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F I I C C E P S P H O B I A Rosanna Scott.

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1 F I I C C E P S P H O B I A Rosanna Scott

2 DSM-5 Diagnostic Criteria
Marked fear/anxiety about specific object/situation. in children this fear/anxiety may be expressed by crying, tantrums, freezing, or clinging. Phobic object/situation almost always provokes immediate fear/anxiety. Phobic object/situation is out of proportion to actual danger it poses and to sociocultural context. Fear/anxiety/avoidance is persistent, typically lasting 6+ months.* Fear/anxiety/avoidance causes clinically significant distress/impairment in social, occupational, or other important areas of functioning. and The object or situation is called the phobic stimulus. *with the timeline criteria, it’s just a general guideline and allows for flexibility. McNally (1987) discusses “irrationality” in a more appropriate way, saying “Like a toothache, physiological fear responding is nonrational rather than irrational. Toothaches and racing hearts have causes, they do not have reasons” (p. 297). While patients may understand that their fear is excessive and thus irrational, they are unable to inhibit their fear responses when they’re exposed to the phobic stimuli.

3 The disturbance is not better explained by other mental disorder, including:
Agoraphobia Obsessions/OCD PTSD Separation Anxiety Disorder Social Anxiety Disorder Panic Disorder The response to the phobic stimuli must be intense or severe and must differ from normal, transient fears that commonly occur in the population. The amount of fear can depend on proximity to the stimulus, and can also take place in anticipation of the stimulus and in the presence of the stimulus. The fear or anxiety may take the form of a panic attack. Fear/anxiety must take place every time a person is exposed to the stimulus, although the severity of the fear/anxiety may vary. Active avoidance: person intentionally behaves in ways that are designed to prevent/minimize contact w/ phobic stimuli. -examples: taking a tunnel instead of a bridge on your way to work because of a fear of heights, avoiding entering a dark room for fear of spiders, not accepting a job in a place where the stimuli is more common. -these avoidance behaviors don’t have to be so obvious—for example, a person with a fear of snakes may avoid looking at pictures that resemble the form of snakes.

4 Specify it . . . Codes based on phobic stimulus. Differentiates b/w:
Animal Natural environment Blood-injection-injury Situational Other -Animal (e.g. spiders, insects, dogs). -Natural Environments (e.g. heights, storms, water). -Blood-injection-injury (e.g. needles, invasive medical procedures). -Situational (e.g. airplanes, elevators, enclosed spaces). -Other (e.g. situations that may lead to choking or vomiting; in children it can be loud sounds or costumed characters). **A child can have multiple specific phobias. The average person w/ specific phobia fears 3 objects or situations, and about 75% of ppl with specific phobia fear more than one situation or object. -associated physiological arousal typically occurs, although it varies: -Ppl w/ situational, natural environment, and animal specific phobias are likely to show sympathetic nervous system arousal. -ppl w/ blood-injection-injury specific phobia often demonstrate vasovagal fainting or near-fainting in response, w/ initial brief acceleration of heart rate and elevation of blood pressure followed by a deceleration of heart rate and drop in blood pressure. -DSM-5 makes one statement about neural systems models, emphasizing “the amygdala and related structures”. Seligman, Ohman, Marks, Menzies, and Clark say that the stimuli typically reflect the dangers that our prehistoric ancestors faced in their Pleistocene savannah environment. As a result of natural selection, fear of these evolutionary dangers became genetically coded. Consequently, modern man may still possess an innate tendency or preparedness to develop fear of spiders, snakes, blood, etc. -this does not, however, explain fears that do not fall into this category. There are cultural influences as well (e.g. negative connotations to certain stimuli as defined by society). **from (Merckelbach et al., 1996): review paper. Seligman (1971) has suggested that this distribution reflects an evolutionarily determined biological preparedness to fear certain situations whose avoidance is likely to be associated with improved survival. Consistent with this objective, “prepared” fears are hypothesized to be easily conditioned but difficult to extinguish.

5 Prevalence Overall in US, the 12 month community prevalence is about 7-9%. Children: 5% Adolescents (13-17 yrs): 16% Overall, females are more affected to males (2:1). Prevalence rates in European countries are similar to that of US, but the rates are generally lower in Asian, African, and Latin American Countries (2-4%). -females more than males, although rates vary across stimuli—animal, natural environment, and situational specific phobias are experienced more by females, whereas the blood-injection-injury specific phobia is experienced equally. -In the Fredrikson et al. (1996) study, point prevalence was highest for situational and environmental phobias followed by animals, then blood-injection-injury phobias. **Fewer than 20% of people with specific phobias seek treatment (Fyers, 1998).

6 Making the Diagnosis Median age of onset: 7-11 years.
Mean age of onset: 10 years. Situational specific phobias tend to have later onset than the other types. Phobias tend to wax/wane in childhood, although if they persist into adulthood the person is unlikely to remit. When it’s being diagnosed in children, two issues should be considered. 1: children may express their fear and anxiety by crying, tantrums, freezing, or clinging. 2: young children typically don’t understand the concept of avoidance. -stresses the importance of interviewing parents, teachers, or other caregivers. Excessive fears are quite common in children but they tend to be transitory and only mildly impairing, thus they’re considered developmentally appropriate. -to differentiate, as a clinician you must assess the degree of impairment and the duration of the fear/anxiety/avoidance compared to that of TD children.

7 How do they develop? DSM-5 lists multiple reasons:
Following traumatic event. Observation of others going through a traumatic event. Unexpected panic attack in the to-be-feared situation. Informational transmission. Many people, however, are unable to recall a specific reason for onset. **individuals w/ specific phobia are 60% more likely to make a suicide attempt than are those w/o the diagnosis. It’s likely these elevated rates are due to comorbidity w/ personality disorders and other anxiety disorders. -The DSM-5 doesn’t specifically address comorbid disorders, it just states that b/c of its early onset specific phobia is usually the first disorder diagnosed, then the person is at a higher risk for other disorders including anxiety disorders, depressive and bipolar disorders, substance related disorders, somatic symptom and related disorders, and personality disorders. -so practically everything.

8 Neurobiological Substrates
Genetics -there may be a genetic susceptibility to certain categories (more likely to get specific phobia that 1st degree relative has). Environmental -Traumatic experiences. -Parental overprotectiveness. -Parental loss/separation. -physical/sexual abuse. Secondary Features: -Active avoidance. -“clinically significant distress in multiple domains”. Neurobiological Substrates -amygdala and related structural differences. -ppl w/ blood-injection-injury phobia are susceptible to fainting. Specific Phobia -Marked fear/anxiety about specific object or situation. Kendler et al. (1992) did a study with 2163 personally interviewed female twins with either animal or situational (both simple phobias) or agoraphobia. They estimated heritability between 30-40%. -broken down further, simple phobias appeared to be more often caused by a childhood traumatic experience, whereas agoraphobia was less affected by environment and more influenced by genetics. -It can reasonably be inferred that specific phobias are the joint product of a modest common genetic factor and learning experiences that are highly specific to these phobias. Associated Outcomes: -unlikely to remit if it persists into adulthood. -higher suicide risk. -life changes via avoidance behaviors. -more likely to develop comorbid disorders. Temperament -Neuroticism

9 Three Systems Model Fear is reflected in:
1: Autonomic systems. e.g. tachycardia, increased respiration. 2: Subjective feelings of apprehension. 3: Avoidance or escape behavior. The extent to which they cooccur varies. Three Systems Model of fear and emotion. (Hugdahl, 1981) Different types of phobias elicit varying responses in relation to the 3 components. For example, while both animal phobia and blood-injection-injury phobia are accompanied by subjective reports of distress, animal phobia distress usually takes the form of fear whereas blood-injection-injury phobia can be associated w/ strong subjective feelings of disgust and repulsion. Physiological reactions vary as well (heightened arousal w/ animal phobics vs. lowered arousal and possible fainting w/ blood-injection-injury phobics). Another difference is that a situational fear, like claustrophibia, seems to be more complex than an animal fear, for example. This is because generally with claustrophibia you not only focus on danger (fear of suffocation), but also anxiety expectancies (fear of going crazy) and bodily sensations (needing to breath, pain, etc.).

