Phobic disorders

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What is the DSM?
Diagnostical statistical manual used to diagnose phobias
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What are the 7 characteristics of phobias?
1. Marked or persistent fear. 2. Exposure to phobic stimulus causes anxiety. 3. Person recognises fear is unreasonable. 4.phobic situation is avoided. 5.anxiety interfers with normal routine 6.under 18s 6months 7.not better accounted for by illness
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What category do phobic disorders fall into?
Anxiety disorders
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What is the difference between phobias and anxiety disorders?
The anxiety symptoms that occur with phobias only happen in response to the phobic situation or stimuli
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What are the three types of phobic disorders?
Agoraphobia, social phobia and specific phobias
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What is agoraphobia?
A fear of being in situations where it is difficult to escape
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What is social phobia?
A phobia of situations involving other people
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What is specific phobia?
A fear of specific objects or activities
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What are the two issues in phobia diagnosis?
Reliability and validity
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What is reliability?
The extent to which a diagnostic system produces consistent or accurate findings
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How does reliabilty link to phobia diagnosis?
The consistency of the measuring instrument to assess how fearful someone is of an object/situation
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What would make phobia diagnosis reliable?
If two or more persons arrived at the same conclusion about a persons phobia.
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How can we use inter-rather reliabilty to assess phobias?
The extent to which two or more diagnosticians would arrive at the same conclusions about the same individuals phobia
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What did brown (2001) identify?
3 factors that make diagnosis of phobias unreliable. 1. Threshold issue 2. Patients symptom report 3. Interviewer error
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How can we apply test retest to phobias to increase reliability?
We could test the patient at regular intervals to see if the phobia remains consant over time.
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Who suggests reliability is an issue for phobia diagnosis and classification?
KENDLER et al(1999) found low reliability when using test retest for diagnosis. Face and telephone interviews used. Reliability decreased over 8years
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Who conflicts KENDLER et al(1999) research
Brown et al (2001) found reliability in inter rather reliability was excellent for phobias. Inter rather was much higher than other disorders. Due to ease of diagnosis
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How could reliabilty be improved in phobia diagnosis?
Use of computerised scales for assessing disorders.
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What did kobackk et al(1993) suggest?
Increased reliability occurs because administrator effects are less likely
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How could computerised systems reduce validity?
Heimberg et al(1999) suggests validity can be reduced as clinicians play important role in disclosure of troubling information
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How does validity apply to phobias?
The extent to phobic diagnostic systems reflecting the true nature of the problem; the prognosis and the extent of treatments being sucessfull
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Is validity possible in the absence of reliability?
No
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What is descriptive validity?
To be valid patients diagnosed with different disorders should differ from each other.
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What is comorbidity?
The extent to which two or more conditions occur together at the same time.
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How does comorbidity reduce descriptive validity?
When patients have 2 or more disorders simultaneously it suggests the disorders are not separate from each other.
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How does comobidity affect validity of phobia diagnosis?
It suggests an overlap of phobias making it hard to distinguish between the disorders. As a result we can't assume phobics have equally sever symptoms..
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What is predictive validity?
If a diagnosis lead to successful treatment the diagnosis is seen as valid.
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How does predictive validity affect phobias?
If we can predict the eventual outcomes from the diagnosis of a phobia it is said to have high predictive validity.
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How does Eysenck (1997) show phobia diagnosis has low descriptive validity due to high comorbidity?
He reported that 66% of patients with one anxiety disorder are also diagnosed with another anxiety disorder.
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What further research suggests validity is an issue in diagnosis?
Vases and dadds(2001) tested the predictive validity of anxiety disorders finding few differences in treatment outcomes for the different subgroups
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What evidence suggests that predictive validity for phobias is high?
As we are able to predict which phobic disorders are easiest to recover from.
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How does Ost (1989) support this?
Used one session exposure exposure to specific phobias feared stimuli. He reported 90% of the patients obtained a clinically significant improvement which was ain't aimed for an average of 4 years
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What is another issue of phobia diagnosis?
It doesn't account for cultural differences. Taijin-Kyofusho(TKS) is recognised in Japan where an divide all has a fear of embarrassing others high is not recognised in the uk.
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What are the two types of twins?
Monozygotic (MZ) and Dizygotic(DZ)
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How do we know if phobias are genetic?
If concordance rate for MZ twins is 100% and DZ twins is 50%
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What suggests that phobias have a genetic influence?
If MZ twins have a higher concordance rate than DZ twins.
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What suggests phobias are caused by the environment?
If MZ twins have a concordance rate significantly less than 100%.
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What do similar concordance rates between MZ and DZ twins suggest?
It is unlikely genes play much of a role and the environment is more likely to cause phobic disorders.
