phobias

• Eloise is frequently having thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet she can't seem to shake the sense of doom and gloom that clouds each day
• The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the best known in the field of mental health and is published by the American Psychiatric Association
• The latest version of the DSM is the 5th edition, which was published in 2013
• Phobias are characterised by excessive fear and anxiety triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus
• Categories of phobia and related anxiety disorder recognised in the DSM-5

  • Specific phobia - phobia of an object, such as an animal or body part, or a situation such as flying or having an injection
  • Social anxiety (social phobia) - phobia of a social situation such as public speaking or using a public toilet
  • Agoraphobia - phobia of being outside or in a public place
• Behavioural characteristics of phobias

  • Panic - a person with a phobia may panic in response to the presence of the phobic stimulus
  • Avoidance - the person tends to go to a lot of effort to prevent coming into contact with the phobic stimulus
  • Endurance - the person chooses to remain in the presence of the phobic stimulus
• Emotional characteristics of phobias

  • Anxiety - an unpleasant state of high arousal that prevents the person from relaxing and experiencing positive emotion
  • Fear - the immediate and extremely unpleasant response experienced when encountering or thinking about a phobic stimulus, usually more intense but experienced for shorter periods than anxiety
  • Emotional response is unreasonable - the anxiety or fear is much greater than is normal and disproportionate to any threat posed
• Cognitive characteristics of phobias

  • Selective attention to the phobic stimulus - the person struggles to look away from the phobic stimulus
  • Irrational beliefs - the person holds unfounded thoughts in relation to phobic stimuli
  • Cognitive distortions - the perceptions of the person may be inaccurate and unrealistic
• Social phobias


  • Fear of public speaking
  • Fear of using public toilets
• Agoraphobia


  • Fear of being outside or in a public place
• Zelda has a phobia of dogs
• As a child she was once bitten by a dog belonging to a family friend
• Now when she thinks about dogs she experiences anxiety and she becomes very afraid whenever she sees a dog near
• Agoraphobia is an extreme fear of leaving one's own home
• Nasim has agoraphobia
• He is a keen A level student but is struggling to attend college because of the acute anxiety he experiences when attempting to leave home in the morning
• His phobia began having frequent thoughts of wishing he was dead
• The behavioural approach emphasises the role of learning in the acquisition of behaviour
• The behavioural approach focuses on behaviour - what we can see
• The two-process model states that phobias are acquired (learned in the first place) by classical conditioning and then continue because of operant conditioning
• Acquisition by classical conditioning

  1. Classical conditioning involves learning to associate something of which we initially have no fear (called a neutral stimulus) with something that already triggers fear (the unconditioned stimulus)

  2. The neutral stimulus becomes the conditioned stimulus that produces the conditioned response of fear
• Maintenance by operant conditioning

  1. Whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have experienced if we had remained there

  2. This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained
• Systematic desensitisation is a behavioural therapy designed to gradually reduce phobic responses through the principle of classical conditioning
• Systematic desensitisation


  1. The anxiety hierarchy is put together to identify situations related to the phobic stimulus, arranged in order of increasing anxiety

  2. The client is taught to relax as deeply as possible

  3. The client is exposed to the phobic stimulus while in a relaxed state, starting at the bottom of the anxiety hierarchy and working up
• Flooding


  1. Flooding involves immediate exposure to a very frightening situation, without a gradual build-up

  2. Flooding stops phobic responses very quickly, possibly because the client quickly learns that the phobic stimulus is harmless
• Flooding is an unpleasant experience so it is important that clients give fully informed consent and are fully prepared before the flooding session
• Systematic desensitisation has a strong evidence base for its effectiveness in treating specific phobias, social phobias and agoraphobia
• Systematic desensitisation is often the most appropriate treatment for people with learning disabilities who have phobias
• Flooding is highly cost-effective as it can work in as little as one session
• Flooding is a highly unpleasant experience that provokes tremendous anxiety, and has higher attrition (dropout) rates than systematic desensitisation