the behavioural approach to treating phobias Flashcards
systematic desensitisation
behavioural therapy designed to reduce unwanted response - such as anxiety.
SD involves drawing up a hierarchy of anxiety-provoking situations related to a person’s phobic stimulus- teaching the person to relax and then exposing them to the phobic situations.
The person works their way through the hierarchy whilst maintaining relaxation
flooding
a behavioural therapy when a person with a phobias is exposed to an extreme form of a phobic stimulus in order to reduce the anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions
counterconditioning
a new response to the phobic stimulus is learned - the phobic stimulus is paired with relaxation instead of anxiety.
1st Process of SD - anxiety hierarchy
put together by a client with phobia and therapist.
The list of situations related to the phobic stimulus that provokes anxiety is arranged in order from least to most frightening.
E.G someone with arachnophobia may identify a picture of a small spider as low anxiety and holding a tarantula at the top of the hierarchy
2nd stage in SD
therapist teaches clients to relax as deeply as possible. You cannot be afraid and relaxed at the same time - so one emotion prevents the other. This is RECIPROCAL INHIBITION.
The relaxation may involve breathing exercises or mental imagery techniques, they can be taught to imagine themselves in relaxing situations or meditation.
Or relaxation can be achieved with drugs such as Valium
3rd stage in SD - exposure
client is exposed to the phobic stimulus while being in a relaxed state .
This takes place over a few sessions - starting at the button of the anxiety hierarchy.
When the client can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy.
Treatment = successful when the client can stay relaxed din situations high on the anxiety hierarchy
STRENGTH - EVIDENCE OF EFFECTIVENESS
One strength of the systematic desensitisation is the evidence base it has for effectiveness.
Gilroy followed up 42 people who had SD for spider phobia in the three, 45 minute sessions.
At both three and 33 months, the DS group was less fearful than a control group treated by relaxation without exposure.
Wechsler 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.
STRENGTH - PEOPLE WITH LEARNING DISABILITIES
A strength of the SD is that it can be used to help people with learning disabilities.
Some people requiring treatment for phobias also have a learning disability. But, the main alternatives to SD are not suitable
People with learning disabilities often struggle with cognitive therapies that require complex 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
SD IN VIRTUAL REALTIY
Traditional SD involves exposure to phobic stimulus in a real world setting.
Using exposure as part of SD in virtual reality can avoid dangerous situations and is cost effective as the psychologists and client do not leave the consulting room.
BUT - there is some evidence to suggest that VR exposure may be less effective than real exposure because it lacks realism - WECHSLER
what is flooding?
Involves exposing people with a phobia to their phobic stimulus without a gradual build up in an anxiety hierarchy.
Flooding involves immediate exposure to a very frightening situation.
Flooding sessions are usually longer than SD sessions - lasting two to three hours. Sometimes one long session is needed to cue the phobia.
how does flooding work?
Flooding stops the phobic responses very quickly. Due to the lack of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless. Classical conditioning terms this process as EXTINCTION.
A learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus. The result is that the conditioned stim no longer produced the conditioned response of fear
In some cases, the client may achieve relaxation in the presence of the phobic stimulus because they become exhausted by their own fear response
ethical safeguards:
Flooding is not unethical but instead is an unpleasant experience so it is important to get the clients informed consent to the traumatic procedure so they are fully prepared before the flooding session.
A client would normally be given the choice of systematic desensitisation or flooding.
STRENGTH - COST EFFECTIVE
A strength of flooding is that it is highly cost effective.
Clinical effectiveness means how effective a therapy is at tackling symptoms but when we provide therapies in health systems like the NHS, we also have 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 opposed to ten sessions for SD
This means that more people can be treated at the same cost with flooding than with SD or other therapies.
LIMITATION - 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.
Schumacher found that pp’s and therapists rates flooding as significantly more stressful than SD
This raises the ethical issue for psychologists of knowingly causing stress to their clients - but it is not a serious problem is they have informed consent
The traumatic experience of flooding means that ATTRITION - dropout rates are higher for SD
This suggests that overall therapists may avoid using this treatment
LIMITATION:
A limitation of behavioural therapies, including flooding, is that they only mask symptoms and do not tackle the underlying causes of phobias
E.g. Persons reported the case of a woman with a phobias of death who was treated using flooding. Her fear of death declined but her fear being criticised got worse.
BUT the only evidence for symptom substitution comes in the form of case studies which - in this case may only generalise to the phobias in the study
