Phobias

Phobias•What are What are

you afraid you afraid of?of?– Air Travel?Air Travel?– Spiders?Spiders?– Snakes?Snakes?– Heights?Heights?– Storms?Storms?

•Small, closed spaces?•Crowds?•Being Attacked?•Blood?•The Dark?•Social Events?•Being Alone?

Definition of PHOBIA: Definition of PHOBIA:

A persistent and unreasonable fear of a A persistent and unreasonable fear of a particular object, activity or situationparticular object, activity or situation

PHOBIA

• The person who has a phobia will go to The person who has a phobia will go to great lengths to avoid the object of the great lengths to avoid the object of the fear and experience great distress if it is fear and experience great distress if it is encountered. encountered.

In the DSM IV, phobias are subdivided...

• AgoraphobiaAgoraphobia• Specific PhobiaSpecific Phobia• Social PhobiaSocial Phobia

Specific Phobia

• A significant and persistent fear when in A significant and persistent fear when in the presence of, or anticipating the the presence of, or anticipating the presence of, the object of fear, which presence of, the object of fear, which may be an object, place or situationmay be an object, place or situation

DSM 5 criteria for specific phobia...

1.1.Strong, out of proportion fear in the presence or Strong, out of proportion fear in the presence or anticipation of a specific object or situationanticipation of a specific object or situation

2.2.Exposure provokes an immediate anxiety Exposure provokes an immediate anxiety response, which may be a panic attack.response, which may be a panic attack.

3.3.The person recognizes that the fear is out of The person recognizes that the fear is out of proportion.proportion.

4.4.The phobic situation(s) is avoided if possible.The phobic situation(s) is avoided if possible.5.5.The phobia interferes with normal lifeThe phobia interferes with normal life

How might a phobia interfere with daily living? Consider different arenas of life…work, home, social

What do you think are the most common

phobias?

Common Phobias...can you guess the fears?1.Arachnophobia 2.Ophidiophobia3.Acrophobia4.Agoraphobia5.Cynophobia6.Astraphobia7.Trypanophobia8.Nyctophobia9.Pteromerhanophobia10.Mysophobia

1.Fear of spiders2.Fear of snakes3.Fear of heights4.Fear of places where escape is difficult5.Fear of dogs6.Fear of storms7.Fear of injections8.Fear of the dark9.Fear of flying10.Fear of germs

How about of these bizarre phobias?

• Fear of # 13: Triskaidekaphobia Fear of # 13: Triskaidekaphobia • Fear of #666: Fear of #666:

HexakosioihexekontahexaphobiaHexakosioihexekontahexaphobia• Fear of long words: Fear of long words:

hippopotomonstrosesquipedaliophobia hippopotomonstrosesquipedaliophobia • Fear of money: ChrometophobiaFear of money: Chrometophobia• Fear of beautiful women: CaligynephobiaFear of beautiful women: Caligynephobia

For a full list...• http://phobialist.comhttp://phobialist.com

Agoraphobia:

abnormal fear of being helpless in an abnormal fear of being helpless in an embarrassing or unescapable situation that is embarrassing or unescapable situation that is characterized especially by the avoidance of characterized especially by the avoidance of open or public placesopen or public places

Social Phobia

• marked and persistent fear of social or marked and persistent fear of social or performance situations in which performance situations in which embarrassment may occur.embarrassment may occur.

Remember...• A diagnosis of phobia requires that the A diagnosis of phobia requires that the

avoidance of the object of phobia avoidance of the object of phobia interfere with life and that encoutering interfere with life and that encoutering the object creates intense disruptive the object creates intense disruptive fear. fear.

EXPLANATIONS OF PHOBIAS• There are several theories about the

origins of phobias.• What do you think might cause

phobias?

Psychodynamic• Do you remember little Hans?

PsychodynamicHow would you explain the psychodynamic

explanation?

Psychoanalytic Explanation• The desires and emotions of the Id are in The desires and emotions of the Id are in

conflict with the Super-ego.conflict with the Super-ego.

