News
Specific Phobias
Raphael D. Rose· Michelle A. Blackmore· Michelle G. Craske
WHAT IS SPECIFIC PHOBIA?
Specific phobias (also known as simple phobias) refer to excessive fears and avoidance of a wide range of circumscribed situations or objects (American Psychiatric Association, 1994). In contrast to more commonly occurring fears, phobias are severe enough to cause significant interference in life functioning and/or cause significant distress (Craske, 2003). Individuals who meet DSM-IV criteria for specific phobia rec-ognize that their fear is excessive or more than what would be expected. Unlike adults, children are not required to acknowledge that their fears are unreasonable or exces-sive, and in order to prevent the overdiagnosis of transitory developmental fears, per-sistence of symptoms is required for at least six months. Historically, the various specific phobias (e.g., animals, heights, blood, flying) were grouped together, but recent research suggests marked differences across the various phobias (Himle, McPhee, Cameron, & Curtis, 1989; Ost, 1987), including age of onset (Curtis, Hill, & Lewis, 1998; Ost, 1987), rates of cooccurring disorders (Himle et aI., 1989), response profiles (Craske, Zarate, Burton, & Barlow, 1993), familial aggregations data (Himle et al., 1989), and genetic variance data (Kendler, Neale, Kessler, Heath, & Eaves, 1993). Hence, while phobias vary greatly in terms of the particular feared stimulus and other factors mentioned above, typically individuals with specific phobias fall into the fol-lowing four subtypes: animal fears (e.g., snakes, insects), natural environment fears (e.g., storms, heights), blood injection-injury fears (e.g., receiving or observing nee-dle injections or blood injuries), and situational fears (e.g., flying or enclosed spaces).
When individuals with specific phobias are not exposed to their feared object or situation, they experience the least severe and impairing anxiety disorder (Barlow et al., 1985). However, when encountering feared objects or situations, individuals with phobias tend to experience severe discomfort and may attempt to escape the situa-tion or else endure it with great distress. This distress is often accompanied by physi-cal symptoms such as palpitations, sweating, blushing, and trembling, which may take the form of a situationally bound panic attack. Individuals may also experience simi-lar distress in advance or anticipation of exposure to a feared situation or object (e.g., before a scheduled flight, prior to a medical appointment). As a result, feared situa-tions are often avoided. Such fear and avoidance may significantly interfere with the individual’s functioning, often resulting in a change in normal routines, a decline in occupational opportunities, negative impact on social relationships, or changes in regular health
BASIC FACTS ABOUT SPECIFIC PHOBIAS
Mild fears of specific situations and objects are quite common in the general pop-ulation (King et al., 1989); however, specific phobias (that cause clinically signifi-cant interference and/or distress) are among the most common of the anxiety
disorders. The National Comorbidity Survey found lifetime prevalence rates for specific phobias, using DSM-IV criteria, to be 12.5% (Kessler, Berglund, Demler, Jin, & Walters, 2005). Fredrikson, Annas, Fischer, and Wik (1966) found slightly higher prevalence rates (16.3%) among their Swedish sample of 704 adults.
Women (15.7%) are more likely than men (6.7%) to receive a specific phobia diagnosis (Kessler et aI., 1994). Overall, 75-90% of individuals with animal, natural environment, or situational specific phobia are female, with slightly lower rates (55-70%) for individuals with phobias of heights or blood-injection (Himle et al., 1989).
Age of onset, course, and demographic characteristics
The majority of individuals with animal and blood-injection specific phobia report an onset of difficulties by childhood (ages 7-9), whereas situational and natural environment subtypes exhibit a bimodal distribution of onset, in early childhood and early adulthood (Himle et al., 1989), with situational subtypes more commonly developing in young adulthood (Ost & Treffers, 2001). Additionally, for those pho-bias occurring during childhood, elevations are often seen between 10 and 13 years of age (Strauss & Last, 1993).
