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129-441: Phobias can be divided into specific phobias , social anxiety disorder , and agoraphobia . Specific phobias are further divided to include certain animals, natural environment, blood or injury, and particular situations. The most common are fear of spiders , fear of snakes , and fear of heights . Specific phobias may be caused by a negative experience with the object or situation in early childhood to early adulthood. Social phobia

258-454: A conditioned response (CR) (fear for the room) (CS+UCS=CR). For example, in case of the fear of heights ( acrophobia ), the CS is heights. Such as a balcony on the top floors of a high rise building. The UCS can originate from an aversive or traumatizing event in the person's life, such as almost falling from a great height. The original fear of nearly falling is associated with being high, leading to

387-495: A 2014 study found evidence against this evolutionary theory, which stated: "Our findings are inconsistent with the hypothesis that fears/phobias of individual stimuli result from genetic and environmental factors unique to that stimulus. Instead, we observed substantial sharing of risk factors across individual fears." There is also evidence for the validity of a genetic component contributing to blood-injection-injury phobias and animal phobias , although this evidence did not support

516-414: A CS than it does for a novel stimulus to become a CS, when the stimulus is paired with an effective US. This is one of the most common ways to measure the strength of learning in classical conditioning. A typical example of this procedure is as follows: a rat first learns to press a lever through operant conditioning . Then, in a series of trials, the rat is exposed to a CS, a light or a noise, followed by

645-546: A US through forward conditioning. Then a second neutral stimulus ("CS2") is paired with the first (CS1) and comes to yield its own conditioned response. For example: A bell might be paired with food until the bell elicits salivation. If a light is then paired with the bell, then the light may come to elicit salivation as well. The bell is the CS1 and the food is the US. The light becomes the CS2 once it

774-498: A US. A compound CS (CS1+CS2) is paired with a US. A separate test for each CS (CS1 and CS2) is performed. The blocking effect is observed in a lack of conditional response to CS2, suggesting that the first phase of training blocked the acquisition of the second CS. [REDACTED] Experiments on theoretical issues in conditioning have mostly been done on vertebrates , especially rats and pigeons. However, conditioning has also been studied in invertebrates , and very important data on

903-671: A combination of both. Medications used include antidepressants , benzodiazepines , or beta-blockers . Specific phobias affect about 6–8% of people in the Western world and 2–4% in Asia, Africa, and Latin America in a given year. Social phobia affects about 7% of people in the United States and 0.5–2.5% of people in the rest of the world. Agoraphobia affects about 1.7% of people. Women are affected by phobias about twice as often as men. The typical onset of

1032-537: A combination of environmental and genetic factors. The degree to whether environment or genetic influences have a more significant role varies by condition, with social anxiety disorder and agoraphobia having around a 50% heritability rate. Rachman proposed three pathways for the development of phobias: direct or classical conditioning (exposure to phobic stimulus), vicarious acquisition (seeing others experience phobic stimulus), and informational/instructional acquisition (learning about phobic stimulus from others). Much of

1161-638: A common form of anxiety disorder , and distributions are heterogeneous by age and gender. An American study by the National Institute of Mental Health (NIMH) found that between 8.7 percent and 18.1 percent of Americans have phobias, making it the most common mental illness among women in all age groups and the second most common illness among men older than 25. Between 4 percent and 10 percent of all children experience specific phobias during their lives, and social phobias occur in one percent to three percent of children. A Swedish study found that females have

1290-457: A correlation between increased insular activation and anxiety. In the frontal lobes, other cortices involved with phobia and fear are the anterior cingulate cortex and the medial prefrontal cortex . In the processing of emotional stimuli, studies on phobic reactions to facial expressions have indicated that these areas are involved in the processing and responding to negative stimuli. The ventromedial prefrontal cortex has been said to influence

1419-480: A deficiency in amygdala habituation may also contribute to the persistence of non-experiential phobia. Certain phobias that are less lethal (e.g. dogs) seem to be more frequently observed and easily acquired in comparison to potentially lethal fears which are more relevant to developed human society (e.g. cars and guns). This was theorised to be due to biological adaptation being passed through evolution which makes recent threats less prone to easy acquisition. However,

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1548-445: A desire to escape the situation. The exact cause of specific phobias is not known. The mechanisms for development of specific phobias can be distinguished between innate (genetic and neurobiological) factors, and learned factors. In neurobiology, one explanation proposed for specific phobia is that the typical activation of the amygdala in response to stimuli may be exaggerated due to pathological changes. According to this theory,

1677-462: A dog's saliva produced as a CR differed in composition from that produced as a UR. The CR is sometimes even the opposite of the UR. For example: the unconditional response to electric shock is an increase in heart rate, whereas a CS that has been paired with the electric shock elicits a decrease in heart rate. (However, it has been proposed that only when the UR does not involve the central nervous system are

1806-496: A fear of heights. In other words, the CS (heights) associated with the aversive UCS (almost falling) leads to the CR (fear) . It is possible, however, to extinguish the CR, and reversing the effects of the CS and UCS. Repeatedly presenting the CS alone, without the UCS, can exinguish the CR. Though historically influential in the theory of fear acquisition, this direct conditioning model is not

1935-420: A great load of difficulty in life. Patients have a lot of distress or interference when functioning in their daily life. Unreasonable or irrational fears get in the way of daily routines, work, and relationships due to the effort that a patient makes to avoid the terrifying feelings associated with the fear. Females are twice as likely to be diagnosed than males with a specific phobia (although this can depend on

2064-612: A higher number of cases per year than males (26.5 percent for females and 12.4 percent for males). Among adults, 21.2 percent of women and 10.9 percent of men have a single specific phobia, while multiple phobias occur in 5.4 percent of females and 1.5 percent of males. Women are nearly four times as likely as men to have a fear of animals (12.1 percent in women and 3.3 percent in men) — a higher dimorphic than with all specific or generalized phobias or social phobias. Social phobias are more common in girls than boys, while situational phobia occurs in 17.4 percent of women and 8.5 percent of men. In

