Behavioural Approach to TREATING phobias Flashcards
What is Systematic Desensitisation, its AIMS 🎯 and how does it work?
- Systematic Desensitisation (SD) is a behavioural 💪🏼 therapy designed to gradually reduce phobic 😣 anxiety through the principle of CC.
If the sufferer can learn to relax 😌 in the presence of the phobic stimulus then a new response (relaxation instead of anxiety) is learned and the phobia is cured.
The learning of a new response is called counter-conditioning. So SD aims to replace faulty association between the CS and the CR that has resulted in a phobic response.
- Its impossible to be afraid 😟 and relaxed 😌@ same time, 1️⃣ emotion prevents the other.
There are 2 types of SD:
> In-vivo- where individual is exposed 😵 to the actual object/situation
> In-vitro - where individual imagines 💭 being exposed to the phobic object/ situation.
How many and what processes are involved in SD?
1) Relaxation 😌
2) The anxiety 😣 hierarchy 🔺
3) Exposure 😵
What is the process of RELAXATION 😌 in SD
The therapist 👩🏻🏫 teaches patient 🙍🏼to relax as deeply as possible. i.e. might involve breathing exercises 👄, e.g. may be taught the 7/11 technique, where you breathe in for a count of 7 and out for 11.
Its used to help people relax 😌 and gain composure in variety of situations or alternatively the patient might learn mental imaginary 💭 techniques.
Patients can be taught to imagine 💭 themselves in relaxing 😌 situations (lying on the beach 🏖 ) or might learn mediation 🤸🏻♂️.
What is the process of THE ANXIETY HIERARCHY 😣🔺in SD
The anxiety hierarchy 😣🔺is put together by the client 🙍🏼 and therapist👩🏻🏫.
It a list 📝of situations related to the phobia that provoke anxiety arranged in order from least 🔚to most frightening🔜.
E.g. a spider 🕷phobic might identify seeing an image 🖼 of a small spider as low ⬇️ on their anxiety hierarchy and holding a tarantula✋🏼🕷 at the top 🔝 of the hierarchy.
What is the process of EXPOSURE 😵 in SD
The patient is then exposed 😵to the phobic stimulus while in a relaxed 😌 state.
This takes place across several sessions, starting at bottom ⬇️ of the anxiety hierarchy.
When the patient can stay relaxed 😌 in the presence of the lower ⬇️ levels of the phobic stimulus they move up 🔝 the hierarchy.
Treatment is successful 👏🏼 when the patient👩🏼can stay relaxed 😌 in situations high 🔝on the anxiety hierarchy 😣🔺.
What are the evaluation points of SD in terms of its EFFECTIVENESS?
1) It is effective ✅
2) Relaxation 😌 may not be necessary (placebo effect) ⛔️
Outline the evaluation point
1) It is effective ✅ in terms of effectiveness
Point:
Strength 💪🏼 of SD for the treatment of phobias is that research 🔬 shows that its effective in the treatment for specific phobias.
E:
Gilroy et al 2️⃣0️⃣0️⃣3️⃣ followed up 👩🏻💼x42 patients who had been treated for spider 🕷 trauma in 3, 45 minute ⏱ sessions of SD. A control group was treated by relaxation 😌without 🚫exposure 😵to spiders🕷
@ both 3 and 33 months after the treatment the SD group were less fearful than the relaxation group.
Additionally, McGrath et al 1️⃣9️⃣9️⃣0️⃣reported that 75% of clients 👩🏻💼 with phobias responded to SD.
According to Choy et al 2️⃣0️⃣0️⃣7️⃣ the key 🔑 to success lies with the actual contact with the feared stimulus, so IN-VIVO techniques are more successful than ones using images 🖼 or imagining 💭 the feared stimulus (IN-VITRO).
Re-cap:
These pieces of research demonstrate that SD is a useful technique in the treatment of specific phobias.
Outline the evaluation point
2) Relaxation 😌 may not be necessary 🚫 (placebo effect) ⛔️ in terms of EFFECTIVENESS
Point:
Weakness ⛔️ is that it may be that the success is more to do with exposure 😵 to the feared situation than relaxation 😌.
