The behavioural approach to treating phobia Flashcards
What is systematic desensitisation?
a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning
When is the patient cured?
When they learn to relax in the presence of the phobic stimulus
What is counter conditioning?
When a new response is learned (phobic stimulus is paired with relaxation instead of anxiety)
What is reciprocal inhibition?
When you cant be afraid and relaxed at the same time so one emotion prevents the other
What are the 3 processes involved in SD?
- The anxiety hierarchy
- Relaxation
- Exposure
What is the anxiety hierarchy process?
It is put together by the patient and the therapist. this is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening. for example, an arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula as the top of the hierarchy
What is the relaxation process?
The therapist teaches the patient to relax as deeply as possible. this might involve breathing exercises or, alternatively the patient might learn mental imagery techniques. patients can be taught to imagine themselves in relaxing situations such as lying on a beach or they might learn meditation. alternatively relaxation can be achieved using drugs such as Valium
What is the exposure process?
Finally the patient 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 patient can stay relaxed in the presence of the lower levels 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.
How is its effectiveness a strength?
-EVALUATION
research shows that systematic desensitisation is effective in the treatment of specific phobias. For example Gill Roy at Al followed at 42 patients who have been treated for spider phobia and three 45 minute sessions of systematic desensitisation. Spider phobia was assessed on several measures including the spider questionnaire and by assessing response to a spider. A control group was treated by relaxation without exposure. Both three months and 33 months after the treatment the systematic desensitisation group were less fearful than the relaxation group. This is a strength because it shows that systematic desensitisation is helpful in reducing the anxiety in spider phobia and that the effects are long lasting.
How is sd being suitable for a diverse range of patients a strength?
-EVALUATION
The alternative is to systematic desensitisation e.g. flooding and cognitive therapies are not well suited to some patients. For example some sufferers of anxiety disorders like phobias also have learning difficulties. Learning difficulties can make it very difficult for some patients to understand what is happening during flooding or to engage with cognitive therapies that requires the ability to reflect on what you are thinking. For this patient systematic desensitisation is probably the most appropriate treatment
How is SD being acceptable to pateints a strength?
-EVALUATION
A strength of systematic desensitisation is that the patients prefer it. Those given the choice of systematic desensitisation or flooding tends to prefer systematic desensitisation. This is largely because it does not cause the same degree of trauma as flooding. It may be because systematic desensitisation include some elements that are actually pleasant e.g. learning relaxation procedures. This is reflected in the lower refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) of SYSTEMATIC desensitisation
WHat is flooding and give an example?
It involves exposing phobic patients to their phobic stimulus but without gradual build up in an anxiety hierarchy. instead flooding involves immediate exposure to a very frightening situation. So an arachnophobic receiving flooding treatment might have a large spider crawl over them for an extended period of time
Are flooding sessions longer than SD?
yes - one sessions often lasts three hours
sometimes only one long session is needed to cure a phobia
How does flooding work?
stops phobic responses very quickly - this may be because without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless- In classical conditioning this is known as extinction . a learned response extinguished when the conditioned stimulus (eg. a dog)
is encountered without the unconditioned stimulus (eg. being bitten). The result is that the conditioned stimulus no longer produces the conditioned response (fear). in some cases, the patient may achieve relaxation in the presence of the phobic stimulus because they become exhausted by their own fear response
What are the ethical safeguards around flooding?
Flooding is not unethical but it is an unpleasant experience so it is important that patients give fully informed consent to this traumatic procedure and that they prepared before the flooding session. A patient would be given the choice of SD or flooding.
