Psychopathology - The Behaviourist Approach to Phobias

Question 1

What are the behavioural factors of phobias?

Answer 1

• Panic: This may involve a range of behaviours such as crying, screaming or running away from the phobic stimulus.
• Avoidance: Considerable effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about everyday life, especially if the phobic stimulus is often seen, e.g. public places.
• Endurance: Freezing to the spot and not being able to move.

Question 2

What are the emotional factors of phobias?

Answer 2

• Anxiety and fear: Fear is the immediate experience when a phobic person encounters or thinks about the phobic stimulus.
• Responses are unreasonable: Response is widely disproportionate to the threat posed, e.g. an arachnophobic will have a strong emotional response to a tiny spider.

Question 3

What are the cognitive factors of phobias?

Answer 3

• Selective attention to the phobic stimulus: The phobic finds it hard to look away from the phobic stimulus, e.g. a pogonophobic (fear of beards) cannot concentrate on a task if there is a bearded man in the room.
• Irrational beliefs: For example, social phobias may involve beliefs such as ‘if I blush people will think I’m weak’ or ‘I must always sound intelligent’.
• Cognitive distortions

Question 4

What is a phobia?

Answer 4

A phobia is an anxiety disorder, which interferes with daily living. It is an instance of irrational fear that produces a conscious avoidance of the feared object or situation.

Question 5

What categories of phobia and related anxiety disorders does the DSM-5 recognise?

Answer 5

• Specific phobia: phobia of an object, e.g. animal or body part; or situation, e.g. flying or injections.
• Social anxiety: phobia of a social situation, e.g. public speaking or using a public toilet.
• Agoraphobia: phobia of being outside or in a public place.

Question 6

What are the features of a phobia?

Answer 6

• marked and persistent fear of a specific object or situation
• exposure to the phobic stimulus nearly always produces a rapid anxiety response
• fear of the phobic object or situation is excessive
• the phobic stimulus is either avoided or responded to with great anxiety
• the phobic reactions interfere significantly with the individual’s working or social life, or they are very distressed about the phobia

Question 7

What is the emotional stroop test?

Answer 7

Selective Attention: Emotional Stroop Test

• We all ignore some things and focus our attention on other things - these things may attract our attention because they are important, attractive or dangerous.
• Stroop tests involve looking at a list of words and trying to name the ink colours they are written in. The longer it takes us to name the ink colours, the more strongly our attention has been grabbed by the content of the words.

Question 8

Why are emotional stroop tests used?

Answer 8

• Emotional stroop tests are used to understand selective attention in mental disorder.
• So arachnophobics should take longer to name ink colours in a list of spider-related words.

Question 9

What was Becker et al. (2001)’s study?

Answer 9

• Becker et al. (2001): attention bias in speech phobia (a social phobia), compared with general anxiety using the emotional stroop test with 92 participants: 29 patients suffering from speech phobia, 32 patients with general anxiety and a control group of 31 non-anxious people.
• Participants undertook the Emotional Stroop Test with four types of word: anxiety-related (injury, debts, stroke, etc.), Speech-related (e.g. stutter, blush, shy), neutral and positive.
• Their task was to name the ink colour each word was written in. The idea was to see whether the speech-phobic group would take longer to name the ink colour of speech-related words than other words.

Question 10

What were the results to Becker et al. (2001)’s study?

Answer 10

The results show the mean time (seconds) needed for the speech phobics to read each list of words.

• Anxiety-related: 69.9
• Speech-related: 72.5
• Neutral: 67.5
• Positive: 68.8

Question 11

What is the two-process model in regards to phobias?

Answer 11

The two-process model uses both classical conditioning and social learning theory to explain the onset of phobias, and operant conditioning to explain how they are maintained (Orval Hobart Mowrer 1960).

• The acquisition of phobias is seen as occurring directly through classical conditioning, or indirectly through social learning.
• The maintenance of phobias is seen as occurring though operant conditioning, where avoiding or escaping from a feared object/situation acts as a negative reinforcer.

Question 12

How are phobias acquitted by classical conditioning?

Answer 12

Classical conditioning involves association.

1. UCS triggers a fear response (fear is a UCR).
2. NS is associated with the UCS.
3. NS becomes a CS producing fear (which is now the CR).