• The tension becomes so great that the The tension becomes so great that the individual may stop functioning or become individual may stop functioning or become psychotic.psychotic.

• The ego DISPLACES (this is a specific defence The ego DISPLACES (this is a specific defence mechanism) the tension of the conflict and the mechanism) the tension of the conflict and the fear of the conflict onto an external object. fear of the conflict onto an external object.

• This causes phobia of that specific object.This causes phobia of that specific object.

• What was the conflict inside Little Hans? What was the conflict inside Little Hans? – He had equinophobia--fear of horses– He also had Ebultophobia--fear of

baths– He also seems to have developed

agoraphobia

(remember what agoraphobia means?)

• Can you come up with a hypothetical Can you come up with a hypothetical conflict between Id and Super-ego conflict between Id and Super-ego which the Ego may not be able to which the Ego may not be able to handle?handle?

• Remembering how Freud resolved Hans' Remembering how Freud resolved Hans' phobias, what might the treatment phobias, what might the treatment involve,involve,

BEHAVIORAL Explanations• Classical Conditioning:Classical Conditioning:

– Little Albert (Watson, 1920)Little Albert (Watson, 1920)– What was the neutral stimulus?What was the neutral stimulus?– What was the unconditioned stimulus?What was the unconditioned stimulus?– What was the unconditioned response?What was the unconditioned response?– What does What does pairing mean? mean?– Finally what was the conditioned Finally what was the conditioned

stimulus and the conditioned response?stimulus and the conditioned response?• What is generalization?What is generalization?

Behavioral Explanation Continued• Avoidance Conditioning, Avoidance Conditioning,

AKA: The two-process theory (or two-AKA: The two-process theory (or two-factor theory) factor theory)

by Mowrer (1947)by Mowrer (1947)

Avoideance Conditioning continued– After Classical Conditioning establishes After Classical Conditioning establishes

a phobic response, Operant a phobic response, Operant Conditioning takes over.Conditioning takes over.

– The person is relieved of fear when she The person is relieved of fear when she avoids the conditioned stimuli.avoids the conditioned stimuli.

Avoidance Conditioning• What kind of consequence is this:What kind of consequence is this:

– Negative Punishment?Negative Punishment?– Positive Punishment?Positive Punishment?– Negative Reinforcement?Negative Reinforcement?– Positive Reinforcement ?Positive Reinforcement ?

•Negative ReinforcementNegative Reinforcement

Social Learning Theory (Remember Albert Bandura?• Child sees mother freak out when she Child sees mother freak out when she

sees a mouse in the kitchen...monkey sees a mouse in the kitchen...monkey see monkey do...through social learning, see monkey do...through social learning, the child comes to understand that mice the child comes to understand that mice are terrifying. (After all, to see Mommy are terrifying. (After all, to see Mommy terrified is scary. Because of this, there terrified is scary. Because of this, there may be a bit of what involved in the may be a bit of what involved in the development of the mice phobia in the development of the mice phobia in the child?child?

Social Learning of phobias• Classical conditioning because mice Classical conditioning because mice

become paired with the scary event of become paired with the scary event of Mommy freaking out.Mommy freaking out.

• The phobic response, through social The phobic response, through social learning, occurs even in other contexts learning, occurs even in other contexts than the original place, the kitchen.than the original place, the kitchen.

Behavioral Treatments• Systematic Desensitization (Wolpe, 1958) Systematic Desensitization (Wolpe, 1958)

– this is a form of what kind of this is a form of what kind of conditioning?conditioning?

– Systematic Desensitization can occur in Systematic Desensitization can occur in three ways:three ways:

– In vitro (imagination)In vitro (imagination)– In vivo (Real life)In vivo (Real life)– Video Reality Exposure Therapy (VRET). Video Reality Exposure Therapy (VRET).

Systematic Desensitization (behavioral treatment)• An anxiety hierarchy represents a An anxiety hierarchy represents a

progression from mild anxiety in relation progression from mild anxiety in relation to the feared object to the most intense to the feared object to the most intense possible encounter with the feared possible encounter with the feared object. object.

