Lesson 7 - Phobias: Behavioural Approach To Treating Phobias (Systematic Desensitisation & Flooding)

Question 1

Ao1: systematic desensitisation

Answer 1

• behavioural therapy developed by Wolpe (1958)
• diminish phobias by using classical conditioning
• person with a phobia experiences fear and anxiety as a behavioural response to an object or situation
• SD uses classical conditioning to replace the irrational fears and anxieties associated with phobic objects with calm and relaxed responses instead
• 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
• thus, if the patient can learn to remain relaxed (a new emotional response) in the presence of their phobia, they can be cured : counter conditioning

Question 2

Ao1: process of systematic desensitisation

Answer 2

1) hierarchy of fear:

• 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

2) relaxation techniques:

• Patients are taught deep muscle relaxation techniques, such as deep breathing, progressive muscular relaxation (PMR) and the relaxation response
• 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 the patient is as relaxed as possible
• When doing the relaxation response patients are asked to sit quietly and comfortably and close their eyes
• 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

3) gradual exposure:

• patient is introduced to their phobic object gradually and they work their way up the fear hierarchy starting with the least frightening stage
• must use their relaxation technique whilst they are exposed to the phobia object at each stage
• When they feel comfortable with one particular stage of the hierarchy (they are no longer afraid) they move on to the next stage in the hierarchy
• patients are instructed to use the relaxation techniques while exposed to scenarios of rising intensity.
• eventually through repeated exposure to phobic objects with relaxation and no fear, the phobia is eliminated
• process will take many therapy sessions

Question 3

Ao3: strength of systematic desensitisation
(Jones supports use of SD to eradicate ‘Little Peter’s phobia)

Answer 3

• 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, which extended to all white fluffy objects
• This shows how SD can work to eliminate phobias

Question 4

Ao3: strength of systematic desensitisation
(Klosko supports use of SD)

Answer 4

• 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
• 33% receiving no treatment at all
• thus, SD is an effective therapy compared to others

Question 5

Ao3: strength of systematic desensitisation
(SD is less traumatic therapy for phobias than over behavioural therapies)

Answer 5

• e.g. flooding, where the patient has to confront their phobias directly
• thus, SD has less ethical implications (less psychological harm) than other types of behavioural therapies
• less upsetting for the patient to endure

Question 6

Ao3: weakness of systematic desensitisation
(Not always practical)

Answer 6

• 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!
• thus, SD might be very difficult to apply to real life situations/phobias and this can question the effectiveness of the therapy

Question 7

Ao3: weakness of systematic desensitisation
(Address symptoms of phobias, however…)

Answer 7

• 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 replaced the ones that have been removed

Question 8

Ao1: flooding (implosion)

Answer 8

• directly exposing the phobic patient to their feared object in an immediate situation
• Beforehand, the patient would be taught relaxation techniques such as deep muscle relaxation, deep breathing and meditation
• however, there isn’t a gradual build up using a fear 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
• can be done “in vivo” which means they do this for real, or it could be virtual; by imagining the situation.
• stops phobic responses very quickly
• because the patient does not have the option for any avoidance behavior, they are not allowed to run away or not face their phobia object
• They might 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
• become so exhausted that the phobic response diminishes
• 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 given the choice of either having SD or flooding
• Flooding therapy sessions usually last 2-3 hours, which is much longer than SD sessions

Question 9

Ao3: strength of flooding
(Cost effective)

Answer 9

• especially when being compared to cognitive behavioural therapies which take months or years to work and rid the person of their phobia
• Flooding seems to be a quick therapy for phobias which is useful as it means that patients are free of their symptoms as soon as possible, and this makes the treatment cost effective and cheaper

Question 10

Ao3: strength of flooding
(Ost stated flooding is effective)

Answer 10

• rapid treatment that delivers immediate improvements for phobic patients
• especially the case when a patient is encouraged to continue self directed exposure to feared objects and situations outside of the therapy situation
• results from flooding can be applied to everyday life outside of the therapy situation

Question 11

Ao3: weakness of flooding
(Less effective for curing some types of phobias)

Answer 11

• e.g. social phobia
• might be because social phobias have more cognitive aspects that flooding cannot address very well
• e.g. addressing negative thoughts about speaking in public
• Social phobias can be cured more successfully by using cognitive therapies

Question 12

Ao3: weakness of flooding
(Highly traumatic experience)

Answer 12

• many patients might be unwilling to continue with the therapy until the end
• Time and money might be wasted preparing patients for the flooding experience, and then the patient might decide that they do not want to take part or complete the treatment, and their phobia remains uncured
• a waste of time and money, and maybe other alternatives might be better such as SD