Systematic desensitisation

Question 1

Assumptions applied to therapy

Answer 1

Developed by Joseph Wolpe in the 1950s.
Behaviour is learnt.
If a behaviour can be learnt, then it can also be unlearnt.
The notion that mental illness and disorders occur as a result of maladaptive or faulty learning and correcting it will resolve the problem.
Systematic desensitisation is based on classical conditioning principles and the stimulus-response association.
The principles of operant conditioning also features in the therapy.
A patient who successfully feels a positive emotion when in the presence of the phobic stimulus will feel reward.
This is an example of positive reinforcement.
This will encourage the patient to continue in order to continue gaining rewards and move through their fear hierarchy.

Question 2

Wolpe and counterconditioning

Answer 2

Developed systematic desensitisation in the 1950s.
Wolpe considered that if the patient has learnt to associate the phobic stimulus with fear, then changing that fear to relaxation and calm by counterconditioning them would remove the phobia.
Counterconditioning would mean that the patient would learn to reassociate the stimulus with a positive feeling rather than negative.
The idea of reciprocal inhibition would also support this.
We can’t easily experience two opposing states of emotion at the same time.

Question 3

Principles / “method”

Answer 3

Patient is taught how to relax their muscles completely.
A relaxed state is incompatible with anxiety.
Therapist and patient together construct a desensitisation hierarchy. A series of imagined scenes, each one causing a little more anxiety than the previous.
Patient gradually works his / her way through the desensitisation hierarchy, visualising each anxiety-evoking event while engaging in the competing relaxation response.
Once the patient has mastered one step in the hierarchy, they’re ready to move on to the next.
The patient will know that they’re ready when they can remain relaxed while imagining the anxiety-evoking event.
Patient eventually masters the feared situation that caused them to seek help in the first place.

Question 4

Menzies and Clarke (1993)

Answer 4

Research has found that actual contact with the feared stimulus is most successful, so in vivo techniques are more successful than covert ones.

Question 5

Different forms

Answer 5

In the early days of systematic desensitisation, clients would learn to comfort their feared situations directly, by learning to relax in the presence of objects or images that would normally arouse anxiety. This is an example of in vivo desensitisation.
Recently, rather than actually presenting the feared stimulus, the therapist asks the subject to imagine the presence of it.
This is an example of in vitro or covert desensitisation.

Question 6

Corner (2002)

Answer 6

Often a number of different exposure techniques are involved including modelling. (Where the client watches someone else who is coping well with the feared stimulus.)

Question 7

Research support

Answer 7

Generally systematic desensitisation has been proven to be successful when the problem is a learned one.

Question 8

Capafons et al (1998)

Answer 8

Found that clients with a fear of flying showed less psychological signs of fear and reported lower fear levels whilst in a flight simulator following a 12–25-week treatment period, where both in vitro and in vivo techniques were used.

Question 9

Not appropriate for all phobias

Answer 9

Research suggests that systematic desensitisation is not effective for more generalised fears.
The therapy may also not be suitable for “ancient fears”.

Question 10

Martin Seligman (1970)

Answer 10

Argued that animals, including humans, are genetically programmed to rapidly learn an association between potentially life-threatening stimuli and fear.
These stimuli are referred to as “ancient fears” - things that would’ve been dangerous in our evolutionary past.
(Snakes, heights and strangers).
It would’ve been adaptive to rapidly learn to avoid such stimuli.
This is an example of biological preparedness.

Question 11

Biological preparedness - definition

Answer 11

The idea that people and animals are inherently inclined to form associations between certain stimuli and responses.

Question 12

Biological preparedness

Answer 12

Would explain why people are much less likely to develop fears of modern objects that are much more of a threat than spiders.
Such “modern” items weren’t a danger in our evolutionary past.

Question 13

Bregman (1934)

Answer 13

Supports Seligman’s concept.
Bregman failed to condition a fear response in infants aged 8-16 months by pairing a loud bell with wooden blocks.
It may be that fear responses are only learned with living animals, a link with ancient fears.

Question 14

Symptom substitution

Answer 14

Behavioural therapies may not work with certain phobias because the symptoms are only the tip of the iceberg.
If you remove the symptoms the cause still remains, and the symptoms will simply resurface, possibly in another form.
This is an example of symptom substitution.
Behavioural therapies may appear to resolve a problem but simply eliminating or suppressing symptoms can result in other symptoms appearing.

Question 15

Freud (1909)

Answer 15

According to the psychodynamic approach phobias develop because of projection.
Freud recorded the case of Little Hans who developed a phobia of horses.
The boy’s actual problem was an intense envy of his father, but he couldn’t express this directly and his anxiety was projected onto the horse.
The phobia was cured when he accepted his feelings about his father.
If the therapist had treated the horse phobia the underlying problem would’ve remained and resurfaced elsewhere.

Question 16

Valid consent

Answer 16

Systematic desensitisation is used mainly with phobias, and not with problems such as depression and schizophrenia.
This means that clients are “in touch” with reality and in a “healthy” enough frame of mind to understand what the therapy will entail.
This means they’re able to provide valid consent to the therapy.
The client also attends the therapy sessions at their own free will.
They’re therefore able to choose to withdraw at any point.
Some would argue that there’s still an element of stress involved as the client is exposed in one way or another to an object / situation that they may have spent many years, or decades, feeling anxious about.

Question 17

Anxiety controlled

Answer 17

Systematic desensitisation is considered to be more ethical than other forms of behavioural therapies, such as “flooding” techniques.
“Flooding” techniques involve rapidly exposing the client to their most feared phobia.
In systematic desensitisation each step is conducted slowly and at a pace dictated largely by the client.
Therefore, the therapist is able to gauge whether the client is fully relaxed at each stage of the therapy. The therapist must only attempt to move up the hierarchy when the client is completely comfortable. Therefore, anxiety shouldn’t be an issue.