treatments for phobias

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  • Created on: 06-05-19 15:25

what is the two-process model

Hobart Mower 1960

Proposed the two-process model based on the behavioral approach to phobias that they are acquired

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Acquisition by classical conditioning

Classical conditioning is learning by association which occurs when two stimuli are repeatedly put together where eventually the neutral stimulus produced the same response as the unconditioned stimulus which is how you acquire phobias  

Unconditioned stimulus - unconditioned response

Neutral stimulus + unconditioned stimulus - unconditioned response

Conditioned stimulus - conditioned response

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little Albert

Watson & Raynor (1920) conducted a laboratory experiment to examine whether a fear response could be learned through classical conditioning, in humans. Their participant was an 11-month-old child called ‘Little Albert’. Before the experiment, Watson & Raynor noted that Albert showed no response to various objects, in particular, a white rat. To examine if they could induce a fear response, Watson & Raynor struck a metal bar with a hammer behind Little Albert’s head, causing a very loud noise, every time he went to reach for the rat. They did these three times. Thereafter, when they showed Little Albert the white rat, he began to cry. This experiment demonstrated that a fear response could be induced through the process of classical conditioning, in humans

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Maintenance by operant conditioning

Operant conditioning reinforcement of behaviour which shapes and maintains phobias through reward and punishments which is how phobias are maintained

it takes place when the behaviour is reinforced either positively or negatively tends to increase the frequency of the behaviour. Positive (repeat behaviour) and negative (avoid unpleasant stimulus). Negative can explain the maintenance of the phobia by avoiding the phobic stimulus we escape the fear and anxiety the absence of fear reinforces avoidance behaviour so the phobia is maintained as we are not getting the fear response

 Although classical conditioning can explain why we develop a phobia, it struggles to explain why our phobias do not decay over time.

For example, it is unlikely that you will be bitten by every dog you encounter and therefore it would be reasonable to assume that our phobia should weaken with every friendly dog we come across. However, most phobias are long-term and according to Mowrer, our phobias are maintained through operant conditioning. it takes place when the behaviour is reinforced either positively or negatively tends to increase the frequency of the behaviour. Positive (repeat behaviour) and negative (avoid unpleasant stimulus). Negative can explain the maintenance of the phobia by avoiding the phobic stimulus we escape the fear and anxiety the absence of fear reinforces avoidance behaviour so the phobia is maintained as we are not getting the fear response

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Good explanatory power

It was proposed in 1960 and went beyond Watsons research which explains the maintenance of phobias over time through operant conditioning has been vital when it comes to therapies it shows the importance of  the need to expose the patient to the phobic stimulus to prevent avoidance  once you reduce the negative reinforcement the behaviour declines which has had real life applications into therapy and how they happen over a long time

Another strength of the behaviourist explanation is its application to therapy. The behaviourist ideas have been used to develop effective treatments, including systematic desensitisation and flooding. Systematic desensitisation helps people to unlearn their fears, using the principles of classical conditioning, while flooding prevents people from avoiding their phobias and stops the negative reinforcement from taking place. Consequently, these therapies have been successfully used to treat people with phobias, providing further support to the behaviourist explanation.

One strength of the behaviourist explanation of phobias comes from research evidence. Watson & Raynor (1920) demonstrated the process of classical conditioning in the formation of phobias in Little Albert, who was conditioned to fear white rats. This supports the idea that classical conditioning is involved in acquiring phobias.

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Incomplete explanation of phobias Even if there is great strength in the explanation of classical and operant conditioning in the development of phobias some aspects of the behaviours need further explanation Bounton 2007 points put that evolution may play an important role we easily gain phobias of things that have been a source of danger in our evolutionary past Seligaman 1971 theory of biological preparedness we have adapted to avoid stimuli that are a threat to our environment like fear of spiders however it is quite rare for people to have a phobia of a car or gun which is a much more common threat in today’s society as only recently so we are not biologically prepared shows there is more to acquiring phobias                             Alternative explanation for avoidance Not all avoidance is a result of anxiety reduction in more complex phobias like agoraphobia suggests that at least some avoidance behaviour appears to be motivated more by positive feelings of safety so avoiding the phobic stimulus is not to prevent the anxiety but sticking with the safe option why many patients with this phobias can leave the house with someone with little anxiety problem of the two process model contrasts the believe that avoidance is motivated by anxiety reduction

However, the behaviourist explanation has been criticised for being reductionist and overly simplistic. The behaviourist approach ignores the role of cognition (thinking) in the formation of phobias and cognitive psychologists suggest that phobias may develop as a result of irrational thinking, not just learning. For example, sufferers of claustrophobia (a fear of confined space) may think: ‘I am going to be trapped in this lift and suffocate’, which is an irrational thought and not taken into consideration in the behaviourist explanation. Furthermore, the cognition approach has also led to the development of cognitive behavioural therapy (CBT), a treatment which is said to be more successful than the behaviourist treatments

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Systematic desensitisation

  • ·         To replace faulty association between CS and CR that has resulted in phobic response
  • ·         It is counter conditioning using the principles of classical conditioning to replace a person’s phobia with a new response

