, strengthening synaptic connections
GABA Stop the message! GLUTAMATE Get the message going!
GABA and anxiety • Lack of the neurotransmitter GABA might lead to over stimulation, and thus heightened anxiety • Benzodiazepines – a class of drugs that ‘calm down’ neural activity. Valiam, Xzanax, Rohypnol, Serepax etc. • These drugs are Agonists– mimic the activity of a neurotransmitter
Benzodiazepines - agonists • Mimic the activity of GABA in inhibiting post synaptic neural activity • Effective in the management of anxiety disorders • So anxiety disorders might be the result of a dysfunctional GABA system, not making enough neurotransmitter • One study showed that anxiety disorder sufferers have 22% less GABA than healthy individuals • Conversely studies show that antagonists drugs can induce anxiety
GABA natural supplements • GABA like substances found in many foods, supplements also available from health food retailers • Unlike drugs that are specifically manufactured for the purpose, there is no evidence that supplements can penetrate the blood brain barrier • The blood brain barrier is a kind of filtration system that only allows certain substances into the brain
Alliumphobia- Fear of garlic Autodysomophobia- Fear of one that has a vile odour
Psychological factors – freud’s psychodynamic model • Mental disorders are caused by unresolved conflicts that occur in the unconscious • Phobias occur due to defence mechanism – displacement. • Males are displacing their fear towards their father to another neutral object that now becomes the ‘phobic stimulus’
freud’s psychodynamic model • As we grow up we progress through different psychosexual stages: • Oral: 0 – 2 • Anal: 2 -3 • Phallic: 4 -5 • Latency: 6 – puberty • Genital: puberty + • 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 psychodynamic model – oedepal complex • Phallic stage 4 – 5 • Male child develops sexual attraction to his mother (oedipal complex) • 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
Peladophobia- Fear of bald people Urophobia- Fear of urine or urinating
Behavioural model • Phobias are learned • Classical conditioning plays a role in the acquisition of specific phobia • Operant conditioning plays a role in the persistence of specific phobia.
Arachnophobia • CLASSICAL CONDITIONING • UCS– spider in sandpit • UCR– fear • NS– spiders • CS– spiders • CR – fear
Cognitive model • Focus on HOW and WHY people think about the phobic stimulus the way they do. • Key assumption – people with phobias have a cognitive bias – a tendency to think in a way that involves errors and bad judgement. • Types of cognitive bias: • 1. Attentional bias • 2. Interpretive bias • 3. Memory bias • 4. Catastrophic thinking
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 looing out for the 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 • What can go wrong will go wrong, and in a big way • Often underestimate their ability to cope with the situation
Cognitive behavioural therapy • Cognitive therapy – thinking therapy, aims to address the problems in cognition that contribute to negative emotions and behaviours • Behavioural therapy – clinical application of learning theories (eg.CC/OC) • A combination of both
Cognitive behavioural therapy • CBT is focused in the present • Recognition that past events shaped now • However focus of CBT is changing the current trend in thinking and behaving • Client taught to identify unhelpful thoughts and to shift thinking to more balanced helpful thoughts • Makes the client responsible for their thoughts rather than being a victim of them
CBT behavioural component • Behavioural component aims to address maladaptive behaviours that are a part of the condition • Behavioural experiments – go on a plane and notice that it did not crash! • steps in behavioural component • Make a prediction • Review the evidence for and against • Devise an experiment to test this • Note the results • Draw conclusions
CBT and phobias • Tries to develop a new understanding of the phobic stimulus • Identify anxiety related thoughts and cognitive biases • Look at evidence that supports/rejects these biases • Switch from unhelpful irrational thoughts to evidence based rational thoughts
Behavioural PSYCHOTHERAPY: Attempts to replace fear response with relaxation Patient taught relaxation techniques Gradually introduced to fear inducing stimulus while practicing relaxation. Systematic desensitisation Fear hierarchy
Behavioural PSYCHOTHERAPY: Expose the patient to their fear straight away They will panic at first Soon realise that nothing bad has happened Flooding
Socio-cultural factors –specific environmental triggers • Traumatic event involving the phobic stimulus • Research shows that the more severe the trauma the more likely it is that a phobia will develop • If the trauma is severe enough only one experience is necessary (unlike normal CC where repeated pairings are needed) • Not a complete explanation, some people do not develop phobias despite severe trauma
Socio-cultural factors – parental modelling • Child who observes an extreme fear reaction from a parent may imitate the same reaction • Modelling bravery can help children cope with fears
Socio-cultural factors – 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
