Outline and Evaluate Biological Treatments for Phobic Disorders (8 and 16 marks)

One Biological Treatment for Phobic disorders is Drugs. There are many types of drugs used to treat phobic disorders but the three main types are Benzodiazepines, Beta-blockers and Anti-depressants. Benzodiazepines work by slowing down you central nervous system by enhancing a neurotransmitter called GABA, Beta-blockers reduce levels and effects of adrenalin and noradrenaline so that thesympathomedullary pathway is less active and Anti-depressants reduce anxiety and increase serotonin which regulates mood and anxiety levels.

​All of these are used as a treatment of the symptoms and not the cause of the phobia and should therefore be used in addition to psychological therapies and only in the short term whilst the causes are being treated. They are cheap compared to other treatments which make them a good option for a lot of people however they are highly addictive, especially Benzodiazepines, and can have a lot of side effects includingoften extensive and long term memory loss memory loss in Benzodiazepines and dizziness, blurred vision and increased suicide rates in Anti-depressants.

​Kindt et al (2009) did a study to support the use of Beta-blockers by conditioning people to have a fear of spiders using electric shock and then giving half a Beta-blocker and half a placebo. 24 hours later those who had had the Beta-blocker showed a reduced fear response whereas those given the placebos did not. This supports the use of Beta-blockers as a treatment for Phobic disorders as it did reduce the fear response the participants had to spider when the placebo didn’t suggesting it was actually the Beta-blocker that had reduced this fear and not another variable.

​There are some ethical issues involved in Kindt’s study as there is an issue of informed consent as most participants were not informed of the comparative success of the Beta-blockers verses placebos and therefore expose themselves to possible side effects unknowingly.

​Another Biological treatment of Phobic Disorders is Psychosurgery. This is a type of surgery done on the brain to treat mental health problems such as phobic disorders and usually involves severing connections between areas of the brain to encourage it to create new pathways. It is used as a last resort when all other means of treatment have been tried but had no effect and has had some success on patients for whom all else has failed and whose mental health condition is life threatening. However the surgery is very dangerous and can cause memory loss and therefore is only used in extreme cases.

​Ruck et al (2003) did a study to support psychosurgery where he gave psychosurgery to 26 people who had been suffering from non-obsessive anxiety disorders for more than 5 years and who had tried various other treatments. A year later 25 out of 26 of the people had dropped from an average of 22.0 to an average of 4.6 on the brief anxiety scale. This would support psychosurgery as a treatment for phobic disorders as it worked as a last resort for 95% of the participants.

However although this study seems to support psychosurgery one year after treatment 7 of the participants had tried to commit suicide and 2 had epileptic fits. This suggests that although psychosurgery may be a working treatment it also carries lots of risks, especially of side effects that must be thought about before taking part in the procedure.

There are a lot of ethical issues involved in psychosurgery as it is totally irreversible. Also informed consent is very hard to get as people can never really be fully informed on the effects of psychosurgery as it is different in each individual case.

Outline and Evaluate Psychological Therapies for Phobic Disorders (8 and 16 marks)

One Psychological Therapy for Phobic Disorders is Systematic Desensitisation (SD). Wolpe (1958) developed SD where you come up with a hierarchy of fear (levels of acceptable exposure) and are gradually exposed to your phobia in accordance to these levels. Before being exposed to your phobia relaxation techniques are learnt to be used during exposure. SD aims to replace fear response with calm andrelaxation.

Systematic Desensitisation is good because it is relatively quick compared to other psychological and biological therapies and there are no side effects that come with it. It can also be self-administered meaning it can cost very little money. However if a therapist is used it can end up being quite expensive.

​Research into SD was done by Masserman (1943) who conditioned a fear reponse to a box in cats by electric shocking them in the box. He then tried to reduce this fear by feeding them in this box and found that he could reduce it by forming new associations with the box. This would have supported SD as a therapy for Phobic Disorders as it shows that fear of something can be replaced, in the case of SD it would be with relaxation. However subsequent research found that this is not so much the case in humans as it is in cats as fear is not as simple as a conditioned association in humans and expectations contribute less to fear in cats than in humans. Therefore we cannot generalise the findings of Masserman’sstudy to humans as it has been shown we have a different psychological makeup regarding fear.  

​A study which supported SD was carried out by Jones (1924) who tried to cure a 3 year old boy, Little Peter, of his fear of white rabbits. She did this by moving a white rabbit closer and closer to him as he ate each day. Through this his fear of white rabbits gradually went away. This supports SD as a therapy for Phobic Disorders as increased exposure of the Phobia eventually cured it.

​Another supporting study of SD was conducted byCapafons (1998) where he used SD treatment on 21 patients from a volunteer sample to try to cure them of aerophobia. They reported levels of fear during the 12-15 week period of two hour sessions a week by a self-report method. He found that by the end all but two patients reported lower fear levels. This supports SD as a therapy for Phobic Disorders as 90% of participants reported less fear after receiving SD.

