Phobic Fear Research Articles

Glucocorticoids reduce phobic fear in humans.

Phobias are characterized by excessive fear, cued by the presence or anticipation of a fearful situation. Whereas it is well established that glucocorticoids are released in fearful situations, it is not known whether these hormones, in turn, modulate perceived fear. As extensive evidence indicates that elevated glucocorticoid levels impair the retrieval of emotionally arousing information, they might also inhibit retrieval of fear memory associated with phobia and, thereby, reduce phobic fear. Here, we investigated whether acutely administrated glucocorticoids reduced phobic fear in two double-blind, placebo-controlled studies in 40 subjects with social phobia and 20 subjects with spider phobia. In the social phobia study, cortisone (25 mg) administered orally 1 h before a socio-evaluative stressor significantly reduced self-reported fear during the anticipation, exposure, and recovery phase of the stressor. Moreover, the stress-induced release of cortisol in placebo-treated subjects correlated negatively with fear ratings, suggesting that endogenously released cortisol in the context of a phobic situation buffers fear symptoms. In the spider phobia study, repeated oral administration of cortisol (10 mg), but not placebo, 1 h before exposure to a spider photograph induced a progressive reduction of stimulus-induced fear. This effect was maintained when subjects were exposed to the stimulus again 2 days after the last cortisol administration, suggesting that cortisol may also have facilitated the extinction of phobic fear. Cortisol treatment did not reduce general, phobia-unrelated anxiety. In conclusion, the present findings in two distinct types of phobias indicate that glucocorticoid administration reduces phobic fear.

Der Einfluss kindlicher Traumatisierung auf eine spätere Drogenabhängigkeit

There are various publications on the impact of the experience of violence and abuse during childhood as it relates to future substance abuse. This study aims to examine how childhood abuse differentiated by type and severity, impacts on future potential for substance abuse. Particular attention is paid to specific psychological symptoms and degree of addiction. 100 patients being treated for substance abuse completed a questionnaire where they were questioned about a childhood history of sexual, physical and emotional abuse, neglect and family violence. Psychopathology and severity of addiction were assessed using the EuropASI and SCL-90. The results demonstrated that the respondents had been exposed to multiple risk factors in their childhood. The subjects were differentiated into groups according to type of abuse. The type and severity of psychological symptoms were measured by the SCL-90-R. The type and severity of psychosocial and environmental problems were measured by the EuropASI. It was shown that patients with a history of abuse had a significantly higher incidence of symptomatology, particularly of co-morbid psychological conditions. When differentiating victims of abuse by sex, women showed a significantly stronger impairment in 2 categories. These were insecurity in social contact and phobic fear. For all other variables of impairment, there were no differences between men and women. The severity of the various types of abuse was then correlated to the course of the disease. A strong correlation was found between severe forms of abuse where victims were involved in sexual abuse or family violence and future severe psychological symptoms.

A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder

To date, no large-scale, controlled trial comparing a serotonin-norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported. This double-blind study compares the efficacy of venlafaxine extended-release (ER) and paroxetine with placebo. A total of 664 nondepressed adult outpatients who met DSM-IV criteria for panic disorder (with or without agoraphobia) were randomly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER (75 mg/day or 150 mg/day), or paroxetine 40 mg/day. The primary measure was the percentage of patients free from full-symptom panic attacks, assessed with the Panic and Anticipatory Anxiety Scale (PAAS). Secondary measures included the Panic Disorder Severity Scale, Clinical Global Impressions--Severity (CGI-S) and--Improvement (CGI-I) scales; response (CGI-I rating of very much improved or much improved), remission (CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks); and measures of depression, anxiety, phobic fear and avoidance, anticipatory anxiety, functioning, and quality of life. Intent-to-treat, last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo. No significant differences were observed between active treatment groups. Panic-free rates at end point with active treatment ranged from 54% to 61%, compared with 35% for placebo. Approximately 75% of patients given active treatment were responders, and nearly 45% achieved remission. The placebo response rate was slightly above 55%, with remission near 25%. Adverse events were mild or moderate and similar between active treatment groups. Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder.

