Phobias

11 Key excerpts on "Phobias"

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  eBook - ePub

  Treatments for Psychological Problems and Syndromes

  • Dean McKay, Jonathan S. Abramowitz, Eric A. Storch, Dean McKay, Jonathan S. Abramowitz, Eric A. Storch(Authors)
  • 2017(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  3 Fears and Specific Phobias Maysa M. Kaskas, Paige M. Ryan, and Thompson E. Davis III Fear is a part of healthy development, and psychological mechanisms are in place beginning at birth to allow individuals to detect and avoid threat. Human beings have evolved to attend to frightening stimuli or environments that may impact survival through thousands of years of repeated classical conditioning paradigms (Ohman & Mineka, 2001). Although some level of fear can aid in survival or motivate individuals to prepare and perform, not all fears are healthy. Some fears can be intense and irrational; they may become chronic in nature and limit an individual’s ability to function. For instance, a child with a severe fear of storms may experience concentration difficulties at school when it rains or may miss out on important social opportunities if he or she is afraid to leave the house in case of a storm. What differentiates healthy, adaptive fear from detrimental, maladaptive phobia? The Nature of the Problem Diagnostic Criteria The Diagnostic and Statistical Manual of Mental Disorders (5th edition [DSM‐5]; American Psychiatric Association, 2013) describes specific phobia as an anxiety disorder that involves a characteristic, unreasonable fear response which has a significant negative impact on daily living. In order to be diagnosed with a specific phobia, an individual must exhibit a marked fear or anxiety about a specific stimulus, situation, or environment. When encountering the feared stimulus, the individual must respond in an excessive manner compared to the posed risk, situation, or socio‐cultural context and often avoid or endure the stimulus with severe distress. This fear must almost always occur in the context of the stimulus, occur for six or more months, and cause impairment in the individual’s functioning (DSM‐5)

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  Phobias

  • Mario Maj, Hagop S. Akiskal, Juan José Lopez-Ibor, Ahmed Okasha, Mario Maj, Hagop S. Akiskal, Juan José López-Ibor, Ahmed Okasha, Juan José Lopez-Ibor, Mario Maj, Hagop S. Akiskal, Juan José López-Ibor, Ahmed Okasha(Authors)
  • 2004(Publication Date)
  • Wiley

    (Publisher)

  A phobia, like so many psychological disorders, is characterized by affective, behavioural, cognitive and physiological responses whose intensity is sufficient to cause distress and interference in our lives. Adults, at least, have some measure of insight into their phobia Phobias. Edited by Mario Maj, Hagop S. Akiskal, Juan Jose ´ Lo ´ pez-Ibor and Ahmed Okasha. &2004 John Wiley & Sons Ltd: ISBN 0-470-85833-8 _________________________________________________________________________________________________ CHAPTER and recognize it as excessive or unreasonable, even though the fear may be so intense that it leads to active avoidance or extreme anxiety if it cannot actually be avoided. Adults seem to know that the level of their fear is unwarranted. Children, by contrast, frequently do not have this awareness. All a child may know is that he or she is scared of a dog, getting a shot at the doctor’s office, or speaking in front of his or her school mates and wants to get away and to avoid the event or situation at all costs, and as soon as possible [1–3]. CLINICAL PICTURE AND DIFFERENTIAL DIAGNOSIS According to Marks [4], ‘‘fear is a normal response to active or imagined threat in higher animals, and comprises an outer behavioural expression, an inner feeling, and accompanying physiological changes’’. As we have noted elsewhere [2,5–7], nearly all children experience some degree of fear during their development. Furthermore, although such fears vary in frequency, intensity and duration, they tend to be mild, age-specific and transitory. Typically, children evince fear reactions to everyday stimuli such as strangers, separation, new situations, loud noises, darkness, water, imaginary creatures, and small animals such as snakes and spiders, as well as other circumscribed or specific events or objects.

