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Om Fobiske Reaksjoner

Erik Arntzen HiOA

erik.arntzen@equivalence.net www.equivalence.net

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Vanlig definisjon

Phobias have been defined as “a special form of fear which: (1) is out of proportion to the demands of the situation, (2) cannot be explained or reasoned away, (3) is beyond voluntary control, and (4) leads to avoidance of the feared situation” (Marks, 1969, p.3).

Further, with children one would have to add a fifth criterion, namely, the fear is age inappropriate.

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Nyttige nettsider

n  http://www.ojohaven.com/fun/phobias.html#triskadekaphobia

n  http://psychology.about.com/library/bl/blglos_phobias.htm

n  http://www.cyberpsych.org/anxsig.htm

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PHOBIA FEARED OBJECT OR SITUATION

Acrophobia Heights

Aerophobia Flying

Agoraphobia Open spaces, public places

Aichmophobia Sharp pointed objects

Ailurophobia Cats

Amaxophobia Vehicles, driving

Anthropophobia People

Aquaphobia Water

Arachnephobia Spiders

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Forts. Astraphobia Lightning

Batrachophobia Frogs, amphibians

Blennophobia Slime

Brontophobia Thunder

Carcinophobia Cancer

Claustrophobia Closed spaces, confinement

Clinophobia Going to bed

Cynophobia Dogs

Dementophobia Insanity

Dromophobia Crossing streets

Emetophobia Vomiting

Entomophobia Insects 02/12/14 5 EA

Forts.

Genophobia Sex Gephyrophobia Crossing bridges Hematophobia Blood Herpetophobia Reptiles Homilophobia Sermons Linonophobia String Monophobia Being alone Musophobia Mice Mysophobia Dirt and germs Nudophobia Nudity Numerophobia Numbers Nyctophobia Darkness, night Ochlophobia Crowds Ophidiophobia Snakes Ornithophobia Birds Phasmophobia Ghosts

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Forts.

Phobophobia Phobias Pnigophobia Choking Pogonophobia Beards Pyrophobia Fire Siderodromophobia Trains Taphephobia Being buried alive Thanatophobia Death Trichophobia Hair Triskaidekaphobia The number 13 Trypanophobia Injections Xenophobia Strangers Zoophobia Animals

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Anxiety disorders are characterized by:

a)  fear/anxiety that results in physiological changes

such as sweaty hands, dizziness, or heart palpitations

b)  the escape and/or avoidance of situations in which

fear is likely to occur, and

c)  interference by the behaviors with the individual's

life.

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Anxiety Disorders DSM V

Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder (Social Phobia) Panic Disorder Panic Attack (Specifier) Agoraphobia Generalized Anxiety Disorder Substance/Medication-Induced Anxiety Disorder Anxiety Disorder Due to Another Medical Condition Other Specified Anxiety Disorder Unspecified Anxiety Disorder

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The DSM anxiety disorders

n  Panic disorder, with or without agoraphobia (300.21) n  Agoraphobia without a history of panics (300.01) n  Social phobia (300.23) n  Specific phobia (300.29) n  Generalized anxiety disorder n  Obsessive-compulsive disorder n  Post-traumatic stress disorder

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Diagnostic criteria for 300.29 Specific Phobia DSM IV - TR

A. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).  B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack.  Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.  C. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.  D. The phobic situation(s) is avoided or else is endured with intense anxiety or distress.  E. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.  F. In individuals under age 18 years, the duration is at least 6 months.  G. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor),Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder with Agoraphobia, or Agoraphobia Without History of Panic Disorder. 

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Social phobia (social anxiety disorder) A.  A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating. B.  Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.   C.  The person recognizes that this fear is unreasonable or excessive. D.  The feared situations are avoided or else are endured with intense anxiety and distress. E.  The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. F.  The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months. G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.

