Anxiety disorder: specific phobia
Lesson objectives
• Learn what an anxiety disorder is, focusing on Specific Phobia• Understand the biological
contributing factors to phobias and the ways to manage phobias
Study design dot point
• application of a biopsychosocial framework to understanding ONE of the following four types of mental disorder and its management:
Anxiety disorder: specific phobia- biological contributing factors: role of the
stress response; role of the neurotransmitter gamma aminobutyric acid (GABA) in the management of phobic anxiety
Anxiety definition
• A state of physiological arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or that something unpleasant is about to happen.
Anxiety disorder definition
• Describes a group of disorders that are characterised by chronic feelings of anxiety, distress, nervousness and apprehension or fear about the future, with a negative effect.
DSM-IV-TR anxiety disorders
• Agoraphobia without history of panic disorder• Panic disorder with/without agoraphobia• Specific phobia• Social phobia• Obsessive compulsive disorder• Post-traumatic stress disorder• Generalised anxiety disorder• Acute stress disorder• Anxiety disorder due to a general medical condition• Substance-induced anxiety disorder
Phobia definition
• An excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning.
Specific phobia definition
• A disorder characterised by significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.
• The specific object/situation producing the fear is called the phobic stimulus.
Phobia activity
• Anunptaphobia: fear of staying single• Arachibutyrophobia: fear of peanut butter
sticking to the roof of the mouth• Hippopotomonstrosesquipped-aphiliophobia:
fear of long words• Keraunophobia: fear of lighting• Ornithophobia: fear of birds• Papaphobia: fear of the Pope• Pentheraphobia: fear of mother-in-laws• Quadrataphobia: fear of quadratic equations• Vuteuthindon: fear of picnics
http://www.youtube.com/watch?v=9rl7Lr6eDLc
• People with a specific phobia know that their level of fear is excessive or unreasonable.
• The fear is in excess of any real danger posed by the phobic stimulus.
Symptoms
• Elevated heart rate & blood pressure
• Hand tremors• Diarrhoea• Sweating• Shortness of breath• Dizziness• Feel like they have no
control over the situation
Exposure to phobic stimulus
Triggers involuntary anxiety response (similar to stress
response)
Can lead to panic attacks (unexpected
onset of intense anxiety that can last a few mins
> an hour)
DSM specific phobia categories
Categories Examples
Animal type
Situation type
Blood, injections and injury type
Natural environments type
Other phobias Choking, vomiting, loud noises, dying, costumed characters
Biopsychosocial framework applied to specific phobia and its management
Biological
factors
Psychological factors
Social factors
Biological factors
Contributing factors:• Role of stress
response• Dysfunctional
GABA system
Management:• Benzodiazepines• GABA supplement• Relaxation
response
Specific
phobia
Biological contributing factors
• Genetic predisposition – moderate level of heritability of anxiety disorders• Role of the stress response• Role of the brain’s neurochemistry
How does the stress response contribute to phobic anxiety?
• Fight-fight response activated• Accounts for phobic
symptoms such as sweating & palpitations• Dizziness due to increase
in ANS arousal then sudden drop in blood pressure
• Becomes problematic when the anxiety response is triggered when there is no real threat or danger
• For example, objects/situations that have little potential for harm • flowers (anthophobia) or clouds
(nephophobia)
• Anxiety remains until the exposure to the phobic stimulus is gone
Role of GABA
• Gamma-amino butyric acid (GABA)• = Primary inhibitory neurotransmitter• Inhibits firing of neurons• Maintains optimal level of
neurotransmission• Low levels of GABA leads to higher
levels of anxiety • Neurons are not stopped from
firingNOT THAT
GABBA…
Role of glutamate(GABA’s mate)
• Glutamate = primary excitatory neurotransmitter
• Makes neurons more likely to fire
• Both GABA and glutamate have important roles in arousal and therefore anxiety
Management of phobias
• Benzodiazepines: a group of drugs which are referred to as minor tranquillisers
• ADVANTAGE: Calm down the body by reducing physiological arousal and promoting relaxation
• DISADVANTAGE: induce drowsiness and are addictive
• Eg: Valium, Temazepam, Xanax etc
How do ‘benzos’ work?
Agonists• Imitate therefore
stimulate a neurotransmitter’s activity
• Benzos are GABA agonists
• Benzos have inhibitory effects on neurons which reduce the symptoms of anxiety
Antagonists
• Inhibit a neurotransmitter’s activity
• Reduce GABA function and increase anxiety symptoms
GABA/anxiety connection
• Researchers believe that some people develop anxiety because they have a dysfunctional GABA system • The result of failure to produce,
release or receive the correct amount of GABA that is needed to regulate neuronal transmission in the brain
GABA may be affected by:
• Genetic inheritance• Socio-cultural factors• Exposure to
prolonged stress• Exposure to
environmental toxins• Nutritional
deficiencies (vitamin B6 and citric acid, and high caffeine intake)
What can you do?• Proposals that GABA
levels can be increased “naturally” by:
• Drinking green tea• Eating foods “high in
GABA” (e.g. beans, dairy foods, eggs, seafoods and wholegrains)
• GABA supplements (although there is no significant research evidence that this works)
Review!
• Draw a flow chart to describe and explain how the stress response contributes to a phobic reaction
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