1. PHOBIAS – AN EXAMPLE OF AN ANXIETY DISORDER Health

2. What is fear? What is anxiety?  Fear - unpleasant feeling of anxiety or apprehension caused by the presence or anticipation of danger  Anxiety - - feeling of worry: nervousness or agitation, often about something that is going to happen - PSYCHIATRY extreme apprehension: a medical condition marked by intense apprehension or fear of real or imagined danger

3. When does anxiety become a problem?  All people experience anxiety at some time.  It is a normal element of human existence.  However, anxiety can become a major problem with disturbing consequences.  What axis in DSM-IV-TR do anxiety disorders come under?

4. Anxiety disorders  Come under Axis 1 and are characterised by extreme apprehension, fear, stress and unease.

5. 5 main types of anxiety disorder 1. Generalised anxiety disorder 2. Post- traumatic stress 3. Panic disorder 4.Obsessive- compulsive disorder 5. Phobic disorder OUR FOCUS

6. What is a phobia?  A phobia is a persistent, irrational and intense fear of a particular object or event.  persistent - existing for an unpleasantly long  irrational - lacking in reason or logic  intense - extreme in a way that can be felt

7. What cause simple phobias?  After many years of extensive research into the origin and maintenance of simple phobias, scientists came to an important conclusion - there is no simple explanation  Main factors are: - Biological - Genetic tendencies - Brain chemistry - Psychological - Sociocultural - Environmental

8. Subcategories of phobias Fear of other people Fear of social situation Social Phobia Fear of leaving a familiar place Agoraphobia One specific object/event e.g. – fear of heights Simple phobia or Specific phobia

9. Four main types of simple phobia: AnimalNatural Environment Situation Phobias Blood - injection -injury phobia Simple Phobias

10. Symptoms of phobic anxiety  elevated heart rate & blood pressure  tremor (shaking in hands)  palpitations (abnormally fast heartbeats that a person is aware of)  diarrhoea  sweating  shortness of breath  dizziness

11. Fear of clowns- symptoms  Watch the following You Tube video that explains the symptoms by someone suffering from a simple phobia. http://www.youtube.com/watch?v=W2 nK_qmvJ7A&feature=related

12. At what age to phobias start?  Age of onset of simple phobias: - Animal7 years - Blood9 years - Dental12years - Claustrophobia20years - SocialBefore 20 years - AgoraphobiaLate adolescence early adulthood Most simple phobias first appear at anytime, but particularly during adolescence.

13. Biological factors & phobias Stress Response flight –or-flight response will occur when a person is frightened or highly stressed GABA- found in 40% of all synaptic junctions. Low levels of the neurotransmitter GABA leads to higher levels of anxiety Anti-anxiety drugs that mimic GABA’s inhibitory effects can help manage anxiety inhibitory Genetic predisposition and inherited vulnerabilities genetic vulnerability is expressed in a person’s personality; people who are nervous and apprehensive about objects and events are more likely to develop simple phobias and anxiety disorders

14. a substance that stops or slows a chemical reactionMicrosoft® Encarta® 2008. © 1993- 2007 Microsoft Corporation. All rights reserved. Inhibitory or agonist - a substance that stops or slows a chemical reaction. Agonist is the opposite to antagonist

15. Theoretical approaches  Psychodynamic model  Behavioural model: classical conditioning and operant conditioning  Cognitive model

16. Psychodynamic model – p479 Oxford  Is based on the work of Freud.  States that the development of phobias is due to unresolved conflicts that arise during the phallic stage of a child’s development. phallic  If a person is unable to deal with this conflict, their anxiety is displaced to a situation or object that is less relevant – e.g. in the case of Hans (see Oxford p480) a fear of horses. Back to 3 theories

17. Phallic stage - in psychoanalytic theory, relating to a stage of psychosexual development during which a young child's sexual feelings are concentrated on the genitals. Oedipal & Electra complexes Back