Anxiety Hierarchy for Systematic Desensitization (Behavioral)1.1. Seeing the word dog, Seeing the word dog, 2.2.Imagining the dog Imagining the dog 3.3.Seeing a pictur of a dogSeeing a pictur of a dog4.4.seeing a video of a dogseeing a video of a dog5.5.Hearing a dog barkHearing a dog bark6.6.Seeing a caged dog.Seeing a caged dog.7.7.Seeing a dog on a leash.Seeing a dog on a leash.8.8.Touching a dog. Touching a dog.

Virtual Reality Exposure Therapy• Also a form of systematic desensitization. Also a form of systematic desensitization.

One advantage of VRET is that it is One advantage of VRET is that it is obvious that there truly is no threat of a obvious that there truly is no threat of a non-real height (for example) yet the non-real height (for example) yet the person feels fear. This allows the person person feels fear. This allows the person more ability to see the fear is completely more ability to see the fear is completely irrational.irrational.

(Rothbaum et. al. 1995)(Rothbaum et. al. 1995)

Behavioral Treatments• Flooding--the terror cannot sustain itself, Flooding--the terror cannot sustain itself,

the organism runs out of energy. Fear the organism runs out of energy. Fear subsides and yet the person is still in the subsides and yet the person is still in the same situation. The brain then has same situation. The brain then has experience of the phobic object without experience of the phobic object without feeling fear. What kind of conditioning feeling fear. What kind of conditioning then takes over to eliminate the phobia?then takes over to eliminate the phobia?

Participant Modeling(Bernstein 1997)(a Social Learning Treatment)

• A model is present to encounter the A model is present to encounter the feared object safely, e.g. handle a snake feared object safely, e.g. handle a snake while the phobic is watching. while the phobic is watching.

• Obviously, this is a kind of social learning.Obviously, this is a kind of social learning.

Applied Tension to prevent fainting

• Blood and needle phobias often lead to Blood and needle phobias often lead to fainting. Not fainting is a good first step for fainting. Not fainting is a good first step for overcoming the phobia.overcoming the phobia.– Tense all the muscles for 30 seconds.Tense all the muscles for 30 seconds.– This raises blood pressure.This raises blood pressure.– Raised BP prevents fainting (classical cond).Raised BP prevents fainting (classical cond).– Then relax for 20 seconds (classical Then relax for 20 seconds (classical

conditioning)conditioning)– Repeat 5-10 times.Repeat 5-10 times.

Cognitive Explanation• SENSITIZATION: The person becomes SENSITIZATION: The person becomes

sensitive to the object and/or her own sensitive to the object and/or her own physiological response. Panic almost physiological response. Panic almost always involves fearing the panic itself.always involves fearing the panic itself.

• e.g. the fast heart rate is thought of as "I e.g. the fast heart rate is thought of as "I will have a heart attack!" (overestimating will have a heart attack!" (overestimating and catastrophising)and catastrophising)

Cognitive Explanation of Phobias• AVOIDANCE: Like the behaviorists, the AVOIDANCE: Like the behaviorists, the

act of avoiding the object of fear creates act of avoiding the object of fear creates relief, negative reinforcementrelief, negative reinforcement

Cognitive Theory of Phobia• IRRATIONAL AND NEGATIVE IRRATIONAL AND NEGATIVE

INTERPRETATION:INTERPRETATION:A false mental interpretation of an object A false mental interpretation of an object

and self is required for a phobic response. and self is required for a phobic response. 1.1. Over-estimating: "Spiders are terrible "Spiders are terrible

and dangerous! They are straight from and dangerous! They are straight from hell!"hell!"

2.Catastrophizing: "I'm going to die!" "I'm going to die!"3.Underestimating ability to cope: "I ability to cope: "I

can't deal with this!"can't deal with this!"

