The Behavioural Approach to Treating Phobias

Question 1

What are the two behaviourist therapies used to treat phobias?

Answer 1

systematic desensitisation and flooding

Question 2

What is flooding?

Answer 2

a form of behavioural therapy used to treat phobias and other anxiety disorders. A client is exposed to (or imagines) an extreme form of the threatening situation under relaxed conditions until the anxiety reaction is extinguished

Question 3

What is systematic desensitisation?

Answer 3

a form of behavioural therapy used to treat phobias and other anxiety disorders. A client is gradually exposed to (or imagines) the threatening situation under relaxed conditions until the anxiety reaction is extinguished

Question 4

Who developed systematic desensitisation (+date!)

Answer 4

Wolpe during the 1950s

Question 5

How many sessions does systematic desensitisation take?

Answer 5

The number of sessions required depends on the severity of the phobia. Usually 4-6 sessions, up to 12 for a severe phobia.

Question 6

What are the two types of exposure used in systematic desensitisation, and what do they mean?

Answer 6

In vitro – the client imagines exposure to the phobic stimulus.
In vivo – the client is actually exposed to the phobic stimulus.

Question 7

What are the 3 stages of systematic desensitisation

Answer 7

First, the patient is taught a deep muscle relaxation technique and breathing exercises. E.g. control over breathing, muscle detensioning or meditation.

This step is very important because of reciprocal inhibition, where once response is inhibited because it is incompatible with another. In the case of phobias, fears involves tension and tension is incompatible with relaxation.

Second, the patient creates a fear hierarchy starting at stimuli that create the least anxiety (fear) and building up in stages to the most fear provoking images. The list is crucial as it provides a structure for the therapy.

Third, the patient works their way up the fear hierarchy, starting at the least unpleasant stimuli and practising their relaxation technique as they go.

When they feel comfortable with this (they are no longer afraid) they move on to the next stage in the hierarchy. If the client becomes upset they can return to an earlier stage and regain their relaxed state.

The client repeatedly imagines (or is confronted by) this situation until it fails to evoke any anxiety at all, indicating that the therapy has been successful.

This process is repeated while working through all of the situations in the anxiety hierarchy until the most anxiety-provoking.

Question 8

Give an example of systematic desensitisation in practice

Answer 8

For example, a spider phobic might regard one small, stationary spider 5 meters away as only modestly threatening, but a large, rapidly moving spider 1 meter away as highly threatening.

The client reaches a state of deep relaxation, and is then asked to imagine (or is confronted by) the least threatening situation in the anxiety hierarchy.

Question 9

Give a real-life application example of systematic desensitisation in practice

Answer 9

Wolpe (1964) successfully used the method to treat an 18 year old male with a severe handwashing compulsion. The disorder involved a fear of contaminating others with urine.

After urinating, the patient felt compelled to spend 45 minutes cleaning his genitalia, two hours washing his hands, and four hours showering.

Treatment involved placing the young man in a state of relaxation and then asking him to imagine low anxiety scenes (such as an unknown man touching a trough of water containing one drop of urine).

As the patient’s anxiety gradually dissipated, Wolpe gradually increased the imaginary concentration of urine.

In addition, a real bottle of urine was presented at a distance and moved closer to the patient in gradual steps.

Finally Wolpe could apply drops of diluted urine to the back of the patient’s hand without evoking anxiety. A follow-up 4 years later revealed complete remission of the compulsive behaviors.

Question 10

What is reciprocal inhibition?

Answer 10

a theory that says two emotional states cannot exist at the same time

Question 11

What are the 2 evaluation points for SD?

Answer 11

1. effectiveness

2. not appropriate for all phobias

Question 12

What is the PEEL paragraph for the SD evaluation point; effectiveness?

