behavioural approach to treating phobias

• Systematic desensitisation (SD)

  A behavioural therapy designed to reduce an unwanted response, such as anxiety. SD involves drawing up a hierarchy of anxiety-provoking situations related to a person's phobic stimulus, teaching the person to relax, and then exposing them to phobic situations. The person works their way through the hierarchy whilst maintaining relaxation.
• Flooding

  A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions.
• One strength of systematic desensitisation (SD) ?

  P - is the evidence base for its effectiveness.

  E - Gilroy et al. 2003) followed up 42 people who had SD for spider phobia in three 45-minute sessions. At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. In a recent review Wechsler et al. (2019) concluded that SD is effective for specific phobia, social phobia and agoraphobia.

  L - SD is likely to be helpful for people with phobias.
• A further strength of SD ?

  P - it can be used to help people with learning disabilities.

  E - Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require complex rational thought. They may also feel confused and distressed by the traumatic experience of flooding.

  L - SD is often the most appropriate treatment for people with learning disabilities who have phobias.
• One strength of flooding ?

  P - it is highly cost-effective.

  E - Clinical effectiveness means how effective a therapy is at tackling symptoms. However when we provide therapies in health systems like the NHS we also need to think about how much they cost. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session this makes flooding more cost-effective.

  L - more people can be treated at the same cost with flooding than with SD or other therapies.
• One limitation of flooding ?

  P - it is a highly unpleasant experience.

  E - Confronting one's phobic stimulus in an extreme form provokes tremendous anxiety. Schumacher et al. (2015) found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent. More seriously, the traumatic nature of flooding means that attrition rates are higher than for SD.

  L - overall, therapists may avoid using this treatment.
• How does flooding work?

  Flooding stops phobic responses very quickly. as without the option of avoidance behaviour, client quickly learns that phobic stimulus is harmless.

  In classical conditioning terms this process 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.

  In some cases the client may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response!
• Systematic desensitisation?

  reduce phobic anxiety through classical conditioning. three processes involved in SD.

  1.  anxiety hierarchy is put together by a client with phobia and therapist. a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening.
  2. Relaxation - therapist teaches the client to relax as deeply as possible. might involve breathing exercises or learn mental imagery techniques. can be taught to imagine themselves in relaxing situations or learn meditation.
  3. Exposure - client is exposed to the phobic stimulus while in a relaxed state. takes place across several sessions, starting at the bottom of the anxiety hierarchy.When they can stay relaxed in the presence of the phobic stimulus move up hierarchy.