2193-439: A more chronic course. Specific phobias in older adults has been linked with a decrease in quality of life. Those with specific phobias are at an increased risk of suicide. Greater impairment is found in those that have multiple phobias. Response to treatment is relatively high but many do not seek treatment due to lack of access, ability to avoid phobia, or unwilling to face feared object for repeated CBT sessions. Specific phobia

2322-440: A more chronic course. Specific phobias in older adults has been linked with a decrease in quality of life. Those with specific phobias are at an increased risk of suicide. Greater impairment is found in those that have multiple phobias. Response to treatment is relatively high but many do not seek treatment due to lack of access, ability to avoid phobia, or unwilling to face feared object for repeated CBT sessions. Many of those with

2451-451: A negative associate strength) then R-W predicts that the CS will not undergo extinction (its V will not decrease in size). The most important and novel contribution of the R–W model is its assumption that the conditioning of a CS depends not just on that CS alone, and its relationship to the US, but also on all other stimuli present in the conditioning situation. In particular, the model states that

2580-414: A phobia is around 10–17, and rates are lower with increasing age. Those with phobias are more likely to attempt suicide . Fear is an emotional response to a current perceived danger. This differs from anxiety which is a response in preparation of a future threat. Fear and anxiety often can overlap but this distinction can help identify subtle differences between disorders, as well as differentiate between

2709-511: A phobia often have more than one phobia. There are also a number of psychological and physiological disorders that tend to occur or coexist at higher rates among this population. As with all anxiety disorders the most common psychiatric condition to occur with a phobia is major depressive disorder. Additionally bipolar disorder, substance dependence disorder, obsessive-compulsive disorder, and post traumatic stress disorder have also been found to occur in those with phobias at higher rates. Phobias are

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2838-439: A phobic event, these symptoms are decreased, making the event less frightening. Beta-blockers are not effective for generalized social anxiety disorder. Hypnotherapy is another effective therapy that uses hypnosis to help manage anxiety and stress. This therapy can help people gain control over their phobias. Hypnotherapy can be used alone and in conjunction with systematic desensitization to treat phobias. Through hypnotherapy,

2967-404: A piece of cardboard. A key idea behind the R–W model is that a CS signals or predicts the US. One might say that before conditioning, the subject is surprised by the US. However, after conditioning, the subject is no longer surprised, because the CS predicts the coming of the US. (The model can be described mathematically and that words like predict, surprise, and expect are only used to help explain

3096-501: A procedure that enabled him to study the digestive processes of animals over long periods of time. He redirected the animals' digestive fluids outside the body, where they could be measured. Pavlov noticed that his dogs began to salivate in the presence of the technician who normally fed them, rather than simply salivating in the presence of food. Pavlov called the dogs' anticipatory salivation "psychic secretion". Putting these informal observations to an experimental test, Pavlov presented

3225-467: A puff of air directed at a person's eye could be followed by the sound of a buzzer. In temporal conditioning, a US is presented at regular intervals, for instance every 10 minutes. Conditioning is said to have occurred when the CR tends to occur shortly before each US. This suggests that animals have a biological clock that can serve as a CS. This method has also been used to study timing ability in animals (see Animal cognition ). The example below shows

3354-419: A replica of the unconditioned response, but Pavlov noted that saliva produced by the CS differs in composition from that produced by the US. In fact, the CR may be any new response to the previously neutral CS that can be clearly linked to experience with the conditional relationship of CS and US. It was also thought that repeated pairings are necessary for conditioning to emerge, but many CRs can be learned with

3483-772: A response that would be expected given a person's developmental stage and culture. The International Classification of Diseases (11th version: ICD-11 ) is a globally used diagnostic tool for epidemiology , health management and clinical purposes maintained by the World Health Organization (WHO) . The ICD classifies phobic disorders under the category of mental, behavioural or neurodevelopmental disorders. The ICD-10 differentiates between Phobic anxiety disorders, such as Agoraphobia, and Other anxiety disorders, such as Generalized anxiety disorder. The ICD-11 merges both groups together as Anxiety or fear-related disorders. Most phobias are classified into 3 categories. According to

3612-403: A role in the storage of threatening stimuli to memory. The basolateral nuclei (or basolateral amygdala ) and the hippocampus interact with the amygdala in-memory storage. This connection suggests why memories are often remembered more vividly if they have emotional significance. In addition to memory, the amygdala also triggers the secretion of hormones that affect fear and aggression . When

3741-428: A single trial, especially in fear conditioning and taste aversion learning. Learning is fastest in forward conditioning. During forward conditioning, the onset of the CS precedes the onset of the US in order to signal that the US will follow. Two common forms of forward conditioning are delay and trace conditioning. [REDACTED] During simultaneous conditioning, the CS and US are presented and terminated at

3870-422: A specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything. Although fears are common and normal, a phobia is an extreme type of fear where great lengths are taken to avoid being exposed to

3999-665: A specific phobia. Exposure therapy is a particularly effective form of CBT for many specific phobias, however, treatment acceptance and high drop-out rates have been noted as concerns. In addition, a third of people who complete exposure therapy as a treatment for specific phobia may not respond, regardless of the type of exposure therapy. Other interventions have been successful for particular types of specific phobia, such as virtual reality exposure therapy (VRET) for spider, dental, and height phobias, applied muscle tension (AMT) for needle phobia, and psychoeducation with relaxation exercises for fear of childbirth. With exposure therapy,

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4128-408: A specific trauma, such as a fear of dogs following a dog bite. Systematic desensitization is a process in which people seeking help slowly become accustomed to their phobia, and ultimately overcome it. Traditional systematic desensitization involves a person being exposed to the object they are afraid of over time so that the fear and discomfort do not become overwhelming. This controlled exposure to

