Phobias
Phobias are classified as anxiety disorders in DSM-IV and are the most common of all
anxiety disorders.
Definition: A phobic disorder is characterised by an irrational, intense fear of an
object, activity or situation, and a powerful urge to avoid that feared stimulus (Cox,
2001).
The classification manual used by psychiatrists in Britain and the USA (DSM IV)
identifies three categories of phobia:
AGORAPHOBIA
Usually known as a ‘fear of open spaces,’ people with agoraphobia have an intense fear
of being away from home. Because being in public places often induces panic attacks,
this phobia is also associated with panic disorder. Most common in women, the onset of
agoraphobia is generally early adulthood.
SOCIAL PHOBIAS
A strong fear of social situations and having to interact with others. This can include
speaking in public, eating in front of others and using public lavatories. It has been
suggested that social phobia is just extreme shyness, but this is too simplistic a view.
Many famous people are very shy but this does not stop them from performing in
public. The age of onset is 15 years with the greatest number of social phobias in
people aged 18-29 years.
SPECIFIC PHOBIAS
Related to a fear of a specific object or situation. Onset is in childhood, average age 79 years. DSM IV organized specific phobias into five different subtypes:
Animal Type – e.g. spiders, snakes, cats.
Situational Type – e.g. flying, enclosed spaces, crowds.
Natural environment Type – e.g. darkness, thunder, fire
Blood/Injection/Injury Type – Injections, blood, illness.
Other Type – those that do not fit into the other four categories.
Most people who suffer from such phobias have more than one of the same type and
some people have multiple phobias of different types.
Psychological Explanation of Phobias: Learning Approach
Classical Conditioning
Phobias can be acquired through classical conditioning by pairing a neutral stimulus with
something unpleasant. Phobia responses can be permanent unless the organism is
subjected to the extinction process, one must confront the fear without the presence
of the unconditioned stimulus. For example, in Watson’s experiment, Little Albert
developed a phobia of white rats (and other furry objects) as a result of pairing the
white rat with a loud bang. The phobia could have been extinguished by repeatedly
exposing Little Albert to the white rat without the loud bang. Another way to
extinguish a phobia is through counter conditioning. In counter conditioning, the
conditioned stimulus is paired with a pleasant stimulus. Little Albert could have
extinguished his phobia of the white rat by pairing it with something pleasant e.g. food,
praise.
Operant Conditioning
Phobias can be maintained by operant conditioning through negative reinforcement.
When a person is confronted with the object or situation of his/her phobia, the person
tends to get anxious and avoid the object or situation. The anxiety is reduced but by
avoiding the object or situation, the avoidance behaviour is negatively reinforced and
the phobia is maintained. For example, a person with a phobia of flying will maintain
that phobia until he/she flies.
Two Process Theory Mowrer (1947) claims that phobias are first acquired by CC then
maintained by OC, reinforcement makes the phobia resistant to extinction.
Social Learning Theory
A person may initially acquire a fear of an object or situation by observing the fear in
another person e.g. a parent. They may also hear about the danger of the object or
situation by someone.
The social learning theory says that phobias should:

Be traceable to an original learning experience.

Centre on objects or situations that are potentially harmful.

