the behavioural approach to treating phobias

what are the two behaviourist approaches to treating phobias?

systematic desensitisation and flooding

systematic desensitisation (SD)

- a behavioural therapy designed to gradually reduce phobic anxiety through the principles of classical conditioning
- if the sufferer can learn to relax in the presence of the phobic stimulus they will be cured
- counterconditioning
- reciprocal inhibition

counterconditioning

a new response to a phobic stimulus is learnt (phobic stimulus is paired with relaxation instead of anxiety)

reciprocal inhibition

it’s impossible to be afraid and relaxed at the same time, so one emotion prevents the other

what are the 3 main processes involved in SD?

relaxation, hierarchy, and gradual exposure

relaxation

relaxation techniques are taught to the patient, these include:
- focusing on breathing and taking slow, deep breaths as when we are anxious we breathe quickly so slowing this down helps us to relax
- focussing on a particular object or visualising a peaceful scene

hierarchy

at the beginning of therapy, therapist and patient create a hierarchy from most to least fearful stimuli

gradual exposure

- SD works by gradually exposing the patient to fearful situations one step at a time
- at each stage the client practices relaxation so the situation becomes more familiar and their anxiety reduces
- treatment is successful when the patient can remain relaxed in situations high on the hierarchy

the stages of SD

- step 1: relaxation techniques are taught
- step 2: hierarchy is established
- step 3: client starts to work their way through hierarchy
- step 4: once each step is mastered, they move onto the next
- step 5: client eventually masters the feared situation or object that caused them to seek help

AO3 - strength of SD: effective

- Gilroy et al. (2003) followed up 42 patients who had been treated for spider phobia (arachnophobia) in three 45min sessions of SD
- arachnophobia was assessed on several measures including the 'Spider Questionnaire' and by assessing response to a spider
- a control group was treated by relaxation without exposure
- at both 3 months and 33 months after the treatment the SD group were less fearful than the relaxation group
- this shows that the gradual exposure element of SD is crucial to the effectiveness of treating phobias as the control group showed more fear when just given relaxation
- it also suggests SD is an effective long term treatment for phobias.

AO3 - limitation of SD: not always appropriate

- evidence suggests that SD may be more effective in treating specific phobias whilst other treatments, e.g. CBT, are better for treating complex phobias such as social phobias
- this might be cuz, rather than simply trying to change the patient's response to the phobic stimulus, CBT aims to identify and challenge irrational thoughts which can have more of an impact on the development of complex phobias in comparison to specific phobias
- this means that SD may not be an appropriate treatment for all types of phobias thus it’s important that when considering which treatments to use the type of phobia should be taken into account.

flooding (aka implosion therapy)

- a behavioural therapy which, rather than exposing a person to their phobic stimulus gradually, exposes the individual to the most anxiety-inducing stimulus immediately e.g. a person who has a phobia of enclosed spaces would be placed into an elevator and would not be able to leave until their anxiety levels reduce
- with flooding, a person is unable to avoid (negatively reinforce) their phobia and through continuous exposure, anxiety levels eventually decrease
- since the option of avoiding the phobic stimulus is removed and high levels of anxiety can’t be maintained for a long period of time the fear will eventually subside
- flooding session normally last longer than SD sessions, one session often lasting 2-3hrs. sometimes only one long session is needed to cure the phobia.

strength of flooding: effective

- e.g. Kaplan and Tolin (2011) - 65% of patients with a specific phobia who were given a single session of flooding showed no symptoms of specific phobia 4yrs laters
- this shows that flooding is an effective long term treatment for specific phobias

COUNTER:

- not all patients were completely cured of their phobia so this suggests flooding may not be suitable for everyone

AO3 - limitation of flooding: ethical issues

- although pps give consent to take part in flooding, it can be highly traumatic for them as it involves forcing the sufferer to experience high levels of anxiety.
- thus, it may not be seen as suitable for children or vulnerable adults and so is not an appropriate treatment for all sufferers
- also, cuz flooding causes intense levels of anxiety high drop-out rate, meaning it could enhance their fear rather than reducing it.