treating phobias

• Systematic desensitisation is a behavioural therapy designed to gradually reduce phobic anxiety through classical conditioning
• Systematic desensitisation involves three stages where the patient will learn to relax in the presence of the phobic stimulus
• In the first stage of systematic desensitisation, the patient and therapist create an anxiety hierarchy, which is a list of situations ordered from lowest to highest anxiety, related to the phobic stimulus
• In the second stage of systematic desensitisation, the therapist teaches relaxation e.g breathing techniques
• In the third stage of systematic desensitisation, the patient is gradually exposed to the phobic stimulus, ensuring they are relaxed at each stage as they move up the anxiety hierarchy
• Flooding is another behavioural therapy, which aims to remove the learned association between the stimulus and response by placing the person in an escapable situation with the thing they fear until the fear response disappears
• The idea of flooding is that the person will learn to pair the feared object or situation with a less anxiety producing response
• Without the option of avoidance, the patient quickly learns that the phobic stimulus is harmless. In classical conditioning terms, this is called extinction
• Gilroy et al followed up 42 patients who had been previously treated using SD for a spider phobia, which was assessed using a spider questionnaire. A control group was set up and received relaxation with no phobia. At both 3 and 33 months after treatment, the SD group were less fearful than the relaxation group.
• A strength of systematic desensitisation is that patients prefer it to flooding
• SD doesn’t cause the same degree of trauma as flooding and includes elements like learning relaxation techniques which are actually pleasant
• there are low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) of systematic desensitisation
• A strength of flooding is that it is cost-effective
• Studies comparing flooding to cognitive therapies (Ougrin 2011) have found that flooding is highly effective and quicker than alternatives. Sometimes only one long session is needed to cure a phobia
• Whilst not unethical, flooding is a highly traumatic experience and so it is important that patients give fully informed consent
• There are high attrition rates and high refusal rates for flooding