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■ Anxiety is an adaptive response that is important for an animal to experience anxiety as it ensures survival – Evolutionary speaking - heightened arousal levels prepare our body for fight or flight.
■ The problem however is that sometimes irrational feelings of anxiety can be transferred into situations that aren’t typically dangerous and this can be disabling to the person concerned.
The DSM-IV Diagnostically and Statistical Manual of Mental Disorders has listed a number of anxiety disorders
■ phobias
■ panic disorder
■ generalised anxiety disorder
■ obsessive compulsive disorder
■ Post traumatic stress disorder
■ Irrational feelings of fear/apprehension
Symptoms include;
■ Cognitive effects – worry – panic
■ Behavioural effects – avoidance behaviour
■ Somatic effects – Changes to body, HR, dry mouth, trembling, perspiration, tension, indigestion etc
■ Insight
■ Leads to panic attacks – always a constant worry
PHOBIAS
■ Phobias are an intense irrational fear of some object or situation, with the level of fear being so strong that the object or situation is avoided whenever possible.
■ People realise their fear makes no sense but that doesn’t stop them from being terrified. There are various different categories of phobia, including social phobias, specific phobias and agoraphobia.
■ Specific phobias involve strong and irrational fears of some specific object or situation. Specific phobias include fear of spiders and fear of snakes, but there are hundreds of different specific phobias.
■ People with social phobia fear being observed. They are afraid they will act in a way that will be embarrassing or humiliating and that they will end up having a panic attack.
■ Agoraphobia involves a great fear of open or public places. Agoraphobia on its own is rather rare but in most cases, panic disorder is accompanied with agoraphobia. Individuals who are very frightened of having panic attacks feel less secure when away from familiar settings and people and know that they would be very embarrassed if they had a panic attack in public.
Using an example, state what is meant by a specific phobia. Suggest how a specific phobia differs from other kinds of phobia. (3 marks)
Using an example, state what is meant by a social phobia. Suggest how a social phobia differs from other kinds of phobia. (3 marks)
Using an example, state what is meant by agoraphobia. Suggest how agoraphobia differs from other kinds of phobia. (3 marks)
|Specific phobia |
| |
|Definition: Specific phobias involve strong and irrational fears of some specific object or situation. Specific phobias include fear of spiders and fear of snakes, |
|but there are hundreds of different specific phobias. DSM-IV has identified 4 major sub-types of specific phobias: |
| |
|Animal type |
|Natural environment type (heights, water, storms) |
|Blood injection type |
|Situational type (fear of various situations, plane, lift, enclosed space) |
|In addition there is a 5th category labelled ‘other type’. This covers all specific phobias that do not fit into any of the above categories, for example a fear of |
|choking, vomiting or contracting an illness. |
| |
|The major diagnostic criteria for specific phobias given by the DSM-IV: |
| |
|A persistent fear of a specific object/situation |
|Exposure to the phobic stimulus nearly always produces a rapid anxiety response |
|The individual recognises that his or her fear of the object/situation is excessive |
|The phobic stimulus is either avoided or responded to with great anxiety |
|The phobic reactions interfere significantly with the individual’s work/social life – causing much distress |
|In individuals are under 18yrs of age, the phobia has lasted for 6 months + |
|Social Phobia |
| |
|Definition: People with social phobia fear being observed. They are afraid they will act in a way that will be embarrassing or humiliating and that they will end up|
|having a panic attack. They recognise the fear is irrational but they still avoid any situations that they think will provoke anxiety. For example, a student may stop |
|writing in an exam when he is being watched by a teacher for the fear of shaking violently or a factory worker may stop going to work for fear he will not be able to do |
|his job if he is being observed. |
| |
|The major diagnostic criteria for social phobia given by the DSM-IV: |
| |
|A persistent fear that one or more situations in which the individual will be exposed to unfamiliar people or to the scrutiny of others |
|Exposure to the feared social situation nearly always produces a high level of anxiety |
|The individual recognises that the fear experienced is excessive |
|The fear situations are either avoided or responded to with great anxiety |
|The phobic reactions interfere significantly with the individuals work/social life causing much distress |
| |
|Social phobia is more common in females than males, with about 70% being female. According to Barlow and Durand (1995) social phobia tends to be more prevalent in |
|people who are younger (18 – 29 yrs), less educated, single and of a lower socio economic class. |
|Agoraphobia |
| |
|Definition: Agoraphobia involves a great fear of open or public places. Agoraphobia on its own is rather rare, as pointed out by the DSM-IV. In most case, the |
|panic disorder starts before the agoraphobia. Individuals who are very frightened of having panic attacks feel less secure when away from familiar settings and people |
|and know that they would be very embarrassed if they had a panic attack in public. These concerns lead them to avoid public places and so agoraphobia is added to the |
|panic disorder. |
| |
|Panic disorder with agoraphobia is defined by the following criteria in the DSM-IV: |
| |
|Recurrent unexpected panic attacks |
|At least one panic attack has been followed by at least one month of worry about the attack, concern about having more panic attacks, or changes in behaviour resulting |
|from the attack |
|Agoraphobia, in which there is anxiety about being in situations from which escape might be hard or embarrassing in the event of a panic attack. |
|The panic attacks are not due to recreational/medicated drugs |
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Biological explanations of phobias
■ Evolutionary theory – biological preparedness/predisposition
■ Autonomic nervous system
■ Genetics
EVOLUTIONARY THEORY
How do you think phobias are related to evolution?
