I. AICE Syllabus
A. Types of phobias
1. Specific phobias (e.g. blood phobias)
2. Agoraphobia
3. Social Phobias
4. Case studies
B. Explanations
1. Behavioral
2. Psychoanalytic
3. Biomedical
4. cognitive
C. Treating Phobias
1. Systematic Desensitization
2. Flooding
3. Applied tension
4. CBT
II. Types of Phobias
A. Phobias in general
1. Considered a type of anxiety disorder
that also includes PTSD and OCD as
well as Generalized Anxiety Disorder
2. Anxiety = a general felling of dread
or apprehensiveness accompanied by
various physiological reactions such
as increased heart rate, sweating,
muscle tension and rapid and
shallow breathing.
Phobia = a persistent fear of an object or
situation in which the sufferer does
anything possible to avoid the feared object
or situation
4. Differs from ordinary fears in the severity
and in the discomfort faced by the sufferer
5. Although we have words for many phobias
including koumpounophobia (fear of
buttons) most are rare while ones like
acrophobia and claustrophobia are more
common.
3.
B. Specific or simple phobias DSM
Criteria
1.
2.
3.
4.
5.
6.
7.
Marked fear or anxiety about a specific
object or situation.
The object always produces immediate
fear/anxiety
The object is avoided or endured with
fear.
The fear is out of proportion to the
actual danger
Typically last 6 months or longer
Causes significant distress or
impairment
Not better explained by some other
mental disorders such as agoraphobia
C. The DSM classifies 5 subtypes of
specific phobias
1.
2.
3.
4.
5.
Animal – including spiders, insects and
dogs
Natural Environment – heights, storms
or water
Blood-injection or injury – fear of
needles, blood or any invasive
procedure
Situational – airplanes, elevators and
enclosed spaces
Other – choking, vomiting, clowns or
other costumed characters
D. Prevalence and Course
1. 12 month prevalence in the US is 7-9%
2. 5% for children and 16% for 13-17 year
olds, then back down to 3-5% for older
adults
3. Females 2x likely in most but 1:1 in
blood phobias
4. Most specific phobias develop in early
childhood before age 10
E. Agoraphobia = traditionally the fear of
the “agora” or the open marketplace.
This term now includes fear of most
public places
Marked fear of 2 or more of the
following
1.
a.
b.
c.
d.
e.
Public transportation
Being in open spaces (parking lots or
open air markets)
Being in closed in spaces (shops, malls or
movie theaters)
Standing in line or being in a crowd
Being outside of the home alone
2.
3.
4.
5.
6.
The individual fears or avoids these
situations
The situations almost always provokes
fear or panic
The fear or anxiety is out of proportion
to the actual danger
Causes clinically significant distress
Not better explained by some other
condition like BDD.
Prevalence and Course
7.
a.
b.
c.
d.
1.7% of teens and adults have this Dx
Only .4% in individuals older than 65
Only in rare cases is this not accompanied by panic disorder
Complete remission is rare (only 10% completely recover)
F. Social Anxiety (Social Phobia) = First
identified in 1960’s
DSM 5 Criteria
1.
a.
b.
c.
d.
e.
f.
Marked fear or anxiety about one or more
social situations where the individual is
exposed to the scrutiny of others.
Fears being negatively evaluated
(awkward)
The social situation almost always
produces fear/panic
Social situation is avoided
Out of proportion to actual danger
Causes significant distress
Prevalence and Course
2.
a.
b.
c.
d.
In the US about 7% of the pop. in a 12
month period
Lower in Europe about 2.3%
Men and women roughly equal
Generally starts in adolescence
G. Famous Case Studies
1. Little Hans –
a.
b.
c.
d.
e.
Case study completed by Freud on a boy
with the pseudonym Hans.
Lasted 2 years
Boy in the phallic stage fascinated with his
widdler.
Hans develops a fear of horses which
Freud explains as an example of the
Oedipal Crises. The boy is really afraid of
his father but his Ego manifests this as
being afraid of horses
Review the adv/dis adv of case studies and
this study as a whole
Little Albert
2.
a.
b.
c.
d.
Famous case studied by Watson and
Rayner
Little Albert conditioned to fear white rat
Rat is the CS and it is paired with the UCS
a loud noise repeated. Each time the UCS
is presented the child cries (UCR).
Eventually after repeated pairings the child
cries at the sight of the Rat (CR)
This case was used as evidence of the
behavioral perspective of the cause of
Phobias as opposed to the case of Little
Hans which supported the Psychodynamic
Perspective
III. Explanation of Phobias
A. The Behavioral Model
1.
Refer back to the Little Albert Study as
an explanation
2. Öst and Hugdahl used the Phobic
Origins Questionnaire (POQ) to assess
the causes of phobias
a.
b.
