Phobiac Disorders - Topic Outline

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  • Created by: Becky
  • Created on: 03-05-15 17:40
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  • Phobias
    • Classification and Diagnosis
      • DSM-IV Criteria of Specific Phobia
        • Persistent and unreasonable fear of an object etc
        • Exposure to stimulus provokes and immediate anxiety response
        • Self awareness that fear is excessive (excl children)
        • Phobic situation avoided or endured with intense stress
        • Interferes with persons functioning
        • If under 18 years, a duration of at least 6 months
      • Specific, Social and Agoraphobia
      • Issues surrounding classification and diagnosis
        • Reliability
          • Inter-rater, Skyre et al:3 clinicians assesed 54 patient interviews using SCID-I (inter-rater was +0.72)
          • Test-retest, Hiller et al: Excellent diagnostic agreement in a test-retest study
          • Test-retest: Kendler et al: phone and in person interviews, found poor agreement over time.
          • Computer diagnosis: Less influence of the expert, but clicians may help share troubling information
        • Validity
          • Comorbidity: If >2 anxiety disorders occur, can't easily identify which one is primary
            • Kender et al: found high levels between social, animal phobias, generalised anxiety disorder...
          • Concurrent validity: Compares 1 method with another good pre-existing method
          • Construct validity: How well does the test measure the key behaviour of the phobia?
            • Beidel et al: found the SPAI correlates with beh. measures of social phobia & lack association with unrelated behaviours.
    • Explainations
      • Biological
        • Evolution
          • Preparedness: Seligman, fear of harmful animals provides an evolutionary advantage
            • Rhesus monkeys (Mineka et al): Found it easier to condition them to fear snakes if another monkey was also scared, but hard with a flower
          • Ohman & Soares found that p#s who were fearful of snakes/spiders showed greater response to masked images than neutral images (prepotent signals)
        • Vunerability
        • Genetics
          • Specific phobias (not social) seem to run in families to an extent (could be SLT)
            • Twin Studies Shields & Slater showed concordance rates MZ to be 49% but DZ was 4%
              • IF MZ twins have been raised separate then it strongly shows the genetic role in phobias.
      • Behavioural
        • Classical Conditioning
          • Little Albert developed the 'furry white' phobia... Explains why dog phobias happen after being bitten
            • Sue et al: Phobia causing event can usually be recalled, BUT not everyone has a traumatic event (DiNardo), biological preparedness can explain this
        • Operant Conditioning
          • Mowrer, classical is followed by operant.  The avoidance of the phobic stimulus reduces fear and no anxiety is experienced from avoidance
        • SLT (Bobo Doll)
          • Phobias may be through modelling.  Seeing a parent scared of spiders may lead to the same for the child
            • Explains how they're maintained and why they developed the phobia
    • Therapies
      • Behavioural
        • CBT (REBT (Ellis' ABC Model))
        • Systematic Desentisation
          • Feared stimulus is gradually introduced (counter-conditioning).  Hierarchy of stages, becoming more fearful.
            • STRENGTH Can be self-administered especially with social phobias (Humphrey).  Very appropriate for specific phobias.  McGrath, 75% of patients w/phobias responded.  Deals with avoidance & anxiety
              • WEAKNESS Reducionist, doesn't account for cognitive effects.  Barrera, p's with animal phobia were just as likely as control group to show avoidance.  Only treats the symptoms, not the cause, highly dependent on p's effort at home. Social skills aren't developed, they might decrease the effectiveness
      • Biological
        • BZ's
          • Treat the physical symptoms (anxiety) Slows activity of SNS
            • More effective than placebos and antidepressants in treating anxiety    BUT      Side effects: more agg, long term memory impairment.  Addictive (only used for ~4 weeks, not long term)
        • Beta Blockers
          • Reduce activity of nora+adrenaline, slower HR and BP, p feels calmer and less anxious
            • Few positive side effects.  Appear highly effective in research, Turner found no difference between BB and placebo (HR and BP etc)
        • Antidepressants (MAOIs & SSRIs
          • Increase serotonin levels.  MAOIs prevent its breakdown. SSRIs prevent reuptake.
            • SSRIs shown to reduce anxiety levels more than placebos.  Link w/SSRI's and suicide risk.  SSRIs take 4 weeks to effect, p#s may stop taking them.  MAOIs have a lot of -ive side effects (insomnia) and require a strict diet or can be lethal
        • Psychosurgery
          • Operations on the limbic system (region associated with emotions) to treat anxiety
            • Ruck et al, 26 p's w/anxiety disorders, significant reduction in anxiety post-surgery.  Irreversible.  Any lasting damage may leave p's with a poorer quality of life than before.  Unethical, last resort only

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