10 Age of Onset Ost (1987) summarized the previous research (as of that time) on age of onset for phobias, and the data is represented in this table.

11 Age of Onset These are Ost’s data for the current study (1987). All patients were either referred for treatment or sought treatment, were outpatients, and all met DSM-III criteria for either agoraphobia (with or without panic attacks), social phobia, or simple phobia. N=370. The simple phobias all started in childhood, except for claustrophobia which had a mean onset age of 20 years. Social phobia started during adolescence (M = 16 years), whereas agoraphobia had the latest onset with a mean of about 28 years. Tukey's HSD tests showed that agoraphobia had a significantly higher (p < .05) onset age than all the other phobias. Furthermore, claustrophobia and social phobia had later onset ages than the simple phobias, and among these, dental phobia started later than animal phobia. In other words, animal phobia started at an earlier age than all the other phobias studied, and agoraphobia started at a later age than all the others. He collected data on heart rate, anxiety experienced at exposure, and avoidance behaviors. While I’m unsure how ethical this would be to do today, he collected this data while patients were exposed to their specific phobias. For agoraphobias, patients were exposed to 15 different situations, each one more difficult than the last (it didn’t give specifics). For social phobics they were forced to have a conversation of at least 5 minutes in length with an unknown person of the opposite sex. For claustrophobics they were locked into a small windowless space for as long as they could take it (max 10 mins). For animal phobics they tested out close each patient could get to a cage with either a snake or spider in it. For blood phobics, they were forced to watch an in-color video of thoracic operations that contained large amounts of blood. Lastly, dental phobics went through a routine dental exam that consisted of 15 steps.

12 Development: Modified Conditioning Model
Classical Conditioning One can condition someone to respond fearfully to a harmless object/situation by repeatedly pairing the harmless stimulus w/ a frightening stimulus. Pair conditioned stimulus w/ unconditioned stimulus. Phobics are unrealistically afraid of situations that others deem harmless, is something similar occurring? The classical conditioning model of specific phobias developed in the 1920s following the work of Watson and other behaviorists (Watson and Rayner, 1920). These investigators observed that one could teach (i.e., condition) an animal or infant to respond fearfully to a harmless object or situation by repeatedly pairing the harmless stimulus (conditioned stimulus) with a frightening one (unconditioned stimulus). For example, a rat could be taught to be afraid of a soft buzzing noise if that noise was repeatedly followed by an electric shock. Following the conditioning sessions the rat would become frightened on hearing the buzz, even if the shock did not follow. Observing that specific phobics are also unrealistically afraid of situations that others deem harmless, the behaviorists suggested this disorder might result from a similar process, i.e., that specific phobias were conditioned fears. Issues w/ this: 1) many individuals with phobias do not recall a conditioning event; 2) a small number of nonrandomly distributed stimuli account for most human phobias; 3) not all individuals who have an aversive encounter with these stimuli develop a phobia; and 4) phobias do not extinguish in the same way as laboratory conditioned fear. (Watson and Rayner, 1920). (Fyer, 1998).

13 Little Albert Watson & Rayner (1920).
Used classical conditioning to elicit fear to various items/animals that initially had no fear response. Whatever happened to Little Albert? (Beck, Levinson, & Irons, 2010). Ethics comment: “At first there was considerable hesitation upon our part in making the attempt to set up fear reactions experimentally. A certain responsibility attaches to such a procedure. We decided finally to make the attempt, comforting ourselves by the reflection that such attachments would arise anyway as soon as the child left the sheltered environment of the nursery for the rough and tumble of the home.” Initially Albert was presented with all of the stimuli, including a white rat, a white rabbit, a dog, a fur coat, wool, masks with and without hair. No fear response was elicited. In order to create a fear response, they paired the stimuli with a loud noise of striking a steel bar with a hammer. Notes from second time they tested Albert: 1. Rat presented suddenly without sound. There was steady fixation but no tendency at first to reach for it. The rat was then placed nearer, whereupon tentative reaching movements began with the right hand. When the rat nosed the infant's left hand, the hand was immediately withdrawn. He started to reach for the head of the animal with the forefinger of the left hand, but withdrew it suddenly before contact. It is thus seen that the two joint stimulations given the previous week were not without effect. He was tested with his blocks immediately afterwards to see if they shared in the process of conditioning. He began immediately to pick them up, dropping them, pounding them, etc. In the remainder of the tests the blocks were given frequently to quiet him and to test his general emotional state. They were always removed from sight when the process of conditioning was under way. 2. Joint stimulation with rat and sound. Started, then fell over immediately to right side No crying.[p.5] 3. Joint stimulation. Fell to right side and rested upon hands, with head turned away from rat. No crying. 4. Joint stimulation. Same reaction. 5. Rat suddenly presented alone. Puckered face, whimpered and withdrew body sharply to the left. 6. Joint stimulation. Fell over immediately to right side and began to whimper. 7. Joint stimulation. Started violently and cried, but did not fall over. 8. Rat alone. The instant the rat was shown the baby began to cry. Almost instantly he turned sharply to the left, fell over on left side, raised himself on all fours and began to crawl away so rapidly that he was caught with difficulty before reaching the edge of the table. This procedure took place 5 times in a month, each time Albert had fear reactions to the stimuli. This fear reaction transferred to different locations and also to other animals, particularly a white rabbit and a fur coat. His reaction to a dog was less fearful, until the dog barked in his face in which a violent fear reaction was elicited. At the end of the experiment: "Detachment" or removal of conditioned emotional responses. Unfortunately Albert was taken from the hospital the day the above tests were made. Hence the opportunity of building up an experimental technique by means of which we could remove the conditioned emotional responses was denied us. -interestingly, after this experiment little Albert disappeared. A group of researchers tried to identify through medical records and other avenues of history who he was and what happened with him, and they think his real name may have been Douglas. That’s as far as their information went. Finding Little Albert: There were no notes left by Watson and Rayner, no patient records, and no employee files. They then remembered that 1920 was a census year. If a census taker came to Johns Hopkins, Albert’s and his mother’s names may have been recorded. A quick check revealed that a census had been taken of people living on campus. No one younger than 14 years of age was listed. But . . . -Watson and Rayner (1920) tested Albert during the winter of 1919–1920. At the time of the study, Albert and his mother were living on the Johns Hopkins campus. Census data show that Douglas’s mother, Arvilla, resided on the Johns Hopkins campus on January 2, 1920. -Watson and Rayner (1920) stated that Albert’s mother was a wet nurse in the Harriet Lane Home. According to family history, Arvilla worked in the Harriet Lane Home. -Douglas was born on March 9, 1919, so Arvilla was probably lactating at the time of the investigation. She could then have served as a wet nurse. -Documents suggest that there were never many, probably no more than four, wet nurses concurrently residing in the Harriet Lane Home. -Douglas was born at Johns Hopkins and was cared for by his mother after she left the hospital. Thus, it is highly probable that Douglas lived on campus with his mother during the winter of 1919–1920. -Assuming that Douglas lived with Arvilla, he, like Albert, spent almost his entire first year at Johns Hopkins. -Like Albert, Douglas left the institution during the early 1920s. -Albert’s baseline was assessed when he was 8 months 26 days of age. By jointly considering Watson and Rayner’s (1920) article, the film ( Watson, 1923), and Watson’s correspondence with Goodnow (1919; Watson, 1919b), we determined that baseline was recorded on or around December 5, Douglas was 8 months 26 days old on December 5, 1919. -Albert and Douglas were Caucasian males. -There are physical resemblances between the two boys. Visual inspection and biometric analyses of the Douglas portrait and the Little Albert film stills revealed “facial similarities.” -No features were so different as to indicate that Douglas and Albert could not be the same individual.

