Phobias

Phobia definition

a persistent and unreasonable fear of a particular object, activity or situation 

How does classical conditioning create a phobia?

UCS: event   
UCR: fear response 
NS: associated with the event 
CS: associated with the event 
CR: fear response

How does operant theory create a phobia?

(self-reinforcement by negative reinforcement ‘if I continue to have this fear/avoid this thing, it will protect myself or others’ – removal of the bad thing (NR) and being proud of the fact the issue has been avoided (PR) ) 

External reinforcement from others if they adapt to your phobia, thus facilitating this behaviour and reinforcing it. Reinforces avoidance  

How does social learning theory create a phobia? (a learned phobia from family/friends)

Role models  
Attention, retention, reproduction, motivation  

Treatments focus on changing the abnormal behaviour – helping the person to unlearn the maladaptive learned behaviour and replace it with a more adaptive response 

Systematic desensitisation aims

To replace the fearful response to the phobic stimuli with a new response which is incompatible with fear (usually muscle relaxation or a lowered HR)

How does systematic desensitisation work?

• functional analysis - using questioning to establish the nature of the anxiety and any possible triggers

• client and therapist establish an ‘anxiety hierarchy’, in which the client’s feared situation is ordered from least to most anxiety-provoking. (Give examples e.g. fear of spiders might begin with a photo of a spider…)

• the client is taught to relax deeply using relaxation training - control of muscle tension, deep breathing

• gradual exposure to the phobia object, beginning with the lowest fear inducing stage on the hierarchy and counter-conditioning is used to replace the fear/anxiety with relaxation. This can only be in-vitro (imaginary) or in-vivo (actual phobic stimuli)

• client can only move onto the next stage of the anxiety hierarchy once they have mastered the step before

Downsides of systematic desensitisation

• can take very long and unspecified periods of time , which can be time consuming and expensive if paying for therapy sessions

• not useful to use on complex or social phobias that are less tangible, as it focusses on the symptoms of the phobia rather than the cause, and it can be difficult to build a phobic hierarchy for more intangible fears. To tackle the root cause of the phobia, psychoanalysis or cognitive behavioural therapy may be a more useful approach

Positives of systematic desensitisation

• least traumatising for the patient, considered to be more ethical as greater protection from harm and distress due to the gradual process

• once finished treatment, they will be able to manage themselves effectively and will not need top-tup sessions - aims to provide them with long term skills to manage any anxiety

• easy to measure outcome or progression through the hierarchical nature of the treatment

• Gilroy found that in 3 x 45 minute sessions, participants were cured of their phobia of spiders

What is flooding

• First session would involve a functional analysis, in which the client and clinician establish both goals and triggers for the client

• They would discuss the most phobic-inducing situation for the client

• a behavioural therapy designed to reduce phobic anxiety in one session, via immediate exposure to the phobic stimulus. This occurs in an environments from which the patient cannot escape, so there is no option for avoidant behaviours (so these behaviours are not reinforced and the phobia is not maintained).

• This method relies on the principle that it is biologically impossible for the body to maintain a state of heightened anxiety for a prolonged period, meaning that eventually the patient’s stress will reduce and they will learn that the phobic stimulus is harmless (extinction of the phobia)

• Classical conditioning - idea that the phobic object was originally as NS and that became paired with UCS, and that this can be reversed. The CS will no longer produce a CR

Positives of flooding

• cost effective compared as the phobia is cured in one session. Non-invasive into the normal life of the patient, allows them to continue living a normal life (as opposed to SD where patient may have to attend sessions every week)

• Ougrin compared flooding to cognitive therapy and found flooding was highly successful and quicker than alternatives

• less effective for treating more complex phobias like social phobias, as these may include a cognitive aspect

• flooding produces high levels of fear and anxiety which can be very distressing

Negatives of flooding

less effective for complex phobias, such as social phobias that involve both anxiety and a cognitive aspect. In such cases, cognitive therapy may be more appropriate in targeting the causes of the phobia 
extremely distressing, arguably less protection from harm than if using systematic desensitisation