Specific Phobias
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Questions and Answers

What is the primary characteristic of a specific phobia?

  • A fear of social situations
  • An intense fear of a specific object or situation (correct)
  • A fear of heights and flying
  • A general feeling of anxiety in all situations
  • What is the typical reaction to a phobic object or situation?

  • Mild anxiety
  • Immediate intense anxiety or fear (correct)
  • A calm and rational response
  • A feeling of excitement
  • What is the primary reason for avoiding a phobic object or situation?

  • To avoid physical harm
  • To avoid social embarrassment
  • To avoid feeling bored
  • To avoid feeling anxious or fearful (correct)
  • How long does the anxiety or fear typically last in a specific phobia?

    <p>6 months or longer</p> Signup and view all the answers

    What is the impact of a specific phobia on daily life?

    <p>It causes clinically significant distress or impairment</p> Signup and view all the answers

    What is the key difference between the fear response in a specific phobia and the actual danger posed by the object or situation?

    <p>The fear response is often exaggerated compared to the actual danger</p> Signup and view all the answers

    What percentage of the general population experiences specific phobias at some point in their lives?

    <p>41% - 50%</p> Signup and view all the answers

    Which type of phobia is most commonly associated with the highest level of impairment?

    <p>Situational phobia</p> Signup and view all the answers

    What is the approximate 'ever' prevalence rate for specific phobias?

    <p>12% - 14%</p> Signup and view all the answers

    What percentage of people with a specific phobia experience severe symptoms?

    <p>22%</p> Signup and view all the answers

    Which of the following is a characteristic of specific phobias?

    <p>A focus on the phobic object or situation</p> Signup and view all the answers

    What is the average age of onset for specific phobias?

    <p>Adolescence</p> Signup and view all the answers

    Which of the following is NOT a common comorbidity with specific phobias?

    <p>Bipolar disorder</p> Signup and view all the answers

    What is the primary difference between specific phobias and post-traumatic stress disorder?

    <p>The presence of a traumatic event</p> Signup and view all the answers

    What is the process of anxiety that occurs in specific phobias?

    <p>Motor escape and avoidance</p> Signup and view all the answers

    What is the percentage of people with a specific phobia who seek professional help?

    <p>20% - 30%</p> Signup and view all the answers

    What is the primary function of the physiological activation response in specific phobias?

    <p>To stimulate escape and motivation in the presence of the feared object</p> Signup and view all the answers

    What is the primary difference between specific phobias and other anxiety disorders?

    <p>The ability to identify the feared object and the response to it</p> Signup and view all the answers

    Which of the following is a common comorbidity with specific phobias?

    <p>All of the above</p> Signup and view all the answers

    What is the primary role of genetic risk factors in specific phobias?

    <p>To increase the risk of developing a specific phobia</p> Signup and view all the answers

    What is the primary mechanism of Mowrer's two-factor model?

    <p>Classical conditioning and operant conditioning</p> Signup and view all the answers

    According to Rachman, how can anxiety be learned?

    <p>Through observation of others or receiving threatening information</p> Signup and view all the answers

    What is the primary role of the biological and evolutionary perspective in specific phobias?

    <p>To highlight the adaptive function of anxiety in response to evolutionarily relevant stimuli</p> Signup and view all the answers

    What is the primary characteristic of biologically prepared fears?

    <p>They are easily acquired through classical conditioning</p> Signup and view all the answers

    What is the primary function of the anxiety module in the context of specific phobias?

    <p>To adapt to historically frequent dangerous situations and prevent them</p> Signup and view all the answers

    What is the primary characteristic of the cognitive component of specific phobias?

    <p>It is a tertiary response domain that overestimates danger and harm</p> Signup and view all the answers

    What is unique about the BII subtype of specific phobias?

    <p>It is characterized by a unique anxiety reaction that often involves fainting and bradycardia</p> Signup and view all the answers

    What is the term for the fainting response that occurs in some people with BII phobia?

    <p>Vasovagal syncope</p> Signup and view all the answers

    What role does disgust play in BII and spider phobias?

    <p>It is a primary motivator for avoidance behavior</p> Signup and view all the answers

    What is the term for the process by which people learn to associate certain stimuli with disgust?

    <p>Evaluative conditioning</p> Signup and view all the answers

    What is the purpose of the disgust response in the context of BII phobia?

    <p>To prevent the spread of disease</p> Signup and view all the answers

    What is the primary outcome of the extinction process?

    <p>A decrease in the conditioned anxiety response</p> Signup and view all the answers

    What is the role of the amygdala during the extinction process?

    <p>It is activated during the initial stages of extinction but deactivated later on</p> Signup and view all the answers

    What is the primary mechanism underlying the extinction process?

    <p>The weakening of the association between the conditioned stimulus and the unconditioned stimulus</p> Signup and view all the answers

    What is the role of the prefrontal cortex in the extinction process?

    <p>It is involved in the retrieval of extinction memories</p> Signup and view all the answers

    What is the term for the neurons that are active during the extinction process?

    <p>Extinction neurons</p> Signup and view all the answers

    What is the principle of equipotentiality in the context of learning theory?

    <p>The observation that any predictor can form an association with any outcome.</p> Signup and view all the answers

    What is the primary effect of extinction in the context of learning theory?

    <p>The weakening of a response to a stimulus over time.</p> Signup and view all the answers

    What is the underlying mechanism of the development of specific phobias, according to the learning theory?

    <p>The process of conditioning.</p> Signup and view all the answers

    What is the role of the CS-UCS association in the context of conditioning?

    <p>To form an association between a predictor and an outcome.</p> Signup and view all the answers

    What is the result of a single traumatic event, according to the learning theory?

