The Behavioural Approach to treating phobias (SD and flooding)

Question 1

The Behaviourist Approach to Treating Phobias

Answer 1

Behavioural therapies are based on the principles of classical conditioning.
Treating the phobia requires breaking the association between the phobic stimulus and the anxiety/avoidance response.

Behavioural therapies involve exposure to the feared stimulus or situation through counter-conditioning:
A patient is taught (through classical conditioning) to associate the phobic stimulus with a new response
i.e. relaxation instead of fear

Question 2

Systematic Desensitisation
Wolpe (1958)

Answer 2

A behavioural therapy for treating anxiety disorders involving gradual exposure to a feared stimulus or situation over several sessions through counter-conditioning:
- the sufferer learns relaxation techniques and then faces a progressive hierarchy of exposure to the objects and situations that cause anxiety

Question 3

what happens in In Vitro Desensitisation:

Answer 3

Imagined exposure to the phobic stimulus.

Question 4

what happens in In Vivo Desensitisation:

Answer 4

Actual exposure to the phobic stimulus.

Question 5

Systematic Desensitisation process

Answer 5

Step 1: Patient is taught progressive muscle relaxation and breathing techniques
(Reciprocal Inhibition: a relaxed state is incompatible with anxiety)

Step 2: Therapist and patient together construct a hierarchy of anxiety-provoking situations

Step 3: Patient gradually works their way through the fear/desensitisation hierarchy, practicing relaxation at each stage.

Step 4: Once the patient has mastered their anxiety at one step in the hierarchy (i.e. completely relaxed in the presence of the phobic stimulus), they are ready to move onto the next.

Step 5: Patient masters the feared situation, once they can stay relaxed in situations at the top of the fear hierarchy.

Question 6

what is counterconditioning

Answer 6

The learning of a different response to the phobic stimulus – the phobic stimulus is paired with relaxation/calm, breaking down the previous association between the phobic stimulus and fear/anxiety.

Question 7

what is reciprocal inhibition

Answer 7

One emotion prevents the other; they are incapable of co-existing simultaneously i.e. it is impossible to be both afraid and relaxed at the same time as they are opposing emotions.

Question 8

what is Desensitisation/Fear/ Anxiety hierarchy

Answer 8

A list of situations related to the phobic stimulus that provoke anxiety, arranged in order from least to most feared.

Question 9

SD is successful for treating a range of phobic disorders:

Answer 9

McGrath et al (1990): 75% of patients with phobias respond to SD.

Question 10

Jones (1924) used SD to eradicate ‘Little Peter’s’ phobia of white fluffy animals/objects i.e. rabbits:

Answer 10

The rabbit was presented at closer distances each time his anxiety levels subsided.
- Peter was rewarded with food to develop a positive association towards the rabbit.
- He developed affection for the rabbit, which generalised onto similar animals/objects

Question 11

Unlike drug therapy e.g. BZs….

Answer 11

…. there are no side effects from SD and no risk of addiction or dependency. BZs are highly addictive and can result in aggression and long-term memory impairments.

Question 12

limitations

Answer 12

Risk of symptom substitution: Systematic Desensitisation only deals with the symptoms and not the root cause of the phobia, so there is a risk that the symptoms will resurface, possibly in another form e.g. another phobia/disorder will develop in its place.
However, there is a lack of evidence for symptom substitution.

In vivo (actual exposure) techniques have been found to be more effective and longer-lasting than in vitro (imagined exposure), as some individuals lack the ability to imagine the feared situation, so might still experience a fear response when they confront the actual objects/situations.
However, it is not always practical to treat patients using in vivo techniques e.g. fear of flying.

SD is time consuming; therapies i.e. flooding, which involve immediate exposure to the phobic stimulus are a quicker alternative.

Question 13

what is flooding

Answer 13

A behavioural therapy, where instead of a step-by-step approach, patients go straight to the top of the hierarchy and imagine (in vitro), or have direct contact with (in vivo), their most feared scenarios, while at the same time practicing relaxation.

Through forced and prolonged exposure, the idea is that patients cannot make their usual avoidance response; anxiety peaks at such high levels it cannot be maintained and eventually subsides.

Question 14

Flooding process

Answer 14

Step 1: Patient is taught progressive muscle relaxation and breathing techniques
(Reciprocal Inhibition: a relaxed state is incompatible with anxiety)

Step 2: Relaxation techniques are applied in one session in the presence of the most feared situation, which usually lasts 2-3 hours.

Step 3: A person’s fear response (and the release of adrenaline underlying this) has a time limit.
As adrenaline levels naturally decrease, a new stimulus-response link can be learned between the feared stimulus and relaxation.

Step 4: Patient masters the feared situation.

Question 15

strengths of flooding

Answer 15

For those patients who choose flooding as a treatment and do stick with it, it appears to be an effective treatment (equally as effective as SD) and is relatively quick (compared to Systematic Desensitisation and CBT).

Question 16

Overall Evaluation of Behavioural Therapies (strengths)

Answer 16

Behavioural therapies are relatively fast and require less effort than CBT: CBT requires a lot of motivation and willpower from the patient in trying to understand their behaviour and apply these insights e.g. homework tasks.

Question 17

limitations of flooding

Answer 17

Individual Differences: Flooding can be highly traumatic (unethical – psychologically harmful) and patients may quit during treatment, which reduces the effectiveness of the therapy for some people.

Flooding is not suitable for patients who are not in good physical health, as the extreme anxiety levels caused by confrontation with the phobic stimulus can be very stressful on the body e.g. increase heart attack risk

Question 18

Overall Evaluation of Behavioural Therapies (limitations)

Answer 18

Not appropriate for treating all phobias: Researchers have suggested that SD and Flooding may not be as effective in treating phobias that have an underlying evolutionary component (e.g. fear of the dark, fear of heights or fear of dangerous animals), than in treating phobias that have been acquired as a result of personal experience.
It also appears to be less effective for treating more complex phobias like social phobias, which may be because they have more cognitive aspects.