■ Fear of objects/situations has evolved over thousands of years
■ Our ancestors became physiologically aroused at the sight of danger and this arousal and instinct for threats has been passed on through our genes…
■ However….research hasn’t shown one specific gene or set of genes as responsible, but it has shown that there are some people who seem to be more biologically predisposed to develop phobias than others (Scher et al 2006)
Guess which phobias are more likely to be evolutionary based?
To have a fear of:
■ Clowns
■ Darkness
■ Planes
■ Heights
■ Guns
■ open spaces
■ Bacteria
■ strangers
Study to support
A study by Ohman et al (2006) showed how people might actually be biologically prepared or ready to develop phobias for animals such as snakes etc since they are a threat to survival.
How?
Method
Participants were put into two groups – in one condition they were given an electrical shock when looking at pictures of a house or face. The other condition when looking at spiders or snakes. Their GSR galvanic skin response was measured as a measure of fear.
When subjects were later shown the pictures again – the group that had seen the spiders and snakes still howed most fear….
Preparedness
■ In biological terms the preparedness to fear could have evolved and been passed on genetically.
ANS
■ The Autonomic Nervous System controls our emotional responses and so is involved in the fear response. Research has shown that some people have higher arousal levels than others and Gabbay (1992) believes this could be related to genetic inheritance.
Genetic evidence
Read the notes below and be able to explain the genetic evidence for all three phobias
Genetic Factors
Some people acquire phobias whilst others do not, even if they have the same opportunities for learning. Suggests biology/genetics may play a role. The main evidence on genetic factors in the development of phobias comes from twin studies, although some family studies have also been carried out.
• Twin studies (attempt to separate genetic factors from environmental factors). They examine the 'rate' of concordance of a disorder (i.e. whether both twins are affected). A comparison is made between monozygotic (MZ) twins, who have identical genetic make-up, and dizygotic (DZ) twins, who are no more genetically alike than any other siblings)
• Family studies examine the occurance of the disorder with first degree relatives (parents, children, siblings)
Panic Disorder with agoraphobia
Torgerseii (1983) looked at pairs of MZ & bZ twins, at least one of who had panic disorder. The concordance rate was 31% for MZs against 0% for DZs.
Noydret al (1986) found that 12% of the first-degree relatives of agoraphobics also had agoraphobia, & 17% suffered from panic disorder. Both of these figures are greater than controls.
Harris et al (1983) found that close relatives of agoraphobic patients were more likely to be suffering from agoraphobia than were the close relatives of non-agoraphobic individuals
These findings are consistent with the view that genetic factors play a part in the development of agoraphobia. However, they cannot eliminate the effects of the environment. It might be that the individuals learnt their phobias through imitation. As although close relatives share genes, they also have considerable opportunity to observe & influence one another. Therefore, although genetics factors may be involved in the cause ofphobias, the degree to which they are important remains inconclusive.
Specific Phobia
Fyer et al (1990) studied 49 first-degree relatives of people with a specific phobia & found that 31% of relatives were also diagnosed with phobias, but only two people had the same type
Ost (1989) found that 64% of those with blood phobia had at least one close relative who also suffered from blood phobia. Again, the results of the above studies are consistent with the notion of the involvement of genetic factors, but the role of imitation cannot be ignored.