    <p>Intense fears of objects related to the trauma.</p> Signup and view all the answers

    What is the basis of the successful treatment of specific phobias, according to the learning theory?

    <p>The extinction process.</p> Signup and view all the answers

    What is the main factor that influences the learning process in conditioning?

    <p>The context, past experiences, and cognition</p> Signup and view all the answers

    What is the role of observationel learning in fear acquisition?

    <p>It is a secondary process that occurs through observation of others</p> Signup and view all the answers

    How does verbal information contribute to fear acquisition?

    <p>It increases fear by providing negative information</p> Signup and view all the answers

    What is the role of the CS2 in second-order conditioning?

    <p>It is the stimulus that is paired with the CS1</p> Signup and view all the answers

    What is the outcome of the conditioning process in fear acquisition?

    <p>The stimulus becomes a CS</p> Signup and view all the answers

    What is the role of the UCS in fear acquisition?

    <p>It is the stimulus that is paired with the CS</p> Signup and view all the answers

    What is the primary function of the feature in feature modulation?

    <p>To provide a context for the conditioned response</p> Signup and view all the answers

    What happens when the conditioned stimulus is paired with a less salient stimulus?

    <p>The conditioned response is overshadowed</p> Signup and view all the answers

    Can a conditioned response be obtained without the presence of the conditioned stimulus or unconditioned stimulus?

    <p>Yes, as long as the person is thinking about the stimulus</p> Signup and view all the answers

    What is the result of second-order conditioning?

    <p>The conditioned stimulus becomes a predictor of the unconditioned stimulus</p> Signup and view all the answers

    What is the characteristic of the unconditioned stimulus?

    <p>It can be any stimulus</p> Signup and view all the answers

    What happens to the conditioned response after extinction?

    <p>It can reappear after a period of time</p> Signup and view all the answers

    What is the role of the mental representation of the stimulus in conditioned responses?

    <p>It is necessary for conditioned responses</p> Signup and view all the answers

    What is the difference between renewal and reinstatement?

    <p>Renewal is the reappearance of the conditioned response after extinction, while reinstatement is the reappearance of the conditioned response after a period of time</p> Signup and view all the answers

    What is the role of the stimulus-trauma association in conditioned responses?

    <p>It is necessary for conditioned responses, and it can occur even after the extinction of the conditioned response</p> Signup and view all the answers

    What is the characteristic of traumatic incidents in conditioned responses?

    <p>They can become traumatic even after the extinction of the conditioned response</p> Signup and view all the answers

    What is the reason why the conditioned response (CR) is mediated by the CS-UCS association?

    <p>Because the VS is reevaluated, leading to a change in the CR</p> Signup and view all the answers

    What is the term for the phenomenon where a CS1 blocks the learning of a CS2-UCS association?

    <p>Blocking</p> Signup and view all the answers

    What determines the strength of a conditioning episode?

    <p>The prior experiences of the organism</p> Signup and view all the answers

    What is the result of a negative correlation between the CS and UCS?

    <p>Conditioned inhibition</p> Signup and view all the answers

    How many trials are required for conditioning to occur?

    <p>One trial</p> Signup and view all the answers

    What is the characteristic of the associations formed after one trial?

    <p>They are persistent</p> Signup and view all the answers

    What determines the type of response elicited by a CS?

    <p>The prior experiences of the organism</p> Signup and view all the answers

    What is the key to conditioning?

    <p>The predictive value of the CS</p> Signup and view all the answers

    What is the result of a negative experience with a CS?

    <p>Conditioned inhibition</p> Signup and view all the answers

    What influences the formation of a CR?

    <p>The prior experiences of the organism</p> Signup and view all the answers

    What is the main idea suggested by the principle of equipotentiality?

    <p>All stimuli have an equal chance of being associated with a negative outcome</p> Signup and view all the answers

    Why do some people develop conditioned anxiety responses more quickly to certain stimuli?

    <p>Because of their individual differences in learning and conditioning</p> Signup and view all the answers

    What is the role of verbal information in the development of anxiety?

    <p>It can contribute to the development of anxiety through indirect learning</p> Signup and view all the answers

    What is the implication of Rachman's observation about indirect learning?

    <p>That conditioning is not sufficient to explain the development of anxiety</p> Signup and view all the answers

    What is the difference between common and uncommon phobias?

    <p>Common phobias are more prevalent, while uncommon phobias are less prevalent</p> Signup and view all the answers

    What is the characteristic of stimuli that are more likely to be associated with anxiety?

    <p>They are more related to survival</p> Signup and view all the answers

    What is the role of observation in the development of anxiety?

    <p>It is a major factor</p> Signup and view all the answers

    What is the implication of the fact that some people develop anxiety responses more quickly to certain stimuli?

    <p>That anxiety is a learned response</p> Signup and view all the answers

    What is the characteristic of common phobias?

    <p>They are more prevalent</p> Signup and view all the answers

    What is the role of indirect learning in the development of anxiety?

    <p>It is a major factor</p> Signup and view all the answers

    What is the primary role of corticotropine-releasing factor (CRF) in terms of anxiety?

    <p>It has an activating effect on the locus coeruleus neurons.</p> Signup and view all the answers

    What is the primary mechanism by which benzodiazepines and barbiturates produce their anxiolytic effects?

    <p>They bind to the GABA receptor complex and increase the frequency of the chloride ion channel opening.</p> Signup and view all the answers

    What is the primary difference between the effects of benzodiazepines and barbiturates on the GABA receptor complex?

    <p>Benzodiazepines require GABA to be present, while barbiturates do not.</p> Signup and view all the answers

    What is the primary role of serotonin in anxiety?

