Anxiety disorder: specific phobia

Anxiety disorders refers to a mental disorder in which the frequency and intensity of feeling anxious is out of proportion to the situation and interferes with everyday life. It is characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect (comes under Axis 1 in DSM).

There are 5 main types of anxiety disorders: general anxiety disorder, phobic disorder, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.

Phobia

Phobia is a persistent, irrational and intense fear of a particular object or event that interferes with everyday functioning. The source of phobia is called the phobic stimulus.

There are several subcategories of phobic disorder:

  • Social phobia: involves the fear of other people and social situations.
  • Agoraphobia: fear of leaving a familiar place such as home.
  • Simple phobia: a disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.
    • Animal phobias (spiders, dogs, snakes, etc.)
    • Natural environmental phobias (heights, darkness, lighting, etc.)
    • Situation phobias (lifts, bridges, enclosed spaces, flying, etc.)
    • Blood-injection phobia (seeing blood, having an injection, getting a cut, etc.)

Biological contributing factors

Role of the stress response

When a threat is perceived, the fight-or-flight response is activated, resulting in the adrenal gland releasing stress hormones into the bloodstream (adrenalin and noradrenaline), an increase in heart rate, increased respiration and sweat gland activity. This arousal can be detrimental to the individual when it is regularly and chronically triggered in response to perceived threats whether real or imagined. Phobic anxiety can be triggered by exposure to the object of threat or situation that triggers the physiological response. This stress response accounts for many symptoms such as heart palpitations, increased perspiration, and increased breathing rate. The memory of the frightening event is consolidated by the hippocampus, while the amygdala stores the emotional memory of this fear and triggers the fear that sets off the fight or flight response when faced with the phobic stimulus.

Treatment

If you experience repeated false alarms, the stress response should diminish as your body learns that there is no threat. Thus phobias can be treated through exposure to the phobic stimulus, as is done in the process of flooding. Flooding is a method of treating phobias in which the patient is exposed to extreme levels of the phobic stimulus, keeping them in contact with it until their fear and associated anxiety disappear. May increase rather than decrease phobia. Has a greater incidence of spontaneous recovery.

Gamma-amino butyric acid

GABA is an inhibitory neurotransmitter found in the CNS of mammal and has a role in the regulation of anxiety, arousal and sleep. Specifically, it makes the postsynaptic neuron less likely to fire. This inhibitory influence counteracts the excitatory effect of glutamate, thus enabling an optimal level of neurotransmission in the brain. Low levels of GABA or a dysfunctional GABA system leads to high levels of anxiety as there is not enough GABA to adequately regulate anxiety or arousal levels, resulting in an over-activated physical response to the phobic stimulus.

Treatment

Anti-anxiety drugs that mimic GABA’s inhibitory effects have been successfully used to manage phobic anxiety (alongside other treatments) – these are called benzodiazepines.

Psychological contributing factors

Psychodynamic model

Proposes that the development of phobias is due to unresolved conflicts that arise during the phallic stage of a child’s development and is characterised by a child feeling hostile towards the parent of the same sex because of their underlying sexual impulses towards the parent of the opposite sex. Known as ‘Oedipal complex’ for males and ‘Electra complex’ for females. If the conflict is unsuccessfully dealt with, their anxiety is displaced to an object/event that is less relevant. Thus, the feared object/event becomes the symbol of the real source of conflict. This approach attempts to resolve these conflicts by tapping into the unconscious and exposing what the symbols mean.

Behavioural model

Focuses on observable behaviours, and thus downplays the importance of cognition. This model proposes that phobias are learnt through classical conditioning and maintained through operant conditioning. Phobias are not simply learned through association, however, a person’s anxiety or stress response to an event or stimulus has more to do with operant conditioning.

    • Avoidance of the unpleasant stimulus acts as a negative reinforcer that strengthens the likelihood of that behaviour being repeated.
    • The feeling of relief as a result of avoiding the feared stimulus presents a positive reinforcement of the behaviour.
    • OC may also explain acquisition (e.g. positive reinforcement of fear/anxiety response when first experiencing phobia stimulus and subsequent occasions).

Treatment

Under the behavioural model, phobias can be treated through systematic desensitisation, which is a process of treating a phobia by introducing stimuli that are more and more fear-provoking while simultaneously using relaxation techniques in order to learn to associate being relaxed with the fear-arousing stimulus. It proposes that eliminating a simple phobia can be achieved by weakening the association between the conditioned stimulus and the conditioned response of fear/anxiety. The objective of this is to recondition people so that the feared object elicits relaxation rather than fear or anxiety.

Cognitive model

This model emphasises how the individual processes information about the phobic stimulus and related events. Distorted thinking processes involved in the development and maintenance of simple phobia are examined. It also argues that anxious individuals have a tendency to exaggerate the threat/perceived level of danger.

Treatment

Under the cognitive model, cognitive behavioural therapy (CBT) is used as treatment for phobias. CBT is a form of psychotherapy that helps a person to change unhelpful or unhealthy thinking habits, feelings and behaviours. CBT aims to teach people that it is possible to have control over their thoughts, feelings and behaviours. CBT helps the person to challenge and overcome automatic beliefs, and use practical strategies to change or modify their behaviour.

Socio-cultural contributing factors

Environmental trigger

A phobia can be developed after a direct negative experience with an object or situation – these environmental triggers are often classically conditioned. The more severe the distress associated with the initial fear experience, the more likely a phobia will develop. If the individual has prior experience relating to the distressing event, a phobia is less likely to develop (e.g. a reptile handler being bitten vs. you being bitten) If the individual exposes themselves to the phobic stimulus after the traumatic encounter rather than avoiding it long term, then the phobia is less likely to persist.

Parental Modelling

Phobias can develop through observation of a parent mode’s fearful response (and consequences) to a specific object or situation. Children in particular are vulnerable to modelling of their parents’ fear response towards an object/situation – e.g. seeing your mum exhibit fear when she sees a fly will cause you to believe that flies are dangerous and should be avoided. Although phobias are developed more commonly through direct experience, it is possible for phobias to be developed through indirect (vicarious) experience. Vicarious transmission of information refers to developing a phobia due to information received directly or indirectly from people or the media about the potential threat or actual threat/danger of a specific object or situation.