Untreated specific phobias tend to be chronic or recurrent (Yonkers, Dyck, &, Keller, 2001), with a remission rate over a seven-year period as low as 16% (Wittchen, 1988). Interestingly, despite the relatively high prevalence and chronic-ity of specific phobias, individuals rarely seek treatment, perhaps because most peo-ple with specific phobias are able to function despite strong fears and phobias. Individuals with higher levels of functional impairment, multiple phobias, panic symptoms in the phobic situation, and surprisingly, absence of blood phobias, injury or medical procedures were all related to higher help-seeking (Chapman, Fyer, Mannuzza, & Klein, 1993). As a result of the generally circumscribed nature of spe-cific phobias, they are associated with less distress overall in comparison to other anxiety disorders (Craske, 2003).
New York City Marathon Program, November 2003 – Gaining a Mental Edge
Months of physical training to prepare for the rigors of running 26.2 miles have made your body stronger and faster than ever. Mental training can bring your mind up to speed with your well-tuned body and turn a good ING New York City Marathon experience into a great one. Here are some psychological tools that you can use before and during your race to maximize performance and enjoyment.
Pre-Race Strategies
Rational thinking. Pre-race thoughts are often filled with worry over things you can’t control. Try to recognize such irrational thinking patterns as “I didn’t train enough,” and “I must break four hours to be happy.” These thoughts are irrational because there is probably no evidence that they are true, and even if they are, there is nothing you can do about them in the days before the race. All they can do is eat away at your mental and physical energy. Replacing these thoughts with rational thinking can help your mind become clear and relaxed. Try to shift to thoughts such as “I would have preferred to train more, but I put in all the effort I could,” and “One of my goals is to break four hours, but I have other important goals as well.”
Thought watching. Sometimes thoughts erode our mental edge because we imbue them with negative energy. A better strategy is to view these thoughts objectively, as neither good not bad. Take a few minutes each day to allow worry thoughts, such as “It might be hot and I won’t finish,” to flash across your mind like words on a movie screen. Regard them with calm detachment, and you may be surprised by how clearheaded you feel. Thought watching is also a great method to use during your race.
Visualizing. Visualizing is a helpful technique because it increases the likely occurrence of -visualized behaviors. MRE studies have shown that visualizing an activity-such as running with good form-activates similar parts of the brain that are activated when performing the activity. Think of visualizing as priming your mind and body for success. For example, you can visualize running with restrained strength along Fourth Avenue in Brooklyn, steadily ascending the Queensboro Bridge, controlling your exuberance on First Avenue in Manhattan, and bearing down for the final tough miles in the Bronx, Harlem, and Central Park. To visualize successfully, sit in a comfortable chair, minimize distractions, and try to make your visions of success as vivid and detailed as possible. You’ll have a mental edge when they happen on race day.
Race-Day Strategies
Focus internally. One way to decrease race-day anxiety and maintain concentration is to focus inward. By concentrating on relaxing and maintaining good form-running tall, keeping a quick cadence, swinging your arms easily at your sides-you can simplify your thoughts, reduce distractions, and even feel sharper and faster.
Accept the challenge. When the going gets tough, recognize that the marathon is difficult and sometimes painful, and know that you have the ability to deal with the challenges. As you persevere through the tough miles, let yourself be surprised by feeling renewed strength after particularly hard patches.
Focus externally. Tuning in to cheering spectators and other runners can boost your mental energy and take the focus off your discomfort. Try some mental imagery, such as throwing an imaginary lasso around a runner 10 feet in front of you, tying the other end to your waist, and letting that runner pull you along.
Experienced runners use a variety of tools to gain the mental edge they need. Find what works best for you, and stay flexible in your approach, both in training and on marathon day. Good luck!
Cognitive behavioral therapy for panic disorder and comorbidity
This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with “straying” to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the I-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent­to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with ‘straying’ to CBT for comorbid disorders. (more…)