Explain:
It might be that the expectation of being able to cope with the feared stimulus is important.
Example:
Klein et al 1️⃣9️⃣8️⃣3️⃣ compared SD with supportive psychotherapy (therapy that combines psychodynamic and cognitive therapies) for patients with specific or social phobias.
Elaborate:
They found no difference in the effectiveness, suggesting that the ‘active ingredient’ in SD may simply be the generation of hopeful expectancies that the phobia can be overcome.
Re-cap:
Suggests the exact reason why SD is effective remains unclear.
What are the evaluation points of SD in terms of its APPROPRIATENESS ?
3) More preferable to flooding 🌊 for many clients 👩🏻💼 ✅
4) Symptom substitution ⛔️
Outline the evaluation point
3) More preferable to flooding 🌊 for many clients 👩🏻💼 ✅ in terms of APPROPRIATENESS
Point:
Strength ✅ of SD is that patients 👩🏻💼 seem to prefer it to flooding 🌊 because they feel that it is less traumatic because of the more gentle 😇 step by step approach.
Explain:
Largely because it doesn’t cause the same degree of trauma as flooding 🌊 - due to slowly working through the anxiety hierarchy is seen more ethical 😇.
Elaborate:
This is reflected in the low refusal rates (NO. of p’s refusing 🙅🏼♂️ to start treatment) and low attribution rates (p’s dropping out of treatment) of SD.
Re-cap:
Suggests that for many clients with phobias, SD is an appropriate treatment.
Outline the evaluation point
4) Symptom substitution ⛔️ in terms of APPROPRIATENESS
Point:
Limitation ⛔️ of SD as treatment for phobias is that the psychodynamic model claims that SD ( & other behavioural therapies e.g. flooding 🌊) focuses only on symptoms & ignores the cause of abnormal 👽 behaviour.
Explain:
Psychoanalysts 👩🏻⚕️ claim that symptoms are merely the tip of the iceberg 💎- the outward expression of deeper underlying emotional problems.
Elaborate:
Psychoanalysts 👩🏻⚕️ believe that whenever symptoms are treated without any attempt to work out the deeper underlying problems, the problem will only show itself in another way, through different symptoms - known as SYMPTOM SUBSTITUTION.
Re-cap:
Behaviourists however reject 🚫 this criticism and claim that we need to not look beyond the behavioural symptoms as the symptoms are the disorder.
What is flooding 🌊 and the aim 🎯 of it?
The aim 🎯 of flooding 🌊 is to expose😵 the sufferer😷 to the phobic object or situation for an extended period of time in a safe and controlled environment.
What does flooding 🌊 include?
- Immediate exposure 😵 to the phobic stimulus
- Exhaustion 😤🙄 of phobic response
- Prevention 🚫of avoidance
What does it mean to Immediately 😵 expose the phobic stimulus?
Involves bombarding ☄️ the phobic patient 😷 with the phobic object (IN-VIVO exposure) until the person is calm and does not fear the stimulus, without a gradual build up.
So a spider 🕷 phobia (arachnophobia) receiving flooding 🌊 treatment may have large spider crawl over their hand ✋🏼🕷until they can fully relax😌. As a result, flooding 🌊sessions are longer⏱ than SD and last for 2-3 hours. Sometimes only 1 long session is required to cure the phobia.
What does it mean by Exhaustion 😤🙄of phobic response?
Means that flooding 🌊 is without the option of avoidance 🚫 behaviour, the patient 👩🏻💼 quickly learns that the phobic object is harmless through the exhaustion of their fear response - aka extinction.
In CC terms, the result is that the CS (spider) no longer produces the CR (fear).
In some cases patient 👩🏻💼 might even achieve relaxation 😌 in presence of phobic stimulus simply because they become exhausted 😤🙄 of their own fear response.
What does it mean by Prevention 🚫 of avoidance?
Avoidance 🚫 behaviours maintain the phobia as the phobic 😷cannot learn that the thing they fear is not harmful.
So stopping the phobic 😷 patient from making their usual avoidance 🚫 responses is necessary to prevent reinforcement of the phobia.
