Stress, phobia and anxiety VCE PSYCHOLOGY UNIT 4 Stress, phobia and anxiety Study design dot points: the distinctions between stress, phobia and anxiety; variation for individuals with stress, phobia and anxiety on a mental health continuum

Specific phobia as an anxiety disorder Do you know anyone who is terrified of spiders or snakes? Have you ever jumped onto a chair and started screaming at the sight of a mouse? How is the stress response related to specific phobias?

Stress, anxiety and specific phobia Before discussing specific phobia in detail, it is important to understand its links to stress and anxiety and to independently define these terms.

What is stress? Stress is defined as the psychological and physical response to internal or external sources of tension (stressors) and arousal

Anxiety Anxiety is characterised by feelings of persistent and extreme apprehension, fear and unease, when stressors are not necessarily present. Severe anxiety is usually accompanied by intense physiological responses e.g. heart palpitations, muscle tension, feeling shaky/hand tremors, choking sensation, dry mouth and an upset stomach Does this sound like the fight-flight-freeze response? It is! https://pixabay.com/en/soldier-daughter-child-looking-870387/

Anxiety disorders Anxiety disorders are a group of disorders that are characterised by chronic feelings of extreme apprehension, fear, stress and unease.

Different types of anxiety disorders

Incidence of anxiety disorders Anxiety disorders impact 1 in 6 Australians at any given time.

Phobia Persistent, irrational and intense fear of a particular object or event. Affects approximately 3% of the Australian population. More common in women than men. There are four categories of phobic stimuli: > animal phobias (for example, fear of snakes, spiders, rats or dogs) > natural environmental phobias (for example, fear of heights, storms, water or darkness) > situation phobias (for example, fear of enclosed spaces, elevators, flying, dentists, driving, tunnels or bridges) > blood-injection-injury phobia (for example, fear of medical procedures or of the sight of blood).

Specific phobias A specific phobia is a persistent, irrational and intense fear of a particular object or event. As with anxiety, the fear response is normal, as long as a rational response to the actual situation. Many people are frightened of spiders or snakes and experience a fear response if one crosses their path. This makes sense from an evolutionary perspective - humans are genetically wired to fear things that pose a threat to survival. However, if that fear starts to interfere with a person’s social functioning –deliberately avoiding the distress-causing object, activity or situation to the point where it affects their day-to-day life = a specific phobia. When faced with the feared object or event - experience acute physiological arousal – the fight-flight-freeze response – as in the case of anxiety disorders. Extreme cases, just thinking about the phobic object can cause intense fear and anxiety.

Specific phobia Exposure to the phobic stimulus triggers an involuntary anxiety response similar to a stress response. Eg. increased heart and blood pressure, sweating, shortness of breath, dizziness, palpitations, hand tremors etc. Criteria: Intense fear, irrational fear, avoids fear object, cannot control fear, fear interrupts daily functioning and overwhelming anxiety. According to the DSM-IV, a diagnosis is only made if the fear has persisted for at least 6 months. Specific phobia is a type of anxiety disorder The physiological activation that occurs when we feel stressed is also accompanied by feelings of anxiety. Not only are stress and anxiety symptoms of specific phobia, they can also act as triggers for the condition. Image used under license from YAYimages

People or social situations Top ten phobias Ranking Fear of Phobia name % of U.S. Population 1 Public speaking Glossophobia 74% 2 Death Necrophobia 68% 3 Spiders Arachnophobia 30.5% 4 Darkness Achlutophobia 11% 5 Heights Acrophobia 10% 6 People or social situations Sociophobia 7.9% 7 Flying Aerophobia 6.5% 8 Confined spaces Claustrophobia 2.5% 9 Open spaces Agoraphobia 2.2% 10 Thunder & lightning Brontophobia 2%

Continuum Like all physical and mental health conditions, we can think about the relative severity of stress, anxiety and specific phobia in terms of their position along a continuum. One model breaks this continuum up into four broad categories: healthy, reacting, injured and disorder Stress Anxiety http://www.moviestillsdb.com/movies/silver-linings-playbook-i1045658/Tgpdrm Phobia