4257-413: A stimulus (e.g. the sound of a metronome ) and then gave the dog food; after a few repetitions, the dogs started to salivate in response to the stimulus. Pavlov concluded that if a particular stimulus in the dog's surroundings was present when the dog was given food then that stimulus could become associated with food and cause salivation on its own. In Pavlov's experiments the unconditioned stimulus (US)

4386-406: A temporal lobectomy, or removal of the temporal lobes, results in changes involving fear and aggression. Specifically, the removal of these lobes results in decreased fear, confirming its role in fear recognition and response. Damage to both side (Bilateral damage) of the medial temporal lobes is known as Urbach–Wiethe disease. It presents with similar symptoms of decreased fear and aggression but with

4515-582: A treatment approach that included cognitive techniques and exposure therapy. He recommended that individuals gradually expose themselves to feared stimuli and train themselves to tolerate the experience until they reach habituation, an approach that mirrors modern therapeutic techniques for treating phobias. This is an exceptional accomplishment considering that the physical symptoms of phobias were mistakenly grouped under physical rubrics in Western medical textbooks and were not believed to be associated with phobias until

4644-522: A treatment option. For social anxiety, the SSRIs sertraline, paroxetine, fluvoxamine, and the SNRI venlafaxine have FDA approval. Similar medications may be offered for agoraphobia. Sedatives such as benzodiazepines (clonazepam, alprazolam) are another therapeutic option, which can help people relax by reducing the amount of anxiety they feel. Benzodiazepines may be useful in the acute treatment of severe symptoms, but

4773-968: A type of cognitive-behavioural therapy, clinically significant improvement was experienced by up to 90% of patients. While very long-term outcomes remain unknown, many of the benefits of exposure therapy persisted after one year. Treatment may be more successful at reducing symptoms in people with low trait anxiety, high motivation, and high self-efficacy entering exposure therapy. In addition, high cortisol levels, high heart rate variation, evoking disgust, avoiding relaxation, focusing on cognitive changes, context variation, sleep, and memory-enhancing drugs can also reduce symptoms following exposure therapy. Exposure can be "live"(in real life) or imaginal (in ones imagination) and can involve: Exposures that are imaginal are less effective. Specifically for acrophobia, in-vivo exposure (exposure to real-world height-scenarios while maintaining anxiety at controlled levels) has been shown to significantly improve measures of anxiety in

4902-444: A weak stimulus is presented. During acquisition, the CS and US are paired as described above. The extent of conditioning may be tracked by test trials. In these test trials, the CS is presented alone and the CR is measured. A single CS-US pairing may suffice to yield a CR on a test, but usually a number of pairings are necessary and there is a gradual increase in the conditioned response to the CS. This repeated number of trials increase

5031-434: Is a basic behavioral mechanism, and its neural substrates are now beginning to be understood. Though it is sometimes hard to distinguish classical conditioning from other forms of associative learning (e.g. instrumental learning and human associative memory ), a number of observations differentiate them, especially the contingencies whereby learning occurs. Together with operant conditioning , classical conditioning became

5160-463: Is a behavioral procedure in which a biologically potent stimulus (e.g. food, a puff of air on the eye, a potential rival) is paired with a neutral stimulus (e.g. the sound of a musical triangle ). The term classical conditioning refers to the process of an automatic, conditioned response that is paired with a specific stimulus. The Russian physiologist Ivan Pavlov studied classical conditioning with detailed experiments with dogs, and published

5289-751: Is childhood to adolescence. During childhood and adolescence, the incidence of new specific phobias is much higher in females than males. The peak incidence for specific phobias amongst females occurs during reproduction and childrearing, possibly reflecting an evolutionary advantage. There is an additional peak in incidence, reaching nearly 1% per year, during old age in both men and women, possibly reflective of newly occurring physical conditions or adverse life events. The development of phobias varies with subtypes, with animal and blood injection phobias typically beginning in childhood (ages 5–12), whereas development of situational specific phobias (i.e., fear of flying) usually occurs in late adolescence and early adulthood. In

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5418-539: Is defined as behaviour that results in the omission of an aversive event that would otherwise occur, intending to prevent anxiety. With the completion of the Human Genome Project in 2003, much research has been completed looking at specific genes that may cause or contribute to medical conditions. Candidate genes were the focus of most of these studies until the past decade, when the cost and ability to perform genome-wide analyses became more available. The GLRB gene

5547-469: Is estimated to affect 6–12% of people at some point in their life. There may be a large amount of underreporting of specific phobias as many people do not seek treatment, with some surveys conducted in the US finding that 70% of the population reports having one or more unreasonable fears. Specific phobias have a lifetime prevalence rate of 7.4% and a one-year prevalence of 5.5% according to data collected from 22 different countries. The usual age of onset

5676-553: Is irrational but cannot override their panic response. These individuals often report dizziness, loss of bladder or bowel control, tachypnea , feelings of pain, and shortness of breath. Phobias may develop for a variety of reasons. Childhood experiences, past traumatic experiences, brain chemistry, genetics, or learned behavior, can all be reasons why phobias develop. There are even phobias that may run in families and be passed down from one generation to another. There are multiple theories about how phobias develop and likely occur due to

5805-433: Is linked to social phobia and other anxiety disorders. The amygdala's ability to respond to fearful stimuli occurs through fear conditioning . Like classical conditioning , the amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear response often seen in phobic individuals. The amygdala is responsible for recognizing certain stimuli or cues as dangerous and plays

5934-422: Is not always a phobia. There must also be symptoms of impairment and avoidance. Impairment is defined as an inability to complete routine tasks, whether occupational, academic, or social. For example, an occupational impairment can result from acrophobia, from not taking a job solely because of its location on the top floor of a building, or socially not participating in an event at a theme park. The avoidance aspect

6063-561: Is not itself a symptom of specific phobias and falls under the criteria of panic disorder . There are a variety of treatment options available for specific phobias, most of which focus on psychosocial interventions . Different psychological treatments have varying levels of effects depending on the specific phobia being addressed. Cognitive behavioral therapy is a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior. CBT represents