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DSM V — Specific Phobias n  Marked and out of proportion fear within an environmental or

situational context to the presence or anticipation of a specific object or situation

n  Exposure to the phobic stimulus provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack.

n  The person recognizes that the fear is out of proportion. n  The phobic situation(s) is avoided or else is endured with intense

anxiety or distress. n  The avoidance, anxious anticipation or distress in the feared

situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

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Spesifikk type

n  Animal Type  Natural Environment Type (e.g., heights, storms, water)  Blood-Injection-Injury Type  Situational Type (e.g., airplanes, elevators, enclosed places)  Other Type (e.g., phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters)

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References n  Agdal, M. L., Raadal, M., Öst, L. G., & Skaret, E. (2012). Quality-of-life before and

after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia. Acta Odontologica Scandinavica, 70(6), 463-470.

n  American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

n  Brand, S., Annen, H., Holsboer-Trachsler, E., & Blaser, A. (2011). Intensive two-day cognitive-behavioral intervention decreases cortisol secretion in soldiers suffering from specific phobia to wear protective mask. Journal of psychiatric research, 45(10), 1337-1345.

n  Burstein, M., Georgiades, K., He, J. P., Schmitz, A., Feig, E., Khazanov, G. K., & Merikangas, K. (2012). Specific phobia among US adolescents: phenomenology and typology. Depression and anxiety, 29(12), 1072-1082.

n  Lipka, J., Hoffmann, M., Miltner, W. H., & Straube, T. (2013). Effects of Cognitive-Behavioral Therapy on Brain Responses to Subliminal and Supraliminal Threat and Their Functional Significance in Specific Phobia. Biological psychiatry.

n  Price, M., Mehta, N., Tone, E. B., & Anderson, P. L. (2011). Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. Journal of anxiety disorders, 25(6), 763-770. 02/12/14 15 EA

Hva forårsaker fobier?

n  Forskning antyder at både genetiske og miljømessige faktorer bidrar til oppstarten på fobier. Spesifikke fobier har vært assosiert med et fryktfullt førstemøte med det fobiske objekt eller situasjon. Spørsmålet er fremdeles om en betingingseksponering er nødvendig eller om fobier kan utvikle seg hos personer som er genetisk predisponert.

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Hvem blir “rammet” av fobier?

n  Angsttilstander er vanlig i alle aldre. Forekomsten av angsttilstander av spesifikke fobier hos barn og ungdom er estimert til 1 prosent som det laveste og 9.2 prosent som det høyeste. Ettersom spesifikke fobier ofte starter i barndommen, så er det viktig at de blir skilt fra normal utviklingsmessig frykt. Sosiale fobier er estimert til å forekomme hos opp til 1.4 prosent av barn og tenåringer. Panikkforstyrrelser kan utvikles i enhver alder, men starter ofte i tenårene eller i ung voksen alder. På dette området gjenstår det mye forskning.

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The phobic disorders are compromised of three disorders:

Ø  Agoraphobia (without history of panic disorder),

Ø  Specific Phobia (formerly simple phobia), and

Ø  Social Phobia.

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Phobic disorders Description Prevalence

Agoraphobia Anxiety about or avoidance of, places from which escape might be difficult or in which help may not be available in the event of having a panic attack or panic-like symptoms.

Ranging from 1–3%

Specific Phobia

Characterized by clinically significant anxiety provoked by exposure to specific feared object or situation, often leading to avoidance behavior

Ranging from 10-11.3%

Social Phobia Characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior

Ranging from 3–13%

American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders: DSM IV, Washington, DC: Author.

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Subtypes of specific phobias Description

Animal Type This subtype should be specified if the fear is cued by animals or insects. This subtype is generally a childhood onset.

Natural Environment Type

This subtype should be specified if the fear is cued by objects in the natural environment, such as storms, heights, or water. This subtype is generally a childhood onset.

Blood-Injection-Injury Type

This subtype should be specified if the fear is cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure.

Situational Type This subtype should be specified if the fear is cued by a specific situation such as public transportation, tunnels, bridges, elevators, flying, driving, or enclosed places.

American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders: DSM IV, Washington, DC: Author.

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Frykt, fobi og angst

n  Frykt har har en spesifikk fokus. Den er som regel episodisk og avtar eller opphører avhengig av om ”faren” blir fjernet eller at personen fjernes fra ”fare”.

n  Intens, men irrasjonell frykt blir betegnet som en fobi, som for eksempel klaustrofobi (intens frykt for lukkede rom/steder), sprøytefobi osv.

n  I sin reneste form er angst diffus, ikke relatert til objekter, ubehagelig og vedvarende.