14 Secondary source: (Fyer, 1998).

15 Development: Preparedness
Seligman (1971): aversive conditioning interacts w/ evolutionary processes to produce phobic fear. Makes extinction difficult. For example . . . Based on natural selection, Seligman suggests we’re “prewired” to fear certain stimuli, particularly those that have been dangerous to us in the past and have been present in history. This preparedness makes extinction of these fears difficult, whereas in most classically conditioned fear created in a lab extinction is fairly simple. Secondary sources: Fyer (1998) and Merkelbach et al. (1996) reviews. No access to full text for Seligman (1971) thru UCF.

16 Preparedness Ohman and associates presented two types of stimuli:
Evolutionary relevant (e.g., slides of spiders). Evolutionary neutral (e.g., slides of flowers). In over a dozen studies they found conditioned responses to evolutionary relevant cues are slower to extinguish than conditioned responses to evolutionary neutral cues. Secondary source: Fyers (1998)—did not have access to Ohman (1986) thru UCF. Thus, they support the central tenet of the preparedness hypothesis, namely that subjects readily acquire robust associations b/w evolutionary relevant cues and aversive outcomes. This has also been tested in rhesus monkeys. They exposed lab-reared monkeys w/ no prior fear of snakes to videotapes of wild-reared monkey reacting fearfully in the presence of a snake or a flower. -using editing techniques the researchers were able to display identical fear reactions in each video, showing them scared of snakes and just as scared of flowers. -the lab-reared monkeys acquired an extremely persistent fear of snakes after they watched the models reacting fearfully to snakes, but in contrasdt, observer monkeys failed to acquire a fear of flowers after watching the same fear being exhibited to flowers.

17 Preparedness Cook & Mineka (1989):
Exposed lab-reared monkeys w/ no prior fear of snakes to either video of wild-reared monkey responding fearfully to a snake or responding equally as fearfully to a flower. Lab-reared monkeys acquired an extremely persistent fear of snakes after watching the models’ reactions, but in contrast they failed to acquire fear of flowers.

18 Development: Nonassociative Models
Nonassociative models are derived from the observation that each species seems to have certain fears that are part of development and can occur even in individuals who have had no previous direct or indirect (e.g., hearing about it) experience with the phobic stimulus. For example, stranger anxiety, fear of visual cliff, and separation anxiety. The major distinction between the nonassociative and conditioning approaches is that in the former the development of a phobia does not necessarily require a prior aversive experience with the phobic stimulus. (Fyer, 1998)

19 Nonassociative Model 1:
Menzies & Clark: specific phobias develop when there is a failure of successful habituation of these intrinsic fears. This results from: Absence of opportunity for safe exposure. Dishabituation in face of increased life stresses. Constitutional deficiency in mechanisms necessary to fear habituation. Menzies and Clarke (1995) have hypothesized that specific phobias develop when there is a failure of successful habituation of these intrinsic fears. This may result from either an absence of opportunity for safe exposure, dishabituation in the face of increased life stresses, or constitutional deficiency in mechanisms necessary to fear habituation. Safe exposure is defined as realistic experi- ence of nonfrightening interaction with the feared object (e.g., a child is introduced to a large dog under the protective guidance of a watchful parent, resulting in a positive experience). The term nonconditioning trauma is used to refer to life stresses (e.g., loss, moving) that may be associated with exacerbation (i.e., dishabituation) of phobic symptoms. Thus, for example, a phobia of heights may result from failure to habituate with respect to one aspect of a developmentally determined fear of loss of support. Menzies and Clarke (1995) argue that most people learn through experience that, despite the visual cues of transparency, they will not fall through the glass (or, e.g., off a roof or through a window). Those who do not learn this become phobic of heights; however, the precise mechanisms or conditions under which this failure to habituate could occur are not well described. Overall the details of Menzies and Clarke’s nonassociative model have not been well studied.

20 Nonassociative Model 2:
Specifically w/ blood-injection-injury: physiological response to phobic stimulus. For those who experience marked bradycardia and hypotension in response to a blood-injection-injury phobia, it is now a reasonable wish to avoid an unpleasant experience vs. an irrational fear of the stimuli. Most individuals with blood injury phobia experience a precipitous drop in blood pressure and heart rate when confronted with their phobic stimulus. The normal sequelae of this physiological response (in phobic or nonphobic individuals) includes sweating, light-headedness, and fainting. What distinguishes these patients is not their fear, but an aberrant physiological response. (Fyer, 1998)

21 Neoconditioning Perspective
Makes 2 changes to classical conditional is it relates to specific phobias: 1: Latent Inhibition Previous experience w/ CS that has no aversive UCS makes it difficult to elicit fear response with a suddenly aversive UCS. 2: UCS Inflation Subjects are exposed to pairings of CS and a mildly aversive UCS, relating them. Later, if it is learned that the UCF is more aversive than previous experience suggested, this postconditioning info will lead to an inflation of the UCS in memory. Thus, the conditioned fear response will become stronger. Big names here: Rachman (1991), Mineka (1985), and Davey (1992a). Overviewed in review paper by Merckelbach (1996). The changes here deal with some inadequacies of the traditional conditioning approach, although Rachman says it’s “Still too liberal. It lacks limits and there is little that it disallows” (1991, p. 169). Latent inhibition: When a subject has extensive experience with a CS that isn’t followed by an aversive UCS. Later, when the subject is exposed to new situation where the CS is suddenly accompanied by a painful UCS (e.g., electric shock), it is difficult to condition a fear response to that familiar CS. -protective factor. UCF inflation example: An individual may witness an unknown person die of a heart attack on a bus or a train. On future occasions, riding on public transport may evoke memories of this incident but no anxiety Subsequently, however, that individual may be present when a close friend or relative dies of a heart attack, thus inflating the aversive properties of heart attacks. This may then give rise to acute anxiety when riding on public transport. In this particular scenario, public transport has never been directly associated with anxiety-eliciting trauma, but the public transport phobia results from a prior learned association between public transport and heart attacks, and subsequent independent inflation of heart attacks as aversive events. (p. 165)

22 Phobia Maintenance Specific phobias are acquired through direct and/or indirect learning pathways. Then, they are maintained by: Avoidance behaviors. Attentional bias. Hyperattention to threatening material. Judgmental bias. Covariation bias: the tendency to overestimate the association b/w phobic stimuli and aversive outcomes. Ex consequentia bias: while most people understand that danger situations elicit anxiety, phobics seem to believe that anxiety symptoms imply presence of danger. Avoidance behaviors: minimize direct and prolonged contact w/ the phobic object and, hence, phobic subjects wouldn’t have the opportunity to learn that the CS in a neutral object and doesn’t predict danger. Most researchers agree that pathological anxiety (like specific phobia) isn’t characterized by a general cognitive dysfunction, or in other words, isn’t not associated with overall deficits in memory, attention, motor function, and the like. Instead, cognitive dysfunctions in specific phobias appear to be restricted to certain information processes and to certain semantic domains. -This leads us to our other maintenance pathways—attentional biases and judgmental biases. Attentional bias: one [controversial] way to show this effect is through the Stroop task. A consistent finding with anxious patients is that their color naming of threatening words is slower than that of neutral words. For example, spider phobics display retarded color naming latencies when they are confronted w/ spider related words (e,g,, spider, creepy), but not when they have to color name neutral words (e.g., car). You see covariation bias experimentally when you show phobic and nonphobic subjects pictures of neutral and fear-relevant stimuli, followed by either a tone or a shock. Tones and shock are distributed equally among the stimuli, but when subjects speak retrospectively about when shock/tone was administered, phobic subjects more often associate the shock with the fear-relevant stimuli. -additionally, the stronger the post-treatment overestimation of the contingency b/w spider pictures and aversive shock, the higher the spider fear at 2-yr follow up, -thus, this tendency helps sustain phobic fear.