6192-431: Is one that is not regularly encountered such as flying a short course may be provided. Beta blockers (propranolol) are another therapeutic option, particularly for those with the performance only subtype of social anxiety disorder. They may stop the stimulating effects of adrenaline, such as sweating, increased heart rate, elevated blood pressure, tremors, and the feeling of a pounding heart. By taking beta-blockers before

6321-493: Is paired with a US until asymptotic CR levels are reached. CS+/US trials are continued, but these are interspersed with trials on which the CS+ is paired with a second CS, (the CS-) but not with the US (i.e. CS+/CS- trials). Typically, organisms show CRs on CS+/US trials, but stop responding on CS+/CS− trials. This form of classical conditioning involves two phases. A CS (CS1) is paired with

6450-401: Is paired with the CS1. [REDACTED] Backward conditioning occurs when a CS immediately follows a US. Unlike the usual conditioning procedure, in which the CS precedes the US, the conditioned response given to the CS tends to be inhibitory. This presumably happens because the CS serves as a signal that the US has ended, rather than as a signal that the US is about to appear. For example,

6579-454: Is paired with the emotional experience of being bitten by a dog, resulting in a chronic fear which is described as a specific phobia to dogs. An alternative proposed mechanism of association is through observational learning . According to this theory, a person may internalize another person's fears about a specific object or situation through observation of their reactions. Diagnosis in the ICD or

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6708-481: Is repeated the organism exhibits a conditioned response (CR) to the conditioned stimulus when the conditioned stimulus is presented alone. (A conditioned response may occur after only one pairing.) Thus, unlike the UR, the CR is acquired through experience, and it is also less permanent than the UR. Usually the conditioned response is similar to the unconditioned response, but sometimes it is quite different. For this and other reasons, most learning theorists suggest that

6837-400: Is the response to the conditioned stimulus, whereas the unconditioned response (UR) corresponds to the unconditioned stimulus. Pavlov reported many basic facts about conditioning; for example, he found that learning occurred most rapidly when the interval between the CS and the appearance of the US was relatively short. As noted earlier, it is often thought that the conditioned response is

6966-472: Is there to help manage stressful situations and respond better. This therapy requires the person to be honest with themselves and confront their feelings and phobias. Cognitive Behavioral Therapy can be beneficial by allowing the person to challenge dysfunctional thoughts or beliefs by being mindful of their feelings to recognize that their fear is irrational. CBT may occur in a group setting. Gradual desensitization treatment and CBT are often successful, provided

7095-469: Is when a person fears a situation due to worries about others judging them. Agoraphobia is a fear of a situation due to perceived difficulty or inability to escape. It is recommended that specific phobias be treated with exposure therapy , in which the person is introduced to the situation or object in question until the fear resolves. Medications are not helpful for specific phobias. Social phobia and agoraphobia may be treated with counseling, medications, or

7224-488: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ), such phobias are considered subtypes of anxiety disorder. The categories are: Phobias vary in severity among individuals. Some individuals can avoid the subject and experience relatively mild anxiety over that fear. Others experience full-fledged panic attacks with all the associated impairing symptoms. Most individuals understand that their fear

7353-433: The cingulated gyrus , hippocampus , corpus callosum , and other nearby cortices. This system has been found to play a role in emotion processing, and the insula, in particular, may contribute to maintaining autonomic functions . Studies by Critchley et al. indicate the insula as being involved in the experience of emotion by detecting and interpreting threatening stimuli. Similar studies monitoring insula activity have shown

7482-446: The false consensus effect . Classical conditioning occurs when a conditioned stimulus (CS) is paired with an unconditioned stimulus (US). Usually, the conditioned stimulus is a neutral stimulus (e.g., the sound of a tuning fork ), the unconditioned stimulus is biologically potent (e.g., the taste of food) and the unconditioned response (UR) to the unconditioned stimulus is an unlearned reflex response (e.g., salivation). After pairing

7611-544: The 19th century. The Western understanding of phobias as a physical condition was influenced by a combination of medical dogma and a limited understanding of psychology and mental health. This view persisted from antiquity through the Renaissance and into the 19th century, until more nuanced psychological frameworks were developed. Specific phobias Specific phobia is an anxiety disorder , characterized by an extreme, unreasonable, and irrational fear associated with

7740-422: The 2 year remission rates for anxiety disorders found that those with multiple anxieties were less likely to experience remission. The majority of those that develop a specific phobia first experience symptoms in childhood. Often individuals will experience symptoms periodically with periods of remission before complete remission occurs. However, specific phobias that continue into adulthood are likely to experience

7869-463: The 9th century, Islamic polymath Abu Zayd al-Balkhi (850-934) was likely the first to identify phobias accurately. In his treatise Sustenance of the Body and Soul , Al Balkhi described phobia as a psychological disorder that may manifest with physical symptoms such as paleness of the skin and trembling of the hands. Remarkably, Al-Balkhi not only recognised phobias as psychological in nature but also proposed

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7998-420: The CR and the UR opposites.) The Rescorla–Wagner (R–W) model is a relatively simple yet powerful model of conditioning. The model predicts a number of important phenomena, but it also fails in important ways, thus leading to a number of modifications and alternative models. However, because much of the theoretical research on conditioning in the past 40 years has been instigated by this model or reactions to it,

8127-424: The CR is said to be "extinguished." [REDACTED] External inhibition may be observed if a strong or unfamiliar stimulus is presented just before, or at the same time as, the CS. This causes a reduction in the conditioned response to the CS. Several procedures lead to the recovery of a CR that had been first conditioned and then extinguished. This illustrates that the extinction procedure does not eliminate

8256-415: The CS and the US causes a gradual increase in the associative strength of the CS. This increase is determined by the nature of the US (e.g. its intensity). The amount of learning that happens during any single CS-US pairing depends on the difference between the total associative strengths of CS and other stimuli present in the situation (ΣV in the equation), and a maximum set by the US (λ in the equation). On

