Phobias Revision (Diagnosis, Causes, Treatments)


Phobias Description

  • 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.
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  • 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.
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Biological Aetiology

  • Genetics
    • 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?
  • Neurotransmitters
    • 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.

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Behavioural Aetiology

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).
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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?
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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?
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Cognitive Aetiology

  • 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
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Psychodynamic Aetiology

  • 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. 
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Behavioural Therapies

  • 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.
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Efficacy of Behavioural Treatments

Systematic Desensitisation

  • Works better than insight therapies for treating phobias. 
  • Good for those who can learn relaxation.
  • Best for people with a good imagination.
  • BUT!
  • 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.
  • BUT!
  • Less than 15% want flooding.
  • 25% drop out
  • Ethics and cost?

Virtual Flooding - 83% improvement (Garcia-Palacios, 2002) but not accessible to all therapists.

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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!
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Biomedical Treatments

  • 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.
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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. 

Cognitive Therapy

  • 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. 


  • Not all therapies will work for everyone, is a case of finding which is most effective.
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