23 Fear Conditioning: A Neurobiological Explanation
Lombroso & Ogren (2008) Consolidation of fearful memories involves the amygdala. Consolidation: turning short term memories into long lasting memories. Must take place w/i a few hours of learning. Involves stimulation of glutamate receptors, protein synthesis, and gene transcription within the hippocampus.

24 Fear Conditioning In a typical experiment, a rodent is placed in a small cage. A tone sounds, then a shock is administered. This is called cued conditioning, where the cue is the tone. w/ cued conditioning, the incoming sounds of the tone activate the auditory nerve neurons of cochlear nucleus thalamus signal splits b/w amygdala and auditory cortex. Lombroso & Ogren (2008)

25 At the end of the tone, the shock is given, which is sensed by the nerve terminals in the paws travels up spinal cord to thalamus splits b/w amygdala and sensory cortex. Critical point: now, neurons in lateral amygdala receive synaptic input from both the tone and the shock. Something happens when these two inputs arrive w/i milliseconds of each other. The connection for the signal representing the tone is strengthened. Lombroso & Ogren (2008)

26 Now, the mouse freezes when hearing the tone only.
This means the tone alone is able to depolarize the postsynaptic neuron in the lateral amygdala sufficiently for an action potential. The signal passes onto neurons w/i the central nucleus of the amygdala, which receives a strong synaptic input producing action potentials and thus passing signals onto various nuclei in the hypothalamus and related structures. What does this mean behaviorally? Lombroso & Ogren (2008)

27 The remaining question is how the tone alone is enough to depolarize the postsynaptic neuron. There are multiple suggestions, split by whether the effect is believed to be in the postsynaptic or presynaptic neuron. It could be that now the presynaptic neuron releases twice the amount of glutamate, producing a more robust response of the postsynaptic terminal. Or possibly there are twice as many glutamate receptors in the postsynaptic terminal. A third suggestion is that there are the same number of receptors but now they’re more sensitive. Further research is warranted. Lombroso & Ogren (2008)

28 Activity in Structures Involved w/ Emotional Processing
Etkin & Wager (2007) completed a meta-analysis, searching for common and disorder-specific functional neurobiological deficits, comparing specific phobia, social anxiety, and PTSD. All studies had healthy control groups. Functional magnetic resonance imaging and positron emission tomography studies of PTSD, social anxiety disorder, specific phobia, and fear conditioning in healthy individuals were compared by quantitative meta-analysis. Included studies compared negative emotional processing to baseline, neutral, or positive emotion conditions. “First, we tested for evidence that the three disorders involve common neural alterations, which reflect abnormally elevated fear. To do so, we compared neuroimaging results from each disorder to results from studies of fear conditioning in healthy subjects. Second, we identified regions in which disorder-specific abnormalities may be related to disorder-specific symptoms. Finally, we performed novel tests of coactivation across regions to test whether, across individual studies, limbic dysregulation is reliably associated with medial prefrontal dysfunction”.

29 Etkin & Wager (2007). Yellow is specific phobia, blue is social anxiety, red is PTSD. Results: Patients with any of the three disorders consistently showed greater activity than matched comparison subjects in the amygdala and insula, structures linked to negative emotional responses. A similar pattern was observed during fear conditioning in healthy subjects. Hyperactivation in the amygdala and insula were more frequently observed in social anxiety disorder and specific phobia than in PTSD. -thus the only two structures with hyperactivity in all three disorders were the amygdala and insula. In patients with specific phobia, hyperactivity was seen in the amygdalae, fusiform gyrus, substantia nigra, insula, and mid-cingulate

30 What does this mean? They concluded that amygdalar hyperactivation in these disorders reflects a common exaggerated engagement of fear circuitry, resulting in shared symptoms among the disorders. Insular hyperactivity is heavily interconnected w/ the amygdala and related structures, thus this reflects increased activation of a network responsible for generating fear responses to symptom-provoking stimuli. They concluded that amygdalar hyperactivation in PTSD, social anxiety disorder, and specific phobia reflects a common exaggerated engagement of fear circuitry, which results in shared symptoms among the disorders. Unlike for the amygdala, a role for the insular cortex in anxiety disorders has not been frequently highlighted. The insula is heavily interconnected with the amygdala, hypo- thalamus, and periaqueductal gray matter, regulates the autonomic nervous system, and is activated during the processing of a variety of negative emotions. -thus, insular hyperactivity therefore likely also reflects increased activation of a network responsible for generating fear responses to symptom-provoking stimuli. Therefore, the data suggest that the amygdala and insula may be key components to a common neurobiological pathway for at least three anxiety disorders.

31 Treatment: Exposure Based on behavioral perspective that phobias are maintained b/c of avoidance behaviors. Thus, exposure therapies are designed to encourage the individual to enter feared situations, usually in a hierarchical manner. Division 12 status: “Strong research support”. From a behavioral perspective, specific phobias are maintained because of avoidance of the phobic stimuli so that the individual does not have the opportunity to learn that they can tolerate the fear, that the fear will come down on its own without avoiding or escaping, and that their feared outcomes often do not come true or are not as terrible as they imagine. Exposure therapies are thus designed to encourage the individual to enter feared situations (either in reality or through imaginal exercises) and to try to remain in those situations. The selection of situations to try typically follows an individually-tailored fear hierarchy that starts with situations that are only mildly anxiety-provoking and builds up to the most feared encounters, though in some forms of exposure therapy (e.g., implosion therapy), the individual starts out being exposed to a very anxiety-provoking stimulus rather than building up to that point more gradually.

32 Types of Exposure: In Vivo Exposure: actually confronting feared stimuli, usually in graduated manner. Applied Muscle Tension: variant of in vivo exposure using muscle tension exercises to help calm physiological responses in blood-injection-injury phobics. Virtual Reality Exposure: helpful when in vivo exposure is difficult/not convenient. Systematic Desensitization: exposing phobic individuals to fear-evoking stimuli and pairing it w/ relaxation to decrease normal fear response. In vivo: for example, a patient may begin by looking at pictures of spiders then work up to touching a large tarantula. A range of phobias respond well to this treatment, although treatment acceptance and dropout can be an issue. Treatment results tend to be well maintained up to a year later, although it is better for animal phobics than for blood-injection-injury phobics. Many exposure therapies also include a cognitive component that involves cognitive restructuring to challenge distorted or irrational thoughts related to the phobic object or response (e.g., I am going to fall, The dog is going to attack me, I can't tolerate this fear, etc.). Further, there is some evidence that either adding cognitive therapy to in vivo exposure or administering cognitive therapy alone can be helpful for claustrophobia, and it may also be useful for dental phobia. Evidence regarding the utility of cognitive therapy for flying phobia is mixed, and it is not clear that adding cognitive therapy to exposure therapy for other phobia types improves outcomes.

