anxiety

• Anxiety


  Fear that is disproportionate to a given situation
• Characteristics of Anxiety Disorders

  • Anxiety refers to fear that is disproportionate to a given situation
  • Different conditions may be triggered by particular stimuli, but all produce excessively fearful reactions in the individual
  • Related to apprehension and worry in the future, it can have a fearful reaction that is disproportionate to a given situation
• Generalised Anxiety Disorder (GAD)


  • Excessive, uncontrollable and often irrational worry, which interferes with daily functioning
  • Physical symptoms of headaches, nausea, numbness in hands and feet, muscle tension, difficulty swallowing and/or breathing, trembling, twitching and sweating
  • Feeling anxious most days and struggling to remember the last time they felt relaxed; as soon as one anxious thought is resolved, another may appear about a different issue
  • It is a long term condition that causes feelings of anxiety about a wide range of situations and issues, rather than one specific event
  • May have 'panic attacks' but do not know its cause
• Phobias


  • Intense, persistent, irrational fear a particular object, event or situation
  • Response is disproportionate and leads to avoidance of phobic object, event or situation
  • Fear is severe enough to interfere with everyday life
  • May or may not be accompanied by panic attacks
• Types of phobias


  • Specific Phobias (animals; things (Koumpounophobia - button phobia); events (flying); bodily (blood; blood injection phobia - haemophobia); situations (enclosed places))
  • Social Phobias (of social situations, public speaking, parties, meeting new people)
  • Agoraphobia (of public crowded places, of leaving safety of home)
• Agoraphobia


  Fear of public crowded places, of leaving safety of home
• Specific phobia


  Intense, persistent, irrational fear of a particular object, event or situation
• Blood injection phobia


  Fear of blood and injections, often results in the person fainting
• Blood Injection Phobia Inventory (BIPI)


  1. Measuring blood and injection phobia assessing the severity and symptoms

  2. Consists of 18 specific scenarios, which encompass both situational anxiety and anticipatory anxiety

  3. Examples: When I feel the needle go into the vein of my arm to extract the blood; When I see a bloody wound or cut

  4. Measures the frequency of a patient's different type of response (cognitive; physiological and behavioural) to the situations on a 4 point scale
• Generalised Anxiety Disorder assessment (GAD-7)

  1. Scores of 0 (not at all), 1 (several days), 2 (more than half the days), and 3 (nearly every day) are assigned

  2. A GAD-7 total score for the seven items range from 0 - 21

  3. Scores: 0 - 5 mild anxiety; 6 - 10 (moderate anxiety); 11 - 15 (moderately severe anxiety); and 15 - 21 (severe anxiety)

  4. Asking about the last 2 weeks

  5. Example items: Over the last two weeks, how often have you been bothered by the following problems?1. Feeling nervous, anxious or on edge (0, 1, 2, 3) 2. Worrying too much about different things (0, 1, 2, 3)
• Phobias could be learnt through the process of classical conditioning - that is, by an involuntary association the person would make between a given stimulus and the experience of fear
• Little Albert study


  1. To induce fear into Albert - who at the beginning showed no fear of these stimuli - a hammer was struck to a steel bar behind Albert's head whenever he was shown a white rat

  2. The loud sound created by this procedure caused Albert to burst into tears. Several such trials were conducted over seven weeks

  3. Results: it was found that Albert had associated the stimuli with the loud noise, and cried as soon as the white rat was shown to him, even before the loud sound could occur

  4. Albert responded by crying to some stimuli that shared characteristics with the white rat - white beards such as the one worn by Santa Claus, a fur coat worn by Dr. Watson, white rabbits, etc. This is known as stimulus generalization which plays an important role in the development of phobias
• For phobias in general, the findings of this study imply that learning to associate a stimulus with fear, can cause a person to develop a phobia of that stimulus
• Phobias stem from unconscious, unresolved psychosexual conflicts, such as the Oedipus complex
• Little Hans study


  1. Freud published his case study of Little Hans, a boy with a phobia of horses in 1909

  2. By means of indirect observation - through the letters written by little Hans' father, Freud studied the case of little Hans over a period of several years, starting from age 3

  3. It was noted that Hans showed an interest in his 'widdler' from age 3, and touched it which led his mother to threaten him to have it cut off from the family doctor. Freud believed that this marked the development of the Oedipus complex - the sexual attraction of a boy for his mother - in Hans

  4. Little Hans often saw horses near his house, and he was seen to be afraid in particular of horses with black marks around their mouth

  5. Freud interpreted this as Hans' projection of his father's fear onto the horses which resembled his father since the black marks resembled his father's moustache, and glasses

