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Learning Objectives . To be aware of the definitions and diagnostic criteria relevant to phobiasTo understand a cognitive behavioural model of phobic disordersTo be aware of current treatment approaches to phobias. Introduction. Phobos
Phobias

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1. Phobias John Kentish, St. Mary?s Hospital Louise Payne, CNWL and Royal Holloway University 26th January 2010

3. Introduction Phobos ? Greek God of fear. Prevalence - Phobias are very common - Lifetime prevalence rate for clinically diagnosable phobias is about 12%. - 60% of the population usually admit to experiencing ?unreasonable fear? at some point in their lives Historical Middle Ages ? Syphilophobia & Plague Phobia 1960?s & early 70?s. ? Seligman?s theory of Biological Preparedness and development of Exposure Therapies 1980?s & 1990?s. ? Increasing understanding of role of cognitive factors in aetiology and maintenance of phobias. Present. Awareness of multiple acquisition mechanisms ? traumatic events, dispositional factors such as increased disgust sensitivity or neither.

4. Definitions of Anxiety Apprehension, tension or uneasiness which stems from the anticipation of danger, the source of which is largely unknown or unrecognised. (American Psychiatric Association 1975) An unpleasant emotional state or condition which is characterised by subjective feelings of tension, apprehension and worry and by activation or arousal of the autonomic nervous system. (Speilberger 1972)

5. Anxiety Vs Anxiety Disorders Anxiety is a normal human response to many everyday situations. Mild anxiety often improves performance and is adaptive. Anxiety disorders are more intense, last longer and may lead to problems that interfere with everyday life. Anxiety disorders are characterised by anticipation of and preparation for negative outcomes of future events ie danger and threat to self.

6. Anxiety Disorders Anxiety disorders occur because people believe situations to be more dangerous than they really are (over-estimate likelihood that feared event will occur, under-estimate ability to cope with that event). Good clinicians help patients to consider alternative, less threatening explanations of their problem.

7. DSM IV Anxiety disorders Panic disorder With agoraphobia Without agoraphobia Agoraphobia without panic Social phobia Specific phobia Animal Natural environment Blood, Injection, Injury Situational Other Obsessive compulsive disorder Post-traumatic stress disorder Acute stress disorder Generalised anxiety disorder

8. ICD 10 F40 Phobic Anxiety Disorders F40.0 Agoraphobia Without panic disorder With panic disorder F40.1 Social phobia F40.2 Specific (isolated) phobias F40.8 Other phobic anxiety disorders F40.9 Phobic anxiety disorder, unspecified F41 Other Anxiety Disorders F41.0 Panic disorder (episodic paroxysmal anxiety) F41.1 Generalised anxiety disorder F41.2 Mixed anxiety and depressive disorder F41.8 Other specified anxiety disorders F41.9 Anxiety disorder, unspecified

