Behavioural approach to treating phobias

• Two ways to treat phobias are: systematic desensitisation and flooding.
• systematic desensitisation aims to gradually reduce anxiety through counterconditioning. phobia is learned so that stimulus (CS) created fear (CR). counterconditioning pairs the CS with relaxation and this becomes the new CR.

  reciprocal inhibition means that it is not possible to be afraid and relaxed at the same time, so one emotion prevents the other.
• Anxiety hierarchies

  patient and therapist design anxiety hierarchies- a list of fearful stimulus arranged in order from least to most frightening.
• how is an anxiety hierarchy used?

  phobic individual first taught relaxation techniques (e.g. deep breathing). patient then works through anxiety hierarchy. at each level the phobic is exposed to the phobic stimulus in a relaxed state. takes place over several sessions starting at the bottom of the hierarchy. treatment is successful when the person can stay relaxed in situations high on the hierarchy.
• flooding

  involves bombarding the phobic with the phobic object without a gradual build-up. without the option of avoidance behaviour, the patient quickly learns that the object is harmless through the exhaustion of their fear response, know as extinction.
• ethical safeguards around flooding

  flooding isn't unethical but is an unpleasant experience so it is important that patients give informed consent. they must be fully prepared and know what to expect.
• strength of SD: effective

  Gilroy et al. followed up 42 patient who had SD for arachnophobia in three 45-min sessions. at both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. this is a strength as it shows SD is helpful in reducing the anxiety in spider phobia and that the effects of the treatment are long-lasting.
• strength of SD: acceptable to patients.

  patients prefer it and tend to choose it over flooding. this is because it doesn't cause the same degree of trauma as flooding. it may also be because SD includes some elements that are actually pleasant, such as time talking with a therapist. this is reflected in the low refusal rates and low attrition rates (number of patients dropping out of treatment) for SD.
• limitation of flooding: traumatic

  highly traumatic experience. problem is not that flooding is unethical (patients give informed consent) but that patients are often unwilling to see it through to the end. this is a limitation as ultimately it means that the treatment is not that effective, and time and money are wasted preparing patients only to have them refuse to start or complete the treatment.
• limitation: flooding is less effective for some types of phobia

  although flooding is highly effective for treating simple phobias, it appears to be less so for more complex phobias like social phobias. this may be because social phobias have cognitive aspects, e.g. a sufferer of social phobia doesn't simply experience anxiety but thinks unpleasant thoughts about the social situation. this type of phobia may benefit more from cognitive therapy because such therapies tackle the irrational thinking