    <p>It has a context-dependent effect, being anxiolytic in some situations and anxiogenic in others.</p> Signup and view all the answers

    What is the primary finding in patients with panic disorder in terms of benzodiazepine binding?

    <p>They have decreased benzodiazepine binding in the frontal lobes.</p> Signup and view all the answers

    What is the primary difference between the symptoms of withdrawal and relapse?

    <p>Withdrawal symptoms occur immediately after stopping the medication and relapse symptoms occur after a week</p> Signup and view all the answers

    What is the purpose of using beta-receptor blockers in the treatment of anxiety?

    <p>To reduce the physical symptoms of anxiety</p> Signup and view all the answers

    What is the recommended minimum time for tapering off benzodiazepines to prevent withdrawal symptoms?

    <p>4 weeks</p> Signup and view all the answers

    What is the primary benefit of using a combination of benzodiazepines and SSRIs in the treatment of panic disorders?

    <p>The benzodiazepine provides immediate relief and the SSRI provides long-term relief</p> Signup and view all the answers

    What is the primary reason for switching from a short-acting benzodiazepine to a long-acting benzodiazepine?

    <p>To reduce the risk of withdrawal symptoms</p> Signup and view all the answers

    What is the primary role of the amygdala in emotional learning?

    <p>To regulate emotional responses</p> Signup and view all the answers

    What is the difference between emotional and declarative learning?

    <p>Emotional learning involves the amygdala, while declarative learning involves the hippocampus</p> Signup and view all the answers

    Why do traumatic events in early life not form conscious memories?

    <p>Because the hippocampus is not fully developed</p> Signup and view all the answers

    What is the result of the emotional memory system being activated?

    <p>The experience of anxiety, fear, and depression</p> Signup and view all the answers

    What is the relationship between emotions and consciousness?

    <p>Emotions are the result of unconscious processes</p> Signup and view all the answers

    What is the primary region associated with anxiety symptoms in OCD?

    <p>anterior cingulate cortex</p> Signup and view all the answers

    What is the typical neural response to a phobic stimulus in patients with specific phobias?

    <p>increased activity in the fear network</p> Signup and view all the answers

    What is the effect of successful exposure therapy on amygdala activity in patients with specific phobias?

    <p>decreased activity in the amygdala</p> Signup and view all the answers

    What is the primary mechanism underlying neural changes in response to mindfulness-based stress reduction (MBSR) therapy?

    <p>changes in emotional regulation</p> Signup and view all the answers

    What is the primary role of the anterior cingulate cortex in anxiety disorders?

    <p>error detection</p> Signup and view all the answers

    What is the effect of cognitive-behavioral therapy (CBT) on brain activity in patients with OCD?

    <p>changed patterns of neural activity</p> Signup and view all the answers

    What is the primary neural correlate of anxiety in patients with specific phobias?

    <p>increased activity in the fear network</p> Signup and view all the answers

    What is the primary mechanism underlying the extinction process in fear conditioning?

    <p>habituation</p> Signup and view all the answers

    What is the effect of successful treatment on brain activity in patients with anxiety disorders?

    <p>changed patterns of neural activity</p> Signup and view all the answers

    What is the primary role of the prefrontal cortex in the extinction process?

    <p>emotional regulation</p> Signup and view all the answers

    Which brain region shows increased activity when participants focus on the conditioned stimulus?

    <p>Subgenuale Cingulate Cortex</p> Signup and view all the answers

    What is the effect of emotion regulation on the activity of the amygdala in response to a conditioned stimulus?

    <p>Decreased activity</p> Signup and view all the answers

    What is the primary difference between the effects of attention and regulation on the conditioned response?

    <p>Attention increases the conditioned response, while regulation decreases it</p> Signup and view all the answers

    Which brain region is involved in the regulation of thoughts and emotions in response to a conditioned stimulus?

    <p>dlPFC</p> Signup and view all the answers

    What is the effect of extinction on the activity of the vmPFC in response to a conditioned stimulus?

    <p>Decreased activity</p> Signup and view all the answers

    Study Notes

    Specific Phobias

    • A specific phobia is an intense, irrational fear of a specific object, situation, or stimulus, characterized by a consistent and excessive anxiety response.

    Diagnostic Criteria

    • A. The individual experiences a clear anxiety or concern about a specific object or situation.
    • B. The phobic object or situation almost always provokes an immediate anxiety response.
    • C. The individual actively avoids or endures the phobic object or situation with intense anxiety.
    • D. The anxiety or fear is not proportional to the actual danger posed by the specific object or situation.
    • E. The anxiety or fear is persistent, lasting at least 6 months.
    • F. The anxiety or fear causes significant distress or impairment in social, occupational, or other areas of functioning.
    • G. The disorder is not better explained by the symptoms of another mental disorder.

    Epidemiology, Comorbidity, and Specific Course of Phobias

    • Specific phobias are relatively common, with 41-50% of the general population experiencing specific phobias at some point in their lives.
    • The total prevalence of specific phobias is around 12%, with a 12-month point prevalence of around 9%.
    • Of those with a specific phobia, 22% experience severe symptoms, 30% experience moderate symptoms, and 48% experience mild symptoms.
    • Situation phobias are the most common, followed by phobias of natural environments, animals, and blood-injury-injection (BII).
    • Acrophobia (fear of heights) is the most common specific phobia.
    • Specific phobias are more common in adolescents and less common in older adults.
    • The diagnosis of specific phobia in adulthood is associated with a diagnosis of specific phobia in childhood or adolescence.
    • Percentages of specific phobias are also higher in women than in men.

