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Anxiety Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions
Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

Section 4
The Psychophysiology of Fear, Anxiety, and Phobia

CEU Question 4 | CEU Test | Table of Contents | Phobias
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On this track, we will discuss differences and correlations between fear and anxiety and phobias and panic.  The purpose of this discussion is to eliminate confusion regarding the meaning behind these words as they relate to clinical diagnoses of phobias and phobic conditions.  As you know, a phobia refers to a specific object of fear.

The definitions of fear and anxiety are often confounded, the words being used interchangeably for the same general concept, even though there are obvious advantages to using two distinct words to designate separate though related phenomena.  In order better to understand the meanings of these terms, let’s consider their dictionary definitions.  The traditional meanings are more useful in clarifying the semantic and conceptual confusion than are some contemporary distinctions made by behavioral therapists.

Fear points to the possible occurrence of an "unwanted" or calamitous event; the event has not yet occurred (that is, it is in the future); and the client is concerned (agitated or foreboding) about the event. Would you agree that fear, then refers to the appraisal that there is actual or potential danger in a given situation?  Fear is a cognitive process as opposed to an emotional reaction.

Anxiety, on the other hand, is defined as a "tense emotional state" and is "often marked by such physical symptoms as tension, tremor, sweating, palpitation and increased pulse rate."  

Phobia refers to a specific kind of fear and is defined as "an exaggerated and often disabling fear."  A phobia is also characterized by an intense desire to avoid the feared situation, and evokes anxiety when one is exposed to that situation.  The clinical descriptions of phobias have not changed much since their earliest descriptions.

Panic is defined as a "sudden overpowering fright. . . accompanied by increasing or frantic attempts to secure safety."  

#1  Anxiety and Fear
Anxiety may be distinguished from fear in that the former is an emotional process while fear is a cognitive one. Fear involves the intellectual appraisal of a threatening stimulus; anxiety involves the emotional re­sponse to that appraisal.  When a client says he fears something, he is generally referring to a set of circumstances that are not present but may occur at some point in the future.  At this point the fear is said to be "latent." 

As you know, when a client has anxiety he experiences a subjectively unpleasant emotional state characterized by unpleasant subjective feelings, such as tension or nervousness, and by physiological symptoms like heart palpitations, tremor, nausea, and dizziness.  A fear is activated when a client is exposed, either physically or psychologically, to the stimulus situation he considers threatening.  

When the fear becomes activated, he experiences anxiety. Fear then, is the appraisal of danger; anxiety is the unpleasant feeling state evoked when fear is stimulated.  In addition to anxiety, a variety of symptoms referable to the autonomic and the somatic nervous systems may be provoked concurrently.

#2  Phobias and Panic Attacks
A phobia refers to a specific object of fear.  Initially, a client is afraid of a specific type of situation or event (for example, heights, closed spaces, or deep water).  When in the situation, he is acutely afraid of the consequences (falling, suffocating, or drowning).  When a phobia or fear is activated, the individual’s reaction may range from mild anxiety to panic.  

The objects of phobias can range from small animals to natural occurrences such as thunderstorms or to events in the social arena, such as speaking in front of large groups or going to parties.  The main quality of a phobia is that it involves the appraisal of a high degree of risk in a situation that is relatively safe.

An example will clarify the complex interrelations among these terms.  A client with a fear of small animals perceives these animals to be dangerous.  However, he does not experience anxiety until he finds himself exposed to a small animal or imagines himself in such a situation.  The presence of, say, a mouse on the scene activates the fear, and the client may think, "The mouse may bite me and I might get rabies and die!" or, "The mouse may bite me and I might faint and become embarrassed in front of all these people!"  

The client who perceives this threat as overwhelming may have a panic attack.  The concept of danger arises from the possible consequences of contact with the animal.  Before a client has contact with the mouse, the fear is latent.  Once in the presence of the mouse, the fear is activated; and all the unpleasant affective and physiological symptoms associated with panic attack are aroused.

Similarly, a client who is phobic of certain social situations such as attending parties or giving lectures is less afraid of the situations themselves than of possible consequences of being in them.  The social phobic is afraid, for example, that, in a social situation, he will make a fool of himself or "go out of control" and embarrass himself.  This client might feel jittery or shaky, sweat profusely, and experience any or all the uncomfortable affective and physiological symptoms of anxiety or panic.

Panic is an intense, acute state of anxiety associated with other dramatic physiological, motor, and cognitive symptoms.  The physiological correlates of panic are an intensified version of those of anxiety—that is, rapid pulse, dizziness, cold and profuse sweating, and tremor.  In addition, one has a sense of impending catastrophe, pervasive inhibitions, and an overwhelming desire to flee or get help.

Think of your phobic client.  What characterizes his or her phobia?  How does your client currently cope with the resulting panic? 

On this track we have discussed differences and correlations between fear and anxiety and phobias and panic. As you know, a phobia refers to a specific object of fear.

On the next track we will discuss Hoch’s Paradox.  You might find that an understanding of Hoch’s Paradox can become a solid foundation on which to base a cognitive therapy intervention with your phobic client.  In addition, we’ll examine a case study in which the cognitive therapy technique of counting automatic thoughts is used. 

-Dubenetzky, Salome. Differential Diagnosis of Anxiety Disorders. Annals of Psychotherapy & Integrative Health. Summer2013, Vol. 16 Issue 2, p40-46. 7p. 

- Jensen, Vicki L.; Hougaard, Esben; Fishman, Daniel B. Sara, A Social Phobia Client with Sudden Change After Exposure Exercises in Intensive Cognitive-Behavior Group Therapy: A Case-Based Analysis of Mechanisms of Change. PCSP: Pragmatic Case Studies in Psychotherapy. 2013, Vol. 9 Issue 3.

Peer-Reviewed Journal Article References:
Erceg-Hurn, D. M., & McEvoy, P. M. (2018). Bigger is better: Full-length versions of the Social Interaction Anxiety Scale and Social Phobia Scale outperform short forms at assessing treatment outcome. Psychological Assessment, 30(11), 1512–1526.

Gorka, S. M., Lieberman, L., Shankman, S. A., & Phan, K. L. (2017). Startle potentiation to uncertain threat as a psychophysiological indicator of fear-based psychopathology: An examination across multiple internalizing disorders. Journal of Abnormal Psychology, 126(1), 8–18.

Lang, P. J., McTeague, L. M., & Bradley, M. M. (2017). The psychophysiology of anxiety and mood disorders: The RDoC challenge. Zeitschrift für Psychologie, 225(3), 175–188.

McCraw, K. S., & Valentiner, D. P. (2015). The Circumscribed Fear Measure: Development and initial validation of a trans-stimulus phobia measure. Psychological Assessment, 27(2), 403–414.

Online Continuing Education QUESTION 4
To what does a phobia refer? To select and enter your answer go to CEU Test.

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Section 5
Table of Contents

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Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

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