Treatment of Phobias- Systematic Desensitisation, Flooding Flashcards
(13 cards)
What does “systematic” and “desensitisation” mean?
Systematic- gradually confronting the object of fear.
Desensitisation- introducing relaxation to CS to change behaviour.
What does systematic desensitisation mean?
This therapy claims that phobias are caused by classical conditioning and therefore aims to treat phobias by associating the feared stimulus with relaxation instead of anxiety.
What does systematic desensitisation say the cause of the phobia is from?
This treatment assumes the cause of the phobia is classical conditioning.
- This is where a previously neutral stimulus (eg dog) has been paired with an unconditioned stimulus (eg bite). As a result, the individual shows fear (CS) when they see the conditioned stimulus (eg dog).
What is counter-conditioning in systematic desensitisation?
This is learning to associate the stimulus you are scared of with feelings of relaxation/ calmness.
- This involved pairing the conditioned stimulus (feared stimulus) with something else that produces a feeling like relaxation, humour or please. It is based on the idea that you can’t feel fear and relaxation at the same time (reciprocal inhibition).
- Often the patient is taught relaxation techniques like controlling their breathing or thinking of relaxing situations.
What is graduated exposure in systematic desensitisation?
What is functional analysis?
This is introducing the feared stimulus in gradual stages, building in intensity.
- The patient produces a stimulation hierarchy or a hierarchy of fears: a list of encounters of a feared stimulus from leaner intense to most intense- this is known as functional analysis. It may often start with looking wt images/ videos, seeing the stimulus from far away or for short durations of time.
- It is important the patient creates this themselves, to have control over the therapy.
- The individual will then be taught relaxation techniques such as hypnosis, muscle control, breathing techniques and meditation.
- The individual will be exposed to each stage of their stimulation hierarchy and at each stage, using their relaxation techniques. Over time, the individual will learn to associate the stimulus with relaxation, not fear. The individual is in charge of the process and will only move onto the next stage when they are ready to.
What is an example of systematic desensitisation using a dog phobia?
Least intense
1. Looking at a photograph of a dog
2. Watching a video of a dog
3. Seeing a dog from 10m away
4. Seeing a dog from 5m away
5. Being next to a small dog
6. Being next to a large dog
7. Touching a dog
8. Stroking a dog
9. Having a dog sit on your lap
10. Having a dog jump up at you
Most intense
What are the strengths of systematic desensitisation?
- Capafons et Al 1998 (credible and valid)- Found fear of flying was reduced by SD treatment. 41 pps completed 16 one hour SD sessions over 8 weeks gradually pairing their hierarchy of fear with relaxation techniques. 39/41 pps reported reported a reduction in their fear levels in all aspects of flying with both self-report and physiological data (‘ran pulse rate dropped from 1.04 to 0.99) showing the treatment is effective for phobias.
- Gilroy et Al 2003 (credible)- Followed up on 42 patients treated for spider phobia in three 45 minute sessions of systematic desensitisation. Spider phobia was assessed on several measures including the spider questionnaire and by assessing response to a spider. A control group was treated by relaxation without exposure. At both 3 months and 33 months after the treatment the SD group were less fearful than the relaxation group.
- It is not as stressful as some other treatments (ethical as there is no psychological harm)- Treatments like aversion therapy or flooding can be unpleasant as negative association is involved and also the maximum amount of fear. In SD, the patient has more control over their treatment as they determine when to move onto the next stage. Also, the person does not have to put themselves in the actual feared situation, they only imagine it, so it is a gentler form of therapy that proplr may be more willing to engage with.
What are the weaknesses of systematic desensitisation?
- Marks 1975 (not credible)- Concluded that systematic desensitisation with relaxation is more effective than graded exposure. He found that the gradual exposure to the object of fear was what made the therapy successful, not the presence of the relaxation. He proposed exposure therapy as a replacement where individuals are exposed to their feared objects, situations or activities in real-life, in a controlled and gradual manner.