Neurophysiological correlates of habituation during exposure in spider phobia

Imaging studies using symptom-provocation paradigms in specific phobia have yielded contradictory results, possibly reflecting a failure to account for habituation processes. Given that a single session of exposure in vivo can result in significant improvement in specific phobia, we used prolonged exposure to phobic stimuli to identify CNS regions showing habituation. Eighteen subjects (12 with spider phobia, 6 healthy controls) underwent H 2 15O-positron emission tomography while being continuously presented with pictures of spiders or butterflies. Results showed main effects (spiders>butterflies) in the phobia group in the left fusiform gyrus (FG) and the right parahippocampal gyrus (PHG), with bilateral perirhinal cortex and right limbic areas approaching significance. Group×condition effects were found in the right amygdala and PHG. During spider scans, large habituation effects were observed in the anterior medial temporal lobe (MTL) bilaterally. Regression analyses demonstrated that state anxiety was correlated with activity in left amygdala, bilateral perirhinal cortex, right FG, and periaquaductal grey; by contrast, phobic fear was only associated with right-sided hippocampal activity. We conclude that prolonged exposure to phobic stimuli is associated with a significant decrease in bilateral anterior MTL regional cerebral blood flow. Right anterior MTL, identified when comparing phobic vs. neutral stimuli and habituation to phobic vs. neutral stimuli in the phobia group, implicates this region in phobic fear. Analyses of covariance suggest a further functional segregation with state anxiety being linked to enhanced activity in amygdala, perirhinal cortex, and tegmentum, and phobic fear with enhanced right hippocampal activity, suggesting a neuroanatomical differentiation between emotional-vegetative and cognitive aspects of (phobic) fear.

Memory–emotional interactions as revealed by fear generalization in animal-fearful individuals

Discriminative fear learning and fear generalization were examined in animal-fearful individuals and in control participants. Electrical shocks were administered contingent upon discriminative pictures of spiders or snakes, respectively, in a generalization-after-discrimination paradigm. Neither discriminative fear learning nor extinction was affected by the individual fear status of the animal categories. Novel feared stimuli, which resembled discriminative stimuli, were treated as more shock predictive than novel non-feared stimuli during generalization testing. Neither preparedness theory nor selective sensitization theory was capable to account for these observations. The findings are commensurable with the hypothesis that phobic fear interferes with the retrieval of memory traces.

The Spider Phobia Card Sorting Test: An investigation of phobic fear and executive functioning

Recent studies indicate that anxious participants show cognitive biases favouring threat‐related stimuli. However, most of this evidence comes from Stroop tasks, which are believed to tap a narrow range of executive skills. The current study investigated phobic fear and cognitive biases using tasks designed to tap a wider range of executive processes: the standard Wisconsin Card Sorting Test (WCST; Heaton, 1981), a modified version that included emotionally salient pictorial stimuli; the Spider Phobia Card Sorting Test (SPCST); and an emotionally valenced version of a verbal fluency task (VF). A total of 80 female participants (38 lower and 42 higher scorers on the Spider Phobia Questionnaire; SPQ) drawn from a larger sample of 126 completed either the standard WCST or the SPCST, the VF, and several mood measures. On the card sort, the higher SPQ SPCST group showed a significantly lower proportion of conceptual level responses, required a greater number of trials to complete the first category, and sorted significantly fewer stimulus cards to the spider target card than the lower SPQ SPCST group, or than either of the groups in the WCST condition who sorted to neutral target cards. On the VF, the higher SPQ group generated significantly more exemplars to the category “spiders” than the lower SPQ group. Therefore, fearful participants seemed to avoid or neglect the spider cue on the card sort, but performed better in generating “spiders” exemplars on the VF, as compared to the nonfearful group. Implications and limitations of these findings are discussed.

