Behavioural treatments

• Systematic desensitisation

  • The patient builds a hierarchy of the stimuli which cause them anxiety, from the least fearful to the most fearful. E.g. look at a picture of the item, hold the picture, see the real item in the distance etc.
  • The patient is taught deep muscle relaxation or to imagine themselves somewhere pleasant and relaxing for them
• Systematic desensitisation pt 2

  • The therapist takes the patient step-by-step through their hierarchy of fear. At each stage the relaxation techniques are used until the patient does not feel anxious and only then will they move to the next level on their hierarchy
  • The patient can apply their newly learnt responses to real-life settings - to demonstrate that their phobias have been removed
• McGrath and Lucy

  • Lucy was a 10 year old girl with a phobia of loud noises & balloons/party poppers.
  • By teaching her to imagine herself playing with her toys at home, over the course of 10 sessions she gradually reduced her fear from a self rating of 7/10 down to 3/10 for balloons popping and from 9/10 to 3/10 for party poppers.
• Flooding

  • One way top make the treatment quicker is to present the feared object directly.
  • The immediate fear response caused by adrenaline is not sustainable and will eventually calm down by itself.
  • The feeling of calm can then be associated with the feared object.
  • However this can cause panic & reinforcement of the phobia rather than extinguish it, especially if the person is allowed to leave the situation before their adrenaline levels have naturally reduced.
• Aversion therapy

  • This can be used to produce an unpleasant association like nausea in alcohol addiction.
  • A drug called an emetic can be used to make people sick.
  • Repeated pairings will result in a learned response of aversion to alcohol.
• Paul and Lentz

  Showed that patients with schizophrenia who were given therapy based on social learning theory together with operant conditioning were twice as likely to be discharged from hospital and ten times more likely to be living independently than patients who had standard drug treatment.
• Cognitive treatment - RET

  • Rational emotive theory
  • A – Activating event (the stimulus/perception/irrational thought)
  • B – Beliefs (about the stimulus)
  • C – Consequences – (the actions to avoid stimulus)

  In therapy the aim is to add D and E to this

  • D – Disputing (questioning the irrational beliefs)
  • E – Effects (restructured thoughts hopefully helping the person to cope)
• Systematic desensitisation ethics

  • Systematic desensitisation is good in that (1) it is better than doing nothing, (2) the patient has control over how quickly they progress up through their fear hierarchy, and (3) it is gentler than the alternative, which is flooding.
  • However, it DOES involve exposing the patient to the stimulus that causes them anxiety.
• Cognitive ethics

  • Cognitive therapies (e.g. RET) put the patient in charge by teaching them self-help strategies.
  • However, (1) they can lead to dependency on the therapist, and (2) cognitive behavioural therapies still involve exposure to the stimulus that causes the anxiety.
• Behavioural usefulness

  • Less useful with adults...
  • McGrath shows that systematic desensitisation can work with children, but it may not work as easily with adults who have had their phobias for longer.  For this treatment to succeed, the patient will need to be motivated to get rid of their phobia.
• Cognitive usefulness

  • Less useful with children…
  • The requirement to imagine other possible thoughts you could have in a given situation requires a level of metacognition [abstract thinking] that may not be available to (say) children.  Patients need to be motivated. 
• Systematic desensitisation and flooding usefulness

  • Systematic desensitisation and flooding have been shown to be effective in helping people overcome their phobias but systematic desensitisation is perhaps more effective at reducing the phobia- however it can take longer to be effective (6-8 sessions).
  • Flooding on the other hand is only effective for some people and situations and could make the phobia worse.
• Aversion therapy usefulness

  Aversion therapy may only have short term effects (i.e. it will work in the therapist’s office but not in the outside world when the person has not taken the nausea inducing drug). Relapse rates are often high.
• RET usefulness

  RET has been shown to be effective the majority of the time to reduce phobias. May be more effective than behavioural treatments because it tackles the negative thoughts that lead to the fear.