Emotional responding to fearful and disgusting stimuli in specific phobics

Individuals with small animal and blood-injection-injury (BII) phobias respond to phobia-relevant stimuli with both fear and disgust. However, recent studies suggest that fear is the dominant emotional response in animal phobics whereas disgust is the primary emotional response in BII phobics. The present study examined emotional responding toward pictures of spiders, surgical procedures, and two categories of general disgust elicitors (rotting food and body products) among analogue spider phobics, BII phobics, and nonphobics. Dominant emotional responses to phobia-relevant stimuli clearly differentiated the groups. as spider phobics were more likely to be classified as primarily fearful when rating pictures of spiders (74%), whereas BII phobics were more likely to be classified as primarily disgusted when rating pictures of surgical procedures (78%). Discriminant function analyses revealed that disgust ratings, but not fear ratings, of the phobic pictures were significant predictors of phobic group membership. Both phobic groups were characterized by elevated disgust sensitivity toward video and pictorial general disgust elicitors. Implications and suggestions for continued research examining fearful and disgusting stimuli in specific phobia are outlined.     

Attentional bias and evoked heart-rate response in specific phobia

The relationship between the evoked heart-rate (HR) reaction to phobic pictures and the attentional bias was investigated in specific phobics. Forty-five specific phobic and 39 control participants were shown phobia-related pictures while HR was being recorded; they were administered the modified dot-probe task, the modified Stroop task, and gave subjective ratings of pictures. Unlike control participants, specific phobics showed HR acceleration to phobia-related pictures, which was significantly correlated with their fear ratings, and a significant Stroop interference effect. There were no group differences with regard to an attentional bias in the dot-probe task but early deceleration of the HR reaction to phobic pictures was related to more pronounced selective attention toward these stimuli in phobics. The results provide partial support for Cook and Turpin's (1997) conjecture of a relationship between the early decelerative orienting component of the HR reaction and the selective attentional bias in phobia.     

Reliability and validity of some specific fear questionnaires

Normative psychometric data on a Swedish translation of fear questionnaires concerning snakes, spiders, public speaking, and mutilation given to 223 college students are presented. High internal consistencies were found for all four questionnaires, and low intercorrelations among the four inventories emerged. In a separate study the inventories were administered to a clinical sample of spider and snake phobics. Phobics scored higher on their respective phobic scale than the college group but did not differ from controls on mutilation or public speaking scales. A significant negative correlation emerged between snake and spider scores among the phobics. One year test-retest reliabilities in the phobic sample were high. Finally, snake and spider phobics viewed and rated phobic and nonphobic slides. Snake phobics rated snake slides as more aversive than spider slides, whereas the reverse was true for spider phobics. The correlation between fear ratings and questionnaire scores was significant. Use of these scales in evaluating therapeutic changes is encouraged.     

UCS expectancy biases in spider phobics: underestimation of aversive consequences following fear-irrelevant stimuli

This paper reports the results of two studies investigating judgements made by spider phobics about the potential threatening consequences (unconditioned stimulus, UCS, expectancies) associated with their phobic stimulus, fear-relevant (FR) stimuli, and fear-irrelevant (FI) stimuli. Using a 'thought experiment' UCS expectancy paradigm, the studies reported found that (1) spider phobics reported significantly higher UCS expectancies to spider stimuli than nonphobics, (2) spider phobics consistently underestimated the probability of aversive consequences following FI stimuli and (3) this underestimation of UCS expectancies to FI stimuli in phobics was not the result of a contrast effect resulting from sequential FR and FI judgements. This differential effect may have important implications for the kind of mechanism which mediates judgements about phobic consequences. These findings suggest that the dimensions on which phobic stimuli are categorised may be 'stretched' in the case of phobics and that this gives rise to the comparative underestimation of threat associated with FI stimuli but also makes phobics more vulnerable to acquiring other phobias.     

The contribution of relaxation and expectancy to fear reduction via graded, imaginal exposure to feared stimuli

Speech phobic subjects received five treatment sessions under either positive or neutral expectancy set. Therapy conditions included hierarchy exposure with contiguous relaxation (desensitization), exposure with noncontiguous relaxation, exposure only, and no-treatment. Expectancy had virtually no outcome effects. Desensitization was superior to the other conditions on subjective outcome measures. In contrast to the two exposure conditions without contiguous relaxation, desensitization resulted in increased imagery vividness, greater cardiovascular response to the first visualization of the initial hierarchy scene, and greater declines in cardiovascular response within repetitious visualizations of scenes and across initial visualizations of increasingly anxiety-provoking scenes. Expectancy significantly influenced both fear ratings and cardiovascular response to scenes during the first session, the latter effect disappearing after the first session. The results are discussed in terms of recent theorizing regarding the role of relaxation and expectancy in desensitization.     