    Natural Course of Phobias

    • Many phobias begin in childhood or adolescence, with a early onset.
    • Phobias related to animals and BII tend to begin earlier than phobias related to natural environments and situation phobias.
    • Although phobias can begin early, specific fears appear even earlier.
    • Phobias are usually chronic and rarely disappear without intervention.

    Impairment and Comorbidity

    • Impairment grows significantly with the number of (specific) fears.
    • All subtypes of specific phobias are associated with greater interference in daily and social functioning compared to the general population.
    • Situation phobias, in general, and the fear of being alone, were associated with the most interference, the greatest likelihood of seeking professional help, and the highest use of medication.
    • Persons with a BII phobia are less likely to pursue certain medical treatments, which can have a negative impact on their overall health.

    Etiology

    • Genetic risk factors contribute to the development of specific phobias.
    • Environmental risk factors, such as parental control, overprotection, and parental involvement, can also contribute to the development of specific phobias.
    • Cognitive perspectives, such as maladaptive cognitions or schemas, can also contribute to the development of specific phobias.

    Cognitive Models

    • The process of anxiety consists of three components: motor escape and avoidance, physiological activation of the sympathetic nervous system, and cognitive evaluations of threat and danger.
    • In specific phobias, physiological activation is the pre-potent response domain that serves to stimulate escape and motivate avoidance in the presence of the feared object.
    • The cognitive component is tertiary and focuses on overestimating threat and danger.

    Types of Phobias

    • There are several subtypes of phobias, including:
      • Animal type (e.g. snakes, rodents, insects)
      • Natural environment type (e.g. thunderstorms, tornadoes, heights, darkness)
      • Blood-injection-injury (BII) type (e.g. needles, blood draws, open wounds)
      • Situational type (e.g. driving, flying, enclosed spaces)

    Blood-Injection-Injury (BII) Phobia

    • Unique characteristics of BII phobia:
      • Typically accompanied by a vasovagal syncope response, leading to fainting
      • 80% of individuals with BII phobia have a history of fainting or near-fainting
      • Often characterized by feelings of disgust or revulsion instead of anxiety
      • BII phobia is a common and unique phobia, with a lifetime prevalence of 3.5% (men and women) and 4.9% for women

    Fainting Response in BII Phobia

    • The fainting response is characterized by a 2-phase or bifasic response:
      • Initial phase: increased heart rate and blood pressure, typical of a fight-flight response
      • Second phase: bradycardia (decreased heart rate) and hypotension (low blood pressure), leading to decreased cerebral blood flow and eventual fainting

    Mechanisms of Specific Phobias

    • The role of disgust in BII and spider phobias:
      • Disgust sensitivity is a robust predictor of spider and BII phobias
      • Disgust mediates the severity of anxiety and distress
      • Disgust towards a stimulus predicts avoidance of spider and injection/ injury stimuli, beyond anxiety and concern
    • Armfield's cognitive vulnerability model of specific phobias:
      • The general tendency to evaluate harmful stimuli as disgusting
      • The specific tendency to evaluate a phobic stimulus as disgusting
      • The tendency to react negatively to one's own feelings of disgust (disgust sensitivity) can all contribute to the etiology, maintenance, and expression of spider and BII phobias

    Treatment of Specific Phobias

    • The recommended treatment for Blood-Injection-Injury (BII) phobia is Applied Tension (AT), which involves tension techniques and in vivo exposure.
    • AT has a significant effect on reducing self-reported levels of anxiety, avoidance during sessions, and fainting.
    • However, when considering the effect sizes before and after treatment, E (exposure alone) performed better than all other treatments.

    Individual Treatment Techniques for BII

    • Exposure (E): Involves exposing patients to a customized hierarchy of feared situations, which is a natural choice for treating BII phobia.
    • Applied Relaxation (AR): Based on the principle of progressive relaxation, involving repeated sequences of short tensing and relaxing of different skeletal muscle groups.
    • Applied Tension (AT): Combines a muscle tension technique with in vivo exposure to prevent fainting responses.
    • Tension (T): Involves exercising tension in arms, legs, and torso to increase blood pressure at will.

    Exposure-Based Therapies

    • In vivo exposure therapy involves three phases: instruction, direct exposure, and maintenance of treatment results.
    • Systematic desensitization involves two crucial modifications: using a variant of Jacobson's progressive muscle relaxation to elicit a hunger response antagonistic to anxiety, and instructing patients to imagine the feared situation and gradually increase its intensity.
    • Geconditioned inhibition involves eliciting a relaxation response antagonistic to the anxiety response during the feared cue, reducing the anxiety response.

    Virtual Reality Exposure Therapy

    • Involves using computer-generated interactive virtual realities, including visual displays, other sensory inputs, and body tracking devices, to conduct exposure therapy.
    • Patients visit these virtual realities over a longer period during multiple sessions.
    • Virtual reality exposure therapy (VRET) is particularly useful when it is difficult to realize the exposure environment in reality.

    Effectiveness of Exposure-Based Therapies

    • Specific phobias respond particularly well to exposure-based therapies, making them the preferred treatment for these disorders.
    • Exposure-based therapies result in significantly better outcomes after treatment, regardless of whether they are evaluated by verbal report measures or behavioral avoidance tests.
    • These therapies are highly effective and provide a stable improvement in self-reported anxiety and behavioral avoidance.

    Active Ingredients of Exposure-Based Therapies

    • In vivo exposure is more effective than systematic desensitization.
    • Massed exposure training in one session is highly effective for treating specific phobias.
    • The degree of therapist involvement during exposure is crucial, particularly in reducing avoidance behavior and increasing the frequency and duration of exposure practice.