- Less effective with more complex phobias (not credible, reductionist, not generalised)- Toozandehjani et al 2001 found that the effects of systematic desensitisation did not last for more than 3 months when used for social phobia. As such it’s effectiveness is only short-lasting and not a comprehensive treatment for some phobias like social phobias and agoraphobia. It’s difficult to imagine these complex phobias in stages that would need to be clearly identified for the hierarchy of fear used in SD.
- SD lacks validity to real life situations (lacks ecological validity)- Wolitzky-Taylor et Al 2008 found that in vivo (real life) exposure therapy is typically more effective than in vitro (imagined) relaxation, imaginal and cognitive therapy. Although the use of virtual reality or hypnosis guided SD can be used effectively.
- Less successful with phobias with underlying survival element (reductionist, not credible)- For example fear of the dark or dangerous animals. This may be because these fears have a deep-rooted evolutionary value such as being afraid of bears is a deep seated in-built fear to ensure that the human race survived. Therefore SD does not work successfully for all phobias.
What does flooding claim the cause of the phobia is from?
Assumed the cause is classic conditioning.
Describe the treatment of flooding in order. (7 bits)
- The patient is placed in a safe environment and confronted with their fear.
- Anxiety and distress are experienced for a prolonged period of time.
- Initially the client will experience full fear (sweating dizziness etc).
- The body cannot maintain this high level of arousal as the autonomic nervous system (ANS) sends signals to the heart, intestines and muscles to fight or flight- there is only so much energy that can be sent through the ANS so the anxiety will reach a peak.
- The parasympathetic nervous system then kicks in which is designed to lower heart rate, dizziness etc, so symptoms will subside after they reach their peak and they will feel relaxed.
- A new association is then formed between feeling relaxed in the presence of the feared object.
- Avoidance learning is prevented as they face the fear.
What forms can flooding take?
In-vivo (real life exposure)
In-vitro (using VR)
What are the strengths of flooding?
- Credible- Wolpe (1973) took a girl who was afraid of cars and drove her around for 4 hours. At first the girl was hysterical, but calmed down when she realised that she was in so danger. Afterwards her phobia disappeared and she learned to enjoy car rides as the phobia was now extinct.
- Credible/ Valid- Keane et al (1989) gave 24 Vietnam veteran soldiers with PTSD symptoms, such as terrifying flashbacks, anxiety and depression, 14-16 sessions of flooding therapy. Compared to the control group, who didn’t receive any therapy, the flooding group had fewer terrifying flashbacks as well as less anxiety and depression, suggesting that flooding can extinguish phobias.
- Representative/ Reliable- Ougrin (2011) found that flooding is highly effective and quicker than alternatives like systematic desensitisation if the patient can tolerate the rapid, intense exposure to the object/ situation of fear. This makes the treatment for cost effective for health service providers.
- Reliable/ Applicable- Shipley and Boudewyns (1980) studies therapists using flooding and found that only 0.2% of 3493 clients reported any serious negative side effects. While it can be stressful for the patient, they agree to the procedure beforehand and it can therefore be a safe, effective treatment for the majority of clients.
What are the weaknesses of flooding?
- Unethical- Wolpe (1969) it can be unethical to expose a patient to something they find so distressing. Wolpe reported the case of a client who had to hospitalised because foooding made her so anxious which is why Wolpe preferred systematic desensitisation to flooding.
- Not Reliable- Spontaneous recovery may be a future: the phobia may return if the patient is not exposed to the object of their fear for some time and is confronted with it again. This is because the flooding sessions aren’t very long and the therapy doesn’t replace the fear response with a different response, it just replaces it with no response.
- Reductionist- Less effective with more complex phobias like social phobias because they have cognitive aspects where they think unpleasant thoughts about a social situation as well as have an anxiety response. Flooding only tackles behaviour responses not the unpleasant thoughts so cannot be a complete treatment for more complex phobias.
- Not Reliable- If the patient withdraws half way through the treatment it can make the phobia worse as the patient has not learned to associate relaxation with the object of fear, instead the process has reinforced the fear associated with the object, and escape/ avoidance learning has been reinforced.