Use the spider example in the case of a specific phobia a ‘healthy’ person may be frightened of them, but their fear is considered to be within a normal range. If they see a spider, they may simply squash it or ask a friend to catch it and release it into the garden. A ‘reacting’ individual will do just that: physically and psychologically ‘react’ to the spider by screaming, or running away each time they see one. If at the ‘injured’ level along the continuum, their phobic symptoms are significantly impacting their functioning. If at the ‘disorder’ end of the spectrum, their specific phobia has affected their functioning to the point where they have a mental disorder that requires significant intervention. On a positive note, as mental health is determined along a continuum, a specific phobia can improve with treatment so that, over time, the person could go from being ‘disordered’ to ‘healthy’.

Interventions: Phobia VCE PSYCHOLOGY UNIT 4 Interventions: Phobia Presented by Kristy Kendall Study design dot point: evidence-based interventions and their use for specific phobia with reference to: the use of short-acting anti-anxiety benzodiazepine agents (gamma amino butyric acid [GABA] antagonists) in the management of phobic anxiety and relaxation techniques including breathing retraining and exercise (biological); the use of cognitive behavioural therapy (CBT) and systematic desensitisation as psychotherapeutic treatments of phobia (psychological); psychoeducation for families/supporters with reference to challenging unrealistic or anxious thoughts and not encouraging avoidance behaviours (social).

Treating phobias Benzodiazopines & relaxation techniques Biological Cognitive behavioural therapy & systematic desensitisation Psychological Psychoeducation for families Social Image used under license from YAYimages

The role of GABA Gamma Amino Butyric Acid (GABA) has an inhibitory role - makes postsynaptic neuron less likely to fire. It regulates anxiety, arousal and sleep. Low levels of GABA means higher levels of anxiety (not enough GABA to regulate anxiety) Anti-anxiety drugs that mimic the effect of GABA can be used to manage simple phobic anxiety.

Image used under license from YAYimages

Benzodiazepine Short acting anti-anxiety medications are known as benzodiazepines. They work selectively on GABA receptors in the brain (antagonist) Benzodiazepines can be used as sedatives and muscle relaxants. Common medications are valium & xanax

Benzodiazepine

Learning more… Are they addictive? Can you overdose? Can you drive? So many questions answered if you wish to explore deeper by visiting: http://www.health.nsw.gov.au/mentalhealth/Factsheets/Pages/benzodiazepines.aspx Watch this video to see natural remedies that act as GABA does: https://www.youtube.com/watch?v=oDaUnKlY4w0

The effect of poor breathing Relaxation technique 1 Breathing training – replacing incorrect breathing techniques with correct ones. The effect of poor breathing High blood pressure Migraines Hyperventilation Muscle tension What is good practice? Speed (8-12 times a minute) Nose not mouth From diaphragm Regularity Depth

Relaxation technique 2 Exercise Produces positive chemicals (i.e. endorphins) Uses negative chemicals produced in a stress response (ie adrenalin) Images used under license from YAYimages

vicious cycle of negative thinking & feeling Treating phobias using psychological factors Feelings Create behaviour Behaviour Creates thoughts Thoughts Create feelings Cognitive Behavioural Therapy Uses a combination of verbal and behaviour modification techniques to help people change irrational patterns of thinking that create a phobia. Focuses on helping the person change negative thoughts and behaviours and replaces them with more positive, realistic ones. Cognitive Behavioural Therapy Helps to crack the vicious cycle of negative thinking & feeling

Treating phobias using psychological factors Systematic desensitisation A graded experience where a sufferer is gradually exposed to phobic stimulus while using relaxation techniques Otherwise known as graduated exposure therapy Utilises classical conditioning principles NS + UCS = UCR CS = CR

Graduated exposure Behaviour Fear rating Think about a spider Look at a photo of a spider Look at a real spider in a closed box Hold the box with the spider Let a spider crawl on your desk Let a spider crawl on your shoe Let a spider crawl on your sleeve Let a spider crawl on your bare arm Image used under license from YAYimages https://pixabay.com/en/soldier-daughter-child-looking-870387/

