1. Anxiety disorder: specific phobia

2. Lesson objectives Learn what an anxiety disorder is, focusing on Specific Phobia Understand the biological contributing factors to phobias and the ways to manage phobias

3. Study design dot point application of a biopsychosocial framework to understanding ONE of the following four types of mental disorder and its management: Anxiety disorder: specific phobia - biological contributing factors: role of the stress response; role of the neurotransmitter gamma aminobutyric acid (GABA) in the management of phobic anxiety

4. Anxiety definition 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.

5. Anxiety disorder definition Describes a group of disorders that are characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect.

6. DSM-IV-TR anxiety disorders Agoraphobia without history of panic disorder Panic disorder with/without agoraphobia Specific phobia Social phobia Obsessive compulsive disorder Post-traumatic stress disorder Generalised anxiety disorder Acute stress disorder Anxiety disorder due to a general medical condition Substance-induced anxiety disorder

7. Phobia definition An excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning.

8. Specific phobia definition A disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour. The specific object/situation producing the fear is called the phobic stimulus.

9. Phobia activity Anunptaphobia: fear of staying single Arachibutyrophobia: fear of peanut butter sticking to the roof of the mouth Hippopotomonstrosesquipped-aphiliophobia: fear of long words Keraunophobia: fear of lighting Ornithophobia: fear of birds Papaphobia: fear of the Pope Pentheraphobia: fear of mother-in-laws Quadrataphobia: fear of quadratic equations Vuteuthindon: fear of picnics

10. http://www.youtube.com/ watch?v=9rl7Lr6eDLc http://www.youtube.com/ watch?v=koNwUeG-iKE People with a specific phobia know that their level of fear is excessive or unreasonable. The fear is in excess of any real danger posed by the phobic stimulus.

11. Symptoms Elevated heart rate & blood pressure Hand tremors Diarrhoea Sweating Shortness of breath Dizziness Feel like they have no control over the situation Exposure to phobic stimulus Triggers involuntary anxiety response (similar to stress response) Can lead to panic attacks (unexpected onset of intense anxiety that can last a few mins > an hour)

12. DSM specific phobia categories CategoriesExamples Animal type Situation type Blood, injections and injury type Natural environments type Other phobiasChoking, vomiting, loud noises, dying, costumed characters

13. Biopsychosocial framework applied to specific phobia and its management Biological factors Psychological factors Social factors Biological factors Contributing factors: Role of stress response Dysfunctional GABA system Management: Benzodiazepines GABA supplement Relaxation response Specific phobia

14. Biological contributing factors Genetic predisposition – moderate level of heritability of anxiety disorders Role of the stress response Role of the brain’s neurochemistry

15. How does the stress response contribute to phobic anxiety? Fight-fight response activated Accounts for phobic symptoms such as sweating & palpitations Dizziness due to increase in ANS arousal then sudden drop in blood pressure

16. Becomes problematic when the anxiety response is triggered when there is no real threat or danger For example, objects/situations that have little potential for harm flowers (anthophobia) or clouds (nephophobia) Anxiety remains until the exposure to the phobic stimulus is gone

17. Role of GABA Gamma-amino butyric acid (GABA) = Primary inhibitory neurotransmitter Inhibits firing of neurons Maintains optimal level of neurotransmission Low levels of GABA leads to higher levels of anxiety Neurons are not stopped from firing NOT THAT GABBA…

18. Role of glutamate (GABA’s mate) Glutamate = primary excitatory neurotransmitter Makes neurons more likely to fire Both GABA and glutamate have important roles in arousal and therefore anxiety

19. How does GABA contribute to phobic anxiety?

20. Management of phobias Benzodiazepines: a group of drugs which are referred to as minor tranquillisers Eg: Valium, Temazepam, Xanax Two types of ‘benzos’ Agonists imitate GABA Antagonists inhibit GABA

21. Questions Where is GABA found? Explain the role that GABA is believed to play in phobic anxiety. Explain how an understanding of the role of GABA can be applied to the management of phobic anxiety. Reference the use of benzodiazepines