Progressively introducing a patient to a situation they feel anxious about to allow them to be de-sensitized.  This is through classical conditioning if the sufferer can learn to relax in the presence of the phobic stimulus they will be cured. A new response to the stimulus is learned this is called counter-conditioning this is to overcome anxiety by learning to relax when faced with a phobia According to systematic desensitisation, two emotional states cannot exist at the same time, a theory known as reciprocal inhibition

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Systematic desensitisation steps

·         The anxiety hierarchy put together with patient and therapist this is a list of situations related to the phobic stimulus that provokes anxiety arranged in order from least to most freighting

If someone has a phobia of dogs might rank seeing a picture of a dog low on their anxiety hierarchy but in contact with a dog high  

·         Relaxation the therapist teaches the patient to relax as deeply as possible this might involve breathing exercises and to imagine themselves in relaxing situations or might learn meditation or can be achieved through relaxation drugs like Valium

·         Exposure finally, the patient is exposed to the phobic stimulus while in a relaxed state this takes place over 7 sessions starting with the bottom of the anxiety hierarchy when they can remain calm around stimulus they move up if successful can stay calm in situations that cause high levels of anxiety  

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is it effective?

  • Can be administered on self-administered on phone apps
  • It is fast and quick with a lack of thinking involved
  •  And is suitable for a diverse range of people with flooding and cognitive therapies are not well suited to some patients some suffers have learning difficulties which make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies that require the ability to reflect on what you are thinking
  • Brosnan and Thorpe 2006 compared students with a fear of computers treated with systematic de-sensation against students with no treatment and found that it was very effective in combating phobias 
  •  McGrath et al. (1990) found that 75% of patients with phobias were successfully treated using systematic desensitization, when using in vivo techniques this shows that systematic desensitization is effective in treating phobias.
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is it effective ?

·         Gillroy with 42 patients and he divided them into 3 different groups for 45-minute sessions for fear of spider

Control group

Relaxation group

Systematic desensitization group

·         The spider phobia was assessed on several measures including spider questionnaire. The relaxation group was treated without exposure to the stimuli and at both intervals after treatment 3 months and 33 months those who part of systematic de-sensation was less fearful showing effective long term

·         It is acceptable to patients tend to prefer this method when given the choice of flooding and systematic-desensitization as it does not cause the same degree of trauma and also includes elements of relaxation techniques this is reflected in low refusal rates

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its not effective

·         It is not effective for all phobias it is very hard to cure evolutionary phobias such as being afraid of the dark because we have evolved to develop them and they become part of us it is more effective for personal experience phobias as evolutionary it is innate it is much more logical to be afraid of cars or guns but much more people afraid of dark

          Systematic desensitization is a slow process, taking on average 6-8 sessions. Although, research suggests that the longer the the technique takes the more effective it is. Not cost effective and draining that can lead to dropping out rates and is dependent on trust and positive working relationship with therapists so might make it worse

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Exposing the patients to the phobic stimulus but without a gradual build up in anxiety hierarchy which involves immediate exposure to a very frightening situation flooding sessions tend to be longer than systematic de-sensitisation and may learn relaxation techniques beforehand  one session can last 2-3 hours sometimes only one session needed to cure phobia

 With flooding, a person is unable to avoid (negatively reinforce) their phobia and through continuous exposure, anxiety levels decrease.

Flooding can take one of two forms:

·         in vivo (actual exposure), or

·         in vitro (imaginary exposure)

If a person has arachnophobia flooding treatment might have large spider crawl over them for extended period

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flooding steps

How does it work?

There is no option of avoidance behaviour so quickly learn that the phobia is harmless and cant cause them any danger in classical conditioning terms this process is called extinction a learned response to get rid of a conditioned stimulus

If the dog is the unconditioned stimulus but being bittern will result in conditioned stimulus that produced conditioned response of fear

This sometimes has given the patients relaxation as the have become exhausted by their own fear

Ethical safeguards

This is not unethical but can be a unpleasant experience so important that patients give full informed consent so they are fully prepared the patient would be given choice of flooding or systematic desensitisation

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is it effective ?

It is cost effective

It is the least effective for treating specific phobias study’s comparing flooding with other cognitive therapies Ougrin 2011 found that flooding is highly effective and quicker than other methods making it cost effective as patients free from their symptoms as soon as possible and that makes the treatment cheaper

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its not effective

Less effective for specific phobias

effective for treating simple phobias but for more complex like social phobias this may be due to the fact that they have cognitive aspects as they do not just get anxiety but experience unpleasant thoughts about social situation where their vary from different social situations cant isolate this may benefit from more cognitive therapies.

Treatment is traumatic for patients

 Highly traumatic patients will give consent but often unwilling to see it through to the end this is a limitation of flooding because time and money are sometimes wasted preparing patients only to have them refuse to start or complete

One weakness of in vitro exposition is that it relies on the client’s ability to be able to imagine the fearful situation. Some people cannot create a vivid image and thus systematic desensitization is not always effective (there are individual differences).

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