Describe and evaluate one or more behavioural approaches to treating phobias.

(16 marks)
Systematic desensitisation therapy aims to gradually reduce the anxiety caused by a phobia through
counterconditioning. If a phobia has been learned so that the phobic stimulus (conditioned stimulus, CS)
produces fear (conditioned response, CR), then the CS can be paired with relaxation and this becomes the
new CR. It is not possible to be afraid and relaxed at the same time, so one emotion prevents the other
(reciprocal inhibition).
The patient and therapist design an anxiety hierarchy – a list of fearful stimuli arranged in order from least
to most frightening. An arachnophobic might identify seeing a picture of a small spider as low on their
anxiety hierarchy and holding a tarantula as the final item.
The phobic individual is first taught relaxation techniques such as deep breathing and/or meditation. The
patient then works through the anxiety hierarchy. At each level the phobic is exposed to the phobic
stimulus in a relaxed state until the phobic stimulus is confronted and the fear extinguished.
A strength of SD is that it is effective. Gilroy et al. (2003) followed up 42 patients who had SD for spider
phobia in three 45-minute sessions. At both three and 33 months, the SD group were less fearful than a
control group treated by relaxation without exposure. This shows that SD is helpful in reducing the anxiety
in spider phobia and that the effects of the treatment are long-lasting.
Another strength is that SD is suitable for a diverse range of patients. The alternatives to SD such as
flooding and cognitive therapies are not well suited to some patients. For example, having learning
difficulties can make it very hard for some patients to understand what is happening during flooding or to
engage with cognitive therapies which require reflection. For these patients, SD is probably the most
appropriate treatment.
A further strength of SD is that patients prefer it. Those given the choice of SD or flooding tend to prefer
SD. This is because it does not cause the same degree of trauma as flooding. It may also be because SD
includes some elements that are actually pleasant, such as time talking with a therapist. This is reflected in
the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of
patients dropping out of treatment) for SD.
The alternative behavioural approach to treating phobias is flooding. Flooding is a behavioural therapy in
which a phobic patient is exposed to an extreme form of a phobic stimulus in order to reduce anxiety
triggered by that stimulus. This takes place across a small number of long therapy sessions.
Although flooding is highly effective for treating simple phobias, it appears to be less so for more complex
phobias like social phobias. This may be because social phobias have cognitive aspects, e.g. a sufferer of a
social phobia doesn’t simply experience anxiety but thinks unpleasant thoughts about the social situation.
This type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational
thinking.
A further limitation is that flooding is traumatic for patients. The problem is not that flooding is unethical
(patients do give informed consent) but that patients are often unwilling to see it through to the end. Time
and money may be wasted preparing patients only to have them refuse to start or complete treatment.