5.2 Phobias and 5.3 Social Anxiety Disorder

The key to greater success in all forms of exposure treatment

Actual contact with the feared object or situation. That is, in vivo exposure tends to be more effective than covert exposure

in vivo desensitization

Therapist has the client face the event at the bottom of the hierarchy through actual confrontation.

covert desensitization

Therapist has the client face the event at the bottom of the hierarchy through imagined confrontation.

exposure treatment

Treatment in which persons are exposed to the objects or situations they dread. Use the exposure techniques of Systematic desensitization, flooding, and modeling. Around 70% show significant improvement.

modeling

Way of acquiring fear reaction. A process of learning in which an individual acquires responses by observing and imitating others. person may observe that others are afraid of certain objects or events and develop fears of the same things.

relaxation training

teaching them how to bring on a state of deep muscle relaxation at will.

cognitive side,

the clinicians and clients have systematic therapy discussions in which the clients are guided to reexamine and challenge their maladaptive beliefs and expectations, given the less-than-dire outcomes of their social exposures.

behavioral side,

they conduct exposure therapy, the intervention so effective with phobias. The therapists encourage clients to expose themselves to their dreaded social situations and to remain in these situations as their fears subside.

participant modeling,

version of modeling where the client is actively encouraged to join in with the therapist.

Modeling in exposure treatment

where it is the therapist who confronts the feared object or situation while the fearful person observes. therapist acts as a model to demonstrate that the person's fear is groundless.

__percent of people in the United States and other Western countries (around 60 percent of them female) experience social anxiety disorder in any given year. __ percent develop this disorder at some point in their lives More common in poor people and white people. __of individuals with social anxiety disorder are currently in treatment.

7%, 12%, 40%

unconditioned response (UCR):

A natural, innate response that needs no training.

conditioned stimulus (CS):

A once-neutral stimulus that has been paired with an unconditioned stimulus to bring about a response formerly caused only by the unconditioned stimulus.

PHOBIA

A persistent and unreasonable fear of a particular object, activity, or situation. People become fearful if they even think about the object or situation they dread. intense and persistent and the desire to avoid the object or situation is stronger. Most fall under "specific phobias".

preparedness

A predisposition to develop certain fears. Theorists often account for these differences in fear reactions by proposing that human beings, as a species, have a predisposition to develop certain fears.

classical conditioning

A process of learning by temporal association in which two events that repeatedly occur close together in time become fused in a person's mind and produce the same response. Common way of acquiring phobias. If one event triggers a fear response, the other may also.

social anxiety disorder

A psychological disorder in which people fear social situations. have severe, persistent, and irrational anxiety about social or performance situations in which they may face scrutiny by others and possibly feel embarrassment. The fear may be broad or narrow. People repeatedly judge themselves as performing less competently than they actually do.

conditioned response (CR):

A response that, after conditioning, follows a previously neutral stimulus.

specific phobia

A severe and persistent fear of a specific object or situation. When sufferers are exposed to the object or situation, they typically experience immediate fear. DSM-5's label for an intense and persistent fear of a specific object or situation. Symptoms effects up to 9% of people in US and 13% during life lime. Women diagnosed outnumber men 2 to1. 32% seek treatment. among the first anxiety disorders to be treated successfully

social skills training

A therapy approach that helps people learn or improve social skills and assertiveness through role-playing and rehearsing of desirable behaviors.Use several techniques are combined. The therapists usually model appropriate social behaviors for clients and encourage the individuals to try them out. The clients then role-play with the therapists, rehearsing their new behaviors until they become more effective. Throughout the process, therapists provide frank feedback and reinforce (praise) the clients for effective performances.

Treatments for Specific Phobias

Actual contact with the feared object or situation is key to greater success in all forms of exposure treatment. Systematic desensitization, flooding, and modeling.

agoraphobia

An anxiety disorder in which a person is afraid to be in public situations from which escape might be difficult or help unavailable if panic-like or embarrassing symptoms were to occur. Effects 1% of population in a year, 1.3% display in lifetime. More common in women. Around 46% receive treatment. Intensity may fluctuate. Often paired with panic attacks and panic disorder.

flooding

An exposure treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless. forced to face their feared objects or situations without relaxation training and without a gradual buildup. can be either in vivo or covert. Therapist may exaggerate the description so that the clients experience intense emotional arousal.

systematic desensitization

An exposure treatment that uses relaxation training and a fear hierarchy to help clients with phobias react calmly to the objects or situations they dread. relaxation response is thought to substitute for the fear response. Uses relaxation training and Fear Hierarchy, clients learn how to pair relaxation with the objects or situations they fear. Relaxation training, Fear hierarchy, in vivo desensitization, Overt desensitization, Virtual reality.

Fear reaction/phobias acquired/learned by

Classical conditioning, Modeling,

home-based self-help programs

Clinicians give clients and their families detailed instructions for carrying out exposure treatments themselves.

What causes specific phobias?

Cognitive-behavioral theories receive most research support. Focus primarily on behavioral dimension. First fear of certain objects, situations, or events are learned through conditioning. Once fears are acquired, individuals avoid dreaded object or situation and permit fears to become entrenched.

How do fears differ from phobias?

