PHOBIAS

(from comer)
(these come under anxiety disorders so introduction me give anxiety, fear n all from cc8 notes plus butcher)
A phobia (from the Greek word for “fear”) is a persistent and unreasonable fear of a particular object,
activity, or situation. People with a phobia become fearful if they even think about the object or situation
they dread, but they usually remain comfortable as long as they avoid it or thoughts about it.
DSM-5 indicates that a phobia is more intense and persistent and the desire to avoid the object or situation is
stronger (APA, 2013). People with phobias often feel so much distress that their fears may interfere
dramatically with their lives.
Most phobias technically fall under the category of specific phobias, DSM-5’s label for an intense and
persistent fear of a specific object or situation. In addition, there is a broader kind of phobia called
agoraphobia, a fear of venturing into public places or situations where escape might be difficult if one were
to become panicky or incapacitated.
(here social phobia is given as different topic- separation anxiety disorder)
❑ SPECIFIC PHOBIAS
A specific phobia is a persistent fear of a specific object or situation. When sufferers are exposed to the
object or situation, they typically experience immediate fear. Common specific phobias are intense fears of
specific animals or insects, heights, enclosed spaces, thunderstorms, and blood.
The impact of a specific phobia on a person’s life depends on what arouses the fear. People whose phobias
center on dogs, insects, or water will keep encountering the objects they dread. Their efforts to avoid them
must be elaborate and may greatly restrict their activities. Urban residents with snake phobias have a much
easier time. The vast majority of people with a specific phobia do not seek treatment (NIMH, 2011). They
try instead to avoid the objects they fear.
⮚Prevalence-
Each year around 12 percent of all people in the United States have the symptoms of a specific phobia
(Kessler et al., 2012). Almost 14 percent of individuals develop such phobias at some point during their
lives, and many people have more than one at a time.
Women with the disorder outnumber men by at least 2 to 1.
The prevalence of specific phobias also differs among racial and ethnic minority groups.
❑ AGORAPHOBIA
People with agoraphobia are afraid of being in public places or situations where escape might be difficult or
help unavailable, should they experience panic or become incapacitated (APA, 2013). This is a pervasive
and complex phobia.
It is typical of people with agoraphobia to avoid entering crowded streets or stores, driving in parking lots or
on bridges, and traveling on public transportation or in airplanes. If they venture out of the house at all, it is
usually only in the company of close relatives or friends. Some insist that family members or friends stay
with them at home, but even at home and in the company of others they may continue to feel anxious.
In many cases the intensity of the agoraphobia fluctuates. In severe cases, people become virtual prisoners in
their own homes. Their social life dwindles and they cannot hold a job. People with agoraphobia may also
become depressed, sometimes as a result of the severe limitations that their disorder places on their lives.
Many people with agoraphobia do, in fact, have extreme and sudden explosions of fear, called panic attacks,
when they enter public places, a problem that may have first set the stage for their development of
agoraphobia. Such individuals may receive two diagnoses—agoraphobia and panic disorder—because their
difficulties extend considerably beyond an excessive fear of venturing away from home into public places
(APA, 2013).
⮚Prevalence-
In any given year, 1.7 percent of the population experience agoraphobia, women twice as frequently as men (Kessler
et al., 2012). The disorder also is twice as common among poor people as wealthy people (Sareen et al., 2011). At
least one-fifth of those with agoraphobia are currently in treatment (NIMH, 2011).
ETIOLOGY (for specific and agoraphobia)
Each of the models offers explanations for phobias. Evidence tends to support the behavioral explanations.
Behaviorists believe that people with phobias first learn to fear certain objects, situations, or events through
conditioning. Once the fears are acquired, the individuals avoid the dreaded object or situation, permitting
the fears to become all the more entrenched.
❑ BEHAVIORAL EXPLANATIONS:
 How Are Fears Learned?