22. Lesson objectives Understand the psychological contributing factors of Specific Phobia Discussion of the management of Specific Phobia using psychological techniques

23. Psychological contributing factors Biological factors Psychological factors Social factors Psychological factors Contributing factors: Psychodynamic model Behavioural model Cognitive model Management: CBT Systematic desensitisation Flooding Specific phobia

24. Psychodynamic model Sigmund Freud Phobias develop as a consequence of an unresolved Oedipal complex (sexual love for your opposite-sex parent) Use defence mechanisms to protect oneself from anxiety Repression prevents the socially unacceptable desire Displacement = directing feelings onto another object which becomes the phobic stimulus http://goanimate.com/videos/0XEB-CrGMfmE

25. Behavioural model Phobias are learned through experience Classical conditioning plays a role in the development of a phobia Operant conditioning plays a role in maintaining the phobia

26. Questions Explain how classical conditioning can cause the development of specific phobia. Explain how operant conditioning can cause the maintenance of a specific phobia.

27. Cognitive model How the individual processes information about the phobic stimulus How and why people with a phobia have an unreasonable and excessive fear Cognitive bias: tendency to think in a way that involves errors of judgment and faulty decision-making

28. Interpretive bias The tendency to interpret ambiguous stimuli and situations in a threatening way For example: interpreting tomato sauce as blood (depending on their phobia)

29. Cognitive behavioural therapy (CBT) Cognitive therapy Focuses on thoughts, beliefs & attitudes Techniques help people to understand how they reason Make people aware of their ‘automatic thoughts’ Behavioural therapy Deals with maladaptive behaviours such as avoidance Exposes client to new environmental conditions to retrain them Conditions new behaviours

30. Main assumption of CBT: if you change the way you think, you can change the way you feel and behave

31. TASK: use this flow chart to explain through a CBT perspective how a Specific Phobia is acquired Object/event Thought Feeling (emotion) Behaviour (action)

32. Questions What is cognitive behavioural therapy? What is the aim of the cognitive component of CBT? What is the aim of the behavioural component of CBT?

33. Systematic desensitisation Behaviour thearpy that aims to replace an anxiety response with a relaxation response Two tasks: Unlearning & reassociation 3 step process: 1. 2. 3.

34. Task Construct a simple flow chart to summarise the three steps in systematic desensitisation.

35. Task You are a psychologist. Your client is suffering from Specific Phobia. It is your job to create a fear hierarchy for any one of the following fears. Flying, heights, snakes, circus clowns, going to the dentist, going swimming, eating in a restaurant Your fear hierarchy should contain 10 steps, from easiest to hardest.

36. Flooding Bringing the client into direct contact with their most feared object or situation away straight away and keeping them in contact with it until their fear and anxiety disappears http://www.youtube.com/watch?v=wE5F-FjbTRk

37. Questions How are systematic desensitisation and flooding similar when used in management of specific phobia? How do systematic desensitisation and flooding differ when used in management of specific phobia? Carly has a phobia of cats. How could systematic desensitisation be used to assist Carly to overcome her phobia? How could flooding be used to assist Carly to overcome her phobia?

38. Lesson objectives Review last lesson To understand the socio-cultural contributing factors to specific phobia Specific environmental triggers Parental modelling Transmission of threat information

39. Review task Briefly compare and contrast the cognitive, psychodynamic and behavioural models for explaining phobias.

40. Socio-cultural contributing factors Biological factors Psychological factors Social- cultural factors Contributing factors: Specific environmental triggers Parental modelling Transmission of threat information Management: Non-fear modelling Gather accurate information Specific phobia

41. Specific environmental triggers Developing a phobia after a direct negative experience with an object or situation

42. Parental modelling Observing and reproducing a parent’s fear of an object or situation

43. Transmission of threat information Exposure to negative or frightening information about an object or situation

44. FIRSTHAND EXPERIENCE Specific environmental triggers – direct experience with a phobic stimulus in the past SECONDHAND EXPERIENCE Parental modelling & transmission of threat – (indirect experience)