Phobias

Disruptive fear of a particular object or situation

Social Phobia
o Persistent, intense fear of social situations
o Fear of negative evaluation or scrutiny (more than shyness alone)
o Exposure leads to anxiety about being humiliated or embarrassed socially
o Onset in adolescence
o Diagnosed with either specific or generalized
Etiology of a Social Phobia
o Cognitive Factors
Negative factors
Fear of negative evaluation by others
Excessive attention to internal cues rather than external ones
o Behavioral Factors:
Person has negative social experience and becomes classically
conditioned to fear similar situations, which the person then
avoids
Specific Phobia
o Unwarranted, excessive fear of specific object or situation
o Most cluster around a few feared objects and situations
o Fears are avoided with intense anxiety
Psychological Treatment of Phobias
o Exposure
Real life has the best outcome and works in fewer sessions
o Social Phobia Exposure
Role playing with the therapist or small group interaction
Social skill training
o Cognitive Therapy
Enhances treatment for social but not specific phobias
Clarks Cognitive Theory more effective than medication or
exposure
Panic Disorders
Frequent attacks & worry about having another
Attacks
o Sudden intense episode of apprehension, terror, feelings of impending
doom
o Symptoms reach peak intensity in 10mins
o Often begin in adolescence
o 25% unemployed for more than 5 years due to symptoms
o Prognosis worse with agoraphobia present (avoidance of situations
where escape would be difficult)
Symptoms
o Sweating, Nausea, Labored breathing, Dizziness, Heart palpitations, Upset
stomach, Lightheadedness, Depersonalization, Derealization, Fear of
insanity
Etiology
o Behavioral
Classical conditioning
Interceptive conditioning (Classical conditioning of panic in
response to bodily sensations)
o Cognitive Factors
Lack of perceived control can trigger panic
Catastrophe misinterpretation of physiological sex
Treatment
o Panic Control Therapy
Exposure to somatic sensations associated with panic attacks in a
safe setting (Increased heart rate, Rapid breathing, dizziness, etc.)
Use of coping strategies to control symptoms (Relaxation & Deep
breathing)
Benefits maintained after treatment ends
o Cognitive Therapy
Increase patients awareness of thoughts that make physical
sensations threatening
Learns to challenge and change maladaptive beliefs
Also effective for agoraphobia (Treatment enhanced when spouse
stops catering to avoidance)

Generalized Anxiety Disorder
Symptoms
o Involves chronic, excessive uncontrollable worry that lasts at least 6
months and interferes with daily life
o Restlessness, Poor concentration, Irritability, Muscle Tension, Tires
easily, Sleep disturbance
o Often begins in adolescence or earlier
Common worries include: relationships, health, finances, daily hassles
Etiology
o GABA system deficits
o Borkovects Cognitive Model
Worry reinforcing because it distracts from more powerful
negative emotions & images
Allows avoidance of more disturbing emotions
Avoidance prevents extinction of underlying anxiety
Psychological Treatment of GAD
o Relaxation training
o Cognitive methods
Challenge and modify negative thoughts
Increase ability to tolerate uncertainty
Worry only during scheduled times
Medications
o Anxiolytics (drugs that reduce anxiety)
o Two types
Benzodiazepenes (Valium, Xanax)
Antidepressants (Tricyclics)
o Side effects
Benzodiazepenes are addictive and Antidepressants have sexual
side effects
Relapse after discontinuation
Develop attachments to medications
Obsessive Compulsive Disorder
Obsessions
o Intrusive, Persistent, and Uncontrollable thoughts or Urges
o Experienced as irrational
o Most common: Contamination, Sexual & Aggressive impulses, body
problems
Compulsions
o Impulse to repeat certain behaviors or mental acts avoid distress
Cleaning, checking, hoarding, counting
o Extremely difficult to resist the impulse
o May involve elaborate behavioral rituals
o Develops either before 10 or late adolescence
Men have an earlier onset than women
o Women have more cleaning compulsions
Etiology
o Behavioral
Operant Reinforcement (Compulsions negatively
reinforced by the rejection of anxiety)
o Cognitive (lack of satiety signal)
Attempts to suppress intrusive thoughts make things worse
o Neurobiological
Hyperactive caudate nucleus, orbitofrontal cortex, anterior
cingulate (too much activity in these areas)
Therapy
o Exposure plus ritual prevention is the most widely used treatment
Stimulus obsession is presented
Response compulsion is not allowed
This breaks the relationship between the O-C
o Cognitive Therapy
Challenge beliefs about anticipated consequences of not
engaging in compulsion