behavioural approach to treating phobias

Question 1

what is systematic desensitisation (SD)?

Answer 1

• 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
• essentially, a new response to the phobic stimulus is learned; phobic stimulus is paired with relaxation instead of anxiety
• this learning of a different response is called counterconditioning

Question 2

what are the 3 processes involved in SD?

Answer 2

1. the anxiety hierarchy
2. relaxation
3. exposure

Question 3

SD: 1) the anxiety hierarchy

Answer 3

• put together by a 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. arachnophobic might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy

Question 4

SD: 2) relaxation

Answer 4

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

Question 5

what might relaxation involve?

Answer 5

• breathing exercises
• mental imagery techniques
  > clients can be taught to imagine themselves in relaxing situations (eg. imagining lying on a beach)
• learning meditation
• relaxation can be achieved using drugs such as valium

Question 6

SD: 3) exposure

Answer 6

• 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 the 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

Question 7

craig newman and katie adams’s (2004) anxiety hierarchy used to treat a phobia of dogs in a teenage boy with learning difficulties

Answer 7

1) introduction to dogs with photographs
10) close proximity to dogs in a park

Question 8

evaluation of SD: evidence of effectiveness

Answer 8

• lisa gilroy et al. (2003) followed up 42 people who had SD for spider phobia in three 45-minute sessions
• at both 3 and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure
• in a recent review, theresa wechsler et al. (2019) concluded that SD is likely to be helpful for people with phobias

Question 9

evaluation of SD: can be used to help people with learning difficulties

Answer 9

• some people requiring treatment for phobias also have a learning difficulty
• however, the main alternatives to SD are not suitable
• people with learning disabilities often struggle with cognitive therapies that require complex rational thought
• they may also feel confused and distressed by the traumatic experience of flood
• this means that SD is often the most appropriate treatment for people with learning disabilities who have phobias

Question 10

evaluationof SD: SD in virtual reality

Answer 10

• traditional SD involves exposure to the phobic stimulus in a real-world setting
• however, conducting the exposure part of SD in VR is useful as it can be used to avoid dangerous situations (eg. heights) and is cost-effective as the psychologist and client don’t need to leave the consulting room
• however, there is some evidence to suggest that VR exposure may be less effective than real exposure for social phobias because it lacks realism (wechsler et al. 2019)

Question 11

what does flooding involve?

Answer 11

• exposing people with a phobia to their phobic stimulus but without a gradual build-up in an anxiety hierarchy
• instead, it involves immediate exposure to a very frightening situation
• eg. a person with arachnophobia receiving flooding treatment might have a large spider crawl over them for an extended period

Question 12

what are some differences between flooding and SD?

Answer 12

• flooding sessions are longer than SD sessions, one session often lasting two to three hours
• sometimes only one long session is needed to cure a phobia
• there is no anxiety hierarchy in flooding
• flooding is very quick

Question 13

why does flooding work very quickly?

Answer 13

• without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless
• 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

Question 14

what is extinction in terms of classical conditioning?

Answer 14

• when a learned response is extinguished when the CS (eg. dog) is encountered without the UCS (eg. being bitten)
• the result is that the conditioned stimulus no longer produces the CR (fear)

Question 15

ethical safeguards of flooding

Answer 15

• flooding is not unethical per se, but it is an unpleasant experience
• therefore, it is 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 choice of SD or flooding

Question 16

evaluation of flooding: highly cost-effective

Answer 16

• clinical effectiveness is how effective a therapy is at tackling symptoms
• when we provide therapies in health systems like the NHS, we also need to think about how much they cost
• a therapy is cost-effective if it is clinically effective and not expensive
• flooding can work in as little as one session as opposed to say, 10 sessions for SD to achieve the same result
• therefore, more people can be treated at the same cost with flooding than with SD or other therapies

Question 17

evaluation of flooding: highly unpleasant and traumatic experience

Answer 17

• confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety
• sarah schumacher et al. (2015) found that participants and therapists rated flooding as significantly more stressful than SD
• this raises the ethical issue for psychologists knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent
• more seriously, the traumatic nature of flooding means that attrition (dropout) rates are higher than for SD
• this suggests that, overall, therapists may avoid using this treatment

Question 18

evaluation of flooding: symptom substitution

Answer 18

• only mask symptoms and do not tackle the underlying causes of phobias (symptom substitution)
• jacqueline persons (1986) reported the case of a woman with a phobia of death who was treated using flooding. her fear of death declined, but her fear of being criticised got worse
• however, the only evidence for symptom substitution comes in the form of case studies which, in this case, may only generalise to the phobias in the study
  > eg. phobia of death may be different from a phobia of heights