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Ways of acquiring phobias and outcome of behavioral treatments

The way of acquisition of phobias was studied in relation to different behavioral treatments for phobias. Ss (N = 183) were clinical patients belonging to six different phobic groups (agoraphobics, claustrophobics, social phobics, animal phobics, blood phobics and dental phobics), and the treatments were categorized as behaviorally focused (exposure in vivo and social-skills training), physiologically focused (systematic desensitization and applied relaxation) and cognitively focused (self-instruction training and fading). Results showed that both for patients with direct conditioning experiences and indirect acquisition those treated with behavioral and physiological methods improved more than those receiving cognitive methods when looking at the change-score data. Regarding the proportion of clinically improved patients there was no difference between treatments among the Ss with a background of conditioning experiences. In the group with indirect acquisition, on the other hand, the cognitive methods were more effective.     

Self-reported automaticity and irrationality in spider phobia

Spider phobic women (n = 39) and nonfearful controls (n = 41) completed a 20-item questionnaire measuring the extent to which they experience their fear reactions to spiders as automatic and irrational. For the phobic sample, therapy outcome data were also collected. Results suggest that spider phobics tend to view their attitude to spiders as irrational and in this respect, they do not differ from control subjects. Furthermore, compared to control subjects, phobics more often perceive their responses to spiders as automatic, i.e., not under intentional control. Contrary to expectation, no robust correlation was found between automaticity and irrationality. Interestingly, automaticity was not related to treatment outcome, while irrationality to some extent predicted therapy outcome (i.e., the more phobics experienced their fear as irrational, the more they profited from exposure treatment).     

SOCIAL PHOBIA: CONTROL PROCESSES IN ANXIETY-PROVOKING SITUATIONS

Control of anxiety-related emotions in anxiety-provoking situations was qualitatively examined for 21 social phobic clients before treatment. A model illustrating the functional coherence of the control processes across those situations was constructed, based on narratives of problematic situations. Results indicated that the model reflects fundamental processes in social phobia, possibly resulting from early attachment. In addition, three groups were identified that differed in respect to control-activity. These results indicate that the differences reflect surface variation of processing, resulting from development and interaction in adolescence and adulthood. Both the coherence and the variation should be taken into account when dealing with and developing treatment procedures for social phobics.     

Validity of Two Questionnaires to Assess Social Fears: The Dutch Social Phobia and Anxiety Inventory and the Blushing, Trembling and Sweating Questionnaire

This report evaluates some psychometric properties of the Dutch Social Phobia and Anxiety Inventory (SPAI-N) as well as a newly developed instrument to assess fear of showing somatic symptoms among social phobic, the Blushing, Trembling and Sweating Questionnaire (BTS-Q). Results support the reliability and discriminative validity of the Dutch SPAI and the BTS-Q. Both questionnaires are able to discriminate social phobics from a community sample. Social phobics with fear of blushing, trembling, and sweating as the main complaint could be discriminated from social phobics without fear of blushing, trembling, and sweating as the main complaint using the BTS-Q. In contrast with expectations derived from cognitive models of social phobia, social phobics with fear of blushing, trembling, and sweating did not have stronger dysfunctional beliefs about (the social consequences of) blushing, trembling, and sweating than social phobics without such fears.     

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.     

Fear and the amygdala: manipulation of awareness generates differential cerebral responses to phobic and fear-relevant (but nonfeared) stimuli

Rapid response to danger holds an evolutionary advantage. In this positron emission tomography study, phobics were exposed to masked visual stimuli with timings that either allowed awareness or not of either phobic, fear-relevant (e.g., spiders to snake phobics), or neutral images. When the timing did not permit awareness, the amygdala responded to both phobic and fear-relevant stimuli. With time for more elaborate processing, phobic stimuli resulted in an addition of an affective processing network to the amygdala activity, whereas no activity was found in response to fear-relevant stimuli. Also, right prefrontal areas appeared deactivated, comparing aware phobic and fear-relevant conditions. Thus, a shift from top-down control to an affectively driven system optimized for speed was observed in phobic relative to fear-relevant aware processing.     

Sensitivity to phobic imagery: a sensory decision theory analysis

The effects of deep muscle relaxation on anxiety were studied in a systematic desensitization context. A Sensory Decision Theory analysis of anxiety ratings to controlled imagery showed that relaxed Ss were significantly more sensitive to phobic properties of the controlled imagery than nonrelaxed Ss. The results are discussed in terms of Wolpe's theoretical basis for systematic desensitization. Sensory Decision Theory is presented as a useful technique for measuring the effects of therapy on emotional states.     

Perception of autonomic reactions and actual heart rate in phobic patients

The relationship between perceived physiological arousal and actual heart-rate reactions was studied in two behavioral test situations. The subjects were 70 phobic patients (34 social phobics and 36 claustrophobics) who were given the general form of the Autonomic Perception Questionnaire about 1 month before the respective behavioral test and the specific form immediately after the test. The results showed significant correlations between APQ and actual heart rate for the social phobics, while the picture was more complicated for the claustrophobics. The implications of these results are discussed.This research was supported by Grant 05452 from the Swedish Medical Research Council.     