​However Capafons’s study did use a self-report method which reduces the validity as participants could have given answers they thought Capafons wanted to hear rather than truthful ones. This needs to be taken into account when using the results from Capafons study so that conclusions are not built on only invalid evidence. To stop this lots of studies should be looked at together and their result collated when looking into whether SD is an effective therapy for Phobic Disorders.

​Another Psychological Theory for Phobic Disorders is Rational Emotive Behavioural Therapy (REBT). REBT was developed by Ellis (1950’s) and aims to replace irrational thought patterns with rational ones. It says that the Phobia itself is not the problem but the irrational thoughts that develop and are associated with the phobia. He developed an ABC model to help identify these irrational thoughts:

-

A – Activating Event (eg. A friend ignores you in the street)

-

B – Irrational Beliefs (eg. You think he has decided he doesn’t like you and that no one else will and that you are worthless)

-

C – Consequences (eg. You avoid social situations in the future)

It was also said that the acting events that cause unproductive consequences, but the beliefs that lead to the self-defeating consequences. Because of this REBT focuses on challenging or disputing these beliefs and replacing them with effective rational beliefs instead such as; Logical disputing (self-defeating thoughts do not flow logically from the information available), Empirical disputing (Self-defeating thoughts may not be consistent with reality), and Pragmatic disputing (Emphasise the lack of usefulness of self-defeating beliefs).

The National Institute of Clinical Excellence claimed that REBT should be the first line of defence for treating phobic disorders and Ellis claimed it had a 90% success rate however it require a lot of time and commitment from the patient as it is a weekly session and takes on average 27 sessions to cure a phobia therefore making it quite expensive.

Discuss Psychological Explanations of Phobic Disorders (8 and 16 marks)

One Psychological explanation for Phobic Disorders is the Behavioural approach which says that phobias are acquired through conditioning. Classical conditioning (or learning through association) first conditions that phobia by associating a fear response with a neutral object/situation. Operant conditioning (or learning through reinforcement) then reinforces this fear response by reinforcing the fact that no fear response is apparent when that situation/object is avoided. Extreme phobias can also be learnt through Social Learning Theory which says we learn through observation and therefore would acquire a phobia of an object/situation as we see someone else doing the same.

Supporting Research into the Behavioural approach as an explanation for phobic disorders was carried out by Watson and Rayner (1920) who worked with 11 month old ‘Little Albert’ who at the beginning  showed no fear response to a series of white fluffy objects. Every time Albert reached for one of the white fluffy objects they would make a very loud noise to startle him. Over time Albert began to cry when faced with white fluffy objects and had a fear response towards them that was not there before. This would support the behavioural approach as an explanation for phobic disorders as it shows that a phobia of a completely neutral object can in fact be learnt.

One positive of the Behavioural approach is that it can account for cultural differences and therefore is more culturally sound than other approaches, such as the psychodynamic approach, as each society has its own culturally specific role models which influence which phobias might be acquired.

Another Psychological explanation for phobic disorders is the Cognitive approach. This says that phobias develop as the consequence of irrational thinking. Beck et al (1985) proposed that phobias occur because people become afraid of situations where fears may occur. He also said that people tend to overestimate their fear, increasing the likelihood of it developing to a phobia.

If Phobic Disorders was a cognitive process it should be treatable through a cognitive behavioural therapy, in the case of Phobias, Rational Emotive Behaviour Therapy (REBT).The National Institute of Clinical Excellence claimed that REBT should be the first line of defence for treating phobic disorders and Ellis claimed it had a 90% success rate. This supports the cognitive approach as an explanation for phobic disorders as it is very treatable through a cognitive process suggesting that this is the basis for it forming in the first place.

A study was conducted by Gournay (1989) conducted a study to support the cognitive approach and found that phobics were more likely than normal people to overestimate risks meaning they are generally more fearful and resulting in them developing phobias a lot easier. This supports the cognitive approach as an explanation for phobic disorders as it shows that those who have an irrational thought meaning they are more fearful are the people who then develop a phobia, not those who do not have irrational thoughts.

One Criticism of the cognitive approach is that it is deterministic as it states that if you have dysfunctional thoughts you WILL become a phobic which is a very narrow view and forgets about us having the free will to choose.

Discuss Biological Explanations for Phobic Disorders (8 and 16 marks)

One Biological explanation for phobic disorders is the Evolutionary Approach. This says that some stimuli are more likely to be feared than others eg. Snakes, heights etc. as these are the stimuli that would have been dangerous and fearful to our ancestors in our Environment of Evolutionary Adaptation (EEA). We have adapted to be fearful of these stimuli as potential threats rather than after an event has happened which gave our ancestors the best chance of survival and to pass on their genes. We are also said to be biologically prepared to rapidly learn an association between particular stimuli and fear from the minute we are born, copying the fear response shown in our parents and learning this ourselves.

