Models_Behavior Therapy and Phobias

Phobias and Behavior Therapy

• Course: PSH 336, Clinical Psychology, Dr. Gillespie

What are Phobias?

• Definition: A phobia is a disproportional fear that disrupts daily life.

• Characteristics:

  • Disproportionate to actual risk/danger involved.

  • Incapacitating and disrupts daily life/routine.

• Specific Phobia:

  • Strong fear and avoidance of a particular object or situation.

  • Clients typically do not have panic attacks or fear of panic attacks (agoraphobia).

  • Exposure to fear may lead to panic-like feelings.

Common Phobic Fears

• List of Phobias:

  • Airplane Phobia

  • Animal Phobias (e.g., bees, snakes, spiders)

  • Fear of Heights

  • Medical Phobias (e.g., blood, injury)

  • Elevator Phobia

Behavioral Fear Reduction Techniques

• Hierarchy Approach:

  • Generates a list of personal fears (10-20 items).

  • Clients learn to relax then visualize hierarchy items while maintaining relaxation.

  • Theory: Anxiety and relaxation are incompatible and mutually exclusive.

  • Effective with all age groups (adults, children, adolescents).

Examples of Anxiety Hierarchies in Adults

• Client 1: Airplane Phobia Hierarchy:

  1. Making reservations (5)

  2. Purchasing ticket (10)

  3. Packing for trip (15)

  4. Calling airport for flight status (20)

  5. Driving to the airport (22)

  6. Checking in (25)

  7. Waiting to board (35)

  8. Boarding the plane (35)

  9. Announcement ready for boarding (40)

  10. Sitting down and fastening seatbelt (45)

  11. Plane cruising (50)

  12. Plane climbing to altitude (55)

  13. Plane taxing (60)

  14. Taking off (65)

  15. Announcement for final descent (75)

  16. Plane descending (80)

  17. Plane banking (85)

  18. Turbulence sign (90)

  19. Touchdown (95)

  20. Rough weather flying (100)

• Client 2: General Phobia Hierarchy:

  1. Hearing a siren (5)

  2. Seeing a snake (10)

  3. Swimming in a pool at night (15)

  4. Thinking about witches (20)

  5. Auto crashes thoughts (35)

  6. Climbing on high objects (40)

  7. Hearing of a fatal disease (70)

  8. Death of loved ones (100)

Child Phobia Examples

• Tammy, Age 8 (Dog Phobia):

  1. Talking about fear of dogs (1)

  2. Movies with dogs (2)

  3. Holding a newborn puppy (3)

  4. Hearing barking dogs (4)

  5. Close proximity to dogs (6)

• Will, Age 6 (Dog Phobia):

  1. Reading a dog book (1)

  2. Looking at pictures of dogs (2)

  3. Petting a stuffed dog (5)

  4. Being in a room alone with a dog (10)

• Sally, Age 8 (Arachnophobia):

  1. Drawing a spider (1)

  2. Seeing a cartoon spider (2)

  3. Holding a plastic spider (5)

  4. Live spider nearby (8)

Case Study: Mary

• Background:

  • 27, married, hotel maid.

  • Developed severe fear of elevators after an attack by a guest.

  • Fear significant enough to hamper her job (avoiding elevators).

• Medical History:

  • No significant medical background; high caffeine consumption.

  • Previous therapy was unhelpful - focused too much on past.

• Diagnosis:

  • Specific Phobia, Situational (Elevators).

Behavioral Assessment and Treatment Plan

• Assessment:

  • Subjective Units of Discomfort (SUDs) ratings during elevator exposure. Unable to go above 3rd floor.

  • Treatment goal: ride to 10th floor without fear.

• Plan Components:

  • Educational: Discuss phobias and treatment.

  • Behavioral: Guided graduated exposure.

  • Cognitive: Use of cognitive restructuring and self-soothing techniques.

• Treatment Hierarchy Example:

  • Initially standing at elevator doors with husband, then moving to alone rides incrementally.

• Relaxation Techniques:

  • Muscle relaxation, imagery of calm scenes.

Progress and Adjustments

• First session: Exposure trials yielded high anxiety.

• Successful progression to independence in using elevator.

• Maintenance of sessions focused on further exposure and reducing anxiety via relaxation exercises.

Therapeutic Gains

• 6-month follow-up shows no anxiety in elevators.

• Reduction in caffeine consumption; increased job satisfaction.