1. Kardinia International College
Unit 4 Psychology Final Review Series
AOS 2: Applications of a Biopsychosocial framework
2. Simple Phobia as an Example of an Anxiety Disorder

2. A state of physiological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or that something unpleasant is about to happen.

3. Anxiety Disorder Defined
Anxiety disorder is a group of disorders characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect.
Anxiety disorders are distinguished from ‘normal’, everyday anxiety in that anxiety disorders involve anxiety that:
• is more severe (intense)
• lasts longer (anxiety may persist for months instead
of going away after the anxiety-provoking situation has passed), and
• significantly interferes with a person’s daily life and
stops them doing what they want to do.

4. Key characteristics are:
Phobia
A phobia is an excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning.
Key characteristics are:
anxiety: exposure to the phobic stimulus almost invariably induces an immediate anxiety response;
awareness: the person recognizes that their fear is excessive or unreasonable;
avoidance: the phobic situation is avoided or else is endured with intense anxiety or distress.

5. Phobias and DSM-IV-TR
As with all other disorders in the DSM-IV-TR, the person’s anxiety and avoidance behavior significantly interfere with their everyday life and causes them great distress.
According to the DSM, a person’s fear of a specific object or situation must have persisted for at least six months for them to be diagnosed as having specific phobia.
 3% of the Australian Population suffer from Phobias
More women than men suffer Phobias

6. Forms of Phobias
DSM-IV-TR divides phobias into three categories: Agoraphobia, Social Phobia and Specific Phobia. In the study design is states that we focus on Simple (specific) phobia.
Simple (specific) phobias involve an intense fear that is restricted, or confined, to a single ‘specific’ stimulus such as fear of heights, ladders, frogs, enclosed places, etc.
Complex phobias involve a non-specific, more ‘general’ fear that usually involves a ‘number of anxieties’ so it is more ‘complex’,
Complex Phobias - Examples
In fear of flying, the person may be afraid of crashing, being enclosed in the plane, and losing self-control
With agoraphobia, the person may be afraid of entering shops, crowds and public places, travelling in trains, buses and planes and is also anxious about being unable to escape to a place of safety.

7. DSM phobia categories Animals Situations Blood / injections
Natural environments
Other (choking, dying, illness, falling etc)

8. Biological Contributing Factors to a Fear-Anxiety Response :
Amygdala: a region in the brain which is involved in processing emotions – in this context – fear.
Noradrenaline: mediates the physiological symptoms of fear / anxiety through the sympathetic nervous system.
The HPA Axis and Adrenaline are involved with the stress response.
HPA Axis activity results in the release of Cortisol from the Adrenal Gland above each kidney.
Adrenaline hormone and subsequent adrenaline neurotransmitter activity results in the wide range of physical changes discussed in the sympathetic nervous system fight or flight response.

9. Role of the Stress Response:
A phobic reaction is an exaggerated fear response.
From a physiological perspective, an extreme fight –flight response occurs when the individual encounters the phobic stimulus or anticipates such an encounter.
The terror experienced is marked by physical anxiety symptoms, cognitive symptoms of fear of the object or situation (fright/fight response), and an intense desire to escape (flight response).

10. Role of the neurotransmitter Gamma-amino butyric acid (GABA) in the management of Phobic Anxiety
GABA (gamma-amino butyric acid) is the major inhibitory neurotransmitter that makes presynaptic neurons less likely to fire in the brain.
GABA inhibitory action counterbalances the excitatory action of glutamate (that makes presynaptic neurons more likely to fire).
It is found in the CNS (brain and spinal cord).

11. Not enough GABA makes me anxious!

12. GABA – Primary Function
Gamma-amino butyric acid is the primary inhibitory neurotransmitter in the CNS.
Inhibits postsynaptic neurons – stops them passing on the neural impulse
Gets in the synapse to block transmission
Helps fine tune brain activity, keeps neural transmission from getting out of control
Without GABA neural activation could spread like fire throughout the brain causing seizures

13. Management of Anxiety Biologically: Use of Pharmaceutical Medication
Lack of the neurotransmitter GABA might lead to over stimulation, and thus heightened anxiety
1. Benzodiazepines – a class of drugs that ‘calm down’ neural activity. Valiam, Xzanax, Rohypnol, Serepax etc.
All drugs are either Agonists – mimic the activity of a neurotransmitter
Or Antagonists – inhibit the activity of a neurotransmitter
2. GABA Supplements can also be prescribed, however their effectiveness is yet to be proven medically as the synthetic GABA has difficulty crossing the blood-brain barrier.

14. GABA
Stop the message!
GLUTIMATE
Get the message going!

15. Psychological Contributing Factors:
Psychodynamic Model
Behavioral and Cognitive Models

16. Freud’s psychodynamic model
Mental disorders are caused by unresolved conflicts that occur in the subconscious
‘skeletons in the closet’
Memories that are too distressing are pushed out of conscious awareness
As we grow up we progress through different psychosexual stages
oral 0 – 2
Anal 2 -3
Phalic 4 -5
Latency 6 – puberty

17. Freud’s psychodynamic model
As we progress through these stages different parts of the body become the focus of attention and pleasure
Each stage has a critical developmental conflict that must be resolved to move onto the next stage
Unresolved conflicts cause anxiety
Freud’s anxiety refers to unpleasant feeling when our instincts make us do something that we will be punished for

18. Freud’s psychodynamic model
We use defence mechanisms to protect ourselves from this anxiety
The ego (conscious part of the mind) distorts, denies or falsifies reality unconsciously
We can then ‘believe’ that there is no reason to be anxious
We lie to ourselves to be happy

19. Freud’s psychodynamic model – oedepal complex
Phallic stage 0 – 3
Male child develops sexual attraction to his mother
Below conscious awareness
Fears father who is bigger and stronger, believes punishment will involve castration
Repression used as defence mechanism
Child identifies with father – being like dad will mean dad will be less inclined to punish me
Displacement can also be used
Anxiety directed onto another irrelevant object, then the child can avoid this stimulus and thus solve the conflict

21. Freud’s psychodynamic model – Pseudoscience?
Based on very small (unhealthy) samples
Very subjective
Can easily shift the facts to fit the theory
Some useful ideas
Not used in its original form today by the majority of practicing psychologists
Remember recovered memory syndrome from Unit 3?

