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- Herausgeber: Vede Marius
- Kategorie: Ratgeber
- Sprache: Englisch
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Veröffentlichungsjahr: 2023
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TABLE OF CONTENTS
CHAPTER 1. The Phobia Protocol Single Traumatic Event Script Notes
CHAPTER 2. The therapist’s corner
CHAPTER 3. Clinicians’ corner
CHAPTER 4. Important take-home messages
CHAPTER 5. Treating Attachment Trauma in Children Protocol Script
CHAPTER 6. Attachment Resource Development
CHAPTER 7. Subjective Units of Disturbance
CHAPTER 8. Patterns of Attachment
CHAPTER 9. The state of mind
CHAPTER 1. The Phobia Protocol Single Traumatic Event Script Notes
Determine to What Extent the Client Fulfills the DSM-5 Criteria of Specific
Phobia
A specific phobia is an intense and irrational fear of a specified object or situation. A phobia is an excessive and overwhelming fear that results in avoidance or extreme distress. Some phobias are centered on a specific fear object, while others are complex and tied to different situations or circumstances.
Phobias affect about 19 million adults, and women are two times more likely than men to have a specific phobia.1 Some people experience multiple specific phobias simultaneously. Approximately 75% of people with a specific phobia fear more than one object or situation.2
DSM-5 Criteria for a Specific Phobia Diagnosis
A fear and a phobia are not the same, so it's important to know the difference. Many people experience fears or aversions to objects or situations, but this does not necessarily mean that they would be diagnosed with a specific phobia.
Therapists cannot use a lab test to make this diagnosis, so they and other mental health professionals consult the DSM-5 (Diagnostic and Statistical Manual, 5th Edition). This guide provides diagnostic criteria for specific phobia from the American Psychiatric Association:3
Unreasonable, excessive fear: The person exhibits excessive or unreasonable, persistent and intense fear triggered by a specific object or situation.
Immediate anxiety response: The fear reaction must be out of proportion to the actual danger and appears almost instantaneously when presented with the object or situation.
Avoidance or extreme distress: The individual goes out of their way to avoid the object or situation, or endures it with extreme distress.
Life-limiting: The phobia significantly impacts the individual’s school, work, or personal life.
Six months duration: In children and adults, the duration of symptoms must last for at least six months.
Not caused by another disorder: Many anxiety disorders have similar symptoms. A doctor or therapist would first have to rule out similar conditions such as agoraphobia, obsessional-compulsive disorder (OCD), and separation anxiety disorder before diagnosing a specific phobia.
Recognizing Fear As Irrational Is Not Required
In previous DSM editions, adults with specific phobias had to recognize that their fears are out of proportion to reality, but children did not. The 2013 edition now says the adults no longer have to recognize the irrationality of their behavior to receive a diagnosis.
Types of Specific Phobias
There are five types of specific phobias:3
Natural/environment type: These are phobias of nature, weather, and environmental events or situations. These can include the fear of thunder and lightning (astraphobia) or water (aquaphobia).
Injury type: This type of fear is related to a fear of physical harm or injury. These include a fear of the dentist (dentophobia) or injections (trypanophobia).
Animal type: These fears are centered on animals or insects. This can include the fear of dogs (cynophobia), snakes (ophidiophobia), and insects (entomophobia).
Situational type: This type of phobia centers on fears triggered by specific situations. These include the fear of washing (ablutophobia) and enclosed spaces (claustrophobia).
Other types: Fears that don't fit into the other four types are included in this category. This can include things such as a fear of dolls, vomiting, or loud sounds.
Causes
There are a number of different factors that can contribute to the development of specific phobias. These include:
Temperament: Research suggests that people who exhibit more behavioral inhibition have a higher risk for a variety of anxiety disorders, including specific phobias.4
Genetics: People who have a family member with an anxiety disorder or phobia are more likely to also develop some type of phobia.5
Experiences: Stressful or traumatic experiences can also play a role in the formation of a phobia. A single incidence of being bitten by a dog, for example, can play a role in the development of a fear of dogs.
What Causes Phobias to Develop?
