Treating Phobias: Psychopathology

• AO1: Systematic Desensitisation


  - SD is a behavioural therapy designed to reduce phobic anxiety through classical conditioning

  - There are 3 processes involved in SD:

  1. The anxiety hierarchy - Put together by client and therapist. Its a list of situations linked to the phobic stimulus that provoke anxiety arranged in order from least to most frightening

  2. Relaxation - Therapist teaches client to relax as deeply as possible. It's impossible to be afraid and relaxed at the same time, so one emotion prevents the other (reciprocal inhibition). Clients might be taught meditation and it might involve breathing exercises.

  3. Exposure - Client is exposed to phobic stimulus while in a relaxed state. Takes place across several sessions. Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy
• AO3 for Systematic desensitisation: Evidence of effectiveness


  - Strength - Evidence base for its effectiveness

  - Gilroy (2003) followed up 42 people who had SD for spider phobia in 3 45 min sessions

  - At both 3 and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure

  - In a recent interview Wechsler (2019) concluded that SD is effective for specific phobia, social phobia and agoraphobia

  - This means that SD is likely to be helpful for people with phobias
• AO3: People with learning disabilities


  - Strength - Can be used to help people with learning disabilities

  - Some people requiring treatment for phobias also have a learning disability

  - However, the main alternatives to SD are not suitablr

  - People with learning disabilities often struggle with cognitive therapies that require complex rational thought

  - They may also feel confused and distressed by the traumatic experience of flooding

  - This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias
• AO1: Ethical Safeguards


  - Flooding is not unethical per se but it is an unpleasant experience so it is important that clients give fully informed consent to this traumatic procedure and that they are fully prepared for it

  - A client would normally be given the choice of systematic desensitisation or flooding
• AO1: How does flooding work?


  - Flooding stops phobic responses very quickly

  - This may be due to the lack of option of avoidance behaviour, so the client learns that the phobic stimulus is harmless

  - In CC, this process is called extinction

  - A learned response is extinguished when the CS (e.g a dog) is encountered without the UC (being bitten)

  - The result is that the CS no longer produces the CR (fear)

  - In some cases the client may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response
• AO1: Flooding


  - Flooding also involves exposing people with a phobia to their phobic stimulus but without a gradual build up in an anxiety hierarchy

  - It involves immediate exposure to a very frightening situation

  - So a person with arachnophobia receiving flooding treatment might have a large spider crawl over them for an extended period
• AO3 for flooding: Cost-effective

  -Strength - Highly cost effective

  - Clinical effectiveness means how effective a therapy is at tackling symptoms

  - However when we provide therapies in health systems like the NHS we also need to think about how much they cost

  - A therapy is cost-effective if it is clinically effective and not expensive

  - Flooding can work in as little as one session as opposed to say 10 sessions for SD to achieve the same result

  - Even allowing for a longer session this makes flooding more cost-effective

  - This means that more people can be treated at the same cost with flooding than with SD or other therapies
• AO3 For Flooding: Traumatic


  - Limitation - Its a highly unpleasant experience

  - Confronting ones phobic stimulus in an extreme form provokes tremendous anxiety

  - Schumacher et al (2015) found that participants and therapists rated flooding as significantly more stressful than SD

  - This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent

  - More seriously, the traumatic nature of flooding means that drop out rates are higher than for SD

  - This suggests that, overall, therapists may avoid using this treatment