33 One-Session Treatment: A Clinical Trial
60 participants b/w ages 7-17. 3 conditions: Child being treated alone Child being treated w/ parent present Wait list control group WLC group was randomly assigned to either treatment 4 weeks later. Treatment consisted of gradual exposure in vivo. Sessions lasted 3 hours. They measured blood pressure and heart rate at baseline and throughout the assessments (as they graduated to more anxiety provoking exposures). The participants were allowed to stop the exposure at any time if they felt the anxiety was too much. They also took self reported rating of anxiety and administered a depression scale. The actual treatment consisted of gradual exposure in vivo, which was set up as a series of behavioral tests in which the child could attempt to get new information. This enabled the child to correct the false beliefs he or she had in regard to the phobic stimulus. None of the phobias were treated imaginally, and there was no cognitive therapy carried out during the treatment session, only encouragement of the patients to draw conclusions regarding their beliefs after an exposure situation had been completed. Examples of exposure situations for a claustrophobic patient are riding elevators, being in small windowless rooms with the door locked, and traveling by bus or underground train, whereas a snake-phobic child would have the opportunity to interact with snakes of different sizes (e.g., a corn snake, a python, and a boa constrictor). Before leaving one situation or object and continuing with the next, there should be at least a 50% drop in subjective anxiety level. Most of the treatments lasted the full 3 hrs. Ost, Svensson, Hellstrom, & Lindwall (2001)

34 There was no significant difference between the two treatment groups—both improved markedly. There was a significant difference between the treatment groups and the WLC group, p<.0001. They not only looked at statistical but also clinical significance. These criteria stipulate that the patient must, in addition to displaying a statistically reliable change, fall within the range of a normal group or outside the pretreatment range of the patient group at the posttreatment assessment, defined as M ± 2 SD in the direction of functionality. As no norm data exist for the variables used, the latter alternative was used. The three variables considered to be the most important in this study were used: (a) the independent assessor rating of phobic severity, (b) the BAT score, and (c) the self-rating of anxiety during the BAT. The cutoff score for the severity rating was pretreatment mean 6.03 —2(SD of 0.82) = 4.39 (i.e., 4). However, because 4 was the criterion to be included in the study, 3 was chosen as the cutoff score. For the BAT score the cutoff score was pretreatment mean (SD of 18.6) = 59.4 (i.e., 60), and for the self-rating of anxiety the cutoff score was pretreatment mean (SD of 1.86) = 1.76. Ost, Svensson, Hellstrom, & Lindwall (2001)

35 Ost, Svensson, Hellstrom, & Lindwall (2001)

36 Ablutophobia- Fear of washing or bathing.
Allodoxaphobia- Fear of opinions. Acarophobia- Fear of itching or of the insects that cause itching. Altophobia- Fear of heights. Amathophobia- Fear of dust. Acerophobia- Fear of sourness. Amaxophobia- Fear of riding in a car. Achluophobia- Fear of darkness. Ambulophobia- Fear of walking. Acousticophobia- Fear of noise. Amnesiphobia- Fear of amnesia. Acrophobia- Fear of heights. Amychophobia- Fear of scratches or being scratched. Aerophobia- Fear of drafts, air swallowing, or airbourne noxious substances. Anablephobia- Fear of looking up. Aeroacrophobia- Fear of open high places. Ancraophobia- Fear of wind. (Anemophobia) Aeronausiphobia- Fear of vomiting secondary to airsickness. Androphobia- Fear of men. Anemophobia- Fear of air drafts or wind.(Ancraophobia) Agateophobia- Fear of insanity. Agliophobia- Fear of pain. Anginophobia- Fear of angina, choking or narrowness. Agoraphobia- Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place. Anglophobia- Fear of England or English culture, etc. Agraphobia- Fear of sexual abuse. Angrophobia - Fear of anger or of becoming angry. Agrizoophobia- Fear of wild animals. Ankylophobia- Fear of immobility of a joint. Agyrophobia- Fear of streets or crossing the street. Anthrophobia or Anthophobia- Fear of flowers. Aichmophobia- Fear of needles or pointed objects. Anthropophobia- Fear of people or society. Ailurophobia- Fear of cats. Antlophobia- Fear of floods. Albuminurophobia- Fear of kidney disease. Anuptaphobia- Fear of staying single. Alektorophobia- Fear of chickens. Apeirophobia- Fear of infinity. Algophobia- Fear of pain. Aphenphosmphobia- Fear of being touched. (Haphephobia) Alliumphobia- Fear of garlic.

37 Apiphobia- Fear of bees.
Automatonophobia- Fear of ventriloquist's dummies, animatronic creatures, wax statues - anything that falsly represents a sentient being. Apotemnophobia- Fear of persons with amputations. Arachibutyrophobia- Fear of peanut butter sticking to the roof of the mouth. Automysophobia- Fear of being dirty. Autophobia- Fear of being alone or of oneself. Arachnephobia or Arachnophobia- Fear of spiders. Aviophobia or Aviatophobia- Fear of flying. Bacillophobia- Fear of microbes. Arithmophobia- Fear of numbers. Bacteriophobia- Fear of bacteria. Arrhenphobia- Fear of men. Ballistophobia- Fear of missiles or bullets. Arsonphobia- Fear of fire. Bolshephobia- Fear of Bolsheviks. Asthenophobia- Fear of fainting or weakness. Barophobia- Fear of gravity. Astraphobia or Astrapophobia- Fear of thunder and lightning.(Ceraunophobia, Keraunophobia) Basophobia or Basiphobia- Inability to stand. Fear of walking or falling. Astrophobia- Fear of stars or celestial space. Bathmophobia- Fear of stairs or steep slopes. Asymmetriphobia- Fear of asymmetrical things. Bathophobia- Fear of depth. Ataxiophobia- Fear of ataxia. (muscular incoordination) Batophobia- Fear of heights or being close to high buildings. Ataxophobia- Fear of disorder or untidiness. Batrachophobia- Fear of amphibians, such as frogs, newts, salamanders, etc. Atelophobia- Fear of imperfection. Atephobia- Fear of ruin or ruins. Belonephobia- Fear of pins and needles. (Aichmophobia) Athazagoraphobia- Fear of being forgotton or ignored or forgetting. Bibliophobia- Fear of books. Atomosophobia- Fear of atomic explosions. Blennophobia- Fear of slime. Atychiphobia- Fear of failure. Bogyphobia- Fear of bogeys or the bogeyman. Aulophobia- Fear of flutes. Botanophobia- Fear of plants. Aurophobia- Fear of gold. Bromidrosiphobia or Bromidrophobia- Fear of body smells. Auroraphobia- Fear of Northern lights. Autodysomophobia- Fear of one that has a vile odor. Brontophobia- Fear of thunder and lightning. Bufonophobia- Fear of toads.

38 Cacophobia- Fear of ugliness.
Claustrophobia- Fear of confined spaces. Cainophobia or Cainotophobia- Fear of newness, novelty. Cleithrophobia or Cleisiophobia- Fear of being locked in an enclosed place. Caligynephobia- Fear of beautiful women. Cleptophobia- Fear of stealing. Cancerophobia or Carcinophobia- Fear of cancer. Climacophobia- Fear of stairs, climbing, or of falling downstairs. Cardiophobia- Fear of the heart. Carnophobia- Fear of meat. Clinophobia- Fear of going to bed. Catagelophobia- Fear of being ridiculed. Clithrophobia or Cleithrophobia- Fear of being enclosed. Catapedaphobia- Fear of jumping from high and low places. Cnidophobia- Fear of stings. Cathisophobia- Fear of sitting. Cometophobia- Fear of comets. Catoptrophobia- Fear of mirrors. Coimetrophobia- Fear of cemeteries. Cenophobia or Centophobia- Fear of new things or ideas. Coitophobia- Fear of coitus. Contreltophobia- Fear of sexual abuse. Ceraunophobia or Keraunophobia- Fear of thunder and lightning.(Astraphobia, Astrapophobia) Coprastasophobia- Fear of constipation. Coprophobia- Fear of feces. Chaetophobia- Fear of hair. Consecotaleophobia- Fear of chopsticks. Cheimaphobia or Cheimatophobia- Fear of cold.(Frigophobia, Psychophobia) Coulrophobia- Fear of clowns. Counterphobia- The preference by a phobic for fearful situations. Chemophobia- Fear of chemicals or working with chemicals. Cremnophobia- Fear of precipices. Cherophobia- Fear of gaiety. Cryophobia- Fear of extreme cold, ice or frost. Chionophobia- Fear of snow. Crystallophobia- Fear of crystals or glass. Chiraptophobia- Fear of being touched. Cyberphobia- Fear of computers or working on a computer. Chirophobia- Fear of hands. Chiroptophobia- Fear of bats. Cyclophobia- Fear of bicycles. Cholerophobia- Fear of anger or the fear of cholera. Cymophobia or Kymophobia- Fear of waves or wave like motions. Chorophobia- Fear of dancing. Chrometophobia or Chrematophobia- Fear of money. Cynophobia- Fear of dogs or rabies. Chromophobia or Chromatophobia- Fear of colors. Cypridophobia or Cypriphobia or Cyprianophobia or Cyprinophobia - Fear of prostitutes or venereal disease. Chronophobia- Fear of time. Chronomentrophobia- Fear of clocks. Cibophobia- Fear of food.(Sitophobia, Sitiophobia)