​Ohman and Soares (1994) conducted a study to support the idea that we fear stimuli as a potential threat rather than after an event occurs by showing a group of participants ‘Masked’ pictures (so they could not fully tell what the object was) of Snakes and Spiders. A higher autonomic nervous system arousal was found in those who had a fear of snakes and spiders when they got shown the masked picture compared to when shown the full picture or compared to that of a participant without a fear of the particular animal. This supports the idea that we have adapted to have a fear of a stimuli as a potential threat as participants were more scared when they were not sure of what the picture was than when they knew exactly what it was.

​Another biological explanation of phobic disorders is Genetic Factors. This says that it may be that people inherit an over sensitive fear response to particular stimuli causing them to develop a phobia of that fear response. This can be looked into using both Twin and Family Studies. In Twin studies comparisons are made between the individuals in both Monozygotic (MZ) twins and dizygotic (DZ) twins and then comparing these results between the sets of twins. If the MZ twins show a more similar fear response than DZ twins it suggests that there is in fact a genetic factor in Phobic Disorders whereas if it is in fact the other way round this suggests there is not a genetic factor. Family studies are more general and look at whether or not relatives within the same family have same of similar phobias.

​One criticism of genetic factors as an explanation for phobic disorders is that it is very on the side of nature in the nature/nurture debate which means that it ignores theories such as Social Learning Theory which would stress the nurture side. This can be a criticism as both Nature and Nurture are said to be important to explaining Phobic disorders. However when researching genetic factors through twin studies both sides of the nature/nurture debate are being looked into which means if there was more of a nurture factor in phobic disorders than a nature factor it would still be discovered.

​Solyom et al (1974) conducted a study to support genetic factors as an explanation for phobic disorders and found that 45% of patients with a phobic disorder had at least one relative with the same disorder compared to only 17% of the non-phobic controls. This supports a genetic basis for phobic disorders as it shows that it is in fact very common for relatives to have the same phobia.

​ Both Biological Explanations of Phobic Disorder can be seen to be deterministic as they assume that how we act is down to just either our genes or evolutionary factors and suggest that we have no free will to develop phobic disorders of stimuli we have had our own personal bad experiences with. This is a criticism as it is very one sided and therefore should be looked at alongside theories such as Social Learning Theory which would say that we learn phobic disorders through observing someone else’s fear and replicating this.

Discuss Issues Associated with the Classification and/or Diagnosis of Phobic Disorders (24 marks)

One issue with diagnosing Phobic Disorders is Reliability. This is the consistency of a measuring instruments such as a questionnaire or scale. Internal Reliability is the extent to which a measure is consistent within itself and can be assessed using the split-half method which involves splitting the test I two and having the same participant do both halves of the test and then seeing how similar they are. External reliability is the extent to which a measure varies from one use to another and can be assessed using the test retest method which involves testing the same participant twice in the same test over a period of time and seeing whether the scores were similar. Inter-rater reliability is a way of testing external validity which involves comparing the ratings of two or more observers and checking for agreement in their measurements, it can be also used for interviews.

​Reliability can be improved through the use of computerised scales. Kobak et al (1993) suggested that increased reliability occurs because there is less opportunity for the experimenter to affect the given answers. Also it helps with things such as people with social phobias as they may prefer to answer without the presence of a person in the room.

​Kendler et al (1999) did a study which undermines the research into the classification and diagnosis of phobic disorders by using face to face and telephone interviews to diagnose phobias over one month and then eight years. He found that test-retest reliability for diagnosing phobic disorders was quite low and decreased with time. He thought this to be because of participant’s level of recall of past phobias. This undermines the reliability of research into the classification and diagnosis of phobic disorders because it shows that it is difficult to be confident in the research as it has such low reliability.

​

The reliability of Kendler’s study was also low because inter rater reliability because it was suggested that different clinicians made different decisions about the severity of symptoms in some phobias. This would reduce the reliability of the classification and diagnosis of phobic disorders as if each clinician sees the severity of symptoms as different they are likely to also classify and diagnose people differently.

​Validity is also an issue in the classification and diagnosis of phobic disorders. Validity is the extent to which the diagnosis represents something that is real and distinct from other disorders and the extent that a classification measures what it claims to measure. There are three things that are measured within validity; Comorbidity which refers to the extent that two or more conditions co-occur, Concurrent Validity which establishes the value of a new measure of phobic symptoms by correlating it with an existing one, and Construct Validity which measures the extent that a test really does measure a target construct of phobias.

​Eysnck (1997) supported comorbidity in diagnosing phobic disorders by finding that 66% of patients with one anxiety disorder are diagnosed with another. He says that because of this we should just say these people have an ‘anxiety disorder’ rather than many specific phobic disorders.This would support comorbidity in phobic disorders as it shows that phobic disorders do co-occur in many people.

​Validity is also affected by cultural factors as some cultures have unique fears which could be seen as abnormal by other cultures. An example of this is Japan. They have a very different culture to ours and have a culture bound social phobia of embarrassing others in public which is diagnosed in Japan only. This shows the cultural differences on classifying and diagnosing phobias as if someone was to have this phobia in a western culture it would never be diagnosed.