A atenção na fobia específica: um caso de globofobia

Abstract

Attention was studied in a case of specific phobia to balloons (globophobia) treated with cognitive behavioural therapy. Attention is an element of cognitive functioning whereby the numerous stimuli we receive are selected and only certain elements are focused on. In anxiety there is a threat-related attentional bias that has also been found also in subjects with specific phobia. Bar-Haim et al. proposed an integrative tentative model of the mechanisms underlying threat processing. The model has four stages: the preattentive threat evaluation system (PTES) that evaluates stimuli, the resource allocation system (RAS) that allocates resources according to the threat valence assigned by the PTES, the guided threat evaluation system (GTES) that evaluates the threat valence of the stimulus by assessing the context, comparing the present threat with previous learning and memory and evaluating the availability of coping resources, and the goal engagement system (GES) that controls goal engagement according to the evaluation of the GTES. Anxiety disorders could stem from abnormal processing patterns in one or several of these systems. In the case that was treated the following abnormalities were observed: an attentional threatrelated bias, with an immediate evaluation of the balloon as a threatening object, that could be explained by a bias in the preattentional PTES system; an alert response (RAS) leading to autonomical symptoms and an urge to escape; and an inability of the GTES to override the RAS response despite the patients rational evaluation of the absence of actual threat. Using cognitive-behavioural interventions such as systematic desensitization, the patient remained focused on balloons for longer periods of time. The prolonged exposure combined with the use of progressive muscle relaxation and socratic questioning led to new possible rational assessments and resources to cope with his symptom. Moreover, the GTES was enhanced, leading to a reduction in the RAS alert response. Thus, cognitive-behavioural techniques were efficient in changing the attentional threat-related bias in this patient with globophobia.