Phobias (Behavioural treatments)

Question 1

Systematic desensitisation- what is it?

Answer 1

• Systematic desensitisation involves teaching the client deep muscle relaxation. The client must be able to master this before starting to tackle their phobia.

Question 2

How does it work? (SD)- pt.1

Answer 2

• The client and therapist work together to design a hierarchy of frightening encounters with their feared stimulus. At the bottom of this hierarchy is the least feared situation, e.g. saying the word ‘spider’ and at the top is the most terrifying situation they could imagine being in e.g. having a spider crawl across their hand.

Question 3

How does it work? (SD)- pt.2

Answer 3

• The therapist then helps the client to work their way up this hierarchy one step at a time. Deep muscle relaxation must be mastered at each stage before moving up to the next. If a client finds it too upsetting, they can return to an earlier stage to build their confidence and regain a relaxed state.

Question 4

Evidence to support the effectiveness of SD

Answer 4

Lang (1963)- used SD with college students who all had a snake phobia.
- They underwent 11 sessions to work through a hierarchy. Hypnosis was used to assist in the maintenance of relaxation.
- Fear ratings fell and improvements were still evident 6 months later.

Question 5

Benefits of SD

Answer 5

• Gradual and the pace of the therapy can be controlled by the patient themselves. Being able to control the intensity of their treatment and the exposure to distress is more ethical than alternative treatments like flooding that are much more traumatic. At each stage the client is consenting to the next level of exposure and this is less likely to cause psychological harm.

Question 6

Limitations to SD

Answer 6

• Time-consuming when compared to treatments like flooding.
• The process of mastering deep relaxation involves training and this can take many sessions. After this the process of working through the hierarchy is also time consuming. This might be a barrier for individuals who do not have the time in their lives to invest in this kind of treatment, they might be demotivated by the slow progress they are making and drop out. Also, this treatment is likely to be very expensive if many sessions with a therapist are needed, this may also mean that a client has to drop out when their funds run out.

Question 7

Limitations of SD- pt.2

Answer 7

• Another problem with SD is that the treatment takes place in a clinical setting and the progress made may not generalise to ‘real-world’ experiences where the therapist is not there to support their client. This limits the external validity (ecological validity) of this this treatment and it may not be as effective as the client hopes.

Question 8

Limitations of SD- pt.3

Answer 8

• SD only treats the observable and measurable symptoms of a phobia. This is a significant weakness because cognitions and emotions are often the motivators of behaviour and so the treatment is only dealing with symptoms not the underlying causes.

Question 9

What is flooding?

Answer 9

• Type of exposure therapy that involves immediate and prolongs exposure to the most feared stimulus with no option of avoidance.

Flooding works on the basis of behavioural principles:
- A learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus.
- The result is that the conditioned stimulus no longer produces the conditioned response.

Question 10

What is flooding?- pt.2

Answer 10

During exposure the individual cannot stay in a heightened state of panic (arousal) for long.
- As time passes, the ‘fight or flight’ response can no longer be maintained and parasympathetic nervous system kicks in to restore a calm state.

• As they calm down and their anxiety is reduced, they are able to acknowledge that they have come to no harm. At this point the client will normally feel more confident to explore their situation and the objective reality of little/ no risk becomes associated with their previously feared stimulus.

Question 11

Evidence to support the effectiveness of flooding

Answer 11

• Boulougouris et al (1969) found that flooding achieves faster results, reducing stress in a quicker period of time than other treatments for phobias (including SD).

Question 12

Benefits of flooding

Answer 12

• Flooding stops phobic responses very quickly, normally within 1 session of 2-3 hours. This is significantly less time than SD and so for many clients, this would be a cheaper and a more convenient option.

Question 13

Limitations of flooding- pt.1

Answer 13

• Flooding is a very unpleasant and distressing experience and for many individuals with phobias, even the idea of immediate and prolonged exposure may be enough for them to reject this approach to treatment.

Question 14

Limitations of flooding- pt.2

Answer 14

• Although flooding is effective for many, an individual who does not complete the full session may leave more traumatised and more terrified of their phobic stimulus than before the therapy. The dropout rates for flooding are higher than for SD, and the consequences of dropping out are much more significant. This means that therapists will be more cautious about recommending this treatment for SD.

Question 15

Limitations of flooding- pt.3

Answer 15

• It is essential that clients give their fully informed consent to this procedure, this would not be possible for children or for individuals with learning difficulties. This means that this treatment is not accessible for everyone.

Question 16

What is meant by counter conditioning?

Answer 16

• It involved pairing the anxiety-provoking stimulus with a new, positive or neutral response to replace the fear response.

Question 17

Explain the role of reciprocal inhibition in SD.

Answer 17

• Wolpe found that anxiety symptoms could be reduced (or inhibited) when the stimuli to the anxiety were presented in a graded order and systematically paired with a relaxation response.