39 Decidophobia- Fear of making decisions.
Domatophobia- Fear of houses or being in a house.(Eicophobia, Oikophobia) Defecaloesiophobia- Fear of painful bowels movements. Doraphobia- Fear of fur or skins of animals. Deipnophobia- Fear of dining or dinner conversations. Doxophobia- Fear of expressing opinions or of receiving praise. Dementophobia- Fear of insanity. Dromophobia- Fear of crossing streets. Demonophobia or Daemonophobia- Fear of demons. Dutchphobia- Fear of the Dutch. Dysmorphophobia- Fear of deformity. Demophobia- Fear of crowds. (Agoraphobia) Dystychiphobia- Fear of accidents. Dendrophobia- Fear of trees. Ecclesiophobia- Fear of church. Dentophobia- Fear of dentists. Ecophobia- Fear of home. Dermatophobia- Fear of skin lesions. Eicophobia- Fear of home surroundings.(Domatophobia, Oikophobia) Dermatosiophobia or Dermatophobia or Dermatopathophobia- Fear of skin disease. Eisoptrophobia- Fear of mirrors or of seeing oneself in a mirror. Dextrophobia- Fear of objects at the right side of the body. Electrophobia- Fear of electricity. Diabetophobia- Fear of diabetes. Eleutherophobia- Fear of freedom. Didaskaleinophobia- Fear of going to school. Elurophobia- Fear of cats. (Ailurophobia) Dikephobia- Fear of justice. Emetophobia- Fear of vomiting. Dinophobia- Fear of dizziness or whirlpools. Enetophobia- Fear of pins. Diplophobia- Fear of double vision. Enochlophobia- Fear of crowds. Dipsophobia- Fear of drinking. Enosiophobia or Enissophobia- Fear of having committed an unpardonable sin or of criticism. Dishabiliophobia- Fear of undressing in front of someone. Entomophobia- Fear of insects. Disposophobia- Fear of throwing stuff out. Hoarding. Eosophobia- Fear of dawn or daylight.

40 Frigophobia- Fear of cold or cold things
Frigophobia- Fear of cold or cold things.(Cheimaphobia, Cheimatophobia, Psychrophobia) Galeophobia or Gatophobia- Fear of cats. Ephebiphobia- Fear of teenagers. Epistaxiophobia- Fear of nosebleeds. Epistemophobia- Fear of knowledge. Gallophobia or Galiophobia- Fear France or French culture. (Francophobia) Equinophobia- Fear of horses. Gamophobia- Fear of marriage. Eremophobia- Fear of being oneself or of lonliness. Geliophobia- Fear of laughter. Ereuthrophobia- Fear of blushing. Gelotophobia- Fear of being laughed at. Ergasiophobia- 1) Fear of work or functioning. 2) Surgeon's fear of operating. Geniophobia- Fear of chins. Genophobia- Fear of sex. Ergophobia- Fear of work. Genuphobia- Fear of knees. Erotophobia- Fear of sexual love or sexual questions. Gephyrophobia or Gephydrophobia or Gephysrophobia- Fear of crossing bridges. Euphobia- Fear of hearing good news. Germanophobia- Fear of Germany or German culture. Eurotophobia- Fear of female genitalia. Erythrophobia or Erytophobia or Ereuthophobia- 1) Fear of redlights. 2) Blushing. 3) Red. Gerascophobia- Fear of growing old. Gerontophobia- Fear of old people or of growing old. Febriphobia or Fibriphobia or Fibriophobia- Fear of fever. Geumaphobia or Geumophobia- Fear of taste. Glossophobia- Fear of speaking in public or of trying to speak. Felinophobia- Fear of cats. (Ailurophobia, Elurophobia, Galeophobia, Gatophobia) Gnosiophobia- Fear of knowledge. Francophobia- Fear of France or French culture. (Gallophobia, Galiophobia) Graphophobia- Fear of writing or handwriting. Gymnophobia- Fear of nudity. Gynephobia or Gynophobia- Fear of women.

41 Hadephobia- Fear of hell.
Hobophobia- Fear of bums or beggars. Hagiophobia- Fear of saints or holy things. Hodophobia- Fear of road travel. Hamartophobia- Fear of sinning. Hormephobia- Fear of shock. Haphephobia or Haptephobia- Fear of being touched. Homichlophobia- Fear of fog. Homilophobia- Fear of sermons. Harpaxophobia- Fear of being robbed. Hominophobia- Fear of men. Hedonophobia- Fear of feeling pleasure. Homophobia- Fear of sameness, monotony or of homosexuality or of becoming homosexual. Heliophobia- Fear of the sun. Hellenologophobia- Fear of Greek terms or complex scientific terminology. Hoplophobia- Fear of firearms. Hydrargyophobia- Fear of mercurial medicines. Helminthophobia- Fear of being infested with worms. Hydrophobia- Fear of water or of rabies. Hydrophobophobia- Fear of rabies. Hemophobia or Hemaphobia or Hematophobia- Fear of blood. Hyelophobia or Hyalophobia- Fear of glass. Hygrophobia- Fear of liquids, dampness, or moisture. Heresyphobia or Hereiophobia- Fear of challenges to official doctrine or of radical deviation. Hylephobia- Fear of materialism or the fear of epilepsy. Herpetophobia- Fear of reptiles or creepy, crawly things. Hylophobia- Fear of forests. Heterophobia- Fear of the opposite sex. (Sexophobia) Hypengyophobia or Hypegiaphobia- Fear of responsibility. Hexakosioihexekontahexaphobia- Fear of the number 666. Hypnophobia- Fear of sleep or of being hypnotized. Hierophobia- Fear of priests or sacred things. Hypsiphobia- Fear of height. Hippophobia- Fear of horses. Iatrophobia- Fear of going to the doctor or of doctors. Hippopotomonstrosesquipedaliophobia- Fear of long words.

42 Ichthyophobia- Fear of fish.
Kopophobia- Fear of fatigue. Ideophobia- Fear of ideas. Koniophobia- Fear of dust. (Amathophobia) Illyngophobia- Fear of vertigo or feeling dizzy when looking down. Kosmikophobia- Fear of cosmic phenomenon. Kymophobia- Fear of waves. (Cymophobia) Iophobia- Fear of poison. Kynophobia- Fear of rabies. Insectophobia - Fear of insects. Kyphophobia- Fear of stooping. Isolophobia- Fear of solitude, being alone. Lachanophobia- Fear of vegetables. Isopterophobia- Fear of termites, insects that eat wood. Laliophobia or Lalophobia- Fear of speaking. Leprophobia or Lepraphobia- Fear of leprosy. Ithyphallophobia- Fear of seeing, thinking about or having an erect penis. Leukophobia- Fear of the color white. Levophobia- Fear of things to the left side of the body. Japanophobia- Fear of Japanese. Judeophobia- Fear of Jews. Ligyrophobia- Fear of loud noises. Kainolophobia or Kainophobia- Fear of anything new, novelty. Lilapsophobia- Fear of tornadoes and hurricanes. Kakorrhaphiophobia- Fear of failure or defeat. Limnophobia- Fear of lakes. Katagelophobia- Fear of ridicule. Linonophobia- Fear of string. Kathisophobia- Fear of sitting down. Liticaphobia- Fear of lawsuits. Katsaridaphobia- Fear of cockroaches. Lockiophobia- Fear of childbirth. Kenophobia- Fear of voids or empty spaces. Logizomechanophobia- Fear of computers. Keraunophobia or Ceraunophobia- Fear of thunder and lightning.(Astraphobia, Astrapophobia) Logophobia- Fear of words. Luiphobia- Fear of lues, syphillis. Kinetophobia or Kinesophobia- Fear of movement or motion. Lutraphobia- Fear of otters. Lygophobia- Fear of darkness. Kleptophobia- Fear of stealing. Lyssophobia- Fear of rabies or of becoming mad. Koinoniphobia- Fear of rooms. Kolpophobia- Fear of genitals, particularly female.

