4.2.3 Behavioural Treatments of Phobias

Systematic desensitisation

• This is the main behaviourist therapy to treat phobias and it is designed to slowly reduce the anxiety caused by the phobia using classical conditioning
• If the patient can learn a new response to the phobic stimulus, as well as learn to relax in the presence of the phobia, then they will be cured

The three process involved in systematic desensitisation are: 

Anxiety Hierarchy

• The patient and therapist work together to construct an anxiety hierarchy, which is a list of situations that involve the phobic stimulus from least to most frightening

Relaxation

• It is impossible to be afraid and relaxed at the same time and so the therapist teaches the patient relaxation techniques
• This could be in the form of breathing exercises or using imagining techniques, where the patient imagines themselves in a relaxing environment
• It could also include medication if needed to help the patient relax, such as Valium

Exposure  

• Whilst in a relaxed state the patient is exposed to the phobic stimulus starting at the bottom of the hierarchy
• This is likely to take several sessions between the patient and the therapist
• Once the patient is comfortable and relaxed in the lower levels of the hierarchy, then they move up the scale
• The aim of the treatment is to allow the patient to be successful and move up to the top of the hierarchy, whilst remaining relaxed

Example of hierarchy for someone who suffers from arachnophobia

1	Imagine what a spider looks like
2	Look at a picture or pictures of spiders
3	Enter a room with a spider in a glass box
4	Look at the spider in the class box
5	Hold the glass box with the spider inside
6	Watch someone else hold the spider
7	Allow the spider to walk close/on to you
8	Hold the spider

Strengths of systematic desensitisation

• Proven to be successful with a range of phobias and effective on different types of people 
  • Gilroy et al. (2003) followed a group of 42 patients who had systematic desensitisation as a treatment for their spider phobia over three 45 minutes sessions and she found that at both 3 and 33 months they were less fearful and more in control of their phobia compared to the control group, who had not had any sessions
• It is successful with patients who have a vivid imagination and can imagine their phobia
• Systematic desensitisation is a fast treatment and requires less effort than most other psychotherapies 
• Technological advances mean dangerous situations can be lessened as the patients can also be treated with virtual reality: They can use VR headsets to go through their anxiety hierarchy
• It is a successful treatment for those with learning disabilities, where other treatments may not be suitable
• Systematic desensitisation doesn't require a huge cognitive load and means the patients are less likely to become confused
• Has huge practical uses: Certain airlines use systematic desensitisation courses to help fearful flyers overcome their phobia
• Such courses start with a walk through the airport, listening to a pilot explain what happens during a commercial flight before taking a short flight themselves

Limitations of systematic desensitisation

• It is less effective for evolutionary therapies 
• Systematic desensitisation doesn't treat the cause of the phobia, only the behaviour it causes 
• This may leave the patient vulnerable to other phobias developing as the real reason behind the fear has yet to be uncovered (Psychodynamic theory)
• Virtual reality systematic desensitisation is less effective than using real stimulus
• Does it work in real life or just in the hierarchy situations?
• This is difficult to prove but it has been noted that some patients struggle to deal with the phobia outside of the therapy sessions
• They cannot apply what they have learned to actual everyday situations

Flooding

• This therapy also works with a patient and therapist
• Flooding does not have the gradual build-up of the hierarchy: the patient is flooded with their phobia all at once

The process of flooding

• The patient receiving this treatment will be flooded with immediate exposure to their phobia
• For example, a patient who has acrophobia (fear of heights) would be taken to stand on the edge of a tall building
• Flooding is designed to stop the phobic response using a 'short, sharp, shock'-type approach
• The idea behind flooding is that the patient cannot avoid the phobic stimulus, avoidance is prevented and the patient is (magically) cured
• In essence, the phobic response stops, and the learned response is extinguished (in classical conditioning, this process is called extinction)
• Counter-conditioning is (theoretically) the result of flooding as the patient learns to relax around the phobic stimulus

Strengths of flooding

• Flooding is cost-effective, although individual flooding sessions are usually longer than systematic desensitisation sessions, fewer sessions are needed
• Flooding works well with 'simple' phobias e.g. arachnaphobia (fear of spiders)

Limitations of flooding

• Flooding can be very traumatic for the patient therefore it may be ethically compromised: Schumacher et al. (2015) found both patients and therapists rated flooding as significantly more stressful than systematic desensitisation
• Flooding is less effective with more complex phobias, such as social phobias