8385-456: The CS. As a result of this "surprising" outcome, the associative strength of the CS takes a step down. Extinction is complete when the strength of the CS reaches zero; no US is predicted, and no US occurs. However, if that same CS is presented without the US but accompanied by a well-established conditioned inhibitor (CI), that is, a stimulus that predicts the absence of a US (in R-W terms, a stimulus with

8514-416: The CS. In the equation, V represents the current associative strength of the CS, and ∆V is the change in this strength that happens on a given trial. ΣV is the sum of the strengths of all stimuli present in the situation. λ is the maximum associative strength that a given US will support; its value is usually set to 1 on trials when the US is present, and 0 when the US is absent. α and β are constants related to

8643-554: The DSM requires a marked fear, anxiety or avoidance that is long-lasting (greater than six months) and consistently occurs in the presence of the feared object or situation. The DSM-5 that the fears should be out of proportion to the danger posed, compared to the ICD-10 which specifies that the symptoms must be excessive or unreasonable. Minor differences have persisted between the ICD-11 and DSM-5. In

8772-488: The DSM-5, there are several types which specific phobia can be classified under: Although the avoidance resulting from specific phobia is comparable to other anxiety disorders, differential diagnosis is done through examining underlying causes for the behavior. Agoraphobia is also considered distinct from specific phobia, along with substance use disorders , and avoidant personality disorder . The occurrence of panic attacks

8901-589: The NMDA receptor partial agonist, d-cycloserine , with virtual reality exposure therapy may improve specific phobia symptoms more than virtual reality exposure therapy alone. As of 2020, studies on the use of adjunct d-cycloserine are inconclusive. The majority of those that develop a specific phobia first experience symptoms in childhood. Often individuals will experience symptoms periodically with periods of remission before complete remission occurs. However, specific phobias that continue into adulthood are likely to experience

9030-461: The Rescorla-Wagner equation. It specifies the amount of learning that will occur on a single pairing of a conditioning stimulus (CS) with an unconditioned stimulus (US). The above equation is solved repeatedly to predict the course of learning over many such trials. In this model, the degree of learning is measured by how well the CS predicts the US, which is given by the "associative strength" of

9159-416: The R–W model deserves a brief description here. The Rescorla-Wagner model argues that there is a limit to the amount of conditioning that can occur in the pairing of two stimuli. One determinant of this limit is the nature of the US. For example: pairing a bell with a juicy steak is more likely to produce salivation than pairing the bell with a piece of dry bread, and dry bread is likely to work better than

9288-402: The US is fully predicted, the associative strength of the CS stops growing, and conditioning is complete. The associative process described by the R–W model also accounts for extinction (see "procedures" above). The extinction procedure starts with a positive associative strength of the CS, which means that the CS predicts that the US will occur. On an extinction trial the US fails to occur after

9417-411: The US is predicted by the sum of the associative strengths of all stimuli present in the conditioning situation. Learning is controlled by the difference between this total associative strength and the strength supported by the US. When this sum of strengths reaches a maximum set by the US, conditioning ends as just described. The R–W explanation of the blocking phenomenon illustrates one consequence of

9546-516: The US, a mild electric shock. An association between the CS and US develops, and the rat slows or stops its lever pressing when the CS comes on. The rate of pressing during the CS measures the strength of classical conditioning; that is, the slower the rat presses, the stronger the association of the CS and the US. (Slow pressing indicates a "fear" conditioned response, and it is an example of a conditioned emotional response; see section below.) Typically, three phases of conditioning are used. A CS (CS+)

9675-418: The US, but the US also occurs at other times. If this occurs, it is predicted that the US is likely to happen in the absence of the CS. In other words, the CS does not "predict" the US. In this case, conditioning fails and the CS does not come to elicit a CR. This finding – that prediction rather than CS-US pairing is the key to conditioning – greatly influenced subsequent conditioning research and theory. In

9804-497: The US, the lifetime prevalence rate is 12.5% and a one-year prevalence rate of 9.1%. An estimated 12.5% of U.S. adults experience specific phobia at some time in their lives and the prevalence is approximately double in females compared to males. An estimated 19.3% of adolescents experience specific phobia, but the difference between males and females is not as pronounced. Conditioned stimulus Classical conditioning (also respondent conditioning and Pavlovian conditioning )

9933-406: The acquisition of any new behavior, but rather the tendency to respond in old ways to new stimuli. Thus, he theorized that the CS merely substitutes for the US in evoking the reflex response. This explanation is called the stimulus-substitution theory of conditioning. A critical problem with the stimulus-substitution theory is that the CR and UR are not always the same. Pavlov himself observed that

10062-467: The activities become more difficult. Progressive muscle relaxation helps people relax before and during exposure to the feared stimulus. Virtual reality therapy is another technique that helps phobic people confront a feared object. It uses virtual reality to generate scenes that may not have been possible or ethical in the physical world. It is equally as effective as traditional exposure therapy and offers additional advantages. These include controlling

10191-408: The addition of the inability to recognize emotional expressions, especially angry or fearful faces. The amygdala's role in learned fear includes interactions with other brain regions in the neural circuit of fear. While damage in the amygdala can inhibit its ability to recognize fearful stimuli, other areas such as the ventromedial prefrontal cortex and the basolateral nuclei of the amygdala can affect

10320-404: The ages of 7 and 9 reflective of normal development. Additionally, specific phobias are most prevalent in children between the ages 10 and 13. Situational phobias are typically found in older children and adults. There are various methods used to treat phobias. These methods include systematic desensitization , progressive relaxation, virtual reality , modeling, medication, and hypnotherapy. Over

10449-612: The amygdala activates this circuit, while the hippocampus is responsible for suppressing it. Glucocorticoid receptors in the hippocampus monitor the amount of cortisol in the system and through negative feedback can tell the hypothalamus to stop releasing CRH. Studies on mice engineered to have high concentrations of CRH showed higher levels of anxiety, while those engineered to have no or low amounts of CRH receptors were less anxious. In people with phobias, therefore, high amounts of cortisol may be present, or there may be low levels of glucocorticoid receptors or even serotonin (5-HT). For