Behaviorists propose classical conditioning as a common way of acquiring phobic reactions. Here, two
events that occur close together in time become strongly associated in a person’s mind, the person then
reacts similarly to both of them. If one event triggers a fear response, the other may also.
In the 1920s, a clinician described the case of a young woman who apparently acquired a specific phobia
of running water through classical conditioning (Bagby, 1922). When she was 7 years old she went on a
picnic with her mother and aunt and ran off by herself into the woods after lunch. While she was climbing
over some large rocks, her feet were caught between two of them. The harder she tried to free herself, the
more trapped she became. No one heard her screams, and she grew more and more terrified.
According to behaviorists, the entrapment was eliciting a fear response.
Entrapment → Fear response
As she struggled to free her feet, the girl heard a waterfall nearby. The sound of the running water became
linked in her mind to her terrifying battle with the rocks, and she developed a fear of running water as
well.
Running water → Fear response
Eventually the aunt found the screaming child, freed her from the rocks, and comforted her, but the
psychological damage had been done. From that day forward, the girl was terrified of running water.
The young woman had apparently acquired a specific phobia through classical conditioning. In
conditioning terms, the entrapment was an unconditioned stimulus (US) that understandably elicited an
unconditioned response (UR) of fear. The running water represented a conditioned stimulus (CS), a
formerly neutral stimulus that became associated with entrapment in the child’s mind and came also to
elicit a fear reaction. The newly acquired fear was a conditioned response (CR).
US: Entrapment → UR: Fear
CS: Running water → CR: Fear
Another way of acquiring a fear reaction is through modeling, that is, through observation and imitation
(Bandura & Rosenthal, 1966). A person may observe that others are afraid of certain objects or events and
develop fears of the same things.
Behaviorists believe that after acquiring a fear response, people try to avoid what they fear. They do not
get close to the dreaded objects often enough to learn that the objects are really quite harmless.
Behaviorists also propose that learned fears of this kind will blossom into a generalized anxiety disorder
if a person acquires a large number of them. This development is presumed to come about through
stimulus generalization: responses to one stimulus are also elicited by similar stimuli. Perhaps a person
experiences a series of upsetting events, each event produces one or more feared stimuli, and the person’s
reactions to each of these stimuli generalize to yet other stimuli. That person may then build up a large
number of fears and eventually develop generalized anxiety disorder.
Research evidence-
Some laboratory studies have found that animals and humans can indeed be taught to fear objects through
classical conditioning. In one famous report, psychologists John B. Watson and Rosalie Rayner (1920)
described how they taught a baby boy called Little Albert to fear white rats.
Research has also supported the behavioral position that fears can be acquired through modeling.
Psychologists Albert Bandura and Theodore Rosenthal (1966), for example, had human research
participants observe a person apparently being shocked by electricity whenever a buzzer sounded. After
the participants had observed several such episodes, they themselves had a fear reaction whenever they
heard the buzzer.
Although it appears that a phobia can be acquired by classical conditioning or modeling, researchers have
not established that the disorder is ordinarily acquired in this way.
 A Behavioral-Evolutionary Explanation
Some phobias are much more common than others. Phobic reactions to animals, heights, and darkness are
more common than phobic reactions to meat, grass, and houses. Theorists often account for these
differences by proposing that human beings, as a species, have a predisposition to develop certain fears.
This idea is referred to as preparedness because human beings, theoretically, are “prepared” to acquire
some phobias and not others.
According to some theorists, the predispositions have been transmitted genetically through an
evolutionary process. Among our ancestors, the ones who more readily acquired fears of animals,
darkness, heights, and the like were more likely to survive long enough to repro duce and to pass on their
fear inclinations to their offspring.
TREATMENT
Every theoretical model has its own approach to treating phobias, but behavioral techniques are more widely
used than the rest, particularly for specific phobias. In addition, research has shown such techniques to fare
better than other approaches in most head-to-head comparisons.
