The Behavioural Approach to Treating Phobias

Question 1

Systematic Desensitisation

Answer 1

• Behaviour therapy
• Gradually reduce phobic anxiety via classical conditioning
• Counterconditioning -> making a new association:
• Initial CS (spider) -> CR (fear)
• New Association: Initial CS (spider) -> CR (relaxation)

Question 2

Three Processes involved in Systematic Desensitisation

Answer 2

1. Anxiety Hierarchy
2. Relaxation
3. Exposure

Question 3

1. Anxiety Hierarchy

Answer 3

• Developed by client and therapist
• List of situations that provoke anxiety from least to most frightening

Question 4

2. Relaxation

Answer 4

• Therapist teaches client reciprocal inhibition (so relaxed you cannot be afraid).
• Ex. Breathing techniques, meditation, or Valium (prescription medication).

Question 5

3. Exposure

Answer 5

• Client exposed to phobic stimulus in relaxed state over several sessions.
• Success = relaxed in situations at top of anxiety hierarchy.

Question 6

Flooding

Answer 6

• Exposure to the phobic stimulus without gradual build-up in anxiety hierarchy.
• Immediate exposure very frightening situation.
• One session lasts 2-3 hours.

Question 7

How does Flooding Work?

Answer 7

• Flooding stops phobic responses quickly.
• Extinction (classical conditioning).
• Relaxation may be achieved because exhausted by own fear response.

Question 8

Flooding Ethical Safeguards

Answer 8

• Not unethical, but unpleasant so informed consent essential.
• Client given choice of systematic desensitisation or flooding.

Question 9

Evaluation: Evidence for Effectiveness for SD

Answer 9

• Strength: evidence base of effectiveness.
• Gilroy et al. (2003): 42 people SD for arachnophobia in 3 45-min sessions.
• Control: relaxation but no exposure.
• Result: at 2 and 33 months, SD group less fearful than control group.
• Wechsler et al. (2019): SD effective for agoraphobia, social phobia, and specific phobia. Review study (meta-analysis).

Question 10

Evaluation of SD: People with Learning Disabilities

Answer 10

Strength: people with learning disabilities struggle with cognitive therapies (too complex) and flooding (too distressing, fully informed consent?).

Question 11

Evaluation Extra: SD in Virtual Reality

Answer 11

• Avoid dangerous situations (e.g., heights) and cost-effective because psychologist and client do not leave the consulting room.

Question 12

Flooding Evaluation

Answer 12

Cost – effective
- Strength: highly cost-effective.
- Clinical effectiveness and cost effective = how effective therapy is at tackling symptoms and cost.
- Flooding can work in one 3-hour session.
- More people treated at same cost than with SD or other therapies.

Traumatic
- Limitation: highly unpleasant experience.
- Schumacher et al. (2015): flooding more stressful for clients and therapists than SD.
- Ethical issues knowingly cause distress (even with informed consent).
- Attrition (drop out) rates higher with flooding.

Symptom Substitution
- Limitation to behaviour therapies: mask symptoms but don’t tackle underlying causes (symptom substitution).
- Pearson’s (1986) woman with phobia of death treated using flooding. Fear of death declined but fear of criticism got worse.
- Only evidence for symptom substitution from case studies and may only apply to that phobia.

Question 13

Cost – effective

Answer 13

• Strength: highly cost-effective.
• Clinical effectiveness and cost effective = how effective therapy is at tackling symptoms and cost.
• Flooding can work in one 3-hour session.
• More people treated at same cost than with SD or other therapies.

Question 14

Traumatic

Answer 14

• Limitation: highly unpleasant experience.
• Schumacher et al. (2015): flooding more stressful for clients and therapists than SD.
• Ethical issues knowingly cause distress (even with informed consent).
• Attrition (drop out) rates higher with flooding.

Question 15

Symptom Substitution

Answer 15

• Limitation to behaviour therapies: mask symptoms but don’t tackle underlying causes (symptom substitution).
• Pearson’s (1986) woman with phobia of death treated using flooding. Fear of death declined but fear of criticism got worse.
• Only evidence for symptom substitution from case studies and may only apply to that phobia.