9. Definitions Alektorophobia - Fear of chickens. Algophobia - Fear of pain. Alliumphobia - Fear of garlic. Allodoxaphobia - Fear of opinions. Altophobia - Fear of heights. Amathophobia - Fear of dust. Amaxophobia - Fear of riding in a car. Ambulophobia - Fear of walking. Amnesiphobia - Fear of amnesia. Amychophobia - Fear of scratches or being scratched. Anablephobia - Fear of looking up. Ancraophobia - Fear of wind. Androphobia - Fear of men. Anemophobia - Fear of air drafts or wind. Anemophobia - Fear of wind. Anginophobia - Fear of angina, choking of narrowness. Anglophobia - Fear of England, English culture, ect. Angrophobia - Fear of becoming angry. Ankylophobia - Fear of immobility of a joint. Anthophobia - Fear of flowers. Anthrophobia - Fear of flowers. Anthropophobia - Fear of people of society. Antlophobia - Fear of floods. Anuptaphobia - Fear of staying single. Apeirophobia - Fear of infinity. Aphenphosmphobia - Fear of being touched. Apiphobia - Fear of bees. Apotemnophobia - Fear of persons with amputations. Arachibutyrophobia - Fear of peanut butter sticking to the roof of the mouth. Arachnephobiba - Fear of spiders. Arachnophobia - Fear of spiders. Arithmophobia - Fear of numbers. Arrhenophobia - Fear of men. Arsonphobia - Fear of fire. Ashenophobia - Fear of fainting or weakness. Astraphobia - Fear of thunder and lightning. Astrapophobia - Fear of thunder and lightning. Astrophobia - Fear of stars and celestial space. Asymmetriphobia - Fear of asymmetrical things. Ataxiophobia - Fear of ataxia (muscular incoordination) Ataxophobia - Fear of disorder or untidiness. Atelophobia - Fear of imperfection. Atephobia - Fear of ruin or ruins. Athazagoraphobia - Fear of being forgotten or ignored or forgetting. Atomosophobia - Fear of atomic explosions. Atychiphobia - Fear of failure. Aulophobia - Fear of flutes. Aurophobia - Fear of gold. Auroraphobia - Fear of Northern Lights. Autodysomophobia - Fear that one has a vile odor. Automatonophobia - Fear of ventriloquist's dummies, animatronic creatures, wax statues-anything that falsely represents a sentient being. Automysophobia - Fear of being dirty. Autophobia - Fear of being alone or of oneself. Aviatophobia - Fear of flying. Aviophobia - Fear of flying. Bacillophobia - Fear of microbes Bacteriophobia - Fear of bacteria. Balenephobia - Fear of pins and needles. Ballistophobia - Fear of missles or bullets. Barophobia - Fear of gravity. Basiphobia - Inability to stand. Fear of walking or falling. Basophobia - Inability to stand. Fear of walking or falling. Bathophobia - Fear of depth. Batonophobia - Fear of plants. Batophobia - Fear of heights or being close to high buildings. Batrachophobia - Fear of amphibians, such as frogs, newts, salamanders, etc. Bibliophobia - Fear of books. Blennophobia - Fear of slime. Bogyphobia - Fear of bogies or the bogeyman. Bolshephobia - Fear of Bulsheviks. Bromidrophobia - Fear of body smells. Bromidrosiphobia - Fear of body smells. Brontophobia - Fear of thunder and lightning. Bufonophobia - Fear of toads. Cacophobia - Fear of ugliness. Cainophobia - Fear of newness, novelty. Cainotophobia - Fear of newness, novelty. Caligynephobia - Fear of beautiful women. Cancerophobia - Fear of cancer. Carcinophobia - Fear of cancer. Cardiophobia - Fear of the heart. Carnophobia - Fear of meat. Catagelophobia - Fear of being ridiculed. Catapedaphobia - Fear of jumping from high and low places. Cathisophobia - Fear of sitting. Catoptrophobia - Fear of mirrors. Cenophobia - Fear of new things or ideas. Centophobia - Fear of new things or ideas. Ceraunophobia - Fear of thunder. Chaetophobia - Fear of hair. Cheimaphobia - Fear of cold. Cheimatophobia - Fear of cold. chemophobia - Fear of chemicals or working with chemicals. Cherophobia - Fear of gaiety. Chionophobia - Fear of snow. Chiraptophobia - Fear of being touched. Cholerophobia - Fear of anger or the fear of cholera. Chorophobia - Fear of dancing. Chrematophobia - Fear of money. Chromatophobia - Fear of colors. Chrometophobia - Fear of money. Chromophobia - Fear of colors. Chronomentrophobia - Fear of clocks. Chronophobia - Fear of time. Cibophobia - Fear of food. Claustrophobia - Fear of confined spaces. Cleisiophobia - Fear of being locked in an enclosed place. Cleithrophobia - Fear of being enclosed.,br>Cleithrophobia - Fear of being locked in an enclosed place.,br>Cleptophobia - Fear of stealing. Climacophobia - Fear of stairs, climbing or of falling downstairs. Clinophobia - Fear of going to bed. Clithrophobia - Fear of being enclosed. Cnidophobia - Fear of strings. Coimetrophobia - Fear of cemeteries. Coitophobia - Fear of coitus. Cometophobia - Fear of comets. Contreltophobia - Fear of sexual abuse. Coprastasophobia - Fear of constipation. Coprophobia - Fear of feces. Coulrophobia - Fear of clowns. Counterphobia - The preference by a phobic for fearful situations. Cremnophobia - Fear of precipices. Cryophobia - Fear fo extreme cold, ice or frost. Crystallophobia - Fear of crystals or glass. Cyberphobia - Fear of computers or working on a computer. Cyclophobia - Fear of bicycles. Cymophobia - Fear of waves or wave like motions. Cynophobia - Fear of dogs or rabies. Cyprianophobia - Fear of prostitutes or venereal disease. Cypridophobia - Fear of prostitutes or venereal disease. Cyprinophobia - Fear of prostitutes or venereal disease. Cypriphobia - Fear of prostitutes or venereal disease. Daemonophobia - Fear of demons. Decidophobia - Fear of making decisions. Defecaloesiphobia - Fear of painful bowels movements. Deipnophobia - Fear of dining and dinner conversation. Dematophobia - Fear of skin lesions. Dementophobia - Fear of insanity. Demonophobia - Fear of demons. Demophobia - Fear of crowds. Dendrophobia - Fear of trees. Dentophobia - Fear of dentist. Dermatophathophobia - Fear of skin disease. Dermatophobia - Fear of skin disease. Dermatosiophobia - Fear of skin disease. Dextrophobia - Fear of objects at the right side of the body. Diabetophobia - Fear of diabetes. Didaskaleinophobia - Fear of going to school. Diderodromophobia - Fear of trains, railroads or train travel. Dikephobia - Fear of justice. Dinophobia - Fear of dizziness or whirlpools. Diplophobia - Fear of double vision. Dipsophobia - Fear drinking. Dishabiliophobia - Fear of undressing in front of someone. Domatophobia - Fear of houses or being in a home. Doraphobia - Fear of fur or skins of animals .Dromophobia - Fear of crossing streets. Dutchphobia - Fear of the Dutch. Dysmorphophobia - Fear of deformity. Dystychiphobia - Fear of accidents. Ecclesiophobia - Fear of church. Ecophobia - Fear of home. Eicophobia - Fear of home surroundings. Eisoptrophobia - Fear of mirrors or of seeing oneself in a mirror. Electrophobia - Fear of electricity. Eleutherophobia - Fear of freedom. Elurophobia - Fear of cats. Emetophobia - Fear of vomiting. Enetophobia - Fear of pins. Enissophobia - Fear of having committed an unpardonable sin or of criticism. Enochlophobia - Fear of crowds. Enosiophobia - Fear of having committed an unpardonable sin or of criticism. Entomophobia - Fear of insects. Eosophobia - Fear of dawn or daylight. Epistaxiophobia - Fear of nosebleeds. Epistemphobia - Fear of knowledge. Equinophobia - Fear of hourse. Eremophobia - Fear of being oneself or of lonliness. Ereuthophobia - Fear of redlights. Fear of blushing. Fear of red. Ereuthrophobia - Fear of blushing. Ergasiophobia - Fear of work or functioning. Surgeon's fear of operating. Ergophobia - Fear of work. Erotophobia - Fear of sexual love or sexual questions. Erythrophobia - Fear of redlights. Fear of blushing. Fear of red. Erytophobia- Fear of redlights. Fear of blushing. Fear of red. Euphobia - Fear of hearing good news. Eurotophobia - Fear of female genitalia. Febriphobia - Fear of fever. Felinophobia - Fear of cats. Fibriophobia - Fear of fever. Fibriphobia - Fear of fever. Francophobia - Fear of France, French culture. Galeophobia - Fear of cats. Galiophobia - Fear of France, French culture. Gallophobia - Fear of France, French culture. Gamophobia - Fear of marriage. Gatophobia - Fear of cats. Geliophobia - Fear of laughter. Geniophobia - Fear of chins. Genophobia - Fear of sex. Genuphobia - Fear of knees. Gephydrophobia - Fear of crossing bridges. Gephyrophobia - Fear of crossing bridges. Gephysrophobia - Fear of crossing bridges. Gerascophobia - Fear of growing old. Germanophobia - Fear of Germany, German culture, etc. Gerontophobia - Fear of old people or of growing old. Geumaphobia - Fear of taste. Geumophobia - Fear of taste. Gnosiophobia - Fear of knowledge. Graphophobia - Fear of writing or handwritting. Gymnophobia - Fear of nudity. Gynephobia - Fear of women. Gynophobia - Fear of women. Hadephobia - Fear of hell. Hagiophobia - Fear of saints or holy things. Hamartophobia - Fear of sinning. Haphephobia - Fear of being touched. Haptephobia - Fear of being touched. Harpaxophobia - Fear of being robbed. Hedonophobia - Fear of feeling pleasure. Heliophobia - Fear of the sun. Hellenologophobia - Fear of Greek terms or complex scientific terminology. Helminthophobia - Fear of being infested with worms. Hemaphobia - Fear of blood. Hematophobia - Fear of blood. Hemophobia - Fear of blood. Hereiophobia - Fear of challenges to official doctrine or of radical deviation. Heresyphobia - Fear of challenges to official doctrine or radical deviation. Herpetophobia - Fear of reptiles or creepy, crawly things. Heterophobia - Fear of the opposite sex. Hierophobia - Fear of priest or sacred things. Hippophobia - Fear of horses. Hippopotomonstrosesquippedaliophobia - Fear of long words. Hobophobia - Fear of bums or beggars. Hodophobia - Fear of road travel. Homichlophobia - Fear of fog. Homilophobia - Fear of sermons. Hominophobia - Fear of men. Homophobia - Fear of sameness, monotony or of homosexuality or of becoming homosexual. Hoplophobia * Fear of firearms. Hormephobia - Fear of shock. Hydrargyophobia - Fear of mercuial medicines. Hydrophobia - Fear of water of of rabies. Hydrophobophobia - Fear or rabies. Hyelophobia - Fear of glass. Hygrophobia - Fear of liquids, dampness, or moisture. Hylephobia - Fear of materialism or the fear of epilepsy. Hylophobia - Fear of forests. Hynophobia - Fear of sleep or of being hypnotized. Hypegiaphobia - Fear of responsibility. Hypengyophobia - Fear of responsibility. Hypsiphobia - Fear of height. Iatrophobia - Fear of going to the doctor or doctors. Ichthyophobia - Fear of fish. Ideophobia - Fear of ideas. Illyngophobia - Fear of vertigo or feeling dizzy when looking down. insectophobia - fear of insects. Iophobia - Fear of poison. Isolophobia - Fear of solitude, being alone. Isopterophobia - Fear of termites, insects that eat wood. Ithyphallophobia - Fear of seeing, thinking about, or having an erect penis. Japanophobia - Fear of Japanese. Judeophobia - Fear of Jews. Kainolophobia - Fear of novelty. Kainophobia - Fear of anything new, novelty. Kakorrhaphiophobia - Fear of failure or defeat. Katagelophobia - Fear of ridicule. Kathisophobia - Fear of sitting down. Kenophobia - Fear of voids or empty spaces. Keraunophobia - Fear of thunder and lightning. Kinesophobia - Fear of movement or motion. Kinetophobia - Fear of movement or motion. Kleptophobia - Fear of movement or motion. Koinoniphobia - Fear of rooms. Kolpophobia - Fear of genitals, particulary female. Koniophobia - Fear of dust. Kopophobia - Fear of fatigue. Kosmikophobi - Fear of cosmic phenomenon. Kymophobia - Fear of waves. Kynophobia - Fear of rabies. Kyphophobia - Fear of stooping. Lachanophobia - Fear of vegitables. Laliophobia - Fear of speaking. Lalophobia - Fear of speaking. Lepraphobia - Fear of leprosy. Leprophobia - Fear of leprosy. Leukophobia - Fear of the color white. Levophobia - Fear of things to the left side of the body. Ligyrophobia - Fear of loud noises. Lilapsophobia - Fear of tornadoes and hurricanes. Limnophobia - Fear of lakes. Linonophobia - Fear of string. Liticaphobia - Fear of lawsuits. Lockiophobia - Fear fo childbirth. Logizomechanophobia - Fear of computers. Logophobia - Fear of words. Luiphobia - Fear of lues, syphillis. Lutraphobia - Fear of otters. Lygophobia - Fear of darkness. Lysssophobia - Fear of rabies or of becoming mad. Macrophobia - Fear of long waits. Mageirocophobia *- Fear of cooking. Maieusiophobia - Fear of childbirth. Malaxophobia - Fear of love play. Maniaphobia - Fear of insanity. Mastigophobia - Fear of punishment. Mechanophobia - Fear of machines. Medomalacuphobia - Fear of losing an erection. Medorthophobia - Fear of an erect penis. Megalophobia - Fear of large things. Melanophobia - Fear of the color black. Melissophobia - Fear of bees. Melophobia - Fear of hatred or music. Meningitiophobia - Fear of brain disease. Merinthophobia - Fear of being bound or tied up. Mertophobia - Fear or hatred of poetry. Metallophobia - Fear of metal. Metathesiophobia - Fear of changes. Meterorophobia - Fear of Meteors. Methyphobia - Fear of alcohol. Microbiophobia - Fear of microbes. Microphobia - Fear of small things. Misophobia - Fear of being contaminated with dirt or germs. Mnemophobia - Fear of memories. Molysmophobia - Fear of dirt or contamination. Molysomophobia - Fear of dirt or contamination. Monopathophobia - Fear of difinite disease. Monophobia - Fear of solitude or being alone. Monophobia - Fear of menstruation. Motorphobia - Fear of automobiles. Mottophobia - Fear of moths. Murophobia - Fear of mice. Musophobia - Fear of mice. Mycophobia - Fear or aversion to mushrooms. Mycrophobia - Fear of small things. Myctophobia - Fear of darkness. Myrmecophobia - Fear of ants. Mysophobia - Fear of germs or contamination or dirt. Mythophobia - Fear of myths or stories or false statements. Myxophobia - Fear of slime. Namatophobia - Fear of names. Nebulaphobia - Fear of fog. Necrophobia - Fear of death or or dead things. Nelophobia - Fear of glass. Neopharmaphobia - Fear of new drugs. neophobia - Fear of anything new. Nephophobia - Fear of clouds. Noctiphobia - Fear of the night. Nosemaphobia - Fear of becoming ill. Nosocomephobia - Fear of hospitals. Nosophobia - Fear of becoming ill. Nostophobia - Fear of returning home. Novercaphobia - Fear of your step-mother. Nucleomituphobia - Fear of nuclear weapons. Nudophobia - Fear of nudity. Numerophobia - Fear of numbers. Nyctohlophobia - Fear of dark wooded areas, of forest at night. Nyctophobia - Fear of the dark or of the night. Obesophobia - Fear of gaining weight. Ochlophobia - Fear of crowds or mobs. Ochophobia - Fear of vehicles. Octophobia - Fear of the figure 8. Odontophobia - Fear of teeth or dental surgery. Odynephobia - Fear of pain. Odynophobia - Fear of pain. Oenophobia - Fear of wines. Oikophobia - Fear of home surroundings, house. Oikophobia - Fear of houses or being in a house. Oikophobia - Fear of home surroundings. Olfactophobia - Fear of smells. Ombrophobia - Fear of rain or being rained on. Ommatophobia - Fear of eyes. Ommetaphobia - Fear of eyes. Oneirogmophobia - Fear of wet dreams. Oneirophobia - Fear of dreams. Onomatophobia - Fear of hearing a certain word or names. Ophidiophobia - Fear of snakes. Opthalmophobia - Fear of being stared at. Optophobia - Fear of opening one's eyes. Ornithophobia - Fear of birds. Orthophobia - Fear of property. Osmophobia - Fear of smells or odors. Osphesiophobia - Fear of smells or odors. Ostraconophobia - Fear