Behavioural Approach to TREATING phobias Flashcards
What is Systematic Desensitisation, its AIMS π― and how does it work?
- Systematic Desensitisation (SD) is a behavioural πͺπΌ therapy designed to gradually reduce phobic π£ anxiety through the principle of CC.
If the sufferer can learn to relax π in the presence of the phobic stimulus then a new response (relaxation instead of anxiety) is learned and the phobia is cured.
The learning of a new response is called counter-conditioning. So SD aims to replace faulty association between the CS and the CR that has resulted in a phobic response.
- Its impossible to be afraid π and relaxed π@ same time, 1οΈβ£ emotion prevents the other.
There are 2 types of SD:
> In-vivo- where individual is exposed π΅ to the actual object/situation
> In-vitro - where individual imagines π being exposed to the phobic object/ situation.
How many and what processes are involved in SD?
1) Relaxation π
2) The anxiety π£ hierarchy πΊ
3) Exposure π΅
What is the process of RELAXATION π in SD
The therapist π©π»βπ« teaches patient ππΌto relax as deeply as possible. i.e. might involve breathing exercises π, e.g. may be taught the 7/11 technique, where you breathe in for a count of 7 and out for 11.
Its used to help people relax π and gain composure in variety of situations or alternatively the patient might learn mental imaginary π techniques.
Patients can be taught to imagine π themselves in relaxing π situations (lying on the beach π ) or might learn mediation π€Έπ»ββοΈ.
What is the process of THE ANXIETY HIERARCHY π£πΊin SD
The anxiety hierarchy π£πΊis put together by the client ππΌ and therapistπ©π»βπ«.
It a list πof situations related to the phobia that provoke anxiety arranged in order from least πto most frighteningπ.
E.g. a spider π·phobic might identify seeing an image πΌ of a small spider as low β¬οΈ on their anxiety hierarchy and holding a tarantulaβπΌπ· at the top π of the hierarchy.
What is the process of EXPOSURE π΅ in SD
The patient is then exposed π΅to the phobic stimulus while in a relaxed π state.
This takes place across several sessions, starting at bottom β¬οΈ of the anxiety hierarchy.
When the patient can stay relaxed π in the presence of the lower β¬οΈ levels of the phobic stimulus they move up π the hierarchy.
Treatment is successful ππΌ when the patientπ©πΌcan stay relaxed π in situations high πon the anxiety hierarchy π£πΊ.
What are the evaluation points of SD in terms of its EFFECTIVENESS?
1) It is effective β
2) Relaxation π may not be necessary (placebo effect) βοΈ
Outline the evaluation point
1) It is effective β in terms of effectiveness
Point:
Strength πͺπΌ of SD for the treatment of phobias is that research π¬ shows that its effective in the treatment for specific phobias.
E:
Gilroy et al 2οΈβ£0οΈβ£0οΈβ£3οΈβ£ followed up π©π»βπΌx42 patients who had been treated for spider π· trauma in 3, 45 minute β± sessions of SD. A control group was treated by relaxation πwithout π«exposure π΅to spidersπ·
@ both 3 and 33 months after the treatment the SD group were less fearful than the relaxation group.
Additionally, McGrath et al 1οΈβ£9οΈβ£9οΈβ£0οΈβ£reported that 75% of clients π©π»βπΌ with phobias responded to SD.
According to Choy et al 2οΈβ£0οΈβ£0οΈβ£7οΈβ£ the key π to success lies with the actual contact with the feared stimulus, so IN-VIVO techniques are more successful than ones using images πΌ or imagining π the feared stimulus (IN-VITRO).
Re-cap:
These pieces of research demonstrate that SD is a useful technique in the treatment of specific phobias.
Outline the evaluation point
2) Relaxation π may not be necessary π« (placebo effect) βοΈ in terms of EFFECTIVENESS
Point:
Weakness βοΈ is that it may be that the success is more to do with exposure π΅ to the feared situation than relaxation π.
Explain:
It might be that the expectation of being able to cope with the feared stimulus is important.
Example:
Klein et al 1οΈβ£9οΈβ£8οΈβ£3οΈβ£ compared SD with supportive psychotherapy (therapy that combines psychodynamic and cognitive therapies) for patients with specific or social phobias.
Elaborate:
They found no difference in the effectiveness, suggesting that the βactive ingredientβ in SD may simply be the generation of hopeful expectancies that the phobia can be overcome.
Re-cap:
Suggests the exact reason why SD is effective remains unclear.
What are the evaluation points of SD in terms of its APPROPRIATENESS ?
3) More preferable to flooding π for many clients π©π»βπΌ β
4) Symptom substitution βοΈ
Outline the evaluation point
3) More preferable to flooding π for many clients π©π»βπΌ β in terms of APPROPRIATENESS
Point:
Strength β
of SD is that patients π©π»βπΌ seem to prefer it to flooding π because they feel that it is less traumatic because of the more gentle π step by step approach.
Explain:
Largely because it doesnβt cause the same degree of trauma as flooding π - due to slowly working through the anxiety hierarchy is seen more ethical π.
Elaborate:
This is reflected in the low refusal rates (NO. of pβs refusing π
πΌββοΈ to start treatment) and low attribution rates (pβs dropping out of treatment) of SD.
Re-cap:
Suggests that for many clients with phobias, SD is an appropriate treatment.
Outline the evaluation point
4) Symptom substitution βοΈ in terms of APPROPRIATENESS
Point:
Limitation βοΈ of SD as treatment for phobias is that the psychodynamic model claims that SD ( & other behavioural therapies e.g. flooding π) focuses only on symptoms & ignores the cause of abnormal π½ behaviour.
Explain:
Psychoanalysts π©π»ββοΈ claim that symptoms are merely the tip of the iceberg π- the outward expression of deeper underlying emotional problems.
Elaborate:
Psychoanalysts π©π»ββοΈ believe that whenever symptoms are treated without any attempt to work out the deeper underlying problems, the problem will only show itself in another way, through different symptoms - known as SYMPTOM SUBSTITUTION.
Re-cap:
Behaviourists however reject π« this criticism and claim that we need to not look beyond the behavioural symptoms as the symptoms are the disorder.
What is flooding π and the aim π― of it?
The aim π― of flooding π is to exposeπ΅ the suffererπ· to the phobic object or situation for an extended period of time in a safe and controlled environment.
What does flooding π include?
- Immediate exposure π΅ to the phobic stimulus
- Exhaustion π€π of phobic response
- Prevention π«of avoidance
What does it mean to Immediately π΅ expose the phobic stimulus?
Involves bombarding βοΈ the phobic patient π· with the phobic object (IN-VIVO exposure) until the person is calm and does not fear the stimulus, without a gradual build up.
So a spider π· phobia (arachnophobia) receiving flooding π treatment may have large spider crawl over their hand βπΌπ·until they can fully relaxπ. As a result, flooding πsessions are longerβ± than SD and last for 2-3 hours. Sometimes only 1 long session is required to cure the phobia.
What does it mean by Exhaustion π€πof phobic response?
Means that flooding π is without the option of avoidance π« behaviour, the patient π©π»βπΌ quickly learns that the phobic object is harmless through the exhaustion of their fear response - aka extinction.
In CC terms, the result is that the CS (spider) no longer produces the CR (fear).
In some cases patient π©π»βπΌ might even achieve relaxation π in presence of phobic stimulus simply because they become exhausted π€π of their own fear response.