Behavioural approach to treating phobias

What is flooding

• immediately exposed to their phobic stimulus without gradual build up of anxiety hierarchy.

• longer individual session (2-3hrs), only 1 may be needed

• Eliminates avoidance behaviour

4 steps of flooding

1- Relaxation techniques taught before, then applied to session with most feared situation

2- patient exposed to highest phobic stimulus in vivo or virtual reality.

3- Exposure for 2-3hrs where adrenaline levels increase then decrease to natural levels.

4- Extinction achieved when conditioned stimulus (dog) is encountered with unconditioned stimulus (being bitten) and dosen’t produce conditioned response (fear)

Strength of Flooding- Cost effective and quicker than other treatments

• its a effective treatment for those who stick with it, quicker than SD.

• Choy et al found SD and Flooding is effective but flooding was more in treating phobias.

• Craske et al found SD and flooding equally effective treatments of phobias

• Shows flooding is effective treatment for phobias amongst other options

Weakness of flooding- Limited effectiveness

• flooding effective for treating simple phobias but not complex phobias like social phobia due to cognitive aspects

• e.g. sufferers don’t simply experience anxiety but think bad thoughts about the situation.

• So this type of phobia benefits from more cognitive therapies like CBT that tackles irrational thinking.

Weakness of flooding- traumatic experience for patient

• its a traumatic procedure so not suitable for every patients) ones w heart problems or learning difficulties)

• Not unethical as Patients give their full consent but there’s high drop out rate as it’s too stressful, reducing its effectiveness.

• So individual differences responding to flooding limit its effectiveness in treating phobias.

What is systematic desensitisation

• Behavioural therapy combining relaxation and gradual exposure to phobic stimulus.

• consist of counter conditioning, relaxation, anxiety hierarchy, reciprocal inhibition

Counter conditioning

• replaces anxiety with relaxation for phobic stimulus.

• patient taught new association to counter original e.g. relaxation with phobia not fear

Relaxation

Patient uses relaxation techniques e.g. breathing focus, muscle relaxation, focus of peaceful scene

Reciprocal inhibition

• impossible to be afraid and relaxed at same time

• relaxation inhibits the response of fear

Anxiety hierarchy

constructed from most to least frightening

5 steps of systematic desensitisation

1- Patient taught how to relax muscles

2- Therapist and patient construct a hierarchy- each one more anxiety than the previous one

3- Patient works their way up hierarchy

4- Once patient mastered 1 step in hierarchy (imagine phobia while being relaxed) they move to next

5- Patient masters feared situation

Strength of SD- prefers over flooding as involves less trauma

• Causes less trauma and distress than flooding. They have choice of continuing to each stage.

• Patient may find talking with therapist during SD pleasant, reflected in low drop out rates.

• So SD viewed as more beneficial than flooding

Weakness of SD- not appropriate for all phobias

• Ohman suggested SD is less effective treating ancient phobias with evolutionary component like the dark, height, dangerous animals.

• Its more effective in treating phobias from learned experiences.

• Suggests SD only be used effectively in some phobias.

weakness of SD- economic implications

its very time consuming and expensive as there’s multiple sessions

Strength of SD- research support

• Gilroy et al examined 42 patients with arachnophobia

• Each patient treated with 3, 45 mins SD sessions

• Examined 3 months and 33 months later, SD group were less fearful this control group (only used relaxation techniques).

• Supports SD as an effective treatment for phobias in long term

Weakness of behavioural therapies- symptom substitution

• Therapies won’t work with certain phobias as the symptoms are only tip of iceberg.

• If symptoms are removed, cause still reminds and symptoms will resurface.

• E.g. child with fear of death may displace their anxiety onto something easier to deal with like fear of leaving the house. If so, real source of anxiety needs to be treated not the displaced fear.

• Lack of focus of underlying causes limits the help they can provide people.