of shellfish. Ouranophobia - Fear of heaven Pagophobia - Fear of ice or frost. Panophobia - Fear of everything. Panthophobia - Fear of suffering and disease. Pantophobia - Fear of everything. Papaphobia - Fear fo the Pope. Papyrophobia - Fear of paper. Paralipophobia - Fear of neglecting duty or responsibility. Paraphobia - Fear of sexual perversion. Parasitophobia - Fear of parasites. Paraskavedekatriaphobia - Fear of Friday the 13th. Parthenophobia - Fear of virgins or young girls. Parturiphobia - Fear of childbirth. Pathophobia - Fear of disease. Patroiophobia - Fear of heredity. Peccatophobia - Fear of sinning. (imaginary crime) Pediculophobia - Fear of lice. Pediophobia - Fear of dolls. Pedophobia - Fear of children. Peladophobia - Fear of bald people. Pellagrophobia - Fear of pellagra. Peniaphobioa - Fear of poverty. Pentheraphobia - Fear of mother-in-law. Phagophobia - Fear of swallowing or eating or of being eaten. Phalacrophobia - Fear of becoming bald. Phallophobia - Fear of penis, esp erect. Pharmacophobia - Fear of taking medicine. Pharmacophobia - Fear of drugs. Phasmophobia - Fear of ghost. Phengophobia - Fear of daylight or sunshine. Philemaphobia - Fear of kissing. Philematophobia - Fear of kissing. Philophobia - Fear of falling in love or being in love. Philosophobia - Fear of philosophy. Phobophobia - Fear of phobias. Phonophobia - Fear of noises or voices or one's own voice; of telephones. Photoaugliaphobia - Fear of glaring lights. Photophobia - Fear of light. Phronemophobia - Fear of thinking. Phthiriophobia - Fear of lice. Phthisiophobia - Fear of tuberculosis. Placophobia - Fear of tombstones. Plutophobia - Fear of wealth. Pluviophobia - Fear of rain or of being rained on. Pneumatiphobia - Fear of spirits. Pnigerophobia - Fear of choking or of being smothered. Pnigophobia - Fear of choking or of being smothered. Pocrescophobia - Fear of gaining weight. Pocresophobia - Fear of gaining weight. Pogonophobia - Fear of beards. Poinephobia - Fear of punishment. Poliosophobia - Fear of contracting poliomyelitis. Politicophobia - Fear or abnormal dislike of politicians. Polyphobia - Fear of many things. Ponophobia - Fear of overworking or of pain. Porphyrophobia - Fear of the color purple. Potamophobia - Fear of rivers or running water. Potophobia - Fear of alcohol. Proctophobia - Fear or rectum. Prosophobia - Fear of progress. Psellismophobia - Fear of stuttering. Psychophobia - Fear of mind. Psychrophobia - Fear of cold. Pteromerhanophobia - Fear of flying. Pteronophobia - Fear of being tickled by feathers. Pupaphobia - Fear of puppets. Pyrexiophobia - Fear of fever. Pyrophobia - Fear of fire. Radiophobia - Fear of radiation, x-rays. Ranidaphobia - Fear of frogs. Rectophobia - Fear of rectum or rectal diseases. Rhabdophobia - Fear of being severely punished or beaten by a rod, or of being severely criticized. Also fear of magic. (wand) Rhypophobia - Fear of defecation. Rhytiphobia - Fear of getting wrinkles. Rupophobia - Fear of dirt. Russophobia - Fear of Russians. Samhainophobia - Fear of Halloween. Sarmassophobia - Fear of love play. Sarmassophobia - Fear of love play. Satanophobia - Fear of Satin. Scabiophobia - Fear of scabies. Scatophobia - Fear of fecal matter. Scelerophobia - Fear of bad men, burglars. Sciaphobia - Fear of shadows. Sciophobia - Fear of shadows. Scoionophobia - Fear of school. Scoleciphobia - Fear of worms. Scopophobia - Fear of being seen or stared at. Scoptophobia - Fear of being seen or stared at. Scotomaphobia - Fear of blindness in visual field. Scotophobia - Fear of darkness. Scriptophobia - Fear of writing in public. Selaphobia - Fear of light flashes. Selenophobia - Fear of the moon. Seplophobia - Fear of decaying matter. Sesquipedalophobia - Fear of long words. Sexophobia - Fear of the opposit sex. Sexophobia - Fear of the opposite sex. Siderophobia - Fear of stars. Sinistrophobia - Fear of things to the left, left-handed. Sinophobia - Fear of Chinese, Chinese culture. Sitiophobia - Fear of food. Sitiophobia - Fear of food or eating. Sitophobia - Fear of food or eating. Sitophobia - Fear of food. Snakephobia - Fear of snakes. Soceraphobia - Fear of parents-in-law. Social Phobia - Fear of being evaluated negatively in social situations. Sociophobia - Fear of society or people in general. Somniphobia - Fear of sleep. Sophophobia - Fear of learning. Soteriophobia - Fear of dependence on others. Spacephobia - Fear of outer space. Spectrophobia - Fear of specters or ghosts. Spermatophobia - Fear of germs. Spermophobia - Fear of germs. Spheksophobia - Fear of wasps. Stasibasiphobia - Fear fo standing or walking. Stasiphobia - Fear of standing or walking. Staurophobia - Fear of crosses or the crucifix. Stenophobia - Fear of narrow things or places. Stigiophobia - Fear of hell. Stygiophobia - Fear of hell. Suriphobia - Fear of mice. Symbolophobia - Fear of symbolism. Symmetrophobia - Fear of symmetry. Syngenesophobia - Fear of relatives. Syphilophobia - Fear of syphilis. The List of Phobia Names: T List of Phobia Names Tachophobia - Fear of speed. Taeniophobia - Fear of tapeworms. Teniophobia - Fear of tapeworms. Taphephobia - Fear of being buried alive or of cemeteries. Taphophobia - Fear of being buried alive or of cemeteries. Tapinophobia - Fear of being contagious. Taurophobia - Fear of bulls. Technophobia - Fear of technology. Teleophobia - Fear fo difinite plans. Fear of Religious ceremony. Telephonophobia - Fear of telephones. Teratophobia - Fear of bearing a deformed child or fear of monsters or deformed people. Testaphobia - Fear of taking test. Tetanophobia - Fear of lockjaw, tetnus. Teutophobia - Fear of German or German things. Textophobia - Fear of certain fabrics. Thaasophobia - Fear of sitting. Thalassophobia - Fear of the sea. Thanatophobia - Fear of death or dying. Thantophobia - Fear of death or dying. Theatrophobia - Fear of theaters. Theophobia - Fear of gods or religion. Theologicophobia - Fear of theology. Thermophobia - Fear of heat. Tocophobia Fear of pregnancy or childbirth. Tomophobia - Fear of surgical operations. Tonitrophobia - Fear of thunder. Topophobia - Fear of certain places or situations, such as stage fright. Toxiphobia - Fear of poison or of being accidently poisoned. Toxophobia - Fear of poison or of being accidently poisoned. Toxicophobia - Fear of poison or of being accidently poisoned. Traumatophobia - Fear of injury. Tremophobia - Fear of trembling. Trichinophobia - Fear of trichinosis. Trichopathophobia - Fear of hair. Trichophobia - Fear of hair. Hypertrichophobia - Fear of hair. Triskaidekaphobia - Fear of the number 13. Tropophobia - Fear of moving or making changes. Trypanophobia - Fear of injections. Tuberculophobia - Fear of tuberculosis. Tyrannophobia - Fear of tyrants. Uranophobia - Fear of heaven. Urophobia - Fear of urine or urinating. Vaccinophobia - Fear of vaccination. Venustraphobia - Fear of beautiful women. Verbophobia - Fear of words. Verminophobia - Fear of germs. Vestiphobia - Fear of clothing. Virginitiphobia - Fear of rape. Vitricophobia - Fear of step-father. Walloonphobia - Fear of Walloons. Wiccaphobia - Fear of witches and witchcraft. Xanthophobia - Fear of the color yellow or the word yellow. Xenophobia - Fear of strangers or foreigners. Xerophobia - Fear of dryness. Xylophobia - Fear of wooden objects. Forests. Zelophobia - Fear of jelousy. Zeusophobia - Fear of God or gods. Zemmiphobia - Fear of the great mole rat. Zoophobia - Fear of animals. Oh?. And finally fear of Hippopotomonstrosesquippedaliophobia ? ?Fear of Long words? such as ?Hippopotomonstrosesquippedaliophobia? http://en.wiktionary.org/wiki/hippopotomonstrosesquippedaliophobia