Be possible to condition and decondition artificially.
Evaluation of the Learning Approach’s Explanation of Phobias
Is there EVIDENCE for the theory?
The idea of acquiring phobias through classical conditioning is supported by the famous
Little Albert study.
Cook and Mineka (1989) conducted a study of phobias using monkeys which supports the
Social Learning Theory.
Can it be APPLIED to real life?
A strength of this explanation is that behavioural treatments for phobias such as
systematic desensitisation and flooding have been developed which are popular and
sometimes successful therapies.
Is this theory REDUCTIONIST?
This theory is less reductionist than other theories from other approaches such as the
psychodynamic approach because it considers three areas.
Can the theory explain INDIVIDUAL DIFFERENCES?
The theory can explain individual differences through people either having bad
experiences in their environment, hence associating fear with the phobic object, or
avoiding the phobic object and reinforcing the phobia, or observing and imitating a role
model.
Which side of the NATURE-NURTURE debate is the theory on?
A weakness of this theory is that it is all nurture and not based on genetics or biology.
It does not consider any genetic vulnerability to anxiety.
Is the theory SCIENTIFIC?
To test this theory lab experiments are usually used and this means it can be measure
empirically and replicated so it can be said to be scientific.
Treatment for Phobias: Systematic Desensitisation
The learning approach to psychological therapies is based on the assumption that
psychological disorders are behaviours that are learned from the environment by
classical and operant conditioning and the social learning theory.
Treatments focus on changing the abnormal behaviour rather than considering thought
processes or underlying biological causes.
If we assume that psychological disorders are learned behaviours, then treatments
should aim to help the person unlearn the maladaptive behaviour and substitute a more
adaptive response in its place.
Systematic Desensitisation
Systematic desensitisation is based on the principle of incompatible responses i.e. the
idea that you cannot be both anxious and relaxed at the same time. According to this
approach phobias, for example, are thought to be learned anxiety responses to
particular stimuli.
Therefore, the treatment assumes that the phobia can be removed by teaching
someone to relax when in contact with the phobic object.
Process
Treatment takes place over a number of sessions depending on the strength of the
phobia and the client’s ability to relax.
Therapist and client both jointly agree on what the therapeutic goal should be and the
therapy is deemed to be successful once the goal has been reached.
The process can either be in real exposure to the object or imaginary exposure to the
object.
Stages
Functional Analysis – Careful questioning to discover the nature of anxiety and possible
triggers.
Construction of an Anxiety Hierarchy – Client and therapist devise a hierarchy of
anxiety – provoking situations from the least to the most fearful.
Relaxation Training – The client is taught to relax using the methods which suit them
best, e.g. listening to their favourite music. Deep muscle relaxation techniques are used
(hypnosis, meditation or Valium)
Gradual Exposure – The phobic object is slowly introduced. Subject relaxes at each
stage starting with least fearful and progresses to next stage when fully relaxed to do
so
Evaluation of Systematic Desensitisation
How EFFECTIVE is this therapy?
This therapy is very effective with simple phobias such as phobia of spiders. McGrath
et al (1990) found that 75% of patients with specific phobias showed clinically
significant improvement following the treatment. Jones applied SD to infants with
phobias. Little Peter had strong phobia of rats and rabbits. Peter was presented with a
rabbit in a cage each time he had lunch, 40 sessions later he was able to stroke rabbit
and eat lunch at same time
However, complex and social phobias such as agoraphobia do not respond so well and
relapse rates are high. Craske and Barlow (1993) found that between 60% and 80% of
agoraphobics show some improvement after treatment and clients often relapse
completely after six months.
Are there any PRACTICAL issues involved in the use of this therapy?
One practical issue for this therapy is patient motivation. Patients who have opted for
therapy will be more motivated than those who have been coerced. The successful
application of systematic desensitisation relies on the patients’ willingness to practise
relaxation techniques and people differ on how successfully they manage this. It does
require little equipment and therefore the cost is low.
Are there any ETHICAL issues involved in the use of this therapy?
The treatment is considered to be more ethical than others based on classical
conditioning, such as aversion therapy. This is because the patient is given more control
and will only move on when they feel ready to.
POWER of practitioner?
The therapist conditioning the desired behaviour is in a position of power; they control
the hierarchy after it has been decided. However, the client has to agree to the
therapy and can withdraw from it, which reduces the power of the therapist.
Treating the SYMPTOMS or the CAUSE?
The treatment only focuses on observable symptoms rather than any deeper underlying
causes of phobias.
Psychodynamic Explanation of Phobias
The psychodynamic view is that the anxiety expressed towards an object or situation is
a displacement of internal underlying anxiety. The psychoanalytic view is that phobias
are associated with unconscious sexual fears (or id impulses) and that they operate
through the defence mechanisms of repression and displacement. The original source of