Question 13

What was the Little Albert case study?

Answer 13

Watson and Raynor (1920) showed how a fear of rats could be conditioned in ‘Little Albert’.

1. Whenever Albert played with a white rat, a loud noise was made close to his ear. The noise (UCS) caused a fear response (UCR).
2. Rat (NS) did not create fear until the bang and the rat had been paired together several times.
3. Albert showed a fear response (CR) every time he came into contact with the rat (now a CS).

Question 14

How can a fear of the stimulus be generalised?

Answer 14

For example, Little Albert also showed a fear in response to other white furry objects including a fur coat and a Santa Claus mask.

Question 15

How are phobias maintained by operant conditioning (negative reinforcement)?

Answer 15

Operant conditioning takes place when our behaviour is reinforced or punished.

Negative reinforcement - an individual produces behaviour that avoids something unpleasant.

When a phobic avoids a phobic stimulus they escape the anxiety that would have been experienced.

This reduction in fear negatively reinforces the avoidance behaviour and the phobia is maintained.

Question 16

Give an example of negative reinforcement.

Answer 16

If someone has a morbid fear of clowns (coulrophobia) they will avoid circuses and other situations where they may encounter clowns.

The relief felt from avoiding clowns negatively reinforces the phobia and ensures it is maintained rather than confronted.

Question 17

What are the strengths of the behavioural approach to explaining phobias?

Answer 17

• the two-process model has good explanatory power and application to therapy

Question 18

What are the weaknesses of the behavioural approach to explaining phobias?

Answer 18

• there are alternative explanations for avoidance behaviour
• the two-process model is an incomplete explanation of phobias
• not all bad experiences lead to phobias
• two-process model doesn’t properly consider the cognitive aspects of phobias

Question 19

How does the two-process model have good explanatory power and application to therapy?

Answer 19

The two-process model went beyond Watson and Rayner’s simple classical conditioning explanation of phobias.

It has important implications for therapy. If a patient is prevented from practising their avoidance behaviour then phobic behaviour declines.

The application to therapy is a strength of the two-process model.

Question 20

What other alternative explanations are there for avoidance behaviour?

Answer 20

In more complex behaviours like agoraphobia, there is evidence that at least some avoidance behaviour is motivated more by positive feelings of safety.

This explains why some agoraphobics are able to leave their house with a trusted friend with relatively little anxiety, but not alone (Buck 2010).

This is a problem for the two-process model, which suggests that avoidance is motivated by anxiety reduction.

Question 21

How is the two-process model an incomplete explanation of phobias?

Answer 21

Even if we accept that classical and operant conditioning are involved in the development and maintenance of phobias, there are some aspects of phobia behaviour that require further explaining.

We easily acquire phobias of things that were a danger in our revolutionary past (e.g. fear of snakes or the dark). This is biological preparedness - we are innately prepared to fear some things more than others (Seligman 1971).

The phenomenon of biological preparedness is a problem for the two-process model because it shows there is more to acquiring phobias than simple conditioning.

Question 22

Do all bad experiences lead to phobias?

Answer 22

Sometimes phobias do appear following a bad experience and it is easy to see how they could be the result of conditioning.

However, sometimes people have a bad experience and don’t develop a phobia (DiNardo et al. 1988). This suggests that conditioning alone cannot explain phobias. They may only develop where a vulnerability exists.

Question 23

How does the two-process model not properly consider the cognitive aspects of phobias?

Answer 23

We know that behavioural explanations in general are oriented towards explaining behaviour rather than cognition (thinking).

This is why the two-process model explains maintenance of phobias in terms of avoidance - but we also know that phobias have a cognitive element.

The two-process theory does not adequately address the cognitive element of phobias.

Question 24

What are the two behavioural approaches to treating phobias?

Answer 24

• systematic desensitisation

- flooding

Question 25

What are the features of systematic desensitisation?

Answer 25

• based on classical conditioning, counterconditioning and reciprocal inhibition
• formation of an anxiety hierarchy
• relaxation practised at each level of the hierarchy

Question 26

How does systematic desensitisation include counterconditioning and reciprocal inhibition?

