13 - Specific Phobia

Use of benzodiazepine agents

- A group of drugs ('agents') that work on the central nervous system, acting selectively on GABA receptors in the brain to increase GABA's inhibitory effects and make post-synaptic neurones resistant to excitation - Has anti-anxiety and sleep inducing properties - also referred to as sedatives, depressants, mild tranquilliser due to slowing down of CNS activity - relieve symptoms of anxiety by reducing physiological arousal and promoting relaxation - induce drowsiness - can be highly addictive and long term use is not recommended

Physcological Contributing Factors - Phobia

- According to behavioural models, phobias are learned through experience and may be acquired, maintained or modified by environmental consequences such as rewards and punishments. - In particular, a specific phobia may be precipitated through classical conditioning and perpetuated by operant conditioning. This two-part process was originally called two-factor learning theory. - Phobias — like most other dysfunctional ways of thinking, feeling or behaving — are learned through classical and operant conditioning processes in much the same way as 'normal' ways of thinking, feeling and behaving are learned.

Agonist vs. Antagonist

- Agonists: drugs/medications that work by stimulating a neurotransmitter's activity - Antagonist: drugs/medications that work by inhibiting a neurotransmitter's activity NOTE: Benzodiazepines are GABA agonists. NOTE: antagonists reduce GABA activity and can therefore produce or increase the severity of anxiety symptoms

Evidence-Based Interventions in the treatment of specific phobia

- Evidence-based interventions are treatments that have been found to be effective on the basis of valid and reliable research studies - aka 'treatments' - Ensures that treatments vary according to the particular disorder and the individual's ('client's) specific symptoms - Ensures that interventions lacking scientific evidence of effectiveness are recognised and avoided - Involve the use of: 1. benzodiazepine 2. breathing retraining and exercise 3. Psychological interventions: involving the use of cognitive behavioural therapy and systematic desensitisation 4. social intervention: involving psycho-education for families and others who may be close to or provide social support for someone with a specific phobia.

More on Anxiety Disorder

- Experiencing severe anxiety can indicate the presence of an anxiety disorder. - Not so severe that individuals lose touch with reality or consistently behave in socially unacceptable ways. - However, people are likely to be diagnosed with an anxiety disorder when their level of anxiety is so severe that it significantly interferes with their daily life and stops them doing what they want to do. - Phobias are a type of anxiety disorder

GABA in Specific Disorders

- GABA also plays a role in anxiety because it acts like a calming agent or 'brake' to the excitatory neurotransmitters that lead to anxiety. There is evidence that some people experience the anxiety associated with phobias because the neurotransmission of GABA becomes dysfunctional. For example, there may be a failure to produce, release or receive the correct amount of GABA needed to regulate neuronal transmission in the brain Some psychologists have proposed that individuals with a low level of GABA are more vulnerable to their flight-flight-freeze response being more easily triggered, which in turn may presdispose them to developing a specific phobia

Biological Factors

- GABA dysfunction - Role of stress response - Long Term Potentiation (LTP)

More on Phobias

- However, a fear response by someone with a phobia is typically out of proportion to the actual danger posed by the object or situation. - There is also a compelling desire to avoid the object or situation. - Sometimes, even the thought of the feared stimulus is enough to cause a phobic reaction. - Having a phobia causes significant anxiety and distress, and interferes with everyday functioning. It is therefore considered a diagnosable mental disorder.

Long Term Potentiation (LTP)

- Perpetuating Factor - Development of phobias is substantially influenced by learning through experience - specific phobias can be aquired through classical conditioning - Long-term potentiation is believed to play an important role in the learning and memory of fear by strengthening synaptic connections in the neural pathway formed during the learning process, resulting in enhanced or more effective synaptic transmission within that pathway. - As with other learning, long-term potentiation can therefore neurologically strengthen the association between a phobic stimulus and a fear or anxiety response through its activity at the synapse. The more that the connection is activated through each encounter with a phobic stimulus, the more the connection is strengthened. The more the connection is strengthened, the more the relevant neural pathway is strengthened, increasing the efficiency in transferring fear information along the pathway and decreasing the likelihood that what has been learnt will be forgotten. - Given the role of the amygdala in conditioned fear responses, it is likely that the LTP is occurring within the amygdala and that the neural pathway(s) formed for a specific phobia will include this structure as well as connections to other relevant structures. - Neurologically strengthen association between a phobis stimulus and a fear/anxiety response through activity at the synapse

Examples of benzodiazepine

- Short-acting means that benzodiazepine remains in the bloodstream and is cleared from the body in a short period of time. - In contrast, a long-actingbenzodiazepine may accumulate in the bloodstream or take a much longer period of time to leave the body.

