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By Lydia Mardirian
A way to investigate possible causes and therefore treatments for the phobia, the ‘Biopsychosocial Framework’ is involved. The 'Biopsychosocial Framework' is an approach to describing and explaining how biological, psychological and social factors combine and interact to influence a persons physical and mental health. The framework is based on the idea that both health and illness are best understood by considering specific factors from within each domain and how these factors may combine and interact, ultimately affecting ones well being. Further, by avoiding the phobic stimulus, it leads to a reduction in anxiety and is therefore negatively reinforced.
1. Nelson (1978)
Grivas, J., Letch, N., Down, R. & Carter, L. (2010)
Psychology VCE: Units 3 & 4 (4th Ed.)
Melbourne: Macmillan Education.
2. Phobia Powerpoint/Notes
3. 'Ambulophobia – Fear of Walking'
Found: 4/9/13
http://www.phobiasource.com/ambulophobia/
4. 'Fear of Falling / Fear of Walking: Help & Treatment for Ambulophobia'
Found: 4/9/13
http://www.peterfieldhypnotherapy.co.uk/Fear-of-Walking-Fear-of-Falling-Ambulophobia.html
5. 'Ambulophobia: Do you have a fear of walking?'
Found: 4/9/13
http://common-phobias.com/ambulo/phobia.html
The 'Bio' component of the framework addresses hormones, nervous system activity, brain function and chemistry. Biological factors involve physiologically based influences. There are three biological factors.
Inherited Factors: Refers to determined influences, such as inherited genes, neurochemistry and personality characteristics. In relation to Ambulophobia, looking at the phobia from this domain, it could be suggested that the sufferer inherited the chemical imbalance in the brain, the particular brain activity and/or personality characteristics associacted with phobias such as a predisposition to anxiety, fear etc. In fact, research into anxiety disorders and the incidence in families shows a moderate level of heritability of anxiety disorders.
Stress Response: The physiological and psychological change experienced when someone is confronted by a stressor. This is unbrella term to which The Fight or Flight response is under. Fight or Flight is an involuntary reaction resulting in a state of physiological readiness to deal with a sudden and immediate threat by either confronting it (fight) or running away to safety (flight). It does this by activating the sympathetic nervous system and the endocrine system. Simply by activating the hypothalamas, then the pituitary gland, then the adrenal glands, releasing cortisol and finally adrenaline/nonadrenaline , the sympathetic NS is activated. Breathing rate then increases, heart rate increases, blood pressure in arteries increase, pupils dialate, the blood flow to skeletal muscles increase, blood flow to muscles inrease and intestinal muscles relax. Once the percieved threat is dismissed, the body returns to normal state. Refering back to Ambulophobia, it would be assumed that this process is activated when about to walk or walking in mentioned.
Role of the GABA: Gamma-Amino Butyric Acid is the primary inhibitory neutrotranmitter in the CNS and works throughout the brain to make post-synaptic neurons less likely to pass on a message. The inhibitory action of GABA counterbalances the excitatory activity of Glutamate and vice versa. It is said that those who have an anxiety disorder lack enough GABA, for they get too aroused/excited over otherwise banal stimuli. Refering back to Ambulophobia, it would be assumed that the reason for the exagerated reaction to walking is due to the lack of GABA.
The social component of the Framework is concerned with social skills, amount of isolation or support, stressors and traumers, cultural values and expectations, life events and environmental conditions.
Specific Environmental Triggers: Invovles developing a phobia after direct negatve experience with an object or situation. Many people diagnosed with a phobia report having a negative and traumatic experience with a particular phobic stimulus at some time in the past and attribute this specific encounter as the cause of their phobia. These 'specific' objects or situations in the 'envionment', 'triggered' an extreme fear response. Referring back to Ambulophobia, it would be assumed that whilst walking one time, the individual began to feel pain, witnessed/experienced an ugly situation - the individual had a negative experience whilst walking and now is scared of the act.