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  Taking America Off Drugs

  Why Behavioral Therapy is More Effective for Treating ADHD, OCD, Depression, and Other Psychological Problems

  • Stephen Ray Flora(Author)
  • 2012(Publication Date)
  • SUNY Press

    (Publisher)

  Chapter 4 Specific Phobias Phobias are irrational fears that cause personal distress and can interfere with a person’s daily functioning. For example, a person with an elevator phobia may avoid buildings with elevators. Such a phobia would limit the person’s employment, living, and social possibilities, and could preclude the person from receiving important personal services. A person with an elevator phobia may refuse to visit doctors, lawyers, or government offi- cials if getting to the office requires a trip in an elevator. In social phobia, the irrational fear is of social situations. Such a phobia, left untreated, may develop into agoraphobia. People labeled with agoraphobia often refuse to step foot outside of their houses or apartments for years. LEARNING AND BEHAVIOR Humans are born with a fear of falling and a fear of loud noises; all other fears, rational and irrational, are learned. They are learned either “vicariously” (through observation or from the verbal community through many sources—novels, religious writings, etc.), or by direct experiences. For example, a dog bite may result in a fear of dogs—a direct conditioning experience. But more common are vicarious condi- tioning experiences. For example, a lick in the face is the most harm my dog would ever do to a child. But in my neighborhood, when chil- dren see me walking my dog up the street, almost invariably one child will scream and start to run. The other children will respond not to my dog, but to the first child’s screaming and running by doing the same. When they “safely” reach a porch, there are great dramatic expressions 43 of relief, followed by laughter. Although no child was harmed by the dog, all the children learned to fear dogs and that running away from dogs is reinforcing. Regardless of the source of learning, vicarious or direct, all phobic fears can be effectively treated as conditioned responses.

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  Phobias

  • Heather Buchanan, Neil Coulson(Authors)
  • 2012(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  Chapter 2 Specific phobia: Diagnosis and classification

    Introduction

  Almost everyone has an irrational fear or two. Indeed, mild fears are common in the general population. Some get anxious at the thought of needles. Others shriek at the sight of a rat and some get flustered when they have to get in a lift. For most individuals, these fears are not major and do not impact on their everyday life. But for some, they are so severe that they cause tremendous anxiety and interfere with normal day-to-day living. From the Greek phobos (meaning ‘fear’), a phobia is an intense fear of something that, in reality, poses little or no actual danger. In Chapters 2 –4 of the book we will focus on specific Phobias and in this chapter we will be discussing their diagnosis, classification and symptoms.

  In this chapter, we will:

  ▪   Outline and discuss how specific Phobias are diagnosed and classified.

  ▪   Consider the characteristics and symptoms that individuals with specific Phobias present with.

  ▪   Consider the prevalence of specific Phobias.

  ▪   Discuss the different methods by which specific Phobias are diagnosed and assessed.

  ▪   Discuss issues related to diagnosis and classification, for example, reliability and validity.

  What is a specific phobia?

  Specific phobia is an anxiety disorder classification that represents unreasonable or irrational fear related to a specific object or situation (The Diagnostic and Statistical Manual of Mental Disorders (hereafter DSM), 4th edition text revision; American Psychological Society, 2000; see Chapter 1 of this book for details of DSM). Originally called simple phobia, the name was changed to specific phobia with the publication of DSM-IV. Thus, in some older research articles or books, you may find that it is referred to as simple phobia (and sometimes authors use the terms interchangeably). More than 300 different specific Phobias have been reported ranging from ones that are familiar (most people have heard of arachnophobia, the phobia of spiders) to others that are less familiar. Box 2.1 outlines how specific Phobias can be named with some examples. When an individual suffers from a specific phobia, the object of their fear (such as spiders) is often referred to as the phobic stimulus

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  Clinical Guide to the Diagnosis and Treatment of Mental Disorders

  • Michael B. First, Allan Tasman(Authors)
  • 2013(Publication Date)
  • Wiley

    (Publisher)