  6. Freud concluded that Hans' fear of being castrated by his father had been projected on the horses that symbolized his father, which caused his phobia
• Genes may predispose some people to anxiety and some phobias. Genetic factor common to all phobias strongly predisposes a person to specific phobias such as blood phobia
• Ost (1992) study


  1. Ost sampled 81 blood phobics and 59 injection phobics. Ost used standardised behavioural tests and interviews and discovered that 61% of those with a specific phobia for blood injuries had 61% first degree relatives (parent or sibling) who had the same phobia

  2. Ost concluded that 'The high percentage of blood phobics with the same fear could mean that a heredity component is of importance
• Cognitive-behavioural therapy (CBT)


  Addresses negative patterns and distortions in the way we look at the world and ourselves. Involves two main components: cognitive therapy which examines how negative thoughts/cognitions contribute to anxiety and phobias, and examining the behaviours/reactions to situations that trigger anxiety.
• CBT for treating button phobia

  1. Patient attends regular appointments

  2. Completes homework assignments to identify triggers

  3. Practices new thinking patterns and behaviours to reduce anxiety around buttons
• Strengths of CBT


  • Supports free will - individual chooses to join therapy and make changes to irrational thoughts
• Weaknesses of CBT


  • Only supports nurture, does not take into account genetic factors that may influence anxiety
• Explanations of phobias


  • Behavioural (classical conditioning, Watson, 1920)
  • Psychoanalytic (Freud, 1909)
  • Biomedical/genetic (Ost, 1992)
• Behavioural explanation of phobias is based on classical conditioning
• Psychoanalytic explanation of phobias is based on Freud's theories
• Biomedical/genetic explanation of phobias is based on research by Ost
• Levels of response criteria

  • Level 3 (5–6 marks)
  • Candidates will show a clear understanding of the question and will outline one strength and one weakness
  • Candidates will provide a good explanation with clear detail
  • Level 2 (3–4 marks)
  • Candidates will show an understanding of the question and will outline one appropriate weakness in detail or one appropriate strength in detail
  • Candidates will provide a good explanation
  • Level 1 (1–2 marks)
  • Candidates will show a basic understanding of the question and will attempt an outline of either a strength or a weakness
  • Candidates will provide a limited explanation
  • Level 0 (0 marks)
  • No response worthy of credit
• Explanations of phobias


  • Behavioural (classical conditioning, Watson, 1920)
  • Psychoanalytic (Freud, 1909)
  • Biomedical/genetic (Ost, 1992)
  • Cognitive (DiNardo et al., 1988)
• Behavioural (classical conditioning, Watson, 1920)

  1. Neutral stimulus paired with something the person is afraid of (the unconditioned stimulus)

  2. If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS

  3. The NS then becomes the CS
• Behavioural (classical conditioning, Watson, 1920)


  • Case of the little Albert who was conditioned to be afraid of a rat by Watson banging an iron bar behind the baby which made him cry
• Psychoanalytic (Freud, 1909)


  • A fear is repressed into the unconscious to protect the ego
  • The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object
• Psychoanalytic (Freud, 1909)


  • Case of little Hans
• Biomedical/genetic (Ost, 1992)


  • Blood-phobic subjects had more first degree relatives with the same phobia compared to injection-phobic participants
  • Blood-phobic patients were more likely to fear they would faint in the phobic situation
• Ost concluded that there appears to be a strong genetic link and more likely to lead to a strong physiological response (fainting)
• Cognitive (DiNardo et al., 1988)


  We have irrational thoughts about an object due to a previous experience that we believe will be repeated
• Cognitive (DiNardo et al., 1988)


  • Over 50% of people with dog phobias could recall being bitten or having a frightening past experience with a dog
  • 50% of the group with no dog phobia also had memories of being bitten by dogs and yet had not developed any anxiety about seeing dogs in the future
• This shows that not everyone who is exposed to conditioning would end up developing a phobia, and it may be explained more through our thought processes after an event than the event itself
• Explanations of phobias to be evaluated

  • Determinism
  • Nature versus nurture debate
  • Comparisons of different explanations
  • Application of psychology to everyday life
  • Reductionist nature of the explanations
  • Evidence to support the explanations
• Treatments and management of anxiety disorders

  • Systematic desensitisation (Wolpe, 1958)
  • Applied tension (Ost et al., 1989)
  • Cognitive-behavioural therapy (Ost and Westling, 1989)
• Systematic desensitisation – Wolpe

  1. Patient is taught muscle relaxation and breathing exercises

  2. A fear hierarchy is created with the most feared item/experience at the top down to the least feared at the bottom

  3. The patient works their way up the hierarchy practising the relaxation techniques at each level til they reach the highest fear
• Applied tension – Ost et al.


  • Developed to help people who have a phobia of blood and/or needles and faint at the sight of them
  • This involves tensing the muscles in the body to raise blood pressure and makes it less likely the person will faint