    Mechanisms of Change

    • The central mechanisms of change during exposure therapy involve extinction, habituation, and contraconditioning.
    • Extinction learning is a key mechanism of change, where the feared stimulus is no longer associated with aversive consequences.
    • The neural correlates of extinction involve the activation of the amygdala and the prefrontal cortex.

    Principles of Learning Theory

    • Equipotentiality: any predictor can form an association with any outcome, leading to the development of phobias.
    • Extinction: the well-documented effect that a conditioned stimulus (CS) alone, without the unconditioned stimulus (UCS), can lead to a decrease in response strength over time.

    Aspects of Conditioning

    • Conditioning is guided by CS-UCS associations, which form during conditioning and mediate the conditioned response (CR).
    • Conditioning depends on past experiences: organisms bring information from past experiences and relationships between CS's and UCS's to conditioning episodes.
    • Conditioning is not dependent on contiguity: the potential phobogenic stimulus does not need to occur simultaneously with a traumatic event.

    Characteristics of Conditioning

    • Conditioning can occur after a single trial: geconditioneerde reacties can be rapidly acquired.
    • Associations formed after one trial are persistent: CS-UCS associations can be formed quickly and remain intact even with random presentations of CS and UCS.
    • The CR and UR are not necessarily the same: the CS can elicit different responses related to the UCS, but not identical to the response elicited by the UCS.
    • The CS does not always produce a CR after conditioning: feature modulation/occasion setting and overshadowing can influence the CR.

    Other Aspects of Conditioning

    • Conditioning can occur without a real CS and UCS: mental representations of stimuli can suffice for learning.
    • Second-order conditioning: a CS1 is paired with a CS2, which becomes a predictor of the outcome, evoking a CR.
    • The UCS does not need to be biologically significant: associations can be formed without an unconditioned response.

    Extinction and Renewal

    • Extinction does not break the CS-UCS association: extinction can be context-dependent, and renewal can occur in certain contexts.
    • Spontaneous recovery: extinguished CR's can reappear over time, even in a different context.

    Traumatic Incidents

    • Traumatic incidents may not be traumatic at the time: the reevaluation of the UCS can make a stimulus traumatic, leading to the development of phobias.

    Classical Conditioning and Anxiety

    • Unconditioned Stimulus (UCS): a stimulus that elicits a natural response, such as food, pain, or sex, resulting in an Unconditioned Response (UCR), a reflex that is not under a person's voluntary control.
    • Conditioned Stimulus (CS): a neutral stimulus that can predict the occurrence of a UCS, leading to a Conditioned Response (CR), a learned response associated with the CS.

    Anxiety and the Body's Response

    • Anxiety Response: a natural response to a perceived threat, characterized by:
      • Increased heart rate and blood pressure
      • Rapid breathing
      • Sweating
      • Tense muscles
      • Pupils dilating
    • Parasympathetic Activation: a response that counters the anxiety response, characterized by:
      • Decreased heart rate and blood pressure
      • Increased digestion
      • Relaxed muscles

    Classical Conditioning Process

    • Learning: the association between a CS and a UCS, leading to a CR
    • Extinction: the process of eliminating the CR by repeatedly presenting the CS without the UCS
    • Spontaneous Recovery: the reappearance of a CR after extinction, which can be triggered by an external stimulus
    • Counterconditioning: a procedure that trains the CS to predict a response opposite to the UCR, such as relaxation

    Higher-Order Conditioning and Complex Phenomena

    • Second-Order Conditioning: the association between a CS and a UCS, where the CS is already associated with another UCS
    • Equipotentiality: the idea that any stimulus can be associated with any outcome, making it possible for two stimuli to be associated with each other
    • Contextual Dependence: the influence of context on the expression of a CR
    • Blocking: the phenomenon where a CS is overshadowed by a more salient stimulus

    Glossary of Terms

    • Latent Inhibition: the observation that multiple experiences with a CS without a UCS can make it harder to learn a CS-UCS association
    • Learned Irrelevance: a phenomenon where a stimulus is repeatedly presented with multiple UCSs, making it harder to learn a new CS-UCS association
    • Superlearning: the rapid learning of a new CS-UCS association due to prior learning with a different stimulus
    • Overshadowing: the phenomenon where a more salient stimulus overshadows a less salient stimulus, making it harder to learn a CS-UCS association

    Operant Conditioning and Anxiety/Fear

    • Operant conditioning explains anxiety/fear through positive reinforcement, negative reinforcement, and punishment.

    Positive Reinforcement

    • Positive reinforcement occurs when a behavior is followed by a positive consequence (+Cpos), increasing the likelihood of the behavior.
    • In the context of anxiety, positive reinforcement can strengthen avoidance behaviors, even if the original fear stimulus is not present.

    Negative Reinforcement

    • Negative reinforcement occurs when a behavior is followed by the removal of an aversive stimulus (-Cneg), increasing the likelihood of the behavior.
    • There are two types of negative reinforcement: escape and avoidance.
    • Escape: a behavior that removes an aversive stimulus, such as a shock.
    • Avoidance: a behavior that prevents an aversive stimulus from occurring, such as not going to a place where a feared stimulus is present.

    Discriminative Stimulus (Sd) and S-Delta (SΔ)

    • A discriminative stimulus (Sd) is a stimulus that increases the likelihood of a response.
    • S-Delta (SΔ) is a stimulus that decreases the likelihood of a response.
    • In anxiety, Sd can be a stimulus that triggers a fear response, while SΔ is a stimulus that does not trigger a fear response.

    Anxiety and Fear

    • Anxiety and fear can be reduced through escape and avoidance behaviors.
    • However, these behaviors can also be negatively reinforced, making it difficult to overcome anxiety and fear.

