Phobic disorders

Benzodiazepines

valium and librium bind to neuroceptors and decrease anxiety - effects are ST: Ray and Bryne

Stein

association between childhood sexual/physical abuse and social phobia in adults especially women - correlational and doesn't show cause and effect. Could be many causes ie. biological/ cognitive

Specific phobia are most common in...

women and children

Kleiner and Marshall

84% agoraphobics had experiences of family problems prior to onset of panic attacks - although some people who experience this don't have anxiety. Comorbidity

Biological explanations

1. evolutionary disposition to fear 2. some inherit disposition to be anxious 3. anxiety caused by disrupted bio chemistry or other abnormal brain activity

How many americans have phobias?

12 % individuals develop phobia according to the National Institute of Mental Health

Family studies

1st degree relatives: 50% of genes - family member that has illness = proband

Needle Phobia

20-33% of population- avoid medical are some never have it Unrelated to normal phobias can be biological become more prominent as people need more injections for things e.g. travel

Rarely develops after

25 - social phobia. More men than women seek help

ICD: agoraphobia

3 or more of specific situations

Torgesen

31% concordance in 13 MZ twins for panic disordr and agoraphobia rather than 0% in 16 DZ twins although none of the twins shared the same phobia

Eysneck

66% of patients with 1 anxiety disorder also have another

Kendler

722 female twins with lifetime history of phobia: MZ had lower concordance rate for agoraphobia than DZ which is against genetic hypothesis - might reflect a protective emotional bond between MZ twins - specific phobia it is environment rather than shared genes. 2000 female twin pairs where one twin had been diagnosed with social phobia, 24% concordance for MZ twins compared 15% concordance rate between DZ

SLT

Bandura shows us taht children will imitate and learn hwo to behave. role models imitation vicarious reinforcement any learning behaviour . What if you/ parents are not scared?

Type of specific phobia

Animals Natural environment Situational

Anxiety vs Fear

Anxiety = faulty cognition and imagination - worry and what if Fear = physical real terror

Reliability of diagnosis: Specific phobias

Some one may have fear of knives and avoidance behaviours or OCD - detailed examination of mental state e,g, may have obsessional thoughts that underline fear e.g. about killing someone

Taylor

Children are only marginally better than placebos

Comorbidity (diagnosis and treatment)

Eysenck

Generalised and non-generalised social phobia

Generalised - fear wide variety of social situations non - generalised - patient has one particular fear

Ellis

Irrational thinking: faulty thought process: generalisation, magnification and minimisation.

Classical conditioning

Little Albert - specific phobia

Spontaneous recovery second hand accounts alternative explanation - horse fell down

Little Hans

Why is it difficult with chidlren?

Mark, 14, moved to a new school and took him 18 months to be diagnosed but his mother was being threatened to go to court over 'truancy'

Construct validity

Mattick and Clarke

Difference?

Not fear of situation but fear embarrassment/ humiliation

Amygadala

PET scans: Tilfors: some people with phobias have increased blood flow to amygadala where they experience anticipatory anxiety when compared to controls

Specific phobia

Persistent, irrational fear of an object excluding social and agoraphobia

Psychodynamic

Sigmund Freud conscious expression of repressed conflicts - ego deals with conflicts by protecting itself and repressing emotions into unconscious mind which causes conflicts which creates anxiety which mind deals with in various ways - Little Hans

Treatment with drugs: :) Furmark

Sitalopram and CBT decreases blood flow in region

Kesser

Social phobia can be predictor of depression/ increased rick of developing depression and more severe depression

The Observer 2008

Social phobia can cause vomiting and headaches and panic attacks

Reliability of diagnosis: shared characteristics

Social phobias share some common characteristics with other mental disorders - schizophrenia sometimes show avoidant behaviour and demonstrate extreme anxiety - comorbididty

Types of phobia

Specific Social Agoraphobia

Differences

What is agoraphobia? What if stay at home and don't have panic attack or be brave and go to work and have more? Crowds? angry/ happy/ sad/ large/ small Public places are not specific - how public Lots of variables

What is hard with shyness

Where do you draw the line e.g. some people will only eat alone or lives are dictated

