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btadros

Spider phobia

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Middle aged lady with fear with fear of spider webs in hedge rows .she won't go out outside

assess and manage

how to conceptualise in behavioural terms

discuss factors maintaing anxiety

would you move her on from one stage on graded heirarchy to another even while little anxious ?

can some one help with this please ?

I thouht is sraitforward ,but I stuck a bit during practising it

thanks

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approach it systematically

issues

1) diagnosis- simple phobia ? or psychotic ( slightly bizarre phobia)? agraphobia

2) impact- loss of function

3) management

First- more info, collateral history( some mention of secondary gain)

assessment- mention may need domicillary visit

try to establish diagnosis, functioning, risk comorbidities, alcohol

physical and investigation

management

psychological- Behavioural ie systematic desensitisation - hiearchy of fear teaching relaxation techniques move up eg

flooding

Cognitive- ie anxiety training, challenging cognitions

consider family, psycho if indicated

review

i would keep it simple as you can dig yourself into a major hole otherwise

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would you move her on from one stage on graded heirarchy to another even while little anxious ?

thanks

Typical exposure sessions in SD last for 30 to 40minutes. During which, 3 to 4 exposures to imaginary stimuli are done. Each exposure lasting only about 10 seconds ( Most of the time is spend in relaxation, before the exposure... so the stimulus is presented to the completely relaxed individual). After each exposure, you ask the patient to rate an SUD (subjective units of distress) rated 0 -100. You keep repeating the exposure till the SUD is 0. It may happen that in the next session, the anxiety comes back. So you start again with the previous stimuli... till it is scored 0.... So you dont go into the next step if the anxiety is persistent...

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how to conceptualise in behavioural terms

discuss factors maintaing anxiety

thanks

I think conceptualising in behavioural terms, will mean that you link it to classic and operant conditioning mechanisms...

In any case in a phobia, the best way to follow is the Mowrer's 2 factor hypothesis...

First step : So the stimulus is classically conditioned with a fear producing stimulus... for eg... spider and death or spider and a loud scream or spider and a scary story which involved spiders...

The second step The operant conditioning - negative reinforcement... the patient avoids the stimulus to escape anxiety... ie avoidance learning...

The maintainence factors would be the avoidance and the escape behaviours, including taking benzos, going out only with people, aviding dark places etc...

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I found during my PMPs that examiners wanted me to get to the point or they would start sighing or making faces! So dont dig yourself a hole by showing off that you can list a massive differential of every psychotic illness it might be or organic cause, get to the point and say...yes this sounds like a simple phobia, spider phobia first off and they will know you have got the idea then go into your structure - in PMPs never ever forget to mention risk!

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