    Avoidance Behaviors

    • Avoidance behaviors can be subtle, such as not going to a place where a feared stimulus is present.
    • These behaviors can provide temporary relief but can also maintain anxiety and fear in the long run.
    • Avoidance behaviors can be reinforced by the removal of an aversive stimulus, but they can also lead to a lack of exposure to the feared stimulus, making it difficult to overcome anxiety and fear.

    Safety Behaviors

    • Safety behaviors are subtle avoidance behaviors that aim to prevent a catastrophic event.
    • These behaviors can provide temporary relief but can also maintain anxiety and fear in the long run.

    Punishment of Avoidance Behaviors

    • Avoidance behaviors can be punished in the long run, leading to difficulties in daily life.
    • Punishment can take three forms: removal of something positive, addition of something negative, or blocking of something positive.

    Conflict in Anxiety

    • The short-term consequences of avoidance behaviors can be rewarding, but the long-term consequences can be negative.
    • This conflict can lead individuals to seek treatment.

    Criticisms of the Learning Theory

    • Retrospective memory: individuals with a specific phobia may not remember the associative learning event.
    • Not all individuals who experience trauma or anxiety develop a phobia.
    • Incubation: the fear response can increase over time, even if the conditioned stimulus is not present.
    • Unequal distribution of anxieties: certain stimuli are more likely to be associated with anxiety and fear.
    • Indirect ways to acquire anxiety: anxiety can be acquired through verbal information and observational learning.

    Operant Conditioning and Anxiety/Fear

    • Operant conditioning explains anxiety/fear through positive reinforcement, negative reinforcement, and punishment.

    Positive Reinforcement

    • Positive reinforcement occurs when a behavior is followed by a positive consequence (+Cpos), increasing the likelihood of the behavior.
    • In the context of anxiety, positive reinforcement can strengthen avoidance behaviors, even if the original fear stimulus is not present.

    Negative Reinforcement

    • Negative reinforcement occurs when a behavior is followed by the removal of an aversive stimulus (-Cneg), increasing the likelihood of the behavior.
    • There are two types of negative reinforcement: escape and avoidance.
    • Escape: a behavior that removes an aversive stimulus, such as a shock.
    • Avoidance: a behavior that prevents an aversive stimulus from occurring, such as not going to a place where a feared stimulus is present.

    Discriminative Stimulus (Sd) and S-Delta (SΔ)

    • A discriminative stimulus (Sd) is a stimulus that increases the likelihood of a response.
    • S-Delta (SΔ) is a stimulus that decreases the likelihood of a response.
    • In anxiety, Sd can be a stimulus that triggers a fear response, while SΔ is a stimulus that does not trigger a fear response.

    Anxiety and Fear

    • Anxiety and fear can be reduced through escape and avoidance behaviors.
    • However, these behaviors can also be negatively reinforced, making it difficult to overcome anxiety and fear.

    Avoidance Behaviors

    • Avoidance behaviors can be subtle, such as not going to a place where a feared stimulus is present.
    • These behaviors can provide temporary relief but can also maintain anxiety and fear in the long run.
    • Avoidance behaviors can be reinforced by the removal of an aversive stimulus, but they can also lead to a lack of exposure to the feared stimulus, making it difficult to overcome anxiety and fear.

    Safety Behaviors

    • Safety behaviors are subtle avoidance behaviors that aim to prevent a catastrophic event.
    • These behaviors can provide temporary relief but can also maintain anxiety and fear in the long run.

    Punishment of Avoidance Behaviors

    • Avoidance behaviors can be punished in the long run, leading to difficulties in daily life.
    • Punishment can take three forms: removal of something positive, addition of something negative, or blocking of something positive.

    Conflict in Anxiety

    • The short-term consequences of avoidance behaviors can be rewarding, but the long-term consequences can be negative.
    • This conflict can lead individuals to seek treatment.

    Criticisms of the Learning Theory

    • Retrospective memory: individuals with a specific phobia may not remember the associative learning event.
    • Not all individuals who experience trauma or anxiety develop a phobia.
    • Incubation: the fear response can increase over time, even if the conditioned stimulus is not present.
    • Unequal distribution of anxieties: certain stimuli are more likely to be associated with anxiety and fear.
    • Indirect ways to acquire anxiety: anxiety can be acquired through verbal information and observational learning.

    Corticotropin-Releasing Factor (CRF)

    • CRF is a small neuropeptide that regulates neuro-endocrine, autonomic, and behavioral responses to stress.
    • CRF induces the release of adrenocorticotropic hormone (ACTH) from the pituitary gland, leading to increased glucocorticoid release from the adrenal cortex.
    • CRF acts as a neurotransmitter in neural circuits involved in stress response, including the amygdala.
    • Intra-ventricular administration of CRF stimulates the sympathetic nervous system, increases plasma adrenaline, and raises heart rate and blood pressure.
    • CRF has multiple effects on feeding, gastrointestinal activity, and energy balance.

    Corticotropin-Releasing Factor (CRF) and Anxiety

    • CRF induces anxiety-like behavior in conflict tests, social interpretation, and exploration in novel open fields.
    • Direct neuronal administration of CRF produces strong stimulating effects in many brain regions, including the hippocampus, amygdala, locus coeruleus, cortex, and hypothalamus.
    • The amygdala has many CRF-expressing neurons and receptors, and CRF release in the amygdala is associated with anxiety symptoms.
    • Higher CRF levels increase the firing rate of cells in the locus coeruleus and increase the turnover of norepinephrine (NE).

