Phobic disorders
• Clinical characteristics of the phobic disorders.
• Issues surrounding the classification and
diagnosis of phobic disorders, including
reliability and validity.
Explanations • Biological explanations of phobic disorders, for
example, genetics, biochemistry.
• Psychological explanations of phobic disorders,
for example, behavioural, cognitive,
psychodynamic and socio-cultural.
Overview
Therapy
• Biological therapies for phobic disorders,
including their evaluation in terms of
appropriateness and effectiveness.
• Psychological therapies for phobic disorders, for
example, behavioural, psychodynamic and
cognitive-behavioural, including their evaluation
in terms of appropriateness and effectiveness.
DSM-IV-TR CRITERIA for specific phobia
Reduce
• Marked and persistent fear that is excessive
or unreasonable.
• Exposure to the phobic stimulus almost
invariably provokes an immediate anxiety
response such as a panic attack.
• The person recognises that the fear is
excessive or unreasonable. This feature
may be absent in children.
• The phobic situation is avoided or endured
with intense anxiety or distress.
• The avoidance, anxious anticipation, or
distress in the feared situation interferes
significantly with the person’s normal
routine,
• In individuals under age 18 years the
duration is at least six months.
• The anxiety, panic attacks or phobic
avoidance is not better accounted for by
another mental disorder, such as OCD
Types of specific phobia
• Animal type (e.g. spiders, dogs).
• Natural environment type (e.g.
heights, storms, water).
• Blood/injection/injurytype.
• Situational type (e.g.aeroplanes,
lifts, enclosed places).
• Other types (e.g. fear of choking
or contracting an illness, or, in
children, fear of loud noises or
costumed characters).
With panic disorder
2. Issues surrounding
classification and diagnosis
• Mental disorder classified
using DSM or ICD.
• Diagnosis depends on use
of a classification system.
• DSM lists 372 disorders.
• Diagnosis based on
1. Principal disorder
2. Personality disorder
3. Medical problems
4. Psychosocial stressor
5. Global assessment of
functioning
2. Issues surrounding
classification and diagnosis
= consistency
Consistency of a measuring instrument such as a
scale to assess fear ratings.
Reliability can be measured
Inter-rater reliability: whether two independent
assessors give similar scores.
Test-retest reliability: whether the test is likely to
produce the same results on two separate
occasions.
2. Issues surrounding
classification and diagnosis
Inter-rater reliability
• Skyre et al. (1991) – three
clinicians assess 54 social
phobics using the
Structured Clinical
Interview (SCID-I). High
agreement (+.72). SCID
requires extensive training
which may explain the
high reliability.
Test-retest
• Hiller et al. (1990) to
excellent diagnostic
agreement using the
Munich Diagnostic
Checklist (MDC).
There is some evidence of poor reliability …
Kendler et al. (1999) erviewed phobics (face-toface or over the telephone). Over a one-month
interval (test-retest) there was a mean
agreement of +.46. Reliability over 8 years was
even lower (+.30).
This may be explained …
Low reliability might be due to the poor recall by
participants of their fears (overexaggerating or
underexaggerating fears) (Kendler et al.)
Interviewers differ in their interpretation of
symptoms, concluding it is clinically significant
or not affecting whether a diagnosis is made.
2. Issues surrounding
classification and diagnosis
• = measures what it claims to
measure.
• = is real i.e. a characteristic of the
individual rather than the
situation.
• A diagnosis cannot be valid if it is
not reliable.
• Why diagnose if there is no
effective treatment specific to
phobic disorders?
2. Issues surrounding
classification and diagnosis
Comorbidity
• If two (or more) conditions cooccur this suggests that they are
not separate entities and
therefore the diagnostic category
is not very useful, e.g. when
deciding what treatment to
advise.
• Research has found high levels of
comorbidity between social
phobias,
This is supported by …
animal phobias,
generalised anxiety Up to 66% of patients with one anxiety disorder are also
diagnosed with another anxiety disorder (Eysenck, 1997).
disorder and
The implications are that the diagnosis should simply be
depression (e.g.
