Intervention Results

Intervention Results

The therapy was developed to reach its successful conclusion, achieving therapeutic goals. The student no longer felt anxiety before exams or academic. He attended the institute welcomed and was confronted with the evidence of safety tests. Was also integrated socially with peers. The situational type specific phobia had been overcome.

The relevant results of this monitoring period and interceptive were:

In the evaluation period the pretest were contemplated altered parameters all questionnaires that were used (school fears Inventory (EMI); inventory situations and anxiety responses (ISRA); The social reserve scale (SRS), The self reported Multifactor test

child adaptation (TAMA) and the Progressive Matrices test of intelligence

(RAVEN)). Through them, we observed high levels of anxiety in

regarding student attendance at school, to examinations,

and social interaction with their peers. There was also a

negative evaluation of the student on itself.

Meanwhile, in the post-evaluation period were seen in all

questionnaires normality in their parameters. Anxiety levels

were low as it highlighted the success of therapeutic tools

employed. The student reported to have acquired a series behaviors

social policies that allowed it to join the peer group (grupoclase)

and participate in learning contexts and standardized interaction.

In figure 1 and 2 are seen scores of evaluative phases

the pretest and posttest: Inventory of school fears (IME), with range: 0

and 196, and the scale of social reserve (SRS) with feature between 22 and 110. in

both tests its direct scores decreased significantly to

term treatment.

RESULTS AND DISCUSSION

As has been noted, and academic anxiety before exams

type as situational specific phobia is a disorder of children and adolescents

disabling, you should be treated therapeutically soon. In this

so it will help the student regain his sanity and continue

growing in the spaces: educational and integrative.

To make this possible interventive action is required from the center

the indispensable help of the school psychologist, that through the process

assessment will determine if the student has the disorder phobic. If so, what

refer the clinical psychologist to confirm the diagnosis and apply the

most appropriate therapy.

Both cognitive and behavioral techniques have appreciated effective

in the treatment of specific phobias in children and adolescents

(Horse and Simon, 2005; Garcia-Sanchez, 2002 and Stein, 2005).

Therapeutic intervention will arise from the slope always interdisciplinary, within which will have a prominent role: the psychologist, the teacher teaching, the tutor, the support teacher, the class group, and family. They should work coordinated and confidently.

It will also be important to work with the family (mother, father, relatives) of the student, giving them support and psychological counseling and educational psychology. They teach and motivate them to maintain an educational style not overprotective, and to support the whole development of interventional action.

Of particular importance is that the available school prevention and intervention programs in order to control and reduce test anxiety and improving academic performance. Thus students will be favored positively by learning techniques: coping skills, relaxation, positive thinking, self esteem, etc.. As a result of this, will benefit areas: education, family, and social.

Finally, for future research on this type of situational specific phobia would be interesting to consider the following significant issues:

- Check if this is related to disorders of agoraphobia, anxiety and stress in children.

- Expand the information we have about the same from the neurobiological side.

- Flesh for the acquisition of this in the developmental stages of childhood and adolescence.

- Check whether psychoactive drugs (eg imipramine), in the case of children with depression associated phobia significantly increase the effectiveness of cognitive behavioral therapy.

- Find the features and impact of this disorder phobic student within the university (university phobia).

- Investigate what relation does this mental disorder in relation to the temperament of the individual who has it.

- Find out the usefulness of new technologies (computers in clinical practice) therapy for school phobia.

- Examine this disorder in children and its relationship neuroendocrine (alteration of certain hormones).

- Clarify whether sex and ethnicity can actually influence the patterns of co morbidity in this phobic disorder.

- Knowing the possible relationship between the type of personality disorder and specific phobia.

- Investigate the relapse rate of school phobic disorder after treatment.

 SOCIAL ANXIETY DISORDER TEST

Procedure

Procedure

Evaluation

In the first week of the intervention plan if treatment was assessed. The evaluation was conducted considering pretreatment measurements (pretest) and after treatment (posttest), and we had the combination of the following assessment tools:

- The interview: through she gained valuable and detailed information about the student's problem, recognizing its components in different response systems (cognitive, psychophysiological, emotional / sentimental, and behavioral), and academic anxiety before exams. In this way they could appreciate the situations perceived as relevant (threat, danger), the strategies used in coping, and the consequences they produce (see Table 2 and 3).

- Also collected data on timing and course of the disorder, and therapeutic attempts were made to solve the case, with their results.

- In addition, interviews were held separately from the parents of the student, the tutor and the school psychologist.

