phobias explain and treatment

mowrer 1947 - two process model

• Approach suggests that all phobias are learnt from the environment

• Classical and operant are able to explain the existence of phobias

  • Classical conditioning explains the initiation of phobias

  • Operant conditioning explains the maintenance of phobias 

little albert - Watson and Rayner 1920

• Tested classical conditioning and phobias on 9 month old Albert

• Albert showed no unusual anxiety at the start of the study

• When initially shown a white rat, Albert wanted to play with it

• Then they paired it with a loud, frightening noise by banging on an iron bar close to Albert's ear

• Operant behaviour - behaviour is reinforced or punished and reinforcement tends to increase frequency of the behaviour

• Negative reinforcement - an individual avoids a situation to avoid the unpleasant consequence (doing something to prevent something else)

  • Mowrer suggested that when we avoid phobic stimuli, we successfully evade the fear and anxiety

  • The reduction in fear reinforces the avoidance behaviour and phobia is maintained

 

• Albert has a fear of rats - he avoids them

• Avoiding rats reduces his anxiety and makes him relaxed

• Outcome of his avoidance behaviour is rewarding - negative reinforcement as he is doing something to avoid something unpleasant

• Avoidance produces escape from the negative state of anxiety

stimulus generalisation

• Stimulus generalisation - when someone has a phobia has the same beliefs and responses towards other items which are similar to their feared phobic stimulus

  • For Albert this was demonstrated as when shown furry objects such as a rabbit, dog, fur coat and Santa Claus beard, Albert was distressed due to this generalisation

 

strengths of two process model

• A strength of the two-process model is its real-world application in exposure therapies (systematic desensitisation or flooding)

• Distinctive element of two-process model is the idea that phobias are maintained by avoidance of the phobic stimulus

• Important in explaining why people with phobias benefit from exposure to phobic stimulus - once avoidance behaviour is prevented, it ceases to be reinforced by the experience of anxiety reduction and avoidance declines

• Phobia is the avoidance behaviour so when the avoidance is prevented, the phobia is cured

• Therefore, this suggests that this practical application can help aid individuals who struggle with debilitating symptoms of phobias - provides effective means of treating them

 

• Another strength of the two-process model is research support for a link between bad experiences and phobias.

  • Obvs Little Albert - Watson and Rayner 1920

• Ad De Jongh et al. (2006) found that 73% of people with a fear of dental treatment had experienced a traumatic experience, mostly involving dentistry

• This was compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event

• This study demonstrates that there is an association between traumatic experiences and developing a phobia

  • However, this goes against the two-process model as within the control group, 21% had a traumatic experience but did not form negative associations as they should have in the two-process model.

  • Same goes for only the 73% having experienced traumatic events - surely it should be 100% for both categories.

  • Furthermore, some people have fear of snakes or animals that are not present in their population/culture therefore this goes against the idea that bad experiences are linked t phobias

• Therefore, this suggests that the association between stimulus (dentistry) and a conditioned response (pain) does lead to the development of the phobia supporting the two-process model.

weakness of two process model

• A limitation of the two-process model is that it does not explain all phobias, and it cannot explain why some people don’t develop a phobia to an object even after a traumatic incident.

• Seligman (1970) suggested that humans are more likely to develop phobias to things that would have been dangerous in our evolutionary past. For example, food scarcity, wild animals such as bears and wolves.

• Bregman (1934) tried to condition a ‘fear response’ in infants to a block of wood by pairing the block with a loud bell. He was unsuccessful, demonstrating that not all objects can easily elicit a conditioned fear response. This research highlighted the importance of considering the 'biological preparedness' of a stimulus since some stimuli are more naturally associated with fear than others

  • Unconditioned stimulus = loud bell

  • Unconditioned response = fear

  • Unconditioned stimulus = loud bell + neutral stimulus = block of wood

  • Conditioned stimulus should have been block of wood

  • Conditioned response should have been fear

• Therefore, this suggests that the two-process model is limited in explaining phobias as the research supports the idea that some phobias are caused by biology rather than conditioning.

 

• Another limitation of the two-process model is that it is not a complete explanation of phobias - it does not account for cognitive aspects of phobias.

• We need cognitive factors to explain why some people do not develop phobias after exposure to frightening stimuli.

  • Behavioural explanations are geared towards explaining observable behaviour - avoidance of the phobic stimulus

  • Phobias are not only avoidance responses but also have cognitive component as some hold irrational beliefs

• Two-process model does not completely explain the symptoms of phobias

 

• DiNardo (1988) studied people who had a traumatic experience with dogs; some developed a phobia of dogs, others did not. Those who developed phobias were more likely to believe that they would have a similar negative experience in the future.

  • Phobias can be maintained or made worse by the way people think about their situation. A high level of anxiety may lead to catastrophising - imagining the worst possible outcome of every situation whilst ignoring the possibility of positive outcomes.