Kendler et al., 1993). ‘anxiety disorder’ rather than phobia or obsessive
compulsive disorder (OCD).
2. Issues surrounding
classification and diagnosis
Concurrent validity
• A means of establishing validity by
comparing an existing a
test/questionnaire with the one you
are interested in.
• Mattick and (1998) that their Social
Phobia Scale (SPS) correlated well
with other standard measures
(varying between +.54 and +.69).
Construct validity
• A means of assessing the validity
or trueness of a psychological
test by demonstrating the extent
to which performance on the test
measures an identified
underlying construct.
• Beidel et al. (1989) found the
Social Phobia and Anxiety
Inventory (SPAI) correlates well
with behavioural measures of
social phobia (e.g. ease of public
speaking) and lacks association
with behaviours unrelated to
social phobia.
2. Issues surrounding
classification and diagnosis
Validity may be increased using computer diagnosis …
Computerised scales for assessing phobic disorders may be preferable because
the presence of another person can create fears of negative evaluation.
Computerised scales also mean there is less of an effect of interviewer
expectations on the patient’s answers (Kobak et al., 1993).
Gender bias …
Women are more likely to be diagnosed with specific phobias, possibly because
clinicians are influenced by gender stereotypes (Worrell and Remer).
Culture differences …
Taijin-kyofusho (TKS) is a culturally distinctive phobia recognised in Japan. This
is a social phobia where an individual has a fear of embarrassing others in
social situations. In the UK a person exhibiting such symptoms would not be
diagnosed with a social phobia, indicating the effect of cultural experiences on
the diagnosis of a disorder.
2. Issues surrounding
classification and diagnosis
• Rosenhan (1973) Sane in Insane
Places
• Pseudopatients diagnosed with
schizophrenia despite being normal
except for saying they heard voices.
• Showed that diagnosis lacked
validity, based on situational factors
rather than a characteristic of the
person.
• Follow up study – real patients
underdiagnosed because clinicians
leaning towards a Type 2 error
(avoiding a false positive – calling a
healthy person sick). End up calling a
sick person healthy (Type 2, false
negative).
Later research has not supported this
Spitzer et al. (1975) gave 74
emergency room psychiatrists a
detailed case description and found
that only three offered a diagnosis of
psychotic depression and only one
third recommended medication.
Part 2
Explanations
Biological
Psychological
Biological: Genetic
Family studies
• Fyer et al. (1995): probands
had 3x as many relatives with
phobias compared to normal
controls.
• Usually the same disorder as
the proband, e.g. Ost
(1989)found that 64% of
blood phobics had a least one
relative with the same
disorder.
Twin studies
• Torgersen (1983) compared
MZ and same-sex DZ twin
pairs with anxiety disorders
with panic attacks. 5X more
frequent in MZ twin pairs.
Biological: Genetic
Family studies
• Fyer et al. (1995): probands
had 3x as many relatives with
phobias compared to normal
controls.
• Usually the same disorder as
the proband, e.g. Ost
(1989)found that 64% of
blood phobics had a least one
relative with the same
disorder.
Twin studies
• Torgersen (1983) compared
MZ and same-sex DZ twin
pairs with anxiety disorders
with panic attacks. 5X more
frequent in MZ twin pairs.
Some phobias have a greater genetic
component than others …
Kendler et al. (1992) estimated a 67%
heritability rate for agoraphobia, 59% for
blood/injury, 51% for social phobias and
47% for animal phobias.
One of the problems with family and
twin studies … they fail to control for
shared experiences. MZ twins are likely
to share more similar experiences
(environments) than DZ twins.
The diathesis-stress model …
It is likely that genetic factors
predispose an individual to develop
phobias but experience plays a role in
triggering such responses.
Biological: Genetic
Inherited tendencies
• High levels of arousal in
the ANS, which creates
increased amounts of
adrenaline and this
leads to an
oversensitive fear
response (adrenogenic
theory).
• Dopamine pathways in
the brain may
predispose some
people to be more
readily conditioned so
that they are more
likely to acquire phobias
easily.
