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.     

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.     

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.     

Spider-Phobic Children Do Not React with Differential Skin Conductance Responses to Masked Phobic Stimuli

In the present study, spider-phobic children (N = 22) were exposed to subliminal presentations of spiders, snakes, and mushrooms, while skin conductance responses (SCRs) were measured. In addition, pre- and post-treatment symptom severity data were obtained. As a group, spider-phobic children did not react with differential SCRs to masked phobic pictures. In addition, no convincing evidence was found to suggest that individual variation in differential SCRs to phobic stimuli is linked to pre-treatment symptom severity or therapy outcome. These findings cast doubts on the idea that phobics' phenomenal experience of their fear as irrational and uncontrollable is a result of pre-attentive physiological fear activation.     

Fear questionnaires for simple phobias: Psychometric evaluations for a Norwegian sample

The present study presents psychometric data for four different phobic fear questionnaires in a Norwegian sample of 284 subjects. The questionnaires concerned fear of flying, snakes, spiders and a questionnaire of general phobic complaints. The results showed a high estimate of internal consistency, and a very high test-retest reliability for all questionnaires. A low to moderate degree of intercorrelation between the questionnaires appeared. A clear sex difference emerged in responding to all four questionnaires. In addition, a clinical sample of phobics with fear of flying as the main symptom was compared to the larger sample on a fear of flying scale. The results showed a clear difference in responding between the samples. The present study concludes that the four different fear questionnaires yielded a high degree of reliability, and their use in clinical practice is encouraged.     

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.     

Spider fear and covariation bias in children and adolescents

Covariation bias can be defined as phobic people's tendency to overestimate the association between fear-relevant stimuli and negative outcomes. The current article presents two studies that examined this type of cognitive bias in children and adolescents aged 8-16 years. Study 1 was concerned with a thought experiment during which youths (N=150) were asked to imagine that they participated in an experiment during which they had to view a series of pictures showing spiders, guns, and flowers, that were occasionally followed by a negative outcome (i.e., a mild electric shock). Participants were asked to estimate the relation between each type of picture and the negative outcome. The results indicated that youths with higher levels of spider fear displayed a specific tendency to relate spider pictures to a negative outcome. In Study 2, youths (N=220) actually participated in a computer game during which they were confronted with pictures of spiders, guns, and flowers, each of which was equally often followed by a negative (i.e., losing candy), positive (i.e., winning candy), or neutral outcome. After the game, participants had to estimate the relation between each type of picture and various outcomes. It was found that youths with higher levels of spider fear estimated more negative and less positive outcomes in relation to spider pictures. Taken together, these findings provide support for a fear-related covariation bias in youths. Further developmental analyses indicated that this type of cognitive bias seems to be more consistently present among adolescents than among children.     

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.     

No attentional bias for pictoral stimuli in spider-fearful subjects

A number of experiments have shown that (spider) fearful subjects direct their attention to fear-relevant words, even when these words are irrelevant to the completion of a target task (e.g., color naming). The present study examined whether subjects with an intense fear of spiders also display such attentional bias for a fear-relevant pictoral stimulus. Female spider-fearful (n=13) and control subjects (n=13) saw neutral patterns (i.e., horizontal and vertical bars). One pattern served as target for a reaction time, while the other pattern served as nontarget. Targets and nontargets were accompanied by either fear-relevant or neutral pictoral material (i.e., a picture of a spider or a picture of a flower, respectively). The fear-relevant picture did not selectively delibate reaction time performance of spider-fearful subjects. Thus, no evidence was found for an attentional bias for fear-relevant pictoral material in subjects with an intense fear of spiders. Instead, fearful subjects exhibited a general inhibition of performance which became stronger over trials. This suggests that the fear-relevant picture induced a state of anxious arousal or defensive withdrawal that interfered with reaction time performance on both fear-relevant and neutral trials.     

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.     

Phobia-relevant illusory correlations: the role of phobic responsivity

The authors investigated the role of phobic responsivity in the generation of phobia-relevant illusory correlations. As a means of disentangling the contributions of prior fear and elicited fear responses, half of a group of phobic women received 1 mg alprazolam (n = 21), and half received a placebo (n = 22). A group of nonfearful women (n = 24) was included to control for prior fear per se. Participants were exposed to slides of spiders, weapons, and flowers that were randomly paired with a shock, a siren, or nothing. Postexperimental covariation estimates and on-line outcome expectancies were assessed. Irrespective of both prior and elicited fear, participants postexperimentally overassociated spiders and shock. Yet, only women with spider phobia displayed a persisting fear-confirming expectancy bias. This bias was similar for the placebo and alprazolam groups. Thus, the bias appeared to be due to preexisting phobogenic beliefs, whereas phobic responsivity played a negligible role.     

Processing of phobic stimuli and its relationship to outcome

In the present study, we explored factors related to successful treatment outcome in a sample of participants with fear of spiders. We specifically examined the relationship of general memory, memory for the phobic stimulus, memory for anxious responses, and perceived self-efficacy to treatment outcome. Forty-eight participants who were afraid of spiders participated in two sessions of in vivo exposure therapy. On day 1, participants completed measures of general memory, memory for the phobic stimulus, recall of anxiety level during exposure tasks, and self-efficacy during exposure tasks. At post-treatment, better memory for anxious responses, but not memory for the phobic stimulus, was related to lower anticipatory and actual anxiety. Greater self-efficacy, on the other hand, was related to better behavioral performance.     

