Behavioural expaination&treatment for phobias

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Classical conditioning - Little Albert
neutral stimulus Rat (NS) - no fear of rats (before conditioning)

A loud bang (UCS) - causes fear and anxiety (UCR) (before conditioning)

rat (NS) and loud bang (UCS) - fear (UCR) (during conditioning)

rat (CS) - fear (CR) (evidence of conditioning)
Operant conditioning = changing a behaviour because of the consequences of a reward or for avoidance.

•Once a fear is established, the individual then avoids the object or situation that produces the fear

•This in turn reduces the anxiety

•It also strengthens the fear and makes it more likely that this object/situation will be avoided in the future.
Mowrer’s Two process model :
Phobias are acquired as a result of classical conditioning and maintained by operant conditioning.
Avoiding an unpleasant situation - it results a pleasant consequence.

•Mowrer suggested that whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have suffered if we had entered its presence or remained there.

•Reducing fear reinforces avoiding behaviour so the phobia is maintained.
Alternative explanation of phobias by Social learning theory:
A child may see a parent respond to a spider with extreme fear and this may lead to them to acquire the same behaviour because the fearful person gets attention. This is a reward.
Evaluation :
The importance of classical conditioning - people can often recall a specific incident when their phobia appeared e.g. being bitten by a dog.
However, not everyone can recall this, so it may be that different phobias are the result of different processes. Spider fear could be social through modelling, where as a dog phobia could be due to a specific incident.
Diathesis stress model:
Not everyone who has a specific negative incident will develop a phobia.
It could be that some people inherit a vulnerability for developing mental health disorders (diathesis). However, it will only develop if triggered by a specific incident (stress) e.g. being bitten by a dog.
Biological preparedness:
The two process model does not account, that some phobias are far more frequent than others in the general population.
It would appear that certain classes of stimuli are more easily conditioned than others. Perhaps because these were dangerous in our evolutionary past.
A good explanatory theory needs to take account of factors such as evolution and biological preparedness. The behavioural explanation on its own cannot be used to explain the development of all phobias.
Systematic desensitisation - a behavioural therapy
i.e. based on learning.
Anxiety hierarchy - high and low anxiety situations identified involving the phobic stimulus.
Relaxation - patient taught relaxation techniques or introduced to anti-anxiety drugs.
Gradual exposure - the patient works up the anxiety hierarchy, maintaining relaxation at each level.
How it works?
Counterconditioning - the phobic stimulus is paired with a
relaxing stimulus until it triggers relaxation, not anxiety.

The aim is to teach a patient to learn more appropriate association with the phobic stimuli. So, the response is relaxation instead of fear.
Aims of behavioural treatment for phobia?
Reduce phobic anxiety through the principle of classical conditioning - a new response to the phobic stimulus is paired with relaxation instead of anxiety - counterconditioning.
Reduce phobic anxiety through the principle of operant conditioning - there is no option for avoidance behaviour.
Systematic Desensitisation :
Wolpe (1958) – two competing emotions cannot occur at the same time so if fear is replaced with relaxation the fear cannot continue
Reciprocal inhibition - is the process of inhibiting anxiety by substituting a competing response (relaxation)
There are three processes involved in SD:
The anxiety hierarchy is constructed by the patient and the therapist (from least to most frightening).
The patient is trained in relaxation techniques so that they are relax quickly and as deeply as possible
The patient is then exposed to the phobic stimulus while practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.
Strength of SD: It is suitable for a diverse range of patients
The alternatives to SD - flooding and cognitive therapies - are not well suited to some patients. e.g. some sufferers of anxiety disorders like phobias also have learning difficulties, which can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies that require the ability to reflect on what you are thinking. For these patients SD is probably the most appropriate treatment.
Strength of SD: It is effective in the treatment of specific phobias. Research evidence - Gilroy et al. (2003) observed 42 patients who had been treated for spider phobia in three 45-minute sessions of SD.
Spider phobia was assessed on several measures (the Spider Questionnaire and by assessing response to a spider).
A control group was treated by relaxation without exposure. At both three months and 33 months after the treatment the SD group were less fearful than the relaxation group.
So it shows that SD helps reduce the anxiety in spider phobia and that the effects are long-lasting.
Strength of SD: It is acceptable to patients
Patients tend to prefer it when given the choice of SD or flooding. This is largely because it does not cause the same degree of trauma as flooding. Also because it includes some elements that are actually pleasant (learning relaxation procedures).
This is reflected in the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) of SD.
Flooding - is behavioural therapy.
Fast process - small number of long sessions, sometimes just one session of three hours.
Preparing the patient - flooding is a traumatic experience so the patient needs to be well prepared for the exposure.
How does flooding work?
Flooding stops phobic responses very quickly
•Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless - extinction.
•A learned response is extinguished when the CS (e.g. a dog) is encountered without the UCS (e.g. being bitten)
•The result is that the CS no longer produces the CR(fear)
Extinction: the conditioned stimulus is presented without the unconditioned stimulus until it no longer triggers a response.
Flooding involves overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur.
•No step by step build up.
•Individual is exposed repeatedly and in an intensive way.
•Individual has their senses flooded with thoughts, images and actual experiences of the object of their phobia.
Limitation of flooding: The treatment is traumatic for patients
*produces high levels of fear and this can be very traumatic and as a result many patients refuse to start or complete treatment.
*So individual difference make it less effective for some people.
*Time and money are sometimes wasted preparing patients only to have them refuse to start or complete treatment.
Strength of flooding: Effectiveness
The quick effect - patients are free of their symptoms as soon as possible.
Makes the treatment cheaper than alternatives.
For patients that do stick at it, it appears to be a very effective treatment.
It is not unethical as patients give their informed consent, so they know exactly what is involved
Patient has to be properly prepared for unpleasant process.
Limitation of behavioural therapies: Symptom substitution
Behaviour therapies may not work with some phobias because the symptoms are not the root cause of the issues.
If symptoms are removed the cause still remains and so the symptoms can resurface in another form.
Evidence is very mixed however behaviourists tend to not believe it happens at all.
Strength of flooding: It is cost-effective
Flooding is at least as effective as other treatments for specific phobias. Studies comparing flooding to cognitive therapies have found that flooding is highly effective and quicker than alternatives.