[pic][pic][pic][pic][pic]Social Phobia
Fyer et al (1993) discovered that 16% of the close relatives of social phobics developed the same disorder, against only 5% of the relatives without social phobia. However, Skre et al (1993) found that the concordance rate for social phobia was similar in MZ & DZ twins, leading them to conclude that social phobia is caused mainly by environmental influences.
Biological 'Preparedness'
Seligman (1971) proposed the concept of biological preparedness. This suggests that all species are innately 'prepared' to fear & avoid certain daft vf stimuli because they are potentially dangerous. We have evolved a predisposition (preparedness) to fear certain stimuli becuase such fears had survival value for our ancestors.
According to this idea, each species finds some kinds of learning much easier than others because of their biological predispositions.Garcia & Koelling (1966) showed that rats could be conditioned easily to avoid life-threatening situations (such as shocks or poisonous liquids), but not to stimuli which carried no nasty consequences such as flashing lights. Therefore, they were 'prepared' to fear dangerous stimuli.
Neurological Explanations
Based on the functioning of the autonomic nervous system (sustains basic life processes of which we are not consciously aware, e.g. respiration, heart rate, 'fight or flight' reaction to emergency situations -i.e. physiological arousal). Lader and St Matthews (1968) found that people who develop social phobia or panic disorder with agoraphobia have high levels of arousal. However, this begs the question of whether high arousal levels are the cause of, or the consequence of the phobia.
OTHER GENERAL EVALUATIONS
■ Biological explanations is not very convincing – weak evidence
■ Biological explanations cover a small no. of phobias so again lacks credibility
■ Genetic studies have been criticised – families with the same disorder could be a result of shared environments and not genes
■ The link between the ANS and anxiety is much more complicated than we think – since different anxiety disorders cause different reactions
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1. Classical Conditioning
Simply put - A person can come to fear a neutral/harmless stimulus if it is paired with a frightening/painful stimulus on numerous occasions.
Below are studies to support emotions (fear) that are classically conditioned: First Fill in the blanks:
The story of ________ _________is a prime example Watson and Rayner ________ where a _________ old baby boy is produced with a white fluffy________, a white rat or white cotton wool (neutral __________) and they did not _________ fear in the baby. However, when they __________ these stimuli with a large bang (unconditioned stimuli), it startled and made Albert cry. They did this ________ times, and repeated the same procedure a week later. The ____________ became so strong that Little Albert developed a _________ not only of white rats, but also anything white and fluffy.
|rabbit |fear |9 month |stimuli |(1920) |
|three |‘Little Albert’ |association |provoke |paired |
Consider the case of a child who is continually beaten with a tan hair brush by her father.
First what is the US _______________
What is the UR _______________
What is the neutral event? _______________
Now what is the CS? _______________
What is the CR? _______________
CASE STUDY
Bagby (1922) reported a case study of a young woman who developed a fear of running water as a result of an experience she had had when her feet got trapped in water near a running waterfall. The young woman had left her family to go for a walk and became trapped in some rocks. As time went on, the woman became more fearful that she would never escape. Her feelings of terror and panic increased. At the same time, the sound of running water from the waterfall became paired with these feelings of panic. The screaming young woman eventually was freed from the rocks by her family but afterwards the woman showed a strong phobia for running water for many years after.
|What was the harmless neutral stimulus that became a fear? |
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Evidence that experiences of traumatic events can result in a person developing a phobia has been found.
