Treating Phobias Flashcards
(12 cards)
Behaviourist Therapy
Behaviourist therapies assume phobias are learnt associations and attempt to replace the fear association with relaxation.
What are the 2 behavioural approaches to treating phobias?
1) Systematic desensitisation
2) Flooding
1) Systematic desensitisation
- This treatment assumes that phobias are caused by the automatic response of fear becoming associated with particular objects/situations via classical conditioning.
- Systematic desensitisation is a form of counter-conditioning, where the therapist tries to replace the fear response by the alternative response of relaxation.
- This is because the body cannot experience fear and relaxation at the same time (they are antagonistic emotions) - this is called reciprocal inhibition, where one response is inhibited because it is incompatible with another, i.e. you cannot be anxious and relaxed at the same time.
1) The therapist teaches the client relaxation techniques, e.g., breathing exercises.
2) The client creates an anxiety hierarchy, a list of feared situations with the phobic stimulus, from the least to the most feared.
3) The client is exposed to each level of the anxiety hierarchy, starting with the least anxiety-producing level. Importantly, the client must relax at each stage, and can only fully move onto the next stage when they are fully relaxed.
4) When the client can come into close proximity to the phobic stimulus without fear, the association is extinct, and a new association with relaxation is formed.
Strength - Systematic Desensitisation
Point: One strength of systematic desensitisation (SD) over flooding is that the client has more control over the process.
Evidence: In SD, the client controls the pace of therapy, only progressing to the next level of the fear hierarchy when they feel comfortable. This helps them manage their anxiety more effectively and makes the experience more pleasant. In contrast, flooding is a more intense and immediate exposure, which can be distressing for some individuals.
Justification: Because SD is a gradual and client-led approach, it is generally more acceptable and suitable for a wider range of people. Flooding, due to its stressful nature, may not be appropriate for older clients, people with heart conditions, or those who are highly anxious. Furthermore, if flooding is ended too early, before anxiety fully subsides, it may actually reinforce the phobia. This highlights the potential drawbacks of flooding and supports the preference for SD in clinical settings.
Implication: This makes SD a more ethical and practical treatment option for many clients, as it allows them to control their exposure at a comfortable pace, reducing distress and fostering a sense of agency.
Counterargument: However, a limitation of systematic desensitisation is that allowing clients control over the process can lead to slower progress.
Evidence: Because clients only move up the fear hierarchy when they feel ready, the process can be time-consuming, requiring more therapy sessions compared to faster treatments like flooding.
Justification: While this client-led approach increases comfort, it may delay improvement and be less cost-effective in the long term. For individuals seeking quicker relief from their phobia, the extended duration may reduce motivation or accessibility, especially in time-limited healthcare settings.
Implication: This means that although SD is more ethical and better tolerated, its slower pace could be a disadvantage for some, particularly when rapid treatment is needed, resources are limited or when the volume of patients to be treated is substantial.
Strength - Systematic Desensitisation
Point: A strength of systematic desensitisation (SD) is its application to modern treatment methods such as virtual reality exposure therapy.
Evidence: Garcia-Palacios (2002) found that 83% of participants treated with VR exposure to spiders showed clinically significant improvement compared to 0% in the control group, who did not receive the virtual reality exposure therapy.
Justification: This finding demonstrates that the principles of SD, particularly gradual exposure to phobic stimuli, are valid. The use of VR allows patients to confront their phobia in a controlled, safe, and effective manner, extending the range of phobias that can be treated beyond what is possible with traditional in-person exposure.
Implication: The success of VR exposure therapy suggests that SD can be adapted to modern technology, making it more accessible and practical for a wider range of individuals with phobias, and increasing the potential for widespread use in clinical settings.
Counterargument: However, virtual reality exposure therapy is limited in its effectiveness as it may not provide the same level of realism as real-life exposure.
Evidence: While VR allows individuals to confront their phobia in a controlled environment, it may not replicate the full sensory experience of facing the actual phobic stimulus. For example, with arachnophobia, VR might not engage all senses, such as touch or the smell of the environment, which could limit the effectiveness of the treatment. Moreover, the individual receiving the treatment knows that they aren’t in any danger and that the phobic stimulus presented virtually doesn’t pose a threat to them, which may reduce the intensity of the fear response.
