Phobias

definition of phobias

Phobias are a type of anxiety disorder which means that a primary symptom is therefore extreme anxiety. Phobias are irrational fears that produce a conscious avoidance of the feared object or situation.

There are different types of phobias including:

• Specific phobias: fear of snakes, spiders etc.

• Agoraphobia: fear of being out in a public place with no escape

• social phobias: fear of talking to a group and interacting with others in social situations

emotional characteristics of phobias

Include feeling of unreasonable, excessive & persistent fear as well as feelings of anxiety and panic. These feelings are brought on by the presence or thought of a specific object or situation. The feelings of anxiety are out of proportion to the actual danger proposed

behavioural characteristics of phobias

The phobic will avoid the situation or object that is the source of the fear. If they come into contact with the phobic stimulus they may show the behaviour of freezing or fainting (this is part of flight or fight stress response - makes a predator think you are dead so increases your chance of surviving!) Avoiding the source of the fear can lead to disruption in normal routine such a being able to work, have an active social life, relationships etc. This is how a phobia is different from more everyday fears that don't have an effect on your life.

cognitive characteristics of phobias

The phobic will have irrational thought processes. They will be resistant to rational arguments e.g. person with a fear of flying is not helped by the fact that flying is the safest form of transport. The person recognises that their fear is irrational which distinguishes between a phobia and a delusion.

two-process model for explaining phobias

First stage:

Classical conditioning: Initiation (explains why phobias develop)

Second stage:

Operant conditioning: Maintenance (explains why phobias continue)

classical conditioning in phobias (initiation)

Suggests phobias are learnt through association. This can be seen in the case study off Little Albert (Watson and Rayner, 1920) who learnt to be scared of a white rat which he associated with the fear brought about due to a loud noise. A white rat was presented to Little Albert who at first showed no fear and was happy to play with the rat. The rat is therefore termed the Neutral Stimulus. One thing that Little Albert was scared of was loud noises. A loud noise was created by hitting a steel bar with a hammer known as UnConditioned Stimulus. Little Albert immediately started to cry. His reaction of fear is known as an UnConditioned Response. Little Albert is then given the rat to play with again but each time the steel bar is hit with the hammer to produce the same loud noise. By pairing the loud noise with the rat, the rat acquires the same properties as the UCS & produces the response of fear. The fear becomes the Conditioned Response. The rat has become the Conditioned Stimulus & now produces fear on its own without being accompanied with a loud noise.

operant conditioning in phobias (maintenance)

Operant conditioning explains why the fear continues and why people avoid the feared object. Rewards reinforce behaviour. Avoiding the feared object will reduce fear. Reduction in fear is rewarding therefore the person will repeat the behaviour and continue to avoid the object. This is known as negative reinforcement e.g. someone who is nervous of open spaces will avoid going out (a type of reward as it reduces anxiety). Reducing fear reinforces the behaviour so avoidance of going out will be repeated leading to agoraphobia.

behaviourist evaluation for explaining phobias summary

• based on scientific lab experiments

• treatments

• reductionist

• deterministic

behaviourist evaluation for explaining phobias - based on scientific lab experiments

A strength of the behaviourist approach to phobias is that the behaviourist model is based on scientific lab experiments that have found support for classical and operant conditioning (Pavlov's dogs & Skinner's rats). This adds validity to the theory that other behaviours such as phobias may also be learnt. This viewpoint is supported by the case study of Little Albert who clearly learnt his phobia through the process of classical conditioning. Therefore there is scientific support.

behaviourist evaluation for explaining phobias - treatments

A strength of the behaviourist approach to phobias is that the behaviourist model is based on scientific lab experiments that have found support for classical and operant conditioning (Pavlov's dogs & Skinner's rats). This adds validity to the theory that other behaviours such as phobias may also be learnt. This viewpoint is supported by the case study of Little Albert who clearly learnt his phobia through the process of classical conditioning. Therefore there is scientific support.

behaviourist evaluation for explaining phobias - reductionist

Reductionist: The behaviourist theory is criticised as being reductionist as it reduces phobias to learnt behaviours which is too simplistic. In fact there are other many explanations that have been proposed to explain phobias: Some phobias may be learnt through different processes (not the two process model) e.g. people who are scared of spiders are more likely to cite modelling as the cause.

Alternatively, the Evolutionary explanation suggests we are genetically programmed to make associations between potentially life-threatening stimuli and fear. This would have helped our early ancestors in the EEA to survive as it would have been adaptive to fear spiders, heights & strangers! Evolutionary theory explains why we rarely develop phobias of modern objects that are quite dangerous e.g. cars, toasters. E.g. one study found that infants aged 8 - 16 months failed to learn a fear of building blocks that were paired with a loud bell. This therefore suggests that fear responses can only be learnt with living animals (a link to EEA).

In conclusion, the Diathesis-stress model proposes that we have a genetic predisposition for developing mental disorders such as phobias (the diathesis).