On the Threshold of Disorder

Two recent reanalyses of epidemiologic studies found that adding a clinical significance criterion reduced disorder prevalence. Patients presenting for clinical care are usually distressed or impaired by their symptoms; thus, the DSM-IV clinical significance criterion might have little impact on diagnosis in clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examine the impact of the DSM-IV clinical significance criterion on diagnostic frequencies of depressive and anxiety disorders in psychiatric outpatients. 1500 psychiatric outpatients were evaluated with the Structured Clinical Interview for DSM-IV. We determined the percentage of patients who met symptom criteria but did not meet the DSM-IV clinical significance criterion for major depressive disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social phobia, specific phobia, panic disorder, and obsessive-compulsive disorder. No patient who met the symptom criteria for current major depressive disorder or PTSD failed to meet the clinical significance criterion. Less than 2% of patients meeting the symptom criteria for current GAD did not meet the clinical significance criterion. There was variability among the remaining anxiety disorders in the percentage of symptomatic patients who met the clinical significance criterion. In psychiatric patients, the clinical significance criterion had little impact on diagnosing major depressive disorder, GAD, and PTSD, disorders that are defined, in part, by disruptions of daily regulatory domains such as sleep, appetite, energy, and concentration. In contrast, the clinical significance criterion had a greater impact in determining whether phobic fears, obsessive thoughts, and panic attacks were sufficiently distressing or impairing to qualify for disorder status.

The looming maladaptive style predicts shared variance in anxiety disorder symptoms: further support for a cognitive model of vulnerability to anxiety

Looming vulnerability pertains to a distinct cognitive phenomenology characterized by mental representations of dynamically intensifying danger and rapidly rising risk as one projects the self into an anticipated future [J. Pers. Soc. Psychol. 79 (2000) 837]. While looming appraisals can be experienced as state elicitation, some individuals are hypothesized to develop an enduring cognitive pattern of cross-situational looming appraisals, the looming maladaptive style (LMS), which functions as a cognitive vulnerability to anxiety. In the present study, we examined the extent to which the LMS predicts common variance in numerous anxiety disorder symptoms, independent of the potentially confounding effects of current depressive symptoms. Specifically, we hypothesized that controlling for depressive symptoms, LMS would predict shared variance in a latent factor comprised of indicators of five anxiety disorder symptoms: obsessive–compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, social phobia, and specific phobic fears. Measures of these anxiety disorder symptoms, depressive symptoms, and looming vulnerability were administered to unselected college student population. Structural equations modeling analyses provided support for our hypothesis that LMS predicts shared variance in anxiety disorder symptoms and suggest that this cognitive style may be an overarching dimension of vulnerability to anxiety.

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.

Active-imaginal exposure: examination of a new behavioral treatment for cynophobia (dog phobia)

The aims of this study were to investigate exposure-based treatments for cynophobia (dog phobia) and to test a newly developed hybrid imaginal exposure treatment that we have named active imaginal exposure. The treatment introduces an in vivo coping component to imaginal exposure whereby the patient physically performs coping responses to an imagined feared stimulus. Eighty-two participants meeting DSM-IV criteria for specific phobia (animal subtype) were randomly assigned to one of three 30-min. treatments: (a) active-imaginal exposure (AI), (b) imaginal exposure alone (IE), or (c) graduated in vivo exposure (IV). Participants completed a behavioral approach test at pre, post, and four-week follow-up. Significant pre- to posttreatment improvement was observed in all three treatment conditions. Response rates at posttreatment were 51.9, 62.1, and 73.1% for the IE, AI, and IV groups respectively. Likewise, effect sizes at posttreatment were 0.76, 1.41, and 1.55 for the IE, AI, and IV groups respectively. Although in the predicted direction, the between group differences were not significant. A similar pattern of results was observed at follow-up. Further, safety behavior utilization during treatment was associated with less improvement—particularly in the two imaginal treatment conditions. Exposure treatments of dog phobia appear feasible and effective in reducing phobic fear and avoidance associated with dog phobia. Furthermore, preliminary evidence suggests that our active-imaginal exposure treatment may be a viable alternative to in vivo exposure.