10. Definitions Agoraphobia Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of having an unexpected or situationally-predisposed panic attack or panic-like symptoms. Specific phobia Persistent and irrational fear of a specific object or a specific situation. Social phobia Persistent fear of one or more situations in which the person is exposed to possible negative evaluation, criticism or rejection by other people. Person often fears they might behave in a way that will be embarrassing.

11. Specific phobia Persistent and irrational fear of a specific object or a specific situation. A compelling desire to avoid the object or situation causing considerable inconvenience. On exposure to the feared stimulus a fear reaction follows immediately. Person realises that the fear is disproportional and irrational. Person usually free of symptoms if they are neither in nor anticipating a phobic situation. The person may dismiss the fear when in a safe place but still believe they are in danger when faced by the feared stimulus.

12. Phobias Specific phobia Animal Natural environment Blood, Injection, Injury Situational Other ? rare / atypical phobias Fear of fear (Rachman and Bichard 1988)

13. In small groups (3 ? 4) Think of a phobia that you hold yourself or that someone you know well has. What do you / they avoid as a result of this phobia? How reasonable does it seem to have this fear? In what ways does it seem to be useful to avoid the situation/ stimulus? How would you feel about having CBT to get rid of it? If you feel unwilling, what would need to change to make you seek help?

14. Specific phobia Simple phobias are widespread in the population. 12% meet lifetime diagnosis. Easy to avoid hence people do not seek treatment. People sometimes seek help so as not to pass on the fear to their children. Most frequent in clinical practice are: - animals, enclosed spaces, height, blood, medical interventions, thunderstorms, flying, darkness, dentist, disease. Claustrophobia - fear of being trapped in an enclosed space. Can cause problems in lifts, lavatories, shower cubicles, cellars, sitting in the back of a two door car. Blood phobia. Very common in the population although more so in children. Most phobias result in autonomic arousal whereas blood phobias cause the opposite and nausea and fainting are common. Might more appropriately be seen as a fainting phobia. Fear is of object itself - not of having a panic attack (as in panic disorder), of humiliation (as in social phobia) or contamination (as in OCD).