- Self-reports: is used to quantify the extent of the student's symptoms and assess the change that occurred with the action of the intervention. Self-reports have been used here are:

- Inventory of school fears (IME), Mendez, 1988.

- Inventory of Situations and Responses of Anxiety (ISRA), of

Vindel Tobal & Cano, 1994.

- The social reserve scale (SRS), and Russell Jones, 1982.

- The self reported test Multifactor Adaptation (TAMAI) Hernandez.

- The test of intelligence Progressive Matrices (Raven), Raven.

- The self-reports: they are practical and accessible techniques that have been used to assess and collect information about the components of the anxiety response, and possible maintenance or factors.

treatment Techniques

Several techniques have been employed within the therapeutic intervention program in order to modify the student's behavior (see Table 5).

Of all these highlights their importance: exposing live phobia and social skills training.

Intervention Program

Analyzed self-report information (pretest) found that patients expressing high levels of anxiety regarding their assistance to the Institute, before exams and social interaction with peers. Subgroup analysis showed a negative assessment of his own image (low self esteem). The intellectual assessment made ​​within normal limits.

Also, it was felt that their anxiety symptoms had manifested over eight months. Assessed all this information and taking into account the recommendations of the DSM-IV diagnostic-TR, the patient was diagnosed: academic anxiety before exams as situational type specific phobia, accompanied by deficits in social skills and self-esteem school.

Then he got up your medical records containing the following information headings: 1) personal identification data, 2) identification data psychologist, 3) The reason for the consultation, 4) The family and sociocultural situation, 5) History previous treatments of the problem and, 6) The symptomatology (Cognitive, Psychophysiological, Emotional / Sentimental, Behavioral, Motivational), 7) The areas evaluated and results, 8) The diagnosis, 9) The treatment and / or recommendations, and 10) The genogram.

After the patient was informed of the disorder and their parents suffering. At the same time, a therapeutic contract was negotiated in which the patient agreed to continue treatment designed for it, attend therapy sessions and perform the tasks entrusted to home. It was also suggested to parents the importance of their cooperation and support in the therapeutic action.

Days after the clinical psychologist contacted the institute director, tutor and psychologist to inform the diagnosis and treatment plan with the patient to continue soliciting participation with the teacher and special education specialist bandmates - class. All were given and worked positively, giving emotional support. Thus was formed a social network and educational therapy.

In interviews it was found that the patient was open to collaborating, and agreed with him recovering overdue homework to be done at home. To this end, put a support teacher.

It was also found that parents ran the consequences of a non-contingent on the behavior expressed by the adolescent. For example, one day the father punished his son not buying a laptop I wanted, the reason was that he left his room to fix daily. But after a few days it was purchased for her birthday, even though it had not changed their behavior at all.

For this reason, we developed a contingency plan that was intended to extinguish the complaints of child and materially and socially reinforce target behaviors. These should be expressed in a simple, realistic and observable. Examples of them were studying at the desk, meet the assigned schedule of school work, attend classes at certain times, etc..

All therapeutic techniques used in interventional treatment were necessary, but among all these, the most important was, in vivo exposure (EV).

For the patient to overcome anxiety school phobic situations, he carefully explained the mechanisms that enable the acquisition and maintenance of anxiety behaviors. At the same time, he noted the importance of confronting feared situations to overcome the lingering fear, excessive and irrational they produce.

After phasing was scheduled to classes during the first three days. This was a binding contract in which the patient agreed to attend several hours of class a day.

The psychologist accompanied the patient to school the first day for the art exhibition. Support also used deep breathing and self-instructions.

He taught learning techniques and strategies of how to study how to deal with the tests, indicating that in the case of failing any of them could recover. Also he trained in social skills.

In many of the activities involved support intervention and emotional support center educational psychologist, specialist teacher in special education. They were also extremely useful the faculty and classmates.

Meanwhile, parents participated from home positively supporting the therapeutic treatment of his son. Which promptly sought from attending the institute, slept properly, desayunase every day, did the exercises both therapeutic school, etc.

 SOCIAL ANXIETY DISORDER TEST

CLINICAL CASE REPORT

CLINICAL CASE REPORT

Problem Description

Roberto is a 14-year ESO attends second grade in a public high school (IES). It is a new student at the center. Since arriving has had difficulty adjusting to their classmates. Is introverted, sensitive and somewhat insecure.

