Psychopathology Phobias

Phobias are anxiety disorders which are  characterised by extreme irrational fears.

These irrational fears produce a conscious avoidance of the feared object or situation.

Avoidance: phobia sufferers often avoid situations which are known to trigger feelings of anxiety. e.g. a person with a fear of spiders avoids being near them, a person with a social phobia avoids being in situations with groups of people.

Freeze or faint: the stress response (fight, flight or freeze) could lead to people fleeing an anxiety provoking situation, or freezing to the spot. These responses have been adapted through evolution to enable our survival.

Fear: feelings of fear are persistent and can be excessive and frightening. Phobias prduce high levels of anxiety due to the presence of or anticipation of feared objecs and situations.

Anxiety and panic: phobias can provide an immediate, extreme response, even panic attacks due to the presence of the phobic object or situation.

Irrational thoughts: a defining characteristic of phobias is the irrational nature of the person's thinking and the resistance to rational arguments, e.g. a person with a fear of flying is not helped by evidence that it is statistically the safest form of travel.

Recognition of exaggerated anxiety: phobics are usually consciously aware that the anxiety levels experienced in relation to their feared object or situation are overstated.

Mowrer (1947) proposed the two-process model to explain how a phobia is acquired and maintained. This states that phobias are learned by classical conditioning (association) or social learning (observation/modelling) and they continue because of operant conditioning (reinforcement).

Acquisition - Classical Conditioning:

Classical conditioning is seen to explain why a phobia may start e.g. through association with a traumatic experience such as being bitten by a dog as a child.

Maintenance - Operant Conditioning:

The phobia is then maintained through positive reinforcement.

When an individual avoids a situation which is unpleasant, the behaviour results in a pleasant consequence, as we successfully escape the fear and anxiety that we would have suffered if we had entered its presence or remained there.

This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained.

In this case study a young boy was presented with a series of animals, each of which he shows no fear response to.

Applying classical conditioning:

Neutral stimulus = no fear of rats (before conditioning)

A loud bang (UCS) causes fear and anxiety (UCR) (before conditioning)

Rat (CS) and loud bang (UCS) together = fear (UCR) (during conditioning)

Rat (CS) = fear (CR) (evidence of conditioning)

+ Evidence to support the model: phobics often do recall a traumatic experience e.g. being bitten by a dog or having a panic attack in a social situation.

- Not all phobias can be linked to a specific experience, this could be that the don't remember the incident as they were too oung or have possibly repressed the experience. However Sue et al suggests that different phobias may have different processes, e.g. agoraphobics may suffer due to a specific experience (conditioning) but arachnophobics may hae observed others being fearful (SLT - modelling)

+ Real world applications: the use of behaviourist techniques to treat phobias (systematic desensitisation and flooding) are effective in treating many phobic sufferers.

- Phobias may have a biological cause: there are evolutionary factos that may inflence the development of phobias and the two process model ignores these. There are things that we have evolved to be afraid of to aid our survival, e.g. dangerious animals or the dark. Seligman calls these innate predisposition "biogical preparedness".

Cognitive aspects: phobias also involve eements in the form of irrational thoughts. This means that using behavioural explanations alone may not fully explain the disorder in all sufferers. Also this could mean that using a combination of cognitive and behavioural technques to treat patients, e.g. CBT may be more effective for some people.

The safety signals hypothesis: Rachman (1984) put forward to "safety signals hypothesis" arguint that some phobics are not motivated by a reduction in anxiety but by positive feelings  associated with safe places or routes.

This explains wy some agoraphobics can go to work following a known route or leave the house with friends or family members that they trust and feel safe with. This sugests that the deveopment and maintenance of phobias may be more complex than Mowrer's two process model proposes.

Aims to teach a patient to earn a more appropriate association and is designed to reduce an unwanted response, such as anxiety, to a stimulus.

Reciprocal inhibition is the process of inhibiting anxiety by substituting a competing response.

Wolpe (1958) argues that two competing emotions cannot occur at the same time so if fear is replaced with relaxation the fear cannot continue.

There are three processes involved in SD:

1. The anxiety hierarch is constructed by the patient and the therapist. This is a stepped approach to getting the person to face the object or situation of their phobia is from least to most frightening.

2. The patient is trained in relaxation technicques so that they can relax quickly and as deeply as possible. This could include breathing techniques, deep muscle reaxation or meditiation.

3. If the patient is then expoed to the public stimulus whilst practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.

This involves overwhelming the individual's senses with the item or situation that causes anxiety so that person realises that no harm will occur.

No relaxation techniques or step by step build up.

Individual is exposed repeatedly and in an intensive way with their phobia.

Indivudual has their senses fooded with thoughts, images and actual experiences of the object of their phobia.

Flooding stops phobic responses very quickly.

Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless - this process is called extinction.

A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten.)

The result is that the conditioned stimulus no longer produces the conditioned response (fear).

+ Supporting evidence: most effective with specific phobias when a particular phobic object/situation can be identified, e.g. bird phobia. Megrath et al (1990) found that about 75% of patients with phobias respond to SD.

+ Wolpe (1960) cured a girl of her phobia of cars. She was forced in a car and driven round for 4 hours until her hysteria was eradicated, demonstrating the effectiveness of this treatment.

+ Barlow (2001) argues that flooding and SD are seen to be equally effective, althought SD is usually more desirable as less traumatic for the patient.

- It is less effective for some types of phobia: flooding and SD can be less effective for treating more complex phobias like social phobias. This may be because social phobias have cognitive aspects - an individual does not simply have an anxiety response, but thinks unpleasant thoughts about the social situation, as such focusing on behavioural aspects alone may not effectively treat the patent.

- Survival instincts: Ohmen et al (1975) argues that some phobias are difficult to treat because they have an evolutionary basis to aid our survival, for example fear of the dark, or heights. This means that SD and flooding may be ineffective if it is going against our innate instincts.

+ It is suitable for a diverse range of patients: as this is a simple process that the patient controls, it is often the most suitable form of treatment. Due to the lack of thinking required, SD can even be used with young children, making a more appropriate  form of treatment than CBT or drugs.

+ It is acceptable to patients: when given the choice between SD and flooding, more often patients choose SD as it does not cause the same degree of trauma and actually invoves a pleasant aspect (the relaxation techniques). However, if chosen, flooding can be quick and very effective.

- Flooding is traumatic for patients: flooding produces high levels of fear and this can be very traumatic and as a result many patients refuse to start or complete treatment. Some people feel overwhelmed and this can cause further symptoms to develop.

- Symptom substitution: the behavioural treatments used treat the symptom, rather than the cause. This is because they are focusing on changing a person's behaviour, rather than why they are suffering with the phobia. This could lead to symptom substitution, where a different disorder starts in its place. This means that a person may be cured of their phobia but develop an anxiety disorder. Psychoanalytical theorists have criticised this approach for not considering the unconscious, repressed material that may be causing a phobia - think little Hans!