Found 3 major pathways = aversive
conditioning, modeling and transmission of
negative information
Studies reveal that aversive conditioning
and modeling play a much greater role in
the formation of phobias than transmission
of negative information
c.
d.
e.
Found that 58% of adults attributed their
phobia to aversive conditioning
Aversive conditioning may be especially
common in the onset of claustrophobia
(Rachman 1997)
Transmission of a phobia through modeling
was demonstrated in a study by Cook and
Mineka on Rhesus monkeys where monkeys
who were previously unafraid of snakes
developed the fear after watching videos of
other Rhesus monkeys reacting with fear to a
toy snake.
f.
g.
Generalizations – like Albert generalizing
his fear of the rat to a rabbit can explain
why one phobia might generalize to other
objects or situations
This view point has often been criticized
because it is too reductionist.
 B. Psychoanalytic (Freud)
 1. You should be able to recall the Little
Hans study as support for this idea
 2. Phobias represent defense
mechanisms against anxiety that stems
from the impulses of the id.
 3. This viewpoint has been widely
criticized as being unscientific
 C. Genetic and Biological Causes
 1. Genetic and temperamental or
personality variables are known to affect
the speed and strength of conditioning.
a.
b.
Eysenck 1965 found that temperament may
directly impact the formation of phobias
Biederman et al 1990 found that children
who were excessively timid at age 21
months more than 6 times as likely to
develop a phobia than their non-inhibited
peers. Furthermore they found that they
feared more objects as well.
Fyer et al 1995 found a modest genetic
link in those that had a 1st degree
relative with a Dx of a specific phobia
3. Kendler et al 1992 found a large study
of twins higher concordance rate in
monozygotic twins than dizygotic
twins
4. Öst 1992 found a 60% concordance
rate with a 1st degree relative for those
with blood phobias
5. Others argue that from an
evolutionary perspective we have
been bred to be more likely to fear
certain objects like snakes over others
like flowers
2.
6. Ohman, Dimberg and Öst 1985 and
Ohman 1996 found in studies of
human subjects that is was easier to
condition fear relevant stimuli like
pictures of snakes and spiders of
fear irrelevant stimuli such as
flowers and mushrooms
7. Cook and Mineka 1989 found
similar findings using toy snakes
and toy rabbits with monkeys as
subjects.
D. Cognitive Explanations
1. Dinardo et all 1988 found in a group
of dog phobics that only 50% could
tie that phobia to a traumatic
experience with dogs. However in
those who reported no dog phobia
50% also had a traumatic
experience with a dog but did not
develop a phobia. The authors
believe that the key difference is
that in those who developed the
fear they had more negative
thoughts about the probability of
future traumatic events.
2.
Kindt & Brosschot 1997 created a
Stroop test using words associated
with spiders. The words are written
in different colors of ink and the
participant is to name the color of
the word not name the word itself. It
took significantly longer to do this
with the spider related words
IV. Treating Phobias
 A. Systematic Desensitization (Wolpe)
1. Works on the same principals as
learning theory (Lil Albert)
2. Steps in Systematic Desensitatization
a.
b.
Taught relaxation techniques
Next the patients create an anxiety
hierarchy
i.
Seeing a cartoon snake
ii.
Seeing a tv show on snakes
iii.
Snake in a cage in same room
iv.
Within 3 feet of a snake
Patients cannot move to the next
level of the hierarchy without first
learning to relax at the previous
level
4. Support for Systematic
Desensitization
3.
a)
b)
Capafons, Sosa, & Avero 1998 found
that in 20 patients with a fear of
flying the use of sys. desens. became
much less fearful of flying
Zettle in 2003 used in people who
fear math (yes math)! Anxiety for
math decreased significantly after
undergoing sys desensitization even
without an improvement in math
ability.
B. Flooding = Instead of the gentle
approach of Systematic
desensensitization the therapist
“floods” the client with the
feared stimuli.
Supported by Öst in 1988
1.
a.
Good for a wide variety of specific
phobias




b. Ideal for patients with 1 fear only and motivated
to change
c. 1 session treatment using in vivo exposure
d. Mean decrease in phobic responses of 78%
e. At follow-up most reported complete recovery
and 90% reported significant clinical improvement
 C. Applied Tension
1.
Applied muscle tension is a technique
developed by Öst in the 1980’s. Designed to
help people with blood and injury phobias.
Works by repeated contracting muscles to help
decrease the fainting response common with
these types of phobias
2. Ditto et al 2003 tested the effectiveness of this
technique with 605 blood donors. The
technique produced significantly less blood
phobia symptoms and more full quotas of
blood donations
3.
Holly, Balegh & Ditto 2011 also
supported the use of applied tension
in a group of 70 participants.
Showed significant reduction in
fainting syptoms.
D. CBT- Öst and Westling 1995 did a
study comparing applied tension to
CBT plus applied tension. The
group getting both had a 74%
reduction in panic attacks and 89%
reduction at follow-up