10578-449: The amygdala by monitoring its reaction to emotional stimuli or even fearful memories. Most specifically, the medial prefrontal cortex is active during the extinction of fear and is responsible for long-term extinction. Stimulation of this area decreases conditioned fear responses, so its role may be in inhibiting the amygdala and its reaction to fearful stimuli. The hippocampus is a horseshoe-shaped structure that plays an essential part in

10707-416: The amygdala) has been shown to slow down the speed of extinguishing a learned fear response and how effective the extinction is. This suggests there is a pathway or circuit among the amygdala and nearby cortical areas that process emotional stimuli and influence emotional expression, all of which can be disrupted when damage occurs. It is recommended that the terms distress and impairment take into account

10836-427: The anxiety-provoking stimulus is key to the effectiveness of exposure therapy in the treatment of specific phobias. It has been shown that humor is an excellent alternative when traditional systematic desensitization is ineffective. Humor systematic desensitization involves a series of treatment activities that elicit humor with the feared object. Previously learned progressive muscle relaxation procedures can be used as

10965-436: The areas in the brain involved in emotion - most specifically, fear - the processing and response to emotional stimuli can be altered when there are damage to any of these regions. Damage to the cortical areas involved in the limbic system, such as the cingulate cortex or frontal lobes, has resulted in extreme emotion changes. Other types of damage include Klüver–Bucy syndrome and Urbach–Wiethe disease . In Klüver–Bucy syndrome,

11094-465: The association of stimuli as described above, whereas in operant conditioning behaviors are modified by the effect they produce (i.e., reward or punishment). The best-known and most thorough early work on classical conditioning was done by Ivan Pavlov , although Edwin Twitmyer published some related findings a year earlier. During his research on the physiology of digestion in dogs, Pavlov developed

11223-423: The assumption just stated. In blocking (see "phenomena" above), CS1 is paired with a US until conditioning is complete. Then on additional conditioning trials a second stimulus (CS2) appears together with CS1, and both are followed by the US. Finally CS2 is tested and shown to produce no response because learning about CS2 was "blocked" by the initial learning about CS1. The R–W model explains this by saying that after

11352-419: The brain's limbic system . This is because it forms memories and connects them with emotions and the senses. When dealing with fear, the hippocampus receives impulses from the amygdala that allow it to connect the fear with a certain sense, such as a smell or sound. The amygdala is an almond-shaped mass of nuclei located deep in the brain's medial temporal lobe. It processes the events associated with fear and

11481-455: The chance of fearful and phobic behaviours. In some cases, physically experiencing an event may increase the fear and phobia more than observing a fearful reaction of another human or non-human primate. Informational/instructional fear acquisition is learning to fear something by getting information. For instance, fearing electrical wire after hearing that touching it causes an electric shock. A conditioned fear response to an object or situation

11610-597: The child can also become afraid of the animal. Through observational learning, humans can learn to fear potentially dangerous objects—a reaction observed in other primates. A study on non-human primates, showed that the primates learned to fear snakes at a fast rate after watching parents' fearful reactions. An increase in fearful behaviours was observed as the non-human primates observed their parents' fearful reactions. Although observational learning has proven effective in creating reactions of fear and phobias, it has also been shown that by physically experiencing an event, increases

11739-526: The conditioned stimulus comes to signal or predict the unconditioned stimulus, and go on to analyse the consequences of this signal. Robert A. Rescorla provided a clear summary of this change in thinking, and its implications, in his 1988 article "Pavlovian conditioning: It's not what you think it is". Despite its widespread acceptance, Rescorla's thesis may not be defensible. Classical conditioning differs from operant or instrumental conditioning : in classical conditioning, behaviors are modified through

11868-400: The context of the person's environment during diagnosis. The DSM-IV-TR states that if a feared stimulus, whether it be an object or a situation, is absent entirely in an environment, a diagnosis cannot be made. An example of this situation would be an individual who has a fear of mice but lives in an area without mice. Even though the concept of mice causes marked distress and impairment within

11997-413: The effect of conditioning. These procedures are the following: Stimulus generalization is said to occur if, after a particular CS has come to elicit a CR, a similar test stimulus is found to elicit the same CR. Usually the more similar the test stimulus is to the CS the stronger the CR will be to the test stimulus. Conversely, the more the test stimulus differs from the CS, the weaker the CR will be, or

12126-490: The experimental results in 1897. In the study of digestion , Pavlov observed that the experimental dogs salivated when fed red meat. Pavlovian conditioning is distinct from operant conditioning (instrumental conditioning), through which the strength of a voluntary behavior is modified, either by reinforcement or by punishment . However, classical conditioning can affect operant conditioning; classically conditioned stimuli can reinforce operant responses. Classical conditioning

12255-580: The extinction procedure, the CS is presented repeatedly in the absence of a US. This is done after a CS has been conditioned by one of the methods above. When this is done, the CR frequency eventually returns to pre-training levels. However, extinction does not eliminate the effects of the prior conditioning. This is demonstrated by spontaneous recovery – when there is a sudden appearance of the (CR) after extinction occurs – and other related phenomena (see "Recovery from extinction" below). These phenomena can be explained by postulating accumulation of inhibition when

12384-422: The fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an "alert" state, which prepares the individual to move, run, fight, etc. This defensive "alert" state and response are known as the fight-or-flight response . However, inside the brain, this stress response can be observed in the hypothalamic-pituitary-adrenal axis (HPA). This circuit incorporates

12513-426: The first pairing of the CS and US, this difference is large and the associative strength of the CS takes a big step up. As CS-US pairings accumulate, the US becomes more predictable, and the increase in associative strength on each trial becomes smaller and smaller. Finally, the difference between the associative strength of the CS (plus any that may accrue to other stimuli) and the maximum strength reaches zero. That is,