❑ TREATMENTS FOR SPECIFIC PHOBIAS
Specific phobias were among the first anxiety disorders to be treated successfully. The major behavioral
approaches to treating them are systematic desensitization, flooding, and modeling. Together, these
approaches are called exposure treatments because in all of them people are exposed to the objects or
situations they dread.
 People treated by systematic desensitization, a technique developed by Joseph Wolpe (1987, 1969),
learn to relax while gradually facing the objects or situations they fear. Since relaxation and fear are
incompatible, the new relaxation response is thought to substitute for the fear response.
Desensitization therapists first offer relaxation training to clients, teaching them how to bring on a
state of deep muscle relaxation at will.
In addition, the therapists help clients create a fear hierarchy, a list of feared objects or situations,
ordered from mildly to extremely upsetting.
Then clients learn how to pair relaxation with the objects or situations they fear. While the client is in
a state of relaxation, the therapist has the client face the event at the bottom of his or her hierarchy.
This may be an actual confrontation, a process called in vivo desensitization. A person who fears
heights, for example, may stand on a chair or climb a stepladder. Or the confrontation may be
imagined, a process called covert desensitization. In this case, the person imagines the frightening
event while the therapist describes it.
The client moves through the entire list, pairing his or her relaxation responses with each feared item.
Because the first item is only mildly frightening, it is usually only a short while before the person is
able to relax totally in its presence. Over the course of several sessions, clients move up the ladder of
their fears until they reach and overcome the one that frightens them most of all.
 Another behavioral treatment for specific phobias is flooding. Therapists who use flooding believe
that people will stop fearing things when they are exposed to them repeatedly and made to see that
they are actually quite harmless. Clients are forced to face their feared objects or situations without
relaxation training and without a gradual buildup. The flooding procedure, like desensitization, can
be either in-vivo or covert.
When flooding therapists guide clients in imagining feared objects or situations, they often
exaggerate the description so that the clients experience intense emotional arousal.
 In modeling it is the therapist who confronts the feared object or situation while the fearful person
observes. The behavioral therapist acts as a model to demonstrate that the person’s fear is groundless.
After several sessions many clients are able to approach the objects or situations calmly. In one
version of modeling, participant modeling, the client is actively encouraged to join in with the
therapist.
Clinical researchers have repeatedly found that each of the exposure treatments helps people with specific
phobias. The key to greater success in all of these therapies appears to be actual contact with the feared
object or situation. In vivo desensitization is more effective than covert desensitization, in vivo flooding
more effective than covert flooding, and participant modeling more helpful than strictly observational
modeling.
In addition, a growing number of therapists are using virtual reality—3D computer graphics that simulate
real-world objects and situations—as a useful exposure tool.
❑ TREATMENTS FOR AGORAPHOBIA
For years clinicians made little impact on agoraphobia, the fear of leaving one’s home and entering public
places. However, approaches have now been developed that enable many people with agoraphobia to
venture out with less anxiety. These new approaches do not always bring as much relief to sufferers as the
highly successful treatments for specific phobias, but they do offer considerable relief to many people.
Behaviorists have developed a variety of exposure approaches for agoraphobia. Therapists typically help
clients to venture farther and farther from their homes and to gradually enter outside places, one step at a
time. Sometimes the therapists use support, reasoning, and coaxing to get clients to confront the outside
world. They also use more systematic exposure methods.
Exposure therapy for people with agoraphobia often includes additional features— particularly the use of
support groups and home-based self-help programs— to motivate clients to work hard at their treatment.
 In the support group approach, a small number of people with agoraphobia go out together for
exposure sessions that last for several hours. The group members support and encourage one another,
and eventually coax one another to move away from the safety of the group and perform exposure
tasks on their own.
 In the home-based self-help programs, clinicians give clients and their families detailed instructions
for carrying out exposure treatments themselves.
