The Behavioural approach to treating phobias

• What are the two types of phobia treatment stemming from the behavioural approach?

  • Systematic desensitisation
  • Flooding
• What is systematic desensitisation?

  • Joseph Wolpe (1968)
  • Aims to gradually reduce phobic anxiety
  • 4-6 short sessions
  • Uses classical conditioning to counter-condition
  • Pairs conditioned phobic stimulus with new response (relaxation)
• How does systematic desensitisation work?

  • Reciprocal inhibition -> when one thing (relaxation) starts, the other thing (anxiety) stops (this allows counter-conditioning)
  • Therapist teaches relaxation techniques (e.g. breathing + grounding exercises)
  • Collaboration on anxiety/desensitisation hierarchy (can involve covert + in vivo desensitisation)
  • Patient gradually works up hierarchy = new stimulus-response link learned
  • Result = mastery of fear
• Systematic desensitisation A&E point 1: research evidence = it is effective

  • Gilroy et al. (2003)
  • 42 patients (SD) + control group (relaxation + no exposure)
  • 3 x 45 min sessions
  • Assessed on several measures including 'Spider Phobia Questionnaire'
  • At 3 months and 33 months, exposure group = less fearful than control
  • McGrath et al. (1990)
  • 75% of patients respond to SD
  • SD clearly works effectively on a majority of people
• Systematic desensitisation A&E point 2: it is not always equally effective

  • Gilroy et al. (2003) -> SD didn't work on 25% of ppts
  • Covert desensitisation doesn't work well for people with poor imagination/aphantasia
  • Particular subtypes of phobias are treatable with SD BUT phobias with no specific source (e.g. social phobias) = SD ineffective
  • Choy et al. (2007) -> SD good at decreasing anxiety but not for decreasing avoidance behaviours = phobia maintained
  • Range of therapies effective as well as SD depending on the person (e.g. CBT)
• Systematic desensitisation A&E point 3: patients have to be highly motivated to continue

  • Involves deliberate engagement with phobic stimulus
  • Requires conscious decision to think about/interact with phobic stimulus
  • Can increase anxiety
  • For SD to be effective, in vivo techniques required (Choy et al. 2007)
  • High drop-out rate because people don't want to go back to sessions
• What is flooding?

  • A.K.A. 'implosion therapy'
  • Thomas Stampfl (1967)
  • One intense long session
• How does flooding work?

  • Reciprocal inhibition -> anxiety + relaxation incompatible
  • Therapist teaches relaxation techniques (must teach people how to calm themselves)
  • Goal is extinction of phobia
  • Immediate exposure to phobic stimulus (either in vivo or in VR)
  • 2-3 hours (fear response limited to 20 mins) + prevention of escape unless entirely necessary (decided upon by therapist)
  • Once initial fear dissipates -> relaxation techniques employed
  • New stimulus-response link learned = mastery of fear
• Flooding A&E point 1: it is effective and cost-effective

  • Ougrin (2011)
  • Equally effective to other therapies, e.g. cognitive therapies
  • Much quicker process
  • Therefore it is cheaper + more accessible
  • Choy et al. (2007)
  • Flooding more effective than SD
• Flooding A&E point 2: ethical issues -> it is highly traumatic

  • Vital that fully informed consent is achieved
  • Inability to leave = considerable problem
  • Frequent drop-outs = wasted money + skews results of studies into effectiveness
  • If not completed it could reinforce the phobia!!
• SD and flooding A& point 1: could be treating the symptoms not the cause

  • Largely believed by non-behavioural psychologists that 'symptom substitution' may be an issue
  • Possible reason for this -> anxiety = displaced + has other underlying cause (one phobia is seemingly 'cured' but another one develops shortly after)
  • Not effective treatment if true as therefore another phobia/disorder will arise
• SD and flooding A&E point 2: suggestion that psychodynamic + biological approaches would be more appropriate

  • Psychodynamic approach -> Little Hans!! (supported by a case of Wolpe's in which a woman with a phobia of spiders was cured by 'talking through' marital problems rather than SD because her husband would call her a bug/insect/spider + the fear became displaced onto real spiders)
  • Biological approach -> Aouizerate et al. (2004) = SSRIs improve anxiety in 50-80% of social phobias