Di Nardo et al (1988)• Only 50% of cynophobics had a bad experience Only 50% of cynophobics had a bad experience

with dogs. with dogs. – Why is this a problem for behaviorists? Why is this a problem for behaviorists? – How do cognitive psychologists explain this?How do cognitive psychologists explain this?

• Also, only 50% of people who were bit by dogs Also, only 50% of people who were bit by dogs developed cynophobia. developed cynophobia. – Why is THIS a problem for behaviorists?Why is THIS a problem for behaviorists?– How do cogntive psychologists explain this? How do cogntive psychologists explain this?

Cognitive Therapy1.1.Identify irrational thoughts/beliefs: "The Identify irrational thoughts/beliefs: "The

dog will bite me! I'm going to die! "dog will bite me! I'm going to die! "2.2.Replace with rational thoughts: "Most Replace with rational thoughts: "Most

dogs don't bite. This one has never dogs don't bite. This one has never bitten. It is wagging its tail. Even if bitten, bitten. It is wagging its tail. Even if bitten, I won't die."I won't die."

3.3.Mentally rehearse appropriate, rational Mentally rehearse appropriate, rational responses to encounters. e.g. imagining responses to encounters. e.g. imagining encountering a dog and petting it.encountering a dog and petting it.

Ost and Westling(1995)CBT vs Applied Relaxation (Classical Conditioning)Both about equally effective.Both about equally effective.• Applied relaxation: Applied relaxation:

– 65% panic-free patients65% panic-free patients– 82% panic-free after one year. 82% panic-free after one year.

• CBT: CBT: – 74% panic-free patients after the treatment74% panic-free patients after the treatment– 89% panic-free after a year. 89% panic-free after a year.

These differences were not significant. These differences were not significant. Complications such as generalised anxiety and depression were also reduced to Complications such as generalised anxiety and depression were also reduced to

within the normal range after one year. within the normal range after one year.

• Maybe the relaxation group had Maybe the relaxation group had acquired altered thoughts about the acquired altered thoughts about the object of fear due to object of fear due to

Biological Explanations• Ost 1992Ost 1992• 62% of people with a blood and injection 62% of people with a blood and injection

phobia reported a 1st-degree relative who phobia reported a 1st-degree relative who shares the same disorder. shares the same disorder.

• The prevalence rate for the general The prevalence rate for the general population is just 3%population is just 3%

How could you argue against the How could you argue against the difference in statistics being purely difference in statistics being purely genetic?genetic?

Preparedness Theory based in Evolution• Seligman (1971) suggested that there was a Seligman (1971) suggested that there was a

‘‘preparednesspreparedness’’ (a physiological (a physiological predisposition) to be sensitive to certain predisposition) to be sensitive to certain stimuli. stimuli.

• It is not the fears themselves that are It is not the fears themselves that are inborn, rather there is an innate (in-born) inborn, rather there is an innate (in-born) tendency to rapidly acquire a phobia to tendency to rapidly acquire a phobia to potentially harmful events potentially harmful events –– we are we are biologically prepared from birth.biologically prepared from birth.

Evidence for preparedness(Ohman et al 1975)• AIM Conducted a series of studies to investigate the preparedness AIM Conducted a series of studies to investigate the preparedness

explanation of phobia acquisitionexplanation of phobia acquisition• METHOD Participants were shown pictures of houses, snakes, spiders METHOD Participants were shown pictures of houses, snakes, spiders

and faces of people. Half the participants received an electric shock and faces of people. Half the participants received an electric shock whenever they were presented with a picture of a house or a face. The whenever they were presented with a picture of a house or a face. The other half received an electric shock whenever they were presented other half received an electric shock whenever they were presented with a picture of a snake or spider.with a picture of a snake or spider.

• RESULTS Both groups of PpRESULTS Both groups of Pp’’s showed fear when subsequently shown s showed fear when subsequently shown pictures they had experienced with an electric shock. This was pictures they had experienced with an electric shock. This was measured by their skin reaction called galvanic skin response (GSR). measured by their skin reaction called galvanic skin response (GSR). Following a period in which PpFollowing a period in which Pp’’s received no electric shocks it was s received no electric shocks it was found that the GSR was higher for those shocked when shown snakes found that the GSR was higher for those shocked when shown snakes and spiders.and spiders.

