امید به خطر، خودکارآمدی و بینش در عنکبوت هراسی

In the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, (1994) Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: author) phobic adults and adolescents are said to “recognize that the phobia is excessive or unreasonable” given the actual danger posed by the feared situation. The present study examined perceptions of danger in 15 spider phobic subjects and a matched set of controls before, during and after a spider-avoidance test. When detached from the phobic stimulus, phobic subjects: (1) gave higher estimates of the probability of being bitten than controls did; (2) gave higher estimates of the injuries that would result from being bitten and (3) in line with these first two findings, believed their high levels of anticipated anxiety were more reasonable and appropriate to the demands of the situation than controls did. These findings are inconsistent with the prevailing notion that when detached from the phobic situation patients can accurately evaluate the danger of potential phobic encounters. Instead, the findings suggest that phobic individuals, whether detached or in the presence of the feared object, have relatively limited insight into the irrationality of their fears. In examining the mediation of phobic phenomena, both self-efficacy and danger estimates remained significantly related to the anxiety and avoidance experienced in the spider-avoidance task. Further research designed to experimentally establish the likely causal roles of these two constructs is warranted.

It is commonly accepted that phobic sufferers are able to accurately assess the level of danger posed by the feared object, activity or situation when detached from it. The client's recognition of the irrationality of their own distress remains a diagnostic criteria for specific phobias in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994). This classificatory manual clearly states that phobic adults and adolescents “recognize that the phobia is excessive or unreasonable” (APA, 1994, p. 406). In a modification of this position, Beck and Emery (1985) argued that the sufferer can recognise the excessiveness of their fear only when distant from a phobic interaction. As such Beck and Emery redefined phobia as “a fear of an object or a situation that by social consensus and the person's own appraisal when detached from the situation is disproportionate to the probability of harm inherent in that situation” ( Beck and Emery, 1985, p. 116, italics added). In addition, like many other cognitive theorists, they argued that it is not the object itself that causes phobic anxiety, rather the expectations of certain aversive consequences that may result from being in contact with the object. Thus, they contend that danger expectations mediate phobic fear and avoidance. Recent empirical findings have raised serious questions about the ability of phobic sufferers to rationally evaluate the danger inherent in a phobic encounter, even when detached from it. Menzies, Harris and Jones (1998) examined the level of insight in individuals with specific fear reactions to spiders, heights and enclosed places. For each fearful group they identified a sub-group of fearfuls who showed poor insight into the actual likelihood of danger when removed from the feared stimuli. Thorpe and Salkovskis (1995) investigated the beliefs concerning physical harm in a group of mixed phobics and a group of spider phobics when detached from the phobic stimulus or situation. While half of the group of spider phobics were more than 40% convinced that they would suffer harm after an encounter with the phobic stimulus, none of the controls expressed this level of belief in harmful outcomes. Similarly, Arntz, Lavy, van den Berg and van Rijsoort (1993) found spider phobics to hold strong, negative catastrophic ideas about spiders. These included beliefs which relate to danger (e.g. spiders bite, spiders are poisonous, spiders can aim at people). Importantly, danger-related beliefs were shown to attenuate following one-session of therapist-assisted exposure. Finally, Di Nardo, Guzy, Jenkins, Bak, Tomasi & Copland (1988), administered a structured interview to 16 dog-fearful and 21 non-dog-fearful college students concerning frightening and painful experiences with dogs and expectations about the consequences of contact with dogs. Despite having had fewer traumatic encounters with dogs (56% of the fearful group had had frightening and painful experiences with dogs compared to 66% of the non-fearful group), the fearful group had greater expectancies of harm. While only 10% of the non-fearful subjects believed that physical harm was a likely consequence of an encounter with a dog, all fearful subjects maintained this view. Several other reports have examined how phobic danger estimates change before, during and after phobic encounters. Menzies and Clarke (1995) obtained danger ratings on the ground and during a height avoidance test on a triple extension ladder with a large sample of solicited acrophobics and age-matched controls. Subjects were not aware that they would soon be asked to climb the ladder when making their pre-task ratings. It was found that even when detached from the phobic situation on the ground, acrophobic patients: (1) gave significantly higher estimates of the probability of falling from a ladder than did controls; (2) gave significantly higher estimates of the injuries that would result from falling and (3) believed their high levels of anticipated anxiety were more reasonable and appropriate to the demands of the situation than controls did. Similarly, Jones, Whitmont and Menzies (1996) found that when detached from the phobic stimulus, spider-fearful subjects; (1) gave significantly higher estimates of the probability of being bitten than controls did; (2) gave significantly higher estimates of the injuries that would result from being bitten and (3) held significantly stronger beliefs that their high levels of anticipated anxiety were more reasonable and appropriate to the demands of the situation than controls. Like Menzies and Clarke, 1995 and Jones et al., 1996 also obtained significant relationships between danger estimates and task anxiety during the Behavioural Avoidance Task. While both of these studies provide evidence for a potential role of danger expectancies in the mediation of phobic phenomenon, the causative nature of the relationship between danger beliefs and subsequent anxiety is questioned by the results in an earlier report of Williams and Watson (1985). These researchers found that when self-efficacy ratings were held constant in partial correlation analyses, the relationships between danger expectancies and anxiety disappeared. Hence, they concluded that self-efficacy is a more likely cognitive mediator of phobic anxiety than danger beliefs. The study conducted by Jones et al. (1996), like that of Menzies and Clarke (1995), did not assess self-efficacy ratings. It is therefore possible that the obtained relationships between danger estimates and anxiety in these reports were simply due to an underlying relationship between danger beliefs and self-efficacy (see further, Menzies & Clarke, 1995). The present study sought to examine the relationships between danger expectancies, self-efficacy and phobic anxiety and avoidance in spider phobia. In relation to the detached baseline ratings, it is hypothesised that phobic group ratings of danger will be higher than those of controls. In relation to changes in ratings from baseline to a Spider Avoidance Task, it is hypothesised that phobic group ratings of danger will increase whereas the ratings of controls will not. In relation to the cognitive mediation of phobic phenomenon, it is hypothesised that both danger and self-efficacy ratings will be significantly correlated with subjective anxiety and avoidance. Finally, in line with outcome expectancy models of anxiety (rather than self-efficacy accounts), it is hypothesised that danger will remain a predictor of phobic behaviour with self-efficacy ratings held constant, whereas self-efficacy would not be significantly related to phobic phenomenon with danger expectancies held constant.