Social phobia features across the DSM-III-R anxiety disorders

One hundred sixty subjects meeting DSM-III-R criteria for the five major anxiety disorders were compared on the extent to which they reported features characteristic of social phobia. The results indicated that many patients in the anxiety disorder categories experience some degree of social anxiety. The differences between subjects with a primary diagnosis of social phobia and subjects with other anxiety disorders appear to be chiefly quantitative on this feature. Compared to the other anxiety disorders, social phobics report fear and avoidance in response to a greater number of social situations and report greater interference in their lives due to social phobic concerns. Among the anxiety disorders, generalized anxiety disorder appears to be associated with the greatest degree of social anxiety, and simple phobia with the least.     

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.     

The potential role of state-dependent learning in cognitive therapy with spider phobics

Investigated the potential role of state-dependent learning in cognitive therapy with spider phobics. It was hypothesized that one strategy for increasing the effectiveness of cognitive therapy for anxiety would be to induce anxiety in subjects while they were learning the cognitive restructuring principles (i.e., during treatment). Thirty-two undergraduate volunteers were randomly assigned to one of six experimental conditions. Subjects in the five treatment conditions (the sixth was a no-treatment control condition) met for three sessions of cognitive restructuring,in vivo exposure, or a facts lecture (i.e., the placebo group). Results indicated that when working with spider phobics, three sessions of cognitive restructuring,in vivo exposure, or a facts lecture resulted in equal effectiveness immediately following treatment, but are more effective than no-treatment at all.     

Prediction of treatment outcome in social phobia: a cross-validation.

This study was a replication of a study on the prediction of treatment outcome in social phobic patients [Chambless, D. L., Tran, G. Q. Glass, C.R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11 221-240]. Results at the posttest and the 18-months follow-up were analyzed for DSM-III-R social phobic patients, with either a generalized social phobia (n = 50) or a nongeneralized fear, i.e. fear of blushing, trembling or sweating in social situations (n = 26). Predictors were pretreatment depression, personality disorder traits, clinician rated severity of impairment and frequency of negative self-statements during social interactions. The criterium variable was (the residual gain score of) self-reported avoidance of social situations. In line with Chambless et al., pretreatment depression showed some predictive value, but smaller and only at the posttest. Change in the frequency of negative self-statements paralleled, but did not predict, change in social phobia symptoms. In contrast with Chambless et al., clinician rated severity was (slightly) predictive for treatment outcome, whereas avoidant personality traits had reverse correlations with outcome in both subgroups. The results are discussed and directions for further research are given.     

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.     

Semi-automated desensitization : a controlled clinical trial

A clinical trial of semi-automated desensitization on phobic patients. Twelve received treatment with a therapist present and 12 received treatment from pre-recorded tapes. Therapy lasted a maximum of 16 weekly sessions. Assessment of progress was by means of self-ratings of phobic behaviour and more global fear ratings, made by the referring psychiatrist. Both treatments produced beneficial results. Both ratings agreed in finding no significant differences between the two methods of administration, thus confirming results from existing non-clinical trials of automated desensitization. Regardless of treatment group, agoraphobics and social phobics tended to improve less markedly, and less rapidly than simple phobics. Some implications of automated therapy for clinical practice are discussed.     

Scary and nasty beasts: Self-reported fear and disgust of common phobic animals

Animal phobias are one of the most prevalent mental disorders. We analysed how fear and disgust, two emotions involved in their onset and maintenance, are elicited by common phobic animals. In an online survey, the subjects rated 25 animal images according to elicited fear and disgust. Additionally, they completed four psychometrics, the Fear Survey Schedule II (FSS), Disgust Scale – Revised (DS-R), Snake Questionnaire (SNAQ), and Spider Questionnaire (SPQ). Based on a redundancy analysis, fear and disgust image ratings could be described by two axes, one reflecting a general negative perception of animals associated with higher FSS and DS-R scores and the second one describing a specific aversion to snakes and spiders associated with higher SNAQ and SPQ scores. The animals can be separated into five distinct clusters: (1) non-slimy invertebrates; (2) snakes; (3) mice, rats, and bats; (4) human endo- and exoparasites (intestinal helminths and louse); and (5) farm/pet animals. However, only snakes, spiders, and parasites evoke intense fear and disgust in the non-clinical population. In conclusion, rating animal images according to fear and disgust can be an alternative and reliable method to standard scales. Moreover, tendencies to overgeneralize irrational fears onto other harmless species from the same category can be used for quick animal phobia detection.     

The effect of very brief exposure on experienced fear after in vivo exposure

Two experiments tested the effect of exposure to masked phobic stimuli at a very brief stimulus onset asynchrony on reducing the subjective experience of fear caused by in vivo exposure to a feared object. In the main experiment, 35 spider-fearful and 35 non-fearful participants were identified with a questionnaire and a Behavioural Avoidance Test (BAT) with a live tarantula. One week later, they were individually administered one of two continuous series of masked images: spiders or flowers. They engaged in the BAT again immediately thereafter. They provided ratings of subjective fear at the end of each BAT (pre- and post-manipulation). Very brief exposure to images of spiders reduced the fearful group's and not the non-fearful group's experience of fear at the end of the BAT. This effect was replicated with another sample of 26 spider-fearful participants from the same population. Theoretical implications are discussed.