For several months manifests intense anxiety, prevents attendance intermittently staying home, do not go to the exams, and is frequently isolated from their peers. Also usually feel: chest tightness with difficulty breathing, nausea, muscle tension, headaches, digestive problems, etc.. Also, usually expressed as negative thoughts and disturbing: "I have fear suspend", "If I go to class, I will come anguish", "You're going to laugh at me all my colleagues", "I can not concentrate before exams "etc. Currently has two continuous weeks without attending the institute.

The tutor along with other teachers exposed to the address of the disturbing situation that was going through the student. Meeting the team of teachers and the school management's claim that the school psychologist who takes over the case.

The psychologist is suspected that students can suffer a situational specific phobia, advises parents and the school management to be treated as soon as possible by a clinical psychologist, to put confirm this hypothesis, and if so, put regimens for treatment. A few days later, the teen is taken by his parents to psychological consultation.

Therapeutic intervention plan

The therapeutic intervention plan, which gave solution to this childish behavior disorder, had one hand performances: identify, assess student needs to organize interventional response levels: psychological, educational psychology, and educational.

To accomplish this task, the clinical psychologist had the cooperation and involvement of qualified professionals (psychologist, special education teacher specialist, etc.), The school management, faculty, classmates and other classrooms, and family (mother, father, brothers, etc..).

Therapeutic intervention plan was developed over ten consecutive weeks, with two follow-Evaluative performed at two and six months. Let each of its parts in detail.

Participants

Therapeutic intervention plan was designed for a single format. It involved the patient aided by the interdisciplinary team. There was a bond of trust between them that allowed therapeutic intervention to flow without resistance.

hypothesis

Three hypotheses were Plan therapeutic intervention taken into account:

1. The responses from the academic anxiety before exams and expressing the student, are linked to lack of coping resources and experience intense stress.

2. The responses of test anxiety hinder the processes of attention and concentration, school performance and academic competitions.

3. Anxiety responses peers behaviors reinforce isolation and hinder social and academic competence.

Objectives

It was necessary that the patient would increase the skills and competence levels: cognitive, emotional and behavioral. Doing so could cope positively with anxiety it was conditioning and prevented face attendance and testing examinatorias. At the same time the changes in his behavior made ​​possible an improvement in their self-esteem, academic performance and social relationship between peers.

 SOCIAL ANXIETY DISORDER TEST

Pharmacotherapy and psychotherapeutic intervention

 specific phobia

Pharmacotherapy

Currently regarding pharmacotherapy phobic disorders is less studied than psychotherapy. However, several studies show that the medication event is an effective drug, alone or in combination of psychotherapy (Stein, 2005).

Among the various drugs used in the treatment of specific phobias in adults are:

- Selective inhibitors of serotonin reuptake inhibitors (SSRIs) are supported by various research studies (Agene and Hamilton, 1998, Benjamin et al., 2000), demonstrating their usefulness together with a psychotherapy, as well as in cases where it can not offer. Antidepressants are better tolerated and safer. They are also effective in patients with concomitant diseases that respond well to these drugs.

- Benzodiazepines (BZD) are the most widely used psychotropic medications for the treatment of anxiety disorders. They are effective in times where you have to make an immediate psychotherapeutic intervention. In addition, these drugs not be used for a long time that some patients can result in abuse and risk tolerance.

- Migraine: is a tricycles antidepressant drug that is capable of raising the concentrations of the neurotransmitters nor epinephrine and serotonin in the brain, improving symptoms of depression and other nerve disorders.

In children and adolescents with specific phobia school phobia situational or migraine has been used. But, the amount of side effects that brings the antidepressant drug, limited case studies of these disorders phobic in childhood, and the positive results of cognitive behavioral psychotherapy advise choosing the latter (Horse, Simon, 2005).

psychotherapeutic intervention

Psychotherapy is the primary tool of the treatment of specific phobias. It can be treated from two notable theoretical strategies: cognitive and behavioral.

In therapeutic practice is often a mix of both, is what is known as cognitive-behavioral treatments.

Cognitive strategies are primarily focused on recognizing distorted thoughts in individuals with some anxiety, and that irrationally perceive any danger or harm. They also tend to perceive a threatening manner and anxious ambiguous or neutral stimuli. In the case of specific phobia, phobic stimulus is perceived by the patient as long as dangerous (Di Nardo et al., 1988, Stein, 2005).

The primary task of cognitive therapies will aim to correct any latent mental or cognitive distortions in the patient, for which the psychotherapist used conscious reasoning.

Shoran et al., 1993, Stein, 2005, indicate that in specific phobia, the decrease in negative cognitions correlates with the decrease of the fear that the patient can perceive. Similarly, the return of fear correlated with the return of cognitions or negative and disturbing thoughts.

