PHOBIAS -
CATAGORIES OF PHOBIAS - THE DSM 5
all phobias are characterised by excessive fear and anxiety, triggered by an object, place or situation
the extent of the fear is out of proportion to any real danger presented by the phobic stimulus
the DSM-5 recognises the following categories of phobias -
SPECIFIC PHOBIAS -phobia of an object, such as an animal or body part, or a situation such as flying or injections
SOCIAL ANXIETY (SOCIAL PHOBIA) - phobia of a social situation such as public speaking or using a public toilet
AGORAPHOBIA - phobia of being outside or in a public space
BEHAVIOURAL CHARACTERISTICS OF PHOBIAS -
we respond to things of situations we fear by behaving in particular ways, we respond by feeling high levels of anxiety and trying to escape
the fear responses in phobias are the same as we experience for any other fear, even if the level of fear is irrational
PANIC - a person with a phobia may panic in response to the presence of a phobic stimulus, could cause crying, screaming or running away
AVOIDANCE - unless the persons consciously trying to combat a fear, they may try really hard to prevent coming into contact with the stimulus, which can make daily life hard. EG if scared of public toilets, may have to limit time outside of the house in order to not have to use them
ENDURANCE - the alternative to avoidance, where a person will remain in the Prescence of a phobic stimulus. EG watching a spider to see where it goes, helps them feel in control
EMOTIONAL CHARACTERISTICS OF PHOBIAS -
ANXIETY - phobias are classed as anxiety disorders, an unpleasant state of high arousal is experienced, prevents relaxation and positive emotions, which can extend long term
FEAR - fear is different to anxiety as fear is an immediate and extremely unpleasant response we experience when encountering or thinking about a phobic stimulus , its more intense but less long lasting than anxiety
UNREASONABLE RESPONSES - the anxiety or fear felt is much greater than ‘normal’ and is disproportionate to the threat which is posed by the phobic stimulus
COGNITIVE CHARACTERISTICS OF PHOBIAS -
the cognitive element is concerned with the ways in which people process information, people with phobias process information about phobic stimuli differently from other objects or situations
SELECTIVE ATTENTION TO THE PHOBIA - if a person can see the phobic stimulus it is hard to look away from it, keeping our attention on something dangerous is a good thing as it gives us the best chance of reacting quickly to a threat, but this isn’t useful when the fear is irrational
IRRATIONAL BELIEFS - a person with a phobia may have thought about a stimulus that cant be easily explained and don’t have any basis in reality EG if someone feels they must always sound intelligent it puts more pressure on them in social settings
COGNITVE DISTORTIONS - the perceptions of a person with a phobia may be inaccurate and unrealistic, EG a person with a fear of spiders may see the spider as way bigger than it actually is
THE BEHAVIOURAL EXPLANATION OF PHOBIAS -
THE TWO PROCESS MODEL
the behavioural approach emphasises the role of learning in the acquisition of behaviour
the behavioural approach aims to explain the behavioural characteristics of phobias ( panic, avoidance, endurance ) instead of the psychological and emotional characteristics
Mowrer (1960) proposed the two process model, it states phobias are acquired by classical conditioning and then maintained by operant conditioning
ACQUISITION BY CLASSICAL CONDITIONING -
classical conditioning involves learning to associate something which we initially have no fear of ( a neutral stimulus ) with something that already triggers a fear response ( an unconditioned stimulus )
Watson and Rayner (1920) created a phobia in a nine month old baby called little albert
he showed no unusual anxiety at the start of the study, when shown a white rat he tried to play with it
but when the rat was then presented, it was always paired with a loud frightening noise
this noise was an unconditioned stimulus (UCS) which creates an unconditioned response (UCR) of fear
when the rat a NS and the UCS are encountered closely together in time, the NS becomes associated with the UCS and both now produce the fear response
albert displayed fear when he saw the rat, so the rat is now a conditioned stimulus which produces a conditioned response of fear
the conditioning then generalised to similar objects, they tested albert by showing him other furry objects, such as a non-white rabbit, a fur coat and Watson wearing a cotton wool santa Claus beard, little albert displayed distress at the sight of all of these
MAINTENANCE BY OPERANT CONDITIONING -
responses acquired by classical conditioning usually tend to decline over time, however phobias are often long lasting
Mowrer has explained that this is a result of operant conditioning
operant conditioning takes place when a behaviour is reinforced (rewarded) or punished
reinforcement tends to increase the frequency of a behaviour, if a person is able to avoid the phobic stimulus they are rewarded with a sense of calmness which means the behaviours more likely to be repeated
Mowrer suggested this is how phobias are maintained
AO3 EVALUATION POINTS -
REAL WORLD APPLICATION -
one strength of the two process model is its real world application in exposure therapies
the distinctive element of the two process model is the idea that phobias are maintained by avoidance of the phobic stimulus
this is important in explaining why people with phobias benefit from being exposed to the phobic stimulus as once the avoidance is stopped, the reinforcement that comes with it is also stopped which leads to a decline in the behaviour
this shows the value of the two-process approach as it identifies a means of treating phobias
COGNITIVE ASPECTS OF PHOBIAS -
one limitation of the two process model is that it does not account for the cognitive aspects of phobias
behavioural explanations, including the two process model are geared towards explaining behaviour, in the case of phobias the key behaviour is avoidance of the phobic stimulus
however we know that phobias are not simply avoidance responses, they also have a significant cognitive component
