The behavioural approach to treating phobias

Systematic desensitisation

• 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 the phobic stimulus they will be cured. A new response to the phobic stimulus is learned (paired with relaxation instead of anxiety). This learning of a different response is called counterconditioning

Systematic desensitisation: The anxiety hierarchy

• Put together by a client with a phobia and a therapist. List of situations related to the phobic stimulus that provide anxiety arranged in order from least to most frightening, e.g. person with arachnophobia may identify a picture of a small spider as low on this and holding a tarantula at the top

Systematic desensitisation: Relaxation

• Therapist teaches this to the client. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other (reciprocal inhibition). Might involve breathing exercises, or the client might learn mental imagery techniques. Clients can be taught to imagine themselves in relaxing situations (like lying on a beach) or they might learn meditation. Can also be achieved using drugs like Valium

Systematic desensitisation: Exposure

• Final step, done in a relaxed state. 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 hierarchy they move up the hierarchy. Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy

Flooding

• Involves exposing people with a phobia to their phobic stimulus (and a very frightening situation) immediately. So a person with arachnophobia might have a large spider crawl over them for an extended period. Typically longer sessions, one session often lasting two to three hours. Sometimes only one session may be needed to cure a phobia

How flooding works

• Stops phobic responses quickly because, without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless. In terms of classical conditioning this is called extinction. A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten). The conditioned stimulus no longer produces the conditioned response (fear)

• Client may also achieve relaxation in the presence of their phobic stimulus; they may become exhausted by their own fear response

Flooding: Ethical safeguards

• It is an unpleasant experience so it is important that clients give fully informed consent to this traumatic procedure and that they are fully prepared before a session. A client would normally be given the choice of which behavioural therapy they want

Evaluation of systematic desensitisation: Strengths

• Evidence of effectiveness. Gilroy et al (2003) followed up 42 people who had SD for arachnophobia in three 45-minute sessions. At both three and 33 months, the SD groups were less fearful than a control group treated by relaxation without exposure. 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

Evaluation of systematic desensitisation: Strengths

• Can be used to help people with learning disabilities. Some people requiring treatment for phobias also have a learning difficulty. People with such 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 SD is often the most appropriate treatment for people with learning disabilities who have phobias

Evaluation of flooding: Strengths

• Highly cost-effective. 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 (perhaps three hours) makes flooding more cost-effective

• This means that more people can be treated at the same cost with flooding than with SD or therapies

Evaluation of flooding: Weaknesses

• Highly unpleasant experience. Confronting one's phobic stimulus in an extreme form provokes tremendous anxiety. Schumacher et al (2015) found that participants and therapists rated flooding as significantly more stressful than SD, raising the ethical issue of knowingly causing stress to clients, although this is not serious provided therapists obtain informed consent. However, 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