Between 60 and 80 percent of agoraphobic clients who receive exposure treatment find it easier to enter
public places, and the improvement persists for years after the beginning of treatment.
Unfortunately, these improvements are often partial rather than complete, and as many as half of
successfully treated clients have relapses, although these people readily recapture previous gains if they are
treated again.
Those whose agoraphobia is accompanied by a panic disorder seem to benefit less than others from exposure
therapy alone.
----------------------------------------------------------------------------------------------------------------------------------
❑ SOCIAL ANXIETY DISORDER (formerly known as social phobia)
People with social anxiety disorder have severe, persistent, and irrational anxiety about social or
performance situations in which they may face scrutiny by others and possibly feel embarrassment (APA,
2013). The social anxiety may be narrow, such as a fear of talking in public or eating in front of others, or it
may be broad, such as a general fear of functioning poorly in front of others. In both forms, people
repeatedly judge themselves as performing less competently than they actually do.
It is because of its wide-ranging scope that this disorder is now called social anxiety disorder rather than
social phobia, the label it had in past editions of the DSM.
Social anxiety disorder can interfere greatly with one’s life. A person who cannot interact with others or
speak in public may fail to carry out important responsibilities. One who cannot eat in public may reject
meal invitations and other social offerings.
Since many people with this disorder keep their fears secret, their social reluctance is often misinterpreted as
snobbery, lack of interest, or hostility.
⮚Prevalence-
Surveys reveal that 7.4 percent of people in the United States and other Western countries (around 60
percent of them female) experience social anxiety disorder in any given year.
Around 13 percent develop this disorder at some point in their lives (Kessler et al., 2012).
It tends to begin in late childhood or adolescence and may continue into adulthood.
Research finds that poor people are 50 percent more likely than wealthier people to have social anxiety
disorder.
ETIOLOGY
The leading explanation for social anxiety disorder has been proposed by cognitive theorists and researchers.
They contend that people with this disorder hold a group of social beliefs and expectations that consistently
work against them.
These include:
 They hold unrealistically high social standards and so believe that they must perform perfectly in
social situations.
 They view themselves as unattractive social beings.
 They view themselves as socially unskilled and inadequate.
 They believe they are always in danger of behaving incompetently in social situations.
 They believe that inept behaviors in social situations will inevitably lead to terrible consequences.
 They believe that they have no control over feelings of anxiety that emerge in social situations.
Cognitive theorists hold that, because of these beliefs, people with social anxiety disorder keep anticipating
that social disasters will occur, and they repeatedly perform “avoidance” and “safety” behaviors to help
prevent or reduce such disasters.
 Avoidance behaviors include, for example, talking only to people they already know well at
gatherings or par ties.
 Safety behaviors include wearing makeup to cover up blushing.
Beset by such beliefs and expectations, people with social anxiety disorder find that their anxiety levels
increase as soon as they enter into a social situation. Moreover, because they are convinced that their social
flaws are the cause of the anxiety, certain that they do not have the social skills to deal with the situation,
and concerned that they cannot contain their negative arousal, they become filled with anxiety.
Later, after the social event has taken place, the individuals repeatedly review the details of the event. They
overestimate how poorly things went and what negative results may take place. These persistent thoughts
actually keep the event alive and further increase the individuals’ fears about future social situations.
Researchers have indeed found that people with social anxiety disorder manifest the beliefs, expectations,
interpretations, and feelings listed here. At the same time, cognitive theorists often differ on why some
individuals have such cognitions and others do not. Various factors have been uncovered by researchers,
including genetic predispositions, trait tendencies, biological abnormalities, traumatic child hood
experiences, and overprotective parent-child interactions during childhood.
TREATMENT
Only in the past 15 years have clinicians been able to treat social anxiety disorder successfully.
Their newfound success is due in part to the growing recognition that the disorder has two distinct features
that may feed upon each other:
(1) sufferers have overwhelming social fears, and
(2) they often lack skill at starting conversations, communicating their needs, or meeting the needs of
others (Beck, 2010).