  E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes signifi- cantly with the person's normal routine, occupational (or academic) functioning, or social activities or relation- ships, or there is marked distress about having the phobia. F. In individuals under age 18 years, the duration is at least 6 months. G. The fear or avoidance is not due to the direct physiologi- cal effects of a substance (e.g. a drug of abuse, a medica- tion) or a general medical condition and is not better accounted for by another mental disorder (e.g., panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive develop- mental disorder, or schizoid personality disorder). H. If a general medical condition or another mental disorder is present, the fear in criterion A is unrelated to it, e.g., the fear is not of stuttering, trembling in Parkinson's disease, exhibiting abnormal eating behavior in anorexia nervosa or bulimia nervosa. Specify if: Generalized: if the fears include most social situations (also consider the additional diagnosis of avoidant personality disorder) Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Rev. Copyright 2000 American Psychiatric Association. Permission Request Needed. DSM-IV-TR Diagnostic Criteria 300.29 Specific phobia A. Marked and persistent fear that is excessive or unrea- sonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). B. Exposure to the phobic stimulus almost invariably pro- vokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. C. The person recognizes that the fear is excessive or unreasonable.

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  Phobias

  • Heather Buchanan, Neil Coulson(Authors)
  • 2012(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  41 Chapter 3 Development of specific phobia: Explanations and perspectives Introduction In Chapter 2 we explored the characteristics, diagnostic criteria and dif-ferent ‘types’ of specific phobia. We considered the different ways specific Phobias can be measured and the high prevalence of this type of phobic disorder. In this chapter, we will explore the explanations put forward for how individuals come to develop specific Phobias and how far the research evidence supports these explanations. In this chapter, we will: ■ Discuss the different psychological and biological approaches/explanations put forward for how specific Phobias are acquired ■ Consider the methodological limitations of some of the research on the aetiology of specific Phobias 42 Phobias Psychological explanations There are a variety of psychological explanations as to why some peo-ple develop specific Phobias. In this first section we will consider the evidence for: ■ Psychodynamic theory ■ The classical conditioning model ■ Vicarious/observational learning ■ Information acquisition ■ Cognitive models Psychodynamic explanations Like many areas of psychology some of these perspectives are best con-sidered in their historical context. One of the earliest theories of why specific Phobias develop comes from a psychodynamic or Freudian per-spective. Psychodynamic theorists believe that Phobias emerge because individuals have impulses that are unacceptable, and they repress these impulses. More specifically, Freud proposed that Phobias emerge because of an unresolved oedipal conflict . The Oedipus Complex is where a young boy develops an intense sexual love for his mother and because of this he sees his father as a rival and wants to get rid of him. In terms of specific phobia, probably the most well-known Freudian case study is that of Little Hans who had a phobia of horses. Little Hans, Freud argued, was afraid of horses because the horse was a symbol for his father.

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  Psychiatry by Ten Teachers

  • Nisha Dogra, Brian Lunn, Stephen Cooper, Nisha Dogra, Brian Lunn, Stephen Cooper(Authors)
  • 2017(Publication Date)
  • CRC Press

    (Publisher)

  What, however, if you repeatedly showed the same response, and the same degree of response, to the sight of a small, harmless spider on the other side of the desk? Or to travelling over a bridge (an entirely safe and structurally secure bridge)? Or to finding yourself in a busy supermarket? Or to eating in public? This situation, where a person experiences a degree of anxiety or panic that is predictable (i.e. happens in recognizable circumstances), is far in excess of what is necessary (i.e. disproportionate) and this causes a significant emotional distress to the individual is what is meant by the term phobia.

  EXERCISE 8.1 Have you ever used the word ‘phobia’ or ‘phobic’ to describe yourself or have you heard others use the word? What did you (or they) mean by the word? What behaviour or feeling was being described by the use of the word ‘phobia’? Aside from a description of an illness, can you think of other medical or non-medical uses of the suffix-phobic, e.g. xenophobic? How does your own use and general use of the word ‘phobia’ relate to its use as a description of a particular mental health problem?

  We can all be excessively anxious about different things and it can be difficult to distinguish between this ‘normal’ anxiety and phobic anxiety. Does this lack of clear-cut distinction bother you? Are you more comfortable with the definition of hypertension? In what ways do the definitions of hypertension or obesity have similar limitations to that of anxiety? It may be useful to revisit Chapter 1 in which we discussed the problems that may arise when the line between what is a disorder and what is not are unclear.

