Phobias

Answers to potential exam questions. Includes clincial characteristics, issues with diagnosis, biological explanations, psychological (behavioural and psychodynamic) explanations, biological therapies and some psychological therapies. 

fairly boring layout but covers most info. evaluation is italic :3

**I intend to add more psychological therapies and the cognitive explanation soon :)

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  • Created by: Beth
  • Created on: 13-01-13 19:52
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Phobias!
3 main types of phobias:
1.Speci
fi
c phobi
a (
fear
of
a
parti
cul
ar obj
ect
/si
tuat
ion)
2.Soci
al
phobia
(f
ear
of
social
/publ
ic
gather
ings)
3.Agor
ap hobi
a (
fear
when away f
rom home)
Outline clinical characteristics of phobic disorders:
Cert
ain
mild f
ears
o f
a
spider
for
examp l
e ar
e
quit
e norma l
amongst some cul
tures,
however
i
f
some one i
s t
o be cl
i
n i
cal
ly
diagnosed wit
h a phobi
a
they
mu st
me et
t
h e
fol
lowing
cri
teri
a.
There
mu st
be a
ma rked
a nd
persist
ent
fear
out
o f
al
l
proport
ion
to t
he actual
danger
posed
by
the
sit
u at
ion,
t
h e
suff
erer
w oul
d
experi
ence an i
mme di
ate
pan i
c at
tack
or anxi
ety
w hen
f
aced wit
h thei
r
fear
sti
mu l
us,
the suf
ferer
mu st
t
hems elves
recogni
se
that
t
h ei
r
fear
is
excessi
ve and unr
e asonabl
e. Furt
her
they
mu st
recognise
that
thei
r
reacti
on
is
beyond
vol
untary
contr
o l
.
The suff
erer
w i
l
l
tend t
o avoi
d
the
ph obi
c si
tuat
ions,
for
examp l
e,
an
agor
a phobi
c wil
l
not go
out
a nd
thi
s avoi
dan ce
w i
ll
i
nter
fere
signi
fi
cantl
y wit
h thei
r
norma l
r
outi
ne
(FFA).
If
an i
ndivi
dual
is
und er
18,
t
he
durati
on of
thei
r
ph obi
a mu st
l
ast
at
least
6
months
b ef
ore a
diagnosis
is
ma de (
accordi
ng
to
the DSM I
V onl
y).
S ymptoms
w i
l
l
incl
ude
i
ncreased ar
o usal
,
possibl
e bl
u shi
ng and
trembli
ng
and breat
hing pr
oblems .
Discuss issues surrounding the classification and diagnosis of phobic disorders:
One i
ssue
rel
ated
to
d i
agnosis
is
rel
iabi
li
ty.
Reli
abi
li
ty
ref
ers
to
the
consi
stency
of
a
measuri
ng i
nst
rume nt
such
as t
he
SC I
D 1,
a
semi st
ruct
ured
int
ervi
ew used
in
the
diagnosi
s
of
phobi
as.
Reli
abi
li
ty
ca n
be mea sur
ed i
n t
e r
ms
of
w het
her
two i
ndependent
assessor
s gi
ve
si
mil
ar
scores
(i
nter
rat
er r
eli
abil
i
ty).
There is research evidence that suggests that SCID1 has high reliability. Skyre et al 1991
assessed interrater reliability for diagnosing social phobia by asking three clinicians to
assess over 50 patient interviews obtained using SCID1. There was a high interrater
agreement of +.72 showing that the diagnosis of phobias is reliable. This may be the case
because using SCID required extensive training.
In contrast Kendler et al 1999 did not find that the reliability for diagnosing phobias was
always high. Kendler used face to face and telephone interviews to assess individuals with
phobias and found low reliability over time (test retest). They suggest this may be because of
poor recall by participants of their fears, for example people tend to over exaggerate fears
when recalling previous distress. Also low reliability might be because some clinicians decide
that the severity of a symptom exceeds the clinical threshold whereas others do not.
A
second i
ssue i
s val
idi
ty
w hi
ch
concerns
both
classi
fi
cat
ion
and di
agnosis.
For
exampl
e
t
here
is
the
issue
of
como rbi
dit
y whi
ch i
s t
he ext
ent
that
t
w o
or
mo r
e condi
ti
ons cooccur
(
such as
phobias
and depressi
on).
Fur
ther
social
and
agoraphobi
a can
co occur
whi
ch
makes i
t
dif
fi
cul
t
to
identi
fy
the
pri
ma r
y di
sorder
for
t
reat
me nt
pur
poses.
Some research has found evidence of comorbidity in phobic disorders. For example Kendler
et al 1993 reported high levels of comorbidity between social phobias, animal phobias and

