Psychopathology L7 - The Behavioural Approach To Treating Phobias - Systemtic Desensitisation And Flooding

Question 1

What does SD stand for

Answer 1

Systematic desensitisation

Question 2

What is SD

Answer 2

• Behavioural therapy developed by Wolpe (1958) to reduce/diminish phobias by using classical conditioning
• A 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
• The 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
• So if the patient can learn to remain relaxed (a new emotional response) in the presence of their phobia, they can be cured - reconditioning

Question 3

Process involved in SD

Answer 3

The hierarchy of fear
Relaxation techniques
Gradual exposure

Question 4

The hierarchy of fear

Answer 4

• 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 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.

Question 5

Relaxation techniques

Answer 5

• Patients are taught deep muscle relaxation techniques, such as deep breathing, progressive muscular relaxation (PMR) and the relaxation response
• The 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
• They 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.

Question 6

Gradual exposure

Answer 6

• The patient is introduced to their phobic object gradually and they work their way up the fear hierarchy starting with the least frightening stage.
• They 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 if 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. This process will take many therapy sessions.

Question 7

Evaluation of SD (x3 positives x2 negatives)

Answer 7

strengths
- research support - Jones
- research support - Klosko
- less traumatic
weaknesses
- not practical
- underlying causes

Question 8

Research support - Jones

Answer 8

Jones (1924) supports the use of SD to eradicate ‘Little Peter’s’ phobia
- A 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 9

Research support - Klosko

Answer 9

• Klosko et al. (1990) supports the use of SD
• He 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 and 33% receiving no treatment at all.
• Therefore SD is an effective therapy compared to others

Question 10

Less traumatic

Answer 10

• SD had the advantages of being a less traumatic therapy for phobias than other behavioural therapies, like flooding, where the patient has to confront their phobias directly
• Therefore SD has less ethical implications (less psychological harm) than other types of behavioural therapies, and it is less upsetting for the patient to endure

Question 11

Not practical

Answer 11

• A disadvantage of SD is that it is not always practical 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! - Therefore SD might be very difficult to apply to real life situations/phobias and this can question the effectiveness of the therapy

Question 12

Underlying causes

Answer 12

• Behavioural treatments do have the advantage that they address the symptoms of phobias.
• However some critics believe the symptoms are merely the tip of the iceberg and claim that underlying causes of the phobia will remain, and in the future the symptoms will return or symptom substitution will occur, when other abnormal behaviours replaced the ones that have been removed.

Question 13

Flooding (implosion)

Answer 13

• Flooding involves 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.
• But there is not 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.
• This can be done “in vivo” which means they do this for real, or it could be virtual; by imagining the situation(with headset) (better to do in person)
• Flooding stops phobic responses very quickly as 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
• They become so exhausted that the phobic response diminishes.

Question 14

Is flooding ethical and how long does it last

Answer 14

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 (signed so can’t sue) so that they were fully prepared for the flooding session.
- Patients are 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 15

Evaluation of flooding (x2 of each)

Answer 15

strengths
- cost effective
- support - Ost
weaknesses
- less effective for certain types of phobias
- highly traumatic

Question 16

Cost effective

Answer 16

• Flooding has the advantage of being cost effective, 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 17

Support - Ost

Answer 17

• Ost (1997) stated that flooding is an effective and rapid treatment that delivers immediate improvements for phobic patients
• This is especially the case when a patient is encouraged to continue self directed exposure to feared objects and situations outside of the therapy situation
• The results from flooding can be applied to everyday life outside of the therapy situation

Question 18

Less effective for certain phobias

Answer 18

• A disadvantage of flooding is that it is less effective for curing some types of phobias such as social phobia.
• This 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 19

Highly traumatic experience

Answer 19

• A disadvantage of flooding is that it is a highly traumatic experience and 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
• This is a waste of time and money, and maybe other alternatives might be better such as SD