Case Study Fear of Spider

Introduction

The client is S, a female student who has undergone a highly remarkable and sudden change after three in session behavioral experiments exposure in a program of the intensive group. There have been a number of strategies employed in enhancing this case’s rigor. The diagnosis of the client has been with the use of a structured diagnostic interview, the interview schedule of the Anxiety Disorders for DSM-IV that was conducted in the student therapist’s presence by the EH or the supervising psychologist having over a decade of experience in outpatient psychiatric setting.

S has a problem of fear of spiders. She did not have an idea as to from where it came from. However, her problem was constant when she had to clear spiders from the bedroom of her young children during the night time. She had chosen of having hypnotherapy of her phobia with spiders after a friend recommended her of it and who suffered from the fear of height.

Ethics statement

This study involves exposure treatment of the subject where care has been taken that S does not dropout from the treatment, does not convey fears of symptom exacerbation, ensuring her concerns of safety, and the boundaries are not blurred between the clients and the therapists. The safety and efficacy of PMR therapy on S is also taken care of.

Diagnosis

S had a phobia on spiders which is a debilitating and overwhelming fear of feeling or a creature (i.e. spider). Her phobia had been more pronounced compared to normal fears. It has developed when she experienced unrealistic or exaggerated sense of danger about spiders or the situations where there will be the presence of spiders. This phobia of S has developed into severity (Hoehn-Saric and McLeod, 1988). This resulted in the restriction of her life in terms of day-to-day activities causing great deal of distress.
The phobia on spiders can be considered as a type of anxiety disorder. S did not have any symptom till she come in contact with this phobia’s source. However, S do experience the feelings of panic or anxiety even thinking about the source’s phobia. When she doesn’t come in contact with the phobia’s source frequently, her everyday life is not affected very much. But when coming into contact with the phobia’s situation (i.e. when she sees spider), the symptoms are inclusive of the followings.

An upset stomach
Shaking or trembling
Breathing shortness
Palpitations or increase in heart rate
Sweating
Nausea
Lightheadedness, dizziness, and unsteadiness (Hoehn-Saric et al., 1989)

S developed the spider phobia during her childhood which was more severe when she was younger and has become less severe with her age. There is no single cause for phobias, although several associated factors exist:

There may be a specific trauma or incident associated with a phobia A learned response can also be a cause of phobia that is developed by an individual from a sibling (sister or brother) or parents A role may be played by genetics as there are evidences suggesting some people tend to be more anxious compared to others Since, S reported that she never had an incident or trauma neither her siblings or parents had any phobia like this, it can diagnosed as a genetically inherited disorder.

Treatment plan

S was assigned in controlling condition, where the histories of the patient was taken and the discussions were held related to the practical problems she faces because of her phobia. She was also assigned for PMR, where she received three weekly sessions of training pertaining to her muscle relaxation on the basis of an abbreviated method advocated by Jacobson (1967). The SC, Forearm sEMG, and blood flow of forearm for 20 minutes have been recorded while S was asked to attempt relaxation after and before the three sessions. No significant after and before were found by the authors by condition that effects within the physiological data, which indicates that activation was not decreased by the relaxation. The authors provided, in this second investigation, brief relaxation training with two weekly sessions. After the training sessions, the session of test relaxation and test control took place. During this session, instructions were given to S of not attempting to relax. In this session, the front nails SC, HR, sEMG, and respiration had their recording. The order pertaining to the two test sessions were assigned randomly. The findings of the investigators were that nonspecific SC fluctuations and frontalis sEMG have been lower significantly in the condition of the test relaxation compared to condition of test control (Hazlett et al., 1994). This indicates that in the relaxed state there is less activation. The conclusion is stated with comparison with other studies. It is concluded that the patients having phobia on spiders in undergo relaxation training leads to the reduction of autonomic activity to the found levels in the normal subjects at rest. However, as there was no testing of the subject prior to the training, they should have the ability of relaxing before the relaxation instructions were received.

Session content

The treatment is comprised of CBT training therapy on the basis of protocols that is evidence based (Barlow, 2002). The interventions that are basic are inclusive of psychoeducation and along with it behavioral (e.g. behavioral exposure and activation therapy) and cognitive (e.g. cognitive restructuring and functional analysis) techniques. As the training therapy is investigated under routine conditions, the basis of the therapy was primarily not on the manuals of specific CBT treatment, but on the conceptions of individual case that trainees have developed collaborating with supervisors. This procedure ensures guaranteeing of the therapeutic interventions’ optimal adaptation on S’s needs.

The progressive muscle relaxation (PMR) and treatment as usual (TAU) was carried out simultaneously. In PMR plus TAU, the session began with the session that is audio taped and session introduced PMR intervention. The duration of the PMR intervention had been for 5 minutes which an experienced expert spoke. The PMR was chosen as the active control group. This is because broadly PMR is accepted as a relaxation exercise that is easy to implement. The development of the PMR control condition had been on the basis of the iterative procedure that had been same as the SIIME.

