4. behaviourist approach to treating phobias

Question 1

SYSTEMATIC DESENSITISATION
Systematic desensitisation (SD) is a behavioural therapy designed to gradually reduce phobic anxiety through the principles of classical conditioning:

Answer 1

If a person can learn to relax in the presence of the phobic stimulus they will be cured.
Essentially a new response to the phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety). This learning of a different response is called counterconditioning.

Question 2

There are three processes involved in SD:

Answer 2

create anxiety hierarchy
relaxation techniques
move up the hierarchy

Question 3

move up the hierarchy

Answer 3

Finally, the client is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom of the anxiety hierarchy. When the client can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy.
Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy.

Question 3

anxiety hierarchy

Answer 3

is put together by a client with phobia and therapist. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening. For example, a person with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy.

Question 4

relaxation techniques

Answer 4

The therapist teaches the client to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. The relaxation might involve breathing exercises or, alternatively, the client might learn mental imagery techniques. Clients can be taught to imagine themselves in relaxing situations or they might learn meditation.

Question 5

FLOODING
Flooding involves exposing people with a phobia to their phobic stimulus but without a

Answer 5

gradual build-up in an anxiety hierarchy. Instead flooding involves immediate exposure to a very frightening situation.

Question 6

Flooding stops phobic responses very quickly. This may be because

Answer 6

without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless.
In classical conditioning terms this process is called extinction. A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten). The result is that the conditioned stimulus no longer produces the conditioned response (fear).

Question 7

AO3: strength of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

SD research support - Gilroy

Answer 7

One strength of systematic desensitisation (SD) is the evidence base for its effectiveness.
Gilroy et al. followed up 42 people who had SD for spider phobia in three 45-minute sessions. At both three and 33 months, the SD group were less tearful than a control group treated by relaxation without exposure.
This means that SD is likely to be helpful for people with phobias.

Question 8

AO3: strength of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

SD useful for people with learing disabilities

Answer 8

A further strength of SD is that it can be used to help people with learning disabilities.
Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require complex rational thought. They may also feel confused and distressed by the traumatic experience of flooding.
This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias.

Question 8

AO3: strength of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

FLOODING - cost effective

Answer 8

One strength of flooding is that it is highly cost-effective.
Clinical effectiveness means how effective a therapy is at tackling symptoms. However, when we provide therapies in health systems like the NHS, we also need to think about how much they cost. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session makes flooding more cost-effective.
This means that more people can be treated at the same cost with flooding than with SD or other therapies.

Question 9

AO3: limitation of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

FLOODING - traumatic (Schumacher)

Answer 9

One limitation of flooding is that it is a highly unpleasant experience.
Confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety.
Schumacher found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided, they obtain informed consent. More seriously, the traumatic nature of flooding means that dropout rates are higher than for SD.
This suggests that, overall, therapists may avoid using this treatment.