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Frykt Angst

n  Spesifikk fokus av truende stimuli

n  Uforståelig forbindelse mellom trussel og frykt

n  Vanligvis episodisk n  Begrenset spenning n  Identifiserbar trussel n  Avtar når trussel fjernes n  Starten er gjenkjennbar n  Trusselen har et begrenset

område n  Trussel kommer umiddelbart

n  Kilden for trusselen er uklar n  Usikker forbindelse mellom angst

og trussel n  Langvarig n  Gjennomgående ubehagelig n  Behøver ikke være knyttet til

objekter n  Vedvarende n  Usikker start n  Uten klare grenser n  Trusselen kommer sjelden

umiddelbart

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John B. Watson and Rosalie Rayner published the first conditioning

experiment of emotional behavior:

“Those experiments would seem to show conclusively

that directly conditioned emotional responses as well as

those conditioned by transfer persist, although with a

certain loss in the intensity of the reaction for a longer

period than one month. Our view is that they persist and

modify personality throughout life”.

(Watson & Rayner, 1920, p.12).

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“Hard-headed” vs. “Soft-hearted”.

William James (1890) suggested that psychologists could be divided

into two groups: the “hard-headed” and the “soft-hearted”. The first

group are data-oriented and highly skeptical. The “soft-hearted”, on

the other hand, are less methodologically rigorous and more

interested in thought experiments than empirically ones. Behavior

therapists have generally been thought of as being the hard-headed

type.

(O'Donohue & Krasner, 1995).

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Different behavioral paradigms each of which holds that phobias are learned through:

n  Respondent conditioning

n  Operant conditioning

n  Two-factor theory of learning

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The golden rule

” Try never to leave a situation until the fear is going down”

(Mathews, Gelder, & Johnston, 1981)

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Importance and implications of stimulus equivalence research

There is a rapidly growing area of research under the general heading of

stimulus equivalence that has important implications for understanding

some very basic and important issues in the fields of learning and

cognition. These include the untrained acquisition of novel stimulus

functions, symbolic behavior, the development of concepts or categories,

and the development and behavioral effects of beliefs, expectancies, and

schema. This research also has implications for understanding the

development and treatment of several clinical disorders including

substance abuse, anxiety disorders, and depression.

(Dougher, 1998, p. 577)

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On the basis of what we know from the implications of research on equivalence and

transfer of functions:

”A step back to the lab and basic science could be one of the most

exciting steps forward for our field because such a step seeks to

reestablish the link between basic science and clinical interventions

– a hallmark of good behavior therapy, past and present.”

(Forsyth & Eifert, 1998, p. 61)

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Fears are acquired by a process of conditioning

”Neurotic reactions, like all others, are learned reactions and must obey the laws of learning.”

Eysenck, 1960, p. 5

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Studie av Di Nardo et al. (1988)

n  2/3 av de som hadde vært utsatt for en betingingshendelse med hund utviklet fobiske reaksjoner. n  Over halvparten hadde blitt påført smerte.

n  I kontrollgruppen var 2/3 av de som hadde vært utsatt for en betingingshendelse med hund som ikke utviklet fobiske reaksjoner. n  Over halvparten hadde blitt påført smerte.

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Ohman (1987)

n  Inspirert av Seligmans arbeid fra 1971 om ”prepared fears”.

n  Ohman og hans kollegaer har konkludert med i sin forskning at mennesker er ”prepared to acquire fears to particular stimuli”.

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n  Slides based on Arntzen & Almaas (1997) are not included.

Arntzen, E., & Almaas, I. K. (1997). Reduction of phobic behaviour for animals in a boy with mental retardation. Scandinavian Journal of Behaviour Therapy, 26, 124–131.

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Conclusion The procedure was shown to be effective in reducing phobic

reactions in the presence of dogs and cats. The results showed

that training with three exemplars of both dogs and cats,

respectively, were needed to obtain generalization effects to

novel exemplars. Furthermore, the treatment of phobic

reactions to one category of animals had effects across animals.

The phobic reactions did not occur during long-term follow-up

probes conducted 72 months after the completion of the

intervention.

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