• CONCLUSION Human beings may be more biologically prepared or CONCLUSION Human beings may be more biologically prepared or ready to develop phobias for animals such as snakes and spiders, which ready to develop phobias for animals such as snakes and spiders, which may threaten survival.may threaten survival.

Preparedness• Preparedness weds biological and Preparedness weds biological and

behavioral ideasbehavioral ideas

• We are genetically programmed to We are genetically programmed to develop classically conditioned phobias develop classically conditioned phobias more rapidly to certain objects!more rapidly to certain objects!

Biological Treatments• Actually, the applied tension technique Actually, the applied tension technique

can be seen as a biological treatment can be seen as a biological treatment since you are overcoming the fear since you are overcoming the fear through behaviorally induced biological through behaviorally induced biological change--increased BP followed by change--increased BP followed by relaxation.relaxation.

Biological Treatments• D-Cycloserine, when used in conjunction with D-Cycloserine, when used in conjunction with

exposure-based cognitive behavior therapy, exposure-based cognitive behavior therapy, helps with fear extinction in an array of helps with fear extinction in an array of anxiety- and stress-inducing disorders.anxiety- and stress-inducing disorders.– Ren, et al. (July 2013)Ren, et al. (July 2013)– Baker, et al (October 2012). Baker, et al (October 2012). – Hoffman & Stefan (2006). Hoffman & Stefan (2006).

D-Cycloserine Continued• D-Cycloserine is an antibiotic used to D-Cycloserine is an antibiotic used to

treat tuberculosis. However it also has treat tuberculosis. However it also has psychotropic effects.psychotropic effects.

D-Cycloserine Continued

• How it works:How it works:

It partially blocks glutamate from stimulating the It partially blocks glutamate from stimulating the amygdala, a part of the brain required for negative amygdala, a part of the brain required for negative emotions such as panic and fear.emotions such as panic and fear.

It augments (added to and improves) exposure It augments (added to and improves) exposure therapy with better results than exposure alone. therapy with better results than exposure alone.

Biological Treatments• SSRI's can be helpfulSSRI's can be helpful– These block serotonin reuptake sites, allowing These block serotonin reuptake sites, allowing

more serotonin to reach the dendrites of the more serotonin to reach the dendrites of the next neuron. Serotonin is beleived to increase next neuron. Serotonin is beleived to increase a sense of well being and may regulate other a sense of well being and may regulate other neurotransmitter systems. People aren't really neurotransmitter systems. People aren't really sure how SSRI's work.sure how SSRI's work.

– Have side effects: loss of libido and ability, Have side effects: loss of libido and ability, appetite and sleep changes, headache, appetite and sleep changes, headache, dizziness, most importantly,dizziness, most importantly, suicidality suicidality

Biological Treatments• BenzodiazepinesBenzodiazepines (Xanax, Valium and MANY more) (Xanax, Valium and MANY more)

– How they work: These drugs work by binding to How they work: These drugs work by binding to GABA type A receptors. After binding, they allow GABA type A receptors. After binding, they allow more GABA to enter the neurons. more GABA to enter the neurons.

– GABA is a neurotransmitter. GABA is like the GABA is a neurotransmitter. GABA is like the breaks of the brain, it inhibits neuronal activity. breaks of the brain, it inhibits neuronal activity. Panic requires a lot of neural activity in the Panic requires a lot of neural activity in the amygdala and other brain areas. Thus, panic and amygdala and other brain areas. Thus, panic and fear are reduced. fear are reduced.

Benzodiazepines Continued• Benzodiazepines have some negative Benzodiazepines have some negative

side-effects and are recommended for side-effects and are recommended for short term use only.short term use only.

– Addictive (This is the main problem)Addictive (This is the main problem)– Negatively effects cognitive abilityNegatively effects cognitive ability– Tendon and ligament damageTendon and ligament damage