The behavioural approach to treating phobias Flashcards
Define Systematic desensitisation (SD) -
A behavioural therapy designed to reduce an unwanted response, such as anxiety, to a stimulus. SD involves drawing up a hierarchy of anxiety-provoking situations related to the phobic stimulus, teaching the patient to relax, and then exposing them to phobic situations.
The patient works
their way through the hierarchy whilst maintaining
relaxation.
Define flooding
A behavioural therapy in which a phobic patient 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.
Systematic desensitisation
Systematic desensitisation (SD) is a behavioural therapy designed to gradually
reduce phobic anxiety through the principle of classical conditioning. If the sufferer
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.
In addition it is impossible to be afraid and relaxed at the same time, so one emotion
prevents the other. This is called reciprocal inhibition.
There are three processes involved in SD.
1. The anxiety hierarchy is put together by the patient 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, an arachnophobic might identify seeing a
picture of a small spider as low on their anxiety hierarchy and holding a tarantula at
the top of the hierarchy.
2. Relaxation The therapist teaches the patient to relax as deeply as possible. This
might involve breathing exercises or, alternatively, the patient might learn mental
imagery techniques. Patients 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 Valium.
3. Exposure Finally the patient 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 patient can stay relaxed in the presence of the lower levels of
the phobic stimulus they move up the hierarchy. Treatment is successful when the
patient can stay relaxed in situations high on the anxiety hierarchy.
Flooding 2
Flooding
Flooding also involves exposing phobic patients to their phobic stimulus but without a
gradual build-up in an anxiety hierarchy. Instead flooding involves immediate exposure
to a very frightening situation. So an arachnophobic receiving flooding treatment might
have a large spider crawl over them for an extended period. Flooding sessions are
typically longer than systematic desensitisation sessions, one session often lasting two to
three hours. Sometimes only one long session is needed to cure a phobia.
How does flooding work?
Flooding stops phobic responses very quickly. This may be because, without the option
of avoidance behaviour, the patient 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 patient may achieve relaxation in the presence of the phobic
stimulus simply because they become exhausted by their own fear response!
Ethical safeguards
Flooding is not unethical per se but it is an unpleasant experience so it is important that
patients give fully informed consent to this traumatic procedure and that they are fully
prepared before the flooding session. A patient would normally be given the choice of
systematic desensitisation or flooding.
Evaluation
It is effective
Research shows that systematic desensitisation is effective in the treatment of specific phobias. For example, Gilroy et al. (2003) followed up 42 patients who had been 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 three months and 33 months after the treatment the systematic desensitisation group were less fearful than the relaxation group. This is a strength because it shows that systematic desensitisation is helpful in reducing the anxiety in spider phobia and that the effects are long-lasting.
It is suitable for a diverse range of patients
The alternatives to systematic desensitisation - flooding and cognitive therapies - are not well suited to some patients. For example, some sufferers of anxiety disorders like phobias also have learning difficulties. Learning difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies that require the ability to reflect on what you are thinking (see pages 148-149). For these patients systematic desensitisation is probably the most appropriate treatment.
It is acceptable to patients
A strength of systematic desensitisation is that patients prefer it. Those given the choice of systematic desensitisation or flooding tend to prefer systematic desensitisation. This is largely because it does not cause the same degree of trauma as flooding. It may also be because systematic desensitisation includes some elements -learning relaxation procedures that are actually pleasant! This is reflected in the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) of systematic desensitisation.
Evaluation
It is cost-effective
Flooding is at least as effective as other treatments for specific phobias. Studies
comparing flooding to cognitive therapies (such as Ougrin 2011) have found that
flooding is highly effective and quicker than alternatives.
This quick effect is a strength because it means that patients are free of their
symptoms as soon as possible and that makes the treatment cheaper.
It is less effective for some types of phobia
Although flooding is highly effective for treating simple phobias it appears to be less
so for more complex phobias like so social phobias. This may be because social
phobias have cognitive aspects. For example, a sufferer of a social phobia does not
simply experience an anxiety response but thinks unpleasant thoughts about the
social situation.
This type of phobia may benefit more from cognitive therapies because such
therapies tackle the irrational thinking.
The treatment is traumatic for patients
Perhaps the most serious issue with the use of flooding is the fact that it is a highly
traumatic experience. The problem is not that flooding is unethical (patients give
consent) but that patients are often unwilling to see it through to the end.
This is a limitation of flooding because time and money are sometimes wasted
preparing patients only to have them refuse to start or complete treatment.