Biological: Genetic
Inherited tendencies
• High levels of arousal in
the ANS, which creates
increased amounts of
adrenaline and this
leads to an
oversensitive fear
response (adrenogenic
theory).
• Dopamine pathways in
the brain may
predispose some
people to be more
readily conditioned so
that they are more
likely to acquire phobias
easily.
There is research support …
Children with signs of behavioural inhibition at birth (a
tendency to withdraw from unfamiliar people and
situations) were found to later have higher ANS
activity and develop significantly more anxiety
disorders (Biederman et al., 1993).
Successful drug therapies for phobics include drugs
that block activity of the adrenergic system (betablockers), reducing anxiety.
Tiihonen et al. found a lower number of dopamine
reuptake sites in patients with social phobia, which
would lead to low levels of dopamine.
However … this does not show that such differences
actually cause phobias in the first place, e.g. drugs
may be treating symptoms that have arisen as an
effect rather than the cause of phobias.
Biological: Evolutionary
Modern phobias are often related to
ancient fears (e.g. snakes, heights)
rather than modern dangers (e.g. guns,
electricity) because no adaptive
selection yet (Marks and Nesse, 1994).
Prepotent
•Inherited tendency to respond prior to
direct experience, e.g. to respond
anxiously to snake-like movement or
sounds.
Prepared
•Inherited tendency to rapidly learn an
association between a stimuli (i.e.
potentially life-threatening) and fear,
and once learned this association is
difficult to extinguish.
Biological: Evolutionary
Modern phobias are often related to
ancient fears (e.g. snakes, heights)
rather than modern dangers (e.g. guns,
electricity) because no adaptive
selection yet (Marks and Nesse, 1994).
Prepotent
•Inherited tendency to respond prior to
direct experience, e.g. to respond
anxiously to snake-like movement or
sounds.
Prepared
•Inherited tendency to rapidly learn an
association between a stimuli (i.e.
potentially life-threatening) and fear,
and once learned this association is
difficult to extinguish.
May not explain clinical phobias.
Öhman and Soares (1994) people
who were fearful of snakes or spiders
showed a greater fear response
(SNS activity measured by GSR)
when shown masked (not
immediately recognisable) pictures of
snake/spiders. This shows that
people respond to prepotent
signals.
McNally (1987) reviewed lab studies
(participants conditioned to fear
prepared and unprepared stimuli).
The participants showed resistance
to extinction of fear responses
conditioned by ‘prepared’ stimuli, but
evidence for rapid acquisition was, at
best, equivocal.
Exam
Corner
Outline and evaluate one psychological explanation for either
phobic disorders or obsessive compulsive disorder. (4 marks + 6
marks) Jan 2011
Outline one psychological explanation and one biological
explanation for either phobic disorders or obsessive compulsive
disorder. (9 marks)
Evaluate explanations for either phobic disorders or obsessive
compulsive disorder. (16 mark)
Outline at least one biological explanation of depression and at
least one psychological explanation of depression. (9 marks)
Evaluate biological and psychological explanations of
depression. (16 marks)
The plurality rule
Discuss one
biological
explanation of
gender.
Discuss two
biological
explanations of
gender.
• You use your ‘best’ explanation.
• IF you only discuss one explanation,
you can get up to ⅔ of the total
marks i.e. 16 marks (which is a Grade
A).
• For explanation number 2 you only
need a ‘small’ version.
Psychological: Psychodynamic
Little Hans (Freud,
1909)
Hans, aged 4, became
terrified of horses.
Freud suggested that
Hans’ phobia
developed because
Hans projected a real
fear (that his mother
would leave him) onto
horses (because he
heard a man say ‘Don’t
put your finger to the
white horse or it’ll bite
you’ and Hans also
once asked his mother
if she would like to put
her finger on his penis).
Psychological: Psychodynamic
Little Hans (Freud,
1909)
Hans, aged 4, became
terrified of horses.
Freud suggested that
Hans’ phobia
developed because
Hans projected a real
fear (that his mother
would leave him) onto
horses (because he
heard a man say ‘Don’t
put your finger to the
white horse or it’ll bite
you’ and Hans also
once asked his mother
if she would like to put
her finger on his penis).