Justification: The lack of full sensory involvement may make VR less effective for some individuals, as they may not experience the same level of anxiety or fear response that they would in real-life exposure. Additionally, some individuals might find the virtual environment too artificial, reducing its impact on their fear.
Implication: This suggests that while virtual reality exposure therapy can be an effective treatment for phobias, it may not be as universally effective as in-person systematic desensitisation, particularly for individuals who require a more immersive and realistic exposure experience. Therefore, traditional methods of SD might still be preferable for certain cases.
Weakness - Systematic Desensitisation
Point: One limitation of systematic desensitisation (SD) is that it is not effective for all types of phobias.
Evidence: Research has shown that phobias which have not developed through personal experience, such as a fear of heights, are often less responsive to SD.
Justification: This is because SD is based on the principles of classical conditioning, and some phobias are believed to have an evolutionary basis rather than being learned. For example, evolutionary psychologists, e.g., Seligman, argue that certain fears—like those of heights or snakes—were advantageous for survival and are therefore innate rather than acquired through experience.
Implication: This suggests that SD is limited in its applicability and may not be effective for treating phobias that are biologically hardwired, thereby reducing the generalisability and effectiveness of this therapy for all individuals.
Strength - Systematic Desensitisation
Point: A strength of systematic desensitisation is the long-term effectiveness in treating phobias.
Evidence: Further support comes from Gilroy et al. (2002), who examined 42 patients with arachnophobia. Each patient received three 45-minute systematic desensitisation sessions. When assessed 3 months and 33 months later, the systematic desensitisation group showed less fear compared to a control group, which was only taught relaxation techniques.
Justification: This study provides evidence for the effectiveness of systematic desensitisation not only in the short term but also in maintaining reduced fear levels over an extended period. The long-lasting results suggest that systematic desensitisation has enduring therapeutic benefits for phobia sufferers.
Implication: The findings imply that systematic desensitisation can be an effective long-term treatment for phobias, making it a useful therapeutic option for those seeking lasting relief from their fears. This highlights the treatment’s potential for lasting positive outcomes in clinical settings.
2) Flooding
- Flooding attempts to counter condition a phobia by immediate and full exposure to the maximum level of phobic stimulus (e.g., the top level of the previous anxiety hierarchy).
- Immediate exposure is expected to cause an extreme panic response in the client, e.g., crying/screaming. The therapist’s job is to stop the client from escaping the situation, i.e. prevent it from being negatively reinforced.
- The patient is taught relaxation techniques, which are the applied to the most feared situation.
- A fear response takes energy. Eventually, the client will become exhausted and calm down in the presence of the phobic stimulus, or when they recognise that their feared object/situation is not an actual threat to them.
- If the client ends the treatment before this point, anxiety will decrease due to removal of the stimulus, and the phobia will have been reinforced.
Flooding can take one of two forms:
a) in vivo (actual exposure)
b) in vitro (imaginary exposure)
Strength - Flooding
Point: One strength of flooding is that it is a highly cost-effective treatment for specific phobias.
Evidence: Ougrin (2011) compared flooding with other treatments, including systematic desensitisation and cognitive therapies, and found that flooding was equally effective in reducing phobic symptoms, but achieved results in a significantly shorter period of time.
Justification: This suggests that flooding can lead to faster recovery, which not only benefits the individual by reducing distress more quickly but also lowers the number of therapy sessions required. Fewer sessions mean reduced costs for both the patient and healthcare systems, such as the NHS, making it a financially practical treatment.
Implication: Therefore, flooding is a valuable therapeutic approach for treating specific phobias efficiently, offering both clinical effectiveness and economic advantages that make it attractive for widespread use in mental health services.
Counterargument: However, despite its merits in regards to time and cost, a limitation of flooding is that it is a highly unpleasant and traumatic experience.
Evidence: Confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety. Sarah Schumacher et al. (2015) found that both participants and therapists rated flooding as significantly more stressful than systematic desensitisation.