DSM-5 indicates that a phobia is more intense and persistent and the desire to avoid the object or situation is stronger. People with phobias often feel so much distress that their fears may interfere dramatically with their lives.

cognitive-behavioral theorists start with the contention that people with this disorder hold a group of dysfunctional beliefs and expectations regarding the social realm like

Holding unrealistically high social standards and so believing that they must perform perfectly in social situations. Believing they are unattractive social beings. Believing they are socially unskilled and inadequate. Believing they are always in danger of behaving incompetently in social situations. Believing that inept behaviors in social situations will inevitably lead to terrible consequences. Believing they have no control over the feelings of anxiety that emerge in social situations.

Specific phobia checklist

Marked, persistent, and disproportionate fear of a particular object or situation; usually lasting at least 6 months.Exposure to the object produces immediate fear.Avoidance of the feared situation.Significant distress or impairment.

Treatments for social anxiety disorder address two distinct features:

Overwhelming social fears (Medications: Benzodiazepine or antidepressant drugs, Cognitive-behavioral therapy: Exposure therapy and systematic therapy discussions) and Lack of social skills (Social skills and assertiveness training)

Social skills training groups and assertiveness training groups,

Reinforcement from other people with similar social difficulties is often more powerful than reinforcement from a therapist alone. Members try out and rehearse new social behaviors with other group members. Such groups also provide guidance on what is socially appropriate.

social anxiety disorder checklist

Pronounced, disproportionate, and repeated anxiety about social situation(s) in which the individual could be exposed to possible scrutiny by others; typically lasting 6 months or more. Fear of being negatively evaluated by or offensive to others. Exposure to the social situation almost always produces anxiety. Avoidance of feared situations. Significant distress or impairment.

agoraphobia checklist

Pronounced, disproportionate, or repeated fear about being in at least two delineated situations. Avoidance of the agoraphobic situations. Symptoms usually continue for at least 6 months. Significant distress or impairment

A Behavioral-Evolutionary Explanation

Some specific phobias are much more common than others. Species-specific biological predisposition to develop certain fears: preparedness Explains why some phobias (snakes, spiders) are more common than others (meat, houses)

Category of phobias

Specific phobia and agoraphobia.

unconditioned stimulus (UCS):

Stimulus that brings about a particular response without having been learned. Occurs naturally.

neutral stimulus:

Stimulus that, before conditioning, does not naturally bring about the response of interest.

Three oldest and best known exposure treatments

Systematic desensitization, flooding, and modeling.

Fear hierarchy

a list of feared objects or situations, ordered from mildly to extremely upsetting.

Support group agoraphobia approach

a small number of people with agoraphobia go out together for exposure sessions that last for several hours. The group members support and encourage one another, and eventually coax one another to move away from the safety of the group and perform exposure tasks on their own.

How Are Phobias Treated?

cognitive-behavioral approach is more widely used and, according to research, more successful than the rest, particularly for specific phobias. practitioners of the model focus primarily on the behavioral dimension of phobias.

What Causes Social Anxiety Disorder?

cognitive-behavioral theorists proposes leading explanation for social anxiety disorder. interplay of both cognitive and behavioral factors. Group of social realm dysfunctional beliefs and expectations held; anticipation of social disasters and dread of social situations Avoidance and safety behaviors performed to reduce or prevent these disasters. Tied to genetic predispositions, trait tendencies, biological abnormalities, traumatic childhood experiences, overprotective parent-child interactions

How Can Social Fears Be Reduced?

either benzodiazepines or antidepressant drugs to help alleviate social fears to some degree in 55% of people. cognitive-behavioral therapy has proved to be at least as effective as medication at reducing social fears, and people helped by this approach seem less likely to relapse than those treated with medications alone.

panic attacks

extreme and sudden explosions of fear.

positive side of fear,

fear can alert us to danger, help us behave constructively, and guide us to make wise decisions.

negative side of fear,

fear can be excessive and inappropriate and contribute to phobias and other anxiety disorders.

cognitive-behavioral theorists explanations for phobias

have received the most research support.Focusing primarily on the behavioral dimension of this disorder, they believe that people with phobias first learn to fear certain objects, situations, or events through conditioning. Once the fears are acquired, the individuals avoid the dreaded object or situation, permitting the fears to become all the more entrenched.

cognitive-behavioral explanations of phobias limits

laboratory studies with children and adults have failed to condition fear reactions. phobia can be acquired by classical conditioning or modeling, researchers have not established that the disorder is ordinarily acquired in this way. Fear reactions not always conditioned. Disorder not ordinarily acquired through classical conditioning or modeling

Cognitive-behavioral theorists believe that after acquiring a fear response,

people try to avoid what they fear. They do not get close to the dreaded objects often enough to learn that the objects are really quite harmless.

Where do predispositions to fear come from?

predispositions have been transmitted genetically through an evolutionary process. Among our ancestors, the ones who more readily acquired fears of animals, darkness, heights, and the like were more likely to survive long enough to reproduce and to pass on their fear inclinations to their offspring

How Can Social Skills Be Improved?

social skills training

Exposure therapy for people with agoraphobia

support groups and home-based self-help programs. Around 70 percent of agoraphobic clients who receive exposure treatment find it easier to enter public places, and the improvement persists for years. improvements are often partial rather than complete, and as many as half of successfully treated clients have relapses. Those whose agoraphobia is accompanied by a panic disorder seem to benefit less than others from exposure therapy alone.