for example people hold irrational beliefs about the phobic stimulus ( such as thinking a spider is big and dangerous )
the two process model explains avoidance behaviour but does not offer an adequate explanation for phobic cognitions
this means that the two process model does not completely explain the symptoms of phobias
PHOBIAS AND TRAUMATIC EXPERIENCES -
a further strength of the two process model is evidence for a link between bad experiences and phobias
the little albert study illustrates how a frightening experience involving a stimulus can lead to a phobia of that stimulus
more systematic evidence comes from a study by Ad De Jongh et al (2006) who found that 73% of people with a fear of dental treatment had had a traumatic experience, mostly involving previous dentistry work
thus can be compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic dental event
this confirms that the association between stimulus and an unconditioned response does lead to the development of a phobia
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
the aim is to replace the conditioned response of fear and anxiety that’s paired with the phobic stimulus with feelings of relaxation
THERE ARE THREE PROCESSES INVOLVED IN SYSTEMATIC DESENSITISATION -
THE ANXIETY HIERACHY - is put together by the client with the phobia and therapist, this is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening EG a person with a phobia of spiders may rate seeing a photo of a spider as low anxiety but holding a tarantula as very high anxiety
RELAXATION - the therapist teaches the client to relax as deeply as possible, its impossible to be afraid and relaxed at the same time, so one emotion prevents the other which is called reciprocal inhibition. the relaxation may involve breathing exercises or mental imagery or drugs such as Valium can be used, but for the phobia to be removed they have to eventually be able to relax in the presence of the stimulus without drugs
EXPOSURE - finally the client is exposed to the phobic stimulus while in a relaxed state, this takes place across several sessions, starting at the bottom of the anxiety hierarchy. when they are able to relax when completing the stages at the bottom of the hierarchy , then the client moves up the stages towards the higher anxiety levels. the treatments successful when a client can stay relaxed in situations high on the anxiety hierarchy
FLOODING -
flooding also involves exposing people with phobias to their phobic stimulus but without a gradual build up in an anxiety hierarchy
instead flooding involves immediate exposure to a very frightening situation, so for example a person with arachnophobia receiving flooding treatment might have a large spider crawl over them for an extended period
flooding sessions are typically longer than systematic desensitisation sessions, one session often lasts two or three hours, and sometimes only one or two sessions is needed
HOW DOES IT WORK -
flooding stops phobic responses very quickly, this may be because without the option of avoidance behaviour the client quickly learns that the phobic stimulus is harmless
in classical conditioning terms this is called extinction as a learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus
this results in the conditioned stimulus no longer causing the conditioned response of fear, in some cases the client may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response
ETHICAL SAFEGUARDS -
flooding is not unethical, but it is an unpleasant experience so its important that clients give fully informed consent to this traumatic procedure and that they are fully prepared before the flooding session
a client would normally be given the option between flooding and systematic desensitisation
AO3 EVALUATION POINTS -
SYSTEMATIC DESENSITISATION -
EVIDENCE OF EFFECTIVENESS -
one strength of systematic desensitization is the evidence base for its effectiveness
Gilroy (2003) followed up with 42 people who has SD for spider phobias in 3 45-minute sessions
at both three and thirty three months the SD group were less fearful than a control group treated by relaxation without exposure
in a review, Wechsler (2019) concluded that SD is effective for specific phobias, social phobias and agoraphobia
this means that systematic desensitization is likely to be helpful when treating people with phobias
PEOPLE WITH LEARNING DISABILITIES -
a further strength of SD is that it can be used to help people with learning disabilities
some people requiring treatment for phobias also have learning disabilities, but the main alternatives to SD are not suitable
people with learning disabilities often struggle with cognitive therapies that require complex rational thought, and may often feel confused and distressed by the traumatic experience of flooding
this means that SD is often the most appropriated treatment for people with learning disabilities who have phobias
FLOODING -
COST EFFECTIVE -
one strength of flooding is that it is highly cost-effective
clinical effectiveness means how effective a therapy is at reducing symptoms, however when we provide therapies through health systems like the NHS, we also need to think about how much they cost
a therapy is cost effective if its clinically effective but not expensive
flooding can work in as little as one session, whereas SD can require many more sessions to achieve the same result
even if longer sessions are provided, floodings more cost-effective, which means that more people can be treated at the same cost with flooding, than if systematic desensitization or other therapies are used
TRAUMATIC -
one limitation of flooding is that it is a highly unpleasant experience, confronting a phobic stimulus in an extreme form provokes very high levels of anxiety
Schumacher (2015) found that participants and therapists rated flooding as significantly more stressful than SD
this raises ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue providing the psychologists obtain informed consent
more seriously, the traumatic nature of flooding means the dropout rates are much higher than for SD
this suggests that, overall, therapists may avoid using this treatment \