Behavioural treatments of phobias
Specification: The behavioural approach to treating phobias: systematic desensitisation, including relaxation and use of hierarchy; flooding.
There are two behavioural treatments for phobias: systematic desensitisation and flooding. Both therapies use the principles of classical conditioning to replace a person’s phobia with a new response – relaxation.
Systematic desensitisation (SD)
Systematic desensitisation uses counter‐conditioning to unlearn the maladaptive response to a situation or object, by eliciting another response (relaxation). There are three critical components to systematic desensitisation:
Fear hierarchy
Relaxation training
Reciprocal inhibition
Firstly, the client and therapist work together to develop a fear hierarchy, where they rank the phobic situation from least to most terrifying. For example:
Thereafter, an individual is taught relaxation techniques, such as breathing techniques, progressive muscle relaxation strategies, or mental imagery techniques.
The final component of systematic desensitisation involves exposing the patient to their phobic situation, while relaxed. According to systematic desensitisation, two emotional states cannot exist at the same time; a theory known as reciprocal inhibition. Therefore, a person is unable to be anxious and relaxed at the same time and the relaxation should overtake the fear. The patient starts at the bottom of the fear hierarchy and when the patient can remain relaxed in the presence of the least feared stimulus, they gradually progress to the next level. The patient gradually moves their way up the hierarchy until they are completely relaxed in the most feared situation; at this point systematic desensitisation is successful and a new response to the stimulus has been learned, replacing the phobia.
Evaluation
One strength of systematic desensitisation comes from research evidence that demonstrates the effectiveness of this treatment for phobias. McGrath et al. (1990) found that 75% of patients with phobias were successfully treated using systematic desensitisation. This was particularly true when using in vivo techniques in which the patient came into direct contact with the feared stimulus rather than simply imagining (in vitro). This shows that systematic desensitisation is effective when treating specific phobias, especially when using in vivo techniques.
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). This provides further support for systematic desensitisation as an effective treatment for phobias in the long‐term.
However, systematic desensitisation is not effective in treating all phobias. Patients with phobias which have not developed through a personal experience (classical conditioning), such as a fear of snakes, are not effectively treated using systematic desensitisation. Some psychologists believe that certain phobias have an evolutionary survival benefit and are not the result of learning. This highlights a limitation of systematic desensitisation, which is ineffective in treating evolutionary phobias which have an innate basis.
Systematic desensitisation is often favoured as a treatment for phobias in comparison to flooding, as it is more ethical in nature. In comparison to flooding treatment for phobias many patients report a preference for systematic desensitisation as it does not cause the same levels of distress that can occur when presented with the fear‐inducing stimulus immediately. This is reflected in the high number of patients who persist with systematic desensitisation providing low attrition rates. It is therefore considered a more appropriate treatment for individuals who may have learning difficulties or suffer from severe anxiety disorders since learning the relaxation techniques can be a positive and pleasant experience.
Flooding
Flooding is a behavioural therapy which, rather than exposing a person to their phobic stimulus gradually, exposes the individual to the anxiety‐inducing stimulus immediately. For example, a person with a phobia of dogs would be placed in a room with a dog and asked to stroke the dog straight away. This intense exposure is done over an extended period of time in a safe and controlled manner.
With flooding, a person is unable to avoid (negatively reinforce) their phobia and through continuous exposure, anxiety levels eventually decrease. Since the option of employing avoidant behaviour is removed, extinction will soon occur since fear is a time‐limited response to a situation which eventually subsides. As exhaustion sets in for the individual they may begin to feel a sense of calm and relief which creates a new positive association to the stimulus.
Evaluation
One strength of flooding is it provides a cost‐effective treatment for phobias. Research has suggested that flooding is equally effective to other treatments, including systematic desensitisation and cognition therapies (Ougrin, 2011), but takes much less time in achieving these positive results. This is a strength of the treatment because patients cure their phobias more quickly and it is therefore more cost‐effective for health service providers who do not have to fund longer options.
Although flooding is considered a cost‐effective solution, it can be highly traumatic for patients since it purposefully elicits a high level of anxiety. Wolpe (1969) recalled a case with a patient becoming so intensely anxious that she required hospitalisation. Although it is not unethical as patients provide fully informed consent, many do not complete their treatment because the experience is too stressful. Therefore, initiating flooding treatment is sometimes a waste of time and money if patients do not engage in or complete the full course of their treatment.
Even though flooding is highly effective for simple (specific) phobias, the treatment is less effective for other types of phobia, including social phobia and agoraphobia. Some psychologists suggest that social phobias are caused by irrational thinking and are not caused by an unpleasant experience (or learning through classical conditioning). Therefore, more complex phobias cannot be treated by behavioural treatments and may be more responsive to other forms of treatment, for example, cognitive behavioural therapy (CBT), which treats the irrational thinking.
An issue for behavioural therapies such as flooding and systematic desensitisation is symptom substitution. This means that although one phobia may be successfully removed through counterconditioning another may appear in its place. If symptoms are treated and removed, the underlying cause may remain and simply resurface under a new guise. Research in this area is mixed, however, and heavily disputed by behaviourists.
Possible exam questions
Explain one limitation of flooding as a treatment for phobias. (2 marks)
Explain one limitation of systematic desensitisation. (2 marks)
Suggest one advantage of using flooding over systematic desensitisation as a treatment for a phobia of spiders. (2 marks)
Explain why using systematic desensitisation might be more appropriate than using flooding as a behavioural treatment for phobias. (2 marks)
Outline what is involved in systematic desensitisation as a treatment for phobias. (3 marks)
Describe what flooding involves as a behavioural treatment for phobias. (3 marks)
Tom has a fear of dogs. His fear stops him going to his local park for walks in case he sees a dog there. Explain how systematic desensitisation could be used as a treatment for Tom’s phobia. (4 marks)
Discuss the behavioural approach to treating phobias. (16 marks)
Sebastian has a severe phobia of birds. His phobia began when he was four years old. A pigeon scared him when it flew down and stole his ice cream! He is now ten years old and so scared that he will not play in the playground at break for fear of seeing a bird. Outline and evaluate systematic desensitisation as a treatment for phobias and refer to Sebastian in your answer. (16 marks)