• A case study concerns one unique individual.
• Hans’ phobia could be explained in terms of classical
conditioning (Hans associated horses with fear).
However there is other research support …
• Bowlby (1973) agoraphobics often had early
experiences of family conflict. Conflict leads a young
child to feel very anxious when separated from their
parents (separation anxiety). Such fears are suppressed
but later emerge as agoraphobia.
• Whiting et al. (1966) found that phobias were more
common in societies that had a structured form of childrearing – stricter, structured parenting might lead to
children having to repress desires.
• The fact that therapies that simply target the symptoms
of phobia (e.g. SD) are not 100% successful may be
because they fail to deal with the underlying causes.
Psychological: Behavioural
Classical conditioning
Little Albert (Watson and Raynor, 1920)
• UCS (loud noise)  UCR (fear)
• NS (furry object) associated with UCS.
• The furry object (now a CS)  CR (fear).
Operant conditioning
Two-process theory (Mowrer, 1947), phobias
acquired:
1. Through classical conditioning.
2. Maintained through operant conditioning, the
avoidance of the phobic stimulus reduces fear
and is thus reinforcing (negative reinforcement).
Social learning
• Imitation, e.g. seeing a parent afraid of spider.
Psychological: Behavioural
Classical conditioning
Not everyone who is bitten by a dog develops
a phobia gs (Di Nardo et al., 1988). Perhaps
only those with a genetic vulnerability for
phobias are affected (diathesis-stress
model).
Operant conditioning
Biological preparedness … Bregman (1934)
failed to condition a fear response in
infants by pairing a loud bell with wooden
blocks. Neutral stimulus may need to be an
‘ancient fear’ (e.g. an animal).
Social learning
Bandura and Rosenthal (1966) an observer
watched a model apparently experiencing
pain every time a buzzer sounded. The
observer later demonstrated an emotional
reaction to the sound.
Cultural differences …
explained e.g. each society
offers its own culture-specific
models that influence
which phobias might be
acquired.
We can conclude …
Different phobias may be the
result of different processes,
e.g. Sue et al. (1994) found
that agoraphobics were most
likely to explain their disorder
in terms of a specific incident
whereas arachnophobics
were most likely to cite
modelling as the cause.
Part 3
Therapies
Biological
Psychological
Biological: Chemotherapy
Antianxiety drugs:
Benzodiazepines
• BZs slow down the
activity of the central
nervous system by
enhancing the activity of
GABA.
• Locks onto GABA
receptors on receiving
neurons, opens a channel
to increase the flow of
chloride ions into the
neuron. Chloride ions
make it harder for the
neuron to be stimulated
by other
neurotransmitters.
Biological: Chemotherapy
Antianxiety drugs:
Benzodiazepines
• BZs slow down the
activity of the central
nervous system by
enhancing the activity of
GABA.
• Locks onto GABA
receptors on receiving
neurons, opens a channel
to increase the flow of
chloride ions into the
neuron. Chloride ions
make it harder for the
neuron to be stimulated
by other
neurotransmitters.
Effectiveness?
Kahn et al. (1986) found that BZs were more
effective than placebos in reducing anxiety.
However … benefits may be largely explained in
terms of placebo effects.
Appropriateness?
Side effects … BZs may cause increased
aggressiveness and long-term impairment of
memory – though recent research (Kindt et al.
2009) has proposed that such negative effects
might be used to remove anxiety-causing
memories.
Addiction … BZs may become addictive, even
when only low doses are given. A maximum use
of four weeks is recommended (Ashton, 1997).
Biological: Chemotherapy
Antianxiety drugs:
Beta-blockers reduce the activity of adrenaline (SNS response to stress).
Biological: Chemotherapy
Antianxiety drugs:
Beta-blockers reduce the activity of adrenaline (SNS response to stress).
Effectiveness?
Research studies (e.g. Liebowitz et al., 1985) have shown
that BBs can also provide an effective means of anxiety
control.
However … Turner et al. found no difference between BB
and placebo groups in terms of reduced heart rate, feelings of
nervousness and so on.
