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A2 Psychology CIE Phobias

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Powerpoint covering the CIE A2 Psychology syllabus on phobias

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A2 Psychology CIE Phobias

  1. 1. Phobias
  2. 2. Phobias • What are you afraidWhat are you afraid of?of? – Air Travel?Air Travel? – Spiders?Spiders? – Snakes?Snakes? – Heights?Heights? – Storms?Storms? •Small, closed spaces? •Crowds? •Being Attacked? •Blood? •The Dark? •Social Events? •Being Alone?
  3. 3. Definition of PHOBIA:Definition of PHOBIA: A persistent and unreasonable fear of aA persistent and unreasonable fear of a particular object, activity or situationparticular object, activity or situation
  4. 4. PHOBIA • The person who has a phobia will go toThe person who has a phobia will go to great lengths to avoid the object of thegreat lengths to avoid the object of the fear and experience great distress if it isfear and experience great distress if it is encountered.encountered.
  5. 5. In the DSM IV, phobias are subdivided... • AgoraphobiaAgoraphobia • Specific PhobiaSpecific Phobia • Social PhobiaSocial Phobia
  6. 6. Specific Phobia • A significant and persistent fear when inA significant and persistent fear when in the presence of, or anticipating thethe presence of, or anticipating the presence of, the object of fear, whichpresence of, the object of fear, which may be an object, place or situationmay be an object, place or situation
  7. 7. DSM 5 criteria for specific phobia... 1.1.Strong, out of proportion fear in the presence orStrong, out of proportion fear in the presence or anticipation of a specific object or situationanticipation of a specific object or situation 2.2.Exposure provokes an immediate anxietyExposure provokes an immediate anxiety response, which may be a panic attack.response, which may be a panic attack. 3.3.The person recognizes that the fear is out ofThe person recognizes that the fear is out of proportion.proportion. 4.4.The phobic situation(s) is avoided if possible.The phobic situation(s) is avoided if possible. 5.5.The phobia interferes with normal lifeThe phobia interferes with normal life
  8. 8. How might a phobia interfere with daily living? Consider different arenas of life…work, home, social
  9. 9. What do you think are the most common phobias?
  10. 10. Common Phobias...can you guess the fears? 1.Arachnophobia 2.Ophidiophobia 3.Acrophobia 4.Agoraphobia 5.Cynophobia 6.Astraphobia 7.Trypanophobia 8.Nyctophobia 9.Pteromerhanophobia 10.Mysophobia 1.Fear of spiders 2.Fear of snakes 3.Fear of heights 4.Fear of places where escape is difficult 5.Fear of dogs 6.Fear of storms 7.Fear of injections 8.Fear of the dark 9.Fear of flying 10.Fear of germs
  11. 11. How about of these bizarre phobias? • Fear of # 13: TriskaidekaphobiaFear of # 13: Triskaidekaphobia • Fear of #666:Fear of #666: HexakosioihexekontahexaphobiaHexakosioihexekontahexaphobia • Fear of long words:Fear of long words: hippopotomonstrosesquipedaliophobiahippopotomonstrosesquipedaliophobia • Fear of money: ChrometophobiaFear of money: Chrometophobia • Fear of beautiful women: CaligynephobiaFear of beautiful women: Caligynephobia
  12. 12. For a full list... • http://phobialist.comhttp://phobialist.com
  13. 13. Agoraphobia: abnormal fear of being helpless in anabnormal fear of being helpless in an embarrassing or unescapable situation that isembarrassing or unescapable situation that is characterized especially by the avoidance ofcharacterized especially by the avoidance of open or public placesopen or public places
  14. 14. Social Phobia • marked and persistent fear of social ormarked and persistent fear of social or performance situations in whichperformance situations in which embarrassment may occur.embarrassment may occur.
  15. 15. Remember... • A diagnosis of phobia requires that theA diagnosis of phobia requires that the avoidance of the object of phobiaavoidance of the object of phobia interfere with life and that encouteringinterfere with life and that encoutering the object creates intense disruptivethe object creates intense disruptive fear.fear.
  16. 16. EXPLANATIONS OF PHOBIAS • There are several theories about the origins of phobias. • What do you think might cause phobias?
