Anxiety disorder specific phobia Learn what an anxiety

Anxiety disorder: specific phobia

• Learn what an anxiety disorder is, focusing on Specific Phobia • Understand the biological contributing factors to phobias and the ways to manage phobias Lesson objectives

• application of a biopsychosocial framework to understanding ONE of the following four types of mental disorder and its management: Anxiety disorder: specific phobia - biological contributing factors: role of the stress response; role of the neurotransmitter gamma aminobutyric acid (GABA) in the management of phobic anxiety Study design dot point

• 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 definition

• Describes a group of disorders that are characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect. Anxiety disorder definition

• • • Agoraphobia without history of panic disorder Panic disorder with/without agoraphobia Specific phobia Social phobia Obsessive compulsive disorder Post-traumatic stress disorder Generalised anxiety disorder Acute stress disorder Anxiety disorder due to a general medical condition Substance-induced anxiety disorder DSM-IV-TR anxiety disorders

• An excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning. Phobia definition

• A disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour. • The specific object/situation producing the fear is called the phobic stimulus. Specific phobia definition

• Anunptaphobia: fear of staying single • Arachibutyrophobia: fear of peanut butter sticking to the roof of the mouth • Hippopotomonstrosesquipped-aphiliophobia: fear of long words • Keraunophobia: fear of lighting • Ornithophobia: fear of birds • Papaphobia: fear of the Pope • Pentheraphobia: fear of mother-in-laws • Quadrataphobia: fear of quadratic equations • Vuteuthindon: fear of picnics Phobia activity

• People with a specific phobia know that their level of fear is excessive or unreasonable. • The fear is in excess of any real danger posed by the phobic stimulus. http: //www. youtube. com/ watch? v=9 rl 7 Lr 6 e. DLc http: //www. youtube. com/ watch? v=ko. Nw. Ue. G-i. KE

• Elevated heart rate & blood pressure • Hand tremors • Diarrhoea • Sweating • Shortness of breath • Dizziness • Feel like they have no control over the situation Symptoms Exposure to phobic stimulus Triggers involuntary anxiety response (similar to stress response) Can lead to panic attacks (unexpected onset of intense anxiety that can last a few mins > an hour)

Categories Examples Animal type Situation type Blood, injections and injury type Natural environments type Other phobias Choking, vomiting, loud noises, dying, costumed characters DSM specific phobia categories

Biological factors Specific phobia Social factors Psychological factors Contributing factors: • Role of stress response • Dysfunctional GABA system Management: • Benzodiazepines • GABA supplement • Relaxation response Biopsychosocial framework applied to specific phobia and its management

• Genetic predisposition – moderate level of heritability of anxiety disorders • Role of the stress response • Role of the brain’s neurochemistry Biological contributing factors

• Fight-fight response activated • Accounts for phobic symptoms such as sweating & palpitations • Dizziness due to increase in ANS arousal then sudden drop in blood pressure How does the stress response contribute to phobic anxiety?

• Becomes problematic when the anxiety response is triggered when there is no real threat or danger • For example, objects/situations that have little potential for harm • flowers (anthophobia) or clouds (nephophobia) • Anxiety remains until the exposure to the phobic stimulus is gone

• Gamma-amino butyric acid (GABA) • = Primary inhibitory neurotransmitter • Inhibits firing of neurons • Maintains optimal level of neurotransmission • Low levels of GABA leads to higher levels of anxiety • Neurons are not stopped from firing Role of GABA NOT THAT GABBA…

• Glutamate = primary excitatory neurotransmitter • Makes neurons more likely to fire • Both GABA and glutamate have important roles in arousal and therefore anxiety Role of glutamate (GABA’s mate)

How does GABA contribute to phobic anxiety?

