Behavioural approach to the treatment of phobias Flashcards
Systematic Desensitisation
Systematic desensitization (SD) is a behavioural therapy developed by Wolpe (1958) to reduce phobias by using classical conditioning. A person experiences fear and anxiety as a conditioned response to a phobic object. SD replaces this fear and anxiety with relaxed responses instead. The central idea of SD is that it is impossible to experience two opposite emotions at the same time e.g. fear and relaxation; this is called reciprocal inhibition. Therefore if the patient can
learn to remain relaxed in the presence of their phobia, they can be cured. This is called counter-conditioning.
Stages of systematic desensitisation
- Fear Hierarchy - A hierarchy of fear is constructed by the therapist and the patient. Situations involving the phobic object are ranked from least fearful to most fearful. If a person has a phobia of snakes the therapist might at first get the patient to merely look at a photo of a snake, then at a snake in a tank, until eventually they are asked to hold a snake.
- Relaxation Techniques - Patients are taught deep muscle relaxation techniques, such as progressive muscular relaxation (PMR) and the relaxation response. The idea behind PMR is to tense up a group of muscles so that they are as tightly contracted as possible, hold them in a state of extreme tension for a few seconds and then relax the muscles to their previous state. Finally, consciously relax the muscles even further so that you are as relaxed as possible. When doing the relaxation response patients are asked to sit quietly and comfortably and close their eyes. They then start by relaxing the muscles of their feet and work up their body relaxing muscles. While doing this they are asked to breathe deeply, meditate and imagine relaxing situations.
Gradual Exposure - The patient is introduced to their phobic object and they work their way up the anxiety hierarchy starting with the least frightening stage. They use their relaxation techniques whilst they are exposed to the phobic object. When they feel comfortable with one particular stage of the hierarchy they move on to the next stage in the hierarchy. Eventually through repeated exposure to phobic objects with relaxation and no fear, the phobia is eliminated.
Advantages of Systematic desensitisation
Klosko et al. (1990) supports the use of SD. He assessed various therapies for the treatment of panic disorders and found that 87% of patients were panic free after receiving SD, compared to 50% receiving medication, 36% receiving a placebo and 33% receiving no treatment at all. Therefore SD is an effective therapy compared to others (+)
+ SD is less traumatic than flooding because of the gradual exposure. It therefore has high completion rates as the gradual process of the therapy allows respite and the relaxation is pleasant. It is also more successful for vulnerable individuals, such as children and those with learning difficulties etc.
+ Jones (1924) supports the use of SD to eradicate ‘Little Peter’s’ phobia of rabbits. A white rabbit was presented to Little Peter at gradually closer distances and each time his anxiety levels lessoned. Eventually he developed affection for the white rabbit.
Disadvantages of systematic desensitisation
A disadvantage of SD is that it is not always practical for individuals to be desensitized by confronting real life phobic situations. Real life step-by-step situations are difficult to arrange and control, e.g. someone is scared of sharks! Therefore SD might be very difficult to apply to real life situations/phobias and this can question the effectiveness of the therapy (-)
A problem of SD is that it is time-consuming especially when compared to alternative therapies such as flooding. The patient with the phobia needs to be trained in relaxation techniques and gradual exposure which can take many sessions and a great deal of time. Flooding however, takes less time than SD and might be suitable for patients that want a quick solution/cure for their phobia. (-)
Flooding
Flooding involves directly exposing the patient to their phobic object. Beforehand, the patient would be taught relaxation techniques such as deep muscle relaxation, deep breathing and meditation. However, there is not a gradual build up using the anxiety hierarchy; instead flooding involves immediate exposure to a very frightening and extreme situation, e.g. a person scared of snakes might be expected to hold a snake for a long period of time.
Flooding stops phobic responses very quickly. This is because the patient does not have the option for any avoidance behaviour, and they quickly learn that the phobic object is harmless, and therefore extinction occurs.
In some cases the patient might achieve relaxation in the presence of their phobic object because they are so exhausted by their own fear response
Is flooding ethical
Flooding is ethical, even though it can cause a great deal of initial psychological harm; the patient would have to give their fully informed consent so that they were fully prepared for the flooding session. Patients are given the choice of either having SD or flooding. Flooding therapy sessions usually last 2-3 hours, which is much longer than SD sessions.
Advantages of flooding
+ Flooding is a cost-effective treatment as it is clinically effective at treating phobias and is relatively cheap.
Ost (1997) stated that flooding is an effective and rapid treatment that delivers immediate improvements for phobic patients. This is especially the case when a patient is encouraged to continue self directed exposure to feared objects and situations outside of the therapy situation. The results from flooding can be applied to everyday life outside of the therapy situation (+)
+ Wolpe (1960) used flooding to remove a patient’s phobia of being in cars. The girl was forced into a car and driven around for four hours until her hysteria was eradicated.
Disadvantages of flooding
- A disadvantage of flooding is that it is a highly traumatic experience and so has low completion rates. The immediate process of the therapy does not allow respite and is unpleasant. Because flooding is traumatic it is unsuitable for children.
- Flooding may not be appropriate for more complex phobias, such as social phobias, where sufferers do not simply experience an anxiety response but also think unpleasant thoughts about the social situation.
- Behavioural treatments address the symptoms of phobias. However some critics believe the symptoms are merely the tip of the iceberg and claim that underlying causes of the phobia will remain. In the future the symptoms will return or symptom substitution will occur, when other abnormal behaviours replace the ones that have been removed