Fear is focused on the inability to escape from the situation, having a panic attack losing control and not being able to escape

agoraphobia

Japan

agoraphobia based on fear of the shame associated with offending other people in social situations (TKS)

Schneier

alcohol related disorders occur twice as often in those affected by social phobia as those without not everyone comes forward for diagnosis because they realise their behaviour is irrational and don't want to labelled as mentally ill. Some people manage lives so never have to face their phobia

Phobia

anxiety disorder

Agoraphobia

anxiety disorder characterised by different situations you may not be able to escape from where you may have a panic attack (panic disorder). Some people go to such lengths to avoid such a situation that they do not leave their home - complication of panic attacks. Onset about 20-40 years and most common in women

Operant conditioning: Maurer

avoiding object doesn't reduce fear it reinforces it - negative reinforcement - rewarded by pleasant feeling of avoiding the stimuli

Seligman

biological 'preparedness' all species are innately prepared to avoid certain stimuli which may be dangerous e.g. heights/ snakes and spiders - human phobias are consistent

Cognitive - behavioural

can explain why some people are more prone to phobias than others and is very successful in therapy at reducing phobias (CBT)

Anxiety

complex set of emotions as a reaction to a real or imagines threat, emotionally, physiologically or physically

Beck

danger beliefs: activated when close to proximity of phobic stimuli - preoccupied with 'fear of fear' rather than feared object. inaccurate expectation of the world - generalised e.g, being hemmed in lift a crowd may transfer to lifts and other situations which causes claustrophobia - irrational thoughts about the future - classical conditioning At a rational level they know that the danger is minimal yet also truly believe that may cause the physical or psychological harm

Huffman

difference between western social phobias and TKS demonstrates how 'individualistic cultures' emphasise the individual whereas western is all about the others

Sue et al:

different causes for different phobias: agoraphobia = specific incident anacrophobia = modelling

Bowlby's theory

early attachment experiences could also be involved with onset of phobias e.g. child experiencing separation anxiety or having over protective parents

Symptoms of Specific phobia

excessive and irrational fear Avoidance Physical symptoms of anxiety anticipatory anxiety

Social phobia/ anxiety

excessive self-consciousness in everyday situation. Persistent fear that will be embarrassed/ humiliated by all their actions so much so that it interferes with work/school. Often combined with low self esteem and depression and anxiety disorders such as OCD - may self medicate and lead to addiction Often runs in families Visible symptoms e.g. cause vicious cycle

Most uses family interview technique

family members provide self reports: vulnerable to memory lapses and distortions as well as demand characteristics

Cognitive - Behavioural approach

faulty thought processes: 1. neg t. about self 2. neg t. about future 3. distorted perception of the world faulty cognitions lead to abnormal behaviour: Beck's ' cognitive errors' based on faulty attributions and schemas (classical conditioning -irrational association)

Genetic explanation

fear and anxiety have evolutionary advantages - fight/ flight > chemicals in brain. Not all people develop extreme fear and especially not to things that are not potentially harmful

Bowlby

found that agoraphobics often had early experiences of family conflict - causes young child to feel very anxious when separated from parents - the fear/ love is repressed but later emerges as a phobia

Parker

found that being overprotected in early childhood lead to phobias later on - agoraphobia is related to parents showed lack of affection > inconsistent evidence

Deviations

from social norms from ideal mental health affecting ability to function Aversion is extreme and unreasonable people adapt their life

Genetic oversensitivity

genetic?

Frederickson and Furmak

people who exposed to phobis stimulus had a started response and increased activity observed in amygadala

Preparedness theory

some phobias are more common than others: biological predisposition from ancestors - natural selection

Noyes

higher than normal rate of agroaphobia 11.^% and panic disorder 17.3% in 1st degree relatives using the family interview method

Animal research

ignores free will - determinism as says that behaviour that has been observed will be carried out and one punished will not - cognitive explanations of behaviour are better at accounting for free will and decision so may be ebtter to combine behaviourist and cognitive

Diathesis stress model

interaction between various factors may explain individual differences on susceptibility to stress and anxiety. Onw individual tolerance threshold form a predisposition to stress - this is vulnerability factor - interaction between this and person's life stress e.g. daily hassles/ uplifts determine their anxiety and phobia