Parental Modelling: Involves oberving and then reproducing a parents fear of an object or situation. Simply observational learning, or modelling can be involved in the development of phobias, for one learns a lot from their parents behaviour, particuarly behaviour that is overt or exaggerated. Using Ambulophobia as an example, the sufferer may have witness their parent being fearful of walking and avoid it and they have simply learnt to do the same.
Transmission of threat information: Refers to the exposure to negative or frightening infomation about an object or situation. This infomation can be transferred from parents, family, peers, teachers, the media and other secondary sources. Research shows that people develop phobias and fears through the aquisition of negative infomation about the object/situation. Perhaps a sufferer of Ambulophobia was told that walking poses a big danger and thus it should be avoided.
The Psycho domain of the Framework is interested in ones thinking and reasoning skills, learning and memory, emotional state, personality traits and coping skills. There are three models in explaining an anxiety disorder such as phobias.
Psychodynamic Model: Cultivated by Freud, the psychodynamic model suggests that all mental disorders are caused by unresolved psychological conflicts that occur in the unconscious part of the mind. In the Psychodynamic Theory, the unconscious mind contains all of the memories and experiences that are a source of anxiety and are difficult to have in our consciousness. Freud stated that our conscious mind protects itself from these conflicts using defence mechanisms, which we unaware of using. The anxiety of repressed emotions, and particulary sexual desires, is reduced by falsifying or distorting reality. According to Freud, a specific phobia, which he called anxiety hysteria, develops as a consequence of an unresolved Oedipal complex, that being the desire to have an intimite relationship with the parent. There is a a cycle to the model: a child has an oedipal complex and experiences castration anxiety, they repress their desires, begin to identify and imitate the undesired parent, the castration anxiety is reduced, repression of thoughts fails, the child displaces anxiety to a new stimuli and thus a phobia is created.
Behavioural Model: According to the behavioural model, phobias are learned through experience and may be acquired, maintained or modified by environmental consequences such as rewards and punishment. They are generally acquire through classical conditioning and strengthened with operant conditioning. Using Ambulophobia as an example, walking (the NS) could have been paired with the anxiety of nearly getting run over (UCS) then that leads to the phobia of walking (CR). The person will then avoid walking (response), the fear/anxiety associated would reduce (consequence) and thus the behaviour would be maintained through the negative reinforcement. Also a person may have been consolled when nearly hit and thus the fear response is positively reinforced.
Cognitive Model: A cognitive model focuses on how the individual processes information about the phobic stimulus and related events. It emphasises how and why people with a phobia have an unreasonable and excessive fear of a phobic stimulus. It is generally assumed that the phobia is due to a cognitive bias (or cognitive distortion) - faulty decision making or beliefs. There are 4 different biases and 1 way of thinking. The 'Attentional Bias' the individuals only attends to threat related stimuli. 'Memory BIas' the recall of negative information is better than of positive. 'Interpretive Bias' the sufferer has a tendency to judge ambiguous in a threatening way. Lastly, 'Catestohic Thinking' tendency to see something as catastrophic when it isn't.
As seen with the Biopsychosocial Framework, health is a combination of the three elements of the self: the physical, the mental and the social, so when attempting to reduce or remove a phobia, it is essential to examine the ways to do so in each domain of the self. Expectedly, each domain supports treatments that target the domain, for example, Bio: chemical and/or physical responses. Psycho: training and/or maniplating thoughts and the mind. Social: supporting and/or informing the sufferer.
Benzodiazepines: Benzodiazepines are a group of drugs called minor tranquillisers. These drugs are prescribed by a doctor to help people with anxiety as they slow down the workings of the brain and the central nervous system, thus alleviating an individual of the tension associated with a phobia. For example, a sufferer of ambulophobia could take a small dosage of benzo, and then, whilst being assisted, walk. They would be more willing to face the phobic stimuli but also associate walking with that relaxed feeling.