Furthermore, behavioral strategies are based primarily on correcting or unsuitable learning unlearn, and disrupting the individual's behavior. As noted Craske and Rowe (1997), Stein, (2005) exposure therapy is most suitable for specific phobia overcome as it has long term effects. It is based on gradual exposure by the student to the phobic stimulus until fear disappears response. In addition, it will help to not overestimate the degree of threat.

Mendez (1999) and Knight and Simon (2005) indicate four general strategies that facilitate the child and adolescent achieve interact with phobic stimuli:

-         Reduce the intensity of fear produced by the phobic situation. The tactics used in this strategy to reduce fear are: a) Graduate presentation of phobic stimuli, b) Employing representations of phobic stimuli, and c) Provide a safe and relaxed.

     - Facilitate external help the student to approach the phobic stimulus. It focuses on the motor component of phobic reactions. To cause or trigger the behavior desired approach, provides physical and social stimuli. The tactics used are: a) The research stimuli, and b) modeling stimuli.

- Provide internal changes in the student to deal with the situation that generates fear. For your objective will focus on the control of mental activity (cognitive responses) and autonomic arousal (psycho physiological responses). The training tactics used are: a) The self-instruction, and b) The progressive relaxation, breathing and creative imagination.

- Encourage the student to repeat his conduct outreach. Once originated interaction with phobic stimulation may manipulate the contingencies that shall primarily eliminate avoidance behavior and develop behavioral approach to the phobic stimulus. To do this, use the following tactics: a) The extinction, b) Positive reinforcement.

Other methods in the behavioral treatment are:

- Techniques neoconductista mediation approach (systematic desensitization, flooding, applied voltage).

- The operative techniques (reinforced practice, successive approximation).

- The modeling procedures (live modeling, symbolic modeling).

The combination of cognitive and behavioral strategies to treat specific phobia has proven therapeutic effectiveness (Booth and Ranchman, 1992, de Jonah et al., 1995, Garcia-Sanchez, 2002 and Stein, 2005).

Although intervention with therapeutic techniques usually give excellent results, in some particular cases there may be resistance, which will cause it to be extended in time. But do not be discouraged by these circumstances, with tenacity and patience will achieve therapeutic goals proposed.

Sometimes with the school phobic disorder, the child or adolescent may suffer memory lapses, lack of attention and concentration, generalized anxiety or depression. These disturbances can promote school failure, and is experienced negative feelings: frustration, sadness and hopelessness. Hence they should be taken into account, so as not to further aggravate the problem already suffering.

It is also essential that the family (mother, father, etc..) Is open to collaborate with the psychologist, the psychologist, faculty, teachers (mentoring, support, special education, etc..), The class group, and director school where the student is studying. It is important to build a network of links and trust between them. Doing so will create a new school and social situation that will flow and positive reinforcement of the therapeutic, educational and socio-affective.

Finally note that timely action on this phobic disorder is vital. Doing so will help the student overcome sooner this disruptive behavior, allowing it to continue to grow in school spaces: educational and integrative.

 SOCIAL ANXIETY DISORDER TEST

Etiology

specific phobia

Etiology

Ranchmen (1977) and Knight and Simon (2005) indicate that the reactions are essentially specific phobias acquired through three possible ways such as: direct conditioning, transmission of information and / or observational learning.

Research has shown that aversive experiences direct and / or indirect are generating specific phobias.

In response to other questions on key variables or factors involved in the genesis of these disorders, hypotheses are: a) The prepare atoriedad b) The vulnerability.

The prepare atoriedad hypothesis attempts to answer the question why individuals acquire fear or phobic responses to stimuli more easily than others? According Horse and Simon (2005), this is because: "The human body is biologically prepared to acquire and maintain phobic responses to stimuli that phyla genetically had threatened the survival of the species." These ideas are based on the theory of preparation for the acquisition of fear of Seligman (1971).

For its part, the vulnerability hypothesis seeks to answer the question: why certain individuals acquire fear responses more easily than others? This is due to the characteristics of different factors that are involved in the genesis of phobic state. These can be grouped into two types of vulnerability:

- The biological vulnerability: contains genetic factors and activation of specific brain circuitry, neurotransmitters and neurohormonal systems. On the first, teachers Sword, Olivares and Mendez (2005), indicate that the genetic contribution can be: specific (higher heritability to develop certain phobias) and / or non-specific (with autonomic nervous system (ANS) unstable or labile ).