|Is the evidence below in support or against the argument that phobias are developed by Classical Conditioning? |Draw either a positive or negative face |
| |accordingly |
|For example, case studies of children who have strong phobias show the origin of some traumatic and unpleasant experience in| |
|the past (King et al 1998). People more often than not will explain unpleasant events as the origin of their phobia. | |
|Barlow & Durand (1995) reported that 50% of those with a specific phobia of driving can actually remember a traumatic | |
|experience they had in the past while driving as having caused the onset of that phobia. These people will not want to | |
|travel, get in a car and would prefer to stay at home than go to see friends. (DiGallo et al, 1997) | |
|Ost (1995) showed the case of a woman with a severe phobia of snakes. She had been told repeatedly about the dangers of | |
|snakes and had been strongly encouraged to wear rubber boots to protect herself against snakes. She finally reached a point| |
|where she would wear the rubber boots to the shops. | |
|However other studies have argued there isn’t always such an association. For example, Menzies and Clarke (1993) found only| |
|2% of individuals suffering from water phobia reported a direct unpleasant experience with actual water. | |
|Further contradictory evidence comes from Ost (1987) who noted that many people with severe fears of snakes, germs, | |
|aeroplanes or heights have had no particularly unpleasant experiences with any of these objects or situations. | |
|Furthermore, Watson & Rayner's findings have proved difficult to replicate. Most laboratory studies have obtained little or | |
|no evidence that individuals can be conditioned to fear neutral stimuli by pairing them with unpleasant ones (Davison & | |
|Neale, 1996). These findings suggest that phobias do not necessarily depend on a frightening experience. | |
2. Observational Learning
Bandura (1986) developed conditioning theory by showing the importance of modelling/observational learning. Phobic responses may be learned through imitating the reactions of others.
An example could include: The social learning theory or observational learning explains the development of phobias as a result of an observer watching or observing another person (the model) experience pain or upset from an object or situation. If the observer was a young child, the model is usually the mother or father. For example if the mother has a fear of spiders and reacts in a highly emotional and extreme way then when there is a large spider in the bath the child, they will develop a phobia of spiders.
This is because the mother acts as a role model for the child, and because the strong emotions of the mother towards the spider may frighten the young child. Here classical conditioning would operate after the imitation as the child pairs the fear reaction of the mother to the stimuli – the spider.
Bandura & Rosenthal (1966) arranged for subjects to watch a model (a confederate of the experimenter) in a painful conditioning situation. The model was wired up to electrical apparatus & each time a buzzer sounded, the model was seen to rapidly remove his/her hand. The physiological responses of the subjects watching were recorded.
After the subjects had seen the model 'suffer' a number of times, they showed stronger emotional responses when the buzzer sounded - began to react emotionally to a harmless stimulus just through observing others' reactions.
Mineka (1984) reared adolescent monkeys with parents who were terrified of snakes. During observational learning sessions, the adolescent monkeys saw their parents interact fearfully with real & toy snakes & non-fearfully with neutral objects. After six sessions, the fear of the adolescent monkeys was identical to that of the parents.
Merckelbach et al (1996) argue that some phobias can be acquired through modelling (e.g. small-animal phobias & blood-injection-injury phobias), but that claustrophobia rarely develops as a result of modelling.
Other general evaluations:
Research has shown that phobias can be acquired through classical conditioning and observational learning; however research has not shown this to be the only way that people acquire phobias and so the explanation lacks true credibility.
Case studies of children and adults point to a particular incident as the start of the phobia but not all phobias can be traced back to an upsetting or traumatic event. For example Keuthen (1980) reported that half of all phobics could not remember anything highly unpleasant. However those who favour a conditioning account have argued that phobics have just forgotten conditioning experiences that happened many years previously.
Also ethical concerns have arisen from studies such as that with Little Albert, especially as he was never reconditioned – he was discharged before they could. They said they conducted the research without hesitation and but decided it was justifiable because it may have been something that Albert may have encountered anyway.
In defence of the behaviourist view – it could be argued that children have a very poor recall of events from early childhood, or they may have repressed the memory of the traumatic event or may not have even realised that the event involved the actual CS – which may have then generalised – as in Little Albert.
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According to cognitive therapists, people who suffer from various anxieties are more likely to suffer from irrational conscious thinking. Clark (1996) developed an explanation based on the idea that phobics think in a distorted way and have catastrophic thoughts. These catastrophic thoughts are where a person thinks that something dreadful will happen to them. For example, a person with a phobia for snakes may think that any snake he or she comes across will attack and bite them, and that the bite will be fatal.
