4.3: Treating phobias

Question 1

When did behavioural therapies mainly emerge?

Answer 1

Behavioural therapies mainly emerged in the 1950s

Question 2

What is the main assumption of the behavioural view?

Answer 2

The main assumption of the behavioural view is that abnormal behaviour is learned in the same way as normal behaviour, through:

1. The principles of classical and operant conditioning
2. The social learning theory

Question 3

The main assumption of the behavioural view is that abnormal behaviour is learned in the same way as normal behaviour, through the principles of classical and operant conditioning and the social learning theory.
Therefore, what?

Answer 3

Therefore, just as it is learned, it can equally be unlearned

Question 4

What is the first stage in behavioural therapy?

Answer 4

The first stage in behavioural therapy is:

1. To identify the problem
2. To decide upon the most appropriate treatment techniques

Question 5

The first stage in behavioural therapy is to identify the problem and to decide upon the most appropriate treatment techniques.
What are the techniques derived from?

Answer 5

The techniques are derived from:

1. Classical conditioning
2. Operant conditioning

Question 6

Systematic desensitisation (SD):
What is systematic desensitisation based on?

Answer 6

Systematic desensitisation is based on classical conditioning

Question 7

Systematic desensitisation (SD):
Systematic desensitisation is based on classical conditioning.
What does systematic desensitisation aim to do?

Answer 7

Systematic desensitisation aims to extinguish (unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation)

Question 8

Systematic desensitisation (SD):
Systematic desensitisation is based on classical conditioning.
Systematic desensitisation aims to extinguish (unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation).
It is used to treat phobias, by doing what?

Answer 8

It is used to treat phobias, by exposing the client to the threatening situation under relaxed conditions, until the anxiety is extinguished

Question 9

Systematic desensitisation (SD):
Systematic desensitisation is based on classical conditioning.
Systematic desensitisation aims to extinguish (unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation).
It is used to treat phobias, by exposing the client to the threatening situation under relaxed conditions, until the anxiety is extinguished.
Who (what year) was systematic desensitisation devised by?

Answer 9

Systematic desensitisation was devised by Wolpe (1958)

Question 10

Systematic desensitisation (SD):
Systematic desensitisation is based on classical conditioning.
Systematic desensitisation aims to extinguish (unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation).
It is used to treat phobias, by exposing the client to the threatening situation under relaxed conditions, until the anxiety is extinguished.
Systematic desensitisation was devised by Wolpe (1958) and was developed specifically to deal with what?

Answer 10

Systematic desensitisation was devised by Wolpe (1958) and was developed specifically to deal with:

1. Fears
2. Phobias
3. Anxieties

Question 11

Systematic desensitisation (SD):
Systematic desensitisation is based on classical conditioning.
Systematic desensitisation aims to extinguish (unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation).
It is used to treat phobias, by exposing the client to the threatening situation under relaxed conditions, until the anxiety is extinguished.
Systematic desensitisation was devised by Wolpe (1958) and was developed specifically to deal with fears, phobias and anxieties.
Systematic desensitisation is based on the idea that it is not possible to do what?

Answer 11

Systematic desensitisation is based on the idea that it is not possible to experience 2 opposite emotions at the same time

Question 12

Systematic desensitisation (SD):
What does the therapist do?

Answer 12

The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening

Question 13

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating what?

Answer 13

The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear

Question 14

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear.
The client is given training in what relaxation techniques and taught what to help them relax?

Answer 14

The client is given training in deep muscle relaxation techniques and taught breathing exercises to help them relax

Question 15

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear.
The client is given training in deep muscle relaxation techniques and taught breathing exercises to help them relax.
They may also be taught what or told to imagine themselves somewhere relaxing?

Answer 15

They may also:
1. Be taught meditation
Or,
2. Told to imagine themselves somewhere relaxing

Question 16

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear.
The client is given training in deep muscle relaxation techniques and taught breathing exercises to help them relax.
They may also be taught meditation or told to imagine themselves somewhere relaxing.
The client is exposed to the phobic stimulus, using what at what?

Answer 16

The client is exposed to the phobic stimulus, using the relaxation techniques at each stage of the hierarchy

Question 17

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear.
The client is given training in deep muscle relaxation techniques and taught breathing exercises to help them relax.
They may also be taught meditation or told to imagine themselves somewhere relaxing.
The client is exposed to the phobic stimulus, using the relaxation techniques at each stage of the hierarchy.
Therapy starts with the least fearful situation and only progresses to the next stage when?