The second, the significant activation (hyper) vegetative dependent autonomic nervous system (ANS), as sympathetic branch, and the somatic nervous system (SNS), which will be reflected in psycho physiological manifestations such as: increased heart rate, excessive sweating, increased muscle tone, etc.. Likewise, trigger other systems such as: the immune, hormonal or endocrine, etc.

- The psychological vulnerability: expressed as a sense of uncontrollability of phobic stimuli and responses. Its causes triggers include: maternal separation, lack of coping skills, maternal or paternal overprotection, etc.

From behavioral strategies emphasize the importance of learning processes in the origin and maintenance of specific phobias or fears.

At present there is much research material on acquisitions of specific phobias in children and adolescents, and there the results differ significantly from each other.

On the other hand, it has also sought to answer the question: why the alteration occurs in the fear circuit activation in specific phobia? For this purpose, two groups have raised etiological model: modified conditioning, and no associative.

The modified model of conditioning associative learning is similar to classical conditioning, which explains the appearance of phobias by this phenomenon.

Within your content, try to answer the question: why in many patients do not cause any kind of conditioning? Its explanatory answer is that these people have forgotten the conditioning event and preserved emotional memory. There are two possible reasons for this fact happens. The first is that there is a developmental delay in the cortical circuit, which will lead to emotional memory encoding but not explicit (Jacobs & Nadel, 1985; Stein, 2005). The latter, being under stress, causing the release of cortical and CRH (or releasing hormone corticotrophin releasing factor) which hippocampus function deteriorates (Beemer et al. 1995; Stein, 2005), but does not spoil the function of amygdale may even promote it (McCaughey et al., 1993; Stein, 2005). In both cases, emotional memories are formed with no explicit or declarative memory.

Given this model, Ranchman et al. (1987) indicate that presents some drawbacks to consider. One of these could be pointing Stein (2005), with the following words: "Many patients experience aversive conditioning but have no phobias, suggesting that other factors are involved. However, no evidence supporting the existence of indirect ways and start vicariate phobias. "

Meanwhile, non-associative models explain certain fears or intrinsic fears are beneficial for normal development of the individual and adaptation to the environment. Also, postulate that specific phobias are the result or product of the lack of habituation to these intrinsic fears, as outlined Menses and Clarke (1995) and Stein (2005).

It has been found that no habituation occurs in the individual by the lack of safe exposure to the stimulus or for not properly learned from practical experience or experiential.

On these models no associative Stein (2005) also notes that Kindler et al. (2002), have been working on and analyzing the mode of acquisition of fears in twins. After several investigations, their conclusions have been that the vulnerability to phobias is largely innate, and therefore away from support for a theory of conditioning / learning.

 SOCIAL ANXIETY DISORDER TEST

Physiologic anatomic

specific phobia

Physiologic anatomic

Emotions based motivational organization can be classified into two major groups: pleasant and unpleasant. The first pulses are associated appetitive, while the latter facing the defensive reactions.

Defensive reactions occur emotional and psycho physiological components, to be associated with negative emotions of anxiety and fear (Kanjorski, 1967; Stein, 2005).

Anxiety is generated by the participation of various brain structures. Of all these, the amygdale is one of the most important. A mass of gray matter (in the form of almond) which is located in the rostral pole temporal lobe. It is a major component of the limbic system. It comprises three cores, which are connected with other important parts of the brain. These are: corticomediales nuclei, basolateral nuclei and central nucleus (ACE).

The amygdale acts as an emotional processor. Participate actively in the experience and expression of emotions. It was found that the central nucleus and the lateral nucleus (a component of the basolateral nuclei), are involved in the acquisition of experience and the negative emotion of fear.

Sensory information (emotional stimulus) enters the amygdale through various channels that lead afferents to the lateral and basolateral nuclei. Once there, organize the components of emotional response that will projected through the core through various channels efferent, that this information will lead to the periaqueductal gray, the lateral hypothalamus, the Para ventricular hypothalamus and the dorsal motor nucleus vague and ambiguous nuclei. From each of them, pass information through their respective channels, which will result in four categories of emotional response of fear conditioning or learned. These are:

- Emotional behavior (eg stopping of homework).

- The sympathetic response (eg blood pressure increase).

- Hormonal response (eg release of cortical and adrenaline).

- Parasympathetic response (eg developing bradycardia).

For its part, the lateral nucleus of the amygdale have the capacity to process information in parallel from multiple channels of stimulation. Receive information from higher-order areas of the necrotic and hippocampus (slow cortical circuit), and from sensory processing areas of the necrotic and thalamus (sub cortical circuit fast). These two circuits help to make possible the acquisition of fear. It is also important to remember that the cortical circuit is involved in the formation of explicit memories.