Envisioning other Minds: The Artistic Drawing and Psychometric Rating of Images and Percepts

During half of this two-hour study, 28 individually tested subjects completed the MMPI. At the outset of the second hour, each subject photographed a frightening view, then described his or her percept of the view as a student artist made a colored chalk drawing of the perceptual experience described. Independent raters later compared the subject's color photograph of the view itself and the colored drawing of the subject's perceptual experience, and rated the extent to which the view itself had been 1) embellished, 2) diminished, and 3) transformed in the subject's perceptual experience of the view. During the conclusion of the second hour, each subject mentally envisioned a frightening image, then described the image as the student artist made a colored chalk drawing of the imaginal experience described. The independent raters, on three more scales, rated the extent to which the drawn image expressed 1) paranoid fear, 2) phobic fear, and 3) chronic fear. Subjects whose perceptual experiences of frightening views transformed the actually viewed stimuli scored significantly higher on the MMPI Schizophrenia scale. In addition, subjects whose frightening images expressed paranoid fear scored significantly higher on both the MMPI Paranoia scale and the MMPI Schizophrenia scale. Such results suggest that artists' drawings of subjects' percepts and images can, with psychological validity, serve to envision other minds.

Clinical features of panic attacks in schizophrenia

Since reports have underscored that panic attacks (PA) may be an identifiable state occurring in schizophrenia, we studied the symptomatology of PA in a group of schizophrenic patients. Of 40 patients (21 males and 19 females) attending a clinic for maintenance therapy of schizophrenia, 19 (36.8%) had a lifetime history of PA. Seven among those 19 patients (36.8%) had or had had spontaneous panic attacks, not related to phobic fears or delusional fears, and for the 12 remaining patients, the PA were related to paranoid ideas. Moreover, the paranoid subtype of schizophrenia tends to be more often associated with a history of panic attack than other subtypes of schizophrenia (52.6% vs 23.8%; χ 2 = 3.5, P = .06). It seems that there are at least two types of PA in schizophrenic patients. The first one could be independent from the psychotic feature, with no psychopathological link. The second kind of PA could be directly related to a schizophrenic disorder, and found in patients with the paranoid subtype.

Treatment of a 50-Year-Old African American Woman Whose Chronic Posttraumatic Stress Disorder Went Undiagnosed for Over 20 Years

Treatment of a 50-Year-Old African American Woman Whose Chronic Posttraumatic Stress Disorder Went Undiagnosed for Over 20 Years

The Heritability of Common Phobic Fear: A Twin Study of a Clinical Sample

The aim of this study was to investigate the genetic and environmental contribution to common phobic fears, and to relate the findings to contemporary theories about the etiology of common phobic fears. Self-reported common phobic fear was studied in a treatment sample of 23 monozygotic and 38 same-sex dizygotic twin pairs. Heritability of .47 was observed for common phobic fear of small animals and social fear, and a heritability of .30 in common agoraphobic fear. For common fear of nature phenomena and situational fear, the heritability was 0. The finding that common nature and situational fears were solely caused by environmental factors is in support of learning theory, whereas results for animal, social, and other common phobic fear are in support of an integrative theory of biological preparedness, learning history, and a cognitive style of fearful expectation.

Principal and additional DSM-IV disorders for which outpatients seek treatment.

Epidemiological studies indicate that most patients in the community do not get treatment for psychiatric disorders. It is unknown whether persons who present for outpatient psychiatric services seek treatment for all the disorders they have or only for the principal disorder for which they are seeking treatment. The goal of this study was to determine which axis I psychiatric disorders motivate patients to seek treatment. Four hundred outpatients at a hospital-affiliated, community-based, psychiatric clinical practice were interviewed with the Structured Clinical Interview for DSM-IV (SCID). For patients with more than one disorder, the diagnoses were assigned as principal or additional according to the DSM-IV convention of whether it was the patient's stated primary reason for presenting for treatment or was an additional disorder. For all current disorders, patients were asked whether the symptoms of each diagnosed disorder were a reason, or one of the reasons, for seeking treatment. Nearly all patients with major depression wanted treatment for this disorder, and more than 85 percent of patients with panic disorder, posttraumatic stress disorder, and generalized anxiety disorder indicated that the symptoms of these disorders were a reason for seeking treatment. Half to two-thirds of patients with social phobia, obsessive-compulsive disorder, intermittent explosive disorder, body dysmorphic disorder, and substance use disorders reported that the symptoms of these disorders were a reason for seeking treatment. Only 30 percent of those with specific phobia indicated that their phobic fears were a reason for seeking treatment. Patients often seek treatment for symptoms of disorders that are diagnosed as comorbid, rather than principal, conditions. It is important for clinicians to conduct thorough diagnostic interviews in order to diagnose disorders that are not related to the patient's chief complaint, as patients often desire treatment for these additional diagnoses.

