The behavioural approach to: treating phobias

What is systematic desensitisation (SD)

A behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. If a person can learn to relax in the presence of a phobic stimulus they will be cured

What is it called when you learn a different response to the phobic stimulus

Counterconditioning - they are essentially pairing the phobic stimulus with relaxation instead of anxiety

What are the 3 processes involved in systematic desensitisation

1) The anxiety hierarchy

2) Relaxation

3) Exposure

What is the anxiety hierarchy

It is put together by a client with a phobia and a therapist. It is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening (e.g. a person with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy, and holding a tarantula at the top of the hierarchy

What is relaxation

The therapist teaches the client to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other - RECIPROCAL INHIBITION. The relaxation might involve breathing exercises or the client may learn mental imagery techniques (they can be taught to imagine themselves in relaxing situations like lying on a beach) or they might learn meditation. Alternatively relaxation can be achieved using drugs such as Valium

What is exposure

The client is exposed to the phobic stimulus whilst in a relaxed state. This takes place across several sessions, starting 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 anxiety triggered by that stimulus. Takes place across a small number of long therapy sessions. Sometimes only one long session is needed to cure a phobia

How does flooding work

It stops phobic responses very quickly because without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless. In classical conditioning terms this process is called EXTINCTION - a learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus, resulting in the conditioned stimulus no longer producing the conditioned response of fear. In some cases the client may achieve relaxation in the presence of the stimulus simply bc they become exhausted by their own fear response

What are the ethical safeguards that need to take place with flooding

Flooding is an unpleasant experience so it is important that the clients give fully informed consent to this traumatic procedure and that they are fully prepared before the session. A client would normally be given the choice of systematic desensitisation or flooding

What is a strength of SD

Evidence base for its effectiveness. Lisa Gilroy et al. (2003) followed up 42 people who had SD for spider phobia 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 Theresa Wechsler et al. (2019) concluded that SD is effective for specific phobia, social phobia and agoraphobia. This means that SD is likely to be helpful for people with phobias

What is another strength of SD

It can be used to help people with learning disabilities.Some people requiring treatment for phobias also have a learning disability. 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. This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias

What is a strength of flooding

It is highly cost-effective. 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 not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session - like three hours - this makes flooding more cost-effective. This means that more people can be treated at the same cost with flooding than with SD or other therapies

What is a limitation of flooding

It is a highly unpleasant experience. Confronting one's phobic stimulus in an extreme form provokes tremendous anxiety. Sarah Schumacher et al. (2015) found that participants and therapists rated flooding as significantly more stressful than SD. This raises the 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 means that attrition (dropout) rates are higher than for SD. This suggests that, overall, therapists may avoid using this treatment