  Types of Phobias

  Phobic situations are divided into three different types depending on the nature of the feared situation: agoraphobia, social phobia and specific phobia.

  1. In agoraphobia, the anxiety is caused by being in a busy situation or an open area where there is no immediate possibility of escape to a ‘safe’ area (the ‘agora’ in ancient Greece was an open area where crowds would gather together and was also used as the busy marketplace).
  2. For social phobia, the anxiety is a ‘fear of scrutiny’ by others, associated with being the focus of attention and being embarrassed or humiliated. Typically relatively small social settings are feared, such as eating with others, speaking in a small group setting or even simply social interaction with another person who is not well known.

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  Origins of Phobias and Anxiety Disorders

  Why More Women than Men?

  • Michelle G. Craske(Author)
  • 2003(Publication Date)
  • Pergamon

    (Publisher)

  That is, the anxiety disorders all involve fear, anxiety, worry, and avoidant or corrective behaviors. They differ from each other in the primary object of threat. In brief, panic disorder refers to recurrent unexpected panic attacks accompanied by persistent apprehension over their recurrence or their consequences. Panic disorder may occur with or without agoraphobia, which refers to anxiety about places or situations from which escape might be difficult or help not available in the event of a panic attack. Agoraphobia without a history of panic disorder refers to the same situational anxiety but in the absence of full-blown panic attacks. Generalized anxiety disorder refers to excessive and uncontrollable worry about a number of different life events and accompanying symptoms of motor tension and vigilance. 2 Origins of Phobias andAnxiety Disorders Social phobia (or social anxiety disorder) represents excessive fear of social or performance situations in which embarrassment might occur. Obsessive-compulsive disorder refers to recurrent intrusive thoughts, images or impulses (obsessions) and/or repetitive behaviors designed to prevent or lessen distress (compulsions) that are time-consuming or cause distress or impairment. Posttraumatic stress disorder refers to a set of symptoms following exposure to a traumatic event at which time intense fear, helplessness, or horror is experienced; the symptoms include re-experiencing of the trauma, avoidance of associated stimuli, and increased arousal. Specific phobia refers to marked and persistent fear of clearly discernible and circumscribed objects or situations. Other anxiety disorders include acute stress disorder, and anxiety disorders due to medical conditions or substance abuse. Prevalence Epidemiological studies of adult community samples indicate that anxiety disorders are one of the most commonly occurring forms of psychological disturbance.

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  Social Phobia

  An Interpersonal Approach

  • Ariel Stravynski(Author)
  • 2014(Publication Date)
  • Cambridge University Press

    (Publisher)

  Social phobia is obviously related to the interpersonal cluster of fears, highlighted in Arrindell et al. (1991), as the fear-eliciting situations trig- gering it are predominantly in the social domain. As is the case with other Phobias, it might be also narrowly defined as a “a fear of a situation that is out of proportion to its danger, can neither be explained nor reasoned away, is largely beyond voluntary control, and leads to avoidance of the feared situation” (Marks, 1987, p. 5). The view that social phobia is a “disorder of anxiety” has had a profound impact on treatment development in that most attempts at psychological What is social phobia and what is its nature? 44 treatment and pharmacotherapy have sought to provide help to patients by means of various methods aiming directly or indirectly at anxiety reduction. In keeping with this, reduction of anxiety serves also as the primary measure of outcome. What is anxiety? What, then, is anxiety and what is the meaning of its being “disordered” or abnormal? A striking fact about much psychological and psychiatric research of anxiety is that the term – although widely in use – is seldom defined (e.g. MacLeod, 1991). Nevertheless, a variety of inventories con- structed for the purpose claim to measure “anxiety.” Are they all assess- ing the same conceptual structure? If not, what constructs then are being assessed? Dictionaries define anxiety as “A painful or apprehensive uneasiness of mind usually over an impending or anticipated ill” (Webster’s New Collegiate Dictionary, 1962) or “A condition of agitation and depres- sion with a sensation of tightness and distress in the praecordial region” (Shorter Oxford English Dictionary, 1972). According to Lader and Marks (1971), “Anxiety is an emotion which is usually unpleasant. Subjectively it has the quality of fear or of closely related emotions.

