Treatment of Phobias

Explanations for Phobias

Systematic Desensatisation

Flooding

Operant Conditioning

Social Learning Theory

Classical Conditioning

  • Phobias are an example of abnormal behaviour learned by association.
  • A fear response to a neutral stimulus arises when the neutral stimulus is paired with an unconditioned stimulus, which leads to an unconditioned response.
  • A traumatic experience early in life, leads to the conditioning of fear to that particular object or situation. This fear then generalises to similar objects or situations.
    . E.g. someone might develop a phobia of dogs after being chased or bitten by one as a child. As an adult, this leads to a general phobia of all dogs.
  • A stimulus - anxiety
    . Little Albert was conditioned to develop a fear (phobia) of a white rat which he generalised to anything white and fluffy.
  • Once a stimulus - anxiety association (CC) has been establish it is maintained through operant conditioning.
  • If phobia behaviours are positively reinforced through increased attention, they may be repeated.
  • The avoidance of, or escape from, the phobic stimulus reduces fear and is thus reinforcing (Negative - the removal of an unpleasant stimulus).
  • Bandura showed children learn to imitate what's observed, particularly behaviour which is rewarded (vicarious reinforcement).
  • If a role model shows fear of something (a phobia), then that behaviour might be imitated, especially if they observed it being rewarded.
    . E.g. a child who's parent has a phobia of spiders, observes their behaviour and also develop that fear of spiders, so they can receive a reward for their fear.
  • Systematic desensitisation is based on the learning theory that assumes that the behaviour has been learned either through association (CC) or reinforcement (OC) and so can be unlearned based on the same principles. An undesired behaviour, such as fear or anxiety, can be removed by counterconditioning - learning a new response to the stimulus. This is the principle behind systematic detestation. It has proved especially effective in specific phobias and is the main treatment for phobias.
    . This approach was developed by Joseph Wolope (1958). Wolope claims that 80-90% of patients are either apparently cured or much improved after an average of 25-30 sessions which is typically shorter than other therapy-based treatments. It takes a client through the following steps:
  1. A trusting relationship is formed with the therapist. Clients are taught relaxation techniques.
  2. With the help of a therapist, clients construct a hierarchy - a list of objects or negative situations ranked from the least to the most undesirable. E.g. a person with arachnophobia might imagine a spider in various situations from a picture in a book (least feared) to crawling over their hand (most feared).
  3. In the presence of the therapist, the client then confronts each item in the hierarchy while they are in a state of deep relaxation. They start with the least feared item and move once they feel relaxed and unafraid in its presence. This confrontation may be real or imagined. The process continues until they reach the top of the hierarchy and feel relaxed in the presence of all the items.
  • If the systematic desensitization works, clients have been counter-conditioned, and they have learnt a new response to a stimulus - relaxation.

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Strengths

Weaknesses

  • Well-controlled research evidence suggests that it is very effective that it is very and it is generally considered to be better than other therapies such as psychodynamic therapy, also showing much greater recovery than with no therapy. 75% of people with specific phobias improve with systematic desensitization therapy.
  • It is considered ethical because that patient has a lot of control over the treatment: progression up the hierarchy only occurs when they feel confident enough. This is the opposite of a therapy called 'flooding' where the patient is exposed to many feared stimuli immediately in one go.
  • Research suggests that the longer the technique takes the more effective it is: it has been shown to have longer-term benefits. The positive effects seem to last longer than other therapies for phobias.
  • It can be time-consuming and expensive as it requires 1:1 sessions with a therapist who can change upwards of £40 per session.
  • It does not work for all phobias, particularly social phobias for objects. It is also ineffective for certain types of abnormality like Sz although it does have some success for anorexia.
  • It relies in the person being completely open and committed to the therapy as a relationship must be built with the therapist and they must be committed to practising the relaxation techniques. This can be difficult or impossible with people who have trouble communicating, like autistic people or those suffering from mental health issues.
  • Flooding works by exposing the patient directly to the phobic object. For example, an individual with a fear of flying will be sent up in a light aircraft.
  • Breaking the link between CS and CR and goes.
  • Starts with the person in extreme anxiety, but when exhaustion sets in and anxiety comes down.
  • Normally all people would do anything they can do to avoid that situation.
  • In flooding, the individual has no choice but to confront their fears and when the panic subsides and they find they have come to no harm.
  • Learn response goes when CS is encountered without the unconditioned stimulus. This results in the CS no longer producing the CR.

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Strengths

Weaknesses

  • Faster than other therapies.
  • Wolpe (1973) - girls afraid of cars, drove her around for hours until she calmed down.
  • The therapy runs a high risk of increasing strength of the conditioned response, to the feared object/ situation rather than extinguishing it.
  • It is questionable whether flooding is ethical way to treat phobias. Psychological harm.