15. Age of onset and sex difference

16. 90% of people with phobias do not seek treatment Phobia only regarded as clinically significant if stimulus frequently encountered and unavoidable Phobias commonly present with other anxiety disorders. Interventions should target primary disorder, and only address phobia if Sx still persist Phobias also linked with depression, low SE, and chronic problems Panic, health anxiety, PTSD, OCD, social phobiaPanic, health anxiety, PTSD, OCD, social phobia

17. Phobias: a differential diagnosis In phobias, anxiety is elicited by a single stimulus (or may have a phobia of several stimuli) Distinguishable from: Panic / agoraphobia ? pervasive anxiety, not about a single stimulus Panic ? variety of situations act as a trigger, focus primarily on bodily symptoms, not an external stimulus Social phobia ? negative evaluation by others vs. a specific stimulus PTSD ? intrusive symptoms and fear as consequence of a life-threatening stressor OCD ? fear is the content of the situation (e.g. contamination) not the stimulus itself

18. Acquisition & maintenance of fears Learning theory Fear acquired by classical conditioning and maintained by operant conditioning Classical conditioning CS + UCS ? CR birds + noise ? fear of birds Operant conditioning Avoidance ? prevents extinction occurring and also produces anxiety reduction which reinforces the fear Vicarious learning Ethological - Seligman 1971. Biological preparedness to acquire certain fears that have evolutionary advantage.

19. What next ? Exposure based treatments for specific phobia Prolonged vs. one session treatments Cognitive model and behavioural experiments

20. Assessment 1 Starts in first session and continues throughout treatment. Aims: To agree a formulation of the target problem with the patient. To gain sufficiently detailed information about factors maintaining the problem to be able to design a treatment plan. Modes of assessment Cognitive-behavioural interview Self-monitoring Self-report Information from other people Direct observation (role play or behavioural tests) Assessment scales (Fear Questionnaire, Fear of Vomiting scale)

21. Assessment 2 Brief description of problem Development: precipitants, time course, predisposing factors Description of problem behaviour: behavioural, cognitive, affective, physiological Contexts and modulating variables: situational, behavioural, cognitive, affective, interpersonal, physiological Maintaining factors: situational, behavioural, cognitive, affective, interpersonal, physiological Avoidance Coping resources and other assets Psychiatric and medical history Previous treatment Beliefs about problem Engagement Mood/mental state Psychosocial situation Family, psychosexual relationships, accommodation, occupation, relationships, hobbies Preliminary formulation

22. Behavioural factors Avoidance leads to a short term decrease in anxiety which is why it is repeated. Avoidance maintains phobia in the long term by preventing new learning i.e. that predicted aversive outcomes do not inevitably occur. Avoidance generalises to other similar situations.

23. Behavioural approaches to phobias Creating a fear hierarchy Exposure: graded vs. flooding Systematic desensitisation

24. Fear Hierarchy List all the cues and situations that cause anxiety Information from detailed assessment Attribute SUDs rating to each one Subjective Units of Distress ?0? No anxiety - ?100? Maximum possible anxiety Create a hierarchy of increasingly fearful situations Lots of items in upper ranges ? 30+ SUDS Items must be ones that the person can actually practice frequently SUDS rated on anxiety when safety behaviours and avoidance cannot be used Hierarchy is flexible. Items can be added or removed

25. Exposure 1 Key assumption: anxiety is maintained by avoidance Person exposed to cues that evoke anxiety until they realise that their fears do not come true and their anxiety reduces: habituation occurs. Exposure may be in-vivo or imaginal. Imaginal exposure used when in vivo not practical because: Cues are internal (memories, thoughts) Cues not immediately available (flight phobia) Cues cannot be evoked (fear of death of family member) Patient who is too anxious to start with in vivo

26. Anxiety during exposure

27. Exposure 2 Preparation. Explain rationale and procedure. Prepare for high levels of initial anxiety. Creation of exposure hierarchy. List of increasingly fearful situations with ?SUD? ratings. Initial exposure. Patient exposed until SUD rating dropped by 50% and habituation occurring. Otherwise anxiety response will be strengthened. Lengthy first session. Repeated exposure. Patient exposes self daily. Continues with an item until it evokes no anxiety and then moves up hierarchy. Keeps records of progress.

28. Exposure 3 Exposure is most effective when it consists of clearly specified tasks that : 1. Evoke anxiety 2. Are prolonged until habituation takes place 3. Are repeated until fear response decreases Problems with exposure 1. Exposure task does not include the relevant anxiety provoking cues 2. Patient engages in subtle form of avoidance such as distraction and does not engage with anxiety provoking cues 3. Exposure is too short (SUDS do not drop by 50%) or carried out too infrequently.

29. Treatment for specific phobia Additional considerations: Massed practice Establishing generalisation Homework compliance Therapist fears

30. Creating a fear hierarchy Hierarchies used to grade exposure to feared scenarios or stimuli. Develop a scale of feared scenarios relating to the phobic stimulus ? each with a SUDs rating from 0 ? 100 Aim is to identify scenarios associated with a range of distress responses. May need to make suggestions if client finds this difficult Focus on scenarios with SUDs ratings between 30 ? 70 May be helpful to use a visual scale, or imagery Start with a realistic goal ? beware of unrealistic predictions by both therapist / patient

31. Fear hierarchy: some useful questions What about thinking about putting yourself in that situation right now? What would it be like if we looked at a picture of ?..? How about talking about [stimulus] or imagining one in your mind?s eye? What about if you stood at the door / in the middle of the room / next to the exit (with feared stimulus in room)? Can you think of anything that would be a little less /more terrifying than that? How much longer could you have managed to stay in that situation? Would you feel more or less able to cope if someone was with you? How about if there was an ?? in the next room? If that situation is a 50%, can you think what a 40% might look like?

32. Fear hierarchy, dog phobia example

33. Exercise: creating a hierarchy for phobias Client: Think of a phobia that you hold yourself, or that of a patient you are working with ? or make one up Therapist: Your task is to give your patient a rationale for exposure interventions for phobia, and to help them to construct a hierarchy of situations relating to their phobia. Rate each of these (SUDS 0 ? 100) Discuss with your client where they think they could start on the hierarchy ? realistic, small goals

34. Animal phobias Five first-order dimensions of animal fears: (Graham Davey) Predatory animals Fear-relevant animals Dry, non-slimy invertebrates Slimy, wet-looking animals Farm animals Most feared animals: 1. Snakes 8. Bee 15. Lizard 2. Wasp 9. Eel 16. Beetle 3. Rat 10.Horse 17. Worm 4. Cockroach 11. Mouse 18. Moth 5. Spider 12. Slug 19. Pig 6. Maggot 13. Dog 20. Cow 7. Bat 14. Goose

35. Disgust Spiders ? why do people fear spiders? - Graham Davey Conditioning? Biological preparedness? Disgust! Disgust emotion is a food-rejection response that has evolved to prevent contamination and the spread of illness and disease. Disease spread (cockroaches & rats) Food contamination (maggots & mice) Similar to primary disgust objects such as mucus (snakes, slugs & snails) Tarantism. For 1000 years, spiders have been blamed for disease spread.