    Norepinephrine (NE) and Anxiety

    • Reciprocal connections between the amygdala and locus coeruleus provide mechanisms for the stimulation of anxiety, orientation, and response to fear stimuli.
    • The locus coeruleus is a large cluster of noradrenergic cell bodies in the dorsal pons, which send axons to various brain regions to increase arousal and attention to physiologically relevant stimuli.
    • The corresponding hypervigilance is similar to that seen in post-traumatic stress disorder (PTSD) and other anxiety disorders.
    • Electrical stimulation of the locus coeruleus induces warning and anxiety reactions.
    • Norepinephrine release in the locus coeruleus is inhibited by GABA and serotonin.

    Norepinephrine (NE) and Emotion

    • Norepinephrine is released in response to emotional stimuli, including fear, and plays a role in the formation of emotional memories.
    • Individuals with panic disorder and PTSD have more dramatic bodily responses to anxiety-provoking stimuli, and veterans with PTSD have higher circulating NE.
    • Norepinephrine and epinephrine have a role in the formation of emotional memories that can contribute to anxiety disorders, including agoraphobia, panic, and PTSD.

    GABA and Anxiety

    • GABA (gamma-aminobutyric acid) has a calming effect on anxiety and is involved in the suppression of anxiety responses.
    • The GABA receptor complex includes a chloride channel, which opens when GABA binds, allowing chloride ions to enter the cell and causing hyperpolarization.
    • The reduction of action potential and the decrease of anxiety responses are a result of this hyperpolarization.
    • Different sedative-hypnotics, such as benzodiazepines and barbiturates, enhance the function of GABA, leading to sedation, reduced anxiety, and anticonvulsive effects.

    5-HT and Anxiety

    • The anxiolytic effects of 5-HT are demonstrated by the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the treatment of anxiety disorders.
    • 5-HT agonists have anxiolytic effects in tasks that require active coping with a stressor, but increase anxiety in tasks that require passive behavior or withholding of a response to expected threat.
    • This can be explained by the subtype of 5-HT receptor involved, differences in acute and chronic treatment, or the specific brain regions involved in anxiety versus fear (active coping versus passive response).

    Anxiolytics

    • Anxiolytics are drugs used to relieve anxiety, which belong to the class of sedativa-hypnotica, a subcategory of CNS-depressiva.
    • This category includes barbiturates, benzodiazepines, and alcohol.

    Mechanism of Action

    • The primary mechanism of action of sedative-hypnotic drugs is to enhance GABA transmission.
    • GABA is the major inhibitory neurotransmitter in the nervous system.
    • GABA agonists produce local hyperpolarization or inhibitory postsynaptic potential and inhibit cell firing.

    Benzodiazepines (BDZ's)

    • BDZ's bind to their modulatory sites on the GABAA complex, enhancing the effect of GABA by increasing the frequency of channel openings.
    • BDZ's have no effect on Cl- channel opening in the absence of GABA.
    • BDZ's are addictive, whereas SSRIs are not, making them a first-choice treatment.

    Comparison with Barbiturates

    • Barbiturates also increase the affinity of the GABAA receptor for GABA.
    • However, they increase the duration of Cl- channel openings triggered by GABA, rather than the frequency.
    • Barbiturates can be lethal, unlike BDZ's.

    Therapeutic Effects

    • BDZ's are commonly used for anxiety relief, reducing feelings of anxiety and anxiety symptoms.
    • Mild sedation from BDZ use decreases after repeated use over a week to 10 days.

    Misuse and Dependence

    • Misuse of BDZ's can be divided into two patterns: intentional misuse and unintentional misuse.
    • Dependence requires evidence of compulsive behavior in seeking drugs and loss of control.
    • Physical dependence is typical of addiction, but it is not a required criterion.
    • Long-term use of BDZ's can cause physical dependence, but it is not necessarily misuse or addiction.

    Withdrawal Symptoms

    • Withdrawal symptoms occur when the blood or tissue concentration of a dependence-forming substance decreases.
    • Symptoms are often the opposite of the acute effects of the medication.
    • Withdrawal symptoms are usually more severe and have a faster onset in patients using BDZ's with shorter half-lives.

    Alternatives to Benzodiazepine Anxiolytics

    • Beta-receptor blockers can control vegetative symptoms of anxiety and tension.
    • SSRIs and SNRIs are effective in treating acute GAD symptoms and panic disorders.
    • There are no pharmacological treatments available for specific phobias.

    Emotional Learning and Memory

    • Fear conditioning involves the thalamus, amygdala, and cortex, with the thalamus communicating with the amygdala to process fear-inducing stimuli.
    • The emotional meaning of a stimulus is determined not only by the stimulus itself but also by the context in which it occurs.

    The Role of the Amygdala and Hippocampus

    • Lesions in the amygdala interfere with the response to tone and conditioning.
    • Lesions in the hippocampus interfere with the response to context, but not tone.
    • The hippocampus plays a crucial role in processing complex information, including spatial context.

    The Auditory Cortex and Anger Conditioning

    • The auditory cortex is involved in the establishment of fear responses, especially for simple auditory stimuli.
    • Lesions in the auditory cortex disrupt fear conditioning for one of the two stimuli paired with shock.
    • The cortex is not necessary for simple fear conditioning, and the thalamus and amygdala can process fear stimuli without cortical involvement.

    Glutamate Transmission and LTP

    • Glutamate transmission is involved in memory formation and long-term potentiation (LTP), a process that strengthens synaptic connections.
    • LTP has been found in the fear-conditioning route, and studies have shown that the prefrontal regions regulate emotional responses through the amygdala.

    Emotional Learning and Extinction

    • Extinction is an active learning process that requires the same neural pathways as fear conditioning.
    • The prefrontal cortex plays a critical role in regulating emotional responses, and damage to this region can make it difficult to extinguish emotional learning.
    • Blocking NMDA receptors in the amygdala disrupts extinction, suggesting that extinction is an active learning process.