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Page 2

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This questions the validity of different kinds of phobias as
a separate disorder.
This is further supported by research by Eysenck. Up to 66% of patients with one anxiety
disorder are also diagnosed with another anxiety disorder. The implications are that the
diagnosis should simply be `anxiety disorder' rather than phobia or obsessivecompulsive
disorder.
Validity may be increased using computer diagnosis. Computer diagnosis may be preferable
because the presence of another person can create fears of negative evaluation.…read more

Page 3

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Addi
ti
on al
t
heories
concern
do pamine
pathw ays
in
the
b r
ain
that
predi
spose some
peo pl
e t
o
be
mo re
readil
y condi
ti
oned so
they ar
e l
ikel
y t
o acquir
e phobias
mo r
e
easil
y,
thi
s di
athesi
s
s
tress
mo del
w i
l
l
predispose
an i
nd i
vi
dual
b ut
experi
ence wil
l
play
a r
ole
in
tri
ggeri
ng
such…read more

Page 4

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Exper
ienci
ng anxi
ety
after
an event
has happened
w oul
d not
be an
adap t
ive
response
t
heref
ore
animals
h ave
evolved a
response t
o pot
enti
al
threat
s.
This
is
call
ed pr
epotency
an d
r
efer
s t
o t
he t
end ency
to
respond
anxiousl
y t
o snake
li
ke moveme nt
f
or example
prepotency
woul
d be
coupled wi
th pr
ep ar
edn ess.…read more

Page 5

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The
b ehavi
oural
approach t
o phobia
acquisi
ti
on would
explai
n Hans'
phobia
in
those
terms.
The
h or
se (neut
ral
sti
mu l
us)
became associ
ated
w i
th
a l
oud noi
se (uncondi
ti
oned st
imulus)
.
The
U CS
produced an uncondi
ti
oned
response
of f
ear.…read more

Page 6

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BZ's have been shown to be effective. For example Kahn et al 1986 found that BZ's were
better than just using a placebo treatment, which suggests they have some pharmacological
value. Hildago et al 2001 found that BZ's had better results than SSRI's.
Bet
a
blocker
s (BB's)
reduce
a nxi
ety
by r
e duci
ng t
he act
ivi
ty
of
adrenali
ne (par
t
of
the
s
ymp atheti
c r
espo nse
to
stress)
.…read more

Page 7

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Therefore, not all drug treatments have the same limitation although it is probably desirable to
administer them alongside some psychological treatment.
An al
ter
n at
ive
biol
o gi
cal
me t
hod f
or t
he t
reatmen t
of
phobi
as i
s psychosurger
y.…read more

Page 8

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There are some limitations with SD. First of all symptom substitution may be a problem. Just
because a certain person stops feeling afraid of an object doesn't mean that their underlying
problem has disappeared. A further issue is that the SD may not work as well with prepared
fears i.e. those with an underlying evolutionary component (such as fear of spiders or the
dark) (Ohman et al 1975).…read more

Page 9

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Unlike other treatment however, it
does not attempt to divert thought processes nor form new associations, it attempts to
eradicate the fear permanently.…read more

Comments

MrsMacLean

a great essay that reads well. The A02 is really good. Thanks  

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