The Behavioural Approach To Treating Phobias

What is systematic desensitisation?

A behavioural therapy designed to reduce an unwanted response, such as anxiety. If a person can learn to relax in the presence of the phobic stimulus, they will be cured.

What are the three processes involved in SD?

1. The anxiety hierarchy.

2. Relaxation.

3. Exposure.

What is the anxiety hierarchy?

This is put together by a client with a phobia and a therapist. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening.

What is relaxation?

The therapist teaches the client to relax deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other, this is called reciprocal inhibition. The relaxation might involve breathing exercises or alternatively, the client might learn mental imagery techniques, Clients can be taught to imagine themselves in relaxing situations of relaxation can be achieved using drugs such as Valium.

What is exposure?

Finally, the client is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, staring at the bottom of the anxiety hierarchy. When the client can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy. Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy.

What is flooding?

A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce the anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions.

Does flooding stop phobic responses quickly or slowly?

(Very) quickly, this may be because without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless. In classical conditioning terns this process is called extinction.

When is a learned response extinguished?

When the conditioned stimulus in encountered without the unconditioned stimulus. The result is that the conditioned stimulus no longer produced the conditioned response of 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.

What are the ethical safeguards regarding flooding?

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 before the flooding sessions. The client would normally be given the choice of systematic desensitisation of flooding.

What are the strengths of SD?

• Evidence of effectiveness.

• It can be used to help people with learning disabilities.

How is evidence of effectiveness a strength of SD?

Gilroy et al. followed up 42 people who had SD for spider phobias in three 45 - minute sessions. At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. In a recent review, Wechsler concluded that SD is effective for specific phobia, social phobia and agoraphobia.

What does the evidence for the effectiveness mean for SD?

This means that SD is likely to be helpful for people with phobias.

How can SD be used to help people with learning disabilities?

Some people requiring treatment for phobias also have learning disabilities, However, the main alternatives to SD are not suitable. 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.

What does people with learning disabilities mean for SD?

That SD is often the most appropriate treatment for people for with learning disabilities.

What is the strength of flooding?

• Cost effective.

How is cost-effectiveness a strength of flooding?

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 inexpensive. Flooding can work in as little as one section. as opposed to say ten sessions of SD to achieve the same result. Even allowing for a longer session makes flooding more cost-effective.

What is the limitation of flooding?

Traumatic.

How is the traumatic experience of flooding a limitation?

Confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety. Schumacher et al. found that participants and therapists rated flooding as significantly more stressful than SD. This raises an 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 mean that dropout rates are higher than for SD.

What does flooding being traumatic suggest?

That overall, therapists may avoid using this treatment.