GABA supplements: Some researchers have proposed that GABA levels can be increased 'naturally' by drinking green tea or eating foods 'high in GABA', foods like beans, dairy products, eggs, seafoods and whole grains. What is also on the market now is GABA in pill form, however no significant research suggests that GABA supplements are useful as they are unable to penetrate the blood-brain barrier (physiological mechanism that protects the brain) and would therefore have no effect of phobic anxiety. Thus this method of treating a sufferer of ambulophobia would not be used on such a patient as it is less likely to have effects.
Relaxation Response: The relaxation response is the counterpart to the fight-or-flight response, it occurs when the body is no longer in perceived danger, and the autonomic nervous system functioning returns to normal. All the stress the body is under whilst the sympathetic NS is running it is alleviated. An individual with ambulophobia who was pushed to walk, or perhaps walking was mentioned would experience the fight or flight response, be in a complete state of stress, however the sympathetic NS can't run the body for long, so the sufferer must begin to walk, and be walking whilst the Relaxation Response, the autonomic NS resumes running the body, so they realsie that there is no reason to stress over walking.
Cognitive Behavioural Therapy: CBT is based on the assumption that the way people feel and behave is largely a product of the way they think. Therefore, according to the principles of CBT, anyone can change the way they feel and behave by thinking about a situation in a more balanced and helpful way. The way CBT is as follows:
Identify fear related thoughts, identify cognitive biases, find evidence to support and not support the fear, encourage objective evaluation and finally changes in feelings/behaviour will be seen. This process could be taken by first investigating the thoughts associated with walking, find evidence, inform the individual that the billions of people who exist walk everyday and will continue to forever etc.
Systematic desensization/ Gradual exposure: Systematic desensitisation is a kind of behaviour therapy that aims to replace an anxiety response with a relaxation response when an individual with a specific phobia confronts a fear stimulus. The process of it is as follows: Learn a relaxation strategy, break phobic stimulus into sequence and finally exposure to increasingly fearful stumuli. An example of this would be to get the sufferer to hold your hand - providing support, then get them to stand up with you. That may be enough until you can get them put one foot infront of the other.
Flooding: Flooding involves bringing the client into direct contact with their most feared object or situation straight away and keeping them in contact with it until their fear and associated anxiety disappear. Relating this back to Ambulophobia, an example of flooding would be to push the sufferer to walk a kilometre, straight up.
Non-fear modelling: It could be said that non-fear modelling is the same process as fear modelling but the emotion or reaction to the phobic stimulus is different. So in non-fear modelling there will be a person showing, either subconciously or purposely that the phobic stimulus needn't be one - that the anxiety associated with the phobia is unnecessary. In reference to ambulophobia, this may be done by simply walking around the person, without drawing attention to the act or by drawing attention to the fact that walking is harmless. It could be quite a powerful technique as one learns so much from what they observe, whether they are conscious of it or not.
Gather accurate infomation and facts: By findng out more infomation on something or perhaps informing the sufferer of the accurate infomation - quite simply giving the sufferer a bit of a reality check, that walking is an essential, normal part of life, that one cannot really function without it.
Anxiety is a state of psychological arousal associated with feeling of apprehension, worry and/or uneasiness that something wrong or unpleasant is going to happen. For some this state comes fleetingly, for others it is a disorder.
The term ‘Anxiety Disorder’ is used to describe a group of disorders that are characterized by chronic feelings of anxiety, distress, nervousness, and apprehension or fear about the future, with a negative effect. Of course there are situations where it is 'normal' or 'expected' to feel anxiety, however, if levels of anxiety are inappropriate in relation to the situation, this may indicate an anxiety disorder. An example of an anxiety disorder is a Phobia.
A phobia is an excessive or unreasonable fear directed towards a particular object, situation or event that causes significant distress or interferes with everyday functioning. In the case of Ambulophobia, the fear is directed to walking meaning individuals with the disorder suffer such symptoms of anxiety as dry mouth, breathlessness, panic attacks, trembling, nausea, fainting and a sense of a lose of control when they may need to walk or even when walking is mentioned. Hence sufferers will avoid walking, in many cases their being becomes bound to a chair.