Armed with this insight, clinicians now treat social anxiety disorder by trying to reduce social fears, by
providing training in social skills, or both.
Social fears are often reduced through medication. Somewhat surprisingly, it is antidepressant medications
that seem to be the drugs of most help for this disorder, often more helpful than benzodiazepines or other
kinds of antianxiety medications. At the same time, several types of psychotherapy have proved to be at least
as effective as medication at reducing social fears, and people helped by such psychological treatments
appear less likely to relapse than those treated with medications alone.
This finding suggests to some clinicians that the psychological approaches should always be included in
the treatment of social fears.
One psychological approach is exposure therapy, the behavioral intervention so effective with phobias.
Exposure therapists encourage clients with social fears to expose themselves to the dreaded social situations
and to remain until their fears subside. Usually the exposure is gradual, and it often includes homework
assignments that are carried out in the social situations.
In addition, group therapy offers an ideal setting for exposure treatments by allowing people to face social
situations in an atmosphere of support and care.
Cognitive therapies have also been widely used to treat social fears, often in combination with behavioral
techniques. Cognitive therapist Albert Ellis used rational-emotive therapy in order to treat people.
Studies show that rational-emotive therapy and other cognitive approaches do indeed help reduce social
fears. And these reductions typically persist for years.
On the other hand, research also suggests that while cognitive therapy often reduces social fears, it does not
consistently help people perform effectively in social settings. This is where social skills training has come
to the forefront.
In social skills training, therapists combine several behavioral techniques in order to help people improve
their social skills. They usually model appropriate social behaviors for clients and encourage the individuals
to try them out. The clients then role-play with the therapists, rehearsing their new behaviors until they
become more effective. Throughout the process, therapists provide frank feedback and reinforce (praise) the
clients for effective performances.
Reinforcement from other people with similar social difficulties is often more powerful than reinforcement
from a therapist alone. In social skills training groups and assertiveness training groups, members try out
and rehearse new social behaviors with other group members. The group can also provide guidance on what
is socially appropriate. According to research, social skills training, both individual and group formats, has
helped many people perform better in social situations.
(From comer full phobia done)
----------------------------------------------------------------------------------------------------------------------------------
[EXTRA FROM TTN- can add these wherever necessary]
SPECIFIC PHOBIA
Behavioral Explanation of Specific Phobia
Fear Conditioning - Mowrer’s Two-Factor Model -
Mowrer’s two-factor model of anxiety disorders, published in 1947, continues to influence Behavioral
theory of anxiety disorder, which focuses on conditioning. Mowrer’s model suggests two steps in the
development of an anxiety disorder (Mowrer, 1947):
1. Through classical conditioning, a person learns to fear a neutral stimulus (the CS) that is paired with an
intrinsically aversive stimulus (the UCS).
2. Through operant conditioning, a person gains relief by avoiding the CS. This avoidant response is
maintained because it is reinforcing (it reduces fear).
Consider an example - Imagine that a man is bitten by a dog and then develops a phobia of dogs. Through
classical conditioning, he has learned to associate dogs (the CS) with painful bites (the UCS). This
corresponds to step 1 above. In step 2, the man reduces his fear by avoiding dogs as much as possible; the
avoidant behavior is reinforced by the reduction in fear. This second step explains why the phobia isn’t
extinguished. With repeated exposure to dogs that don’t bite, the man would have lost his fear of dogs, but
by avoiding dogs, the man gets little or no such exposure.
It should be noted that Mowrer’s early version of the two-factor model does not actually fit the evidence
very well; several extensions of this model, which we look at next, have been developed that fit the evidence
better (Mineka & Zinbarg, 1998). One extension of the model has been to consider different ways in which
classical conditioning could occur (Rachman, 1977). These include the following:
• It could occur by direct experience, like the conditioned fear of dogs in the example above.
