Psychopathology: Lesson 7 - Behavioural Approach To Treating Phobias

Question 1

What is Systematic Desensitisation?

Answer 1

• a 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
• Therefore if the patient can learn to remain relaxed (a new emotional response) in the presence of their phobia, they can be cured
• This is called counter conditioning.

Question 2

What is the process involved in Systematic Desensitisation?

Answer 2

1) Hierarchy of fear
2) Relaxation techniques
3) exposure

Question 3

What happened in the ‘hierachy of fear’ stage of Systematic Desensitisation?

Answer 3

• 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 4

What happens in the ‘relaxation techniques’ stage if Systematic Desensitisation?

Answer 4

• 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 5

What happens in the ‘exposure’ stage of Systematic Desensitisation?

Answer 5

• The patient is introduced to their phobic object 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
• 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
• This process will take many therapy sessions.

Question 6

Evaluation of Systematic Desensitisation (Jones, ‘little Peter) (+)

Answer 6

• 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

Question 7

Evaluation for Systematic Desensitisation (Klosko et al. (Panic disorders) (+)

Answer 7

• 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 8

Evaluation of Systematic Desensitisation (less traumatic than flooding (+)

Answer 8

• SD had the advantages of being a less traumatic therapy for phobias than other behavioural therapies, like flooding, where the patients 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 9

Evaluation of Systematic Desensitisation (not always practical) (-)

Answer 9

• 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 10

Evaluation of Systematic Desensitisation (symptom substitution) (-)

Answer 10

• 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 11

What is flooding/implosion?

Answer 11

• A behavioural therapy technique where the patient is directly exposed to the feared object
• Relaxation techniques are taught beforehand
• There is no gradual build up like the hierarchy of fear, instead the patient is immediately exposed to a very frightening and extreme situation
• Flooding stops phobic responses very quickly
• This is because the patient does not have the option for any avoidance behaviour, and they 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
• 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 12

Evaluation of flooding (cost effective) (+)

Answer 12

• Flooding has the advantage of being cost effective, especially when being compared to cognitive behavioural therapies
• 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 13

Evaluation of flooding (less effective with social phobias) (-)

Answer 13

• 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