treatment of phobias Flashcards
(6 cards)
systematic desensitisation
Systematic desensitisation (SD) is 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.
There are three processes involved in SD.
1. 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.
2. Relaxation 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 Valium.
3. Exposure 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.
flooding
Flooding also involves exposing people with a phobia 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 a person with arachnophobia 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 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!
Ethical safeguards
Flooding is not unethical per se but it is an unpleasant experience so 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 systematic desensitisation or flooding.
strength-effectiveness of systematic desensitisation
Further support comes from Gilroy et al. (2002) who examined 42 patients with arachnophobia (fear of spiders).
Each patient was treated using three 45-minute systematic desensitisation sessions.
When examined three months and 33 months later, the systematic desensitisation group were less fearful than a control group (who were only taught relaxation techniques without exposure).In a recent view Theresa Wechsler et al concluded that SD is effective for specific phobia,social phobia and agoraphobia.
This provides support for systematic desensitisation as an effective treatment for phobias in the long-term.
limitation-flooding is highly traumatic
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.
strength-SD-people with learning difficulties
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.
strength-flooding-cost effective
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.