Appropriateness?
BBs have few side effects and no addiction.
Biological: Chemotherapy
Antidepressants
• SSRIs, are currently the preferred
drug for treating anxiety disorders
(Choy and Schneier, 2008). They
increase levels of the
neurotransmitter serotonin that
regulates mood/anxiety.
• MAOI, older class of antidepressants,
are more effective with some
patients (Lader and Petursson, 1983).
Monoamine oxidase (MAO) is the
enzyme responsible for breaking
down monoamine neurotransmitters
(e.g. serotonin and dopamine) so an
inhibitor prevents this happening,
leading to higher levels of
monoamines in the synaptic gap.
Biological: Chemotherapy
Antidepressants
• SSRIs, are currently the preferred
drug for treating anxiety disorders
(Choy and Schneier, 2008). They
increase levels of the
neurotransmitter serotonin that
regulates mood/anxiety.
• MAOI, an older class antidepressants,
are more effective with some
patients (Lader and Petursson, 1983).
Monoamine oxidase (MAO) is the
enzyme responsible for breaking
down monoamine neurotransmitters
(e.g. serotonin and dopamine) so an
inhibitor prevents this happening,
leading to higher levels of
monoamines in the synaptic gap.
Effectiveness?
SSRIs led to improved levels of selfrated anxiety when compared to a
placebo treatment (Katzelnick et al.,
1995).
MAOIs have been found to be more
effective than placebos and more
effective in the reduction of anxiety than
BBs (Liebowitz et al., 1992).
Appropriateness?
SSRIs are linked to increased suicides
in adolescents (Barbui et al., 2008).
MAOIs have a number of side effects,
e.g. dizziness, insomnia.
Biological: Chemotherapy
Not a cure …
Drugs can’t provide a complete treatment
as they focus on symptoms (symptom
substitution).
Ethical issues …
The issue of informed consent concerns
the extent to which patients are not
informed about the fact that drugs may
not actually be much better than
placebos.
Psychological: SD
Phobias are perpetuated because the anxiety
created blocks any attempt to re-experience the
stimulus.
Joseph Wolpe (1958) developed a technique where
the feared stimulus is re-introduced gradually.
•Counterconditioning: Forming a new association
that runs counter to the original association.
‘Reciprocal inhibition’ because the relaxation
inhibits the anxiety.
•Desensitisation hierarchy: Therapist and patient
construct a series of imagined scenes, each one
progressively more fearful. They then work through
this hierarchy, relaxing and mastering each stage
before moving on to the next.
•Different forms of SD: In vivo, covert (also known
as in vitro), flooding.
Psychological: SD
Effectiveness ?
• Research has found that SD is successful for a range of phobic
disorders, e.g. McGrath et al. (1990) found about 75% success rates.
• In vivo techniques more successful than covert ones (Menzies and
Clarke, 1993), though often a number of different exposure techniques
are involved – in vivo, covert and modelling where the patient watches
someone else who is coping well with the feared stimulus (Comer).
• However … Öhman et al. (1975) suggest that SD may not be as
effective in treating phobias that have an underlying evolutionary survival
component (e.g. fear of the dark or dangerous animals).
Appropriateness ?
• SD requires less effort from the patient than other psychotherapies.
• SD can be self-administered, a method that has proved successful with,
for example, social phobia.
• Positive expectancies may be the most important ingredient, e.g. Klein
et al. (1983) found SD and supportive psychotherapy equally effective
for patients with either social or specific phobias.
Psychological: REBT
Ellis proposed that phobias occur because of
irrational thinking.
ABC model (Ellis, 1957)
A = activating event e.g. friend ignores you in the
street.
B = irrational beliefs arising from A, e.g. your friend
must have decided he doesn’t like you; no one likes
you, you are worthless.
C = self-defeating consequences, e.g. avoid social
situations in the future.
Disputing
•Logical disputing e.g. ‘Does thinking this way make
sense?’.
•Empirical disputing (evidence based) e.g. ‘Where is
the proof that this belief is accurate?’.
Psychological: REBT
Effectiveness ?
