Om fobiske reaksjoner-4 - Erik Arntzen sin hjemmeside

Om Fobiske Reaksjoner
Erik Arntzen
HiOA
[email protected]
www.equivalence.net
02/12/14
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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
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
n 
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1
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
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Forts.
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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
Panic disorder, with or without agoraphobia (300.21)
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
n 
n 
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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. 02/12/14
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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 
n 
n 
n 
n 
Marked and out of proportion fear within an environmental or
situational context to the presence or anticipation of a specific object
or situation
Exposure to the phobic stimulus provokes an immediate anxiety
response, which may take the form of a situationally bound or
situationally predisposed panic attack.
The person recognizes that the fear is out of proportion.
The phobic situation(s) is avoided or else is endured with intense
anxiety or distress.
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
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 CognitiveBehavioral 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
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disorders, 25(6), 763-770.
n 
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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:
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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
Ranging from
which escape might be difficult or in which help 1–3%
may not be available in the event of having a
panic attack or panic-like symptoms.
Specific
Phobia
Characterized by clinically significant anxiety
Ranging from
provoked by exposure to specific feared object 10-11.3%
or situation, often leading to avoidance behavior
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
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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-InjectionInjury 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
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.
n 
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7
n 
n 
n 
n 
n 
n 
n 
n 
n 
Frykt
Angst
Spesifikk fokus av truende
n 
stimuli
n 
Uforståelig forbindelse mellom
trussel og frykt
n 
Vanligvis episodisk
n 
Begrenset spenning
n 
Identifiserbar trussel
Avtar når trussel fjernes
n 
Starten er gjenkjennbar
n 
Trusselen har et begrenset
n 
område
n 
Trussel kommer umiddelbart
Kilden for trusselen er uklar
Usikker forbindelse mellom angst
og trussel
Langvarig
Gjennomgående ubehagelig
Behøver ikke være knyttet til
objekter
Vedvarende
Usikker start
Uten klare grenser
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:
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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.
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(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 
I kontrollgruppen var 2/3 av de som hadde vært
utsatt for en betingingshendelse med hund som ikke
utviklet fobiske reaksjoner.
n  Over
n  Over
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halvparten hadde blitt påført smerte.
halvparten hadde blitt påført smerte.
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Ohman (1987)
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”.
n 
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n 
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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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