Panicky et al., (1994) and Stein (2005), also indicate that the information output of the amygdale can be grouped into two main classes: the defensive action (fight-flight response), and immobility somatomotor (freezing).

It is also appreciated that when an unconditioned stimulus (ENC) is associated with a threat or paired (conditioned stimulus, CS), in future exposures to that stimulus will be an intense startle response, which will reflect the fear. This phenomenon is known as: fear potentate startle.

Other brain structures such as the hippocampus that is located within the temporal lobe, involved in defense responses, such as avoidance of stimuli feared. Also involved in memory and spatial orientation.

Likewise, it has been found that CRF or CRH (or releasing hormone corticotrophin releasing factor) is an abundant neuropeptide in the amygdale (Van Bookstall, Colugo and Valentino, 1998). This is released by neurons of the central core (ACE), and from here be projected towards the core of the bed. Thus when the activated tonsil, activates both long term and the core bed by the action of the hormone (CRH), causing an antigenic effect lasting (Skanska, Shibasaki, and Ledgers, 1986; Stein, 2005).

Moreover, the CRH also has a potentiating effect on the antigenic response (reflection) of startle in individuals. Also involved in the response to stressful stimuli.

Biological predisposition to acquire certain fears (evolutionarily prepared fears) in humans, together with the possibility of the hyper activation of tensile system (activation stimuli quickly to low power), and the differential activation of various pathways have facilitated the emergence efferent specific phobia, manifested as a neuronal circuit abnormal activation of fear.

There are many clinical investigations with its exploration data collected from their involvement in this type of fear circuit in specific phobia. The most compelling comes from studies using the technique of positron emission tomography (PET), which through their images (horizontal cuts), have been observed activation of neural circuits in the amygdale, striatum, and thalamus, as well as increased blood flow in the area of the limbic cortex Para limbic (Wick et al., 1996; Stein, 2005).

 SOCIAL ANXIETY DISORDER TEST

specific phobia

Symptoms

When you see the situation or the object causing the phobia, the individual

may show some characteristics or symptoms that are useful for

diagnosis, and points the manual DSM-IV-TR, and teachers Garcia-Sanchez (2002), Horse and Simon (2005), Nathan Gorman, and Sal kind (2005). We summarize below some of them:

- Automatic Reaction severe anxiety voluntary exposure to the phobic stimulus. This can cause a panic attack about situational linked to a given situation. In children, the anxiety may be expressed: hugs, tantrums, freezing and crying.

- Understanding the fear experienced as completely irrational and disproportionate to a possible threat to their well-being or safety. In children, this irrational and excessive fear may be missing.

- Triggering psycho physiological reactions and emotional levels, the most common being the following: exhaustion, anxiety, exhaustion, anxiety, menstrual disorders, hopelessness, diarrhea, impaired breathing, headache, difficulty falling or staying asleep, discomfort, restlessness, impatience, irritability, easy fatigability, malaise, Frequent or urgent urination, fear, gastrointestinal upset, need to shun away from the situation or object, nausea, throat, nervousness, chest pain or discomfort, palpitations, loss of appetite, digestive problems, anger, shortness of breath, dizziness, dry mouth, flushing or blushing, sweating, trembling in the hands, knees trembling, muscle tension, sadness, vomiting, etc..

- Avoidance of the situation or the object causing the phobia. If it supports will experience intense discomfort or anxiety, and exhaustion.

- Expression level cognitive thoughts, mental images, reviews, performances, erroneous and negative related to the phobic situation.

Characteristics associated

After detailed psychological research has shown that specific phobia coexists with other mental disorders, growing to 65% co morbidity (Strategic and Bogojevic, 1997, Stein, 2005). It appears that sex and ethnicity influence patterns of co morbidity.

Of all the disorders that may coexist with higher probability or frequency are: alcoholism, drug addiction, anxiety disorders (especially social phobia and PTSD), psychosomatic manifestations, depression, and obsessive-compulsive disorder (OCD) . The latter can sometimes be a risk factor for suicide.

All of these disorders can occur in adolescence causing clinically significant distress impaired school, family and society. But among all co morbid depression is seen as the most serious in carrying implicit suicide attempts.

An example of this coexistence of disorders could be: a student who has a situational specific phobia (fear of being injured in playground games), together with an obsessive-compulsive disorder (washing hands frequently, lest we sully the dress), and social phobia (fear of being ridiculed publicly).