Treatment
While specific phobias can be serious and debilitating, effective treatments are available. These can help reduce or even eliminate symptoms. They include:
Medication
While medication is not usually used on its own to treat phobias, it may sometimes be prescribed to help people manage physical and emotional reactions associated with phobias. Such medications are usually most effective when paired with psychotherapy.
Psychotherapy
There are a number of psychotherapy techniques that may be used to treat phobias, but exposure therapy and cognitive-behavioral therapy (CBT) are the two that are more commonly used.
Exposure therapy involves gradual and progressive exposure to the feared object or situation.6 Such exposure is paired with relaxation strategies until the fear reaction is reduced or extinguished.
Cognitive-behavioral therapy involves helping people learn to identify and then change the automatic negative thoughts that contribute to phobic reactions.
The DSM-5 states that people with specific disorders also have an elevated risk for suicide. These phobias also tend to commonly occur alongside other mental health conditions including panic disorder, post-traumatic stress disorder (PTSD), and substance use disorder.2 Because of this, getting appropriate treatment is essential.
Preparing for Treatment
If you have decided it's time to seek professional help for your fear, take some time to prepare yourself for your first appointment. To make the most of your appointment, and help your therapist determine if you have a fear or a phobia, create three lists:
Symptoms: Make a list of physical and psychological symptoms, including your trigger, how you cope with your fear, and things that make your anxiety better or worse.
Personal life: Make a list of anything stressful going on in your life, including relationship issues or trouble at work. Listing new situations that seem like a positive thing, including promotion or a budding romance, is also important, as good news can cause anxiety, too.
Medication and supplements: Make a list of all medication and supplements you take regularly, such as vitamins and herbal teas. These substances can affect your mental state and interfere with treatment.
Questions to Ask Your Therapist
While you're in the therapist's office, you have an opportunity to ask questions. Worried you won't be able to think of any on the spot? Here are some you can use:
What options for treatment do you recommend?
How can I best manage my other health conditions while in treatment?
If I follow the recommended treatment plan, how much improvement can I expect to see, and when?
A Word From Verywell
People who have a specific phobia may be aware that their fears are irrational, but knowing this doesn't mean that their fear isn't very real and often debilitating. Specific phobias are common, and are often rooted in the primal, instinctual fears that many people (even those without a diagnosis of phobia) experience and understand. It is important to remember that effective treatments are available that can help relieve these fears and the symptoms they cause.
Identify the Stimulus Situation (Conditioned Stimulus, CS)
Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus (e.g. food) is paired with a previously neutral stimulus (e.g. a triangle). It also refers to the learning process that results from this pairing, through which the neutral stimulus comes to elicit a response (e.g. salivation) that is usually similar to the one elicited by the potent stimulus.
Classical conditioning is distinct from operant conditioning (also called instrumental conditioning), through which the strength of a voluntary behavior is modified by reinforcement or punishment. However, classical conditioning can affect operant conditioning in various ways; notably, classically conditioned stimuli may serve to reinforce operant responses.
Classical conditioning was first studied in detail by Ivan Pavlov, who conducted experiments with dogs and published his findings in 1897. During the Russian physiologist's study of digestion, Pavlov observed that the dogs serving as his subjects drooled when they were being served meat.[1]
Classical conditioning 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.[2]
Together with operant conditioning, classical conditioning became 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 the false consensus effect.[3]
Definition
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 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.[4]
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 the conditioned stimulus comes to signal or predict the unconditioned stimulus, and go on to analyze the consequences of this signal.[5] 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".[6] Despite its widespread acceptance, Rescorla's thesis may not be defensible.[7]
Classical conditioning differs from operant or instrumental conditioning: in classical conditioning, behaviors are modified through the association of stimuli as described above, whereas in operant conditioning behaviors are modified by the effect they produce (i.e., reward or punishment).[8]
Procedures
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.[9] During his research on the physiology of digestion in dogs, Pavlov developed a procedure that enabled him to study the digestive processes of animals over long periods of time. He redirected the animal's 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 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.
Terminology
In Pavlov's experiments the unconditioned stimulus (US) 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.[10] Likewise, the responses of the dog follow the same conditioned-versus-unconditioned arrangement. The conditioned response (CR) 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.[11]
As noted earlier, it is often thought that the conditioned response is 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.[6][8] It was also thought that repeated pairings are necessary for conditioning to emerge, but many CRs can be learned with a single trial, especially in fear conditioning and taste aversion learning.