the fear is repressed into the unconscious and the fear is then displaced onto some
other person, object or situation. Thus the fear appears to be irrational because there
is no explanation for it.
Displacement – To place your anxiety onto something else.
Repression – Motivated forgetting (unconscious)
Evaluation of Psychodynamic Approach
Is there EVIDENCE for the theory?
Little Hans has been used as evidence to suggest that phobias can be displaced.
Whiting – Cross cultural study – Authoritarian culture – Strong correlation between
phobias and authoritarianism.
Can it be APPLIED to real life?
This approach uses many different types of therapies and psychotherapy can be used
to try to uncover the real underlying fears.
Is this theory REDUCTIONIST?
This theory is not reductionist because it is complex and has a lot of explanations as
everyone has lots of experiences.
However, it can be reductionist because some may argue that everything cannot be
down to the unconscious.
Can the theory explain INDIVIDUAL DIFFERENCES?
The theory can explain individual differences because everyone has different
experiences.
Which side of the NATURE-NURTURE debate is the theory on?
The theory takes into account nature, such as personality components, psychosexual
stages etc. It also takes into account nurture because of experiences.
Is the theory SCIENTIFIC?
A weakness of this theory is that it cannot be tested scientifically (usual criticism of
Freud’s theories)
Psychoanalytic Treatment to Phobias: Dream Analysis
According to Psychoanalyst Freud, phobias are a defence against anxiety produced by
repressed impulses. Anxiety is moved to an object or situation and then becomes the
phobic stimulus. In order to not deal with the repressed conflict, the person tries to
avoid the object or situation. For example, Freud used the case study of Little Hans
where his unconscious fear of castration by the father was symbolically displaced as a
fear of being bitten by white horses.
In order to treat the phobia the analyst must therefore access the patient’s
unconscious mind. One way of doing this is through dream analysis. When we sleep our
ego’s defences are more relaxed, so material that usually stays in our unconscious
enters our conscious mind in the form of a dream.
However, because the material is still threatening to our peace of mind it cannot be
allowed into our conscious in its actual form. The material is disguised, and symbols in
dreams represent the real content of the dream. The content of the dream that we
remember is called the manifest content, whilst what the dream actually means is
called the latent content. It is the analyst’s job to uncover the true meaning of a
patient’s dream and eventually find the underlying cause of the phobia. This can take
some time, as the analyst needs a number of recorded dreams rather than just one.
Evaluation of dream analysis
How EFFECTIVE is this therapy?
Although patients find the therapy helpful in decreasing general anxiety and resolving
conflicts, the phobic symptoms often remain.
Eysenck (1952) reviewed many early studies on psychoanalysis and found that this
therapy was no more effective than having no therapy at all.
Are there any PRACTICAL issues involved in the use of this therapy?
One of the problems with this therapy is that the clients might not remember their
entire dream or they may not want to tell the therapist all aspects of their dream and
these problems may not reflect what’s really in the unconscious.
The interpretations of the dreams are very subjective and different analysts would
have different interpretations.
Are there any ETHICAL issues involved in the use of this therapy?
Dreams are very sensitive and personal and people will have to be willing to be analysed.
POWER of practitioner?
The therapist has expert power and has to make sure they don’t abuse that power.
Treating the SYMPTOMS or the CAUSE?
A strength of this therapy is that it aims to treat the cause as well as the symptoms.
SECTION 4 – STUDIES IN DETAIL
On Being Sane in Insane Places (Rosenhan, 1973)
Aim
To see if the sane could be distinguished from the insane using the DSM classification
system and, if they can be differentiated, how sanity can be identified.
Procedure
Eight pseudo-patients were involved; one was Rosenhan, and others were mainly
professionals. Only the chief psychologist and hospital administrator where Rosenhan
carried out the research knew about it; nobody else did. There were 12 hospitals used,
in five different US states, and they were varied in character.
The pseudo-patients called the hospital for an appointment and arrived saying they had
been hearing voices of the same sex saying ‘empty’, ‘hollow’ and ‘thud’. Apart from that
and changing some details so they were not recognisable, the participants gave
accurate answers to any questions.
When they were admitted they behaved ‘normally’ in every way and, though they were
given medication they did not take it. All wanted to be discharged so they behaved very
well and followed all instructions from staff.
Results
All the pseudo-patients were admitted, and none were detected as being sane. All but
one of them had a diagnosis of schizophrenia in remission. They stayed in hospital for
between 7-52 days, with the average being 19 days. In three hospitals, 35 out of 118
patients were suspicious about the insanity of the pseudo-patients.
Conclusion
Rosenhan concluded that staff in psychiatric hospitals were unable to distinguish
between those who were sane from those who were insane, and that DSM was
therefore not a valid measurement of mental illness at that time. Psychiatrists have to
be very careful when diagnosing patients with a mental disorder; they need to see if
the patient displays all the symptoms instead of going for the most common diagnosis.
Evaluation
Strengths:

