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Discuss two or more psychological therapies for phobic disorders (8 + 16 marks)
Wolpe developed a technique called Systematic Desensitisation (SD), a behavioural therapy, where the
feared stimulus is reintroduced gradually. The patient is taught relaxation techniques and given the
opportunity to experience the feared stimulus while relaxed, forming a new association replacing the original
association. Wolpe called this reciprocal inhibition because the relaxation inhibits anxiety. Research has found
that SD is successful for a range of phobias as McGrath et al. found 75% success rates showing support for
the effectiveness of SD. The therapist and patient construct imagined scenes, one progressively more
fearful, this is called a desensitisation hierarchy. They work through this, relaxing at each stage before moving
onto the next. There are different forms of SD; in vivo desensitisation which is confronting feared situations
directly and covert desensitisation which is imagining the feared stimuli.
Capafóns et al. found overall success for 41 aerophobics receiving two 1 hour sessions per week over a
12-15 week period, using in vivo and covert techniques, but SD was not 100% effective which may suggest
the cause may not be psychological and therefore other factors must be considered e.g. biological reasons.
Menzies and Clarke found in vivo techniques are more successful than covert ones, although a number of
different exposure techniques are involved such as in vivo, convert and also modelling where the patient
watches someone who is coping well with the feared stimulus. However, Öhman et al. suggests that SD may
not be as effective in treating phobias that have an underlying evolutionary survival component e.g. fear of
the dark, than in treating phobias that have been acquired as a result of personal experience thus challenging
the effectiveness of psychological treatment.
In terms of the appropriateness of SD, it requires less effort from the patient than other psychotherapies
such as REBT, and it can be self-administered which proved to be successful with social phobics. However, SD
may appear to resolve a problem but suppressing symptoms may result in other symptoms, although,
Langevin argues there is no evidence of this. A further criticism for SD is that it was based on research
conditioning cats. In humans, fear may not be produced as simply because expectations play a greater role,
therefore, questioning the reliability of the appropriateness of SD in terms of is it truly effective on humans.
Another psychological therapy by Ellis proposed phobias occur because of irrational thinking, therefore,
treatment should make thinking rational and also address emotional and behaviour problems hence being
called Rational-emotive behaviour therapy (REBT). Ellis explains the process using an ABC model where `A'
stands for the activating event, a situation that result in feelings of frustration and anxiety. The `B' stands for
irrational beliefs, arising from the activating event. Lastly, the C represents self-defeating consequences to
which beliefs lead to this. Therefore, REBT focuses on disputing those beliefs e.g. using logical disputing
empirical disputing which is evidence based and pragmatic disputing which relates to usefulness. The phobic
moves from catastrophising to more rational interpretations. This helps the phobic become more
In terms of the effectiveness of REBT, it has generally done well in outcome studies e.g. a meta-analysis by
Engels et al. concluding REBT as an effective treatment for different disorders including social phobics. Ellis
claimed a 90% success rate, taking an average of 27 sessions to complete showing strong support for the
effectiveness of REBT. Also the NICE identified CBT, of which REBT is an example, as the first-line approach to
treating anxiety disorders. However, Emmelkamp et al. argued that REBT was less effective than in vivo
exposure treatments at least for agoraphobia showing inconsistency between disorders which challenges
the overall effectiveness of REBT.
In terms of the appropriateness of REBT, it is not suitable for all, to which Ellis argued that this is because
people who claimed to be following REBT principles, were not putting their revised beliefs into action and
therefore the therapy was not effective. Ellis also suggested that some people simply do not want the direct
sort of advice and cognitive effort associated with REBT.