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How does Togerson (1983) provide evidence from twin studies to support a genetic component to phobic disorders?
He examined the incidence of panic disorders and aggoraphobia in MZ and DZ twin were at least one twin had the disorder. MZ twins had a rate of 31% and DZ twins 0%
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Who suggests that there isn't a genetic component to phobic disorders?
KENDLER et al(1992) interviewed 722 female twins with a history of agoraphobia and found MZ twins had significantly lower concordance rate than dz twins.
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What is an issue with twin studies evidence?
KENDLER et l estimated a 67% heir ability for agoraphobia and one 47% for
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Who suggested the theory of preparedness?
Selligman (1970)
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What does preparedness suggest?
Individuals biologically learn to associate life threatening stimuli with a flight response.
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Why does this suggest about phobias?
That they have been inherited from our ancestors which adapted the flight response to activate in the presence of a harmful stimuli.
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Why would this have been an evolutionary advantage?
As survival would have been more likely
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How does seligmans theory differ from conditioning?
Because it suggest we inherit the flight response from our ancestors, that used it to urvive in the presence of harmful stimuli rather than it being learnt.
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Who supports supporting evidence for the theory of preparedness?
Ohman et al (1975) used electric shocks to see if a fear of snake could be more easily conditioned than faces or houses. It was much easier to create a fear of snakes suggesting a biological prepardness to fear these things
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What alternative theory can be applied to phobias?
Expectancy bias, Davey et al(1995) suggests we have a an expectation of fear provoking stimuli to cause negative consequences
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What does the adrenergic theory suggest?
We inherit a genetic over sensitivity of the sympathetic nervous system putting us at higher risk of developing phobias.
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What does this theory propose?
That those who develop phobias show high levels of arousal in the autonomic nervous system which leads to high levels of adrenaline thus causing anxiety
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What does it suggest about people who inherit over sensitivity to phobias?
That they respond to normal situations with abnormal levels of anxiety, once a person has experienced a panic attack it creates further anxiety of it happening again in the future.
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What did Lacey (1967) identify?
A dimensions of autonomic activity labelled stability-liability.
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What does he suggest about those on the liable end?
That they have particularly edgy and jumpy autonomic system which reacts to a range of stimuli. Thought to be influenced b genetics.
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What evidence supports the adrenergic theory?
The use of beta blockers has been successful in treating phobias as they reduce the anxiety that a phobia causes. They do this by blocking the activity of the adrenergic system. However this may only be treating the cause and not the effect
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What is the diathesis stress model?
A model that proposes that people who are biologicall vulnerable to developing phobias may be more likely to develop it if they are subjected o certain environmental stressors.
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What is this approach more accurate?
It both biological and environmental factors.
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What drugs are used in the treatment of phobias?
Anti depressants and anti anxiety medication
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What antidepressants are used to treat phobic disorders?
Mono amine oxidase inhibitors(MAOI)
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How are antidepressants thought to treat phobias?
Thought to help social phobia and agoraphobia as both of these phobias often have depressive symptoms as well.
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How do monoamine oxidase inhibitors reduce depressive symptoms?
By increasing the level of seratonin in the brain. Seratonin is a neurotransmitter in the brain associated with mood. They make noradrenaline and seratonin stay in the synapse longer boosting its affect.
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How do MAOI's work?
By inhibiting the production of monoamine oxidase which naturally controls seratonin levels in the brain
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How do antidepressants link to phobic disorders?
They reduce the depressive are often linked to social phobias and aurora phobias making people more able to get other treatment as well as this antidepressant control noradrenaline levels which helps to reduce the anxiety phobias cause.
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Why are drug therapies not very helpful for treating specific phobias?
Individuals with specific phobia only really have the anxiety related feelings when presented with the phobic stimulus therefore don't need drugs to calm them all the time. It is seen as less serious condition and behavioural therapy is very effectiv
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What are palliative treatments?
Treatments that only treat the effect of the condition and not the cause.
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What are curative treatments?
Cures the cause of the condition so symptoms do not re occur.
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In terms of treatment what is effectiveness?
Whether the treatment works and successfully treats the phobia
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In terms of treatment what is appropriateness?
Whether or not the treatment should be used to treat the phobia
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Who supports the effectiveness off MAOI antidepressants?
Heimberg (1998) compared phenelzine and CBT and found phenelzines beneficial elect started working much faster. However they were both the same for treating symptoms by the end of the study.
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Who suggests that antidepressants are less effective than other therapies?
Liebowitz(1999) followed up heimberg's patients for 6months after the end o their treatment. No one who had CBT had a relapse where as 33% of the people receiving drug therapy did.
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What other drugs are used to treat phobias?
Beta blockers
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What type of phobias are beta blockers used for?
Social phobias
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Why are beta blockers used for phobic disorders?
