Behavioural treatments of phobias

• Systematic Desensitisation developed by Joseph Wolpe uses the principle of "counterconditioning" in the treatment of phobias and is based on the classical conditioning process.
• Systematic Desensitisation aims to replace the current stimulus-response association (eg spider-fear) with a new response to the feared situation (eg spider-relaxation)- was termed 'reciprocal inhibition'.
• Systematic Desensitisation:

  • Stage 1: patient taught deep relaxation techniques (eg, deep breathing).
  • Stage 2: forming a hierarchy of fear, ie situations involving the conditioned stimulus are ranked from least fearful to most fearful.
• Systematic Desensitisation:

  • Stage 3: patient works their way up the hierarchy, starting at least unpleasant & practicing their relaxation technique until they feel comfortable (will happen naturally anyway- calm down) with this (no longer afraid), and can move onto the next stage.
  • Stage 4: the continued pairing of the relaxation responses with the feared stimulus as the patient works up the hierarchy, gradually leads the fear response to be extinguished & the relaxation response to take its place.
  • Exposure without avoidance eliminates the negative reinforcement that maintains the phobia.
• Systematic Desensitisation Evaluation- Strength:

  • It is extremely effective for simple phobias (60-90% cured).
  • This gives credibility.
• Systematic Desensitisation Evaluation- Strength:

  • It is relatively quick and requires less effort than other therapies- 6-8 week sessions.
  • This is compared to a lifetime of fear & other therapies.
• Systematic Desensitisation Evaluation- Weakness:

  • Doesn't work for complex phobias.
  • Ohman et al (1975) suggests that systematic desensitisation is only effective for learned phobias rather than those which have an underlying evolutionary basis or cognitive (eg social phobia, heights).
  • This shows how it is not always appropriate.
• Flooding involves one long session where a patient experiences their phobia at its worst, while at the same time practicing relaxation (reciprocal inhibition).
• In flooding, the session continues until the patient is fully relaxed and response is extinguished. Eg, a person afraid of clowns is placed in a room full of clowns & the therapist encourages the patient to use their relaxation techniques until eventually their anxiety disappears.
• Key feature of flooding: the patient cannot leave still being afraid.
• Flooding Evaluation- Strength:

  • It's cost effective.
  • Ougrin (2001) found that flooding is highly effective and quicker than alternative treatments.
  • The quick effect is a strength because it means patients are free of their symptoms as soon as possible and that makes it cheaper.
• Flooding Evaluation- Weakness:

  • Less effective for some types of phobias.
  • It appears to be less effective for more complex phobias like a social phobia, because social phobias have cognitive aspects (thinks unpleasant thoughts are about the social situation).
  • This type of phobia may benefit more from cognitive therapies, because such therapies tackle the irrational thinking.
• Flooding Evaluation- Weakness:

  • Most serious issue is that it's a highly traumatic experience for patients; they face their phobia at its absolute worst immediately.
  • Also, the problem is not that it is unethical (as informed consent given), but rather that patients are sometimes unwilling to see the treatment through to the end.
  • Is a limitation because time & money are sometimes wasted preparing patients, only to have them refuse to start or complete treatments.
  • If a patient leaves mid-treatment, the phobia can be made worse through negative reinforcement.