- Phobia = a persistent fear leading to great anxiety that is excessive, unreasonable and irrational.
- Usually occurs when a person's fear has a specific focus, e.g. animal / situation / object.
Types of Phobia
- Simple/Specific Phobia = presence of specific object or situation causes fear.
- Social Phobia = fear of being scrutinised by / exposed to unfamiliar people.
- Agoraphobia = anxiety of situations which person believes are dangerous/uncomfortable - e.g. crowdedness or vast openness.
- Person knows fear is irrational but can't do anything about it.
- Phobia can be kept under control if feared stimulus avoided --> will do anything to avoid
- Avoidance can lead to difficult and long-term problems by reinforcing phobia.
- Phobias are extremely common.
- Experienced by a lot more women than men.
- deGraaf et al (2002) - women at least 2x more likely to develop phobia
- High comorbidity - if someone has one specific phobia its likely they will also have another.
- Are women just more likely to share phobias/report symptoms?
- Phobias present in all cultures but differ greatly due to different attitudes --> different DSM criteria.
- Hettema et al (2003) - 20-40% heritability from twin studies.
- Kendler et al (2001) - family member with phobia = increased chance of developing phobia.
- Fear Circuit
- Malizia (2003) set of brain structures tend to be activated when people are feeling anxious or fearful.
- Amygdala - critical for conditioning fear in animals - sends signals to hypothalamus,thalamus, hippocampus etc.
- Medial Frontal Cortex -Shin et al (2003) - people who meet criteria for anxiety disorders show less activity.
- Deficits in MFC may disrupt functioning of amygdala = increased emotional responses.
- Nervous System (Sympathetic) - overactive in some individuals? - primed and ready for action in response to minor fear?
- Serotonin - poor functioning in anxiety disorder sufferers (Chang et al, 2003)
- NA - high levels linked to anxiety disorders (Chang et al, 2003)
- GABA - dysfunction in neurons producing GABA = less GABA anxiety.
Classical Conditioning (Cause)
- A neutral event is paired with a traumatic event resulting in fear.
- Leads to the neutral event causing fear on its own.
- E.g. Little Albert and the white rats.
- Classical conditioning causes/initiates a phobia.
- A single event may be enough to produce fear
- Yule et al (2010) - surviving sinking ship = fear of water and boats.
Operant Conditioning (Maintenance)
- Once learnt the feared neutral stimulus is avoided.
- Avoidance reinforced by a reduction in anxiety.
- Phobias are maintained by this constant reinforcement from avoidance.
- Avoidance gives short-term relief but long-term can lead to increase in physical symptoms and use of safety behaviours.
- Not everyone with phobia can recall a traumatic event.
- Not everyone that experiences a traumatic event develops a phobia.(Rachman, 1977; Marks, 1977).
Observational Learning Aetiology
Modelling (Bandura, 1966)
- Observe someone being fearful or hear negative feedback about something = more likely to be fearful yourself.
- Overprotective parents make child think the world is dangerous = anxious child.
- Muris (1996) - mothers responses influence childhren.
- Davey et al (1993) - claimed it is people's reactions after an event which are important e.g. negative reaction after seeing a spider = more likely to instill fear in observers.
- BUT! - behavioural/learning view suggests all things equally likely to be phobic.
- why are certain objects/situations more likely to be reported as phobias than others?
Preparedness and Evolution Theory
- Seligman (1971) - born with innate predisposition to learn fear to some things more than others as they were real threats to ancestors.
- Poulton & Menzies (2002) - we are born wary of certain stimuli.
- LoBue et al (2011) claim fear is learnt in first years of life, not innate.
- Babies don't show fear but are more attentive to stimuli accompanied by a fearful voice.
- Raikson (2009) - female infants learn to associate negative face expressions to spider.
- Evolutionary sense for females to be more wary/fearful to protect selves and offspring?
- People develop phobias because think about/perceive world in different way.
- Phobias are caused by cognitive biases/maladaptive thinking.
- Phobics attend to threat-relevant material more than non-phobics.
- Williams et al (1996) - arachnophobics take longer to process spider related words.
- BUT! - as yet no evidence for cause and effect.
- Cognitive biases <===?===> phobias
- Freud --> phobia is the expression/projection of repressed unconscious conflicts.
- Case Study --> Little Hans' fear of horses caused by oedipus complex/fear of father.
- Phobias are a defence against the anxiety produced by repressed id drives.
- Ego uses defence mechanisms (displacement/projection) to transfer phobia to other object/event so it is easier to deal with/avoid.
- Behaviour is a product of learning, what can be learnt can be unlearned.
- Aim of treatment is to break the avoidance cycle.
- Clients must approach NOT avoid feared stimuli.
- If avoidance is prevented, person will realise situation is not dagerous.
1) Systematic Desensitisation - Joseph Wolpe (1958)
- Goal = to weaken association between neutral object and anxiety.
- Reconditioning takes place so neutral object associated with relaxation.
- 1) build anxiety hierarchy (lowest to highest fear)
- 2) Trained in deep muscle relaxation
- 3) Work through hierarchy until can face top (biggest fear) without anxiety.
2) Implosion Therapy and Flooding
- Expose client at outset to most fearful situation.
- Fear exhaustion takes place.
- Impossible to avoid thus avoidance is no longer rewarding.
- Implosion = takes place in client's mind.
- Flooding = takes place in real life situation.
Efficacy of Behavioural Treatments
- Works better than insight therapies for treating phobias.
- Good for those who can learn relaxation.
- Best for people with a good imagination.
- Difficulty transferring to real life from imagination?
- Cost of facing phobias in real life e.g. fear of flying?
Implosion and Flooding
- Marks (1981) - 80% effective.
- Ost (1996) - can be effective after just 3 hours.
- Ost (1996) - 70-90% still show improvement after one year.
- Less than 15% want flooding.
- 25% drop out
- Ethics and cost?
Virtual Flooding - 83% improvement (Garcia-Palacios, 2002) but not accessible to all therapists.
Observational Learning Treatment
- watch filmed or live models dealing calmly with a phobic situation.
- Client feels less anxiety when faced with the same stimulus
- Bandura & Menlove (1968)
- Important to note that behaviour and learning therapies are effective at altering overt behaviour but don't root out the underlying cause!
- Anti-anxiety drugs (minor tranquilisers)
- reduce anxiety, tension, nervousness etc.
- very common but can lead to dependency and side effects.
- Side effects include addiction, lethargy and rebound anxiety.
- Cortisol treatment
- hormone makes people forget what they are scared of, can't retrieve memory.
- Helps form new memories and overwrite old ones.
- Lydiard et al (1996)
- Temporary effects, the effects wear off if the medication/treatment stops.
- How long will the drugs have to be taken? - for rest of life?
- Drugs may cause addiction and dependency as use must be continued for benefits to be seen.
Psychotherapy and Cognitive Therapy
- Phobias are caused by underlying conflicts.
- Conflicts must be brought to the surface in order to be dealt with in light of adult reality.
- Dream Analysis and Free Association used.
- BUT! - these methods have less evidence of success with phobias.
- Little point changing thoughts as person knows fear is irrational.
- Can try to alter beliefs/cognitive biases if faulty or present.
- Help individual reappraise the situation and realise there is no danger
- Help realise that feeling of danger is due to faulty thoughts.
INTEGRATION OF THERAPIES IS NEEDED FOR MAXIMUM EFFECTIVENESS! - E.G. COMBINE DRUG TREATMENTS WITH ANY OTHER THERAPIES WHICH WORK
- Not all therapies will work for everyone, is a case of finding which is most effective.