Answer 17

Therapy:

1. Starts with the least fearful situation
2. Only progresses to the next stage when the client feels sufficiently relaxed to do so

Question 18

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear.
The client is given training in deep muscle relaxation techniques and taught breathing exercises to help them relax.
They may also be taught meditation or told to imagine themselves somewhere relaxing.
The client is exposed to the phobic stimulus, using the relaxation techniques at each stage of the hierarchy.
Therapy starts with the least fearful situation and only progresses to the next stage when the client feels sufficiently relaxed to do so.
Gradually, what happens over a number of sessions?

Answer 18

Gradually, they are exposed to their whole hierarchy of feared situations over a number of sessions

Question 19

Systematic desensitisation (SD):
The therapist works with the client to make a list of feared situations, starting with those that arouse least anxiety, progressing to those that are the most frightening, creating a hierarchy of fear.
The client is given training in deep muscle relaxation techniques and taught breathing exercises to help them relax.
They may also be taught meditation or told to imagine themselves somewhere relaxing.
The client is exposed to the phobic stimulus, using the relaxation techniques at each stage of the hierarchy.
Therapy starts with the least fearful situation and only progresses to the next stage when the client feels sufficiently relaxed to do so.
Gradually, they are exposed to their whole hierarchy of feared situations over a number of sessions.
What can the client eventually do when confronted with their phobic object/situation?

Answer 19

The client can eventually remain calm when confronted with their phobic object/situation

Question 20

Systematic desensitisation (SD):
What is the principle behind this technique?

Answer 20

The principle behind this technique is to make the person:
1. Feel relaxed
,rather than
2. Feel fear

Question 21

Systematic desensitisation (SD):
The principle behind this technique is to make the person feel relaxed, rather than feel fear.
It is what that causes the desensitisation?

Answer 21

It is the pairing of relaxation with the feared stimulus that causes the desensitisation

Question 22

Systematic desensitisation (SD):
The principle behind this technique is to make the person feel relaxed, rather than feel fear.
It is the pairing of relaxation with the feared stimulus that causes the desensitisation (this is to reduce the sensitivity of something, for example what)?

Answer 22

It is the pairing of relaxation with the feared stimulus that causes the desensitisation (this is to reduce the sensitivity of something, for example a spider will have less effect)

Question 23

Systematic desensitisation (SD):
The principle behind this technique is to make the person feel relaxed, rather than feel fear.
It is the pairing of relaxation with the feared stimulus that causes the desensitisation (this is to reduce the sensitivity of something, for example a spider will have less effect).
How can systematic desensitisation be conducted?

Answer 23

Systematic desensitisation can be conducted:
1. Intro (imagined imagery), covert desensitisation
Or,
2. Real life (in vivo desensitisation)

Question 24

Where do all behavioural therapies have their roots?

Answer 24

All behavioural therapies have their roots in the learning theory

Question 25

All behavioural therapies have their roots in the learning theory.
Who (what year) suggests that systematic desensitisation works, because of exposure to the feared stimulus, not the relaxation?

Answer 25

Marks (1973) suggests that systematic desensitisation works, because of exposure to the feared stimulus, not the relaxation

Question 26

All behavioural therapies have their roots in the learning theory.
Marks (1973) suggests that systematic desensitisation works, because of exposure to the feared stimulus, not the relaxation.
The technique can be explained in terms of what, rather than the classic learning theory?

Answer 26

The technique can be explained in terms of cognitive restructuring, rather than the classic learning theory

Question 27

What do McGrath et al. (1990) claim?

Answer 27

McGrath et al. (1990) claim that sensitive desensitisation is effective for around 75% of people with specific phobias

Question 28

McGrath et al. (1990) claim that sensitive desensitisation is effective for around 75% of people with specific phobias.
Sensitive desensitisation has also been used with patients who suffer from what?

Answer 28

Sensitive desensitisation has also been used with patients who suffer from OCD

Question 29

McGrath et al. (1990) claim that sensitive desensitisation is effective for around 75% of people with specific phobias.
Sensitive desensitisation has also been used with patients who suffer from OCD.
What did Comer (2002) find?

