The behavioural approach to treating phobias

Question 1

What are the two main ways in which the behavioural approach treat phobias?

Answer 1

Systematic desensitisation

Flooding

Question 2

What is systematic desensitisation?

Answer 2

Behavioural therapy designed to reduce an unwanted response such as anxiety to a stimulus.
It involves drawing up a hierarchy of anxiety provoking situations relating to the phobic stimulus teaching the patient to relax before exposing them to phobic situations. They make their way through the hierarchy while maintaining relaxation

Question 3

What is flooding?

Answer 3

A behavioural therapy which a phobic patient is exposed to an extreme form of the phobic stimulus in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions.

Question 4

What principle is systematic desensitisation based on?

Answer 4

Classical conditioning - if the sufferer can learn to relax in the presence of the phobic stimulus they will be cured - you essentially learn a new response to the phobic stimulus.

Question 5

What is counter conditioning?

Answer 5

The learning of a new response

Question 6

What is reciprocal inhibition?

Answer 6

The idea that it is impossible to be relaxed and scared at the same time so one emotion prevents the other

Question 7

What are the three processes involved in systematic desensitisation?

Answer 7

The anxiety hierarchy
Relaxation
Exposure

Question 8

What is the anxiety hierarchy?

Answer 8

Put together by patient and therapist - its a list of situations related to the phobic stimulus that provoke anxiety from least to most frightening

Question 9

What is relaxation?

Answer 9

The therapist teaches the patient to relax as quickly as possible - this may involve breathing exercises or alternatively they may use mental imagery techniques
Relaxation can also be achieved by meditation or using drugs such as Valium

Question 10

What is exposure?

Answer 10

The patient is exposed to the phobic stimulus in a relaxed state. Takes place over several sessions - when they can stay relax in presence of lower level of the phobic stimulus they move up the hierarchy . Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy

Question 11

How is flooding different to SD?

Answer 11

Flooding involves immediate exposure to a very frightening situation - there is no gradual build up or anxiety hierarchy
Flooding sessions are often longer lasting 2-3 hours

Question 12

Why does flooding stop the phobic response so quickly?

Answer 12

There is no option for avoidance behaviour so the patient quickly learns that the phobic stimulus is harmless - this is called extinction
They may learn to relax simply because they become exhausted by their own fear response

Question 13

Is flooding unethical?

Answer 13

While not labelled unethical it is unpleasant so it is important to have the patients’ fully informed consent and that they are fully prepared for the flooding session.

Question 14

Is systematic desensitisation effective - what research supports this?

Answer 14

It is effective in the treatment of specific fears
Gill Roy et al 2003 followed up 42 patients who had been treated for spider phobia in 3, 45 minute sessions of SD. Spider phobia was assessed on several measures including questionnaire and assessing response to a spider. In a control group they were treated with relaxation without exposure. At both 3 and 33 months after treatment the SD group were less fearful than the relaxation group Shows effects are long lasting

Question 15

Give one way in which SD is better than flooding and cognitive therapy?

Answer 15

It is suitable for a diverse range of patients - flooding and cognitive therapy are not well suited to some patients e.g. some suffering anxiety disorders like phobias also have learning difficulties which could make it hard for patients to understand what is happening during flooding or to engage in cognitive therapies

Question 16

What is meant by it is acceptable to patients?

Answer 16

Patients tend to prefer SD when given the choice between that and flooding because it does not cause the same degree of trauma as flooding and SD includes some elements that are actually pleasant - reflected in low refusal and low attrition rates of SD

Question 17

What is a key strength of flooding?

Answer 17

Cost effective -It is at least as effective as other treatments for specific phobias and studies comparing flooding to cognitive therapy have found it is quicker than alternatives meaning patients are free of their symptoms sooner and makes it cheaper.

Question 18

What phobias can/can’t flooding treat?

Answer 18

It is highly effective for treating simple phobias but seems to be less effective for treating complex phobias like social phobias - this could be due to the cognitive aspects (these patients may benefit from cognitive therapies that tackle irrational thinking

Question 19

What is the most serious issue with the use of flooding?

Answer 19

The treatment is traumatic for patients - because of this patients are often unwilling to see it through to the end and this means time and money is often wasted preparing patients for them to refuse.

Question 20

What is a common criticism of both SD and flooding?

Answer 20

Symptom substitute - when one phobia disappears another one may take its place e.g. a phobia of snakes may be replaced with a phobia of spiders
Evidence for this is very mixed to therapists tend not to believe it.