Phobias

• Panic


  The patient suffers from heightened physiological arousal upon exposure to the phobic stimulus, caused by the hypothalamus triggering increased levels of activity in the sympathetic branch of the autonomic nervous system
• Avoidance


  Avoidance behaviour is negatively reinforced because it is carried out to avoid the unpleasant consequence of exposure to the phobic stimulus
• Endurance


  The patient remains exposed to the phobic stimulus for an extended period of time, but also experiences heightened levels of anxiety during this time
• the two process model- behaviourist (phobia)


  1. Classical conditioning: Phobias are acquired through pairing a neutral stimulus with an unconditioned stimulus, resulting in the neutral stimulus eliciting a fear response

  2. Operant conditioning: Phobias are maintained through negative/positive reinforcement of avoidance behaviour or feeling relief
• Systematic desensitisation

  Gradual exposure to the phobic stimulus, paired with relaxation techniques, to reduce phobic anxiety through counterconditioning and reciprocal inhibition
• Reciprocal inhibition

  It's impossible to be both relaxed and anxious at the same time
• Systematic desensitisation


  1. Therapist teaches patient relaxation techniques (e.g. deep muscle relaxation)

  2. Patient and therapist draw up an anxiety hierarchy (starts at least threatening to most)

  3. Patient gradually works their way up through the hierarchy whilst encouraged to use relaxation techniques. When no anxiety is experienced, patient can move up to the next level

  4. Phobia is cured when patient can remain calm at the highest anxiety level
• Flooding

  a single exposure to the most feared situation. The phobic is exposed to the actual phobic stimulus or to a virtual reality version of it until they are calm, or the fear is extinguished/ becomes extinct
• Flooding relies on the principle that it is physically impossible to maintain a state of heightened anxiety for a prolonged period which should then cause the anxiety to subside as the client learns that the stimulus is harmless
• +ve for flooding

  cost effective- flooding is both an effective clinical treatment but also is inexpensive for the NHS. Quicker and therefore cheaper than cognitive therapies or systematic desensitisation as the patient's phobia will typically be cured in 1 session as opposed to 10. This suggests that many people may be able to be treated for their phobias using flooding at the same cost of treating one person using systematic desensitisation.
• -ve for flooding

  may not be suitable for complex phobias like having social phobias; involve both an anxiety and cognitive aspect to it. cognitive therapy may be more appropriate as it can target the distal causes of the phobia
• a phobia is an extreme fear of an object, situation or activity.  The fear is irrational and is disproportionate to the actual danger the object, situation or activity poses.  The fear leads to avoidance and often disruptive to everyday life
• emotional characteristics of phobias


  • excessive and unreasonable fear- the individual feels scared or terror and may believe that the phobic stimulus may hurt them in some way
  • anxiety- the individual feels worried or distressed in the presence of the phobic stimulus
  • emotional response is unreasonable- the fear and anxiety are out of proportion to the danger posed by the object, situation or activity
• behavioural characteristics of phobias


  • panic- behaviours such as crying, running, screaming, fainting, collapsing or vomiting in the presence of the phobic stimulus
  • avoidance- the individual will not go to places where the phobic stimulus would be present
  • endurance
• cognitive characteristics of phobias


  • irrational thinking about the phobic stimulus
  • resistance to rational argument about the actual danger if poses
  • cognitive distortions- the way that individuals with a phobia perceive their trigger is not the same as others
• classical conditioning


  NS -> no response

  UNC -> UCR

  UCS + NS -> UCR

  CS (old NS) -> CR (old UCR)
• operant conditioning


  phobias can be negatively reinforced. This is where a behaviour is strengthened because an unpleasant consequence is removed/avoided. This avoidance reduces the persons feelings of anxiety and so negatively reinforces their behaviour, making the person more likely to repeat this behaviour (avoidance) in the future

  Relief, the feeling that comes from not having to face the phobic stimulus provides a form of positive reinforcement that continues to maintain the phobia
• +ve for behaviourist explanation of phobias


  empirical evidence- Watson & Rayner classically conditioned Little Albert to associate a white rat (NS) with a loud bang (UCS) which created fear (UCR). Albert learned to fear white rats which suggests that abnormal behaviours, such as phobias, are learnt through the process of classical conditioning
• +ve for behaviourist explanation of phobias

  empirical evidence: when asked about their phobias, some people could recall a specific event that led to their phobia developing. A psychologist  found that 73% of people with a fear of dental treatment had experienced a traumatic event, often involving dentistry. A control group of people with low dental anxiety found only 21% of people had experienced a negative event. This supports the idea that an association has been formed between a neutral stimulus and an unconditioned response, such as pain.​
• -ve for behaviourist explanation of phobias

