Lesson 7: Behavioural Treatments For Phobias

Question 1

What is systematic desensitisation?

Answer 1

• behavioural therapy developed by Wolpe (1958) to reduce phobias by using classical conditioning. A person experiences fear and anxiety as a behavioural 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 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.
• in vivo (irl), in vitro (in imagination)

Question 2

First stage of systematic desensitisation

Answer 2

Anxiety 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 they might get the patient to first look at a picture of the snake then at a snake in a tank until they are eventually asked to hold a snake.

Question 3

Second stage of systematic desensitisation

Answer 3

Relaxation training - the therapist teaches the patient to relax as deeply as possible. As it is impossible to be afraid and relaxed at the same time, one emotion prevents the other. This may involve breathing exercises, mental imagery techniques and or access to Valium for relaxation.

Question 4

Third stage of systematic desensitisation

Answer 4

Gradual exposure - patient is introduced to the phobic object, beginning at the bottom of the anxiety hierarchy. When the patient can remain relaxed in the presence of the phobic stimulus, they can move up the hierarchy. Treatment is considered successful when patients can stay relaxed in situations high up on the anxiety hierarchy.

Question 5

Strengths of systematic desensitisation

Answer 5

+ Quite quick and requires less effort than other forms of psychotherapies where the patient needs to play an active role. Behavioural therapies may be the only treatment suitable for certain groups of people e.g. individuals with severe learning difficulties

+ It does work for certain phobias e.g. blood injection and spider phobias - success rate is up to 90%. For example, Gilroy et al (2003) followed up 43 patients with spider phobias who had SD in three 45-minute sessions. At both 3 months and 33 months the patients were significantly less fearful of spiders than a control group who were treated with only training in relaxation. This suggests that it is effective in the long term as well as the short term.

+ It is an ethical method to use for treating phobias because the stages enable participants to feel comfortable unlike flooding where the person is ‘thrown into the deep end’ quickly which could be very stressful thus patients generally prefer this procedure because it does not involve the same level of trauma.

Question 6

Weaknesses of systematic desensitisation

Answer 6

• only works for certain types of phobias for example, might not work for social phobias which require more detailed or an alternative therapy such as CBT
• relies on the clients ability to be able to imagine the fearful situation e.g. when using the in vitro technique. Some people cannot create a vids image in their mind in which case the in vivo technique might be more useful but more costly, especially for someone with a fear of heights.
• while SD might be effective in the therapeutic situation, it may not work in the real world. Patients with phobias which have not developed through a personal experience (classical conditioning; for example a fear of heights, seem to be less effectively treated using systematic desensitisation. Some psychologists believe certain phobias gave an evolutionary survival benefit and are not the result of personal experience but the result of evolution. These phobias highlight a limitation of systematic desensitisation which is ineffective in treating evolutionary phobias.

Question 7

Flooding

Answer 7

• involves directly exposing 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. This can be done for real or virtually by imagining the situation. Flooding stops phobic responses very quickly as there is no option for avoidance behaviour and they quickly learn that the phonic object is harmless and therefore extinction occurs. In some causes the patient may achieve relaxation as they are so exhausted by their own fear response.
• typically lasts two or three hours, sometimes only one session is needed
• not unethical as patients have to give fully informed consent

Question 8

Strengths of flooding

Answer 8

+ cost effective as it is highly effective and quicker than systematic desensitisation enabling patients to be free of their symptoms as soon as possible which makes treatment cheaper. Studies comparing flooding to cognitive therapy e.g. Ougrin (2011) have found that flooding is highly effective and quicker than alternative. Choy (2007) found flooding to be more effective than systematic desensitisation in treating phobias.

Question 9

Weaknesses of flooding

Answer 9

• It is less effective for some types of phobia : flooding less effective for complex phobias such as social phobias because these phobias often have a cognitive aspect to them. These types of phobias would benefit more from cognitive therapies which tackle irrational thinking.
• treatment is traumatic for patients : although flooding is considered cost-effective it can be highly traumatic for patients as it purposefully causes high levels of anxiety. Wolpe (1959) recalled a case with a patient becoming so intense to anxious she had to be hospitalised. Although it is not unethical, many do not complete treatment as it is so stressful meaning it is sometimes a waste of time and money.

Question 10

Overall weakness of SD and Flooding

Answer 10

Symptom substitution : means that although one phobia may be successfully removed through counter-conditioning another may appear in its place. If symptoms are treated and removed, the underlying cause may remain and simply resurface under a new guise. Research in this area is mixed and heavily disputed by behaviourists