6. Behavioural Approach To Treating Phobias

Question 1

What are the two behavioural therapies for treating phobias?

Answer 1

Systematic desensitisation and flooding

Question 2

what is systematic desensitisation?

Answer 2

a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning

Question 3

central idea of SD

Answer 3

if the sufferer can learn to relax in the presence of the phobic stimulus they will be cured

Question 4

how is counterconditioning involved in SD?

Answer 4

a new response to the phobic stimulus is learned by pairing it with relaxation instead of anxiety

Question 5

what is reciprocal inhibition (SD)?

Answer 5

it is impossible to be afraid and relaxed at the same time so one emotion prevents the other

Question 6

what are the 3 processes involved in SD?

Answer 6

anxiety hierarchy, relaxation, exposure

Question 7

what does the first stage of SD involve?

Answer 7

anxiety hierarchy is put together by patient and therapist which is a list of situations related to the phobic stimulus that provoke anxiety arranged from least to most frightening

Question 8

what does the second stage of SD involve?

Answer 8

relaxation methods are taught to the patient which may involve breathing exercises, meditation, or mental imagery techniques. Alternatively, Valium can be used to relax

Question 9

what does the third stage of SD involve?

Answer 9

the patient is exposed to the phobic stimulus which takes place over several sessions as they work up the hierarchy. When the patient can remain relaxed in the presence of lower levels of the phobic stimulus they move up the hierarchy

Question 10

when is SD treatment successful (linked to the last stage)?

Answer 10

when the patient can stay relaxed in situations high on the anxiety hierarchy

Question 11

what is flooding?

Answer 11

a behavioural therapy involving immediate exposure to a very frightening situation without a gradual build-up in an anxiety hierarchy

Question 12

how long are typical flooding sessions?

Answer 12

longer than SD sessions, typically 2-3 hours

Question 13

how does flooding work?

Answer 13

through extinction: stops phobic responses very quickly because without the option of avoidance the patient learns the phobic stimulus is harmless

Question 14

how does the process of extinction occur in flooding?

Answer 14

learned response is extinguished when the CS (e.g. dog) is encountered without the UCS (e.g. being bitten), the result is that the CS no longer produces the CR of fear

Question 15

how are ethical safeguards employed in flooding?

Answer 15

flooding is an unpleasant experience so it is important that patients give fully informed consent and that they are prepared

Question 16

3 AO3 points for SD

Answer 16

supporting evidence, suitable for a diverse range of patients, acceptable to patients

Question 17

3 AO3 points for flooding

Answer 17

cost-effective, less effective for some types of phobia, it is traumatic

Question 18

AO3 point 1 for SD: supporting evidence

Answer 18

Gilroy et al. (2003) followed up 42 patients who had been treated for spider phobia in 3 45-minute sessions of SD. Spider phobia was assessed on several measures including the Spider Questionnaire and by assessing response to a spider. A control group was treated by relaxation without exposure. At both 3 months and 33 months after, the SD group were less fearful than the relaxation group

Question 19

AO3 point 2 for SD: suitable for a diverse range of patients

Answer 19

the alternatives to SD (flooding and cognitive therapies) are not suitable to some patients such as those with learning difficulties. This can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies that require the ability to reflect on what you are thinking, SD is most appropriate

Question 20

AO3 point 3 for SD: acceptable to patients

Answer 20

patients prefer it; those given the choice of SD or flooding tends to choose SD largely because it does not cause the same degree of trauma and includes some elements like relaxation that are actually pleasant. This is reflected in the low refusal rates and low attrition rates

Question 21

AO3 point 1 for flooding: cost-effective

Answer 21

studies comparing flooding to cognitive therapies (Ougrin 2011) have found that flooding is highly effective and quicker than alternatives. This is a strength because patients are free of their symptoms as soon as possible and this makes treatment cheaper

Question 22

AO3 point 2 for flooding: less effective for some types of phobia

Answer 22

highly effective for treating simple phobias but less so for more complex phobias like social phobias. This may be because social phobias have cognitive aspects such as unpleasant thoughts. These types may benefit more from cognitive therapies meaning flooding should not be used in all cases

Question 23

AO3 point 3 for flooding: it is traumatic

Answer 23

the problem is not that flooding is unethical because patients give fully informed consent but that patients are often unwilling to see it through to the end. Limitation because time and money are sometimes wasted preparing patients only to have them refuse to start or complete the treatment

Question 24

extra overall AO3 point

Answer 24

symptom substitution: common criticism is that when one phobia disappears another may appear in its place. Evidence for this is very mixed and most behaviourists tend to believe it does not happen but if it does it is a significant limitation as it suggests they are not effective