Other typical catastrophic thoughts that people with phobias report having are:
• Being out of control
• Being trapped and unable to escape to somewhere safe
• Suffocating because of shallow breathing when having a panic attack
Social phobia
People with social phobias tend to have negative thoughts about how other people think about them. For example, those with social phobia usually think that other people will think about them as uninteresting and boring to talk to. They can also perceive their behaviour in social situations to be more negative than it appears to observers, so they will think generally negative events are more likely to happen to them than people who do not have phobias. (Menzies and Clark, 1995)
Panic Disorder
Clark et al (1998) assessed ways that people suffering from panic disorder with agoraphobia (or not) will interpret a range of ambiguous situations. These people will monitor their own bodily sensations very closely. They are much more acutely aware of and think about their heartbeat, breathing, dryness of mouth, compared to people without phobias. They interpret these sensations in a catastrophic and life threatening way making their sensations become worse and so causing them even more anxiety.
One reason suggested as to why people with agoraphobia/panic disorder misinterpret their bodily sensations has been explained as caused by a previous illness that caused them even to have concern for their own wellbeing and so more aware generally compared to people who have not suffered from a previous illness. Verburg et al (1995) found that 43% of their patients with pd had also suffered from at least one respiratory disease compared with only 16% of patients with other anxiety disorders.
Study
Ehlers and Breuer (1992) conducted a study to show how people who suffer from panic attacks are more likely to be aware of their heartbeat and other bodily reactions than people who do not suffer from panic attacks. People who suffered from panic attacks were asked to estimate how fast their heart was beating compared to those who did not suffer from panic attacks. The results showed that those who suffered from panic attacks were much more accurate on their estimate of how fast their hearts were beating. So people who suffer from panic attacks monitor their bodily functions much more closely than those who do not suffer from panic attacks
EVALUATIONS
• There is clear evidence that people who suffer from anxiety disorders also suffer from a range of catastrophic thinking which leads them to misinterpret events or situations.
• However it is difficult to know if these irrational thoughts cause the phobias or if the phobias cause the irrational thoughts.
• Nevertheless, the cognitive explanation has proved valuable to psychologists who want to discover exactly what people with phobias are thinking. This has led to better more effective treatments which aim to tackle this illogical thinking.
• One important factor concerning the cognitive explanations is that it is closely tied to the behavioural explanations. For example, the individual first is exposed to the fearful situation/event which then subsequently initiates the phobia (Conditioning theory). So the environment affects a person before the irrational thoughts about the future possibility begins
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The psychodynamic explanation of phobias is based on Freud’s idea that people have unconscious wishes and thoughts that cause conflict between the ego and the id or superego. The ego is threatened by the unconscious conflict and fear that the anxiety caused by the conflicts will overwhelm it. This would result in the ego not being able to function at all. This is because all the egos energy is used up trying to cope with the anxiety or feelings of panic. To cope with this the ego uses a defense mechanism called displacement – which displaces these unconscious thoughts and conflicts onto something external. This results in a specific phobia.
The psychodynamic explanation goes on to say that it is less threatening to the individual to have a phobia than to have unconscious thoughts/conflicts and not do anything about them.
Specific phobias
Either way, from a psychodynamic perspective the person is trapped in a no win situation since a phobia can be as debilitating as the original unconscious thoughts and desires. For the ego, though a phobia is an acceptable compromise because the real source of anxiety resulting from unconscious thoughts has been avoided.
|Case study: Little Hans |
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|Freud's theory of phobias rests on his 1909 case study of a boy named Little Hans who developed a fear of horses. Freud believed that the boy's phobia was directly related|
|to his unconscious fear of his father of castration anxiety and this instead was displaced onto a fear of horses. He displaced his fear that his father would harm him for|
|having sexual thoughts about his mother. |
Agoraphobia
The psychodynamic explanation explains agoraphobia also – as resulting from separation anxiety experienced by a young child. This is at an unconscious level and is to do with the irrational thoughts that the young child has about separation from the mother and/or father and the realisation of the dependency of caregivers. Agoraphobia serves the function of keeping the person at home, and for the unconscious irrational mind this reduces separation anxiety. This is because unconsciously the person thinks that separation from either both parent or caregivers is less likely if the person is at home all the time.
EVALUATIONS
The problem with the case study of Little Hans is that he did not show a phobic reaction every time he saw a horse. In fact he only showed his phobia when he saw a horse pulling a cart at high speed. Hans' horse phobia originally developed after he had seen a serious accident involving such a horse & cart travelling fast. Therefore, classical conditioning would be a better explanation for his phobia, not unconscious fears!
All this is supposed to be happening at an unconscious level which makes scientific enquiry very difficult. It is difficult to investigate objectively, and difficult to prove.
