Phobia: types and management

1. By
MS NEHA BHATT

2. DEFINITION
Phobia is defined as an irrational fear of a specific object,
situation or activity, often leading to persistent
avoidance of the feared object, situation or activity
Mark defined phobia with four criteria
• The fear is out of proportion to the demand of
situation
• It cannot be explained or reasoned away
• It is beyond voluntary control
• The fear leads to an avoidance of the feared situation

3. CLASSIFICATION
ICD-10 Classification
F40-F48 neurotic, stress-related & somatoform
disorder
• F40 phobic anxiety disorder
• F40.0 Agoraphobia
• .00 With out panic disorder
• .01 with panic disorder
• F40.1 social phobia
• F40.2 specific phobia
• F40.8 other phobic disorder
• F40.9 phobic anxiety disorder, unspecified

4. ETIOLOGY
• A. Behavioural factors
1. Stimulus response model
Anxiety is aroused by naturally frightening stimulus
that occurs in contiguity with a second inherently
neutral stimulus .as a result of contiguity
especially when the two stimuli are paired on
several occasion ,the originally neutral stimulus
takes on the capacity to arouse anxiety by itself
.the neutral stimulus ,therefore, becomes a
conditioned stimulus for anxiety production

5. CONT…
• 2. Operant conditioning
Anxiety is a drive that motivates the organism to do
what it can ,to obviate the painful affect in the
course of its random behavior ,the organism
learns that certain action enable it to avoid the
anxiety –provoking stimulus .those avoidance
pattern remain stable for long periods of time ,as
a result of the reinforcement they receive from
their capacity to diminish activity

6. CONT…
• B. Psychoanalytic theories
The major function of anxiety is a signal to the
ego ,that a forbidden unconscious drive in
pushing for conscious expression thus altering
the ego to strengthen & marshal its defenses
against the threatening instinctual force

7. CLINICAL FEATURES
AGORAPHOBIA
• It is characterized by an irrational fear of being
in places away from the familiar setting of home,
in crowds or in situation that the patient cannot
leave easily
• As the agoraphobia increases in severity, there is
a gradual restriction in normal day to day
activities. The activity may become so severely
restricted that the person becomes self
imprisoned at home.

8. CONT…
Signs and Symptoms
• Overriding fear of open or public space
• Deep concern that help might not be available
in such places
• Avoidance of public places and confinement
to home
• When accompanied by panic disorder, fear
that having panic attack in public will lead to
embarrassment or inability to escape

9. CONT…
SIMPLE PHOBIA
• It is an irrational fear of a specific object or stimulus.
Simple phobias are common in childhood. By early
teenage most of these fears are lost, but a few
persist till adult life. Sometimes they may reappear
after a symptom free period.

10. CONT…
Signs and Symptoms
• Irrational and persistent fear of object or situation
• Immediate anxiety on contact with feared objects or
situation
• Loss of control, fainting or panic response
• Avoidance of activities involving feared stimulus
• Anxiety when thinking about stimulus
• Worry with anticipatory anxiety
• Possible impaired social or work functioning

11. SOCIAL PHOBIA
It is an irrational fear of performing activities in the presence of
other people or interacting with others. The patient is afraid of
his own actions being viewed by others critically insulting in
embarrassment or humiliation.
• Hyperventilation
• Sweating, Cold, clammy
hands
• Blushing
• Palpitations
• Gastrointestinal
symptoms
• Trembling hands and
voice
• Urinary urgency
• Muscle tension
• Anticipatory anxiety
• Fear or embarrassment
or ridicule
• Confusion
Signs and Symptoms

12. CONT…
DIAGNOSIS
• No specific diagnostic test, diagnosis
confirmed if ICD10 criteria met
• History of anxiety when exposed to or
anticipatory specific entity or situation

13. TREATMENT
PHARMACOTHERAPY
• Benzodiazepines (for example alprazolam,
clonazepam, lorazepam, diazepam )
• Antidepressants ( for example imipramine,
sertraline, phenelzine)

14. TREATMENT
BEHAVIOR THERAPY
• Desensitization therapy to gradually reintroduce
the feared situation while coaching the patient
on relaxation techniques (progressive muscle
relaxation, deep breathing exercises, listening to
calming music)
• Role playing in guided imagery to allow the
patient to rehearse ways to relax while
confronting a feared object or situation
• Assertiveness training to help the patient become
assertive in her interpersonal interactions.

15. CONT….
Modeling behavior:
• Patient observes someone modeling or
demonstrating appropriate behavior when
confronting with feared situation

16. CONT….
A cognitive behavioural technique called negative
thought stopping to reduce the frequency and
duration of disturbing thoughts by interrupting
them and substituting competing thoughts:
• Teaches patients to recognize negative thoughts
• Involves using an intense distracting stimulus to
stop the thought
• With practice, allows patient to control thoughts
without using distracting stimulus.

17. CONT…
PSYCHOTHERAPY
• Supportive psychotherapy is a helpful adjunct
to behavior therapy and drug treatment.
NURSING MANAGEMENT
• NURSING ASSESSMENT
History &MSE

18. Nursing Diagnosis
Fear related to specific stimulus or causing embarrassment to
self in front of others, evidenced by behavior directed
towards avoidance of the feared object / situation.
Nursing Interventions
• Reassure the patient that he is safe
• Explore patient’s perception of the threat to self concept
• Include patient in making decisions related to selection of
alternative coping strategies
• If the patient elects to work on eliminating the fear,
techniques of desensitization or implosion therapy may be
employed
• Encourage patients to explore underlying feelings that may
be contributing to irrational fears.

19. Nursing diagnosis
• Social isolation related to fear of being in a place from which
one is unable to escape, evidenced by staying alone, refusing
to leave home/room.
Nursing Interventions
• Convey an accepting attitude and unconditional positive
regard. Make brief, frequent contacts. Be honest
• Attend group activities with the patient that may be
frightening for him
• Administer anti-anxiety medications as ordered by physician,
monitor for effectiveness and adverse affects
• Discuss with the patient signs and symptoms of increasing
anxiety and techniques to interrupt the response.
• Give recognition and positive reinforcement for voluntary
interactions with others.