Behavioural approach to treating phobias

Hierarchy

A system where things or people are placed in an order from most important to least important

Relaxation

The patient is taught to use relaxation techniques like focusing on their breathing, visualising a peaceful scene or using progressive muscle relaxation when introduced to the fearful situations

Counter-conditioning

The patient is taught a new association that is counter to the original association

Desensitisation hierarchy

The patient creates a hierarchy. They progressively face more fearful situations. The gradual steps take about a month to complete. Fear thermometer is used scoring 1-10

Systematic desensitisation

Behavioural therapy designed to reduce an unwanted response like anxiety.

1. Patient is taught relaxation techniques (deep breathing)

2. Construct desensitisation hierarchy between patient and therapy with imagined scenes / actual contact. Progressively more fearful

3. Patient engages in relaxation each time they imagine an anxiety-envoking effect. They cannot move onto the next step until they can control their anxiety.

4. Patient is confronted with their phobia

Flooding

Behavioural therapy where a person with a phobia is exposed to an extreme form of a phobic stimulus to reduce anxiety triggered by it. This takes place across a small number of sessions

1. Patient taught how to relax their muscles using relaxation techniques

2. In the same session the patient is confronted with their phobia either imagined or in vivo until they are fully relaxed and habituated

3. As the adrenaline levels naturally decrease, a new stimulus-response link can be learned.

S Effective treatments

McGrath

75% of patients responded to SD but in vivo techniques were more successful.

The treatments are successful for a range of phobias

Behaviourist approach practical applications.

S Less effort on patient’s part

Behaviourist treatments can be self-administered compared to CBT which requires a lot of effort from patients understanding their behaviour.

Behavioural therapies are useful for people who lack insight into their behaviour.

May be preferred over other treatments

SD S Jones

Used SD to reduce “Little Peter’s” phobia of white fluffy animals.

Replaced the phobia towards rabbits with affection by presenting the rabbit at closer distances each time Peter’s anxiety levels reduced.

He was rewarded with food to create a positive association

Shows that behaviourists treatments can successfully eradicate phobias

SD W Less effective for people with particular cognitive characteristics

Böhnlein

Systematic review of 111 studies of exposure therapies and found evidence to show that exposure is less effective for groups of people with low self-efficacy and high anxiety.

Suggests that the exposure part of SD may not work

F S Cost-effective

Clinical effectiveness is how effective a therapy is. However, when we provide therapies in the NHS we need to think about the cost.

A therapy is cost-effective if it is not expensive and clinically effective

Flooding can work in 1 session compared to 10 in SD to achieve the same or similar result.

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

F W Ethical issues

Extremely traumatic. May be unsuitable for children or people in poor physical health.

SD is more preferred even though flooding is more effective.

The distress can lead to patients quitting and reduces its effectiveness.