Behavioural treatments of phobias

• What is systematic desensitisation?

  Behavioural therapy that gradually reduces phobic anxiety through classical conditioning
• What is using classical conditioning to learn a different response to phobias called?

  Counterconditioning
• What are the three processes involved in classical conditioning?

  • Anxiety hierarchy
  • Relaxation
  • Exposure
• What is an anxiety hierarchy?

  A list of situations related to the phobic stimulus that provoke anxiety arranged from the least to most frightening
• Who comes up with the anxiety hierarchy?

  Both the client and the therapist
• What do therapists do in the second stage of systematic destination?

  Relax the client with breathing exercises, mental imagining techniques or even medication
• What is it called where you cannot be anxious and relaxed at the same time?

  Reciprocal inhibition
• Why can't you be anxious and relaxed at the same time?

  You can't in both the sympathetic and parasympathetic state at the same time
• How does exposure work in systematic desensitisation?

  The client is then exposed to the phobic stimulus while in a relaxed state Several sessions from bottom of the anxiety hierarchy to top when the client can stay relaxed in the presence of the phobic stimulus
• When is systematic desensitisation successful?

  When the client can stay relaxed in situations high on the anxiety hierarchy
• What is flooding?

  Exposing people to their phobic stimulus without a gradual build-upImmediate exposure to a very frightening situation
• How does flooding work?

  • client quickly learns that the phobic stimulus is harmless
  • A learned response is extinguished when the conditioned stimulus is encountered without unconditioned stimulus
  • The conditioned stimulus no longer produces the conditioned response
• What happens in flooding in classical conditioning terms?

  Extinction
• Ethical problems with flooding

  • An unpleasant experience and so it is important that clients give fully informed consent.
  • They need to fully understand and be prepared before the flooding session
  • A client would usually be given a choice between flooding or systematic desensitisation.
• Strengths of systematic desensitisation

  • Is the evidence base for its effectiveness
  • Helps treat phobias in individuals with learning disabilities
• Why "Is the evidence base for its effectiveness" a strength of systematic desensitisation?

  • Gilroy et al (2003) followed up 42 people who had SD in 3 45 minute sessions
  • At both 3 and 33 months SD group were less fearful than control group treated by relaxation without exposure
  • In a recent review Wechsler et al (2019) concluded that SD is effective for specific, social and agoraphobia
  • SD is likely to be helpful for people with phobias
• Strenth - "Helps treat phobias in individuals with learning disabilities"

  
  

  • People with learning disabilities often struggle with cognitive therapies that aim to change thinking patterns
  • This is because they require complex rational thought, They may also feel confused and distressed by the traumatic experience of flooding
  • SD is often the most appropriate treatment for individuals with learning disabilities who have phobias
• VR for systematic desensitisation point


  • Traditional systematic desensitisation involves exposure to the phobic stimulus in a real-world setting
  • However advances in technology have led to part of the exposure being conducted in virtual reality
• VR for systematic desensitisation strengths

  • Controllable
  • Less expensive - flying
  • Avoids dangerous situations - heights
  • Participants more willing to take part
• VR for systematic desensitisation limitations

  Lacks realism - particularly for social phobias, meaning it can be less effective - Wechsler et al 2019
• Strength of flooding

  Highly cost-effective
• Why "Highly cost-effective" a strength of flooding?

  • When providing therapies in systems like the NHS we also need to think about how much they cost
  • Cost-effective if it is clinically effective and not expensive Flooding can work in one session compared to SD which takes longer
  • More people can be treated at the same cost with flooding than with SD or other therapies
• Limitation of flooding

  Highly unpleasant experience (traumatic)
• Why "Highly unpleasant experience (traumatic)" a limitation of flooding?

  • Confronting phobic stimulus in extreme form provokes tremendous anxiety
  • Schumacher et al (2015) found that participants and therapists rated flooding as significantly more stressful than SD
  • Ethical issue for psychologists of knowingly causing stress to their clients, need informed consent
  • More traumatic nature of flooding means that dropout rates are higher than for SDTherapists may avoid using this treatment