1. Treating phobias 4.1.4 Psychopathology
The behavioural approach to treating phobias: systematic desensitisation, including relaxation and use of hierarchy; flooding.

2. Behavioural Treatments
Psychologists are interested in explaining why phobias develop but also in understanding how to treat them
The specification identifies two behavioural methods used in the treatment of phobias:
systematic desensitisation
flooding

3. Behavioural Treatments
In his two-process model of phobia acquisition, Mowrer suggests that phobias are acquired as a result of classical conditioning and maintained by operant conditioning.
Behavioural treatment therefore aims to:
reduce phobic anxiety through the principle of classical conditioning whereby a new response to the phobic stimulus is paired with relaxation instead of anxiety - counterconditioning
reduce phobic anxiety through the principle of operant conditioning whereby there is no option for avoidance behaviour

4. Systematic Desensitisation (SD)
Wolpe (1958) – two competing emotions cannot occur at the same time so if fear is replaced with relaxation the fear cannot continue
Systematic desensitisation aims to teach a patient to learn a more appropriate association and is designed to reduce an unwanted response, such as anxiety, to a stimulus
Reciprocal inhibition is the process of inhibiting anxiety by substituting a competing response.

5. Systematic Desensitisation (SD)
There are three processes involved in SD
The anxiety hierarchy is constructed by the patient and the therapist. This is a stepped approach to getting the person to face the object or situation of their phobia from least to most frightening
The patient is trained in relaxation techniques, so that they an relax quickly and as deeply as possible
The patient is then exposed to the phobic stimulus whilst practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.

6. Example of an anxiety hierarchy
Step 1: Learn relaxation techniques
Step 2: Create a hierarchy of what you fear
Step 3: Engage each level of the hierarchy while using relaxation techniques
Behaviour
Think about a spider
Look at a photo of a spider
Look at a real spider in a closed box
Hold the box with the spider
Let a spider crawl on a table in front of you
Let a spider crawl on your shoe
Let a spider crawl up your leg
Let a spider crawl on your sleeve
Let a spider crawl on your bare arm

7. Evaluation – page 147 It is effective
These techniques have proven most effective with specific phobias when a particular phobic object/situation can be identified- less effective with agoraphobic and social phobias.
It is suitable for a diverse range of patients
As this is a simple process that the patient controls, it is often the most suitable form of treatment
It is acceptable to patients
When given the choice between SD and flooding, more often patients choose SD as it does not cause the same degree of trauma and actually involves a pleasant aspect (the relaxation techniques)

8. Flooding
This involves overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur.
No relaxation techniques or step by step build up.
Individual is exposed repeatedly and in an intensive way with their phobia.
Individual has their senses flooded with thoughts, images and actual experiences of the object of their phobia.

9. How does flooding work? Flooding stops phobic responses very quickly
Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless – 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)

10. Ethics
Flooding is not unethical as patients give their informed consent so they know exactly what is involved
It is of course an unpleasant experience and a patient has to be properly prepared
A patient would normally be given the choice of systematic desensitisation or flooding

11. Evaluation – page 147 It is cost-effective
The quick effect that flooding can have means that patients are free of their symptoms as soon as possible and this makes the treatment cheaper than alternatives
It is less effective for some types of phobia
Flooding is less effective for treating more complex phobias like social phobias. This may be because social phobias have cognitive aspects – an individual does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation
The treatment is traumatic for patients
Flooding produces high levels of fear and this can be very traumatic and as a result many patients refuse to start or complete treatment

12. Review How are flooding and systematic desensitisation similar?
How are flooding and systematic desensitisation different?

13. Exam Questions
Outline one behavioural method for treating phobias. (4 marks)
Evaluate flooding as a way to treat phobias. (4 marks)
Explain one limitation of using systematic desensitisation to treat phobias (4 marks)
Stuart has had a phobia of horses since he tried riding as a child whereupon his horse bolted and threw him, leaving him with a broken collarbone. As a young adult, Stuart has now decided to tackle his fear of horses. Having researched alternative treatments, he has opted for systematic desensitisation. Explain how you might put together an anxiety hierarchy to treat Stuart's phobia of horses. (4 marks)