Treating phobias:

• What are the two ways of treating phobias?

  1. Systematic desensitisation
  2. Flooding
• What is systematic desensitisation?

  Therapeutic technique for reducing anxiety by gradually exposing a person to feared stimuli.
• What are the three process involved in SD?

  1. Anxiety hierarchy
  2. Relaxation
  3. Exposure
• Anxiety hierarchy:

  The anxiety hierarchy is put together by the patient and therapist. 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 patient to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. The relaxation might involve breathing exercises or alternatively the patient might learn mental imagery techniques. Patients can be taught to imagine themselves in relaxing situations or they might learn meditation.
• Exposure:

  Finally the patient is exposed to the phobic stimulus while in a relaxed state. This takes place over several sessions, starting at the bottom of the anxiety hierarchy. When the patient can stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy. Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy.
• What is flooding?

  Flooding involves exposing phobic patients to their stimulus without a gradual build up in an anxiety hierarchy. Instead flooding involves immediate exposure to a very fearful situation. So an arachnophobia receiving flooding treatment might have a large spider crawl over them for an extended period.
• How do flooding sessions differ from SD sessions?

  Flooding sessions are typically longer, one session typically lasts two or three hours.
• What is the result of flooding?

  Flooding stops phobic responses very quickly. This may be because, without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless. In classical conditioning this is called extinction. A learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus. The result is that the conditioned stimulus no longer produces the conditioned response (fear).
• Strength of SD:

  P- One strength is that there is evidence that SD is an affective treatment for phobias

  E- For example, Gilroy et al al (2003) studied 42 arachnophobic patients who had received three 45-minute sessions of SD. These patients were compared to a control group who where taught relaxation techniques but did not experience exposure. At both 3 months and 33 months after treatment ended, the SD group were less fearful than the control group.

  L- This suggests that SD is effective at treating phobias, and that the effects are long lasting
• Strength of SD:

  P- An additional strength is that SD can be used to help people with learning difficulties. Some people requiring treatments for phobias also have a learning need, however the main alternatives to SD are not suitable.

  E- People with learning difficulties often struggle with cognitive therapies that require complex rational thoughts. They may also feel confused and distressed by the traumatic experience of flooding.

  L- This means that SD is often the most appropriate treatment for those who maybe need additional support and care.
• Limitation of SD:

  P- One limitation of SD is that there is evidence that SD is not effective at treating all phobias

  E- For example, Ohman et al (1975) found that SD is not as effective at treating phobias that have an underlying evolutionary survival component (e.g. fear of snakes, rats and heights)

  L- It is most effective at treating phobias that have been acquired through a traumatic incident. This suggests that SD can only be used effectively in tackling some phobias.
• Strength of Flooding:

  P- One strength of flooding is that there is evidence to show that it is an effective treatment

  E- For example, Choy et al (2007) reported that flooding is more effective that SD at treating phobias. Also, Ougrin (2011) found that flooding is more effective and faster than cognitive treatments for phobias.

  L- This supports the use of flooding as a behavioural treatments for phobias. However, other reviews concluded that SD and flooding were equally effective, which suggests that flooding is just one of several options for the treatments of phobias
• Limitation of flooding:

  P- One limitation is that flooding can be highly traumatic for patients

  E- Schumacher et al (2015) found that patients and therapists rated flooding as significantly more stressful that SD. This raises an ethical issue for psychologists of knowingly causing stress to their clients.

  L- This suggests that therapists may avoid using the treatment as they are aware that flooding is a highly unpleasant experience and may lead to high drop out rates.
• Limitation of flooding:

  P- A limitation of behavioural therapies, including flooding is that they only mask symptoms and do not tackle the underlying cause of phobias (symptom substitution)

  E- For example, Persons (1986) reported a case of a woman with a phobia of death who was treated using flooding. Her fear of death declined, but her fear of being criticised got worse.

  L- This suggests that even though the symptoms are removed, the cause still remains and symptoms will resurface, possibly in another form.