Treating phobias using social factors Psychoeducation for families and supporters: Challenging unrealistic thoughts (i.e. irrational fear) Discouraging avoidance behaviours which can act as a negative reinforcer and strengthen the phobic behaviour https://pixabay.com/en/soldier-daughter-child-looking-870387/

Challenging cognitive bias Attentional bias Tendency to selectively attend to phobia related stimuli rather than other stimuli. Memory bias A better recollection of phobic events and information than other information, or of negative over positive information. Interpretative bias Tendency to interpret non-threatening stimuli as threatening. https://pixabay.com/en/soldier-daughter-child-looking-870387/

Multiple choice activity A psychologist treated a patient who suffered a phobia of flying. During the therapy the psychologist helped the patient to identify his unhelpful thoughts about flying, and to identify other helpful and more rational thoughts about flying. The therapy that the psychologist used was : cognitive behavioural therapy (CBT) systematic desensitisation. biofeedback flooding (VCAA 2012 Exam Q27)

Multiple choice response A psychologist treated a patient who suffered a phobia of flying. During the therapy the psychologist helped the patient to identify his unhelpful thoughts about flying, and to identify other helpful and more rational thoughts about flying. The therapy that the psychologist used was : cognitive behavioural therapy (CBT) systematic desensitisation. biofeedback flooding (VCAA 2012 Exam Q27)

Multiple choice activity Anxiety disorders can be managed with a group of drugs known as benzodiazepines. Benzodiazepines imitate the activity of the neurotransmitter, gamma-amino butyric acid (GABA). Benzodiazepines work by: activating post-synaptic neurons in the brain to calm the body and reduce arousal. activating post-synaptic neurons in the brain to activate the body and increase arousal. inhibiting post-synaptic neurons in the brain to calm the body and reduce arousal. inhibiting post-synaptic neurons in the brain to activate the body and increase arousal. (VCAA 2012 Exam Q33)

Multiple choice response Anxiety disorders can be managed with a group of drugs known as benzodiazepines. Benzodiazepines imitate the activity of the neurotransmitter, gamma-amino butyric acid (GABA). Benzodiazepines work by: activating post-synaptic neurons in the brain to calm the body and reduce arousal. activating post-synaptic neurons in the brain to activate the body and increase arousal. inhibiting post-synaptic neurons in the brain to calm the body and reduce arousal. inhibiting post-synaptic neurons in the brain to activate the body and increase arousal. (VCAA 2012 Exam Q33)

Fast five: Question 1 A state of physiological and psychological tension is known as what?

Question 1 (Response) A state of physiological and psychological tension is known as what? Answer: Stress

Fast five: Question 2 What is the term given to fear and uneasiness that something is about to happen?

Question 2 (Response) What is the term given to fear and uneasiness that something is about to happen? Answer: Anxiety

Fast five: Question 3 An intense, irrational and persistent fear is known as what?

Question 3 (Response) An intense, irrational and persistent fear is known as what? Answer: Phobia

Fast five: Question 4 What kind of mental disorder is a phobia?

Question 4 (Response) What kind of mental disorder is a phobia? Answer: Anxiety

Fast five: Question 5 T/F: Anxiety disorders are the most commonly experienced mental disorders.

Question 5 (Response) T/F: Anxiety disorders are the most commonly experienced mental disorders. Answer: True

Fast five: Question 1 What are the group of drugs called that mimic GABA in the brain?

Question 1 (Response) What are the group of drugs called that mimic GABA in the brain? Answer: Benzodiazapine

Question 2 (Response) Drugs that block the brains neuortransmitters are known as what? Answer: Antagonist

Fast five: Question 2 Drugs that block the brains neuortransmitters are known as what?

Fast five: Question 3 Which sort of factor is CBT?

Question 3 (Response) Which sort of factor is CBT? Answer: Psychological

Fast five: Question 4 Which learning principle is systematic desensitisation based on?

Question 4 (Response) Which learning principle is systematic desensitisation based on? Answer: Classical conditioning

Fast five: Question 5 Which type of factor in treating a phobia is psychoeducation for family?

Question 5 (Response) Which type of factor in treating a phobia is psychoeducation for family? Answer: Social