12642-468: The foundation of behaviorism , a school of psychology which was dominant in the mid-20th century and is still an important influence on the practice of psychological therapy and the study of animal behavior. Classical conditioning has been applied in other areas as well. For example, it may affect the body's response to psychoactive drugs , the regulation of hunger, research on the neural basis of learning and memory, and in certain social phenomena such as

12771-421: The gold standard and first line of therapy in specific phobias. CBT is effective in treating specific phobias primarily through exposure and cognitive strategies to overcome a person's anxiety. Computer-assisted treatment programs, self-help manuals, and delivery by a trained practitioner are all methods of accessing CBT. A single session of CBT in one of these modalities can be effective for individuals who have

12900-420: The idea that other specific phobias had genetic influence. Blood-injection-injury phobias are also believed to be the most heritable among specific phobias. The classical conditioning model of learning has also been used to suggest that a phobia will be learned when an event that causes a fear or anxiety reaction is paired with a neutral event. An example of this model is when being near a dog (neutral event)

13029-477: The individual, because the individual does not usually encounter mice, no actual distress or impairment is ever experienced. It is recommended that proximity to, and ability to escape from, the stimulus also be considered. As the phobic person approaches a feared stimulus, anxiety levels increase, and the degree to which the person perceives they might escape from the stimulus affects the intensity of fear in instances such as riding an elevator (e.g. anxiety increases at

13158-498: The limited role of benzodiazepines, do not currently have established guidelines due to minimal supporting evidence. Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs ), serotonin-norepinephrine reuptake inhibitors ( SNRIs ), or monoamine oxidase inhibitors ( MAOIs ) may be helpful in some cases. SSRIs / SNRIs act on serotonin, a neurotransmitter in the brain. Because of serotonin's positive impacts on mood, an antidepressant may be offered and prescribed as

13287-423: The midway point between floors and decreases when the floor is reached and the doors open). The DSM-V has been updated to reflect that an individual may have changed their daily activities around the feared stimulus in such a way that they may avoid it altogether. The person may still meet criteria for the diagnosis if they continue to avoid or refuse to participate in activities they would involve possible exposure to

13416-400: The model.) Here the workings of the model are illustrated with brief accounts of acquisition, extinction, and blocking. The model also predicts a number of other phenomena, see main article on the model. Δ V = α β ( λ − Σ V ) {\displaystyle \Delta V=\alpha \beta (\lambda -\Sigma V)} This is

13545-417: The more it will differ from that previously observed. One observes stimulus discrimination when one stimulus ("CS1") elicits one CR and another stimulus ("CS2") elicits either another CR or no CR at all. This can be brought about by, for example, pairing CS1 with an effective US and presenting CS2 with no US. Latent inhibition refers to the observation that it takes longer for a familiar stimulus to become

13674-467: The neural basis of conditioning has come from experiments on the sea slug, Aplysia . Most relevant experiments have used the classical conditioning procedure, although instrumental (operant) conditioning experiments have also been used, and the strength of classical conditioning is often measured through its operant effects, as in conditioned suppression (see Phenomena section above) and autoshaping . According to Pavlov, conditioning does not involve

13803-416: The only proposed way to acquire a phobia. This theory in fact has limitations as not everyone that has experienced a traumatic event develops a phobia and vice versa. Vicarious fear acquisition is learning to fear something, not by a subject's own experience of fear, but by watching others, oftentimes a parent ( observational learning ). For instance, when a child sees a parent reacting fearfully to an animal,

13932-419: The particular danger. Phobias are considered the most common psychiatric disorder, affecting about 10% of the population in the US, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) , (among children, 5%; among teens, 16%). About 75% of patients have more than one specific phobia. It can be described as when patients are anxious about a particular situation. It causes

14061-461: The past several decades, psychologists and other researchers have developed effective behavioral, pharmacological, and technological interventions for the treatment of phobia. Virtual Reality treatments produce similar effects to in vivo exposure, another efficacious therapy great for treating phobias. Although Virtual Reality is great for treating phobias, the treatment will not work for every phobia. The treatment has positive effects, but depending on

14190-636: The person is willing to endure some discomfort. In one clinical trial, 90% of people no longer had a phobic reaction after successful CBT treatment. Research in the UK has suggested that for childhood phobias a single session of CBT can be effective. Evidence supports that eye movement desensitization and reprocessing (EMDR) is effective in treating some phobias. Its effectiveness in treating complex or trauma-related phobias has not been empirically established. Primarily used to treat post-traumatic stress disorder , EMDR has been demonstrated to ease phobia symptoms following

14319-402: The phobia, in vivo would be another ideal treatment to use over Virtual Reality. In vivo exposure is a great way to reduce fear over time and is actually more preferred when trying to treat anxiety and fear related problems. Cognitive behavioral therapy (CBT) is an evidence-based treatment that can help with phobias. It is a talk therapy that can be used alone or along with other therapies. CBT

14448-619: The phobic stimulus. A specific phobia is a marked and persistent fear of an object or situation. Specific phobias may also include fear of losing control, panicking, and fainting from an encounter with the phobia. Specific phobias are defined concerning objects or situations, whereas social phobias emphasize social fear and the evaluations that might accompany them. The DSM breaks specific phobias into five subtypes: animal, natural environment, blood-injection-injury, situational and other. In children, blood-injection-injury phobia , animal phobias, and natural environment phobias usually develop between

14577-401: The process of receiving stimuli, interpreting them, and releasing certain hormones into the bloodstream. The parvocellular neurosecretory neurons of the hypothalamus release corticotropin-releasing hormone (CRH), which is sent to the anterior pituitary. Here the pituitary releases adrenocorticotropic hormone (ACTH), which ultimately stimulates the release of cortisol . In relation to anxiety,