Answer 12

P - research has found that SD is successful for a range of phobias
E - for example, McGrath et al. (1990) reported that about 75% of patients with phobias responded to SD.
E- the key to success appears to lie with actual contact with the feared stimulus, so in vivo techniques are more successful that ones just using pictures or imagining the feared stimulus (in vitro) (Choy et al., 2007). Often a number of different exposure techniques are involved - in vivo, in vitro and also modelling, where the patient watches someone else who is coping well with the feared stimulus (Comer, 2002)
L - this demonstrated the effectiveness of SD, but also the value of using a range of different exposure techniques

Question 13

What is the PEEL paragraph for the SD evaluation point; not appropriate for all phobias?

Answer 13

P - SD may not be effective against all phobias
E - Ohman et al., (1975) suggest that SD may not be as effective in treating phobias that have an undelying evolutionary surival component (e.g. fear of dark, fear of heights or fear if dangerous animals), than in treating phobias which have been acquired as a result of personal experience
L - This suggest that SD can only be used effectively in tackling some phobias

Question 14

What are the 2 evaluation points for flooding?

Answer 14

1. Effectiveness

2. Individual differences

Question 15

What is the PEEL paragraph for the flooding evaluation point; effectiveness?

Answer 15

P - Flooding can be an effective treatment for those who stick with it and it is relatively quick (compared CBT)
E - For example, Choy et al., reported that both SD and flooding were effective of the two at treating phobias
E - On the other hand, another review (Craske et al., 2008) concluded that SD and flooding were equally effective in the treatment of phobias
L - This shows that flooding is an effective therapy, albeit just one of several options

Question 16

What is the PEEL paragraph for the flooding evaluation point; individual differences

Answer 16

P - Flooding is not for every patient (or indeed for every therapist)
E - It can be a highly traumatic procedure. Patients are obviously made aware of this beforehand but, even, then, they might quit during the treatment, which reduces the ultimate effectiveness of the therapy for some people
L - Individual differences in responding to flooding therefore limit the effectiveness of the therapy

Question 17

What are the 3 evaluation points for behaviour therapies in general?

Answer 17

1. Strengths of behavioural therapies
2. Relaxation may not be necessary
3. Symptom substitution

Question 18

What is the PEEL paragraph for the behaviour therapies in general evaluation point; strengths of behavioural therapies

Answer 18

P - behavioural therapies for dealing with phobias are generally relatively faster, cheaper and recquire less effort on the patient’s part than other psychotherapies
E - For example,CBT requires a willingness for people to think deeply about their mental problems, which is not true for behavioural therapies.
E - This lack of ‘thinking’ means that the techniques is also useful for people who lack insight into their motivations or emotions, such as children or patients with learning difficulties.
E - A further strength of behavioural therapy is that it can be self administered - a method that has proved successful with, for example, social phobias (Humphrey, 1973)
L - these benefits were confirmed in studies, which also found that delf-amdministerred therapy was an effective as therapist-guided therapy

Question 19

What is the PEEL paragraph for the behaviour therapies in general evaluation point; relaxation may not be necessary

Answer 19

P - it may be that the successful of both SD and flooding is more to do with exposure to the feared situation than relaxation
E - it might also be that the expectation of being able to cope with the feared stimulus is most important.
E - for example, Klein et al (1983) compared SD with supportive psychotherapy for patients with either social or specific phobias. They found no difference in effectiveness, suggesting that the ‘active ingredient’ in SD or flooding may simply be the generation of hopeful expectancies that the phobia can be overcome
L - this suggests that cognitive factors are more important than the behavioural approach generally acknowledges

Question 20

What is the PEEL paragraph for the behaviour therapies in general evaluation point; symptom substitution

Answer 20

P - behaviural therapies may not work with certain phobias because the symptoms are only the tip of the iceberg
E - if the symptoms are removed the cause still remains, and the symptoms will simply resurface, possibly in another form (known as symptom subsitution)
E - for example, according to the psychodynamic approach phobias develop because or projection. Freud (1909) recorded that the case of Little Hans who developed a phobias of horses. The boy’s actual problem was an intense envy of his father, but he could not express this directly and his anxiety was projected onto the horse. The phobia was cured when accepted his feelings about his father
L - this demonstrates the importance of treating the underlying causes of a phobia rather than just the symptoms