Little evidence has been found to support the explanation that agoraphobia in adults as a result from a fear of separation anxiety during childhood (Barlow, 2002). Psychologists do agree however that separation in early childhood can lead to other general psychological disorders…
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Not all people who suffer from phobias seek treatment. Some people can lead almost normal lives by simply avoiding that frightening situation, i.e. if they are scared of using lifts then they can use the stairs instead. However there are others who hate how their phobia interferes with their daily life and so they seek treatment.
Behavioural treatment of phobias
1. Using concepts from classical/operant conditioning the individual is offered a treatment labelled systematic desensitisation (Wolpe,1958). This is where a person must pass through a hierarchy of fear provoking situations that lead eventually to the real specific/social phobia. During these levels each time the client will practice the deep relaxation techniques that were taught earlier so that they remain calm throughout.
For example, someone with a fear of flying would be asked to complete a series of steps where they would be introduced to the flying on a plane in progressive stages. First, they’ll look at pictures of planes, then watch a video, then physically watch someone get on a plane and watch it take off; next they would get on the plane etc. The person may take a friend who could help them to practice their deep relaxation techniques. They will face their fears!
Lang and Lazovik (1963) conducted a study where they would assess the effectiveness of desensitisation as a treatment of phobias of snakes. People with this phobia were divided into 2 groups – either they received the desensitisation or they didn’t. Those who received the desensitisation showed a dramatic drop in fear up to 6 months later compared to the control group thus we can conclude desensitisation has an immediate and dramatic effect for the long term.
2. Flooding or Exposure therapy
Almost like the opposite to the above – flooding does not involve relaxation or progression – instead the individual is exposed immediately and repeatedly to their phobia. In the case of a spider phobic, the client could be put asked to imagine being surrounded by dozens of spiders and then immediately after placed in a room full of spiders. The client’s senses are initially flooded or overwhelmed by fear & anxiety.
Exposure therapy is where the initial stages of the therapy are usually very unpleasant and produce high levels of anxiety. So it is the therapist’s job to keep them motivated to stay. However, physiologically it is not possible to maintain a state of anxiety for a long period, & the fear starts to diminish. If the client can cope with the first few sessions then the therapist will use in vivo exposure – using flooding with the real object from the very start rather than just imagining it.
EVALUATIONS
• These treatments are widely adopted by clinical psychologists within the NHS & are relatively quick (taking usually a few months) as opposed to psychodynamic therapies which usually last several years.
• The effectiveness of behavioural techniques has been shown to be quite high. McGrath (1990) claims that systematic desensitisation is effective for around 75% of people with specific phobias.
• Comer (1995) cites a study on 'flooding' conducted by Hogen & Kirchner
(1967). Twenty-one people with a phobia for rats were asked to imagine themselves having their fingers nibbled & being clawed by rats. After treatment, twenty were able to open a rat's cage and fourteen were able to pick it up.
• However, Kendall & Hammen point out three criticisms of behaviour therapy:
➢ It is a mechanical treatment & only sees benefits in terms of changes in observable behaviour
➢ It fails to consider the underlying causes of mental illness - only symptoms, plus it seems only to be effective with social/specific phobias and not agoraphobia.
➢ There is a problem of generalisation - the client may produce the desired behaviour in the therapist's room, but does it follow that the same behaviour will be produced in other situations?
Biological Therapy
Numerous drugs are prescribed by doctors as there is a belief out there that anxiety and panic attacks are associated with abnormal brain activities – such as abnormal neurotransmitter levels including norepinephrine, dopamine and serotonin – which the drugs will alter accordingly.
Agoraphobia in particular is usually treated with anti-anxiety drugs, including the Benzodiazepines sedatives known as Valium) or anti depressants which are taken more long term.
Evaluations
• These are all powerful drugs that can have many side effects including drowsiness, lethargy, weight gain, memory loss, dry mouth etc.
• They should generally be used over fairly short periods of time and should be used in conjunction with other forms of therapy.
• There can be unpleasant withdrawal symptoms when patients stop taking them, there are potential problems of addiction, tolerance dependency. Therefore, when coming off the drugs it must be done gradually over a period of months
• Drug therapy can be useful in providing rapid reduction of anxiety in patients who are very distressed. However, anti-anxiety drugs are only designed to reduce the symptoms of anxiety & do not tackle the underlying problems.
