Treating Phobias: Behavioural Approach Flashcards
two behavioural treatments for phobias
systematic desensitisation
flooding
what is meant by systematic desensitisation
Systematic Desensitisation (SD) is a behavioural therapy for phobias which assumes that, if phobias are learned (or conditioned), they can therefore be ‘unlearned’ (or counter-conditioned)
SD aims to treat the client step by step (systematically) to replace their learned sensitivity or fear response with a harmless response (desensitisation)
what is the aim of systematic desensitisation
SD aims to treat the client step by step (systematically) to replace their learned sensitivity or fear response with a harmless response (desensitisation)
It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other, this is known as ‘reciprocal inhibition’
outline the process of systematic desensitisation
- SD begins by teaching the client deep relaxation techniques such as deep breathing or progressive muscle relaxation (calming responses intended to replace the fear response)
- The client then works with the therapist to develop an ‘anxiety hierarchy’.
This is step-by-step plan of situations the client would normally struggle to cope with, starting with the least fearful situations at the bottom (e.g. imagining a spider), getting systematically more fearful with each step up to the top which is the most fearful situation of all (e.g. holding a spider). - The client starts the process by firstly learning to associate (classical conditioning) the deep relaxation with the least fear-provoking situation at the bottom of the hierarchy and, only once this is achieved which may take several attempts, the client is encouraged to the next step of the hierarchy.
This is done step-by-step, associating the relaxed response with the fearful situation at each stage until they associate the most fearful situation at the top of the hierarchy with the relaxed response
Evaluation: systematic desensitisation
- STRENGTHS
P: extremely effective at treating many phobias
E: SD has been shown to be an extremely successful therapy for a range of different types of phobia
E: Evidence to support this comes from McGrath et al (1990) who found that 75 % of patients showed an improvement in their symptoms after SD
L: seems to work in most cases as the client is in control
P: can be seen as beneficial for the economy
E: estimated that mental health issues cost the English economy around £22.5 billion a year and any effective treatments for mental illness could help to reduce this
E: eg, an effective therapy for phobias such as SD might reduce unnecessary healthcare costs on treatments for phobias that do not work
L: SD may not only have a positive impact on sufferers’ lives, but also have economic benefits too
P: sufferers tend to prefer it to the alternative behavioural therapy of ‘flooding’
E: SD does not cause the same degree of trauma as flooding and also SD includes elements that are actually pleasant (e.g. learning relaxation techniques)
E: Evidence from low refusal rates of SD and low attrition rates (the number of people dropping out of treatment is low) of SD
L: SD is clearly an acceptable treatment for patients
Evaluation: systematic desensitisation
- LIMITATION
P: SD is not an effective treatment for all phobias
E: argued that phobias with an underlying evolutionary component (i.e. fears that are more instinctive and beneficial for survival) are not as easily treated by SD as phobias that have been learned through experience
E: eg, it is argued that fears of the dark, of heights or of a dangerous animal that may be the result of evolution are harder to treat through SD
L: SD might be limited to only treating specific types of phobia
P: ethical issues
E: asking a person with a major fear to confront the object of their anxiety in this way may be criticised for a lack of protection from harm, even if the exposure is gradual
E: eg, asking someone with a fear of flying to work towards taking a flight may cause them excessive anxiety when alternative therapies may be less stressful
L: may go against the ethical code of conduct
what is meant by flooding
‘Flooding’ is a behavioural therapy used to treat phobias
Rather than the gradual exposure to a phobic stimulus through a hierarchy as used in Systematic Desensitisation, in ‘Flooding’ the patient is given one long session where the phobia is experienced at its worst, while at the same time practising relaxation.
The session continues until the patient feels completely relaxed in the company of their phobic stimulus.
outline flooding
An alternative behavioural therapy used to treat phobias is ‘Flooding’.
Rather than the gradual exposure to a phobic stimulus through a hierarchy as used in Systematic Desensitisation, in ‘Flooding’ the patient is given one long session where the phobia is experienced at its worst, while at the same time practising relaxation.
The session continues until the patient feels completely relaxed in the company of their phobic stimulus.
For example, a person who is afraid of spiders (arachnophobia) may have a large spider crawl freely over them for an extended period.
A therapist will encourage the patient to use their relaxation techniques until their anxiety disappears (physical symptoms of anxiety can only last a certain amount of time)
Sessions of flooding can last for 2 to 3 hours.
Flooding stops phobic behaviour very quickly, this is because a sufferer is unable to demonstrate avoidance behaviour and quickly learns that their stimulus is harmless: This process is called extinction.
A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. 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 simply because they become exhausted by their own fear response.
Evaluation: flooding
- STRENGTHS
P: effective at treating many phobias
E: for those patients who do choose flooding, it has been shown to be at least as effective as SD
E: Evidence to support this comes from Choy et al (2007) who found that flooding was more effective than SD at treating phobias
L: seems to work in most cases where patients stick with it for the duration of the session
P: cost-effective
E: flooding is relatively cheap
E: only requires one session rather than SD which requires multiple sessions
L: many therapists favour flooding for this reason, even if it may not always be as acceptable or preferable for many patients
E: more accessible - treat more patients
Evaluation: flooding
- LIMITATIONS
P: ethical issues
E: directly confronting the most extreme aspect of a patient’s anxiety may be criticised for a lack of protection from harm E: eg, asking someone with a spider phobia to have a spider crawl over them may be seen as inappropriate when alternative therapies may be less stressful (SD)
L: goes against the ethical code of conduct
E: lack of right to withdraw
P: not an effective treatment for all phobias
E: argued that complex phobias such as ‘social phobias’ cannot be treated effectively with flooding
E: eg, it is argued that flooding can only treat ‘simple phobias’ and not social phobias which have cognitive aspects (unpleasant thoughts in addition to the anxiety response)
L: flooding might be limited to only treating specific types of phobia
P: argued that relaxation may not be necessary
E: some believe the success of both flooding and SD is more to do with exposure to the feared situation and the expectation of being able to cope in these situations this brings
E: Evidence to support this comes from Klein et al (1983) who found that supportive psychotherapy was just as effective as SD in treating phobias
L: suggests that the ‘active ingredient’ in SD or flooding may simply be the generation of hopeful expectations that the phobia can be overcome
differences between SD and flooding
- SD is a gradual exposure to the phobic stimuli, whereas flooding is an immediate exposure to the phobia at its worst
- SD requires several sessions whereas flooding requires one long session 2-3 hours
- SD is expensive to run as it takes longer whereas flooding is more cost effective and cheaper as it is one session