Ethical 😇 safeguards
Flooding 🌊 is not unethical, but it is an 😩 unpleasant experience so it is important that patients 👩🏻💼 give informed consent 📋.
They must be fully prepared and know what to expect .
Before exposure, the client might be trained in relaxation 😌 techniques so that they are best able to control their fearful responses.
What are the evaluation points of flooding as a behavioural approach to treating phobias as an EFFECTIVENESS?
1) Effectiveness ✅
2) It is less effective for social phobia ⛔️
Outline the evaluation point
1) Effectiveness in terms of effectiveness ✅
Point:
Strength ✅ of flooding 🌊 as a treatment for phobias is that it appears to be an effective treatment and it is relatively quick (compared to Cognitive Behavioural Therapy).
Example:
Wolpe 1️⃣9️⃣7️⃣3️⃣ took a girl 👱🏼♀️ who was scared of cars 🚗 , and drove her around for hours 🕓. Initially the girl 👱🏼♀️was hysterical 😩but she eventually calmed 😐 down when she realised 😧that her situation was safe. From then on she associated a sense of ease with cars.
Elaborate:
Also in comparison to SD, Choy et al 2️⃣0️⃣0️⃣7️⃣ reported that flooding 🌊 was the more effective of the two at treating phobias.
Re-cap:
The fact that flooding 🌊 is a quick treatment for phobias is also a strength ✅ because it means that patients are free of their symptoms faster and that makes the treatment cheaper 💵.
Outline the evaluation point
2) It is less effective for social phobia in terms of effectiveness ⛔️
Point:
Limitation ⛔️ of flooding 🌊 as a treatment for phobias is that although flooding is highly effective for treating simple phobias it appears to be less so far more complex phobias like social phobias.
Explain:
This may be because social phobias have cognitive aspects.
Example:
E.g. a sufferer 😷 of a social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation.
Elaborate:
This type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational 👎🏼 💭 thinking.
Re-cap:
This suggests that the effectiveness of flooding 🌊 as a method of treating phobias is more dependent on the type of phobia.
What are the evaluation points of flooding 🌊 as a behavioural approach to treating phobias as APPROPRIATENESS ?
3) The treatment can be traumatic for patients ⛔️
4) Symptom substitution ⛔️
Outline the evaluation point
3) The treatment can be traumatic for patients ⛔️ in terms of APPROPRIATENESS
Point:
Limitation ⛔️ of flooding 🌊 as a treatment for phobias is that it can be a highly traumatic experience.
Explain:
It is important that a cost-benefit analysis is carried out before engaging with flooding 🌊 as it can be psychologically harmful (although the cost-benefit analyses may regard the long term benefits of getting rid of the phobia as outweighing the short term costs of distress).
Elaborate:
Flooding 🌊 is not unethical 😇 (patients 👩🏻💼must give fully informed consent📋 and they must be fully prepared before the session), however, it might be viewed to be too traumatic for children 👧🏻👦🏼, and they may not be able to fully understand what they are consenting too.
Re-cap:
Additionally, many patients 👩🏻💼 who start with flooding 🌊 are unwilling to see it through to the end, which is a limitation ⛔️of flooding 🌊because time ⏱and money 💰 may be wasted preparing patients only to have them refuse to start or complete treatment.
Outline the evaluation point
4) Symptom substitution ⛔️ in terms of APPROPRIATENESS
Point:
Limitation ⛔️of flooding 🌊 as a treatment for phobias is that the psychodynamic model claims that flooding 🌊 (and the other behavioural therapies in general e.g. SD) focuses only on symptoms and ignores the causes of abnormal behaviour.
Explain:
Psychoanalysts 👩🏻💼claim that the symptoms are merely the tip of the iceberg 💎- the outward expression of deeper underlying emotional problems.
Elaborate:
Psychoanalysts 👩🏻💼believe that whenever symptoms are treated without any attempt to work out the deeper underlying problems, then the problem will only show itself in another way, through different symptoms - known as symptom substitution.
Re-cap:
Behaviourists however reject this criticism and claim that we need not look beyond the behavioural symptoms as the symptoms are the disorder.