The study was carried out in actual psychiatric hospitals, using real staff who
were unaware of the study so it has ecological validity.

As a range of hospitals was used from around the country, including old and new
and using different methods of funding, the results could be generalised to
other psychiatric hospitals at the time.

The number of days the pseudo-patients stayed in hospital is an objective
measurement, and the fact that the pseudo-patients could see what life was like
from a patient’s perspective adds validity.
Weaknesses:

Whilst the pseudo-patients’ observations would try to be objective, some
subjectivity and the emotions of the pseudo-patients could have influenced
these observations.

There are ethical problems, as the hospital staff were deceived about the
patients’ symptoms. Nor did they know they were in a study so were unable to
give consent. However, Rosenhan did not name any staff or hospitals so there
was no risk of identification.

Another problem is that all doctors, either of physical or mental illness, tend to
play safe and go for the most serious or common diagnosis before ruling it out,
rather than immediately trying to see if the patient is faking it. Psychiatrists
have to be especially careful, as if they release someone with a mental disorder
there can be serious consequences (for them or for others).

The pseudo-patients insisted on being admitted to the hospital, which is an
important symptom in itself, so the voices were not the only symptom they
presented. Nor was their behaviour totally normal once they were admitted, as
they didn’t say that they were in fact normal and insist on being released (which
is what most normal people would do).

Psychiatrists point out that DSM has been revised since Rosenhan’s study and
such results are less likely. Another study now is therefore unlikely to replicate
the results.

Spitzer argues that the diagnosis of schizophrenia in remission was in fact due
to how the pseudo-patients behaved and not to that fact that the psychiatrists
couldn’t tell they were normal, as it is a very rare diagnosis for real patients.
Therefore, he argues, the psychiatrists recognised there was something
different about the pseudo-patients.
Twin Study into Schizophrenia (Gottesman and Shields, 1996)
Aim
To investigate whether schizophrenia has a genetic basis.
Procedure
The researcher used secondary data from the Maudsley and Bethlem Royal Joint
Hospital studying both MZ and DZ twins, where at least one of the twins had been
diagnosed with schizophrenia.
Out of the 392 patients, they found 68 patients were one of twins and had been
diagnosed with schizophrenia.
3 patients were omitted because they couldn’t tell if they were MZs or DZs and a
further 3 were omitted because they were overseas, leaving 62 patients.
There were 31 males and 31 females in the group of patients diagnosed, with ages from
19-64.
They used blood tests and visual tests to check whether they were MZs or DZs.
Data were collected using hospital records, case histories for the twins, tape
recordings gathered through semi-structured interviews, personality testing and a test
to look at thought disorders.
They looked at the concordance rate within MZ twins to see when one twin had been
diagnosed with schizophrenia the likelihood of the other twin also developing the
disorder.
Results
They found a 42% concordance rate for MZ twins meaning around 42% of the time
when one twin has schizophrenia, the other one has it too.
For DZ twins, the concordance rate was 9%.
Conclusion
The research concluded that there appears to be a genetic component in the cause of
schizophrenia. Findings can be explained through the diathesis-stress model where one
may have a genetic predisposition to schizophrenia which is triggered through
environmental factors.
Evaluation
Strengths:

The study replicates other studies and the results are backed up by them, which
mean they are likely to be reliable. For example, Inouye (1961) in Japan found a
74% concordance rate for people with progressive chronic schizophrenia and
39% where twins had a mild transient schizophrenia. These figures are similar
to those of Gottesman and Shields.