  17. 17. Psychodynamic • Do you remember little Hans?
  18. 18. Psychodynamic How would you explain the psychodynamic explanation?
  19. 19. Psychoanalytic Explanation • The desires and emotions of the Id are inThe desires and emotions of the Id are in conflict with the Super-ego.conflict with the Super-ego. • The tension becomes so great that theThe tension becomes so great that the individual may stop functioning or becomeindividual may stop functioning or become psychotic.psychotic. • The ego DISPLACES (this is a specific defenceThe ego DISPLACES (this is a specific defence mechanism) the tension of the conflict and themechanism) the tension of the conflict and the fear of the conflict onto an external object.fear of the conflict onto an external object. • This causes phobia of that specific object.This causes phobia of that specific object.
  20. 20. • What was the conflict inside Little Hans?What was the conflict inside Little Hans? –He had equinophobia--fear of horses –He also had Ebultophobia--fear of baths –He also seems to have developed agoraphobia (remember what agoraphobia means?)
  21. 21. • Can you come up with a hypotheticalCan you come up with a hypothetical conflict between Id and Super-egoconflict between Id and Super-ego which the Ego may not be able towhich the Ego may not be able to handle?handle?
  22. 22. • Remembering how Freud resolved Hans'Remembering how Freud resolved Hans' phobias, what might the treatmentphobias, what might the treatment involve,involve,
  23. 23. BEHAVIORAL Explanations • Classical Conditioning:Classical Conditioning: – Little Albert (Watson, 1920)Little Albert (Watson, 1920) – What was the neutral stimulus?What was the neutral stimulus? – What was the unconditioned stimulus?What was the unconditioned stimulus? – What was the unconditionedWhat was the unconditioned response?response? – What doesWhat does pairing mean?mean? – Finally what was the conditionedFinally what was the conditioned stimulus and the conditionedstimulus and the conditioned response?response? • What is generalization?What is generalization?
  24. 24. Behavioral Explanation Continued • Avoidance Conditioning,Avoidance Conditioning, AKA: The two-process theory (or two-AKA: The two-process theory (or two- factor theory)factor theory) by Mowrer (1947)by Mowrer (1947)
  25. 25. Avoideance Conditioning continued – After Classical Conditioning establishesAfter Classical Conditioning establishes a phobic response, Operanta phobic response, Operant Conditioning takes over.Conditioning takes over. – The person is relieved of fear when sheThe person is relieved of fear when she avoids the conditioned stimuli.avoids the conditioned stimuli.
  26. 26. Avoidance Conditioning • What kind of consequence is this:What kind of consequence is this: – Negative Punishment?Negative Punishment? – Positive Punishment?Positive Punishment? – Negative Reinforcement?Negative Reinforcement? – Positive Reinforcement ?Positive Reinforcement ? •Negative ReinforcementNegative Reinforcement
  27. 27. Social Learning Theory (Remember Albert Bandura? • Child sees mother freak out when sheChild sees mother freak out when she sees a mouse in the kitchen...monkeysees a mouse in the kitchen...monkey see monkey do...through social learning,see monkey do...through social learning, the child comes to understand that micethe child comes to understand that mice are terrifying. (After all, to see Mommyare terrifying. (After all, to see Mommy terrified is scary. Because of this, thereterrified is scary. Because of this, there may be a bit of what involved in themay be a bit of what involved in the development of the mice phobia in thedevelopment of the mice phobia in the child?child?
  28. 28. Social Learning of phobias • Classical conditioning because miceClassical conditioning because mice become paired with the scary event ofbecome paired with the scary event of Mommy freaking out.Mommy freaking out. • The phobic response, through socialThe phobic response, through social learning, occurs even in other contextslearning, occurs even in other contexts than the original place, the kitchen.than the original place, the kitchen.
  29. 29. Behavioral Treatments • Systematic Desensitization (Wolpe, 1958)Systematic Desensitization (Wolpe, 1958) – this is a form of what kind ofthis is a form of what kind of conditioning?conditioning? – Systematic Desensitization can occur inSystematic Desensitization can occur in three ways:three ways: – In vitro (imagination)In vitro (imagination) – In vivo (Real life)In vivo (Real life) – Video Reality Exposure Therapy (VRET).Video Reality Exposure Therapy (VRET).