Forward conditioning
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.[12][13]: 69 Two common forms of forward conditioning are delay and trace conditioning.
Delay conditioning: In delay conditioning, the CS is presented and is overlapped by the presentation of the US. For example, if a person hears a buzzer for five seconds, during which time air is puffed into their eye, the person will blink. After several pairings of the buzzer and the puff, the person will blink at the sound of the buzzer alone. This is delay conditioning.
Trace conditioning: During trace conditioning, the CS and US do not overlap. Instead, the CS begins and ends before the US is presented. The stimulus-free period is called the trace interval or the conditioning interval. If in the above buzzer example, the puff came a second after the sound of the buzzer stopped, that would be trace conditioning, with a trace or conditioning interval of one second.
During simultaneous conditioning, the CS and US are presented and terminated at 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
Second-order or higher-order conditioning follow a two-step procedure. First a neutral stimulus ("CS1") comes to signal 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.[13]: 66 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 is paired with the CS1.
Backward conditioning
Backward conditioning occurs when a CS immediately follows a US.[12] 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.[13]: 71 For example, a puff of air directed at a person's eye could be followed by the sound of a buzzer.
Temporal conditioning
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 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.
Zero contingency procedure
In this procedure, the CS is paired with 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.[14] This finding – that prediction rather than CS-US pairing is the key to conditioning – greatly influenced subsequent conditioning research and theory.
Extinction
In 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 a weak stimulus is presented.
Phenomena observed
Acquisition
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 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.[5][8] The process slows down as it nears completion.[15]
Extinction
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 the CR is said to be "extinguished."[5][1
External inhibition
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.
Recovery from extinction
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 the effect of conditioning.[8] These procedures are the following:
Reacquisition: If the CS is again paired with the US, a CR is again acquired, but this second acquisition usually happens much faster than the first one.
Spontaneous recovery: Spontaneous recovery is defined as the reappearance of a previously extinguished conditioned response after a rest period. That is, if the CS is tested at a later time (for example an hour or a day) after extinction it will again elicit a CR. This renewed CR is usually much weaker than the CR observed prior to extinction.
Disinhibition: If the CS is tested just after extinction and an intense but associatively neutral stimulus has occurred, there may be a temporary recovery of the conditioned response to the CS.
Reinstatement: If the US used in conditioning is presented to a subject in the same place where conditioning and extinction occurred, but without the CS being present, the CS often elicits a response when it is tested later.
Renewal: Renewal is a reemergence of a conditioned response following extinction when an animal is returned to the environment *(or similar environment) in which the conditioned response was acquired.
Stimulus generalization
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.[5] Conversely, the more the test stimulus differs from the CS, the weaker the CR will be, or the more it will differ from that previously observed.
Stimulus discrimination
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.[5]
Latent inhibition
Main article: Latent inhibition
Latent inhibition refers to the observation that it takes longer for a familiar stimulus to become a CS than it does for a novel stimulus to become a CS, when the stimulus is paired with an effective US.[5]
Conditioned suppression
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 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.)
Conditioned inhibition
Typically, three phases of conditioning are used.
Phase 1
A CS (CS+) is paired with a US until asymptotic CR levels are reached.
Phase 2
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.
Phase 3
Summation test for conditioned inhibition: The CS- from phase 2 is presented together with a new CS+ that was conditioned as in phase 1. Conditioned inhibition is found if the response is less to the CS+/CS- pair than it is to the CS+ alone.
Retardation test for conditioned inhibition: The CS- from phase 2 is paired with the US. If conditioned inhibition has occurred, the rate of acquisition to the previous CS− should be less than the rate of acquisition that would be found without the phase 2 treatment.
Blocking
Identify the Expected Consequence or Catastrophe (Unconditioned Stimulus, UCS)
Examples of Unconditioned Stimuli
Unconditioned stimuli are all around us. Think about:
The smell of a favorite food, which immediately makes you feel hungry
A feather tickling your nose, which causes you to sneeze
An onion's smell as you cut it, which makes your eyes water
Pollen from grass and flowers, which causes you to sneeze
A unexpected loud bang, which causes you to flinch
In each of these examples, the unconditioned stimulus naturally triggers an unconditioned response or reflex. You don't have to learn to respond to the unconditioned stimulus; it occurs automatically.
