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Treatments: Treating
phobias with systematic
desensitisation
A2
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What is a phobia?
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With a partner write down your own definition.
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Once complete we will discuss your answers.
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Official definition of a phobia:
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A phobia is defined as an irrational, intense fear of an object or
situation that poses little or no actual danger. At first glance, a
phobia may seem similar to a normal fear, but it's is the degree
to which a person is affected that determines whether that fear
has become a phobia.
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Whats the worst degree a person could be affected by?
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In psychology, preparedness is a concept
developed to explain why certain associations are
learned more readily than others. For example,
phobias related to survival, such as snakes, spiders,
and heights, are much more common and much
easier to induce in the laboratory than other kinds of
fears. According to Seligman, this is a result of our
evolutionary history. The theory states that organisms
which learned to fear environmental threats faster
had a survival and reproductive advantage.
Consequently, the innate predisposition to fear these
threats became an adaptive human trait (Ohman &
Mineka, 2001).
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http://www.youtube.com/watch?v
=4tEIh_fJ_9g
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What is the difference between a
fear and a phobia?
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What is the difference between a
fear and a phobia?
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Up to a fifth of people suffer from a fear or phobia (are you one of
them?)
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The difference between fears and phobias is the degree of suffering.
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A fear of snakes is not often a problem in the UK & we can kind of get
away with a fear of heights if we let someone else climb the ladder!
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A phobia is characterised by a marked and persistent fear.
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You will know that you are reacting completely over the top.
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Just thinking about the feared situation may cause you to feel the panic
rising.
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You are desperate to avoid it and/or you worry endlessly in anticipation
of being exposed to it.
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What do you think the 10 most
common phobias are?
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3 mins with a partner!
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What do you think the 10 most
common phobias are?
1 ) Arachnophobia
2) Sociaphobia
3) Aviophobia
4) Agoraphobia
5) Claustrophobia
6) Acrophobia
7) Emetophobia
8) Carcinophobia
9) Brontophobia
10) Necrophobia
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What do you think the 10 most
common phobias are?
1 ) Arachnophobia
2) Sociaphobia (slide coming up – DSM
5)
3) Aviophobia
4) Agoraphobia (Aoraphobia is a form of anxiety disorder, the
abnormal fear of expecting or experiencing a difficult or embarrassing
situation from which the sufferer cannot find an escape.
5) Claustrophobia
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What do you think the 10 most
common phobias are?
6) Acrophobia
7) Emetophobia (an excessive or
irrational fear of vomiting)
8) Carcinophobia (Fear of Cancer)
9) Brontophobia
10) Necrophobia (Fear of death or dead things)
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DSM-IV diagnostic criteria for
300.23 Social Phobia
1) A marked and persistent fear of one or more social or
performance situations in which the person is exposed to
unfamiliar people or to possible scrutiny by others. The individual
fears that he or she will act in a way (or show anxiety symptoms)
that will be humiliating or embarrassing. Note: In children, there
must be evidence of the capacity for age-appropriate social
relationships with familiar people and the anxiety must occur in
peer settings, not just in interactions with adults.
2) Exposure to the feared social situation almost invariably
provokes anxiety, which may take the form of a situationally bound
or situationally predisposed Panic Attack. Note: In children, the
anxiety may be expressed by crying, tantrums, freezing, or
shrinking from social situations with unfamiliar people.
3) The person recognizes that the fear is excessive or
unreasonable. Note: In children, this feature may be absent.
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Treatment for Phobias:
Systematic Desensitisation
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http://www.youtube.com/watch?v=lMZ5o2uruXY
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Treatment for Phobias:
Systematic Desensitisation
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The learning approach to psychological therapies is based on
the assumption that psychological disorders are behaviours that
are learned from the environment by classical or operant
conditioning.
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Operant conditioning focuses on using either positive
reinforcement or negative reinforcement to increase or
decrease a behavior.
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Through this process, an association is formed between the
behavior and the consequences for that behavior.
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Positive Reinforcement:
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Positive reinforcement works by presenting a
motivating/reinforcing stimulus to the person after the desired
behavior is exhibited, making the behavior more likely to
happen in the future.
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The following are some examples of positive reinforcement:
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A mother gives her son praise (positive stimulus) for doing
homework (behavior).
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The little boy receives $5.00 (positive stimulus) for every A
he earns on his report card (behavior).
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A father gives his daughter candy (positive stimulus) for
cleaning up toys (behavior).
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Negative Reinforcement:
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Negative reinforcement occurs when a certain stimulus (usually an
aversive stimulus) is removed after a particular behavior is exhibited.
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The likelihood of the particular behavior occurring again in the future
is increased because of removing/avoiding the negative consequence.
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Negative reinforcement should not be thought of as a punishment
procedure.
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With negative reinforcement, you are increasing a behavior, whereas
with punishment, you are decreasing a behavior.
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The following are some examples of negative reinforcement:
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Bob does the dishes (behavior) in order to avoid his mother nagging
(negative stimulus).
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Natalie can get up from the dinner table (negative stimulus) when
she eats 2 bites of her broccoli (behavior).
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Punishment:
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When thinking about reinforcement, always remember that
the end result is to try to increase the behavior
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whereas punishment procedures are used to decrease
behaviour.
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For positive reinforcement, think of it as adding something
positive in order to increase a response.
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For negative reinforcement, think of it as taking something
negative away in order to increase a response.
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Punishment
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When people hear that punishment procedures are being
used, they typically think of an aversive or harmful
consequence. This is not always the case as you can see
below.
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Punishment is a process by which a consequence
immediately follows a behavior which decreases the future
frequency of that behaviour.
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Like reinforcement, a stimulus can be added (positive
punishment) or removed (negative punishment).