• Benzodiazepines: a group of drugs which are referred to as minor tranquillisers • Eg: Valium, Temazepam, Xanax • Two types of ‘benzos’ • Agonists imitate GABA • Antagonists inhibit GABA Management of phobias

• Where is GABA found? • Explain the role that GABA is believed to play in phobic anxiety. • Explain how an understanding of the role of GABA can be applied to the management of phobic anxiety. • Reference the use of benzodiazepines Questions

• Understand the psychological contributing factors of Specific Phobia • Discussion of the management of Specific Phobia using psychological techniques Lesson objectives

Biological factors Psychological factors Contributing factors: • Psychodynamic model • Behavioural model • Cognitive model Specific phobia Social factors Psychological contributing factors Management: • CBT • Systematic desensitisation • Flooding

Sigmund Freud • Phobias develop as a consequence of an unresolved Oedipal complex (sexual love for your opposite-sex parent) • Use defence mechanisms to protect oneself from anxiety • Repression prevents the socially unacceptable desire • Displacement = directing feelings onto another object which becomes the phobic stimulus • http: //goanimate. com/videos/0 XEB-Cr. GMfm. E Psychodynamic model

• Phobias are learned through experience • Classical conditioning plays a role in the development of a phobia • Operant conditioning plays a role in maintaining the phobia Behavioural model

• Explain how classical conditioning can cause the development of specific phobia. • Explain how operant conditioning can cause the maintenance of a specific phobia. Questions

• How the individual processes information about the phobic stimulus • How and why people with a phobia have an unreasonable and excessive fear • Cognitive bias: tendency to think in a way that involves errors of judgment and faulty decision-making Cognitive model

• The tendency to interpret ambiguous stimuli and situations in a threatening way • For example: interpreting tomato sauce as blood (depending on their phobia) Interpretive bias

Cognitive therapy Behavioural therapy • Focuses on thoughts, beliefs & attitudes • Techniques help people to understand how they reason • Make people aware of their ‘automatic thoughts’ • Deals with maladaptive behaviours such as avoidance • Exposes client to new environmental conditions to retrain them • Conditions new behaviours Cognitive behavioural therapy (CBT)

Main assumption of CBT: if you change the way you think, you can change the way you feel and behave

Feeling (emotion) Object/event Thought Behaviour (action) TASK: use this flow chart to explain through a CBT perspective how a Specific Phobia is acquired

• What is cognitive behavioural therapy? • What is the aim of the cognitive component of CBT? • What is the aim of the behavioural component of CBT? Questions

• Behaviour thearpy that aims to replace an anxiety response with a relaxation response • Two tasks: Unlearning & reassociation • 3 step process: 1. 2. 3. Systematic desensitisation

• Construct a simple flow chart to summarise three steps in systematic desensitisation. Task

• You are a psychologist. Your client is suffering from Specific Phobia. It is your job to create a fear hierarchy for any one of the following fears. • Flying, heights, snakes, circus clowns, going to the dentist, going swimming, eating in a restaurant • Your fear hierarchy should contain 10 steps, from easiest to hardest. Task

• Bringing the client into direct contact with their most feared object or situation away straight away and keeping them in contact with it until their fear and anxiety disappears • http: //www. youtube. com/watch? v=w. E 5 F-Fjb. TRk Flooding

• How are systematic desensitisation and flooding similar when used in management of specific phobia? • How do systematic desensitisation and flooding differ when used in management of specific phobia? • Carly has a phobia of cats. • How could systematic desensitisation be used to assist Carly to overcome her phobia? • How could flooding be used to assist Carly to overcome her phobia? Questions

• Review last lesson • To understand the socio-cultural contributing factors to specific phobia • Specific environmental triggers • Parental modelling • Transmission of threat information Lesson objectives

• Briefly compare and contrast the cognitive, psychodynamic and behavioural models for explaining phobias. Review task

Social-cultural factors Contributing factors: • Specific environmental triggers • Parental modelling • Transmission of threat information Management: • Non-fear modelling • Gather accurate information Biological factors Socialcultural factors Specific phobia Psychological factors Socio-cultural contributing factors

• Developing a phobia after a direct negative experience with an object or situation Specific environmental triggers

• Observing and reproducing a parent’s fear of an object or situation Parental modelling

• Exposure to negative or frightening information about an object or situation Transmission of threat information

• FIRSTHAND EXPERIENCE • Specific environmental triggers – direct experience with a phobic stimulus in the past • SECONDHAND EXPERIENCE • Parental modelling & transmission of threat – (indirect experience)