treating phobias

• both methods are based mainly on classical conditioning, but you should also notice how operant conditioning is involved. in practice, the two forms of conditioning work together - because that is how the phobia is learned in the first place
• systematic desensitisation was developed by wolpe during the 1950s. it aims to remove the fear response of a phobia, and substitute a relaxation response to the conditional stimulus gradually using counter conditioning
• there are three phases to systematic desensitisation:

  1. the patient is taught deep muscle relaxation techniques and breathing exercises
  2. create a desensitisation hierarchy
  3. the patient works their way up the fear hierarchy in a systematic way, starting at the least unpleasant stimuli and practising their relaxation technique as they go. this is a form of counterconditioning
• counter conditioning

  • the basis of the therapy where a patient is taught a new association that counters the original association that counters the original association
  • so via classical conditioning, the patient will be taught to relax when presented with the feared stimulus
  • this is also known as reciprocal inhibition because the relaxation inhibits anxiety
• in systematic desensitisation, if the client becomes upset, they can return to an earlier stage and regain their relaxed state. the client repeatedly imagines this situation until it fails to evoke any anxiety at all, indicating that the therapy has been successful.
• in systematic desensitisation, the number of sessions required depends on the severity of the phobia. usually 4-6 sessions, up to 12 for a severe phobia. the therapy is complete once the agreed therapeutic goals are met (not necessarily when the person’s fears have been completely removed)
• exposure in systematic desensitisation can be done in two ways:

  • in vivo: client is actually exposed to the phobic stimulus
  • in vitro: client imagines exposure to the phobic stimulus

  menzies and clarke (1993) research has found that in vivo techniques are more successful than in vitro
• a quicker form of therapy is called flooding (also known as implosion therapy)
• flooding works by exposing the patient directly to their worst fears - e.g. a claustrophobic will be locked in a closet for 4 hours or an individual with a fear of flying will be sent up in a light aircraft
• what flooding aims to do is expose the sufferer to the phobic object or situation for an extended period of time in a safe and controlled environment, preventing the unusually reinforcing escape response. it uses something called ‘stimulus satiation’ - the fact that fear is a time limited response
• in flooding, the person is at first in a state of extreme anxiety, perhaps even panic, but eventually exhaustion sets in and the anxiety level begins to go down
• flooding still uses counterconditioning - but without the hierarchy - and can be conducted in vivo or in virtual reality
• flooding stops phobic responses quickly. without the option for avoidance, the patient quickly learns that the phobic stimulus is harmless - 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