Behavioural approach- treatment of phobias

• Systematic desensitisation = a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning, if a person can learn to relax in the presence of the phobic stimulus they will be cured.
• There are three processes involved in systematic desensitisation:

  • The anxiety hierarchy
  • Relaxation
  • Exposure
• The anxiety hierarchy:

  This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening.
• Relaxation:

  The therapist teaches the client to relax as deeply as possible. It is impossible to be relaxed and afraid at the same time, so one emotion prevents the other. This is called reciprocal inhibition. The relaxation might involve breathing techniques, meditation or mental imagery techniques or even drugs.
• Exposure:

  Finally the client 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 client can stay relaxed in the presence of lower levels of the phobic stimulus they move up the hierarchy. Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy.
• Flooding = immediate exposure to a very frightening situation
• Flooding sessions are typically longer than systematic desensitisation sessions. Sometimes only one long session of flooding is needed to cure a phobia.
• Flooding also exposes people with a phobia to their phobic stimulus but without a gradual build -up in an anxiety hierarchy.
• Flooding stops phobic responses very quickly. This may be because without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless. In classical conditioning this process is called extinction.
• Flooding:

  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).
• Flooding is not unethical but it is an unpleasant experience so it is important that clients give fully informed consent to this traumatic procedure and that they are fully prepared before the flooding session. A client would normally be given the choice of systematic desensitisation or flooding.
• A strength of SD is the evidence base for its effectiveness. Gilroy et al. followed up 42 people who had SD for spider phobia in three 45-minute sessions. At both 3 and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. In a recent review, Wechsler et al. concluded that SD is effective for specific phobia, social phobia and agoraphobia. This means that SD is likely to be helpful for people with phobias.
• Another strength of SD is that it can be used to treat people with learning disabilities. The main alternatives to SD are often not appropriate for people with learning disabilities as they often struggle with cognitive therapies that require a high level of rational thought. People with learning disabilities may also feel confused and distressed by the traumatic experience of flooding. This means SD is often the most appropriate treatment for people with learning disabilities who have phobias.
• One strength of flooding is that it is highly cost-effective. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say ten sessions for SD to achieve the same result. Even allowing for a longer session this makes flooding more cost-effective. This means more people can be treated at the same cost with flooding than with SD or other other therapies.
• A limitation of flooding is that it is a highly unpleasant experience. Confronting one’s phobic stimulus in an extreme form provoked tremendous anxiety. Schumacher et al. found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent. ore seriously, the traumatic nature of flooding means that attrition (dropout) rates are higher than SD. This suggests that therapists may avoid using flooding.