Behavioural Treatments of Phobias (AQA A-Level Psychology): Revision Notes

Behavioural Treatments of Phobias

Introduction to behavioural treatments

Behavioural approaches to treating phobias are based on the principle that phobias represent maladaptive learned behaviours. Since these fears are acquired through learning processes, they can be replaced with more adaptive responses using conditioning techniques. The goal is to substitute fear responses with feelings of calm and relaxation when encountering the phobic stimulus.

Systematic desensitisation

Systematic desensitisation (SD) is a gradual behavioural therapy that treats anxiety disorders by teaching patients relaxation techniques before exposing them to a progressive hierarchy of feared objects or situations. This approach was developed by Wolpe in 1958 and remains one of the most widely used behavioural treatments for phobias.

Principles of systematic desensitisation

The treatment is based on the principle of reciprocal inhibition, which suggests that anxiety and relaxation are opposing emotional states that cannot coexist simultaneously. When a person learns to relax in the presence of anxiety-provoking stimuli, the fear response is gradually reduced and eventually eliminated.

SD follows a structured, step-by-step approach that typically takes about a month to complete. The process involves three main stages:

1. Hierarchy construction - Before treatment begins, a desensitisation hierarchy is created, ranking feared objects or situations from least to most anxiety-provoking
2. Relaxation training - Patients learn specific relaxation strategies for each stage of contact with phobic stimuli
3. Gradual exposure - Progressive work through the hierarchy, combining relaxation with increasing exposure

Types of desensitisation

Covert desensitisation involves patients imagining scenarios with the feared stimulus, which is often the initial approach.

In vivo desensitisation requires actual contact with real phobic objects or situations. For example, someone with snake phobia might begin SD treatment by looking at pictures of snakes and progressively work through to actually holding one.

Flooding

Flooding (also called implosion) represents a more direct behavioural therapy approach where patients immediately confront their most feared scenarios rather than following a gradual progression. This technique involves direct confrontation with the feared object or situation without the opportunity for typical avoidance responses.

How flooding works

The principle behind flooding is that patients cannot maintain high levels of anxiety indefinitely, so the fear response will eventually subside naturally. By preventing avoidance behaviours and forcing direct contact with the phobic stimulus, anxiety peaks at such extreme levels that it cannot be sustained and gradually decreases.

Research evidence

Contemporary research: technophobia treatment

Brosnan & Thorpe (2006) conducted important research examining whether systematic desensitisation could effectively treat technophobia - the fear of interacting with modern technology. Their study is particularly relevant given the increasing importance of technology in modern life.

Classical research studies

• Jones (1924) provided early evidence for systematic desensitisation by treating 'Little Peter's' phobia of white fluffy animals and objects. The rabbit was gradually presented to Peter at closer distances as his anxiety levels decreased, with food rewards given for progress. Eventually, Peter developed positive associations with the rabbit, and this improvement generalised to similar animals and objects.
• Wolpe (1960) demonstrated flooding effectiveness by treating a girl's car phobia. The patient was placed in a car and driven around for four hours until her extreme fear reaction was completely eliminated, showing the rapid effectiveness of direct exposure methods.
• Rothbaum et al. (1998) explored virtual reality exposure therapy as an alternative to traditional systematic desensitisation and flooding. This approach allows treatment within controlled environments without leaving the therapist's office, providing more control over phobic stimuli while reducing patient exposure to harm and embarrassment.

Evaluation

Strengths of behavioural treatments

• Effectiveness for simple phobias: Behavioural treatments demonstrate high success rates for treating straightforward, specific phobias. Research consistently shows positive outcomes when these techniques are applied to clearly defined fears.
• Scientific basis: These approaches are grounded in well-established learning principles and supported by extensive empirical research. The systematic nature of the treatments allows for measurable progress and objective assessment of outcomes.
• Practical advantages: SD is particularly suitable for patients who can learn relaxation strategies and have sufficient imagination to visualise feared scenarios effectively. The gradual approach helps build confidence and ensures patient comfort throughout treatment.
• Rapid results: Flooding can deliver immediate improvements, especially when patients are encouraged to continue self-directed exposure outside therapy sessions. Some studies suggest flooding is equally effective as SD but achieves results more quickly.

Limitations of behavioural treatments

• Limited effectiveness for complex phobias: Behavioural treatments work best for simple, specific phobias but show reduced effectiveness with agoraphobia and social phobias. This suggests that more complex fears may not be adequately explained or treated through purely behavioural approaches.
• Individual differences: SD requires patients who can effectively use relaxation strategies and have vivid enough imaginations to engage with feared scenarios. Not all individuals possess these capabilities, limiting the treatment's applicability.
• Ethical concerns: Both SD and flooding raise ethical considerations as they can be psychologically distressing. Cost-benefit analyses must weigh the long-term benefits of eliminating phobias against the short-term psychological costs of treatment.
• Physical health considerations: Flooding is unsuitable for patients with poor physical health, as the extreme anxiety levels during direct confrontation with feared stimuli can cause significant physiological stress, potentially triggering heart attacks or other medical complications.
• Uncertainty about mechanisms: While these treatments show effectiveness, there's no guarantee that imaginary confrontation with phobias (covert desensitisation) will translate to real-world situations, suggesting that in vivo treatment may be superior for lasting results.