22. Behavioural model Phobias are learned
Learned through classical conditioning or observational learning
Maintained through operant conditioning

23. Behavioural model: Watson and Little Albert

24. Classical Conditioning of Arachnophobia
UCS– spider in sandpit
UCR– fear
NS– spiders
CS– spiders
CR – fear
Avoidance of spiders or spider related places, images etc is negatively reinforcing, avoiding the bad stimulus.
This strengthens further avoidance behaviours

25. Role of Operant Conditioning
Acquisition: Phobias can be acquired by operant conditioning processes through positive reinforcement.
Maintenance: Phobias can be maintained by operant conditioning processes through negative reinforcement.
When a person is confronted with their feared object or situation, the person experiences intense, almost unbearable, anxiety but their fear/anxiety is reduced by avoiding the object or situation.
The avoidance behaviour is therefore negatively reinforced (more likely to occur again in the future) and the phobia is maintained.

26. LITTLE ALBERT OPERANT CONDITIONING:
Little Albert’s specific phobia of white rats (and all things white and furry) was then maintained through operant conditioning, specifically, through negative reinforcement.
   

27. Cognitive model Maladaptive (Negative) Cognition:
A cognitive theory of phobia, that says that a person may experience shame or embarrassment at the thought that he or she may become frightened in public and may avoid such a risk (further negatively reinforcing the avoidance behaviour).
Key Assumptions:
The focus or emphasis of cognitive models in explaining the development and persistence of a specific phobia:
Focus: how the individual processes information and thinks about the phobic stimulus and related events (e.g. their perceptions, memories, beliefs, attitudes, appraisals and expectations).
Emphasis: how and why people with a specific phobia have an unreasonable and excessive fear of a particular phobic stimulus.

28. Cognitive model – Attentional Bias
Seek out and notice threatening stimuli over normal stimuli
Eg. Arachnophobias might notice a spider web in the corner while everyone else is looking at the painting on the wall
Tend to be hyper vigilant – always looking out for the phobic stimulus

29. Cognitive biases:
Cognitive biases are tendencies to think in some kind of erroneous/mistaken or distorted way that involves an error(s) of judgment and faulty decision-making (and therefore also referred to as ‘mistakes in thinking’ or cognitive distortions).
Note: In relation to phobias, cognitive biases make individuals more prone or vulnerable to experiencing fear and anxiety in response to a phobic stimulus.

30. Cognitive model – memory bias
Remember the bad things more readily
Eg. Only remember being dumped by a big wave, not the hundreds of small waves that were enjoyable to jump over
Memories reconstructed to be worse than the actual event

31. Cognitive model – interpretive bias
Neutral situations or stimuli interpreted as threatening
Eg. Fluff on the carpet is a spider, a dog running over happily is going to attack

32. Cognitive model: Catastrophic Thinking
Negative thinking in which things are percieved in the ‘worst possible’ light
Often underestimate their ability to cope with the situation
What can go wrong will go wrong, and in a big way
e.g. a person with a phobia of bees
may think that any bee they
encounter will attack and kill them.

33. The Use of Psychotherapies in the Treatment of Anxiety:
Cognitive Behavioural Therapy (CBT)
Systematic Desensitisation
Flooding

34. Cognitive Behavioural Therapy (CBT)
CBT helps people with phobias face up to their fears by teaching them new skills to help them react differently to the situations that trigger their phobia.
Patients also learn to understand how their thinking patterns contribute to the:
Situations that trigger their phobia
Symptoms
How to Change their beliefs to reduce or stop these symptoms and, in time, accept whatever was causing their extreme anxiety.

35. Systematic Desensitisation
A process where individuals extinguish the association between the phobic stimulus and anxiety through a series of graded steps – known as a fear hierarchy.

36. Systematic Desensitisation
Incremental exposure allows the patient to gradually face the phobic stimulus and replace the fear response with the specific relaxed response.

37. Flooding
Flooding involves exposing a phobic person repeatedly to the object of fear either in vivo (real life/natural setting) or indirectly by imagination or virtual reality. – The technique initially creates significant distress in the patient.

38. Flooding
It is not suggested for most individuals because it can trigger a higher level of sensitisation or fear reinforcement.
It works well when the individual is highly motivated and given appropriate support through the process.
Eventually through sustained contact the patient learns to relax in the presence of the phobic stimulus.

39. Socio-cultural Contributing Factors
Specific Environmental Triggers such as being bitten by a dog
Where something in the environment triggers the anxiety-fear response.
All Specific Phobias have a direct relationship to the person’s environment or their knowledge of it.

40. Parental Modelling Modelling bravery can help children cope with fears
Where parental influences have shaped the development of anxiety disorders of their children, particularly relevant in social anxiety.
Modelling bravery can help children cope with fears
Reference to Bandura’s stages of Observational Learning are relevant here:
Attention, retention, reproduction, motivation- reinforcement.

41. Transmission of threat information
Delivery of information from others about potential threat
Children might develop a phobia if constantly warned about the dangers of going outside alone
Research suggests that fears develop largely due to negative information about a specific event, object or situation being communicated often enough vs