Justification: This raises ethical concerns for psychologists, who must knowingly cause distress to clients—though these concerns are somewhat mitigated by the use of informed consent. A more serious consequence is the high attrition rate, as clients may withdraw before the therapy is completed due to its traumatic nature.
Implication: This suggests that therapists may be reluctant to use flooding and patients may be unwilling to engage in it, limiting its practicality in real-world clinical settings.
Weakness - Flooding
Point: A limitation of flooding is that it is not effective for all types of phobias.
Evidence: Although flooding is highly effective for simple (specific) phobias, it is less effective for more complex phobias, such as social phobia and agoraphobia. Some psychologists argue that these types of phobias are the result of irrational thinking rather than learned associations through classical conditioning.
Justification: This suggests that behaviourist treatments like flooding may not be appropriate for treating complex phobias, as they do not address the cognitive distortions underlying the fear. In contrast, treatments like cognitive behavioural therapy (CBT), which focus on identifying and challenging irrational thoughts, may be more suitable for these cases.
Implication: This means that flooding has limited usefulness as a general treatment for phobias and may need to be combined with or replaced by cognitive approaches to effectively treat complex phobias.
Weakness - Flooding
Point: One limitation of flooding is that its effectiveness may be limited to controlled environments.
Evidence: For example, a person may overcome their fear of birds when exposed to a tame bird in a therapist’s office, but their phobic response might resurface when faced with multiple wild birds in an unpredictable, real-world setting.
Justification: This suggests that the controlled exposure provided in therapy may not translate well to real-life situations where the phobic stimulus is more intense or variable.
Implication: As a result, flooding may not provide long-term relief for all individuals, particularly if their fear is triggered by unpredictable or complex real-world stimuli, reducing its ecological validity.
Counterargument: However, there is evidence that flooding can still produce lasting behavioural change beyond the therapy setting.
Evidence: Many individuals who complete flooding therapy report significant reductions in anxiety and avoidance behaviours when encountering the phobic stimulus outside of therapy. Barlow et al. (2000) found that exposure therapies, including flooding, were effective in reducing phobic symptoms, with improvements generally maintained in real-world situations over time.
Justification: This suggests that the intense exposure during flooding helps to extinguish the learned fear response at its root, making it less likely to return even in varied real-life situations.
Implication: Therefore, despite concerns about generalisability, flooding can be a robust treatment for specific phobias, especially when the therapy is followed by real-world exposure and reinforcement.
Weakness
Point: Pharmacological interventions, such as antidepressants and benzodiazepines, are considered effective alternative treatments for phobias.
Evidence: These medications effectively reduce anxiety and alleviate phobic responses, and they are generally quicker and less expensive than flooding, which involves exposing an individual to the most anxiety-provoking situation.
Justification: Medications like antidepressants (e.g., SSRIs) and benzodiazepines are commonly prescribed to reduce the symptoms of anxiety and phobias, providing a more immediate and manageable form of treatment. In contrast, flooding can be a time-consuming and emotionally intense experience, which may not be suitable for all patients.
Implication: Pharmacological treatments offer a less invasive and more accessible alternative to behavioral therapies such as flooding, making them appealing for patients who may not be able to tolerate the intensity of exposure-based treatments or simply lack the motivation.
Point: Nonetheless, due to the temporary nature of drug therapy and the potential adverse effects, sufferers often prefer behavioural treatments.
Evidence: Drug therapies, while effective in the short-term, may not provide lasting relief from phobias and often come with side effects such as dizziness, sleep disturbances, and dependency issues. As a result, many patients prefer behavioural treatments like systematic flooding, which focus on addressing the root cause of the phobia rather than merely masking the symptoms.
Justification: Although pharmacological interventions are useful in managing immediate symptoms, they may not address the underlying psychological factors contributing to the phobia. Behavioural treatments, on the other hand, aim to eliminate the phobia through exposure and learning, offering longer-term solutions.
Implication: This highlights a strength of flooding in comparison to drug treatments, as they provide a more sufficient, long-term solution for phobias, instead of merely alleviating symptoms.