  Incomplete explanation: a phobia does not always develop after a traumatic incident.  DiNardo et al found that not everyone who is bitten by a dog develops a phobia of dogs so, the behavioural explanation alone is incomplete.
• The diathesis stress model may offer a better explanation and a more holistic explanation of phobias than the two process model. This model suggests we inherit a genetic vulnerability for developing mental disorders, but a disorder will only manifest itself if triggered by a life event.  Therefore, a dog bite will only lead to a phobia in a person with a genetic vulnerability to develop a phobia.
• +ve for behaviourist explanation of phobias

  Real world application: it has led to the development of treatments such as systematic desensitisation. McGarth et al found that 75% of phobics responded positively to SD. This suggests that systematic desensitisation can be used to successfully treat patients, which provides further support for the effectiveness of the behaviourist explanation. 
• alternative explanation for phobias

  Evolutionary psychologists suggest that phobias towards dangerous stimuli such as snakes and spiders are innate and not learned. The avoidance of these particular stimuli would have ensured the survival of our ancestors.  Through a process of natural selection, these phobias are now innate within many members of the population. Therefore, evolutionary explanations directly challenge the two-process model, which suggest that phobias are learnt and instead, evolutionary explanations site biological preparedness as the cause of the phobias.  
• two types of systematic desensitisation

  in vivo- when the patient has actual contact with the feared stimulus

  in vitro- when the patient imagines the feared stimulus or uses pictures of the feared situation in therapy
• +ve for systematic desensitisation

  effective- there is evidence demonstrating the success of SD in treating phobias. A strength because it offers support for the direct use of SD in phobia treatment. Gilroy et al (2003) followed 42 people who has SD for spider phobias across 3 45-minute sessions. At 3 and 33 months, the SD group were less fearful than a control group treated with no exposure. Therefore, it can be assumed that systematic desensitisation offers a valuable approach to treating a variety of phobic conditions. 
• +ve for systematic desensitisation

  more ethical than flooding: it has fewer ethical issues compared to flooding therapy. The patient is gradually exposed to the source of their phobia and thus the anxiety produced in the treatment is limited whereas in flooding therapy the patient is bombarded with fear, which may cause long-term psychological issues/trauma.  Therefore, SD is more appropriate for a wide range of clients including children.
• -ve for systematic desensitisation


  it is time consuming compared to alternative therapies such as flooding.  This is because SD requires the patient to be trained in relaxation techniques and gradually exposed to various stimuli. This can take many sessions and therefore SD may not be appropriate for all patients.
• -ve for systematic desensitisation

  it is not suitable for all types of phobias. For example, if someone has a social phobia it is difficult to create a hierarchy as there are no obvious target behaviours. Social skills training on the other hand does seem to reduce social phobias.  Therefore, SD is not appropriate for the treatment of all phobias. 
• -ve for flooding

  can result in symptom substitution. This means that therapies mask the symptoms of the phobia but are unable to tackle the underlying cause. This is a weakness as it can lead to displacement of the phobia or a temporary loss in which the phobia returns at a later date, meaning extinction has not successfully occurred. Therefore, it must be considered that flooding may need to be used in conjunction with other methods to successfully treat a phobia and is thus an ineffective treatment on its own.
• -ve for flooding

  it raises ethical issues. Flooding exposes patients to the most feared situation immediately. This can cause the patient severe psychological harm/trauma, as there is no guarantee they can eventually cope with the situation.  Flooding could potentially make their phobia worse to the point that their life becomes dysfunctional. Therefore, flooding therapy may not be an appropriate therapy for many patients, especially children.
• -ve of flooding


  it may be ineffective- evidence to suggest that flooding is not successful in treating phobias. This suggests that there is limited clinical benefit to flooding. Schumacher (2015) suggested that the traumatic nature of flooding leads to higher attrition (dropout) rates than other treatments. This suggests that many clients struggle to remain in the process to the point of extinction of their phobia. Therefore, it may be the case that flooding is not an effective approach to treating phobias in comparison with other methods such as systematic desensitisation.