    Two Routes for Emotional Learning

    • There are two routes for emotional learning: the cortical "high-road" and the subcortical "low-road".
    • The high-road involves the cortex and is involved in more complex emotional processing, while the low-road is a faster, more instinctual response.
    • Therapy can improve the high-road, leading to better emotional regulation.

    Emotional Memory and Trauma

    • Emotional memories can be stored in the declarative memory, but they are stored as cold facts.
    • Traumatic events can influence mental and behavioral functions later in life through processes that are inaccessible to conscious awareness.
    • The emotional memory system, which develops earlier, forms and stores unconscious memories of traumatic events.

    Neuroanatomy and Neuroimaging of Anxiety Disorders

    Fear Network

    • The amygdala is crucial for the perception and expression of emotion, specifically for anxiety-related negative affects and anxiety conditioning.
    • The insula is involved in subjective feelings and emotional processing in general.
    • The anterior cingulate cortex (ACC) is related to approach and avoidance behavior during anxiety learning.

    Generalized Anxiety Disorder (GAD)

    • Functional neuroimaging studies have shown a higher response of the amygdala and insula to anxiety-related or aversive images in GAD compared to healthy controls.
    • Hyperresponsivity of the medial prefrontal cortex (PFC), specifically dorsal and rostral ACC, was observed in adolescent GAD patients.

    Social Anxiety Disorder (SAD)

    • Higher amygdala and hippocampal responses to conditioned stimuli were found in SAD.
    • Neutral faces used as conditioned stimuli evoked amygdala activation.
    • Learned improved emotional response to social stimuli may be a key factor in SAD.

    Specific Phobias

    • Hyperreactivity in the amygdala, insula, hippocampus, and dorsal medial PFC was observed during anticipation and processing of phobia-related versus neutral stimuli.

    Post-Traumatic Stress Disorder (PTSD)

    • Amygdala hyperreactivity was found for symptom provocation or anxiety learning in PTSD.
    • Reduced amygdala response was associated with higher resilience in PTSD.
    • A negative association was found between medial PFC response and symptom severity.

    Panic Disorder

    • Hyperreactivity in the amygdala, thalamus, and hippocampus, together with hyporesponsivity of frontal cortical regions, is important in the pathophysiology of PD.

    Obsessive-Compulsive Disorder (OCD)

    • Dysfunctional thalamo-cortico-striatal circuits with higher responses in the striatum are associated with OCD.
    • Hyperresponsivity in the PFC and ACC is related to anxiety and obsessive thoughts.

    Connectivity Studies

    • Deficient interaction between the amygdala and medial PFC was found in PTSD.
    • A significant negative interaction between the amygdala and dorsolateral PFC was observed during conditioning.

    Neuroimaging in Anxiety Disorders

    • Functional neuroimaging studies have shown hyperactivty of the amygdala during symptom provocation in anxiety disorders.
    • Ventral PFC and ACC are also involved in anxiety processing.
    • CCK-4-induced panic attacks can serve as a useful model to study the pathophysiology and neurobiological basis of PD.

    Imaging Neural Correlates of Treatment

    • Changed patterns of neural function were observed after successful treatment of specific phobias.
    • Amygdala activity decreased after successful exposure therapy in spinfobics.
    • Changes in patterns of brain activity were observed after CBT in OCD patients.

    Circuitry Underlying Regulation of Conditioned Fear

    • The study examines the neural mechanisms underlying the regulation of conditioned fear using two approaches: extinction of conditioned fear and cognitive emotion regulation.
    • The research aims to investigate the similarities and differences in the neural mechanisms underlying these two paradigms for reducing fear.

    Neural Mechanisms of Extinction and Emotion Regulation

    • Extinction learning involves the formation of new inhibitory associations that reduce the expression of conditioned fear responses.
    • The ventromedial prefrontal cortex (vmPFC) plays a crucial role in extinction learning, and its cortical thickness predicts the speed of extinction.
    • Cognitive emotion regulation strategies can also reduce fear responses, and the study examines the neural mechanisms underlying this process.

    Cognitive Emotion Regulation Strategies

    • The study uses a cognitive reappraisal strategy, where participants are instructed to reinterpret emotional stimuli in a less negative way.
    • This strategy is associated with decreased activity in the amygdala and increased activity in the dorsolateral prefrontal cortex (dlPFC).
    • The dlPFC is involved in working memory, decision-making, and emotion regulation.

    Neural Correlates of Emotion Regulation

    • The study uses functional magnetic resonance imaging (fMRI) to examine the neural correlates of emotion regulation.
    • Blood oxygenation level-dependent (BOLD) signal is used to measure neural activity in different brain regions.
    • The results show that cognitive emotion regulation is associated with increased activity in the dlPFC and decreased activity in the amygdala.

    Overlap with Extinction Mechanisms

    • The study finds that the neural mechanisms underlying cognitive emotion regulation overlap with those involved in extinction learning.
    • Both processes involve the vmPFC and amygdala, suggesting that similar neural mechanisms are recruited to reduce fear responses.

    Key Findings

    • Emotion regulation strategies can reduce conditioned fear responses by decreasing activity in the amygdala and increasing activity in the dlPFC.
    • The vmPFC plays a general regulatory role in diminishing fear across different paradigms.
    • Cognitive emotion regulation strategies can be used to reduce fear responses, and the neural mechanisms underlying this process involve similar regions as extinction learning.

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    Learn about specific phobias, the intense fear of certain objects, stimuli, or situations, and their diagnostic criteria. Understand the characteristics of specific phobias and how they can be triggered.

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