• It could occur by seeing another person harmed or frightened by a stimulus (e.g., seeing a dog bites a man
or watching a YouTube video of a vicious dog attack). This type of learning is called modeling (Fredrikson,
Annas, & Wik, 1997). In one study, researchers showed participants a movie of a man who received shocks.
Participants were told that they would receive shocks next. When watching the stranger receive shocks,
participants demonstrated increased activity in the amygdala, just as they would if they had personally
experienced the aversive stimulus (Olsson,Nearing, & Phelps, 2007).
• It could occur by verbal instruction—for example, by a parent warning a child that dogs are dangerous.
Application Of Behaviour Therapy (Treatment of Specific Phobia)
The most studied and most effective treatment for phobias is probably behavior therapy.
The key aspects of successful treatment are - (1) The patient's commitment to treatment; (2) Clearly
identified problems and objectives; and (3) Available alternative strategies for coping with the feelings.
1) Systematic Desensitization-
A variety of behavioral treatment techniques have been used, the most common being systematic
desensitization, a method pioneered by Joseph Wolpe. In this method, the patient is exposed serially to a
predetermined list of anxiety-provoking stimuli graded in a hierarchy from the least to the most frightening.
Through the use of antianxiety drugs, hypnosis, and instruction in muscle relaxation, patients are taught how
to induce in themselves both mental and physical repose. After they have mastered the techniques, patients
are taught to use them to induce relaxation in the face of each anxiety-provoking stimulus. As they become
desensitized to each stimulus in the scale, the patients move up to the next stimulus until, ultimately, what
previously produced the most anxiety no longer elicits the painful affect.
Developed by Wolpe, systematic desensitization is based on the behavioral principle of counter
conditioning, whereby a person overcomes maladaptive anxiety elicited by a situation or an object by
approaching the feared situation gradually, in a psychophysiological state that inhibits anxiety. In systematic
desensitization, patients attain a state of complete relaxation and are then exposed to the stimulus that elicits
the anxiety response. The negative reaction of anxiety is inhibited by the relaxed state, a process called
reciprocal inhibition. Rather than using actual situations or objects that elicit fear, patients and therapists
prepare a graded list or hierarchy of anxiety-provoking scenes associated with a patient's fears. The learned
relaxation state and the anxiety-provoking scenes are systematically paired in treatment.
Thus, systematic desensitization consists of three steps: relaxation training, hierarchy construction, and
desensitization of the stimulus.
 Relaxation Training- Relaxation produces physiological effects opposite to those of anxiety: slow
heart rate, increased peripheral blood flow, and neuromuscular stability. A variety of relaxation
methods have been developed. Some, such as yoga and Zen, have been known for centuries. Most
methods use so-called progressive relaxation, developed by the psychiatrist Edmund Jacobson.
Patients relax major muscle groups in a fixed order, beginning with the small muscle groups of the
feet and working cephalad or vice versa. Some clinicians use hypnosis to facilitate relaxation or use
tape-recorded exercise to allow patients to practice relaxation on their own. Mental imagery is a
relaxation method in which patients are instructed to imagine themselves in a place associated with
pleasant, relaxed memories. Such images allow patients to enter a relaxed state or experience (as
Herbert Benson termed it) the relaxation response. The physiological changes that take place during
relaxation are the opposite of those induced by the adrenergic stress responses that are part of many
emotions. Muscle tension, respiration rate, heart rate, blood pressure, and skin conductance decrease.
Finger temperature and blood flow to the finger usually increase. Relaxation increases respiratory
heart rate variability, an index of parasympathetic tone.
 Hierarchy Construction- When constructing a hierarchy, clinicians determine all the conditions that
elicit anxiety, and then patients create a hierarchy list of 1 0 to 1 2 scenes in order of increasing
anxiety. For example, an acrophobic hierarchy may begin with a patient's imagining standing near a
window on the second floor and end with being on the roof of a 20-story building, leaning on a guard
rail and looking straight down.