The contribution of relaxation to symbolic modeling in the modification of dental fears.

Studies of symbolic modeling suggest that it is a technique which is at least as effective and more efficient (faster) than imaginal desensitization in the treatment of fears (Bandura el al., 1969; Woody and Schaible, 1969). Bandura et al. (1969) assessed the contributions of relaxation to the procedure and found less subjective anxiety and greater positive attitude change with relaxation but no significant differences in oven behavior nor in generalized anxiety reduction. In this study the ‘symbolic modeling only’ subjects received their treatment after they and the other subjects had received the original post-testing assessment. The present experiment was an attempt to assess the contributions of deep muscle relaxation to symbolic modeling without such confounding and with a more nearly clinical population. Dental fear represents a ‘near clinical’ phobia which satisfies Bernstein and Paul's (1971) criteria for analogue desensitization research. That is. dental phobics exhibit a strong, costly and distressing avoidance response which increases in strength as a function of exposure despite high demand.     

Blood phobics and nonphobics: psychological differences and affect during exposure.

This study compared psychological dimensions of blood phobics and nonphobic controls, examined affect in response to phobic and neutral stimuli, and investigated the relationship between reported feelings of faintness and blood pressure. Blood phobics (24 adults with extreme Mutilation Questionnaire scores) and 24 nonphobics completed several psychological measures and viewed one of two 60 sec surgery scenes and a 60 sec neutral scene in counterbalanced order. Subjective, psychophysiologic, and motoric measures of affect were assessed. On questionnaires, phobics reported greater anxiety sensitivity, empathic distress, fear and insecurity, and nightmares, but no difference in autonomic arousal, muscle tension, motion sickness, or other empathy domains. During surgery scenes, phobics had more negative affect than controls; however, phobics were more anxious during only one of the two surgeries, and often only when the surgery was presented prior to the neutral scene. Fainting did not occur, and self-reported feelings of faintness were unrelated to blood pressure changes. The findings highlight the lack of information on blood phobic stimulus properties, fainting's relationship to self-reports and blood pressure, and the specific emotion experienced in blood phobia.     

Assessing the process of desensitization therapy: Five practical measures

Assessment of phobic behavior has included self-report, physiological, and in vivobehavioral measures. While self-report measures are convenient, they suffer from subject bias and a low predictive validity. Physiological and in vivobehavioral measures are often too cumbersome to implement in standard clinical practice. The current study investigated the validity of five convenient measures of phobic behavior during the process of desensitization therapy. Responses of 14 clinically phobic patients were compared on phobic and neutral scenes presented within the context of systematic desensitization therapy. Phobic scenes resulted in less clarity of scene visualization, a longer latency to clear scene visualization, higher subjective units of discomfort (SUDs) at clear visualization, a longer latency to relaxation, and higher SUDs at relaxation. The measures seemed to reflect accurately the process and stages of desensitization therapy and showed low to high intercorrelations. The pragmatic value of these measures is discussed, as well as suggestions for future validational research.     

Covariation bias,classical conditioning,and phobic fear

The present study investigated whether phobics show an illusory correlation (IC) between phobia-relevant stimuli and aversive events. Nineteen treated and 19 untreated spider phobics were exposed to a series of 72 slides. Three different categories were used: Phobia-relevant slides (spiders), alternative fear-relevant slides (weapons), and neutral slides (flowers). Slides were randomly paired with either a shock, a siren, or nothing at all. All slide/outcome combinations occurred equally frequently. A posteriori recorded contingency estimates indicated that untreated phobics dramatically overestimate the covariation of spiders and shock. On-line recorded outcome expectancies revealed that the bias to overestimate the spider-shock contingency is highly resistant to extinction. The covariation bias was accompanied by differentially heightened electrodermal first interval responses (FIR) and unconditioned electrodermal responses (third interval responses: TIR) on phobia-relevant trials. Treated phobics did not show a covariation bias, indicating that such bias can be modulated by behavioral treatment. The present findings sustain the hypothesis that phobic subjects process information in a fear-confirming way.     

Fears of phobic patients: Factor analyses of self-report data

Fear questionnaires completed by 171 phobic patients were factor-analysed. Factors previously identified in student and non-phobic patients were replicated, and in addition an agoraphobia factor was found. Separate analyses of (i) a group of psychiatrically diagnosed agoraphobics and (ii) a group of miscellaneous phobics revealed that agoraphobics are generally more fearful and depressed than other phobics, and score more highly on a cluster of items which include ‘breathing difficulties’ and ‘dizziness’. A distinct agoraphobia factor was not identifiable in the group of miscellaneous phobics, pointing to the all-or-none nature of this fear.     

Avoidant personality disorder and the generalized subtype of social phobia.

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.