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Phobia - Normal or Abnormal?

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Course 6 Normal or Abnormal?

Problem 6.1 Just Scared? (Butcher&DSM-5&Davey&Zlomke; Davis article)

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Phobia is a persistent, irrational fear triggered by an object or situation. It creates feelings of panic and fear, making the person anxious. It has five types of believes: it will be unpredictable, it will harm, it will chase, it will be invasive and it will be responsive. Some anxieties can be comorbid (cross-disorder phenomena) because they share the same physiological and cognitive components.

Fear is an alarm reaction that occurs in response to immediate danger. Fear is a basic emotion that promotes “fight-or-flight” responses and is elected automatically. Components of fear:

  1. Cognitive/subjective components (e.g. feeling afraid)

  1. Physiological components (e.g. higher heart-rate)
  1. Behavioural components (e.g. look away)

Anxiety involves a general feeling of apprehension about possible future danger ( anxiety disorders; 30-40% of the population). The adaptive value of anxiety is that it helps us plan and prepare for possible threat, but it doesn’t activate a fight-or-flight reaction. In mild to moderate degrees, anxiety actually enhances learning and performance.

  1. Cognitive/subjective components (e.g. worrying)

  1. Physiological components (e.g. tension and chronic overarousal and having nightmares)
  1. Behavioural components (e.g. avoidance of certain situations)

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Diagnostic Criteria for Specific Phobia

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  1. Marked fear or anxiety about a specific object or situation

  1. The phobic object or situation almost always provokes immediate fear or anxiety.
  1. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
  1. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation
  1. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

  1. The fear, anxiety, or avoidance causes clinically significant distress or impairment in important areas of functioning.
  1. The disturbance is not better explained by the symptoms of another mental disorder, as in agoraphobia; obsessive-compulsive disorder; reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Diagnostic Criteria for Social Phobia

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  1. Marked fear or anxiety about social situations in which the individual is exposed to possible scrutiny by others.

  1. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
  1. The social situations almost always provoke fear or anxiety.
  1. The social situations are avoided or endured with intense fear or anxiety.
  1. The fear or anxiety is out of proportion to the actual threat posed by the social situation
  1. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
  1. The fear, anxiety, or avoidance causes clinically significant distress or impairment in important areas of functioning.
  1. The fear, anxiety, or avoidance is not attributable to the effects of a substance or another medical condition.
  1. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder.
  1. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.


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Brain and Panic Disorders

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The amygdala is a collection of nuclei in front of the hippocampus in the limbic system of the brain that is critically involved in the emotion of fear. It is recognized that increased activity in the amygdala plays a central role in panic attacks than does activity in the locus coeruleus, which then releases serotonin. Phobic stimuli enter the amygdala through the thalamus which provides connections to higher brain function-related cortical areas and subcortical nuclei. This information goes back to the amygdala and thalamus, creating motor output. People who have social phobia show greater activation of the amygdala in response to negative facial expressions.

The hippocampus is thought to generate conditioned anxiety and is probably also involved in the learned avoidance associated with agoraphobia.

Specific Phobias

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A person is diagnosed as having a specific phobia if she or he shows strong and persistent fear

that is triggered by the presence of a specific object or situation. Avoidance is a characteristic of

phobias; it occurs both because the phobic response itself is so unpleasant and because of the

phobic person’s irrational appraisal of the likelihood that something terrible will happen.


Animal phobia

Natural environment phobia (e.g. thunderstorms)

Blood-injection-injury phobia

Situational phobia (e.g. elevators, flying, tunnels)

Other (e.g. vomit)


12% of the people encounter a specific phobia in their lifetime

More common in women than in men

Some phobias are developed during childhood, others during adulthood

Causal Factors

Psychoanalytic view (FREUD): phobias represent a defence against anxiety that stems from

repressed impulses from the ID. Because it is too dangerous to “know” the repressed ID impulse,

the anxiety is displaced onto some external object or situation that has some symbolic

relationship. KEEP IN MIND: Freud was never really right.

Learning view: fear response can readily be conditioned to previously neutral stimuli when these

stimuli are paired with traumatic or painful events.

Inflation effect means that the phobia will grow with more exposure.

The two factor theory claims that there is a classical conditioning process (1) and a reward

system (2). Phobias develop through classical conditioning and maintain by operant

conditioning. Phobic behaviour tents to be reinforced (avoiding the situation makes the

stress go away).

Generalization means that the fear crosses over to similar objects/situations. KEEP IN

MIND: they do NOT have to have the same level of fear

Vicarious conditioning/ observational classical conditioning: fear being

transmitted from one person to another by watching someone else interacting fearfully with

an object or situation.

Individual differences:

  Some life experiences may serve as risk factors and make certain people more

vulnerable to phobias than others, and other experiences may serve as protective factors

for the development of phobias.

  The individual’s prior familiarity with an object or situation can determine whether a

phobia develops.

  The experiences that a person has after a conditioning experience may affect the

strength and maintenance of the conditioned fear.

  It has also been shown that our cognitions, or thoughts, can help maintain our phobias

once they have been acquired.

Evolutionary view: primates and humans seem to be evolutionarily prepared to rapidly

associate certain objects with frightening or unpleasant events (helps us survive). This is called

prepared learning. Prepared fears are not inborn or innate but rather are easily acquired or

especially resistant to extinction. KEEP IN MIND: this does not explain fear or harmless objects.

Biological Factors

Genetic and temperamental variables affect the speed and strength of conditioning of fear. A

large female twin study found that monozygotic twins were more likely to share animal phobias

and situational phobias than were dizygotic twins. However, the same studies also found

evidence that non-shared environmental factors also played a very substantial role in the origins

of specific phobias.


A form of behaviour therapy called exposure therapy (involves controlled exposure to the

stimuli or situations that elicit phobic fear). One variant on this procedure, known as participant

modelling, is often more effective than exposure alone. This can be done in two ways:

Flooding is very effective (80% recovery), it starts with the highest fear in the hierarchy.

From low to high in the fear hierarchy

Recently, however, some studies have shown that a drug called d-cycloserine, which is known

to facilitate extinction of conditioned fear in animals. KEEP IN MIND: this drug has no effect on

its own.

Social Anxiety Disorder

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Meaning        Social phobia is characterized by disabling fears of one or more specific social situations. A person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others or that she or he may act in an embarrassing or humiliating manner.



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