COGNITIVE THERAPY
Cognitive therapy attempts to remove the conscious distorted catastrophic thoughts people with phobias typically have. One technique is cognitive restructuring which has been developed from Rational Emotive Therapy (Ellis, 1970). The client is asked to tell the therapist exactly what they are thinking when the client must be shown that these are irrational and not based on reality.
Ellis (1962) developed Rational-Emotive Therapy as a way of removing irrational & negative thoughts & replacing them with more rational & positive ones. This is point D - a dispute belief system that allows people to interpret life's events in ways, which do not cause anxiety/depression. Therefore, since phobias are maintained by irrational beliefs, the client is taught to dispute the irrational belief whenever encountering the phobic object or situation & replace these with more positive & rational ways of thinking.
Another technique is cognitive rehearsal where a client with social phobia is asked to think about being in front of a group of people and asked to give a presentation. The client is then asked to think about specific behaviours that are appropriate to the social situation. These are likely to be suggested by the therapist. The client will mentally rehearse these behaviours and then when it comes to the real thing they should be able to stop thinking about any negative intruding thoughts and get on with the task at hand.
Beck (1976) regarded people with phobias as having a negative view of their problem solving abilities and exaggerating the extent to which specific phobias /situations etc are actually threatening. Beck’s form of cognitive therapy is very task orientated and based on helping people to realize that they can solve their own problems successfully and that their threats are not justified. They must think positively about themselves.
Newmark et al (1973) found that anxious patients are much more likely than normals to have irrational beliefs. They found that 65% of anxious patients (but only 2% of normals) agreed with the statement: "It is essential that one be loved or approved of by virtually everyone in his community."
Evaluations
• Cognitive therapy has been especially successful at treating public speaking nerves and claustrophobia in particular.
• The techniques taught can be practiced at any time anywhere – they do not need to be in a therapeutic setting. This means that the client should consistently be able to maintain coping with their phobia even after the therapy has stopped.
PSYCHODYNAMIC THERAPY
Psychoanalysis aims to treat the root cause of the phobia rather than the symptoms. In order to discover what is happening in this unconscious conflict is to use free association, word association and dream analysis.
Free association is a very simple method to attempt to uncover repressed ideas & gain insight (a conscious understanding of thoughts/feelings which have been repressed). The client is encouraged to say the first thing that comes into his/her mind. It is hoped fragments of repressed memories will emerge during the course of free association.
Word Association: The client is read a list of words one at a time & asked to reply with whatever comes instantly to mind. The analyst pays particular attention to unusual responses, hesitations & mental blanks which may indicate repression.
The role of the therapist is to make the client aware that their anxieties and conflicts have been displaced onto some other object/situation and once this has been achieved they can then try to come to terms with that conflict and accept them no matter how hard the process – i.e. penis envy, castration anxiety?
Evaluations
• This form of therapy may take years and sometimes the client will get worse before getting better. The therapist must make sure the ego is strong and able to cope with irrational thoughts from the unconscious id and superego.
• Smith and Glass (1977) actually found that this type of therapy was slightly less effective than other types- behavioural and cognitive coming out best
• However the advantage of psychodynamic therapy is that it does aim to treat the cause of the phobia not just the symptoms. However the other therapies allow the client to develop their techniques and so lead a normal life as possible.
• Overall relapse when coming off drugs is quite high so the best way to treat phobias is to use a combination of SD, DT and CT.
Exam questions
• Using an example, state what is meant by a social phobia. Suggest how a social phobia differs from other kinds of phobia. (3 marks)
Be able to answer this question for all three phobias, specific and agoraphobia…
[AO1 = 1, AO2 = 2] AO1 Extreme/irrational/leads to avoidance/maladaptive fear of a social situation. AO2 One mark for explanation of how social phobia differs from other types of phobia. Likely answers: social phobias are not of single object; social phobias are less easy to treat. Plus one mark for valid example.
• Describe a study in which the cause of one anxiety disorder was investigated. Indicate why the study was conducted, the method used, results obtained and conclusion drawn. (5 marks) [AO1 = 5, AO2 = 0]
AO1 Any study in which the cause of an anxiety disorder was investigated is acceptable. Examples: genetic studies, eg Slater and Shields 1969, Goldberg 1990; conditioning, eg Watson & Rayner 1920, Jones 1924; cognitive factors, eg Yun 1997.
