Phobias

• Systematic desensitisation


  A behavioural treatment method based on classical conditioning, where the phobia is counter-conditioned or unlearned
• Systematic desensitisation


  1. Replacing a fearful reaction with relaxation

  2. The conditioned stimulus (the feared object/situation) is gradually re-experienced and a new response (relaxation rather than fear) is learned
• Processes involved in systematic desensitisation

  1. Client is taught deep muscle relaxation techniques (e.g. breathing techniques, visualising a peaceful scene) to achieve a relaxed state

  2. Client and therapist establish a fear hierarchy which lists fearful situations starting from the least anxiety provoking situation up to the most fearful situation

  3. Client is then introduced to the least anxiety provoking stimulus whilst muscle relaxation is induced. When they are relaxed, the next stimulus on the hierarchy is introduced, again until they are relaxed. The process continues through the hierarchy until the client can experience the most anxiety-provoking stimulus while staying relaxed
• Systematic Desensitisation


  A therapy where a pleasant stimulus is introduced whenever the feared stimulus is present, gradually reducing the fear response
• Case of Little Peter (Jones 1924)

  • Little Peter had an extreme fear of rats, rabbits, feathers, and cotton wool. A pleasant stimulus (food) was introduced whenever the rabbit was present, starting with the rabbit being far away and progressing to Peter petting the rabbit. By the end, Peter showed no fear of the rabbit.
• Systematic Desensitisation


  • The key to success appears to lie with actual contact with the feared stimulus so in vivo (real life) techniques are more successful than in vitro (imagination)
• McGrath et al (1990) reported that about 75% of patients with phobias respond to systematic desensitisation
• Klosko et al (1990) suggested that systematic desensitization was as good as or better in treating phobias than the most popular drugs. On completion of treatment, 87% of patients from the systematic de-sensitization treatment group were free of fear/anxiety compared to 50% of the drug treatment group.
• Systematic desensitisation


  • Less appropriate for complex phobias like agoraphobia or social phobias
  • Not practical to expose gradually a client to the variety of stimuli involved
  • Entirely appropriate for simple phobias (a phobia for one stimulus)
• Symptom substitution


  May be an issue as the treatment does not deal with the cause of the phobia (it simply replaces the effect / symptom), the symptoms can re-emerge, possibly in another form

  This is supported by Freud's case study of Little Hans - his fear of his father was displaced onto horses
• Flooding


  • Quicker alternative treatment
  • Client is exposed to a feared object (eg. spider) or situation (e.g. heights) without any gradation of exposure or attempt to reduce prior anxiety
  • More traumatic for this reason
  • Ethically systematic desensitisation may be a better alternative
• Flooding


  A behaviourist therapy where clients go straight to the top of the hierarchy and imagine or have direct contact with their most feared scenarios
• Flooding treatment


  1. Clients are taught relaxation techniques first

  2. Arachnophobic (fear of spiders) receives a large spider crawling over them for an extended period or imagines being locked in a room full of spiders
• Theory of flooding


  • Clients cannot make their usual avoidance responses and anxiety peaks at such high levels it cannot be maintained and eventually decreases
  • As the response is decreasing, the patient is learning that the phobic stimulus is harmless
• Extinction (in classical conditioning)

  • A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten)
  • The conditioned stimulus no longer produces the conditioned response (fear)
• Flooding


  A treatment where a person is forced to confront their feared object/situation until their anxiety is eradicated
• Flooding


  • Wolpe (1960) used flooding to remove a girl's phobia of being in cars. The girl was forced into a car and driven around for four hours until her hysteria was eradicated and her phobia extinguished
• Flooding appears to be less effective for treating more complex phobias like social phobias

  This may be because social phobias have cognitive aspects.

  For example, a sufferer of a social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation.
• Systematic desensitisation


  An alternative treatment to flooding
• Flooding


  • It is a quicker alternative treatment to systematic desensitisation
  • It is only suitable for patients who are in good physical health, as the extreme anxiety levels caused by confrontation with feared objects/situations, although short lived can be very stressful on the body incurring risks of heart attacks etc.
• Flooding is clearly a very unethical treatment - deliberately inducing fear in clients
• Should the patient's reaction be very severe and the patient does not complete the entire duration of the therapy, this could result in a phobia that is worse than the original one.

  The patient will now associate this very averse response with the stimulus, which will have the effect of making the phobia worse and the patient may become less likely to seek treatment again.

  Potential for further complications: Flooding