43 Macrophobia- Fear of long waits.
Motorphobia- Fear of automobiles. Mageirocophobia- Fear of cooking. Mottephobia- Fear of moths. Maieusiophobia- Fear of childbirth. Musophobia or Muriphobia- Fear of mice. Malaxophobia- Fear of love play. (Sarmassophobia) Mycophobia- Fear or aversion to mushrooms. Maniaphobia- Fear of insanity. Mycrophobia- Fear of small things. Mastigophobia- Fear of punishment. Myctophobia- Fear of darkness. Mechanophobia- Fear of machines. Myrmecophobia- Fear of ants. Medomalacuphobia- Fear of losing an erection. Mythophobia- Fear of myths or stories or false statements. Medorthophobia- Fear of an erect penis. Megalophobia- Fear of large things. Myxophobia- Fear of slime. (Blennophobia) Melissophobia- Fear of bees. Nebulaphobia- Fear of fog. (Homichlophobia) Melanophobia- Fear of the color black. Necrophobia- Fear of death or dead things. Melophobia- Fear or hatred of music. Nelophobia- Fear of glass. Meningitophobia- Fear of brain disease. Neopharmaphobia- Fear of new drugs. Menophobia- Fear of menstruation. Neophobia- Fear of anything new. Merinthophobia- Fear of being bound or tied up. Nephophobia- Fear of clouds. Metallophobia- Fear of metal. Noctiphobia- Fear of the night. Metathesiophobia- Fear of changes. Nomatophobia- Fear of names. Meteorophobia- Fear of meteors. Nosocomephobia- Fear of hospitals. Methyphobia- Fear of alcohol. Nosophobia or Nosemaphobia- Fear of becoming ill. Metrophobia- Fear or hatred of poetry. Nostophobia- Fear of returning home. Microbiophobia- Fear of microbes. (Bacillophobia) Novercaphobia- Fear of your step-mother. Microphobia- Fear of small things. Nucleomituphobia- Fear of nuclear weapons. Misophobia or Mysophobia- Fear of being contaminated with dirt or germs. Nudophobia- Fear of nudity. Mnemophobia- Fear of memories. Numerophobia- Fear of numbers. Molysmophobia or Molysomophobia- Fear of dirt or contamination. Nyctohylophobia- Fear of dark wooded areas or of forests at night Monophobia- Fear of solitude or being alone. Nyctophobia- Fear of the dark or of night. Monopathophobia- Fear of definite disease.

44 Obesophobia- Fear of gaining weight.(Pocrescophobia)
Ostraconophobia- Fear of shellfish. Ochlophobia- Fear of crowds or mobs. Ouranophobia or Uranophobia- Fear of heaven. Ochophobia- Fear of vehicles. Pagophobia- Fear of ice or frost. Octophobia - Fear of the figure 8. Panthophobia- Fear of suffering and disease. Odontophobia- Fear of teeth or dental surgery. Panophobia or Pantophobia- Fear of everything. Odynophobia or Odynephobia- Fear of pain. (Algophobia) Papaphobia- Fear of the Pope. Papyrophobia- Fear of paper. Oenophobia- Fear of wines. Paralipophobia- Fear of neglecting duty or responsibility. Oikophobia- Fear of home surroundings, house.(Domatophobia, Eicophobia) Paraphobia- Fear of sexual perversion. Olfactophobia- Fear of smells. Parasitophobia- Fear of parasites. Ombrophobia- Fear of rain or of being rained on. Paraskavedekatriaphobia- Fear of Friday the 13th. Ommetaphobia or Ommatophobia- Fear of eyes. Parthenophobia- Fear of virgins or young girls. Omphalophobia- Fear of belly buttons. Pathophobia- Fear of disease. Oneirophobia- Fear of dreams. Patroiophobia- Fear of heredity. Oneirogmophobia- Fear of wet dreams. Parturiphobia- Fear of childbirth. Onomatophobia- Fear of hearing a certain word or of names. Peccatophobia- Fear of sinning or imaginary crimes. Pediculophobia- Fear of lice. Ophidiophobia- Fear of snakes. (Snakephobia) Pediophobia- Fear of dolls. Ophthalmophobia- Fear of being stared at. Pedophobia- Fear of children. Opiophobia- Fear medical doctors experience of prescribing needed pain medications for patients. Peladophobia- Fear of bald people. Pellagrophobia- Fear of pellagra. Optophobia- Fear of opening one's eyes. Peniaphobia- Fear of poverty. Ornithophobia- Fear of birds. Pentheraphobia- Fear of mother-in-law. (Novercaphobia) Orthophobia- Fear of property. Osmophobia or Osphresiophobia- Fear of smells or odors. Phagophobia- Fear of swallowing or of eating or of being eaten..

45 Phalacrophobia- Fear of becoming bald.
Poinephobia- Fear of punishment. Phallophobia- Fear of a penis, esp erect. Ponophobia- Fear of overworking or of pain. Pharmacophobia- Fear of taking medicine. Porphyrophobia- Fear of the color purple. Phasmophobia- Fear of ghosts. Potamophobia- Fear of rivers or running water. Phengophobia- Fear of daylight or sunshine. Potophobia- Fear of alcohol. Philemaphobia or Philematophobia- Fear of kissing. Pharmacophobia- Fear of drugs. Proctophobia- Fear of rectums. Philophobia- Fear of falling in love or being in love. Prosophobia- Fear of progress. Philosophobia- Fear of philosophy. Psellismophobia- Fear of stuttering. Phobophobia- Fear of phobias. Psychophobia- Fear of mind. Photoaugliaphobia- Fear of glaring lights. Psychrophobia- Fear of cold. Photophobia- Fear of light. Pteromerhanophobia- Fear of flying. Phonophobia- Fear of noises or voices or one's own voice; of telephones. Pteronophobia- Fear of being tickled by feathers. Pupaphobia - Fear of puppets. Phronemophobia- Fear of thinking. Pyrexiophobia- Fear of Fever. Phthiriophobia- Fear of lice. (Pediculophobia) Pyrophobia- Fear of fire. Phthisiophobia- Fear of tuberculosis. Radiophobia- Fear of radiation, x-rays. Placophobia- Fear of tombstones. Ranidaphobia- Fear of frogs. Plutophobia- Fear of wealth. Rectophobia- Fear of rectum or rectal diseases. Pluviophobia- Fear of rain or of being rained on. Rhabdophobia- Fear of being severely punished or beaten by a rod, or of being severely criticized. Also fear of magic.(wand) Pneumatiphobia- Fear of spirits. Pnigophobia or Pnigerophobia- Fear of choking of being smothered. Rhypophobia- Fear of defecation. Pocrescophobia- Fear of gaining weight. (Obesophobia) Rhytiphobia- Fear of getting wrinkles. Rupophobia- Fear of dirt. Pogonophobia- Fear of beards. Russophobia- Fear of Russians. Poliosophobia- Fear of contracting poliomyelitis. Politicophobia- Fear or abnormal dislike of politicians. Polyphobia- Fear of many things.