Answer 29

Comer (2002) found that 60% of patients improved if they used sensitive desensitisation

Question 30

Systematic desensitisation

Answer 30

Systematic desensitisation is a behavioural therapy for treating anxiety disorders in which the sufferer:

1. Learns relaxation techniques
2. Then faces a progressive hierarchy of exposure to the objects/situations that cause anxiety

Question 31

What is the main behaviourist treatment for phobias?

Answer 31

Systematic desensitisation is the main behaviourist treatment for phobias

Question 32

Systematic desensitisation (SD):
Systematic desensitisation is based on classical conditioning.
Systematic desensitisation aims to extinguish (unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation).
It is used to treat phobias, by exposing the client to the threatening situation under relaxed conditions, until the anxiety is extinguished.
Systematic desensitisation was devised by Wolpe (1958) and was developed specifically to deal with fears, phobias and anxieties.
Systematic desensitisation is based on the idea that it is not possible to experience 2 opposite emotions at the same time.
What is this called?

Answer 32

This is called reciprocal inhibition

Question 33

Systematic desensitisation (SD):
Snake phobics may begin systematic desensitisation treatment by doing what?

Answer 33

Snake phobics may begin systematic desensitisation treatment by looking at a picture of snakes in a sealed tank

Question 34

Systematic desensitisation (SD):
Snake phobics may begin systematic desensitisation treatment by looking at a picture of snakes in a sealed tank and progressively work through to doing what?

Answer 34

Snake phobics may:

1. Begin systematic desensitisation treatment by looking at a picture of snakes in a sealed tank
2. Progressively work through to actually holding one

Question 35

Systematic desensitisation (SD) research:

Jones (1924) used systematic desensitisation to eradicate ‘Little Peter’s’ phobia of white fluffy animals and objects, for example rabbits and cotton wool.
The rabbit was presented to the patient at closer distances each time his anxiety levels subsided to permit movement onto the next stage and Peter was rewarded with food to develop a positive association towards the rabbit.
Eventually, he developed affection for the rabbit, which generalised onto similar animals and objects.

Rothbaum et al. (1998) reported on virtual reality exposure therapy where patients are active participants within a computer generated 3D world that changes naturally with head movements.
The advantage of this over normal systematic desensitisation and flooding is that treatment occurs without ever leaving the therapist’s office, more control is gained over phobic stimuli and there’s less exposure of patients to harm and embarrassment.

Barlow (2002) reports that flooding has been shown to be equally as effective in treating phobias as sensitive desensitisation, but sensitive desensitisation is preferred, because it is better tolerated by most patients.

Answer 35

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Question 36

Systematic desensitisation (SD) evaluation:
For:
1. Systematic desensitisation is mainly suitable for patients who are able to learn and use relaxation strategies and who have imaginations vivid enough to conjure up images of feared objects/situations.

2. Although patients can gradually confront phobias in an imaginary sense, there’s no guarantee that this will work with actual objects/situations, suggesting that in vivo treatment is superior to covert desensitisation.
3. Effectiveness.
   Systematic desensitisation is highly effective in treating phobias and other anxiety disorders.
   For example, McGrath et al. (1990) found that 75% of patients with phobias respond to systematic desensitisation.
   Capafons (1998) found that when used with aerophobics (people who have a fear of flying), those who had undergone systematic desensitisation reported lower levels of fear (compared to a control group) and lwer physiological signs of fear during a flight simulation, showing that both perception of fear and bodily fear responses are effectively reduced.
   Furthermore, there is evidence that its effectiveness is long-lasting.
   For example, Gilroy et al. (2003) found that spider phobics were still less fearful than a control group, who had only experienced relaxation training, 33 months later.
   This also shows that systematic desensitisation’s effectiveness is not simply due to the relaxation element, demonstrating that the exposure element also makes a significant contribution to the reduction of fear.
4. Appropriateness.
   Systematic desensitisation is generally suitable for a wide range of patients and requires less cognitive effort from the client than other psychotherapies, where a patient must play a more active role in their treatment (for example cognitive behavioural therapy).
   Because of this, it can be used even with children or clients with severe learning difficulties, making it broadly applicable.
5. There are no ethnical objections to systematic desensitisation, because the client has a lot of control over the treatment.
   Progression up the hierarchy only occurs when they feel confident enough.
   Therefore, although it involves fear exposure, no harm is caused by systematic desensitisation.