  • DiNardo found only half of the people who had had a traumatic experience with dogs develop a phobia, therefore they must interpret the event differently from those without phobias. (faulty thinking pattern)

• Therefore, this faulty thinking links to a cognitive explanation of phobias and suggests that phobias may be due to catastrophizing – a form of irrational thinking. This indicates that we must also consider other approaches (e.g., cognitive) when explaining phobias.

what is systematic desensitisation

• This takes place over several sessions and starts at the bottom of the hierarchy - if client can stay relaxed in the presence of lower levels of phobic stimulus then they can move up

• Counter conditioning

  • Used to teach a new association (conditioned response) to replace the original association

    • Process where a new conditioned response is intentionally developed to actively counteract and weaken an existing undesirable conditioned response

  • Person will learn to associate the phobic stimulus with relaxation instead of fear

  • Relaxation inhibits the anxiety as you can not be both scared and relaxed at the same time - reciprocal inhibition

• Relaxation

  • Relaxation techniques are taught to help reduce the anxiety

  • Diaphragmatic breathing, 7/11 breathing, mental imaginary techniques or muscle relaxation

    • Could also use drugs

  • This encourages reciprocal inhibition

• Gradual

  • Introduction to the feared situation is gradual

  • Gradual exposure

• Desensitisation hierarchy (anxiety hierarchy)

  • Put together by client and therapist

  • Patients work their way through a series of events which start off as less stressful and build up to those which are more stressful

  • Relaxation practiced at each event of hierarchy; patient must remain relaxed so reciprocal inhibition occurs

  • Each stage is practiced until the fear is extinguished

strengths of SD

• Strength - evidence base for its effectiveness, Gilroy et al 2003 followed up 42 people who had SD for a spider phobia in three 45 minute sessions

  • At both three and 33 months, SD group was less fearful than control group treated by relaxation without exposure

  • Wechsler et al 2019 - concluded that SD is effective for specific phobia, social phobia and agoraphobia

    • Research has found that SD is successful for a range of phobic disorders. McGrath et al. (1990) reported that about 75% of patients with phobias responded to this treatment. 

• Strength - used to help those with learning disabilities

  • Some require treatment for phobias also have learning disabilities, main alternatives to SD are not favourable

  • They may struggle with cognitive therapies that require complex rational thought and may feel confused and distressed by trauma of flooding

  • SD is often most appropriate treatment for people with learning disabilities who have phobias

• SD involves exposure to phobic stimulus in real-world setting but the advantages to exposure part of SD in VR

  • Exposure through VR can be done to avoid dangerous situations and is cost-effective because no need for psychologist and client to leave the consulting room

    • HOWEVER some evidence suggests that VR exposure may be less effective than real exposure for social phobias because it lacks realism (Wechsler et al 2019)

weaknesses of SD

• Ohman et al (1975) suggested that SD may not be as effective in treating phobias that have an underlying evolutionary survival component (e.g., fear of the dark) than in treating phobias that have been acquired as a result of personal experience (e.g., fear of clowns). 

• Behavioural therapies might not work with certain phobias because the symptoms are a result of a deeper, underlying issue. If you remove the symptoms, the cause remains, and symptoms will simply resurface later.

  • Freud (1909) reported the case of Little Hans who suffered from a phobia of horses. Freud concluded the boy’s actual problem was intense envy of his father which he could not express and so the anxiety was projected onto the horse. The phobia was cured when the boy accepted his feelings towards his father. 

what is flooding

• Much longer sessions than SD ones as they need to be in the presence of the phobic stimulus for an extended period of the way

• Immediate exposure to feared stimulus

• Patients are prevented from avoiding the phobic stimulus

• Relaxation techniques are practised and new stimulus-response link can be learnt replacing fear with relaxation

• Anxiety eventually subsides as adrenaline levels naturally start to decrease (1-3 hours)

• This is practiced until the fear is extinguished and the patient will remain calm around the phobic stimulus

• This can be done in vivo (real life) or in vitro (imaginary)

  • Phobic responses end very quickly due to the fact that the patient cannot leave and so they learn the phobic stimulus is harmless - extinction of the classical conditioning

  • Learned response is extinguished when conditioned stimulus is encountered without unconditioned stimulus - result is that the conditioned stimulus won't produce the conditioned response

  • Client may achieve relaxation due to being exhausted by fear

• Not unethical but is an unpleasant experience and so have to give fully informed consent to the traumatic procedure - fully prepared before the flooding  session

  • Clients typically given the choice of SD or flooding

strengths of flooding

• Strength - highly cost-effective (clinically works and is not expensive), work in as little as one session rather than multiple needed for SD, more people can be treated at the same cost with flooding

  • increases accessibility

• Choy et al (2007) found flooding was more effective than SD. 

• Craske et al. (2008) conducted a review of research and concluded that SD and flooding were equally effective.

weaknesses of flooding

• Limitation is that it is a highly unpleasant experience - provokes tremendous anxiety as one has to confront the phobic stimulus, Schumacher et al 2019 found ppts and therapists rated flooding as significantly more stressful than SD, raises ethical issues (but informed consent removes this)

  • Attrition rates (dropout) are higher in flooding than SD

• Only mask symptoms and do not tackle underlying causes (symptom substitution), Persons 1986 reported a woman who had a phobia of death and was treated for it using flooding, the woman's fear of being criticised got worse

  • HOWEVER  only evidence for this issue comes form case studies which may only generalise to those specific phobias in the study