Comparison of neural activation in response to phobic and non-phobic fear relevant stimuli

Comparison of neural activation in response to phobic and non-phobic fear relevant stimuli

Diagnóstico y tratamiento de fobia a la terapia con presión nasal positiva continua de aire

The obstructive sleep apnoea syndrome (OSAS) is characterized by destructured sleep due to repeated episodes of obstruction of the superior respiratory tract during sleep. Treatment by nasal continuous positive airway pressure (n-CPAP) using air is one of the most common forms of treatment of OSAS, although some patients cannot tolerate it. One of the causes of intolerance of n-CPAP is the phobic reaction of some patients. The objective of this study is to show that phobia is one of the causes of n-CPAP not being accepted by OSAS patients and demonstrates the efficacy of treatment by exposure in cases of phobic fear of mask. Patients and methods. We studied six patients with phobic intolerance of CPAP and established the diagnosis of phobia according to the criteria of DSM-IV. Subsequently, they were treated by real-life exposure, one of the behavior techniques most often used for phobic disorders, and consisting of exposure to the feared object under conditions in which escape or avoidance is impossible. Following the diagnosis of phobia of the CPAP mask, it was seen that treatment involving real-life exposure was effective.

Worry Affects the Immune Response to Phobic Fear

Worry, the cognitive enumeration and anticipation of potential future negative events, is associated with autonomic dysregulation, which may in turn have implications for the immune system. People endorsing high (n = 7) and normal levels of trait worry (n = 8) were briefly exposed to a phobic stimulus and the autonomic and immune responses and recovery were assessed. A time-matched control group (n = 6) was not exposed to any stimulus. Both worry groups showed increased heart rate and skin conductance in response to phobic fear. However, only the normal worry group showed a concomitant increase in natural killer cells in peripheral blood. Patterns of change during the follow-up period suggested that phobic fear had disrupted a normal circadian increase in natural killer cells. Adrenergic and hypothalamus–pituitary–adrenal mechanisms may be responsible for the differences between high and normal worry groups in their natural killer cell response to and recovery from phobic fear.

No interactive effects of naltrexone and benzodiazepines on pain during phobic fear

Animal research has shown that anxiety may inhibit pain through the release of endogenous opioids. On the other hand, anxiety is often believed to exacerbate pain in clinical situations, and anxiety reduction has been shown to attenuate the affective component of pain. In the present study phobic anxiety was induced by confronting forty-eight spider phobic subjects with a spider, after which they received two mildly painful electrical stimuli at two different current levels. The benzodiazepine alprazolam (1 mg) was administered to investigate the influence on pain of a reduction in anxiety, while the role of endogenous opioids was studied by administering the opioid antagonist naltrexone (50 mg). Alprazolam resulted in lower anxiety and pain ratings during pain stimulation, supporting the idea that (presumably pain-related) anxiety may increase the experience of pain. Naltrexone did not influence pain and anxiety ratings, nor was there a significant interaction between the two pharmacological manipulations. These findings confirm previous evidence that phobic fear does not necessarily induce an endogenous opioid-mediated analgesia.

Studies on the role of disgust in the acquisition and maintenance of specific phobias

Disgust has been proposed as a possible factor in phobic acquisition and maintenance, particularly in spider phobia. Cognitions and processes concerning disgust were examined in a series of studies with spider phobics, other specific phobics and nonphobic controls. Beliefs about the disgusting nature of their phobic objects were present in phobics but did not contribute to an attentional bias. Measures of global disgust sensitivity were not closely linked to the phobic fear response. The disgust associated with phobic objects appears to have different constituents to the disgust associated with objects that do not evoke the phobic response. In the light of evidence presented here, it seems unlikely that disgust plays a central role in the aetiology or maintenance of spider phobia in particular and specific phobias in general. It is proposed that when stimuli normally associated with disgust become the focus of phobic anxiety the disgust response may be amplified.