Kayak Angst

inuit disorder which involves fear of kayaking alone in Artic conditions and seems to be variation agoraphobia

Subconcious

is impossible to test

Latency 7-puberty

less sexually motivated - social relationships

Genital stage - puberty to adulthood

libido is once again raised

Mannuza:

made distinction between generalised and non generalised and found that 16% of relatives also had social phobia in generalised group with only 6% in non generalised which is interesting because suggests that the two types of social phobia have different origins: generalised - genetic component whereas non generalised might have developed in response to some learning experience

Magnification

magnify small events e.g. set backs so appear more serious than actually are

Classification for phobia

major levels of anxiety considerable emotional distress Avoidance behaviour

Question on validity

medicalisation of normal adaptive behaviour - fear. Therefore only people who meet the criteria can be diagnosed

Bandura

model experience pain when buzzer - children shwo fear response to buzzer :)

Ost

sometimes traumatic events happen but are forgotten

Bowlby's attachment theory

monotropic theory: biologically pre-programmed to form attachment because this will help them survive - agoraphoia is related to the fear of losing someone who have become attached to e.g. mother - seperation anxiety particularly where parents are over protective

DSM: agoraphobia

more than 4 panic attacks in 4 weeks - panic disorder?

Reliability of diagnosis: social phobia

needs to be distinguished from normal phobias - continuum from being slightly shy through to totally non-functioning. Someone with social phobia may be confident and outgoing in one situation and not the next

Beiling and Alden

negative self-appraisal appears key feature in social phobia - need for perfection - people with social phobia scored higher on controls for need to perfectionism and had lower perceptions of their social ability

Inconclusive evidence:

not all people with phobias show blood flow abnormalities and not clear about causality

Sneet

not everyone remember's their frightening experience

DiNardo

not everyone who gets bitten by a dog develops a phobia - against classical conditioning

Whitinhg

occurrence of other phobias in other cultures - found that in structured child rearing societies where the child rearing is stricter and have more repression and more phobias

20%

only about 20% of adult phobias go away in their own time

what is inherited

oversensitivity high amounts of adrenaline ANS dopamine serotonine

Role of GABA

people who maintain phobias have high levels physiological arousal makes them particularly sensitive to their external environment - dysfunction in in neurons that exhibit anxiety - caused by low levels of neurotans. GABA - automatically released in response to high levels of arousal - binds to receptors on excited neurons and inhibit thier activity which reduces arousal and decreases anxiety.

Anal stage 1-3

pleasurable feelings from bladder and anus

Oral stage 0-1

pleasure from mouth

Phallic 3-6

pleasure from self exploration of genitals

Fyer:

probands had 3x many relatives with phobias than normal controls. also 16& of 1st degree relatives also had social phobia compared to 5% of the control group - more common with siblings than with parents! Family interview od 49 first degree relatives of those with specific phobia and found 31% of relatives also had phobia but only 2 people had the same type

Behaviourist = too simplistic and ignores other factors

reduces it down to rewards and punishment some specific phobias can be explained this way but not social or agoraphobia. But that and preparedness theory hard to explain why someone becomes phobic of feathers or books

Kesseler

said that at any one time about 8% of the population have a phobia

Garcia and Koelling

showed that rats could be easily conditioned to avoid life-threatening stimuli such as shocks or toxic liquids but not to avoid stimuli which carried no adverse consequences such as flashing light

cognitive error

small set back in life cannot be overcome and will fail at everything

Mattick and Clarke

social phobia correlated well with other standard measures - .54 which indicates that method for diagnosis was reliable at measuring real

Biochemical explanation

structural or biochemical abnormalities should be detected in brains of those diagnosed with phobic disorders - change anatomy

Williams

subjected people with agoraphobia to hierarchy of increasingly scary tasks whilst monitoring their thoughts throughout - statements were mainly preoccupied with their anxiety rather than their safety - panic attacks research

Minimisation

success into something insignificant

Panic Attacks

sudden and intense anxiety - physical symptoms: shaking/ confusion/ disorientation/ peak about 10 mins

Generalisation

tendency to reach conclusion about world based on single event

Against Freud

there is no evidence of symptom substitution - once remove phobia no new one takes place even though not got rid of cause

Recognise

they recognise their fear is irrational and yet still fear anyway