46 Samhainophobia: Fear of Halloween.
Sitophobia or Sitiophobia- Fear of food or eating. (Cibophobia) Sarmassophobia- Fear of love play. (Malaxophobia) Snakephobia- Fear of snakes. (Ophidiophobia) Satanophobia- Fear of Satan. Soceraphobia- Fear of parents-in-law. Scabiophobia- Fear of scabies. Social Phobia- Fear of being evaluated negatively in social situations. Scatophobia- Fear of fecal matter. Scelerophibia- Fear of bad men, burglars. Sociophobia- Fear of society or people in general. Sciophobia Sciaphobia- Fear of shadows. Somniphobia- Fear of sleep. Scoleciphobia- Fear of worms. Sophophobia- Fear of learning. Scolionophobia- Fear of school. Soteriophobia - Fear of dependence on others. Scopophobia or Scoptophobia- Fear of being seen or stared at. Spacephobia- Fear of outer space. Scotomaphobia- Fear of blindness in visual field. Spectrophobia- Fear of specters or ghosts. Spermatophobia or Spermophobia- Fear of germs. Scotophobia- Fear of darkness. (Achluophobia) Scriptophobia- Fear of writing in public. Spheksophobia- Fear of wasps. Selachophobia- Fear of sharks. Stasibasiphobia or Stasiphobia- Fear of standing or walking. (Ambulophobia) Selaphobia- Fear of light flashes. Staurophobia- Fear of crosses or the crucifix. Selenophobia- Fear of the moon. Stenophobia- Fear of narrow things or places. Seplophobia- Fear of decaying matter. Stygiophobia or Stigiophobia- Fear of hell. Sesquipedalophobia- Fear of long words. Suriphobia- Fear of mice. Sexophobia- Fear of the opposite sex. (Heterophobia) Symbolophobia- Fear of symbolism. Siderodromophobia- Fear of trains, railroads or train travel. Symmetrophobia- Fear of symmetry. Syngenesophobia- Fear of relatives. Siderophobia- Fear of stars. Syphilophobia- Fear of syphilis. Sinistrophobia- Fear of things to the left or left-handed. Sinophobia- Fear of Chinese, Chinese culture.

47 Tachophobia- Fear of speed.
Topophobia- Fear of certain places or situations, such as stage fright. Taeniophobia or Teniophobia- Fear of tapeworms. Toxiphobia or Toxophobia or Toxicophobia- Fear of poison or of being accidently poisoned. Taphephobia Taphophobia- Fear of being buried alive or of cemeteries. Traumatophobia- Fear of injury. Tapinophobia- Fear of being contagious. Tremophobia- Fear of trembling. Taurophobia- Fear of bulls. Trichinophobia- Fear of trichinosis. Technophobia- Fear of technology. Trichopathophobia or Trichophobia- Fear of hair. (Chaetophobia, Hypertrichophobia) Teleophobia- 1) Fear of definite plans. 2) Religious ceremony. Triskaidekaphobia- Fear of the number 13. Telephonophobia- Fear of telephones. Tropophobia- Fear of moving or making changes. Teratophobia- Fear of bearing a deformed child or fear of monsters or deformed people. Trypanophobia- Fear of injections. Testophobia- Fear of taking tests. Tuberculophobia- Fear of tuberculosis. Tetanophobia- Fear of lockjaw, tetanus. Tyrannophobia- Fear of tyrants. Teutophobia- Fear of German or German things. Uranophobia or Ouranophobia- Fear of heaven. Urophobia- Fear of urine or urinating. Textophobia- Fear of certain fabrics. Vaccinophobia- Fear of vaccination. Thaasophobia- Fear of sitting. Venustraphobia- Fear of beautiful women. Thalassophobia- Fear of the sea. Verbophobia- Fear of words. Thanatophobia or Thantophobia- Fear of death or dying. Verminophobia- Fear of germs. Vestiphobia- Fear of clothing. Theatrophobia- Fear of theatres. Virginitiphobia- Fear of rape. Theologicophobia- Fear of theology. Vitricophobia- Fear of step-father. Theophobia- Fear of gods or religion. Thermophobia- Fear of heat. Tocophobia- Fear of pregnancy or childbirth. Tomophobia- Fear of surgical operations. Tonitrophobia- Fear of thunder.

48 Walloonphobia- Fear of the Walloons.
Wiccaphobia: Fear of witches and witchcraft. Xanthophobia- Fear of the color yellow or the word yellow. Xenoglossophobia- Fear of foreign languages. Xenophobia- Fear of strangers or foreigners. Xerophobia- Fear of dryness. Xylophobia- 1) Fear of wooden objects. 2) Forests. Xyrophobia-Fear of razors. Zelophobia- Fear of jealousy. Zeusophobia- Fear of God or gods. Zemmiphobia- Fear of the great mole rat. Zoophobia- Fear of animals.

49 Neurobiological Substrates Specific Phobia
Genetics -there may be a genetic susceptibility to certain categories (more likely to get specific phobia that 1st degree relative has). -Preparedness Temperament -Neuroticism Protective Factors -prior exposure w/ stimulus -perceived controllability Environmental -Traumatic experiences. -Parental overprotectiveness. -Parental loss/separation. -physical/sexual abuse. Secondary Features: -“clinically significant distress in multiple domains”. Neurobiological Substrates -amygdalar hyperactivation -insular hyperactivity -strengthened neural connections w/ fear conditioning -ppl w/ blood-injection-injury phobia are susceptible to fainting. Specific Phobia -Marked fear/anxiety about specific object or situation. -avoidance behaviors -attentional bias -judgmental bias Associated Outcomes: -unlikely to remit if it persists into adulthood. -higher suicide risk. -life changes via avoidance behaviors. -more likely to develop comorbid disorders. Experience w/ Stimulus: -direct -vicarious -information transmission Treatment -Exposure

50 References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: Author. Beck, H. P., Levinson, S., & Irons, G. (2009). Finding little Albert: A journey to John B. Watson’s infant laboratory. American Psychologist, 64(7), 605. Cook, M., & Mineka, S. (1989). Observational conditioning of fear to fear-relevant versus fear-irrelevant stimuli in rhesus monkeys. Journal of abnormal psychology, 98(4), 448. De Jong, P. J., Andrea, H., & Muris, P. (1997). Spider phobia in children: Disgust and fear before and after treatment. Behaviour Research and Therapy, 35(6), Division 12, American Psychological Association. Exposure therapies for specific phobias. Retrieved from https://www.div12.org/PsychologicalTreatments/treatments/specificphobia_exposure.html Etkin, A., & Wager, T. (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164(10), Fredrikson, M., Annas, P., Fischer, H., & Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behaviour Research and Therapy, 34(1),

51 Fyer, A. J. (1998). Current approaches to etiology and pathophysiology of specific phobia. Biological Psychiatry, 44(12), doi: Hugdahl, K. (1981). The three-systems-model of fear and emotion—a critical examination. Behaviour Research and Therapy, 19(1), Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1992). The genetic epidemiology of phobias in women: the interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of General Psychiatry, 49(4), Lombroso, P. J., & Ogren, M. P. (2008). Learning and Memory, Part I: Brain Regions Involved in Two Types of Learning and Memory. J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 47(11). McNally, R. J. (1987). Preparedness and phobias: A review. Psychological Bulletin, 101(2), doi: / Menzies, R. G., & Clarke, J. C. (1995). The etiology of phobias: A nonassociative account. Clinical Psychology Review, 15(1), Merckelbach, H., de Jong, P. J., Muris, P., & van Den Hout, M. A. (1996). The etiology of specific phobias: A review. Clinical Psychology Review, 16(4), doi: Öst, L.-G. (1987). Age of onset in different phobias. Journal of abnormal psychology, 96(3), 223.

52 Öst, L. -G. , Svensson, L. , Hellström, K. , & Lindwall, R. (2001)
Öst, L.-G., Svensson, L., Hellström, K., & Lindwall, R. (2001). One-session treatment of specific phobias in youths: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 69(5), 814. Seligman, M. E. P. (1971). Phobias and preparedness. Behavior therapy, 2(3), Watson, J. B., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3(1), 1.


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