  30. 30. Systematic Desensitization (behavioral treatment) • An anxiety hierarchy represents aAn anxiety hierarchy represents a progression from mild anxiety in relationprogression from mild anxiety in relation to the feared object to the most intenseto the feared object to the most intense possible encounter with the fearedpossible encounter with the feared object.object.
  31. 31. Anxiety Hierarchy for Systematic Desensitization (Behavioral) 1.1. Seeing the word dog,Seeing the word dog, 2.2.Imagining the dogImagining the dog 3.3.Seeing a pictur of a dogSeeing a pictur of a dog 4.4.seeing a video of a dogseeing a video of a dog 5.5.Hearing a dog barkHearing a dog bark 6.6.Seeing a caged dog.Seeing a caged dog. 7.7.Seeing a dog on a leash.Seeing a dog on a leash. 8.8.Touching a dog.Touching a dog.
  32. 32. Virtual Reality Exposure Therapy • Also a form of systematicAlso a form of systematic desensitization. One advantage of VRETdesensitization. One advantage of VRET is that it is obvious that there truly is nois that it is obvious that there truly is no threat of a non-real height (for example)threat of a non-real height (for example) yet the person feels fear. This allows theyet the person feels fear. This allows the person more ability to see the fear isperson more ability to see the fear is completely irrational.completely irrational. (Rothbaum et. al. 1995)(Rothbaum et. al. 1995)
  33. 33. Behavioral Treatments • Flooding--the terror cannot sustain itself,Flooding--the terror cannot sustain itself, the organism runs out of energy. Fearthe organism runs out of energy. Fear subsides and yet the person is still in thesubsides and yet the person is still in the same situation. The brain then hassame situation. The brain then has experience of the phobic object withoutexperience of the phobic object without feeling fear. What kind of conditioningfeeling fear. What kind of conditioning then takes over to eliminate the phobia?then takes over to eliminate the phobia?
  34. 34. Participant Modeling(Bernstein 1997) (a Social Learning Treatment) • A model is present to encounter theA model is present to encounter the feared object safely, e.g. handle a snakefeared object safely, e.g. handle a snake while the phobic is watching.while the phobic is watching. • Obviously, this is a kind of social learning.Obviously, this is a kind of social learning.
  35. 35. Applied Tension to prevent fainting • Blood and needle phobias often lead toBlood and needle phobias often lead to fainting. Not fainting is a good first step forfainting. Not fainting is a good first step for overcoming the phobia.overcoming the phobia. – Tense all the muscles for 30 seconds.Tense all the muscles for 30 seconds. – This raises blood pressure.This raises blood pressure. – Raised BP prevents fainting (classical cond).Raised BP prevents fainting (classical cond). – Then relax for 20 seconds (classicalThen relax for 20 seconds (classical conditioning)conditioning) – Repeat 5-10 times.Repeat 5-10 times.
  36. 36. Cognitive Explanation • SENSITIZATION: The person becomesSENSITIZATION: The person becomes sensitive to the object and/or her ownsensitive to the object and/or her own physiological response. Panic almostphysiological response. Panic almost always involves fearing the panic itself.always involves fearing the panic itself. • e.g. the fast heart rate is thought of as "Ie.g. the fast heart rate is thought of as "I will have a heart attack!" (overestimatingwill have a heart attack!" (overestimating and catastrophising)and catastrophising)
  37. 37. Cognitive Explanation of Phobias • AVOIDANCE: Like the behaviorists, theAVOIDANCE: Like the behaviorists, the act of avoiding the object of fear createsact of avoiding the object of fear creates relief, negative reinforcementrelief, negative reinforcement
  38. 38. Cognitive Theory of Phobia • IRRATIONAL AND NEGATIVEIRRATIONAL AND NEGATIVE INTERPRETATION:INTERPRETATION: A false mental interpretation of an objectA false mental interpretation of an object and self is required for a phobicand self is required for a phobic response.response. 1.1. Over-estimating: "Spiders are terrible"Spiders are terrible and dangerous! They are straight fromand dangerous! They are straight from hell!"hell!" 2.Catastrophizing: "I'm going to die!""I'm going to die!" 3.Underestimating ability to cope: "Iability to cope: "I can't deal with this!"can't deal with this!"
