Treatments: Treating phobias with systematic desensitisation

1. Treatments: Treating phobias with systematic desensitisation A2

2. What is a phobia? • With a partner write down your own definition. • Once complete we will discuss your answers.

3. Official definition of a phobia: • 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. • Whats the worst degree a person could be affected by?

4. 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).

5. http://www.youtube.com/watch?v=4tEIh_fJ_9g

6. What is the difference between a fear and a phobia?

7. What is the difference between a fear and a phobia? • Up to a fifth of people suffer from a fear or phobia (are you one of them?) • The difference between fears and phobias is the degree of suffering. • 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! • A phobia is characterised by a marked and persistent fear.  • You will know that you are reacting completely over the top.  • Just thinking about the feared situation may cause you to feel the panic rising.  • You are desperate to avoid it and/or you worry endlessly in anticipation of being exposed to it.

8. What do you think the 10 most common phobias are? • 3 mins with a partner!

9. 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

10. What do you think the 10 most common phobias are? 1 ) Arachnophobia 2) Sociaphobia (slide coming up – DSM 5) 3) Aviophobia 4) Agoraphobia (Aoraphobiais 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

11. 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)

12. 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.

13. Treatment for Phobias: Systematic Desensitisation • http://www.youtube.com/watch?v=lMZ5o2uruXY

14. Treatment for Phobias: Systematic Desensitisation • 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. • Operant conditioning focuses on using either positivereinforcement or negativereinforcementto increase or decrease a behavior. • Through this process, an association is formed between the behavior and the consequences for that behavior.

15. Positive Reinforcement: • 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. • The following are some examples of positive reinforcement: • A mother gives her son praise (positive stimulus) for doing homework (behavior). • The little boy receives $5.00 (positive stimulus) for every A he earns on his report card (behavior). • A father gives his daughter candy (positive stimulus) for cleaning up toys (behavior).

16. Negative Reinforcement: • Negative reinforcement occurs when a certain stimulus (usually an aversive stimulus) is removed after a particular behavior is exhibited. • The likelihood of the particular behavior occurring again in the future is increased because of removing/avoiding the negative consequence. • Negative reinforcement should not be thought of as a punishment procedure. • With negative reinforcement, you are increasing a behavior, whereas with punishment, you are decreasing a behavior. • The following are some examples of negative reinforcement: • Bob does the dishes (behavior) in order to avoid his mother nagging (negative stimulus). • Natalie can get up from the dinner table (negative stimulus) when she eats 2 bites of her broccoli (behavior).

17. Punishment: • When thinking about reinforcement, always remember that the end result is to try to increase the behavior • whereas punishment procedures are used to decreasebehaviour. • For positive reinforcement, think of it as adding something positive in order to increase a response. • For negative reinforcement, think of it as taking something negative away in order to increase a response.

18. Punishment • 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. • Punishment is a process by which a consequence immediately follows a behavior which decreases the future frequency of that behaviour. • Like reinforcement, a stimulus can be added (positive punishment) or removed (negative punishment). • There are two types of punishment:

19. What is Positive Punishment? • Positive punishment works by presenting a negative consequence after an undesired behavior is exhibited, making the behavior less likely to happen in the future • A child picks his nose during class (behavior) and the teacher reprimands him (negative stimulus) in front of his classmates. • A child grabs a toy from another child (behavior) and is sent to time out (negative stimulus)

20. What is Negative Punishment? • 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. • 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). • 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. • 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).

21. Positive versus negative reinforcement: • With punishment, always remember that the end result is to try to decrease the undesired behavior. • Positive punishment involves adding a negative consequence after an undesired behavior is emitted to decrease future responses. • Negative punishment includes taking away a certain desired item after the undesired behavior happens in order to decrease future responses. • 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.  • 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.

22. Treatment for Phobias: Systematic Desensitisation • Treatments focus on changing the abnormal behaviour rather than considering thought processes or underlying biological causes… Weakness? • 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.

23. Systematic Desensitisation • Systematic desensitisationis based on the principle of incompatible responses i.e. the idea that you cannot be both anxious and relaxed at the same time. • According to this approach phobias, for example, are thought to be learned anxiety responses to particular stimuli. • Therefore, the treatment assumes that the phobia can be removed by teaching someone to relax when in contact with the phobic object.

24. Process: • Treatment takes place over a number of sessions depending on the strength of the phobia and the client’s ability to relax. • 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. • The process can either be in real exposure to the object or imaginary exposure to the object.

25. Stages: • Functional Analysis – Careful questioning to discover the nature of anxiety and possible triggers. • 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

26. Stages: • 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) • 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?

27. Evaluation of Systematic Desensitisation • How EFFECTIVE is this therapy? • This therapy is very effective with simple phobias such as phobia of spiders. • McGrath et al (1990) found that 75% of patients with specific phobias showed clinically significant improvement following the treatment. • 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.

28. Evaluation of Systematic Desensitisation • Wolpe (1988) claims that 80-90% of patients are either apparently cured or much improved after an average of 25-30 sessions. • However, systematic desensitisation is not effective with disorders such as schizophrenia.

29. Evaluation of Systematic Desensitisation • How EFFECTIVE is this therapy? • Complex and social phobias such as agoraphobia do not respond so well and relapse rates are high. • Craskeand Barlow (1993) found that between 60% and 80% of agoraphobics show some improvement after treatment and clients often relapse completely after six months.

30. Evaluation of Systematic Desensitisation • Are there any PRACTICAL issues involved in the use of this therapy? • One practical issue for this therapy is patient motivation. • Patients who have opted for therapy will be more motivated than those who have been coerced. • The successful application of systematic desensitisation relies on the patients’ willingness to practice relaxation techniques and people differ on how successfully they manage this. • It does require little equipment and therefore the cost is low.

31. Evaluation of Systematic Desensitisation • Are there any ETHICAL issues involved in the use of this therapy? • The treatment is considered to be more ethical than others based on classical conditioning, such as flooding. • This is because the patient is given more control and will only move on when they feel ready to.

32. Evaluation of Systematic Desensitisation • POWER of practitioner? • The therapist conditioning the desired behaviour is in a position of power; they control the hierarchy after it has been decided. • However, the client has to agree to the therapy and can withdraw from it, which reduces the power of the therapist.

33. Evaluation of Systematic Desensitisation • Treating the SYMPTOMS or the CAUSE? • The treatment only focuses on observable symptoms rather than any deeper underlying causes of phobias.