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

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, however, flooding does not have the gradual build-up of the hierarchy, and instead, the patient is flooded with their phobia.

The process of flooding

• The patient receiving this treatment will be flooded with immediate exposure to their phobia
• For example, a patient who has arachnophobia would have a large spider crawling over them, or be in a room with lots of spiders at once
• Flooding stops the phobic responses quickly
• This is likely because the patient cannot avoid the phobia in the flooding situation and, therefore, their irrational behaviour of avoidance is stopped and the patient realises the phobic stimulus is harmless
• Therefore, the phobic response stops, and the learned response is extinguished: In classical conditioning, this process is called?extinction
• Counterconditioning happens and the patient learns to relax around the phobic stimulus instead of the anxiety they faced before

Strengths of flooding

• It is cost-effective, although individual flooding sessions are usually longer than systematic desensitisations sessions, often much fewer sessions are needed, with lots of cases only needing one session to be cured of their phobia
• Flooding has higher rates of success than any other behavioural treatment
• Works very well with 'simple' phobias e.g. phobias of one specific thing or object

Limitations of flooding

• It is very traumatic for the patient and an unpleasant experience for them
• If the patient panics and the treatment is not completed, it may leave them with an even worse fear/phobia of the object/event
• Schumacher et al. (2015)?found both patients and therapists rated flooding as significantly more stressful than systematic desensitisation
• Less effective with more complex phobias, such as social phobias
• It is not suitable for individuals who are not in good health as the extreme levels of stress and anxiety caused during the session are very stressful on the body and could cause heart attacks