This in the eighth in a series of blog posts about Cognitive Behavioural Therapy formulations. This blog will focus on Cognitive Behavioural Therapy formulation for specific phobia.
1. What is Specific Phobia?
Specific phobia is characterized by significant fear of a specific situation or object. Common phobias include fear of vomiting, heights or injections). In order to meet diagnostic criteria the situation or object must always provoke an immediate fear response, be actively avoided and feared out of proportion to the danger posed by the situation or object. The experience of fear may range from anticipatory anxiety to a panic attack. The fear experienced must have lasted for 6 months or more and lead to clinically significant distress or impairment within social, occupational and other areas of functioning.
Some people may be more vulnerable than others to developing these difficulties.
2. Predisposing factors
Predisposing factors may include: early exposure to a traumatic event whether it be through direct experience or observed experience of others (e.g. witness a loved one go through a period of illness, going under water in the swimming pool), experience of a panic attack in the presence of the now feared object/situation or informational transmission (e.g. hearing reports of plane crashes or buildings collapsing on the tv or news).
3. Precipitating factors
Precipitating factors include exposure to the feared situation or object.
4. Perpetuating factors
Perpetuating factors include avoidance of the fear situation or object. Consistent transmission of negative information of the feared situation may also maintain the fear (e.g. continued news reports of plane crashes etc), hyper vigilance to situations or objects similar to that, which is feared. Additionally, the individual may engage in safety behaviours such as reassurance seeking with regards anticipatory anxiety of the feared situation or object.
5. Protective factors
Protective factors include: interests in engaging in activities and support from family and friends.
6. Case example
Tina’s grandfather was very ill for the first three years of her life. She remembers hearing him vomit and seeing him look very frail and pale. Tina’s father speaks about many of his work colleagues being off sick today. Tina starts to feel very anxious and leaves the room each time her father enters the room. Tina does not speak to her father for several days. When Tina feels the threat has passed she talks to her parents about this.
This can be understood within a CBT formulation as follows:
Predisposing factor: Tina has witnessed a loved one being ill at a very early age for a prolonged period of time. This happened at a time when she was so young she was likely to not have understood what was going on and experienced lots of fear around this.
Precipitating factor: Tina’s father discussing his colleagues being ill was a trigger for her becoming anxious.
Perpetuating factors: Tina’s avoidance of her father may teach her that by avoiding others’ in contact with viruses/germs will keep her from getting sick.
Protective factors: Tina spoke about her fears with her parents.
7. How does CBT work for other mental health conditions?
To find out more about how Cognitive Behavioural Therapy work for other specific mental health conditions such as low mood & depression or anxiety disorders please read our series of blog posts on this topic:
- A Guide to Cognitive Behavioural Therapy
- Cognitive Behavioural Therapy for Anxiety Disorders
- Cognitive Behavioural Therapy for Depression
- Cognitive Behavioural Therapy for Health Anxiety
- Cognitive Behavioural Therapy for Social Anxiety
- Cognitive Behavioural Therapy for Panic Disorder
- Cognitive Behavioural Therapy for Obsessive Compulsive Disorder