36. 1 session treatments Lars Goran-Ost Spiders, snakes, birds, wasps, blood-injury, injection, claustrophobia, flying & numerous other specific phobias Exposure in-vivo, sometimes with modelling

37. Treatment of injection phobia 1 Lars-Goran Ost Aim ? To prick 10 fingers, to do 12 sub-cutaneous injections and 2-4 venipunctures during 1 session of prolonged exposure. Behavioural analysis interview ? To obtain a detailed description of patients behaviour in phobic situations as well as catastrophic cognitions when exposed. 50% have a history of fainting Many fear the pain Disgust at thought of needle penetrating the skin. Fear that blood vessel that has been penetrated will not stop bleeding. Fear that needle will break off and wander around inside the body.

38. Treatment of injection phobia 2 Treatment Describe and demonstrate each small step Each time obtain pts permission to proceed Start with pricking fingers Obtain prediction of what will happen and belief that this will occur Demonstrate finger pricking and proceed Ask patient to rate degree of anxiety and pain and to compare this with the expectation Continue to subcutaneous injection when anxiety rating is less than 30. Explain the procedure ? needle into fatty sub-cutaneous tissue. 1 in 3 chance of hitting a pain receptor Initially insert and remove. Then inject saline. May have to break this down into smaller steps. After 4-6 injections and anxiety rating below 30 then proceed to venipuncture Explain the process and proceed

39. What about the cognitive bit? Relatively neglected - outcome data from exposure studies suggests repeated, prolonged exposure is highly effective in treating phobias. 70 ? 85% cases significantly improved (Roth and Fonagy, 2005) Behavioural theory suggests fear is reduced by habituation and extinction, BUT underlying mechanisms unclear: behaviourists include cognitive variables to help explain this (self efficacy, emotional processing and perceived control) Inclusion of cognitive factors may enhance motivation, effectiveness and generalisability of exposure tasks

40. A cognitive model of phobias Phobic anxiety is a rational response to situations seen as dangerous, as a result of biases in perception, interpretation and memory Behaviour has a key role in maintaining phobias, but key Tx. target is thinking. Behaviours make sense, given the beliefs that underpin them Identification of idiosyncratic fear cognitions allows specifically targeted interventions Key aim is to facilitate new understanding that feared stimuli are not / are unlikely to be dangerous (thus safety behaviours are unnecessary)

41. Development Assumptions (If?then) ? Trigger (frightening object / situation) ? ? Anxious cognitions (thoughts and images about the feared stimulus) ? OVEREST. THREAT & CONSEQUENCES/ UNDEREST. COPING AND RESCUE ? Anxious mood Physiological Sx. ? Hypervigilance Anxious cognitions re. stimulus Anx. Cognitions about Sx to physical Sx It will attack suddenly I will go mad with fear I won?t be able to protect myself I?ll start screaming will be sectioned It knows I?m afraid and will seek me out My heart will give out ? ? ? Safety behaviours Safety behaviours (Related to anxious thoughts about (related to fear of fear) feared object / situation) ? ? ? ? Secondary Cognitions ? ? ? Depression, hopelessness, loss of confidence, low self-esteem ?

42. Key maintenance processes implicated in phobias Anxious predictions: exaggerated estimates of harm/danger, and underestimation of coping / rescue (Beck et al, 1985) Physiological arousal Hypervigilance ? for cues related to phobic objects, and to physiological symptoms Safety behaviours ? serve to prevent anxious predictions from being disconfirmed Anxious predictions ? bias perception of and understanding of both external objects and situations / anxiety in highly idiosyncratic ways Physiological arousal ? a source of further anxious predictions (e.g. panic predictions, such as I will go mad)Anxious predictions ? bias perception of and understanding of both external objects and situations / anxiety in highly idiosyncratic ways Physiological arousal ? a source of further anxious predictions (e.g. panic predictions, such as I will go mad)

43. Key cognitions involved in phobias Overestimation of the probability of damage, harm, pain or injury Overestimation of the consequences of damage, harm, pain or injury Underestimation of coping Underestimation of rescue factors Secondary cognitions In general, involve exaggerated estimates of harm/danger, and underestimation of coping / rescue (Beck et al, 1985) Damage, harm, injury, pain: e.g. catastrophic wounds from being attacked by an animal, overestimation of fear, some stimuli seen as very predictable (rats always go for the jugular) others unpredictable (you just don?t know what they?ll do) Consequences: I?ll be disabled and disfigured, I?ll be left dying in the street. I?ll go crazy Coping ? increased sense of personal vulnerability - if that dog attacked me I?d be defenceless, and belief that cannot cope with Sx of anxiety Rescue ? others will ignore cries for help, laugh at him, unavailability of medical help, fragility of physical structures Secondary: I am weak, foolish, mad, wasting my life; other would think I?m riddiculous, I?ll never get over thisIn general, involve exaggerated estimates of harm/danger, and underestimation of coping / rescue (Beck et al, 1985) Damage, harm, injury, pain: e.g. catastrophic wounds from being attacked by an animal, overestimation of fear, some stimuli seen as very predictable (rats always go for the jugular) others unpredictable (you just don?t know what they?ll do) Consequences: I?ll be disabled and disfigured, I?ll be left dying in the street. I?ll go crazy Coping ? increased sense of personal vulnerability - if that dog attacked me I?d be defenceless, and belief that cannot cope with Sx of anxiety Rescue ? others will ignore cries for help, laugh at him, unavailability of medical help, fragility of physical structures Secondary: I am weak, foolish, mad, wasting my life; other would think I?m riddiculous, I?ll never get over this