 Desensitization of the Stimulus- In the final step, called desensitization, patients proceed
systematically through the list from the least to the most anxiety-provoking scene while in a deeply
relaxed state. The rate at which patients progress through the list is determined by their responses to
the stimuli. When patients can vividly imagine the most anxiety-provoking scene of the hierarchy
with equanimity, they experience little anxiety in the corresponding real-life situation.
2) Flooding-
Other behavioral techniques that have been used more recently involve intensive exposure to the phobic
stimulus through either imagery or desensitization in vivo. In imaginal flooding, patients are exposed to the
phobic stimulus for as long as they can tolerate the fear until they reach a point at which they can no longer
feel it. Flooding (also known as implosion) in vivo requires patients to experience similar anxiety through
exposure to the actual phobic stimulus. Flooding is based on the premise that escaping from an anxiety-
provoking experience reinforces the anxiety through conditioning. Thus, clinicians can extinguish the
anxiety and prevent the conditioned avoidance behavior by not allowing patients to escape the situation.
Clinicians encourage patients to confront feared situations directly, without a gradual buildup, as in
systematic desensitization or graded exposure. No relaxation exercises are used, as in systematic
desensitization. Patients experience fear, which gradually subsides after a time. The success of the procedure
depends on having patients remain in the fear-generating situation until they are calm and feel a sense of
mastery. Prematurely withdrawing from the situation or prematurely terminating the fantasized scene is
equivalent to an escape, which then reinforces both the conditioned anxiety and the avoidance behavior and
produces the opposite of the desired effect.
3) Modeling-
As the name implies, in modeling the client learns new skills by imitating another person, such as a parent or
therapist, who performs the behavior to be acquired. A younger client may be exposed to behaviors or roles
in peers who act as assistants to the therapist and then be encouraged to imitate and practice the desired new
responses. Modeling and imitation are adjunctive aspects of various forms of behavior therapy as well as
other types of therapy. For example, in an early classic work, Bandura (1964) found that live modeling of
fearlessness, combined with instruction and guided exposure, was the most effective treatment for snake
phobia, resulting in the elimination of phobic reactions in over 90 percent of the cases treated.
SOCIAL PHOBIA
Application Of Cognitive And Behaviour Therapy (Treatment of Social Phobia)
1) Exposure therapy- Exposure Therapy appears to be an effective treatment for social anxiety disorder;
such treatments often begin with role playing or practicing with the therapist or in small therapy groups
before undergoing exposure in more social situations (Marks, 1995). With prolonged exposure, anxiety
typically extinguishes (Hope, Heimberg, & Bruch, 1995).
2) Social skills training- Social skills training in which a therapist might provide extensive modeling of
behavior can help people with social anxiety disorder who may not know to do or say in social
situations. Remember that safety behaviors, like avoiding eye contact, are believed to interfere with the
extinction of social anxiety (Clark & Wells, 1995). Consistent with this idea, the effects of exposure
treatment seem to be enhanced when people with social anxiety disorder are taught to stop using safety
behaviors (Kim, 2005). That is, not only are people asked to engage in social activities but, while doing
so, they are asked to make direct eye contact, to engage in conversation, and to be fully present. Doing
so leads to immediate gains in how they are perceived by others, and it enhances the power of the
exposure treatment (Taylor & Alden, 2011).
3) Role playing- Therapeutic role playing is a very effective treatment for phobia sufferers. The person
learns new behaviors to help overcome the phobia. This therapy allows a person to with a phobia to
practice new behaviors. The therapist plays the role of someone that the person is afraid of, for example
a parent or an employer. The person then interacts with the therapist by using the new behaviors. A
debriefing session follows the role playing session where discussions are done about what happened
how the interaction can be improved.
