treating phobias (behavioural approach)

• behavioural approach to treating phobias

  • systematic desensitisation (SD) = involves gradually increasing exposure to the feared stimuli until it no longer induces anxiety
  • flooding (F) = involves exposing the subject to the most extreme scenarios straight away
• based on classical conditioning (SD)

  • therapy aims to gradually reduce anxiety through counterconditioning:
  • phobia is learned so that phobic stimulus (CS) produces fear (CR)
  • CS is paired with relaxation and this becomes the new CR
  • reciprocal inhibition = not possible to be afraid and relaxed at the same time, so one emotion prevents the other
• formation of anxiety hierarchy (SD)

  • client and therapist design an anxiety hierarchy - fearful stimuli arranged in order from least to most frightening
  • a person with arachnophobia might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula as the final item
• relaxation practiced at each level of the hierarchy (SD)

  • person with phobia is first taught relaxation techniques (such as deep breathing and/or meditation)
  • person then works through the anxiety hierarchy
  • at each level the person is exposed to the phobic stimulus in a relaxed state
  • this takes place over several sessions, starting at the bottom of the hierarchy
  • treatment is successful when the person can stay relaxed in high-anxiety situations
• strength = evidence of effectiveness (SD)

  • Gilroy et al = followed up to 42 people who had SD for spider phobia
  • at follow up, the SD group were less fearful than a control group
  • Wechsler et al = concluded that SD is effective for specific phobia, social phobia and agoraphobia
  • means that SD is likely to be helpful for people with phobias
• strength = usefulness for people with learning disabilities (SD)

  • main alternatives to SD are unsuitable for people with learning disabilities
  • eg = cognitive therapies require a high level of rational thought and flooding is distressing
  • SD does not require understanding or engagement on a cognitive level and is not a traumatic experience
  • means that SD is often the most appropriate treatment for some people
• limitation = timely and requires motivation (SD)

  • SD therapies have to take place over multiple sessions
  • with the sessions becoming even more intense (anxiety hierarchy) the patient may lose motivation to continue
  • => SD may not be as effective as thought for all patients
• immediate exposure to the phobic stimulus (F)

  • flooding involves exposing a person with a phobia with the phobic object without a gradual build up
  • eg = a person with arachnophobia receiving flooding treatment may have a large spider crawl over their hand until they can relax fully (person not spider)
• extremely quick learning through extinction (F)

  • without the option of avoidance = the person quickly learns that the phobic object is harmless through the exhaustion of their fear response (called exhaustion)
• ethical safeguards (F)

  • flooding is not unethical but it is an unpleasant experience - so it is important that people being treated give informed consent
  • they must be fully prepared and know what to expect
• strength = cost effective (F)

  • a therapy is described as cost effective if it is clinically effective and not expensive (flooding can work as little as one session)
  • even with a longer session (eg 3 hours) this makes more cost-effective than alternatives
  • => more people can be treated at the same cost by flooding than by SD or other therapies
• limitation = it is traumatic (F)

  • Schumacher et al = found that both pps and therapists rated flooding as more stressful than SD
  • => there are ethical concerns about knowingly causing stress (offset by informed consent), and the traumatic nature of flooding also leads to higher attrition rates than for SD
  • suggests that overall therapists may avoid using this treatment
• extra evaluation = symptom substitution (F)

  • behavioural therapies do not treat causes so symptoms reappear (eg Persons found that a woman with death phobia which turned into a fear of criticism)
  • BUT = the only evidence for symptom substitution comes in the form of case studies which may not generalises to all cases and phobias
  • means that symptom substitution is largely a theoretical idea and there is only relatively poor empirical evidence to support it