Epidemiology

According to prevalence studies, specific phobia is one of the most common mental disorders, with rates ranging between 4.7% and 11.3%, (Who et al., 1989, Kessler et al., 1994 and Stein , 2005).

Also confirmed after numerous studies specific phobia is more common in women than in men. The reason for this is because in women is more common role modeling, which allows the transmission of social phobias and fears (Fredrik son et al, 1996; Stein, 2005).

Furthermore, research has shown that the annual prevalence of specific phobia in adolescents reached 3.5%, showing that more girls than boys who meet the diagnostic criteria or reach. (Esau et al., 2000; Stein, 2005).

In research with children (4 to 12 years) the prevalence of specific phobia was 17, 6% (Maris and Merckelbach, 2000; Stein, 2005). And between 1 and 1.5% of children for school phobia (Echeburúa, 1998; Horse and Simon, 2005).

Furthermore, Escalon and Tobol (1992) found through their research that between 15 and 20% of students have high levels of test anxiety.

Evaluation

The assessment of children and adolescents with type specific situational phobia will be developed taking into account the stages of pretreatment and post treatment, within which used a combination of various tools or techniques previously designed as:

- The interview: through which student information is obtained, the family (mother, father, siblings), the school psychologist, classroom teachers, classmates, the tutor, etc..

- Inventories of fear: these psychometric tools will be released in a quantitative way the intensity of symptoms student. Allow also perceive and evaluate the changes that are generated through the psychotherapeutic action. Top Rated for its usefulness and scientific recognition are:

- Test Anxiety Inventory (TAI), Spiel Berger, 1980.

- The inventory of fears (FI, Fear Inventory), Stealth and Eosins, 1983.

- The inventory of fears for Children-Revised (FSSC-R, Revised Fear Survey Schedule for Children) of Ollendick, 1983.

- Inventory of school fears (IME), Mendez, 1988.

- Questionnaire fears exams and classes (CTEC) of

Conseco, 1989.

- Questionnaire test anxiety (ASAC) of Bas, 1991.

- Inventory of Situations and Responses of Anxiety (ISRA) of Vandal Tobol & Cano, 1994.

- Test anxiety questionnaire (CAEX), Valero Ague, 1999.

- The observation of behavior: is based on the contemplation of student behavior in their natural environment, facilitating analysis of their behavior (eg absences to school, etc.).

- The self-reports: through structured information they collect from the anxiety response in the natural environment of the student, and the possible factors that keep it active. All data are collected this information for the student.

- The rating scales: to quantify the degree of fear that has the student. They have the ability to be quick and easy to apply, and have the advantage of being used in combination with other assessment instruments (eg interview, fear inventories, etc..). Also, allow a continuous analysis of the intensity of the fear of the critical situations that cause it.

- The psycho physiological recordings: are evaluation techniques specific phobias are usually reserved for the field of research, based on feasibility and economics. It is easier and more comfortable to hold still while children and adolescents are shown the phobic stimulus in the laboratory space, which will analyze and record their psycho physiological constant through precision scientific instruments.

After specific phobia depression is the second most common primary diagnosis (Rudd et al., 1993, Stein, 2005).

Patients with this type of phobic disorder should be evaluated psychologically and psychiatrically, not only to determine their symptoms but also to specify how they influence the functional level. Also consider carefully whether other co morbidities, ie matching (eg heart problems or social phobia).

Also explore whether the patient has other phobias classified in the DSM-IV-TR.

                      SOCIAL ANXIETY DISORDER TEST

Origin and maintenance

specific phobia

Origin and maintenance

Sword, Olivares and Mendez (2005), tells us that the origin of specific phobias can be understood through the interaction of a number of biological and psychological factors. Some of them could be: lack of coping resources, lack of social skills, educational style too overprotective, negative life experiences direct or indirect, genetic endowment, etc..

Through these factors can be explained as the individual becomes anxious expectation to the feared object or situation that will result in an anticipatory somatic arousal, expectations and interpretations of anxiety and danger, and a sentimental and negative emotional state. At the same time develop an overestimation of the aversiveness and probability of exposure to phobic stimuli.

The avoidance behavior of feared situations happen when there is an imbalance in the balance of anxious expectation and perceived lack of resources to cope and irrational fear.

When there is the avoidance phobia is reinforced negatively to lessen or prevent anxiety and prevent the presumed occurrence of the aversive effects. In certain cases, the phobia can be positively reinforced through the support and care of others, and so on.

