Powerpoint covering the CIE A2 Psychology syllabus on phobias

1. Phobias

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. 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. 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. In the DSM IV, phobias are subdivided...
• AgoraphobiaAgoraphobia
• Specific PhobiaSpecific Phobia
• Social PhobiaSocial Phobia

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. 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. How might a phobia interfere with
daily living? Consider different
arenas of life…work, home, social

9. What do you think are the most
common phobias?

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. 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. For a full list...
• http://phobialist.comhttp://phobialist.com

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. 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. 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. EXPLANATIONS OF PHOBIAS
• There are several theories about the
origins of phobias.
• What do you think might cause
phobias?

17. Psychodynamic
• Do you remember little Hans?

18. Psychodynamic
How would you explain the psychodynamic
explanation?

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. • 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. • 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. • Remembering how Freud resolved Hans'Remembering how Freud resolved Hans'
phobias, what might the treatmentphobias, what might the treatment
involve,involve,

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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