Against:
1. Systematic desensitisation doesn’t work equally well for all types of phobia, nor it is 100% effective, therefore it doesn’t work for everyone with a phobia.

Answer 36

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Question 37

Flooding

Answer 37

Flooding is a behavioural therapy used to remove phobias through direct confrontation of a feared:
1. Object
Or,
2. Situation

Question 38

What is flooding also known as?

Answer 38

Flooding is also known as implosion

Question 39

Flooding is where instead of a step-by-step approach, patients go straight to the top of the hierarchy and what?

Answer 39

Flooding is where instead of a step-by-step approach, patients:

1. Go straight to the top of the hierarchy
2. Imagine, or have direct contact with, their most feared scenarios

Question 40

Flooding is where instead of a step-by-step approach, patients go straight to the top of the hierarchy and imagine, or have direct contact with, their most feared scenarios.
What is the idea?

Answer 40

The idea is that:

1. Patients cannot make their usual avoidance responses
2. Anxiety peaks at such high levels that it cannot be maintained and eventually subsides

Question 41

What does flooding stop very quickly?

Answer 41

Flooding stops phobic responses very quickly

Question 42

Flooding stops phobic responses very quickly.

Without the option for avoidance behaviour, what does the patient quickly learn?

Answer 42

Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless

Question 43

Flooding stops phobic responses very quickly.
Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless.
What is this process called?

Answer 43

This process is called extinction

Question 44

Flooding stops phobic responses very quickly.
Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless.
This process is called extinction.
A learned response is extinguished when the CS (for example a dog) is encountered without the UCS (for example being bitten).
What is the result?

Answer 44

The result is that the CS no longer produces the CR (fear)

Question 45

Flooding is an alternative to the gradual exposure used in systematic desensitisation.
Instead of creating a hierarchy of fears, the worst possible phobic stimulus is identified.
The client is taught relaxation techniques to use and is then exposed to their most feared situation, without the possibility of escape, for how long?

Answer 45

The client is taught relaxation techniques to use and is then exposed to their most feared situation, without the possibility of escape, for a prolonged period of time

Question 46

Flooding is an alternative to the gradual exposure used in systematic desensitisation.
Instead of creating a hierarchy of fears, the worst possible phobic stimulus is identified.
The client is taught relaxation techniques to use and is then exposed to their most feared situation, without the possibility of escape, for a prolonged period of time.
Eventually, the fear begins to subside.
This is partly because of the relaxation techniques and also because there is a time limit to the body’s fear response, why?

Answer 46

This is:

1. Partly because of the relaxation techniques
2. Also because there is a time limit to the body’s fear response, because adrenalin levels naturally decrease over time (2 - 3 hours)

Question 47

Flooding involves overwhelming what?

Answer 47

Flooding involves overwhelming the individual's senses with the:
1. Object
Or,
2. Situation
that causes anxiety

Question 48

Flooding involves overwhelming the individual’s senses with the object or situation that causes anxiety, so that the person realises that no harm will occur, why?

Answer 48

Flooding involves overwhelming the individual’s senses with the:
1. Object
Or,
2. Situation
that causes anxiety, so that the person realises that no harm will occur

Question 49

Flooding involves overwhelming the individual’s senses with the object or situation that causes anxiety, so that the person realises that no harm will occur, so that the person realises that no harm will occur.
There is no step by step build up.
The individual is exposed repeatedly and in a what way with their phobia?

Answer 49

The individual is exposed repeatedly and in an intensive way with their phobia

Question 50

Flooding involves overwhelming the individual’s senses with the object or situation that causes anxiety, so that the person realises that no harm will occur, so that the person realises that no harm will occur.
There is no step by step build up.
The individual is exposed repeatedly and in an intensive way with their phobia.
What does the individual have their senses flooded with?

Answer 50

The individual has their senses flooded with:
1. Thoughts
2. Images
3. Actual experiences
of their phobia

Question 51

Flooding research:
Wolpe (1960) used flooding to remove a girl’s phobia of being in cars.
The girl was forced into a car and driven around for 4 hours until her hysteria was eradicated, demonstrating the effectiveness of the treatment.

Ost (1997) found that flooding is a rapid treatment that often delivers rapid, immediate improvements, especially when a patient is encouraged to continue self-directed exposure to feared objects and situations outside of therapy sessions.

