Phobias

• Phobias are extreme, irrational fears of something (specific objects)
• Behavioural characteristics:

  • Panic - Heightened physiological arousal upon exposure to the stimulus. This is caused by the hypothalamus triggering an increase in activity levels of the sympathetic nervous system.
• Behavioural characteristics:

  • Avoidance - Physically adapting normal behaviour to avoid phobic objects. This is negatively reinforced and severely impacts the patient's ability to deal with everyday life.
• Behavioural characteristics:

  • Failure to function - Difficulty taking part in activities required to perform a normal life (eg going to work / social gatherings)
• Emotional characteristics:

  • Anxiety - Uncomfortably high and persistent state of arousal making it difficult to relax. Anxiety is heightened when the individual is likely to encounter the phobia.
• Emotional characteristics:

  • Fear - An intense emotional state linked to the fight or flight response. It is a sensation of extreme unpleasant alertness in the presence of the phobia and only subsides when the phobic stimulus is removed.
• Cognitive characteristics:

  • Irrational beliefs - Negative mental processes that include exaggerated thoughts in harm that the phobic object may cause them.
• Cognitive characteristics:

  • Reduced cognitive capacity - Patient remains focused on the phobic stimulus even though it causes them severe anxiety, which impacts their concentration. This is also referred to as selective attention.
• Behaviourist approach to explaining phobias:

  • Behaviour is learnt through experience and interacting with the environment.
• Behaviourist approach to explaining phobias:

  • Mowrer (1960) - Two process model.

  Phobias are acquired through classical conditioning and maintained by operant conditioning.

  Watson and Rayner (1920) - Little Albert experiment. This is an example of classical conditioning.

  Patients practice avoidance behaviours which helps them avoid the associated fear with the phobic object. By avoiding the unpleasant consequence (fear), the behaviour is negatively reinforced and likely to be repeated again. This is an example of maintenance through operant conditioning.
• Strengths of the behaviourist approach to explaining phobias:

  • Practical benefits in SD and flooding - Mowrer shows the importance of exposing patients to the phobic stimulus to prevent the negative reinforcement of avoidance behaviours. This would help the patient realise the phobic stimulus is harmless and their responses are irrational, leading to successful therapy.
• Strengths of the behaviourist approach to explaining phobias:

  • Stimulus generalisation - Watson and Rayner (1920) conditioned a fear response in Little Albert when presented with a rat. They later found the phobic response could be generalised to other similar objects, such as small dogs and fluffy festive hats.
• Limitations of the behaviourist approach to explaining phobias:

  • Limited explanation - Buck suggested safety is a greater motivator for avoidance behaviour. For example, sufferers of social anxiety can venture in public with a friend, despite being exposed to many strangers, which would usually trigger the anxiety and fear response.
  • Also, DiNardo showed phobias such as 'dog bites' are common in those with dog phobias (56%) and those without (66%).
• Limitations of the behaviourist approach to explaining phobias:

  • Alternative explanations for the acquisition of phobias - Seligman suggested we are more likely to develop phobias to prepared stimuli. These are things which would have posed threats to our evolutionary ancestors (eg fire or deep water), so running away from them increases our survival chances (selective evolutionary advantages). This means alternative theories can explain why some phobias are more frequent than others.
• Behaviourist approach to treating phobias:

  • Systematic desensitisation - A therapy designed to reduce phobic anxiety through gradual exposure to the phobic stimulus.

  It relies on counter-conditioning which is learning a new response to the stimulus (one of relaxation rather than panic). This works by reciprocal inhibition - panic and relaxation can not be felt at the same time, and so if the therapist is able to get the patient to relax when in the presence of the stimulus, then they have been successfully counter-conditioned.
• Behaviourist approach to treating phobias - Systematic desensitisation:

  1. Anxiety hierarchy - Situations involving the phobic stimulus rated on a scale from least to most feared.
  2. Relaxation techniques - Therapist teaches breathing techniques and meditations to help relax at each level.
  3. Exposure to each level - Patient must be completely relaxed at each stage, and only then will the therapist move up the hierarchy.
  4. Counter-conditioned - Patient is able to remain clam and relaxed at the highest level of the hierarchy.
• Strengths of systematic desensitisation:

  • Supporting evidence - Gilroy et al. (2003) followed up 42 patients treated in 3 sessions of SD for arachnophobia. Progress was compared to a control group of 50 patients who only learnt relaxation techniques. The extent of the phobias was measured using a spider questionnaire and observation. At 3 and 33 months, the SD group showed a reduction in their symptoms compared to the control group.
• Strengths of systematic desensitisation:

  • Generalisability - Suitable for majority of patients, including those with learning difficulties. Anxiety disorders are often alongside learning difficulties meaning CBT would not be as effective for them. This is because they may not be able to make full cognitive commitment association with it, or have the ability to evaluate their own thoughts. Therefore, SD would be particularly suitable to them.
• Strengths of systematic desensitisation:

  • Ethics and economics - Many patients prefer SD as it is less anxiety inducing and has lower refusal rates compared to flooding. The idea also has many economical benefits as it increases the likelihood that the patient will agree to start and continue treatment, as opposed to getting 'cold feet' and wasting the time and effort of the therapist.
• Limitations of systematic desensitisation:

  • Limited effectiveness - Conducted in a controlled setting which is not the same as the real world. For example, a person may conquer their fear of birds in a therapist's office as the bird is tame and controlled, but when faced with numerous wild birds outside the office, the phobia may resurface.
• Limitations of systematic desensitisation:

  • Limited treatment - Effective in treating specific object related phobias rather than social phobias. This is because it is easier to construct an anxiety hierarchy with object related phobias than to stimulate social situations and interactions with unfamiliar individuals in a therapist's office.
• Behaviourist approach to treating phobias:

  • Flooding - A behavioural therapy designed to reduce phobic anxiety in one session through immediate exposure to the phobic stimulus.

  This is performed in a controlled environment from which the patient can not escape, preventing avoidance behaviours from being reinforced. This relies on the principle that it is impossible to maintain a state of heightened anxiety for a prolonged period of time, meaning that eventually the patient will learn the phobic stimulus is harmless.
• Strengths of flooding:

  • Economics - Ougrin (2011) compared flooding to cognitive therapies and found it to be cheaper (cost-effective). This is because the fear is usually cured in one session, freeing them of their symptoms and allowing them to continue with their everyday life.
• Limitations of flooding:

  • Limited effectiveness - Less effective for complex phobias, such as social phobias. This is because they involve anxiety and a cognitive aspect (eg thinking unpleasant things about a situation). Therefore, in such cases CBT may be more appropriate as it can target the causes of the phobia as opposed to the indirect cause.