Behavioural treatment for phobias

• Two types of treatment for phobias using behavioural approach

  1. systematic desensitisation
  2. flooding
• Systematic desensitisation

  The therapy aims to gradually reduce anxiety through counterconditioning :

  • Phobia is learned so that the phobic stimulus (CS) produces a fear response (CR)
  • The CS is paired with relaxation and this becomes the new CR

  Reciprocal inhibition - not possible to be afraid and relaxed at the same time, so one emotion prevents the other
• Systematic desensitisation

  Client and therapist design an anxiety hierarchy so the fearful stimuli is arranged in order from least to most frightening.

  The client is taught relaxation techniques like deep breathing and meditation. The client then works through the anxiety hierarchy and at each level is exposed to the phobic stimulus in a relaxed state.

  This takes place over multiple sessions starting at the bottom of the hierarchy. Treatment is successful when the person can stay relaxed in high anxiety situations.
• Flooding

  flooding involves exposing a person with a phobic stimulus without a gradual build up. Without the option of avoidance behaviour, the person quickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction.

  Flooding is not unethical butt it is an unpleasant experience so it is important that people being treated give informed consent. They must be fully prepared and know what to expect.
• Evaluation

  One strength of systematic desensitisation is evidence for effectiveness. Gilroy followed up 42 people who had systematic desensitisation for a spider phobia. At follow up, the group was less fearful that a control group. In a recent review, Wechsler concluded that systematic desensitisation is effective for specific phobia, social phobia and agoraphobia. This means that systematic desensitisation is likely to be helpful for people with phobias.
• Evaluation

  One strength is systematic desensitisation is useful for people with learning difficulties. Main alternatives to systematic desensitisation are unsuitable for people with learning disabilities as most cognitive therapies require a high level of rational thought and flooding is distressing. Systematic desensitisation on the other hand doesn't require understanding or engagement on the cognitive level and is not a trauma experience. This means systematic desensitisation is often the most appropriate treatment for some people.
• Evaluation

  One strength of flooding is that it is cost effective. A therapy is describes as cost effective if it is clinically effective and not expensive. Flooding can work in as little as one session. Even with a longer session this makes flooding more cost effective than alternatives. This means that more people can be treated as the same cost by flooding than by systematic desensitisation or other therapies.
• Evaluation

  One limitation is that flooding is traumatic. Schumacher found that both participants and therapists rated flooding as more stressful than systematic desensitisation. Thus there are ethical concerns about knowingly causing stress and the traumatic nature of flooding also leads to higher attrition rates than for systematic desensitisation. This suggests that overall, therapists may choose to avoid this treatment.