The Behavioural Approach To Treating Phobias Flashcards
Systematic desensitisation
Behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. If a person can learn to relax in the presence of the phobic stimulus they will be cured.
Three processes involved — Anxiety hierarchy, relaxation and exposure.
Anxiety hierarchy
List of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening.
For example, a person with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy.
Relaxation
The therapist teaches the client to relax as deeply as possible.
The relaxation might involve breathing exercises or the client might learn mental imagery techniques.
Clients can be taught to imagine themselves in relaxing situations (such as imagining lying on a beach) or they might meditate.
Exposure
Finally the client is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom 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 is successful when the client can stay relaxed in situations high on the anxiety hierarchy.
SD
AO3 — Strength
Jones (1924)
Used SD to remove a fear of white fluffy animals and objects like cotton wool in ‘Little Peter’.
The rabbit was presented at closer and closer distances each time as his anxiety levels subsided. Peter was rewarded with food to develop a positive association with the rabbit.
This supports SD as it provided evidence that a re-association with a phobic object can be learnt.
SD
AO3 — Weakness
Convert desensitisation
SD is mainly suitable for patients that are able to learn and use relaxation strategies, and have vivid enough imagination to create images of feared objects.
If used in an imaginary sense there is no guarantee it will work in a real situation, suggesting in vivo treatment is superior to covert desensitisation.
SD
AO3 — Strength
Effective treatment
Gilroy (2003) followed up 42 people who had SD for spider phobia in three 45-minute sessions. At both 3 and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure.
In a recent review, Wechsler (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.
SD
AO3 — Strength
Benefits people with learning disabilities
Some people that require 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 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.
Flooding
Flooding involves immediate exposure to a very frightening situation. The fear is taken to the worst case, either imagined or real, until the client can no longer feel fear due to exhaustion.
How does flooding work?
Flooding stops phobic responses very quickly because without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless.
This process is called extinction — A learned response is extinguished when the conditioned stimulus (dog) is encountered without the unconditioned stimulus (being bitten). The result is that the conditioned stimulus no longer produces the conditioned response (fear).
In some cases the client may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response.
Example of flooding
Direct confrontation with a snake with no means of escape. The high anxiety produced would not be sustainable and would reduce itself naturally, thus removing the phobia as no avoidance response could be made.
Flooding
AO3 — Weakness
Ethics
Unpleasant experience so it is important that clients give fully informed consent to this traumatic procedure and that they are fully prepared before the flooding session.
Flooding is not suitable for all patients who are not in good health, it could risk heart attacks.
A client would normally be given the choice of systematic desensitisation or flooding.
Flooding
AO3 — Strength
Wolpe (1960)
Flooding was used to remove a phobia of cars. The girl was forced to be driven around in a car for four hours until her fear was eradicated. This supports flooding as it shows the effectiveness of the treatment.
Flooding
AO3 — Weakness
Cost effective
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.
Flooding
AO3 — Weakness
Traumatic experience
Schumacher (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. Also, the traumatic nature of flooding means that dropout rates are higher than for SD.
This suggests that therapists may avoid using this treatment.
