Transcript Kardinia International College

Kardinia International College
Unit 4 Psychology Final Review Series
AOS 2: Applications of a Biopsychosocial
framework
2. Simple Phobia as an Example of an Anxiety
Disorder
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.
Anxiety Disorder Defined
• Anxiety disorder is a group of disorders characterised by chronic
feelings of anxiety, distress, nervousness and apprehension or fear
about the future, with a negative effect.
• Anxiety disorders are distinguished from ‘normal’, everyday anxiety
in that anxiety disorders involve anxiety that:
•
is more severe (intense)
•
lasts longer (anxiety may persist for months instead
of going away after the anxiety-provoking situation has
passed), and
•
significantly interferes with a person’s daily life and
stops them doing what they want to do.
Phobia
• A phobia is an excessive or unreasonable fear directed
towards a particular object, situation or event that
causes significant distress or interferes with everyday
functioning.
Key characteristics are:
• anxiety: exposure to the phobic stimulus almost
invariably induces an immediate anxiety response;
• awareness: the person recognizes that their fear is
excessive or unreasonable;
• avoidance: the phobic situation is avoided or else is
endured with intense anxiety or distress.
Phobias and DSM-IV-TR
• As with all other disorders in the DSM-IV-TR, the
person’s anxiety and avoidance behavior
significantly interfere with their everyday life
and causes them great distress.
• According to the DSM, a person’s fear of a
specific object or situation must have persisted
for at least six months for them to be diagnosed
as having specific phobia.
• 3% of the Australian Population suffer from
Phobias
• More women than men suffer Phobias
Forms of Phobias
• DSM-IV-TR divides phobias into three categories: Agoraphobia, Social
Phobia and Specific Phobia. In the study design is states that we focus on
Simple (specific) phobia.
• Simple (specific) phobias involve an intense fear that is restricted, or
confined, to a single ‘specific’ stimulus such as fear of heights, ladders,
frogs, enclosed places, etc.
• Complex phobias involve a non-specific, more ‘general’ fear that usually
involves a ‘number of anxieties’ so it is more ‘complex’,
• Complex Phobias - Examples
In fear of flying, the person may be afraid of crashing, being enclosed in the
plane, and losing self-control
With agoraphobia, the person may be afraid of entering shops, crowds and
public places, travelling in trains, buses and planes and is also anxious about
being unable to escape to a place of safety.
DSM phobia categories
1. Animals
2. Situations
3. Blood / injections
4. Natural environments
5. Other (choking, dying, illness, falling etc)
Biological Contributing Factors to a
Fear-Anxiety Response :
Amygdala: a region in the brain which is involved in
processing emotions – in this context – fear.
Noradrenaline: mediates the physiological symptoms of
fear / anxiety through the sympathetic nervous system.
The HPA Axis and Adrenaline are involved with the stress
response.
HPA Axis activity results in the release of Cortisol from
the Adrenal Gland above each kidney.
Adrenaline hormone and subsequent adrenaline
neurotransmitter activity results in the wide range of
physical changes discussed in the sympathetic nervous
system fight or flight response.
Role of the Stress Response:
• A phobic reaction is an exaggerated fear
response.
• From a physiological perspective, an extreme
fight –flight response occurs when the individual
encounters the phobic stimulus or anticipates
such an encounter.
• The terror experienced is marked by physical
anxiety symptoms, cognitive symptoms of fear of
the object or situation (fright/fight response), and
an intense desire to escape (flight response).
Role of the neurotransmitter
Gamma-amino butyric acid (GABA)
in the management of Phobic Anxiety
• GABA (gamma-amino butyric acid) is the
major inhibitory neurotransmitter that makes
presynaptic neurons less likely to fire in the
brain.
• GABA inhibitory action counterbalances the
excitatory action of glutamate (that makes
presynaptic neurons more likely to fire).
• It is found in the CNS (brain and spinal cord).
Not enough GABA makes me anxious!
GABA – Primary Function
• Gamma-amino butyric acid is the primary
inhibitory neurotransmitter in the CNS.