• REBT has generally done well in outcome studies, e.g. a meta-analysis by
Engels et al. (1993).
• Ellis (1957) claimed a 90% success rate, taking an average of 27 sessions
to complete.
• However … Emmelkamp et al. (1998) concluded that REBT was less
effective than in vivo exposure treatments, at least for agoraphobia.
Appropriateness ?
• Not suitable for all … Ellis believed that some people don’t put their revised
beliefs into action or don’t want the direct sort of advice and cognitive effort
associated with REBT.
• There is research support … People who hold irrational beliefs form
inferences that are significantly less functional than those that are formed by
people who hold rational beliefs (Bond and Dryden, 2002).
• Ethical issues … REBT is regarded as one of the most aggressive CBTs
(Rosenhan and Seligman, 1989) and, in addition, it is judgmental. These
aspects of the therapy raise ethical concerns because of the psychological
harm that may be caused to a person’s self-esteem.
Exam
Corner
Briefly describe one psychological therapy for the anxiety
disorder that you outlined in your answer to. (5 marks)
Evaluate psychological therapies for this anxiety disorder. (16
marks)
June 2010
Reduce
Essay answer to mark
(a) Outline clinical characteristics of one anxiety disorder. (4 marks)
Examiner notes
AO1 = 4 marks The outline might include:
• physiological, behavioural, emotional and cognitive signs/symptoms
• incidence and prevalence
• course and prognosis
• diagnostic criteria
Examiners should bear in mind that there are only 4 marks available here so
candidates are not expected to cover all these points to access top marks.
The list of particular clinical characteristics obviously depends on the choice of
anxiety disorder. Phobic disorder is an umbrella term covering specific
phobias, social phobias and agoraphobia and it is legitimate for candidates
to describe just one of these or all three. However, simply naming different
types does not meet the requirement of describing the clinical
characteristics of the disorder, so cannot attract marks unless there is an
accompanying description.
Essay answer to mark
(a) Outline clinical characteristics of one anxiety disorder. (4 marks)
The DSM identifies clinical characteristics that differentiate between a clinical
phobia and a mere fear. Firstly the individual must recognise that their
behaviour is irrational but continue to act in that way. Secondly the phobia must
encroach on everyday life, interfering with their day to day, normal activities,
such as going out in public. Moreover the individual suffering from the phobic
disorder will not feel in control of their actions and the anxiety associated with
the disorder will have a substantial longevity – in children the disorder must
have lasted for at least 6 months. Lastly panic attacks may accompany the
phobia, especially when the individual is presented with situational cues of the
phobia or comes into direct contact with it – this especially will lead to irrational
behaviour and often crying in children.
(132 words)
Essay answer to mark
(b) Briefly describe one psychological therapy for the anxiety disorder that
you outlined in your answer to part (a). (5 marks)
Examiner notes
AO1 = 5 marks
AO1 is a brief outline of one psychological therapy for the chosen anxiety
disorder. If candidates outline more than one type of therapy, examiners
should look at both accounts and credit the one which attracts most
marks. Answers which describe a biological therapy eg drugs attract no
credit. The most likely therapy is some form of behavioural therapy eg
systematic desensitisation or implosion for phobias, or for OCD, ERP or
modelling.
AO1 mark allocation
Essay answer to mark
(b) Briefly describe one psychological therapy for the anxiety disorder that
you outlined in your answer to part (a). (5 marks)
Systematic desensitisation is a psychological therapy used to help the
suffering individual overcome their fear. Joseph Wolpe originally came up
with the therapy and suggested that deep relaxation is the key to
overcoming the fear as relaxation and anxiety are not able to occur at the
same time. Wolpe came up with the idea of counterconditioning – once an
individual is able to relax fully, it is possible to replace the conditioned
stimuli to which they have attached their phobia with a more positive
conditioned stimuli taking their place. For example, research was carried
out where cats were conditioned to acquire a phobia of a box in which they
were placed. The researchers gave the cats electric shocks so they were
conditioned to have a phobic response to the box. Counterconditioning
took place when the cats were fed in the box because they no longer
associated it with the box.
continued ……
Essay answer to mark
In order to relate this to humans, Wolpe invented the idea of a desensitisation
hierarchy, which has many stages and each brings the phobic closer to
confronting their fear. They may find it is not so scary after all but prior to
systematic desensitisation they were unable to confront it to find out.