They reduce symptoms within an hour and a half. They work directly on the nervous system by reducing heart rate and lowering blood pressure.
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How do beta blockers work?
Reduce the activity of adrenaline and noradrenaline which is part of the sympathomedullary response to stress.
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What do beta blockers bind to?
Receptors cells on the heart which are stimulated during arousal. This makes the cells harder to stimulate making the heart beat lower decreasing blood pressure. This makes the person calmer.
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How do beta blockers treat phobias?
They reduce the anxiety that occurs when in the presence of the phobic stimulus or situation.
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What is a placebo?
A medicine that treats psychological being rather than the real symptoms.
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What did Kindt et al (2009) find?
Conditioned people to have a fear of spiders using electric shocks and then gave half beta blockers and half a placebo. The group given beta blockers showed reduced fear as the placebo group did not.
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What is the problem with Kindt et al(2009) study?
It has ethical issues as participates were not fully informed of the aims of the study and most participants did not get told which condition they were n so could have been exposed to unnecessary side affects.
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How effective are beta blockers?
Only treat the effects of the phobic disorders and therefore if treatment is stopped symptoms reoccur.
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How appropriate are beta blockers?
When used along side psychological therapies drugs are effective. However they do not treat all phobias and do not help specific phobics but can help social phobic become open to curative treatments.
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What does the behavioural explanation suggest about phobias?
That phobias are learnt through condition. It is the most likely explanation as it offers a clear description on phobia development.
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What is classical conditioning?
The pairing of a neutral stimulus with a negative situation learning by association.
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What is a neutral stimulus?
A stimulus which initially produce no specific behavioural response
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What is an unconditioned stimulus?
A stimulus that is responded to instinctively (it is innate)
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What is a conditioned stimulus?
A formerly neutral stimulus that after association with an unconditioned stimulus comes to produce a conditioned response.
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What is an unconditioned response?
An unlearned response that occurs naturally in response to an unconditioned stimulus.
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What is a conditioned response?
The learned response to a previously neutral stimulus.
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What does this explanation suggest about phobia development?
That a neutral stimulus will be associated with and unconditioned response of pain, anxiety or fear making the person believe that every time the see the neutral stimulus something bad will happen, or the will experience pain fear or anxiety.
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What is operant conditioning?
Conditioning that maintains the phobia through negative reinforcements
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What did mowrer (1947) propose?
That phobias are acquired in a two process theory
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What is the firs stage?
The classical conditioning of a neutral stimulus
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What is the second stage?
Operant conditioning maintains the negative association by negative reinforcement. For example someone who is afraid of dogs crosses thee road when she sees a dog relieving her anxiety and negatively reinforcing her phobia.
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What evidence supports the classical conditioning explanation?
Watson and Ranyner(1920) conditioned baby Albert to be fearful of rats as every time a white rat approached him a loud bell would be struck behind his head. Albert then associated fear with white rats becoming afraid of the animal.
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What evidence conflicts Watson and Rayners(1920) study?
Bregman(1934) failed to condition a fear response in infants aged 8-16months by pairing a loud bell with wooden blocks
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What alternative approach could explain Watson and Rayners findings?
Seligmans concept of biological preparedness, suggesting fear response are only learned in face of particular stimuli that would have been a threat in the EEA
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What evidence contradicts conditioning of phobias?
DiNardo(1988) found 50% o dog phobic became anxious in the presence of a dog, however 50% of healthy individuals also became anxious when encountering a dog
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What alternative explanation coul explain DiNardo(1988)'s research?
The diathesis stress model which would suggest that onl those with genetic vulnerability would develop a dog phobia after a frightening encounter with a dog.
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What does the gognitive behavioural explanations of phobias suggest?
That phobias develop due to faulty thinking. The faulty thinking process are linked to a focus on negative stimuli and negative events related to the phobic situation
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What does beck(1963) suggest?
That irrational and dysfunctional beliefs contribute to a phobia development.
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What does becks propose?
That phobias are because people become afraid of situations where fears may occur.
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What is a cognitive error in logic?
When a person who suffers from a phobia wrongly believes that every time they encounter the situation or object they are afraid of something bad will happen to them.
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What maintains a phobia once it is acquired?
Cognitive rehearsal of fear where people think about the phobic stimulus in its absence and all the possible dreadful outcomes.
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What evidence supports phobics having dysfunctional assumptions?
Gournay(1989) found phobics were more likely than normal people to overestimate risks making them generally more fearful.
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How does Liebowitz (1999) provide further supporting evidence?
He followed up Haimberg(1998) patients and found that none of the phobics who had CBT relapsed which shows that changing the dysfunctional assumptions remove a phobia.
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What two psychological therapies can be used to treat phobias?