4) CBT- butcher 213pg
5) Schema-focused therapy- The existence of self-schemas of inefficacy and incompetence to deal with
social situations in social phobics has been inferred from patient’s frequent use of negative self
descriptives. However, few studies have investigated systematically, the schema structure of patients
suffering from social phobia, comparing it with the schema structure of patients with other anxiety
disorders. Clinical experience suggests that the dysfunctional thinking style of more severe cases of
social phobia, includes other core beliefs about the self and others, similar to the ones described by
Young (1990, 1999), rather than just maladaptive beliefs about inefficacy and social incompetence.
Relevant patterns of those core beliefs include emotional deprivation, mistrust/abuse, shame and guilt,
among others. In his schema-focused therapy, Young (1990, 1999) used the concept of Early
Maladaptive Schemas (EMSs), as self-perpetuating dysfunctional cognitive structures that developed
during childhood, resulting from dysfunctional relationships with significant others and these are related
to psychopathology. EMSs represent core beliefs (unconditional assumptions) about the self and the
others that guide environmental information processing in a dysfunctional way, thus affecting self-
perception and influencing interpersonal relationships (Young, 1999). The unconditional nature of core
beliefs makes them resistant to change, which gives origin to selective information processing that is
congruent with its content and minimizes information, which is not consistent with the schema
(Williams, Watts, Macleod, & Mathews, 1997). In clinical assessment and treatment of social phobia,
evaluation of the EMSs could provide important information about the core beliefs associated with
social anxiety. Furthermore, core beliefs of mistrust/abuse, emotional deprivation and shame should be
systematically assessed in patients with social phobia, and can be particularly relevant in patients that do
not improve with the standard cognitive therapy interventions for social phobia (Pinto-Gouveia et al.,
2006).These patients might benefit from a specific therapeutic approach for the maladaptive schemas
with the use of schema-focused therapy, which can trace the development of these core beliefs by
employing a cognitive restructuring methodology that is more emotional and interpersonal focused
(Nordahl & Nysaeter, 2005; Young et al., 2003).
AGORAPHOBIA
Cognitive Explanation Of Agoraphobia
Because agoraphobia was only recognized as a distinct disorder with the DSM-5, less is known about its
etiology. As with other anxiety disorders, the development of agoraphobia appears related to genetic
vulnerability and life events (Wittchen et al., 2010). Here we focus on a cognitive model of how these
symptoms evolve.
Cognitive Factors:
The Fear-of-Fear Hypothesis- The principal cognitive model for the etiology of agoraphobia is the fear-of-
fear hypothesis (Goldstein & Chambless, 1978), which suggests that agoraphobia is driven by negative
thoughts about the consequences of experiencing anxiety in public. There is evidence that people with
agoraphobia think the consequences of public anxiety would be horrible (D. A. Clark, 1997). They seem to
have catastrophic beliefs that their anxiety will lead to socially unacceptable consequences (e.g., “I am going
to go crazy”) (Chambless, Caputo, Bright, & Gallagher, 1984).
Application Of Cognitive And Behaviour Therapy (Treatment of Agoraphobia)
Cognitive behavioral treatments of agoraphobia also focus on exposure—specifically, on systematic exposure to
feared situations. Exposure treatment of agoraphobia is more effective when the partner is involved (Cerny, Barlow,
Craske, & Himadi, 1987). The partner without agoraphobia is encouraged to stop catering to the partner’s avoidance
of leaving home. There is also good support for self-guided treatment, in which those with agoraphobia use a manual
to conduct their own step-by-step exposure treatment (Ghosh & Marks, 1987).
----------------------------------------------------------------------------------------------------------------------------------
From comer and ttn ka notes se done- apart from these ttn mam gave another note can see that later almost same thing
is given plus genetic and psychoanalytic explanations are also given so can check that (in cc11 final grp ill make)
Also can check Kaplan waha chota chota krke ek do chiz h but not needed hi.