1 mark - why study was conducted (must go beyond the stem)
1 mark - information about the method
1 mark - indication of results
1 mark - indication of conclusion to be drawn
1 mark - additional or extra detail (accept evaluative points here only if they add to the description of the study in some way).
• Emily has recently become so afraid of social situations that she hardly ever goes out of the house. Even harmless everyday situations, like meeting friends in a café, are terrifying for Emily. (i) Identify three characteristics of phobias shown by Emily. (3 marks) [AO1 = 0, AO2 = 3]
AO2 Credit up to 3 marks as follows:
Emily’s fear is extreme/severe emotional response (terrified of going out) (1)
Emily’s fear is irrational (she fears everyday situations) (1)
Emily shows avoidance (she goes out as little as possible) (1)
Emily’s fear is disproportionate (fears everyday situations) (1)
Candidates should identify the characteristics of phobias and not gain credit for simply repeating the stem. Emily’s two friends are studying psychology at university. Each of them has a different explanation for Emily’s phobia. Jo thinks the problem is due to some unconscious fear or wish. Allie thinks the problem is due to conditioning.
• Describe and discuss the psychological explanations for Emily’s phobia referred to by Jo and Allie. (12 marks) please note this was an essay in the old specification at A2 level but just take out two marks and you have a 10 mark essay).
[AO1 = 6, AO2 = 6] AO1 Usually award up to 3 marks each for identifying and describing the two psychological explanations: Jo - The psychodynamic explanation; fear is due to repression; manifest object of fear merely symbolises latent fear; due to childhood event. Allie - The behaviourist explanation; fear is due to classical conditioning; temporal association between UCS (original cause of fear) and CS (going outside/people, etc); leads to a conditioned response; elicited inappropriately; credit relevant labeled diagram; operant conditioning - reinforcement of avoidance behaviour; 2 process conditioning. Credit description of relevant evidence up to 2 marks.
AO2 Usually award up to 3 marks each for discussion and analysis of the psychodynamic and behaviourist explanations. Likely points: Psychodynamic - lack of evidence; based on case studies; Little Hans; subjective interpretation; intuitive appeal; negative approach/backward looking Behaviourist - more appropriate for specific phobias; neglects cognitive factors; based on animal research; based on sound scientific research. Credit use of relevant evidence.
• Briefly explain two reasons why a person who is mildly afraid of something cannot be said to be suffering from a phobia. (4 marks) [AO1 = 2, AO2 = 2]
AO1 One mark for each reason given. Possible answers: unlike a mild fear, a phobia involves avoidance; fear is extremely intense; phobia affects how person lives their everyday life; phobia interferes with normal activities; phobias are irrational fears. AO2 One further mark each for expansion/explanation of each reason. Although not specifically requested, the expansion may come in the form of an example.
Discuss behavioural therapy as a treatment of anxiety disorders. (12 marks) [AO1 = 4, AO2 = 8]
AO1 Up to 4 marks for knowledge of behavioural therapy. Accept either behaviour therapy or behaviour modification. Examples: systematic desensitisation, exposure, flooding. Award marks for relevant detail: classical conditioning; hierarchy; gradual exposure; temporal association; UCS/UCR CS/CR; operant conditioning; association between response and consequence; positive/negative reinforcement. Also credit references to modelling - phobias, and aversion therapy - compulsive behaviours. Not all of the above is expected for four marks. Candidates may give a general description of a range of behavioural therapies or may focus on one in depth. Maximum 2 marks for list of 2 or more therapies.
AO2 Up to 8 marks for application/discussion. Candidates may offer analysis of the link between theoretical aspects and treatments for anxiety disorders, eg how classical conditioning is involved in systematic desensitisation, exposure/response prevention, or how operant conditioning might be used to reinforce substitute behaviours. Possible discussion points: treats behaviour not cause; may develop alternative inappropriate behaviours; ethical issues, g control/manipulation; generalisation outside the therapeutic context; relative effectiveness in relation to other forms of treatment, eg anti-anxiety drugs. Credit references to evidence, eg Jones 1924, Steketea and Foa 1984, Emmelkemp 1994, Wolpe et al 1994.
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