44. Treatment plan for specific phobia Assessment Initial clinical evaluation of fears and phobias Description of current difficulties and maintenance cycles (safety behaviours), historical development and attempts at coping Socialisation to treatment Develop a formulation of the phobia and its treatment Identify costs and benefits of addressing phobia Identify key cognitions relating to the phobia Consider cognitions about the stimulus, physiological responses and secondary cognitions Socratic questioning to develop the possibility of an alternative perspective Rate beliefs in current cognitions, and belief in new perspective Develop behavioural experiments to target key cognitions Discovery Theory 1 vs. theory 2 experiments Eliminating safety behaviours Establishing generalisation

45. Identifying key cognitions Make sure the patient understands the connection between thoughts, feelings and behaviour Socratic questioning and thought monitoring to identify relevant cognitions, including downward arrow. Have you got the ?hot? thought? Help patient to be aware of their thinking biases ? selective attention, catastrophisation etc Help patient to decentre and re-appraise cognitions. This may include: Exploring the evidence for/against Psychoeducation (e.g. airline safety records for turbulence) Impact of info processing style on information attended to Developing an alternative or balanced perspective on the basis of evidence ? and rate conviction in new belief

46. BEs vs. exposure : similarities & differences In anxiety disorders, BE?s & exposure may look very similar (e.g. both may involve exposing a phobic client to their fear) BUT there are important differences: - Theoretical framework & goals: habituation vs. testing beliefs - Repeated prolonged exposure vs. targeted BEs - Importance of safety behaviours in BEs

47. The learning cycle: Key Questions

48. What are you interested in discovering? Whether a catastrophic outcome actually occurs? Whether an outcome is as catastrophic as predicted? If and how a safety behaviour maintains distress? The implications of an alternative interpretation? What thoughts and images occur in the feared situation? Whether secondary cognitions about having the phobia are realistic? Whether secondary cognitions about coping are realistic?

49. Maximising learning from behavioural experiments. Need to be formulation driven. Plan carefully. Know exactly what you want to test and why. Need clear predictions based on a question of significance to the client e.g. If I come into contact with a spider it will leap at me It will bite me It will be hairy and disgusting and I will be terrified My heart will beat so fast that it will burst and I will collapse

50. Maximising learning from behavioural experiments. Construct experiments that involve dropping all safety behaviours (use a graded approach if necessary) Predictions must relate to danger not unpleasantness The client decides how far to go Continue testing the prediction until the client is satisfied

51. Preparing the patient for behavioural experiments Check out: What is the specific belief you are testing? Can the client find evidence / for against this view? Generate an alternative interpretation based on a review of the evidence Can they recognise alternative interpretations as feasible?

52. Assess safety behaviours Things people deliberately do or don?t do in order to prevent the perceived worst from happening Which safety behaviours: Are being used to prevent perceived harm? Prevent disconfirmation of catastrophic fears? Increase misinterpretations? Increase preoccupation and rumination?

53. Predictions and safety behaviours in phobias (see Bennett-Levy et al, 2004, chapter 8)

54. Going through the steps It takes time to do behavioural experiments, but then it takes time not to get anywhere in therapy? Build alternative through verbal testing & rate belief Develop testable predictions & rate belief A: ?wasps will attack my face and sting me in the eye? B: ?wasps will fly around and will not sting me unless I aggravate them by hitting them.? Make a detailed plan for experiment Carry out and record Review outcome Re-rate beliefs Set up further / refined experiments It takes time to do behavioural experiments, but then it takes time not to get anywhere in therapy? Build alternative through verbal testing & rate belief Develop testable predictions & rate belief A: ?wasps will attack my face and sting me in the eye? B: ?wasps will fly around and will not sting me unless I aggravate them by hitting them.? Make a detailed plan for experiment Carry out and record Review outcome Re-rate beliefs Set up further / refined experiments

55. Exercise Taking turns as therapist, help your client to develop a behavioural experiment relevant to their phobia. You already have a description of their difficulties ? the experiment needs to target beliefs and safety behaviours If doing a theory A/B experiment, make sure you have identified a target cognition and developed an alternative prediction (with belief ratings) Does the experiment need to be graded? If so, develop clear and explicit stages What subsequent behavioural experiment(s) might be needed to consolidate and generalise learning?

56. Feedback How did you get on? Were you able to construct an experiment? What was the experience like as the patient? Did you feel that you were willing to try the experiment? What have you learnt from doing this that will be helpful when treating phobias in clinical practice?

57. BEs and phobias: issues to consider Acknowledge courage: Trust and collaboration, shared formulation Multiple vs. 1-session interventions: beware too much information about the treatment plan, but no ?nasty surprises? either Be clear about specific cognitions you are targeting ? and grade appropriately If grading, try and identify NATs / residual SBs that may undermine impact Coping techniques (e.g. distraction, breathing, relaxation) may be helpful to get started ? but should be dropped asap. NATs / residual SBs ? I managed to sit in the dark for 2 minutes but any longer I would have gone madNATs / residual SBs ? I managed to sit in the dark for 2 minutes but any longer I would have gone mad

58. BEs and phobias: issues to consider Very high anxiety ? stay calm and encouraging (but don?t buy into their predictions). Allow breaks if necessary ? aim is to test predictions, not habituate to anxiety Patient too scared to do the experiment: Therapist modelling and grading of difficulty level, flashcards re. alternative perspective being tested and how fits with formulation, motivational work Avoidance of affect: no emotional processing / discovery that anxiety is not harmful: discussion beliefs about experiencing emotion ? & targeted BEs

59. BEs and phobias: issues to consider Subtle safety behaviours ? if anxiety persists, look out for monitoring, distraction, reassurance seeking, rushing through the expt. Interpersonal maintaining factors Co-morbidity Generalisability

60. Phobias: Recommended Reading Beck, A.T., Emery, G., and Greenberg R.(1985). Anxiety Disorders and Phobias: a Cognitive Perspective. Basic Books Bennett-Levy, J., Butler G., et al (2004). Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford University Press Davey, G.C.L (ed) (1997). Phobias: A Handbook of Theory, Research and Treatment. Wiley, Chichester Sanders, D. A CBT approach to dealing with specific phobias. Booklet available from Oxford Cognitive Therapy Centre.



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