behavioural approach to treating phobias Flashcards
systematic desensitisation definition
a behavioural therapy designed to reduce an unwanted response, such as anxiety. SD involved drawing up a hierarchy of anxiety-provoking situations related to a person’s phobic stimulus, teaching the person to relax, and then exposing them to phobic situations. the person works their way through the hierarchy whilst maintaining relaxations
flooding definition
a behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus. this takes place across a small number of long therapy sessions
what are the 2 ways of treating phobias
-systematic desensitisation
-flooding
what is systematic desensitisation
behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. if a person can learn to relax in presence of phobic stimulus they will be cured
what happens to phobic stimulus in systematic desensitisation
a new response to the phobic stimulus is learned as paired with relaxation instead of anxiety. this is called counterbalancing
what are the 3 processes in systematic desensitisation
1-anxiety hierarchy
2-relaxation
3-exposure
what is anxiety hierarchy in systematic desensitisation
put together by client and therapist. list of situations related to the phobic stimulus that provoke anxiety arranged in order form least to most frightening.
who makes anxiety hierarchy in systematic desensitisation
client with the phobia and the therapist
arachnophobia example of anxiety hierarchy in systematic desensitisation
might identify a photo of a small spider as low on anxiety hierarchy and holding a tarantula at the top of the hierarchy
what is relaxation in systematic desensitisation
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.
what are the does the relaxation in systematic desensitisation involve
breathing exercises or mental imagery techniques. clients can be taught to imagine themselves in relaxing situations (such as lying on a beach) or they might learn meditation. alternatively relaxion can be achieved by use of drugs such as valium
what is exposure as part of systematic desensitisation
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 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
what is flooding
exposing people to phobic stimulus without gradual build up in an anxiety hierarchy. involves immediate exposure of a frightening situation
flooding arachnophobia example
large spider crawl over them for an extended period
how long are flooding sessions
typically longer than systematic desensitisation, one session lasts 2 or 3 hours. sometimes only one long session is needed to cure the phobia
how quickly does flooding stop phobic responses
very quickly
how does flooding work
stops phobic responses very quickly. may be because without the option of avoidance behaviour, the client learns the phobic stimulus is harmless. in classical conditioning terms the process is called extinction. a learned response is extinguished when the conditioned stimulus is encountered without he unconditioned stimulus. the result is that the unconditioned stimulus no longer produces conditioned response of fear.
how may some clients achieve relaxation due to exhaustion
client may achieve relaxation in presence of phobic stimulus simply because they become exhausted by their own fear response
ethical safeguards of flooding
not necessarily unethical but is unpleasant so important that clients give fully informed consent to the traumatic procedure and are fully prepared before the flooding session, a client would normally be given the choice of systematic desensitisation or flooding
strength of systematic desensitisation- evidence of effectiveness
-evidence base for its effectiveness -Gilroy et al 2003 followed up 42 people who has SD for spider phobia in 3, 45mins sessions. at 3 and 33 months the SD group were less fearful than the control group treated by relaxation without exposure. in recent review Wechsler et al 2019 concluded that SD is effective for specific phobia, social phobia and agoraphobia –> likely to be helpful for people with phobias
strength of systematic desensitisation - people with learning disabilities
-used to help people with learning disabilities
-some people requiring treatment for phobias have a learning disability. however, the main alternative to SD are not suitable. people with learning disabilities often struggle with cognitive therapies that require complex rational thought. they may also fell confused and distressed by the traumatic experience of flooding –> SD is often most appropriate treatment for people with learning disabilities who have phobias
evaluation of systematic desensitisation - SD in virtual reality
-traditional SD involves exposure to the phobic stimulus in a real-world setting. however, there are advantages to conducting the exposure part of SD in virtual reality. exposure through VR can be used to avoid dangerous situations and is cost effective because the psychologist and client don’t need to leave the consulting room
-however, there is some evidence to suggest VR exposure may be less effective than real exposure for social phobias because it lacks realism (Wechsler at al 2019)
strength of flooding - cost-effective
-highly cost-effective
-clinical effectiveness mans how effective a therapy is at tackling symptoms, however when we provide therapies in health systems such as the NHS we also need to think about how much they cost. a therapy is cost-effective is it is clinically effective and not expensive, flooding can work in as little as one session as opposed to around 10 for SD to achieve the same result. even allowing for a longer session (3 hours) making flooding more cost-effective –> more people can be treated at the same cost with flooding than SD or other therapies
limitation of flooding - traumatic
-highly unpleasant experience
-confronting one’s phobic stimulus is an extreme form provoking tremendous anxiety. Schumacher et al 2015 found participants and therapists rated flooding as significantly more stressful than SD. this raises the ethical issue for psychologists for knowing causing stress to their clients although this not a serous issue provided they obtain informed consent, more seriously, the traumatic nature of flooding means attrition (dropout rates) are higher than for SD –> overall, therapists may avoid using this treatment
evaluation of flooding - symptom substitution
-limitation of behaviour therapies, including flooding is they only mask symptoms and do not tackle underlying causes of phobias (symptom substitution). for example persons 1986 reported the case of a women with a phobia of death who was treated using flooding. her fear of death declined, but fear of being criticised got worse
-however, the only evidence form substitution comes in the form of case studies which may only generalise to the phobia in the study