• Inhibits postsynaptic neurons – stops them
passing on the neural impulse
• Gets in the synapse to block transmission
• Helps fine tune brain activity, keeps neural
transmission from getting out of control
• Without GABA neural activation could spread like
fire throughout the brain causing seizures
Management of Anxiety Biologically:
Use of Pharmaceutical Medication
• Lack of the neurotransmitter GABA might lead to over stimulation,
and thus heightened anxiety
1. Benzodiazepines – a class of drugs that ‘calm down’ neural activity.
Valiam, Xzanax, Rohypnol, Serepax etc.
• All drugs are either Agonists – mimic the activity of a
neurotransmitter
• Or Antagonists – inhibit the activity of a neurotransmitter
2. GABA Supplements can also be prescribed, however their
effectiveness is yet to be proven medically as the synthetic GABA has
difficulty crossing the blood-brain barrier.
GABA
Stop the message!
GLUTIMATE
Get the message going!
Psychological Contributing Factors:
• Psychodynamic Model
• Behavioral and Cognitive Models
Freud’s psychodynamic model
• Mental disorders are caused by unresolved conflicts that
occur in the subconscious
• ‘skeletons in the closet’
• Memories that are too distressing are pushed out of
conscious awareness
• As we grow up we progress through different psychosexual
stages
• oral 0 – 2
• Anal 2 -3
• Phalic 4 -5
• Latency 6 – puberty
Freud’s psychodynamic model
• As we progress through these stages different
parts of the body become the focus of attention
and pleasure
• Each stage has a critical developmental conflict
that must be resolved to move onto the next
stage
• Unresolved conflicts cause anxiety
• Freud’s anxiety refers to unpleasant feeling when
our instincts make us do something that we will
be punished for
Freud’s psychodynamic model
• We use defence
mechanisms to protect
ourselves from this anxiety
• The ego (conscious part of
the mind) distorts, denies
or falsifies reality
unconsciously
• We can then ‘believe’ that
there is no reason to be
anxious
• We lie to ourselves to be
happy
Freud’s psychodynamic model –
oedepal complex
• Phallic stage 0 – 3
• Male child develops sexual attraction to his
mother
• Below conscious awareness
• Fears father who is bigger and stronger, believes
punishment will involve castration
• Repression used as defence mechanism
• Child identifies with father – being like dad will
mean dad will be less inclined to punish me
• Displacement can also be used
• Anxiety directed onto another irrelevant object,
then the child can avoid this stimulus and thus
solve the conflict
Freud’s psychodynamic model –
Pseudoscience?
• Based on very small (unhealthy) samples
• Very subjective
• Can easily shift the facts to fit the theory
• Some useful ideas
• Not used in its original form today by the majority
of practicing psychologists
• Remember recovered memory syndrome from
Unit 3?
Behavioural model
• Phobias are learned
• Learned through classical conditioning or
observational learning
• Maintained through operant conditioning
Behavioural model:
Watson and Little Albert
Classical Conditioning of
Arachnophobia
•
•
•
•
•
UCS– spider in sandpit
UCR– fear
NS– spiders
CS– spiders
CR – fear
• Avoidance of spiders or spider related places,
images etc is negatively reinforcing, avoiding the
bad stimulus.
• This strengthens further avoidance behaviours
Role of Operant Conditioning
• Acquisition: Phobias can be acquired by operant
conditioning processes through positive reinforcement.
• Maintenance: Phobias can be maintained by operant
conditioning processes through negative
reinforcement.
• When a person is confronted with their feared object
or situation, the person experiences intense, almost
unbearable, anxiety but their fear/anxiety is reduced by
avoiding the object or situation.
• The avoidance behaviour is therefore negatively
reinforced (more likely to occur again in the future) and
the phobia is maintained.
LITTLE ALBERT OPERANT
CONDITIONING:
•
•
•
•
Little Albert’s specific phobia of white rats
(and all things white and furry) was then
maintained through operant conditioning,
specifically, through negative reinforcement.