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  International Handbook of Cognitive and Behavioural Treatments for Psychological Disorders

  • V.E. Caballo(Author)
  • 1998(Publication Date)
  • Pergamon

    (Publisher)

  Social phobia can be effectively treated nowadays through cognitive-behavioural interventions. Although there remain many problems to be solved, we can point out that the cognitive-behavioural approach consists of empirically validated treatments for social phobia. In the following section, we present some of the theoretical bases upon which applications of different treatments for social phobia are supported.

  Classical, Operant, and Vicarious Conditioning

  Although the precise cause of Phobias is unknown, it is usually considered learned fear, acquired by means of direct conditioning, vicarious conditioning (when fear is learned by observing others), or by the transmission of information and/or instructions (

  Caballo, Aparicio &c Catena, 1995

  ).

  However, it is not very usual for an individual with social phobia to describe a single traumatic event as the onset of the phobia. The fear gradually increases as a result of repeated fear-producing experiences or as a result of social learning. Sometimes this happens during a period of stress or high stimulation, when fearful responses are easily learned.

  A comprehensive interpretation of Mowrer’s two-factor theory explains the acquisition and maintenance of phobic reactions. Symptoms of social phobia are a conditioned response acquired via the association between the phobic object (the conditioned stimulus) and an aversive experience. Once the phobia has been acquired, avoidance of the phobic situation avoids or reduces the conditioned anxiety, consequently reinforcing avoidance behaviour. This avoidance maintains the anxiety since it makes it difficult to learn that the feared object or situation are not in fact dangerous, or not as dangerous as the patient believes or anticipates. Thoughts can also maintain fear, such as thoughts about somatic symptoms, about the possible negative consequences of performance, etc.

  Öst & Hugdahl (1981) found that 58% of individuals with social phobia acquired their Phobias as a result of a direct experience. Turner et al. (1992)

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  Progress in Behavior Modification

  Volume 16

  • Michel Hersen, Richard M. Eisler, Peter M. Miller, Michel Hersen, Richard M. Eisler, Peter M. Miller(Authors)
  • 2013(Publication Date)
  • Academic Press

    (Publisher)

  COGNITIVE TREATMENT OF PHOBIA CYNTHIA G. LAST Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania I. Introduction 65 II. Rationale 66 A. The Role of Cognitions in Fear: A Cognitive Model 66 B. Empirical Support 67 III. Treatment 70 A. Cognitive Treatments 70 B. Empirical Support 72 C. Interpretation of Findings 74 IV. Assessment of Cognitions 75 A. Cognitive Measures 76 B. Classification of Cognitions 78 V. Summary and Conclusions 79 References 80 I. INTRODUCTION Within the past decade, cognitive and cognitive-behavioral interventions have become popular in the treatment of a variety of clinical disorders. This trend is evident particularly in the treatment of Phobias, in which cognitive treatment strategies have been used increasingly either alone or in conjunction with behav-ioral, exposure-based techniques (e.g., in vivo exposure, imaginai flooding). Despite the widespread use of cognitive treatments by clinicians, empirical findings in this area have accumulated only recently to a point at which a critical review of the efficacy of these techniques appears warranted. As such, the primary aim of this article is to consider whether the continued utilization of cognitive treatments with phobies is justified on an empirical basis. 65 Copyright © 1984 by Academic Press, Inc. PROGRESS IN BEHAVIOR MODIFICATION, VOLUME 16 All rights of reproduction in any form reserved. ISBN 0-12-535616-1 66 Cynthia G. Last II. RATIONALE A. The Role of Cognitions in Fear: A Cognitive Model The significance of maladaptive cognitions in the genesis of anxiety reac-tions and maintenance of anxiety disorders has been discussed by several cogni-tive and cognitive-behavioral theorists (Beck, 1976; Ellis, 1962; Meichenbaum, 1977). Specifically, they have proposed that catastrophic or irrational thoughts play a critical role in mediating maladaptive physiological-emotional and behav-ioral responses.

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