Answer 26

The therapy aims to gradually reduce anxiety through counterconditioning:

• phobia is learned so that phobic stimulus (conditioned stimulus) produces fear (conditioned response)
• CS is paired with relaxation and this becomes the new CR

Reciprocal inhibition - it is not possible to be afraid and relaxed at the same time, so one emotion prevents the other.

Question 27

What is an anxiety hierarchy?

Answer 27

Patient and therapist design an anxiety hierarchy - a list of fearful stimuli arranged in order from least to most frightening.

Exposure is normally achieved by imagining scenarios (covert desensitisation) but can also involve actual contact (in vivo desensitisation)

An arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula as the final item.

Question 28

How is relaxation practised at each level of the hierarchy?

Answer 28

Phobic individual is first taught relaxation techniques such as deep breathing and/or meditation.

Patient then works through the anxiety hierarchy. At each level, the phobic is exposed to the phobic stimulus in a relaxed state.

This takes place over several sessions starting at the bottom of the hierarchy. Treatment is successful when the person can stay relaxed in situations high on the hierarchy.

Question 29

What are the features of flooding?

Answer 29

• immediate exposure to the phobic stimulus
• very quick learning through extinction
• ethical safeguards

Question 30

How are people immediately exposed to the phobic stimulus?

Answer 30

Flooding (implosion therapy) involves bombarding the phobic patient with the phobic object without a gradual build-up.

An arachnophobic receiving flooding treatment may have a large spider crawl over their hand until they can relax fully. The idea is that anxiety peaks at such high levels that it cannot be maintained, and so it subsides.

Question 31

What is extinction?

Answer 31

Without the option of avoidance behaviour, the patient quickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction.

Question 32

What are the ethical safeguards of flooding?

Answer 32

Flooding is not unethical but it is an unpleasant experience so it is important that patients give informed consent. They must be fully prepared and know what to expect.

Question 33

What are the strengths of the behavioural approach to treating phobias?

Answer 33

• systematic desensitisation is effective
• systematic desensitisation is suitable for a diverse range of patients
• systematic desensitisation tends to be acceptable to patients

Question 34

What are the weaknesses of the behavioural approach to treating phobias?

Answer 34

• flooding is less effective for some types of phobia
• flooding is traumatic for patients
• although patients can gradually confront phobias in an imaginary sense, there’s no guarantee this will work with actual objects/situations

Question 35

How is systematic desensitisation effective?

Answer 35

Gilroy et al. (2003) followed up 42 patients who had SD for spider phobia in three 45-minute sessions.

At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure.

This is a strength because it shows that SD is helpful in reducing the anxiety in spider phobia and that the effects of the treatment are long-lasting.

Question 36

How is systematic desensitisation suitable for a diverse range of patients?

Answer 36

The alternatives to SD such as flooding and cognitive therapies are not well suited to some patients.

For example, having learning difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies which require reflection.

For these patients, SD is probably the most appropriate treatment.

Question 37

How does systematic desensitisation tend to be acceptable to patients?

Answer 37

A strength of SD is that patients prefer it. Those given the choice of SD or flooding tend to prefer SD.

This is because it does not cause the same degree of trauma as flooding. It may also be because SD includes some elements that are actually pleasant, such as time talking with a therapist.

This is reflected in the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) for SD.

Question 38

Why is flooding less effective for some types of phobia?

Answer 38

Although flooding is highly effective for treating simple phobias, it appears to be less so for more complex phobias like social behaviours.

This may be because social phobias have cognitive aspects, e.g. a sufferer of social phobia doesn’t simply experience anxiety but thinks unpleasant thoughts about the social situation.

This type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational thinking.

However, Barlow (2002) reports that flooding has been shown to be equally effective as systematic desensitisation, but systematic desensitisation is preferred by most patients.

Question 39

What’s the effect of flooding being traumatic for patients?

Answer 39

Perhaps the most serious issue with the use of flooding is the fact that it is a highly traumatic experience.

The problem is not that flooding is unethical (patients do give informed consent) but that patients are often unwilling to see it through to the end.

This is a limitation because ultimately it means that the treatment is not effective, and time and money are wasted preparing patients only to have them refuse to start or complete treatment.

Question 40

Who was Rothbaum et al. (1998)?

Answer 40

Rothbaum et al (1998) reported on virtual reality exposure therapy where patients are active participants in a computer generated world.