It addresses criticisms of previous studies by detailing the sampling carefully so
that it was understood which twins were included and why. This is great detail
about the different diagnoses – for example, whether the diagnosis was
schizophrenia, some other psychosis or some abnormality.
Weaknesses:

The researchers felt that a concordance rate simply notes if one twin has an
abnormality, the other one has it too. It would have been useful to have
information about the degree of the abnormality, such as scale showing
‘schizophrenia’ though ‘other psychiatric diagnoses’ to ‘some abnormality’ to
‘normal’.

The researchers suggest there might be different forms of schizophrenia. They
also suggest that some of the disorders diagnosed might come from life
experiences (such as being a prisoner of war) rather than genes, and the study
did not easily distinguish between reasons for schizophrenia.
Observational conditioning of fear-relevant Vs fear-irrelevant stimuli in rhesus
monkeys (Cook and Mineka, 1989)
Aim
To test whether monkeys can acquire fear responses through imitation of other
monkeys and to see whether they are more likely to learn fear of dangerous objects
than non-dangerous ones.
Procedure
Two laboratory experiments were run. In the first, 22 lab-reared rhesus monkeys aged
between 4-11 years observed a 32 year old wild reared monkey who had a fear of
snakes. The observer monkeys watched a videotape of the model responding with fear
to a snake. They also watched a video in which the fear response was spliced with
footage of flowers so that it appeared the model was afraid of the flowers.
In the second experiment, the procedure was repeated with 20 lab-reared rhesus
monkeys. This time the model was lab-reared and had been taught to fear crocodiles.
In one condition, the observers watched footage of the model reacting with fear to a
crocodile or the fear response spliced with a toy rabbit so that the model appeared to
be afraid of the toy. Fear in the observers was then assessed by the time taken to
reach for food in the presence of the fear stimulus (toy snake, toy crocodile, flowers
or toy rabbit).
Results
In both experiments the times taken to reach for food increased after watching the
videotape when the fear stimulus was dangerous, that is, the snake or crocodile (for
example, it increased from 9-27 seconds in the presence of a toy snake after watching
the video). It did not increase when the fear stimuli was not dangerous- as in the case
of the flowers or the toy rabbit.
Conclusion
Fear responses can be acquired by social learning, but only to objects that are
potentially dangerous.
Evaluation
Experimental Validity

The experiment took place in a laboratory so all extraneous variables were
controlled.

The monkeys could not show demand characteristics as they are unable to guess
the aim of the study.
Ecological Validity

Monkeys in the lab were not in their natural setting.

Some people think we are not similar to animals therefore there is low ecological
validity for humans as it tells us little about how humans develop phobias.

Not a realistic explanation therefore not that valid an explanation for humans.
Ethical Issues

Monkeys were getting distressed and fearful.

Not ethical to use animals for research.
Population Validity

Difficult to generalise from monkeys to humans BUT we can learn about phobias
in other monkeys
Reliability

Standardised lab experiment so easy to repeat.

Well controlled with the videos and objects.
SECTION 5 – SHORT PRACTICAL ON A KEY ISSUE
Understanding Schizophrenia
Schizophrenia is defined as a psychotic disorder which involves loss of contact with
reality and typically involves hallucinations and/or delusions.
Somewhere between 0.2% and 2% of the population will develop schizophrenia. Some
recover fully, but many suffer recurring episodes for the duration of their lifetime.
Males are most likely to develop the disorder between the ages of 16 and 25, then
diagnosis trails of sharply. Women are most likely to develop schizophrenia in their 20s,
but it trails off more gradually, so from 35 onwards, onset is higher in women than men.
The DSM IV distinguishes between positive symptoms and negative symptoms.
Leaflets for Those Who May Think They Have Schizophrenia

What you included

Was it effective

Did it suit your target audience

Was there anything which might have been inappropriate

Feedback from school counselor/Headteacher