The Unconditioned Stimulus in Pavlov's Experiment
In Ivan Pavlov's classic experiment with dogs, Pavlov and his assistants showed the dogs edible and non-edible items and measured saliva production with each. Salivation occurred automatically and without the dogs' conscious effort when they smelled the food.
This response required no learning. The food was an unconditioned stimulus because it prompted a reflexive response.
The Little Albert Experiment
Building on Pavlov's work, behaviorist John B. Watson and graduate student Rosalie Rayner conducted what came to be known as "the Little Albert experiment." The research showed that emotional reactions could be classically conditioned in people.
Watson and Rayner exposed a 9-month-old child, Albert, to a white rat, a rabbit, a monkey, masks, and burning newspapers and observed the boy's reactions. He showed no fear of them at first.
But after Watson began making a loud noise—an unconditioned stimulus that provoked Albert's crying—whenever he showed Albert the white rat, Albert became frightened whenever he saw the white rat. Because he'd learned to associate the white rat with a noise he feared, he ultimately reacted with fear to the rat as well. The rat, once a neutral stimulus, had become a conditioned stimulus.1
The Neutral Stimulus
For the purposes of classical conditioning or learning, you need a neutral stimulus as well as an unconditioned stimulus. In other words, for conditioning to take place, you must first start by pairing a neutral stimulus with an unconditioned stimulus.
A neutral stimulus doesn't trigger any particular response at first, but when used together with an unconditioned stimulus, it can effectively stimulate learning, eventually becoming a conditioned stimulus. A good example of a neutral stimulus is a sound or a song.
When it is initially presented, the neutral stimulus has no effect on behavior. As it is repeatedly paired with an unconditioned stimulus, it will begin to cause the same response as the UCS.
For example, the assistants in Pavlov's experiment initially elicited no salivation and therefore were neutral stimuli. Likewise, the sound of a squeaky door opening is initially a neutral stimulus. If that sound is repeatedly paired with an unconditioned stimulus, such as feeding your cat, that sound will eventually come to trigger a change in your cat's behavior. Once an association has been formed, your cat may react as if it is being fed every time it hears the squeaky door open.
Unconditioned Stimulus vs. Conditioned Stimulus
An unconditioned stimulus causes a response without any prior learning on the part of the subject. The response is automatic and occurs without thought. In contrast, a conditioned stimulus produces a reaction only after the subject has learned to associate it with a given outcome.
In Pavlov's experiments, the dogs learned to salivate when they saw the assistants' white lab coats because they'd formed an association between the assistants and the food they presented, The salivary response to the assistants was not an automatic, physiological process, but a learned one. The presence of the assistants, initially a neutral stimulus, became a conditioned stimulus.
Timing of Learned Behavior
Throughout the classical conditioning process, a number of factors can influence how quickly associations are learned. The length of time that passes between presenting the initially neutral stimulus and the unconditioned stimulus is one of the most important factors in whether learning occurs.
The timing of how the neutral stimulus and the unconditioned stimulus are presented is what influences whether or not an association will be formed, a principle that is known as the theory of contiguity.2
Types of Classical Conditioning
In Pavlov's experiment, the sound of a buzzer was initially a neutral stimulus, while the smell of food was an unconditioned stimulus. Presenting the tone close to presenting the smell of food resulted in a stronger association. Ringing the buzzer, the neutral stimulus, long before the unconditioned stimulus led to a much weaker or even nonexistent association.
Different types of conditioning may use different timing or order between the neutral stimulus and the UCS.3
In simultaneous conditioning, the neutral stimulus is presented at the exact time as the unconditioned stimulus. This type of conditioning leads to weak learning.
In backward conditioning, the unconditioned stimulus is given first, and the neutral stimulus is presented afterward. This type of conditioning also tends to result in weak learning.
In trace conditioning, the neutral stimulus is presented briefly and then stopped, then the unconditioned stimulus is presented. This type of conditioning produces good results.
In delayed conditioning, the neutral stimulus is presented and continues while the unconditioned stimulus is offered. This type of conditioning produces the best results.
