Treating Phobias

• What is the behaviourist approach to treating phobias?

  behaviourist therapies assume phobias are learnt associations and attempt to replace the fear association with relaxation
• What is reciprocal inhibition?

  - fear and relaxation are two antagonistic emotions

  - you cannot feel two opposite emotions simultaneously

  - if the therapist can help the client hold the object without fear, they have been successfully counter-conditioned and no longer have the phobia
• What is the main difference between systematic desensitisation and flooding?

  how they help the client reach the point of feeling no fear in the presence of the phobic object
• What is systematic desensitisation?

  1) therapist teaches the client relaxation techniques e.g. breathing exercises

  2) the client creates an anxiety hierarchy, a list of feared situations with the phobic object, from the least to the most feared

  3) the client is exposed to each level of the anxiety hierarchy, starting with the least anxiety-producing level of the anxiety hierarchy. Importantly, the client must relax at each stage, and the therapist moves to the next step only when the client is fully relaxed

  4) when the client can hold the phobic object without fear, the association is extinct and a new association with relaxation is formed
• What is flooding?

  1) flooding attempts to counter-condition a phobia by immediate and full exposure to the maximum level of phobic stimulus e.g. the top level of the anxiety hierarchy

  2) immediate exposure is expected to cause an extreme panic response in the client e.g. crying/ screaming

  3) the therapist's job is to stop the client from escaping the situation

  4) a fear response takes energy. Eventually, the client will becomes exhausted and calm down in the presence of the phobic object

  5) if the client ends the treatment before this point, anxiety will decrease due to removing the stimulus and the phobia will have been reinforced
• WEAKNESS of the Behaviourist approach to treating phobias: SD and Flooding not always effective

  EVIDENCE - SD is often the client's preferred treatment as they are in control of their progress. This makes it a more pleasurable experience as they limit their anxiety. However, this slower process can result in more sessions compared to flooding, which sometimes is just one session of 3hours (to achieve the same result)

  EXP - Due to it's stressful nature, flooding isn't appropriate for older people, people with heart conditions or children

  EVAL - Also, the phobia is reinforced if flooding fails and the client is released before the anxiety subsides
• WEAKNESS of the Behaviourist approach to treating phobias: SD and Flooding aren't generalisable

  EVIDENCE - the effectiveness of both SD and flooding may be limited to the controlled environment of a therapist's office (when the phobia is being treated)

  EXP - it could be that this effect isn't generalisable to experiences in the real world

  EVAL - for instance, a person may successfully conquer their fear of birds in the presence of a tame bird within the therapist's rooms, but when confronted with numerous wild birds in the outside world, their phobia may resurface
• WEAKNESS of the Behaviourist approach to treating phobias: SD and Flooding cannot treat social phobias

  EVIDENCE - both SD and flooding are more effective in treating specific phobias (e.g. fear of objects) than social phobias. For simple phobias, they have a 80-90% success rate

  EXP - it is generally easier to construct and gradually advance an anxiety hierarchy for object-related phobias, or undergo a complete and intense exposure to snakes within a controlled setting than to stimulate social situations and interactions with unfamiliar individuals in a therapist's office

  EVAL - this suggests that SD and flooding aren't effective treatments for all phobias
• WEAKNESS of the Behaviourist approach to treating phobias: drug treatments may be better

  EVIDENCE - pharmacological (drug) interventions such as benzodiazepines and antidepressants are considered effective alternative treatments for phobias

  EXP - these medications effectively reduce anxiety and alleviate phobic responses, and are generally quicker and less expensive than SD or flooding, which require multiple sessions with a qualified therapist

  EVAL - nonetheless, due to the temporary nature of drug therapy and the potential adverse effects, sufferers often prefer behavioural treatments, and medications are typically used as a temporary measure before undergoing therapy
• STRENGTH of the Behaviourist approach to treating phobias: the principles of SD are valid

  EVIDENCE - recent developments of virtual-reality technology have allowed the principles of SD to be adapted into 'virtual reality exposure therapy'

  EXP - Garcia-Palacios found 83% of pps treated with VR exposure to spiders showed clinically significant improvement, compared to 0% in the control group

  EVAL - this demonstrates that the principles of SD are valid, and the use of VR allows a wider range of phobias to be treated
• What type of therapy is SD and Flooding?

  Behavioural
• How does SD work?

  • based on the principles of classical conditioning
  • maladaptive learning is unlearnt and new associations with relaxation are formed
  • counter-conditioning - the phobic stimulus is paired with a relaxing stimulus until it triggers relaxation instead of anxiety
• How does flooding work?

  • patient experiences full exposure to their fear in a safe environment
  • avoidance is prevented and exposure continues until they are calm, the anxiety has receded and the fear is extinguished
  • a new stimulus-response link is learned between the feared stimulus and relaxation
• WEAKNESS of the Behaviourist approach to treating phobias: symptom substitution may occur

  EVIDENCE - behavioural therapies may not work with certain phobias because the symptoms are only the tip of the iceberg

  EXP - if the symptoms are removed, the cause still remains, and the symptoms will simply resurface in another form

  EVAL - this is because the behavioural therapies make no attempt to address any deeper psychological/ emotional issues