PATH 03 - Phobias treatments 1 Flashcards
(20 cards)
1
Q
What is SD?
A
- A behavioural therapy designed to reduce an unwanted response such as anxiety through the principle of classical conditioning
- SD involves drawing up a hierarchy of anxiety-provoking situations related to a person’s phobic stimulus, teaching the person to relax, and then exposing them to phobic situations
- The person works their way through the hierarchy whilst maintaining relaxation
2
Q
What is flooding?
A
- A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus
- This takes place across a small number of long therapy sessions
3
Q
What is counterconditioning?
A
- When a new response to the phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety)
- Being taught a new association that is the opposite of the original association, thus removing the original association
4
Q
What is reciprocal inhibition?
A
- Opposing emotions inhibiting one another
- It is impossible to anxious and relaxed at the same time, so relaxation prevents anxiety
5
Q
What are the rationale of behavioural therapies?
A
- Use of classical conditioning so the patient can learn a new response to the phobic stimulus (learning of new response is referred to as counterconditioning)
- Key belief: It is impossible to anxious and relaxed at the same time, so relaxation prevents anxiety
- Both therapies avoidance behaviour so phobia cannot be maintained by operant conditioning. The phobic stimulus-response link becomes extinct
6
Q
What are the three process involved in SD?
A
1) The anxiety hierarchy
2) Relaxation
3) Exposure
7
Q
Explain the anxiety hierarchy process in SD.
A
- The anxiety hierarchy is put together by a client with 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
- For example, a person with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy
8
Q
Explain the relaxation process in SD.
A
- 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
- The relaxation might involve breathing exercises or, alternatively, the client might learn mental imagery techniques
- Clients can be taught to imagine themselves in relaxing situations (such as imagining lying on a beach) or they might learn meditation
- Alternatively, relaxation can be achieved using drugs such as Valiu
9
Q
Explain the exposure process in SD.
A
- 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 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
10
Q
How does flooding work?
A
- Involves immediate exposure to phobic stimulus
- Flooding sessions are typically longer than SD sessions, one session often lasting 2 or 3 hours
- Sometimes only one session is needed to cure a phobia
- 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 process is called extinction
- A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten)
- The result is that the conditioned stimulus no longer produces the conditioned response (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
11
Q
What are the strengths of SD?
A
- Evidence of effectiveness
- Can be used to help individuals with learning disabilities
12
Q
What are the limitations of SD?
A
Cost
13
Q
What evidence is there for the effectiveness of SD?
A
- One strength of systematic desensitisation (SD) is the evidence base for its effectiveness
- Lisa Gilroy et al. (2003) followed up 42 people who had SD for spider phobia in three 45-minute sessions
- At both three 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 effective for specific phobia, social phobia and agoraphobia
- This means that SD is likely to be helpful for people with phobias
14
Q
How can SD be used to help individuals with learning disabilities?
A
- 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 a learning disability.
- 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 flooding
- This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias
15
Q
How is cost a limitation for SD?
A
This treatment can be costly for the patient and the NHS, as it costs time for the patient to attend the many sessions and money for the NHS to fund a specialist
16
Q
What are the strengths of flooding?
A
Highly cost effective
17
Q
What are the limitations of flooding?
A
- Highly unpleasant/traumatic experience
- It only masks symptoms
18
Q
How is flooding highly cost effective?
A
- One strength of flooding is that it is highly cost-effective
- Clinical effectiveness means how effective a therapy is at tackling symptoms
- However, 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, ten sessions for SD to achieve the same result
- Even allowing for a longer session (perhaps three hours) this makes flooding more cost-effective
- This means that more people can be treated at the same cost with flooding than with SD or other therapies
19
Q
How is flooding a high unpleasant/traumatic experience?
A
- One limitation of flooding is that it is a highly unpleasant experience
- 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 of 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
20
Q
How does flooding only mask symptoms?
A
- A limitation of behavioural therapies, including flooding, is that they only mask symptoms and do not tackle the underlying causes of phobias (symptom substitution)
- For example, 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 (e.g. phobia of death may be different from a phobia of heights)