18. Behavioural Model: Classical and Operant Conditioning – p 481 Oxford  Focuses on observable behaviours and downplays cognition  Behaviours are learned through classical conditioning and maintained through operant conditioning  e.g. development of dentist phobia dentist phobia  Think about ‘Little Albert’ – draw a similar diagram to explain how his phobia developed & was maintained. Back to 3 theories

19. Dentist Phobia Classical Conditioning – phobia develops Before Conditioning NS  No Response UCS  UCR pain from injection fear: due to pain from injection During Conditioning NS + UCS  UCR dentist pain fear: due to pain from injection After Conditioning CS  CR visit to dentist fear: due to visit to dentist Operant conditioning – phobia maintained The avoidance of the unpleasant injection acts as a negative reinforcer the strengthens the likely hood of that behaviour being repeated. Back

20. Cognitive Model  emphasises the influences of thought processes  is used to examine the distorted thinking process involved in the development  Argues that anxious individuals are more likely to exaggerate perceived threats, making then more likely to interpret some situations, objects or activities as more dangerous than the average person would

21. Treatments for simple phobias 1. Cognitive behaviour therapy (CBT): p482 Oxford - uses a combination of verbal and behaviour modification to help people change their thinking - focuses on the person to change negative thoughts (flies can kill me) to more positive ones (flies are unpleasant but they won’t hurt me if I am careful). - person is encouraged to recognise that the likelihood of their perceived events happening in real life is very small. - often combined with relaxation to treat a wide range of phobias; click on feather to view video about CBT.

22. Treatments for simple phobias 2. Systematic desensitisation - based on the idea that most anxiety responses are initially required through classical conditioning, therefore getting rid of a phobia can be achieved through counter conditioning Steps involved 1. Therapist helps client build an anxiety/fear hierarchy 2. Therapist trains the client in deep muscle relaxation 3. Client tries to work through the hierarchy, learning to remain relaxed; repeat until person can imagine situation/object with no anxiety.

23. Systematic desensitisation: Click me to view a video about systematic desensitisation.

24. Treatment of phobias  3. Flooding - based on the idea that phobias are learnt through classical conditioning - occurs when the client is exposed to feared stimulus all at once for long periods of time - helps the client to replace feelings of anxiety/fear with feelings of relaxation - although effective, is not suitable for everyone and can increase rather than decrease their phobia. - http://www.youtube.com/watch?v=DkaeVrs7- ZA&feature=relmfu http://www.youtube.com/watch?v=DkaeVrs7- ZA&feature=relmfu

25. Sociocultural factors & phobias  Social and cultural factors can contribute to the type and incidence (the rate of occurrence) of simple phobia.  e.g. A child whose parents suffer a phobia of moths is more likely to develop the same or similar phobia.  Some phobias are culturally specific.  e.g. taijin kyofusho, a social phobia that appears almost exclusively in Japan. This is a fear of offending or harming others in social situations. It is different from a traditional social phobia, in which the sufferer is afraid of being personally embarrassed on humiliated.

26. Sociocultural factors & phobias: cont  Parental modelling can lead to the transmission of threat information which is incorporated into a child’s LTM and phobia can develop  i.e. children who are exposed to parents with phobic responses are more likely to develop comparable fears to similar stimuli

27. Biopsychosocial Approach  Health professionals take a holistic approach to treating simple phobias and consider the following factors - genetic vulnerability - physiological processes - psychological determinants - family history of anxiety and simple phobia - environmental influences - symptoms and whether the person can function effectively at work, home and socially.

28. Example of factors considered Biological – has the person been born with an easily startled personality Sociocultural – has the person learnt to fear something by observing other family members Psychological – has the person overestimated the perceived level of danger

29. Combining all the factors  Biological, psychological and social-environmental factors must be considered when treating simple phobias  Step 1 - Full understanding of all the elements needed  Step 2- determine which therapy or combination of therapies is suitable (e.g. CBT, Systematic desensitisation or flooding)  Step 3 – determine if anti-anxiety medication is also needed