  39. 39. Di Nardo et al (1988) • Only 50% of cynophobics had a bad experienceOnly 50% of cynophobics had a bad experience with dogs.with dogs. – Why is this a problem for behaviorists?Why is this a problem for behaviorists? – How do cognitive psychologists explain this?How do cognitive psychologists explain this? • Also, only 50% of people who were bit by dogsAlso, only 50% of people who were bit by dogs developed cynophobia.developed cynophobia. – Why is THIS a problem for behaviorists?Why is THIS a problem for behaviorists? – How do cogntive psychologists explain this?How do cogntive psychologists explain this?
  40. 40. Cognitive Therapy 1.1.Identify irrational thoughts/beliefs: "TheIdentify irrational thoughts/beliefs: "The dog will bite me! I'm going to die! "dog will bite me! I'm going to die! " 2.2.Replace with rational thoughts: "MostReplace with rational thoughts: "Most dogs don't bite. This one has neverdogs don't bite. This one has never bitten. It is wagging its tail. Even if bitten,bitten. It is wagging its tail. Even if bitten, I won't die."I won't die." 3.3.Mentally rehearse appropriate, rationalMentally rehearse appropriate, rational responses to encounters. e.g. imaginingresponses to encounters. e.g. imagining encountering a dog and petting it.encountering a dog and petting it.
  41. 41. Ost and Westling(1995)CBT vs Applied Relaxation (Classical Conditioning) Both about equally effective.Both about equally effective. • Applied relaxation:Applied relaxation: – 65% panic-free patients65% panic-free patients – 82% panic-free after one year.82% panic-free after one year. • CBT:CBT: – 74% panic-free patients after the treatment74% panic-free patients after the treatment – 89% panic-free after a year.89% panic-free after a year. These differences were not significant.These differences were not significant. Complications such as generalised anxiety and depression were also reduced toComplications such as generalised anxiety and depression were also reduced to within the normal range after one year.within the normal range after one year.
  42. 42. • Maybe the relaxation group hadMaybe the relaxation group had acquired altered thoughts about theacquired altered thoughts about the object of fear due toobject of fear due to
  43. 43. Biological Explanations • Ost 1992Ost 1992 • 62% of people with a blood and injection62% of people with a blood and injection phobia reported a 1st-degree relative whophobia reported a 1st-degree relative who shares the same disorder.shares the same disorder. • The prevalence rate for the generalThe prevalence rate for the general population is just 3%population is just 3% How could you argue against theHow could you argue against the difference in statistics being purelydifference in statistics being purely genetic?genetic?
  44. 44. Preparedness Theory based in Evolution • Seligman (1971) suggested that there was aSeligman (1971) suggested that there was a ‘‘preparednesspreparedness’’ (a physiological(a physiological predisposition) to be sensitive to certainpredisposition) to be sensitive to certain stimuli.stimuli. • It is not the fears themselves that areIt is not the fears themselves that are inborn, rather there is an innate (in-born)inborn, rather there is an innate (in-born) tendency to rapidly acquire a phobia totendency to rapidly acquire a phobia to potentially harmful eventspotentially harmful events –– we arewe are biologically prepared from birth.biologically prepared from birth.
  45. 45. Evidence for preparedness(Ohman et al 1975) • AIM Conducted a series of studies to investigate the preparednessAIM Conducted a series of studies to investigate the preparedness explanation of phobia acquisitionexplanation of phobia acquisition • METHOD Participants were shown pictures of houses, snakes,METHOD Participants were shown pictures of houses, snakes, spiders and faces of people. Half the participants received anspiders and faces of people. Half the participants received an electric shock whenever they were presented with a picture of aelectric shock whenever they were presented with a picture of a house or a face. The other half received an electric shock wheneverhouse or a face. The other half received an electric shock whenever they were presented with a picture of a snake or spider.they were presented with a picture of a snake or spider. • RESULTS Both groups of PpRESULTS Both groups of Pp’’s showed fear when subsequently showns showed fear when subsequently shown pictures they had experienced with an electric shock. This waspictures they had experienced with an electric shock. This was measured by their skin reaction called galvanic skin response (GSR).measured by their skin reaction called galvanic skin response (GSR). Following a period in which PpFollowing a period in which Pp’’s received no electric shocks it wass received no electric shocks it was found that the GSR was higher for those shocked when shownfound that the GSR was higher for those shocked when shown snakes and spiders.snakes and spiders. • CONCLUSION Human beings may be more biologically prepared orCONCLUSION Human beings may be more biologically prepared or ready to develop phobias for animals such as snakes and spiders,ready to develop phobias for animals such as snakes and spiders,
  46. 46. Preparedness • Preparedness weds biological andPreparedness weds biological and behavioral ideasbehavioral ideas • We are genetically programmed toWe are genetically programmed to develop classically conditioned phobiasdevelop classically conditioned phobias more rapidly to certain objects!more rapidly to certain objects!
