Phobias treatment Behaviourist

• What is systematic desensitization based on?

  • classical conditioning
  • No two emotional states cannot exist at the same time
• What is counter conditioning?

  • Patient is taught a new association that runs counter to the original
  • Classical conditioning used to associate the phobic stimulus with relaxation instead of fear = anxiety is reduced or desensitised.
  • Reciprocal inhibition - the response of relaxation inhibits the response of anxiety
• SD step 1 - relaxation

  • patient learns relaxation techniques
  • E.g. Controlled breathing
• SD step 2 - desensitization

  • gradually introducing the person to the feared situation
  • At each stage patient practices relaxation so their anxiety diminishes
• 6 steps of Systematic Desensitisation

  1. Teach relaxation techniques
  2. Construct a desensitization hierarchy (least to most fear provoking)
  3. Gradually work through hierarchy
  4. Only move onto next step after last has been 100% mastered
  5. Reach top of hierarchy (patient has overcome fear)
  6. Can be in vivo (in person) or in vret / vitro (images of phobia)
• Strength of SD

  • effectiveness
  • Successful for a range of phobic disorders
  • McGrath (1990) - reported 75% of patients with phobic disorders respond to SD
  • Choy (2007) - in vivo is the best method
  • Comer (2003) - modelling can also help - watching someone else who is coping well with stimulus
• Strength of SD - general effectiveness of behavioural therapies

  • generally fast and less effort than psychotherapies
  • so they are useful for those that lack insight, such as children or adults with learning difficulties.
  • SD can also be self-administrated and has been found to be just as effective as therapist lead SD, this will be a lot cheaper
• Weakness of SD- not appropriate for all phobias

  • Ohman (1975)- due to the preparedness, SD may not be as effective in treating phobias with an evolutionary survival component
  • such as fear of the dark, compared to those that have been developed due to a personal experience.
• What is flooding?

  • one long session that lasts 3 hours
  • Patient experiences the phobia at its worst while practicing relaxation techniques
  • Can be in vivo or in vret
• Example of flooding:

  Patient who fears spiders- put in a room full of roaming spiders for 3 hours
• How does flooding work?

  • the fear response has a time limit as it is exhausted
  • A new association between feared stimulus and relaxation is learned
  • Very quick learning through extinction - no option for avoidance, fear response is exhausted (known as extinction)
• Flooding ethics (AO1)

  • isn't unethical, but is unpleasant
  • Important that those being treated give informed consent
• Strength of flooding:

  • quick and cost effective
  • Only 1 session - many for SD,
  • However, Craske (2008) - SD and flooding were equally effective.
  • cost-effective = it is clinically effective and not expensive (can work in as little as one session)
  • Even with a longer session it is more cost-effective than alternatives
• Weakness of flooding

  • traumatic
  • Isn’t for everyone -> it is very intense and puts the patient under immense anxiety
  • Therefore patients may quit during the treatment which reduces the ultimate effectiveness of flooding.
  • Schumacher at al. (2015)- participants and therapists rated flooding as more stressful than SD - there are ethical concerns about the stress caused
  • So therapists may avoid using it
• Weakness of flooding

  • symptom substitution
  • Behavioural therapies remove symptoms but does not treat the overall cause.
  • May lead to symptom substitution
  • E.g. a smoker quits smoking but then comfort eats because the underlying smoking issue was not dealt with.