Wolpe developed ‘in vivo’ type of systematic desensitisation and also a
‘covert’ type. The former actually requires the phobic to physically confront
their fear while the covert type just asks participants to imagine pictures of it.
‘Flooding’ is also associated with systematic desensitisation – individuals are
shown their phobia prior to any therapy.
(254 words)
Essay answer to mark
(c) Evaluate psychological therapies for this anxiety disorder. (16 marks)
Examiner notes
AO2/3 = 16 marks
Candidates are required to evaluate psychological therapies appropriate for
the anxiety disorder outlined in 04. Because evaluation can be very
generic, partial performance criteria do not apply. They are likely to
consider issues such as appropriateness and effectiveness of the
therapies. They can also consider the quality of the research evidence
which supports the therapies.
Essay answer to mark
AO2/AO3 mark scheme
Essay answer to mark
Subsequent research on systematic desensitisation has confirmed that it is an
effective therapy in helping individuals overcome their fears. A significant
number of participants responded well to the treatment but it was found that
‘in vivo’ was more effective than the ‘covert’ method. Also systematic
desensitisation may, according to research, be more effective on specific
phobias rather than social phobias. This may be due to the fact that many
specific phobias are exaggerations of ‘ancient fears’ such as snakes and
spiders. These phobias are less likely to encroach on the lives of individuals
suffering as they are more easily avoidable, whereas social phobias often
effect every aspect of a sufferer’s life. A further criticism of systematic
desensitization is that it does not treat the cause of an individual’s phobia but
only desensitises them to the symptoms they experience when confronted. If,
as Freud suggests, their phobia is a result of early trauma and ego conflict, the
individual may subsequently relay their true fear onto another object or
situation and the cycle will start again.
continued …
Essay answer to mark
However, a strength of the theory is that it can be self-administered and
requires little input from participants, so they can go at their own pace. The
research mentioned earlier concerning the cats (they were placed in a box and
electrocuted to condition a fear response) may have influenced Joseph Wolpe
to come up with systematic desensitization, but it has been criticised for being
overly reductionist as it is reducing the complexities of overcoming a phobia to
a more simple organism, which raises issues as it is not generalisable to the
population.
Albert Ellis came up with a different psychological therapy for phobias. He
proposed that Rational Emotive Behaviour Therapy (REBT) could cure an
individual of an addiction by altering the way in which they think. Phobics
have been found to have delusional thoughts about themselves and things
around themselves and things around them , which may lead them developing
a phobia. Ellis targets these irrational thoughts in his therapy, proposing the
ABC model as a way of aiding participants to alter their thinking. This has
been found to be effective , especially among social phobics as these are
thought to be derived from irrational thoughts in many cases. For example, an
continued …
Essay answer to mark
individual may see a friend in the street who ignores them (Activating event).
They will then display irrational Belief which will lead to a social phobia of
going out in the street as a Consequence. (The irrational belief includes
irrational thoughts that the person must hate them). This therapy is effective
as it targets the causes of an individual’s phobia but it has been criticised as
individual differences play a part in its administration. Many people do not
respond to REBT as they do not like to be told what to do and cannot be
helped under strict conditions. Others flourish under these conditions and their
phobias are ‘cured’.
REBT also takes a long time to carry out and has been criticised for being too
logical – it is not always as straightforward as that as the phobia has been
acquired as a result of one particular, irrational thought. Therefore, REBT is
also deterministic as there must be other factors involved or the success rate
would be 100%. Also REBT cannot help phobics who do not suffer from
irrational thinking.
(560 words)
EVERY MARK COUNTS
June 2010
Unit 3
Average mark =
Unit 4
A*
A
B
C
D
E
54/75
47
40
34
28
22
72%
63%
45%
29%
18
15.7
11.3
7.3
56/85
50
66%
59%
44
38
45%
32
26
31%