  47. 47. Biological Treatments • Actually, the applied tension techniqueActually, the applied tension technique can be seen as a biological treatmentcan be seen as a biological treatment since you are overcoming the fearsince you are overcoming the fear through behaviorally induced biologicalthrough behaviorally induced biological change--increased BP followed bychange--increased BP followed by relaxation.relaxation.
  48. 48. Biological Treatments • D-Cycloserine, when used in conjunction withD-Cycloserine, when used in conjunction with exposure-based cognitive behavior therapy,exposure-based cognitive behavior therapy, helps with fear extinction in an array ofhelps with fear extinction in an array of anxiety- and stress-inducing disorders.anxiety- and stress-inducing disorders. – Ren, et al. (July 2013)Ren, et al. (July 2013) – Baker, et al (October 2012).Baker, et al (October 2012). – Hoffman & Stefan (2006).Hoffman & Stefan (2006).
  49. 49. D-Cycloserine Continued • D-Cycloserine is an antibiotic used toD-Cycloserine is an antibiotic used to treat tuberculosis. However it also hastreat tuberculosis. However it also has psychotropic effects.psychotropic effects.
  50. 50. D-Cycloserine Continued • How it works:How it works: It partially blocks glutamate from stimulating theIt partially blocks glutamate from stimulating the amygdala, a part of the brain required for negativeamygdala, a part of the brain required for negative emotions such as panic and fear.emotions such as panic and fear. It augments (added to and improves) exposureIt augments (added to and improves) exposure therapy with better results than exposure alone.therapy with better results than exposure alone.
  51. 51. Biological Treatments • SSRI's can be helpfulSSRI's can be helpful – These block serotonin reuptake sites,These block serotonin reuptake sites, allowing more serotonin to reach theallowing more serotonin to reach the dendrites of the next neuron. Serotonin isdendrites of the next neuron. Serotonin is beleived to increase a sense of well being andbeleived to increase a sense of well being and may regulate other neurotransmittermay regulate other neurotransmitter systems. People aren't really sure how SSRI'ssystems. People aren't really sure how SSRI's work.work. – Have side effects: loss of libido and ability,Have side effects: loss of libido and ability, appetite and sleep changes, headache,appetite and sleep changes, headache, dizziness, most importantly,dizziness, most importantly, suicidalitysuicidality
  52. 52. Biological Treatments • BenzodiazepinesBenzodiazepines (Xanax, Valium and MANY more)(Xanax, Valium and MANY more) – How they work: These drugs work by binding toHow they work: These drugs work by binding to GABA type A receptors. After binding, they allowGABA type A receptors. After binding, they allow more GABA to enter the neurons.more GABA to enter the neurons. – GABA is a neurotransmitter. GABA is like theGABA is a neurotransmitter. GABA is like the breaks of the brain, it inhibits neuronal activity.breaks of the brain, it inhibits neuronal activity. Panic requires a lot of neural activity in thePanic requires a lot of neural activity in the amygdala and other brain areas. Thus, panic andamygdala and other brain areas. Thus, panic and fear are reduced.fear are reduced.
  53. 53. Benzodiazepines Continued • Benzodiazepines have some negativeBenzodiazepines have some negative side-effects and are recommended forside-effects and are recommended for short term use only.short term use only. – Addictive (This is the main problem)Addictive (This is the main problem) – Negatively effects cognitive abilityNegatively effects cognitive ability – Tendon and ligament damageTendon and ligament damage

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