In the condition of TAU, there had been no application of the introduction of standardized session. S was given the freedom of arranging the beginning of the therapy in the same way that seemingly has the consistency for them. In a typical way, there were applications of the routine introduction of CBT.

Results

The clinical effectiveness of PMR therapy has been found to be high for S in relation to her fear of spider. The evidence of the PMR’s effectiveness had been shown with the reduction of anxiety at the sight of spider for S. Based on the three PMR sessions conducted on S, PMR can be concluded to be effective as exposure based, cognitive or pharmacologic interventions for agoraphobia, which in this case is fear of spider. However, if compared with other therapies, it seems that relaxation therapy is less effective in spider phobia. However, the PMR has been found to have produced superior outcomes to CBT (cognitive behavior therapy) or CT (cognitive therapy).

Moreover, the experiment also found that autonomic nervous system cease working as a single unit. The subject, rather, reacted to stressors with respect to some measures with increases and in others with decreases. It was found out that S had a stereotyped response pattern to the presence of spider. The activation’s degree varied significantly on different physiological measures as with S the appearance of the response pattern was repetitive. Although, the muscle relaxation produced the decrease overall in the stress that appeared on the presence of spider for S, sEMG biofeedback training could not affect the autonomic parameters of skin temperature, respiration, SC, and HR (Jones and Evans, 1981). S learned to relax, although it did not lead to the reduction of physiological arousal.

As analysis, reduction, and collection of sEMG data has the requirement of special amplifiers and analysis and recording programs, the therapists had relied on the self report in assessing the muscle tension. However, this study has not found any relationship between the physiologically measured and self-reported tension of S. Moreover, to record from multiple muscles has indispensability as assumption cannot be made that any single muscle represents other muscles or the body’s tensional state as a whole. Recording also met the technical standards assuring the quality of data (Fridlund and Cacioppo, 1986).

Limitations and flaws

Despite the justification of assumptions and their doubts, the use of PMR method which is a physiologically rationalized method to treat anxiety and stress caused by the presence of spider, various types of biofeedback and breathing training are here to stay (Meuret et al., 2003). With regards to the PMR therapy, the patients sometimes find the patients very anxious in relation to their fright in undertaking the exposure protocols. The patients in this study initially believed in therapy and since she was helped by the PMR therapy and the therapist, the exposure therapy was strengthened. The cost is less with PMR method compared to the emotion-oriented or cognitive methods as the application of the PMR can be in standardized ways. However, to know the PMR therapies alone is not enough in terms of clinical effectiveness. In improving and applying them optimally, there must be better idea of the way and for whom they work.

Conclusion

This empirical treatment study has indicated that PMR is effective clinically to treat the fear of spider. However, the doubts can be added by the theoretical skepticism about the assumptions validity of PMR. With regards to the PMR therapy, the patient in this study have benefitted from it, who have entered the therapy with elevated muscle tension. After the success of the therapy, she left the therapy with an ability that is newly learned for relaxing her muscles at will. The muscle relaxation led to less anxiety and tension when she sees a spider. This reduction in anxiety and fear took place in her behavioral, psychological, and psychic realms, not only to reduce fear and tension in group of muscles or in a single muscle.

Take a deeper dive into Case Study Chris Societal Perceptions with our additional resources.

References

• Barlow, D.H. (2002) Anxiety and its disorders (2nd ed.), New York: Guilford.
• Fridlund, A. J. and Cacioppo, J. T. (1986) ‘Guidelines for human electromyographic research’, Psychophysiology, 23(5), 567–589.
• Hazlett, R. L., McLeod, D. R. and Hoehn-Saric, R. (1994) ‘Muscle tension in generalized anxiety disorder: elevated muscle tonus or agitated movement?’, Psychophysiology, 31(2), 189–195.
• Hoehn-Saric, R. and McLeod, D. R. (1988) ‘The peripheral sympathetic nervous system. Its role in normal and pathologic anxiety’, Psychiatric Clinics of North America, 11(2), 375–386.
• Hoehn-Saric, R., McLeod, D. R. and Zimmerli,W. D. (1989) ‘Somatic manifestations in women with generalized anxiety disorder. Psychophysiological responses to psychological stress’, Archives of General Psychiatry, 46(12), 1113–1119.
• Jacobson, E. (1967) Tension in medicine, Springfield, IL: Thomas.
• Jones, G. E. and Evans, P. A. (1981) ‘Effectiveness of frontalis feedback training in producing general body relaxation’, Biological Psychiatry, 12(4), 313–320.
• Meuret, A. E., Wilhelm, F. H., Ritz, T. and Roth, W. T. (2003) ‘Breathing training for treating panic disorder. Useful intervention or impediment?,’ Behavior Modification, 27(5), 731–754.