Biological Interventions

- Target bodily mechanisms believed to contributing to a phobia or its symptoms - Involve the use of medications that target GABA dysfunction and can minimise the onset or severity of symptoms - relaxation techniques - can help in the management of symptoms

Role of the Stress Response

- Underlying and interacting with the psychological component of stress (feelings of apprehension, worry or uneasiness) is a physiological component that is like the physiological response to a stressor. - Flight-Fight-Freeze is activated - heart rate and strength of heartbeat increase to speed up blood flow, blood is redirected from places where it is not needed, the speed and depth of breathing increase, adrenal hormones surge into the bloodstream - These types of reactions account for many of the symptoms associated with phobic anxiety, such as palpitations resulting from a pounding heart and sweating due to increased perspiration. When breathing becomes faster and deeper than necessary, this can result in hyperventilation ('over-breathing') which can heighten the anxiety being experienced and also induce a panic attack. - Phobic anxiety becomes problematic and especially non-adaptive when the stress response is triggered in the absence of any real threat or danger; for example, in response to objects or situations that have very little or no potential for actual harm, such as clouds (nephophobia) or flowers (anthophobia).

Numerous types of specific phobias

- animal e.g. spiders, snakes, dogs, insects, birds, fish, mice - situational e.g. aeroplanes, elevators, enclosed spaces, tunnels - natural environment e.g. heights, storms, darkness, thunder, lightning, being near water - blood-injection-injury e.g. seeing blood, having blood taken, having an injection, getting a cut, any invasive medical procedure - other phobias e.g. choking, vomiting, loud noises, costumed characters, falling down, becoming ill, dying.

GABA (Gamma-amino butyric acid)

- plays role in the experience of anxiety - Primary inhibitory neurotransmitters in CNS - Makes postsynaptic neurones less likely to be activated - Fine tunes neurotransmission - Maintains neurotransmission and neuronal activity at an optimum level - Absence of GABA = activation of postsynaptic neurone might get out of control

Specific Phobia

A disorder characterised by marked fear or anxiety about a specific object or situation, often leading to avoidance behaviour.

Anxiety

A state of arousal involving feelings of apprehension, worry, or uneasiness that something is wrong or something unpleasant is about to happen

Stress

A state of physiological and psychological arousal produced by internal or external stressors that are perceived by the individual as challenging or exceeding their ability or resources to cope

Phobia

Characterised by excessive or unreasonable fear of a particular object or situation

Figure 13.3

Example of Continuums for mental health and associated characteristics

Panic Attack

Period of sudden onset of intense fear or terror, often associated with feelings impending doom

Phobia vs. Fear

Phobia: excessive or unreasonable fear; irrational Fear: rational response when confronted by some things or when in certain situation

Anticipatory

The gradual rise in anxiety level as a person thinks about, or 'anticipates' being exposed to a phobic stimulus in the future

Anxiety Disorder

Used to describe a group of mental disorders that are characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect

What happens when a benzodiazepine attaches to a GABA receptor?

When a benzodiazepine attaches to a GABA receptor, it changes the shape of the receptor to make it more receptive to the activity of GABA and consequently more resistant to excitation. Reducing the excitability of neurons reduces the communication between neurons and, therefore,has a calming effect on many of the functions ofthe brain. If there is no GABA at a receptor on a postsynaptic neuron, a benzodiazepine has very little effect on the neuron. If GABA is present, then the benzodiazepine will usually amplify the impact of GABA

Severe Anxiety

generally accompanied by intense physiological sensations and responses, such as shortness of breath, sweating, trembling, nausea, stomach cramps, dizziness, feelings of suffocating, feelings of losing control and/or feelings of impending doom, depending on the stimulus and the individual involved.

Psychological Contributing Factors

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