The behavioural approach to treating phobias Flashcards
Symptom substitution
A common criticism of behavioural therapies, including flooding, is that they only mask symptoms and do not tackle the underlying causes of mental disorders like phobias. This is called symptom substitution, i.e. as one symptom gets better another appears or gets worse because the underlying anxiety which is the real cause of the phobia is still there. For example Jacqueline Persons (1986) reported the case of a woman with a phobia of death. The woman was treated using flooding which was partly successful – her fear of death declined, however her fear of being criticised got worse.
On the other hand the only evidence for its existence comes from case studies such as the one above. As we know the case study approach is flawed. For example one issue with using case studies as the sole source of evidence for symptom substitution is that they may not generalise to all phobias.
This means that symptom substitution is largely a theoretical idea and there is only relatively poor empirical evidence to support it.
SD in virtual reality
On one hand there are some clear advantages to conducting the exposure part of SD in virtual reality (VR). Exposure using VR can be used to avoid dangerous situations such as heights, and it is cost-effective because the psychologist and client need not leave the consulting room. For phobias like flying this saving of time and money is significant because physical world exposure would involve actual flying.
On the other hand traditional SD involves exposure to the phobic stimulus in a real-world setting. The advantage of real-life exposure is its realism. There is some evidence to suggest that real-world exposure is more effective than VR exposure for treating social phobias (Wechsler et al. 2019).
This means that some phobias are best treated using VR exposure while others are probably better treated traditionally using real-world exposure.
Evaluation cost
Cost-effective
One strength of flooding is that it is highly cost-effective.
Clinical effectiveness means how effective a therapy is at tackling symptoms, However when we provide therapies in health systems like the NHS we also need to think about how much they cost. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session (perhaps three hours) this makes flooding more cost-effective.
This means that more people can be treated at the same cost with flooding than with SD or other therapies.
Traumatic
One limitation of flooding is that it is a highly unpleasant experience.
Confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety. Sarah Schumacher et al. (2015) found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent. More seriously, the traumatic nature of flooding means that attrition (dropout) rates are higher than for SD.
This suggests that, overall, therapists may avoid using this treatment.
Evidence of effectiveness
One strength of systematic desensitisation (SD) is the evidence base for its effectiveness.
Lisa Gilroy et al. (2003) followed up 42 people 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. In a recent review Theresa Wechsler et al. (2019) concluded that SD is effective for specific phobia, social phobia and agoraphobia.
This means that SD is likely to be helpful for people with phobias.
People with learning disabilities
A further strength of SD is that it can be used to help people with learning disabilities.
Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require A mplex rational thought. They may also feel confused and distressed by the traumatic experience of flooding
This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias.
