7. treating phobias

ways of treating phobias

1. systematic desensitisation (SD)

2. flooding

what is SD

• a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning

• essentially a new response to the phobic stimulus is learned known as counterconditioning

processes involved in SD

1. anxiety hierarchy

2. relaxation

3. exposure

anxiety hierarchy

• the anxiety hierarchy is put together by a client with phobia and therapist

• its a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening

relaxation

• therapist teaches the client to relax as deeply as possible as its impossible to be afraid and relaxed at the same time, so one emotion prevents the other - reciprocal inhibition

• relaxation techniques may involve breathing exercises or mental imagery and sometimes even drugs like valium

exposure

• client is exposed to phobic stimulus while in a relaxed state

• takes place across several sessions starting at the bottom of the anxiety hierarchy - when client can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy

• treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy

evaluation

1. evidence of effectiveness

2. people with learning disabilities

3. SD in virtual reality

evidence of effectiveness

• proven to be effective in reducing phobic symptoms

• gilroy et al found that people treated for a spider phobia with SD were less fearfyk even after 33 months, compared to a control group - suggests it leads to a long term improvement and is not just a temporary fix

• therefore has wide applications to treat specific phobias as well as social phobias making it a reliable therapy option

people with learning disabilities

• more suitable for individuals with learning disabilities than other treatments

• eg cognitive therapies require complex thinking and flooding can be too distressing for those with learning difficulties - whereas SD is a gradual and structured approach making it easier for indiviauls with learning disabilities to cope with

• useful for those with cognitive impairments or autism

SD in virtual reality

• VR can be used for SD but it may be less effective

• VR exposure may lack realism, making it less beneficial for social phobias as it cannot replicate real life anxiety triggers

what is flooding

• involves exposing people with a phobia to their phobic stimulus but without a gradual build up in anxiety hierarchy - immediate exposure to a very frightening situation

• sessions are typically longer than SD - one session lasts two to three hours

• sometimes only one long session is needed to cure a phobia

how does flooding work

it stops phobic responses very quickly

• because without the option of avoidance behaviour, the client quickly learns the phobic stimulus is harmless - in classical conditioning terms this process is called extinction

• a leanred response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus - result is that the condition stimulus no longer produces the conditioned response

• in some cases, the client may achieve relaxation in the presence of the phobic stimulus simply beause they become exhausted by their own fear response

ethical safeguards

• it is an unpleasant experience so it is important that clients give fully informed consent to the traumatic procedure and that they are fully prepared before the flooding session

• a client would normally be given the choice of systematic desensitisation or flooding

evaluation

1. cost effective

2. traumatic

3. system substitution

cost effective

• its a quick and cost effective treatment

• unlike SD which requires multiple sessions, it can be completed in one or wo sessions which reduces costs for healthcare providers like the NHS which makes treatment more accessible

• more people can be treated within the same budget making it a practical choice

traumatic

• highly distressing which leads to high dropout rates

• schumacher et al found participants and therapists rated flooding as as significantly more stressful than SD - raises ethical concerns as patients may be unwilling or unable to complete treatment, reducing effectiveness

• therapists must obtain full informed consent and consider whether a patient can tolerate the intensity of flooding

symptom substitution

• may eliminate the symptoms of a phobia but not the underlying cause

• persons reported a case where a womans fear of death was treated with flooding, but she later developed a fear of criticism - suggests treating a phobia does not always resolve the deeper psychological issues behind it

• flooding may need to be combined with other therapies eg CBT to address the root cause of their phobias rather than just symptoms