But a disorder will only develop if there is an environmental trigger (the stress). This explains why not everyone who is bitten by a dog develops a phobia as they must already have a genetic predisposition for this type of phobia.

behaviourist evaluation for explaining phobias - deterministic

Deterministic: The behavioural theory is also criticised for being deterministic because it suggests that people have no control over their phobia as it is determined by environment. For example, the theory says a learnt association WILL lead to a phobia when in fact it might not eg you might be bitten by a dog but still not develop a dog phobia. Therefore the theory may not be valid

background information for behavioural treatment

Phobias may persist because people avoid their phobia. This means that they never get a chance to learn that their feared stimuli is not so scary after all.Treatments therefore allow patients to unlearn negative associations and replace them with a positive response through the process of relaxation (counter conditioning).

systemic desensitisation

The individual initially constructs an anxiety hierarchy which consists of situations linked to their phobia. These situations are ordered from the least to most anxiety. Relaxation training is then given with the aim of achieving complete relaxation. They may be taught breathing exercises and progressive muscle relaxation.The patient is asked to imagine, as vividly as possible, the scene at the bottom of the hierarchy and is told to relax at the same time. When they feel fully relaxed, they will work their way up the anxiety hierarchy. This is known as graded pairings. SD can be done with a real stimulus or imagining each stage in the hierarchy. Graded pairing of the real stimulus is almost always more effective and longer lasting than the imagined technique.

evaluation for systematic desensitisation summary

• effectiveness

• appropriateness - no anxiety

• appropriateness - fast

• appropriateness - under one set of conditions

evaluation for systematic desensitisation - effectiveness

Effectiveness: SD has a high success rate of 75% for simple phobias and 90% for blood-injection phobias after 5 sessions of graded exposure. The treatment is most successful when real stimulus are used rather than imagined stimulus. Thus there is research evidence that shows SD can be a very effective treatment for phobias.

evaluation for systematic desensitisation - appropriateness - no anxiety

Appropriateness: A strength of SD is that the patient does not have to experience intense anxiety as they are in control of their treatment i.e. they only move up the anxiety hierarchy when they feel relaxed and are ready to do so. Therefore, there shouldn't be any ethical issues with the use of this treatment in comparison to flooding where there may be issues of protection from harm.

evaluation for systematic desensitisation - appropriateness - fast

Appropriateness: SD is relatively fast and requires less effort from the patient compared to other psychological therapies such as CBT which requires patients to understand their thinking and restructure their thoughts in order to change their behaviours. The lack of 'thinking' in systematic desensitisation means it can be successful with children & adults with learning difficulties so it is an appropriate treatment for most patients.

evaluation for systematic desensitisation - appropriateness - under one set of conditions

Appropriateness: A weakness of SD is that behaviour learnt under one set of conditions (therapy) does not always generalise to another (real life). It is very different facing your fear alone when you have previously had the safety of a therapist beside you so SD may not be appropriate for all phobias Therefore it may not be a long lasting treatment.

flooding

This therapy still involves exposure to the phobic stimulus. However, in contrast to systematic desensitisation where exposure to the phobia is gradual, flooding consists of one long session where the patient experiences their phobia at its worse. At the same time, they practise relaxation until their anxiety disappears. The session may last 2-3 hours as fear response has a time limit. As adrenaline levels naturally decrease, a new stimulus-response link can be learned between feared stimulus and relaxation.

flooding evaluation summary

• effectiveness

• appropriateness - quick

• appropriateness - traumatic

flooding evaluation - effectiveness

Effectiveness: Flooding has been shown to be effective e.g. Choy et al (2007) reported that both SD & flooding were effective but flooding was the most effective of the two. However, although flooding is highly effective for simple (specific) phobias, the treatment is less effective for other types of phobia, including social phobia and agoraphobia. Some psychologists suggest that social phobias are caused by irrational thinking and are not caused by unpleasant experiences (or learning through classical conditioning). Therefore, more complex phobias cannot be treated by behaviourist treatments and may be more responsive to other forms of treatment, for example cognitive behavioural therapy (CBT), which treats the irrational thinking

flooding evaluation - appropriateness - quick

Appropriateness: Flooding is a relatively quick treatment (compared to CBT and SD). This is because it only involves 1 single treatment session as it works on the basis that fear has a time limit, whereas SD involves multiple sessions & a much slower exposure of the patient to the stimulus. This means it would be useful if someone had such an intense phobia that it was affecting their life and they needed to deal with it quickly. In addition it would make it a cheaper treatment. Therefore it may be more appropriate for many patients compared to SD.

flooding evaluation - appropriateness - traumatic

Appropriateness: Flooding can be a highly traumatic treatment as patients will experience intense anxiety. This is especially true when flooding is compared with SD which gradually exposes the patient to the phobic object/situation. If patients quit during treatment due to the intense anxiety, its effectiveness will be reduced In fact, it could make a phobia worse as Ps are most likely to quit when the fear is at its greatest. This will reinforce the fear before the negative association has had time to be broken. Therefore, there are ethical and practical issues with the use of this treatment.

general evaluation point for treatments

Treats the symptoms and not the cause: Some argue that behaviourist techniques are not dealing with the cause of the phobia only the symptoms. Even if the symptoms are removed by the treatment, the cause of the phobia still remains. This means the symptoms could resurface at a later date. E.g. psychodynamic approach suggests that phobias develop because of projection. Freud recorded the case of Little Hans who had a phobia of horses. The boy's actual problem was intense envy of his father but he could not express this directly so his anxiety was projected onto the horse. The phobia was cured when he accepted his feelings about his father. If the therapist had only treated the horse phobia the underlying problem might have resurfaced elsewhere.