Systematic desensitisation and cognitive behavioural therapy
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Who devised systematic desensitisation?
Joseph Wolp(1958)
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What is SD based on?
Classical conditioning
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What do behavioural therapist suggest about SD?
That maladaptive behaviour can be unlearnt and replaced with new more desirable behaviours.
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What is the basic idea of SD?
To gradually expose a phobia suffere to the object of their phobia to reduce their anxiety,
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What is vitro desensitisation?
Where clients receiving SD imagine themselves in the fearful situation
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What is Vivo desensitisation?
Where clients recieving SD is put in the presence of actual objects that are feared
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What is the first stage of systematic desensitisation?
Relaxation techniques, such as breathing exercise and muscle control are learnt. Patients learnt to use deep muscle relaxation which prepares them for the next stages of treatment. These skills are learnt to be used to react to anxious situations.
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What is the next stage of SD?
To construct and establish a fear hierarchy, with help from their therapist patients create a set of situations provoking anxiety responses ranging from mild to extreme.
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What is stage 3 of SD?
The client will start with the least anxiet provoking situation by imagining themselves in the situation, when no fear is experienced from the imagination they can then move up the hierarchy.
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What is the final stage of SD?
After the hierarchy has been imagined in a number of sessions, the therapy will progress to physically experiencing these situations sung relaxation techniques to reduce anxiety.
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When is the client regarded as cured?
When they can confront the most feared object on the hierarchy without any fear
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How does counter conditioning work?
A process whereby a fearful reaction is replaced by another emotional response incompatible with fear.
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What evidence supports SD's effectiveness?
McGrath et al(1990) found SD had successfully treated 75% of phobics who had used this therapy.
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What further evidence supports treatment was effective after time?
Denholtz(1978) found 60% of clients who had SD continued to fly for a 3.5year follow up period.
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Who contradicts the effectiveness of SD?
Capafons(1998) used 41 aero phobics. 21 were assigned to a waiting group and the others received SD immediately. Those being treated showed lower levels of fear and lower physiological signs of fear. 1 person recovered spontaneously and 2 had no effe
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How appropriate is SD?
It is quick and effective allowing people to get on with their lives. Hellstrom(1996) demonstrated improvement can occur after a single 3hour session
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What is a weakness of SD?
In vivodesensitisation is not always appropriate due to the amount of stress and anxiety involved. Is continuation can do more harm than good as it can further reinforce a phobia
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What phobia is cognitive behavioural therapy most often used for?
Social phobia
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What is CBT?
A combination of behavioural therapy and cognitive restructuring.
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What is the aim of CBT?
To help phobics identify irrational and maladaptive thoughts towards the feared stimulus and replace the with positive adaptive way of thinking
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What techniques can therapist use with their patients?
Cognitive restructuring and cognitive rehearsal
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What is cognitive restructuring?
Review of irrational beliefs and expectations to develop more rational strategies to cope with the anxiety associated with their phobia.
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What is cognitive rehearsal?
Allowing clients to rehearse adaptive approaches to difficult situations which is particularly useful when the fear is not easily stimulated in a clinical setting
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What s CBT based on?
The idea that phobias arise from and are maintained by irrational beliefs about the phobic stimulus and CBT then challenges these beliefs.
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What cognitive processes did Davey(1999) identify to cope and downplay a phobics fears?
Threat devaluation, denial and cognitive disengagement.
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Who shows CBT to be an effective treatment for phobics?
Liebowits(1999) followed up heimberg's(1998) patients who had been treated with drug therapy or CBT and found 33% of the patients on drug therapy relapsed where as no one who received CBT relapsed.
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What type of treatment does CBT offer?
A curative treatment making it more effective than drug treatments that are palliative.
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How appropriate is CBT?
CBT addresses the cause of the phobia and not just the anxiety symptoms that occur with it. CBT allows patients to adapt to their fears in everyday life
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Why is CBT not always appropriate?
It requires much commitment from the patient with sessions and follow ups that can go on for up to a year. A suffere has to ask themselves before treatment if they have the motivation to stick to the treatment.
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What is the best treatment of phobias?
A combined approach of biological therapies which reduce the anxiety of the phobia while psychotherapy gets the the cause of the phobia. Some phobics cannot attend therapy due to sever anxiety so drugs reduce this so they become open to other treatme
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Card 2

Front

What are the 7 characteristics of phobias?

Back

1. Marked or persistent fear. 2. Exposure to phobic stimulus causes anxiety. 3. Person recognises fear is unreasonable. 4.phobic situation is avoided. 5.anxiety interfers with normal routine 6.under 18s 6months 7.not better accounted for by illness

Card 3

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What category do phobic disorders fall into?

Back

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Card 4

Front

What is the difference between phobias and anxiety disorders?

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Card 5

Front

What are the three types of phobic disorders?

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