Cognitive model
Maladaptive (Negative) Cognition:
• A cognitive theory of phobia, that says that a person may
experience shame or embarrassment at the thought that he or she
may become frightened in public and may avoid such a risk (further
negatively reinforcing the avoidance behaviour).
Key Assumptions:
• The focus or emphasis of cognitive models in explaining the
development and persistence of a specific phobia:
• Focus: how the individual processes information and thinks about
the phobic stimulus and related events (e.g. their perceptions,
memories, beliefs, attitudes, appraisals and expectations).
• Emphasis: how and why people with a specific phobia have an
unreasonable and excessive fear of a particular phobic stimulus.
Cognitive model – Attentional Bias
• Seek out and notice threatening stimuli over
normal stimuli
• Eg. Arachnophobias might notice a spider web
in the corner while everyone else is looking at
the painting on the wall
• Tend to be hyper vigilant – always looking out
for the phobic stimulus
Cognitive biases:
• Cognitive biases are tendencies to think in some
kind of erroneous/mistaken or distorted way that
involves an error(s) of judgment and faulty
decision-making (and therefore also referred to
as ‘mistakes in thinking’ or cognitive distortions).
• Note: In relation to phobias, cognitive biases
make individuals more prone or vulnerable to
experiencing fear and anxiety in response to a
phobic stimulus.
Cognitive model – memory bias
• Remember the bad things more readily
• Eg. Only remember being dumped by a big
wave, not the hundreds of small waves that
were enjoyable to jump over
• Memories reconstructed to be worse than the
actual event
Cognitive model – interpretive bias
• Neutral situations or stimuli interpreted as
threatening
• Eg. Fluff on the carpet is a spider, a dog
running over happily is going to attack
Cognitive model:
Catastrophic Thinking
• Negative thinking in which things are percieved in
the ‘worst possible’ light
• Often underestimate their ability to cope with the
situation
• What can go wrong will go wrong, and in a big
way
e.g. a person with a phobia of bees
may think that any bee they
encounter will attack and kill them.
The Use of Psychotherapies in the
Treatment of Anxiety:
• Cognitive Behavioural Therapy (CBT)
• Systematic Desensitisation
• Flooding
Cognitive Behavioural Therapy (CBT)
• CBT helps people with phobias face up to their fears by
teaching them new skills to help them react differently to
the situations that trigger their phobia.
• Patients also learn to understand how their thinking
patterns contribute to the:
– Situations that trigger their phobia
– Symptoms
• How to Change their beliefs to reduce or stop these
symptoms and, in time, accept whatever was causing their
extreme anxiety.
Systematic Desensitisation
• A process where individuals extinguish the
association between the phobic stimulus and
anxiety through a series of graded steps –
known as a fear hierarchy.
Systematic Desensitisation
• Incremental exposure allows the patient to
gradually face the phobic stimulus and replace
the fear response with the specific relaxed
response.
Flooding
• Flooding involves exposing a phobic person
repeatedly to the object of fear either in vivo
(real life/natural setting) or indirectly by
imagination or virtual reality. – The technique
initially creates significant distress in the
patient.
Flooding
• It is not suggested for most individuals
because it can trigger a higher level of
sensitisation or fear reinforcement.
• It works well when the individual is highly
motivated and given appropriate support
through the process.
• Eventually through sustained contact the
patient learns to relax in the presence of the
phobic stimulus.
Socio-cultural Contributing Factors
• Specific Environmental Triggers such as being
bitten by a dog
Where something in the environment triggers the anxiety-fear
response.
All Specific Phobias have a direct relationship to the person’s
environment or their knowledge of it.
Parental Modelling
Where parental influences have shaped the
development of anxiety disorders of their
children, particularly relevant in social anxiety.
• Modelling bravery can help children cope with
fears
• Reference to Bandura’s stages of
Observational Learning are relevant here:
• Attention, retention, reproduction,
motivation- reinforcement.
Transmission of threat information
• Delivery of information from others about potential
threat
• Children might develop a phobia if constantly warned
about the dangers of going outside alone
• Research suggests that fears develop largely due to
negative information about a specific event, object
or situation being communicated often enough
vs