The development of phobias has been understood in various ways. It has been proposed that individuals who experience panic attacks or panic-like symptoms have high levels of anxiety sensitivity, or the tendency to perceive anxiety as harmful (Reiss, Peterson, Gursky, & McNally, 1986). Studies have found that individuals with panic disorder with agoraphobia have high scores on a measure of anxiety sensitivity, indicating their aversion to the experience of anxiety itself (Antony et al., 1997).
In addition to a higher level of anxiety sensitivity, there is enhanced attentional selectivity or interoception for physical cues (Barlow, 2001). Individuals with phobias tend to be more aware of body sensations related to arousal. Thus, these individuals have a vulnerability to be able to detect subtle bodily experiences, perceive these experiences as dangerous and aversive, and, as a consequence, are more prone to develop panic attacks or paniclike symptoms. These symptoms are maintained out of a "fear of fear" in which the experience of panic attacks or paniclike symptoms leads to a fear of experiencing these symptoms again. Because of the increased awareness of bodily sensations, any sensation resembling that of panic is perceived as panic. Phobia then develops as the individual begins to fear the occurrence of another panic attack or paniclike symptoms. They start to avoid situations or objects in which the panic may occur or in which the ability to escape such a situation would be difficult or impossible. Thus, a type of conditioning occurs in which the panic attacks or paniclike symptoms begin to be associated with particular situations or objects, especially those in which escape may not be possible. Studies have supported this idea, finding that the onset of agoraphobia and specific phobias occurred as a result of direct conditioning experiences (Ost, 1985, 1987). In one study, 81% of individuals with agoraphobia, 58% of individuals with social phobia, and between 45 and 68% of individuals with specific phobias ascribed the onset of their phobia to conditioning experiences (Ost, 1987).
Phobias can be understood from physiological, cognitive, and behavioral perspectives. Cognitive-behavioral therapy has been shown to be effective in treating agoraphobia, social phobia, and specific phobias by focusing on one or more of these three elements. The following sections will provide additional information about each phobia and its treatment.
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