BEHAVIOURAL APPROACH TO TREATING PHOBIAS

• Systematic desensitization (SD) is a behavioral therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning
• The aim of SD is to replace a faulty association between the conditioned stimulus and conditioned response that has resulted in a phobic response
• Counter-conditioning is when the sufferer learns to relax in the presence of the phobic stimulus, leading to a new response of relaxation instead of anxiety
• Reciprocal inhibition states that it is impossible to be afraid and relaxed at the same time
• There are two types of systematic desensitization: in vivo (exposed to the actual phobic object or situation) and in vitro (imagining being exposed to the phobic object or situation)
• Processes involved in SD:

  • Relaxation: therapist teaches patient to relax deeply, using techniques like breathing exercises or mental imagery
  • Anxiety hierarchy: a list of situations related to the phobia arranged from least to most frightening
  • Gradual exposure: patient is gradually exposed to the phobic stimulus while in a relaxed state, moving up the hierarchy as they stay relaxed
• Effectiveness- It is effective

  • Research shows it is effective in treating specific phobias
  • Gilroy et al (2003) found that patients treated for spider phobia with SD were less fearful than a control group treated with relaxation, both at 3 and 33 months after treatment
  • McGrath et al (1990) reported that 75% of clients with phobias responded to SD
  • Choy et al (2007) highlighted that in vivo exposure (actual contact with the feared stimulus) is more successful than exposure through pictures or imagination (in vitro)
• Effectiveness-Relaxation may not be necessary.

  • The success of SD may be more related to exposure of the feared situation rather than relaxation.
  • Klein et al (1983) found no difference in effectiveness between SD and supportive psychotherapy, suggesting that the 'active ingredient' in SD may be generating hopeful expectancies that the phobia can be overcome.
• Appropriateness- It is more preferable to flooding for many

  
  

  • Patients prefer SD over flooding because of its more gentle step-by-step approach
  • SD is seen as less traumatic and more ethical due to working slowly through the hierarchy
  • Low refusal rates and low attrition rates indicate that SD is an appropriate treatment for many clients with phobias
• Appropriateness-symptom substitution:

  • The psychodynamic model claims that SD and other behavioural therapies focus only on symptoms and ignore the underlying causes of abnormal behaviour
  • Psychoanalysts believe that treating symptoms without addressing underlying emotional problems can lead to symptom substitution, where the problem manifests in different symptoms
  • Behaviourists argue that symptoms are the disorder and do not see a need to look beyond the behavioural symptoms
• Immediate exposure to the phobic stimulus

  • Flooding aims to expose the sufferer to the phobic object or situation for an extended period of time in a safe and controlled environment
  • Immediate exposure to the phobic stimulus in flooding involves bombarding the phobic patient with the phobic object (in-vivo exposure) until the person is calm and does not fear the stimulus, without a gradual build-up
  • Flooding sessions are typically longer than systematic desensitization (SD) sessions, with one session often lasting two to three hours
• Prevention of avoidance:

  • Avoidance behaviors maintain the phobia as the phobic cannot learn that the thing they fear is not harmful
  • Stopping the phobic patient from making their usual avoidance responses is necessary to prevent reinforcement of the phobia
• Ethical safeguards for flooding:

  • Flooding is not unethical, but it is an unpleasant experience, so it is important that patients give informed consent
  • Patients must be fully prepared and know what to expect before exposure
  • Clients might be trained in relaxation techniques before exposure to better control their fearful response
• Exhaustion of Phobic Response:

  • Without the option of avoidance behavior, the patient quickly learns that the phobic object is harmless through the exhaustion of their fear response
  • Known as extinction, where the conditioned stimulus (spider) no longer produces the conditioned response (fear)
• Effectiveness- It is effective

  • Appears to be an effective treatment
  • Wolpe (1973) conducted a study where a girl scared of cars was driven around for hours, leading her to associate a sense of ease with cars after realizing her safety
  • Choy et al (2007) found flooding more effective than systematic desensitization at treating phobias
• Effectiveness- It is less effective for social phobia

  • Less effective for social phobias compared to simple phobias
  • Social phobias involve cognitive aspects where sufferers have unpleasant thoughts about social situations
  • Cognitive therapies may be more beneficial for social phobias as they tackle irrational thinking
• Appropriateness- Treatment can be highly traumatic for patients

  • Can be highly traumatic for patients
  • Important to conduct a cost-benefit analysis before engaging in flooding as it can be psychologically harmful
  • Flooding is not unethical, but might be viewed as too traumatic for children who may not fully understand what they are consenting to
  • Many patients starting with flooding may not see it through to the end, leading to wasted time and money preparing patients who refuse to start or complete treatment
• Appropriateness- symptom substitution

  • Psychodynamic model claims that flooding focuses only on symptoms and ignores the underlying causes of abnormal behavior
  • Psychoanalysts believe that treating symptoms without addressing underlying problems leads to symptom substitution, where the problem manifests in different symptoms
  • Behaviorists reject this criticism, stating that symptoms are the disorder and do not need to look beyond them