The increase in patient anxiety when the feared situations, making stimulus can not be avoided. Then it will increase expectations of anxiety and distress, and somatic anticipatory activation. All these elements will drive the expression of defensive behaviors, such as: escape the situation, carrying objects reassuring, taking medication, smoking, drinking or alcohol, etc.. These behaviors produce immediate relief but will contribute to the maintenance of the disorder.

The intensity of the anxiety that is experienced with the feared situation will depend on various factors conditioning. Among the mostrelevant are: the characteristics of the phobic stimulus type, the existence of safety signs, the emotional and sentimental person, the level of impairment of escape, etc.

As danger expectations, it will be maintained through the avoidance defensive behaviors.

Also important to note is that maintaining these specific phobic behavior may be due to new and negative experiences (direct or indirect) with the feared stimulus and unexpected stressful events.

Moreover, clinical research and academic anxiety before exams as situational specific phobia has revealed a number of triggers that can facilitate the development of the disorder. Among all of them stand out for their importance as follows:

- The separation of parents (mostly mothers).

- The disease of parents.

- The death of parents.

- The separation of a brother / sister.

- The overestimation of potential hazards and parents.

- The tendency to avoid negative emotions and situations by parents.

- The overprotective parents.

- Perfectionism parent.

- The family educational style.

- The genetic endowment.

- Temperament.

- The personality.

- The change of school or college.

- The change of academic level.

- The fear of failing academically.

- The absence from school due to illness or convalescence.

- The teaching style of teachers.

- Fear of a teacher too demanding.

- The fear of threats with peers.

- Fear fights with peers.

- Bullying (bullyng).

- Social anxiety disorder (social phobia).

- The lack of coping skills, social skills and problem solving.

- Stress for other special events.

- Etc.

The model explaining the origin and maintenance of academic anxiety before exams as situational specific phobia could explain briefly as follows:

A student is in a situation of fear. He's afraid to attend school and face the exams. Several of their biological and psychological factors have facilitated the emergence of precipitation and phobic state.

Among these factors that make you vulnerable to anxiety include: stress experience motivated by changing schools, separation of parents, lack of coping resources in social skills and problem solving (eg poor school level).

It has acquired an expectation of anxiety about the situation you fear. This will generate an intense anxiety state which manifest:

- Expectations and interpretations of anxiety and danger, which will be evidenced through cognitive expressions as: "I will stay the course," "You're going to laugh at me at school," "It is very difficult", etc..

- An anticipatory somatic arousal (psychophysiological responses), reflecting through: discomfort, tension, dry mouth, headache, etc..

- A negative emotional state and sentimental, which is expressed by: insecurity, discouragement, failure, sadness, etc..

- An overstatement aversive when exposed to external stimuli phobic.

The avoidance of the feared situation happen when there is a mismatch between the perception that students have of the requirements that poses the feared situation (anxious expectation) and coping resources available.

When there is avoidance behavior will be reinforced phobia negatively. This is because the pupil lessens or prevents anxiety, preventing the occurrence of the presumed aversive effects. Phobia may also be positively reinforced (eg through the deferral of homework and go to school, facilitated and supported by their parents).

Anxiety will increase the student when the situations they fear can not be avoided. Experience an increase in anticipatory somatic activation, and expectations of anxiety and danger. These elements will favor the expression of defensive behaviors in the situation. Example of these are: avoid attending school, refusing to get dressed and eat breakfast, do not take the exam, accompanied by a trusted person (parents, friends), interrupting homework, go to class, leaving the exam before have done, to avoid being asked in class, mourn, angry, eat something, postponing the study, carried tranquilizers objects (ie blessed religious medal, etc.). All of them produce immediate relief, but reinforce the maintenance of phobic disorder. Expressions cognitive expressed in these circumstances could be: "I am locked", "I can not concentrate or study," "I'm no good", "I'll stay safe", etc..

The intensity level of anxiety that the student experience to the feared situation, will always depend on the following factors: the characteristics of the phobic stimulus (situation: academic, examination, teaching and learning), the emotional and sentimental student, degree of impairment of escape, etc.

Anxiety can also interfere negatively on student attention and concentration of upsetting their implementation and school performance. This deterioration will facilitate the response increases anxiety in him.

Furthermore, the danger will be kept expectations through defensive behaviors and avoidance.

It is also important to consider that the maintenance of this school phobic disorder may be due to new experiences and negative, direct or indirect with the feared stimulus (eg testing situation), and stressful life events (eg change of school, the mother dies ). Figure 1 provides a schematic explanatory model origin and maintenance of this disorder.

 SOCIAL ANXIETY DISORDER TEST