Solter (2007) reported on the case study of a 5 month old baby who showed signs of traumatic stress after a 3 day hospital stay for surgery to correct the shape of his head.
Flooding was used, whereby the child was allowed to have a full-blown emotional response during several treatment sessions.
The outcome was positive, with the disappearance of some symptoms of traumatic stress disorder after the first week and no remaining symptoms after 2 months.
Follow-up evaluations for one year revealed normal development with no return of symptoms.
This suggests that flooding is an effective therapy and can be used with very young children.

Answer 51

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Question 52

Flooding evaluation:
For:
1. Wolpe (1960) treated an adolescent girl with agoraphobia by putting her into the back of a car and driving her around for 4 hours.
Her fear initially rose to hysterical panic, but then receded.
By the end of the journey, she was completely calm.
This shows flooding to be highly effective and also a very rapid treatment.
However, this is a case study, with no data on long-term effectiveness.
It is not known if she was permanently cured of her phobia, so we need more evidence before we can conclude that flooding is effective.
However, other studies have confirmed the effectiveness of flooding, with some reporting continued improvement as long as 9 years later.

2. There are serious ethical concerns with a treatment that involves traumatising patients.
   The treatment is traumatic for patients, because their anxiety level will be at its peak, as flooding produces high levels of fear.
   As a result, many patients refuse to start or complete treatment.
   Although informed consent is obtained, and the patient can withdraw from treatment if they wish, it is possible that longer-term, negative side effects may occur.
   However, Shipley and Boudewyns (1980) found that only 0.2% of patients experienced side effects - The same, or fewer than, alternative treatments.
   Therefore, they concluded that flooding is safe, effective and appropriate for the majority of phobic patients.
3. Flooding is not unethical, because patients give their informed consent and so they know what is involved.
   It is ofcourse an unpleasant experience and the patient’s anxiety will be at its peak, but a patient has to be properly prepared.
   A patient would also normally be given the choice of sensitive desensitisation or flooding.
4. Flooding is cost-effective.
   The quick effect that flooding can have means that patients are free of their symptoms as soon as possible and this makes the treatment cheaper than alternatives.

Against:
1. Flooding is not suitable for patients who are not in good physical health, as the extreme anxiety levels caused by confrontation with feared object/situations, although short-lived, can be very stressful on the body, incurring risks of heart attacks, for example.

2. There is mixed evidence for the effectiveness of flooding, compared to sensitive desensitisation or other treatments for phobias.
   For example, Choy et al. (2007) found flooding to be superior to sensitive desensitisation, while Craske et al. (2008) found no difference.
3. Individuals have to be highly motivated to undergo flooding and drop out rates can be high.
   This reduces the appropriateness of flooding for many people with phobias.
4. Flooding is less effective for some types of phobia.
   Flooding is less effective for treating more complex phobias like social phobias.
   This may be because social phobias have cognitive aspects and an individual does not simply experience an anxiety response, but thinks unpleasant thoughts about the social situation.

Answer 52

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Question 53

Behavioural therapies evaluation:
For:
1. There are ethical considerations with both systematic desensitisation and flooding, as they can both be psychologically harmful, although cost-benefit analyses may regard long-term benefits of eradicating the phobia as outweighing the short-term costs of distress.

Against:
1. Although patients can gradually confront phobias in an imaginary sense, there’s no guarantee that this will work with actual objects/situations, suggesting in vivo treatment to be superior to covert desensitisation.

2. Behaviourist treatments work best in treating simple phobias, but are less effective with agoraphobia and social phobias, which suggests that these types of phobias may not be best explained through behaviourist means.
3. Kendall and Hammen (1998) criticise behavioural therapy, as they describe it as mechanical in its applications and as limiting the benefits of treatment to changes in observable behaviour.
   The focus of behavioural therapies on eliminating symptoms is very limited.
   The failure to consider the underlying causes of mental illness leads to the danger of symptom substitution.
4. The problem of generalisation.
   The application of behavioural therapy may serve to produce the desired behaviour by the patient in the therapist’s room, but it does not necessarily follow that the same behaviour will be produced in other situations.
   Yet, the effectiveness of behavioural therapies has been shown to be quite high.
   Agoraphobia is one of the most difficult phobias to treat, yet Craske and Barlow (1993) found that systematic desensitisation has resulted in improvement for between 60 and 80% of cases.
   However, improvements are shown to be only partial and in 50% of cases, relapses occur.

Answer 53

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