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There are two types of punishment:
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What is Positive Punishment?
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Positive punishment works by presenting a negative
consequence after an undesired behavior is exhibited,
making the behavior less likely to happen in the future
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A child picks his nose during class (behavior) and the
teacher reprimands him (negative stimulus) in front of
his classmates.
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A child grabs a toy from another child (behavior) and is
sent to time out (negative stimulus)
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What is Negative Punishment?
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Negative punishment happens when a certain desired stimulus is
removed after a particular undesired behavior is exhibited, resulting in
the behavior happening less often in the future.
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For a child that really enjoys a specific class, such as PE (probably
because Mr Mallen is teaching them!) or music classes at school,
negative punishment can happen if they are removed from that
class (desired stimulus) and sent to the principal’s office because
they were acting out/misbehaving (behavior).
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If a child does not follow directions or acts inappropriately
(behavior), he loses a token for good behavior (desired stimulus)
that can later be cashed in for a prize.
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Siblings get in a fight (behavior) over who gets to go first in a game
or who gets to play with a new toy, the parent takes the game/toy
away (desired stimulus).
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Positive versus negative
reinforcement:
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With punishment, always remember that the end result is to try to decrease
the undesired behavior.
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Positive punishment involves adding a negative consequence after an
undesired behavior is emitted to decrease future responses.
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Negative punishment includes taking away a certain desired item after the
undesired behavior happens in order to decrease future responses.
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Research shows that positive consequences are more powerful than
negative consequences for improving behavior. Therefore, it is always
suggested that these interventions be tried prior to negative
consequences.
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Do you have any experiences with reinforcement or punishment that
you would like to share? Write down each of the 4 types with examples
from your own experiences.
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Treatment for Phobias:
Systematic Desensitisation
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Treatments focus on changing the abnormal behaviour
rather than considering thought processes or underlying
biological causes… Weakness?
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If we assume that psychological disorders are learned
behaviours, then treatments should aim to help the person
unlearn the maladaptive behaviour and substitute a more
adaptive response in its place.
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Systematic Desensitisation
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Systematic desensitisation is based on the principle of
incompatible responses i.e. the idea that you cannot be both
anxious and relaxed at the same time.
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According to this approach phobias, for example, are
thought to be learned anxiety responses to particular stimuli.
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Therefore, the treatment assumes that the phobia can be
removed by teaching someone to relax when in contact with
the phobic object.
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Process:
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Treatment takes place over a number of sessions depending
on the strength of the phobia and the client’s ability to
relax.
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Therapist and client both jointly agree on what the
therapeutic goal should be and the therapy is deemed to be
successful once the goal has been reached.
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The process can either be in real exposure to the object or
imaginary exposure to the object.
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Stages:
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Functional Analysis – Careful questioning to discover the nature of
anxiety and possible triggers.
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Construction of an Anxiety Hierarchy – Client and therapist devise a
hierarchy of anxiety – provoking situations from the least to the most
fearful.
- Example (have a read then complete your own):
Fear of spiders
1 Think about spider
2 See picture of spider
3 Be in same room as spider in glass tank
4 Sit next to glass tank with the lid closed
5 Sit next to glass tank with the lid open
6 Put hand in tank
7 Hold spider in hands
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Stages:
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Relaxation Training – The client is taught to relax using the
methods which suit them best, e.g. listening to their favourite
music. Deep muscle relaxation techniques are used
(hypnosis, meditation or Valium)
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Gradual Exposure – The phobic object is slowly introduced.
Subject relaxes at each stage starting with least fearful and
progresses to next stage when fully relaxed to do so
But does it work?
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Evaluation of Systematic
Desensitisation
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How EFFECTIVE is this therapy?
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This therapy is very effective with simple phobias such as
phobia of spiders.
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McGrath et al (1990) found that 75% of patients with specific
phobias showed clinically significant improvement following
the treatment.
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Jones applied SD to infants with phobias. Little Peter had
strong phobia of rats and rabbits. Peter was presented with a
rabbit in a cage each time he had lunch, 40 sessions later he
was able to stroke rabbit and eat lunch at same time.
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Evaluation of Systematic
Desensitisation
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Wolpe (1988) claims that 80-90% of patients are either
apparently cured or much improved after an average of 2530 sessions.
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However, systematic desensitisation is not effective with
disorders such as schizophrenia.
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Evaluation of Systematic
Desensitisation
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How EFFECTIVE is this therapy?
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Complex and social phobias such as agoraphobia do not
respond so well and relapse rates are high.
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Craske and Barlow (1993) found that between 60% and 80%
of agoraphobics show some improvement after treatment and
clients often relapse completely after six months.
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Evaluation of Systematic
Desensitisation
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Are there any PRACTICAL issues involved in the use of
this therapy?
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One practical issue for this therapy is patient motivation.
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Patients who have opted for therapy will be more motivated
than those who have been coerced.
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The successful application of systematic desensitisation
relies on the patients’ willingness to practice relaxation
techniques and people differ on how successfully they
manage this.
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It does require little equipment and therefore the cost is low.
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Evaluation of Systematic
Desensitisation
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Are there any ETHICAL issues involved in the use of this
therapy?
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The treatment is considered to be more ethical than others
based on classical conditioning, such as flooding.
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This is because the patient is given more control and will
only move on when they feel ready to.
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Evaluation of Systematic
Desensitisation
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POWER of practitioner?
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The therapist conditioning the desired behaviour is in a
position of power; they control the hierarchy after it has been
decided.
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However, the client has to agree to the therapy and can
withdraw from it, which reduces the power of the therapist.
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Evaluation of Systematic
Desensitisation
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Treating the SYMPTOMS or the CAUSE?
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The treatment only focuses on observable symptoms rather
than any deeper underlying causes of phobias.