14706-491: The progress in understanding the acquisition of fear responses in phobias can be attributed to classical conditioning (Pavlovian model). When an aversive stimulus and a neutral one are paired together, for instance, when an electric shock is given in a specific room, the subject can start to fear not only the shock but the room as well. In behavioral terms, the room is a conditioned stimulus (CS). When paired with an aversive unconditioned stimulus (UCS) (the shock) , it creates

14835-461: The region's ability to not only become conditioned to fearful stimuli but to extinguish them eventually. Through receiving stimulus info, the basolateral nuclei undergo synaptic changes that allow the amygdala to develop a conditioned response to fearful stimuli. Damage to this area, therefore, have been shown to disrupt the acquisition of learned responses to fear. Likewise, damage in the ventromedial prefrontal cortex (the area responsible for monitoring

14964-411: The risk-benefit ratio usually goes against their long-term use in phobic disorders. This class of medication has recently been shown as effective if used with negative behaviours such as excessive alcohol use. Despite this positive finding, benzodiazepines are used with caution due to side effects and risk of developing dependence or withdrawal symptoms. In specific phobia for example if the phobic stimulus

15093-400: The salience of the CS and the speed of learning for a given US. How the equation predicts various experimental results is explained in following sections. For further details, see the main article on the model. The R–W model measures conditioning by assigning an "associative strength" to the CS and other local stimuli. Before a CS is conditioned it has an associative strength of zero. Pairing

15222-410: The same specific phobia. Similarly, social anxiety disorder is found two to six times more frequently in those with first degree relatives that have it versus those that do not. Agoraphobia is believed to have the strongest genetic association. Beneath the lateral fissure in the cerebral cortex , the insula, or insular cortex , of the brain has been identified as part of the limbic system , along with

15351-429: The same time. For example: If a person hears a bell and has air puffed into their eye at the same time, and repeated pairings like this led to the person blinking when they hear the bell despite the puff of air being absent, this demonstrates that simultaneous conditioning has occurred. [REDACTED] Second-order or higher-order conditioning follow a two-step procedure. First a neutral stimulus ("CS1") comes to signal

15480-460: The scenes and having the phobic person endure more exposure than they might handle in reality. Medications are a treatment option often utilized in combination with CBT or if CBT was not tolerated or effective. Medications can help regulate apprehension and fear of a particular fearful object or situation. There are various medication options available for both social anxiety disorder and agoraphobia. The use of medications for specific phobias, besides

15609-476: The severity of an individual's disorder as well as how long they have been experiencing symptoms. For example, in social anxiety disorder (social phobia) a majority of individuals will experience remission within the first couple of years of symptom onset without specific treatment. On the other hand, in Agoraphobia as few as 10% of individuals are seen to reach complete remission without treatment. A study looking at

15738-1130: The short-term, but this effect decreased over a longer term. Likewise, virtual reality exposure was statistically significant in some measures of anxiety reduction, but not others. As of late 2020, there is limited evidence for the use of pharmacotherapy in the treatment of specific phobia. Pharmacological treatments are typically used in combination with behaviorally-focused psychotherapy, as introducing pharmacological interventions independently may result in relapsing of symptoms. Different treatments are better suited for certain types of specific phobia. For instance, beta blockers are useful in those with performance anxiety. The selective serotonin re-uptake inhibitors (SSRIs), paroxetine and escitalopram , have shown preliminary efficacy in small randomized controlled clinical trials. However, these trials were too small to show any definitive benefits of anxiolytic medication alone in treating phobia. Benzodiazepines are occasionally used for acute symptom relief, but have not been shown to be effective for long-term treatment. There are some findings suggesting that adjuvant use of

15867-524: The stimulus). Children and adolescents who are diagnosed with a specific phobia are at an increased risk for additional psychopathology later in life. Fear, discomfort or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. The main behavioral sign of a specific phobia is avoidance. The fear or anxiety associated with specific phobia can also manifest in physical symptoms such as an increased heart rate, shortness of breath , muscle tension, sweating , or

15996-418: The strength and/or frequency of the CR gradually. The speed of conditioning depends on a number of factors, such as the nature and strength of both the CS and the US, previous experience and the animal's motivational state. The process slows down as it nears completion. If the CS is presented without the US, and this process is repeated often enough, the CS will eventually stop eliciting a CR. At this point

16125-403: The temporal conditioning, as US such as food to a hungry mouse is simply delivered on a regular time schedule such as every thirty seconds. After sufficient exposure the mouse will begin to salivate just before the food delivery. This then makes it temporal conditioning as it would appear that the mouse is conditioned to the passage of time. [REDACTED] In this procedure, the CS is paired with

16254-455: The unconscious can be retrieved. This state makes people more open to suggestion, which helps bring about desired change. Consciously addressing old memories helps individuals understand the event and see it less threateningly. Outcomes vary widely among the phobic anxiety disorders. There is a possibility that remission occurs without intervention but relapses are common. Response to treatment as well as remission and relapse rates are impacted by

16383-453: The underlying cause of the phobia may be uncovered. The phobia may be caused by a past event that the person does not remember, a phenomenon known as repression. The mind represses traumatic memories from the conscious mind until the person is ready to deal with them. Hypnotherapy may also eliminate the conditioned responses that occur during different situations. People are first placed into a hypnotic trance, an extremely relaxed state in which

16512-487: Was identified as a possible target for agoraphobia. An area still in development is reviewing epigenetic components or the interaction of the environment on genes through methylation. A number of genes are being examined through this epigenetic lens which may be linked with social anxiety disorder, including MAOA, CRHR1, and OXTR. Each phobia related disorder has some degree of genetic susceptibility. Those with specific phobias are more likely to have first degree relatives with

16641-477: Was the food because its effects did not depend on previous experience. The metronome's sound is originally a neutral stimulus (NS) because it does not elicit salivation in the dogs. After conditioning, the metronome's sound becomes the conditioned stimulus (CS) or conditional stimulus; because its effects depend on its association with food. Likewise, the responses of the dog follow the same conditioned-versus-unconditioned arrangement. The conditioned response (CR)

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