Phobias
Clinical Characteristics
DSM-5 Categories of Phobia:
Specific Phobia – phobia of an object such as an animal or body part or a situation such as flying
Social Anxiety (Social Phobia) – phobia of a social situation such as speaking in public or eating in public are you?
Agoraphobia – phobia of being outside or in a public place.
Emotional Characteristics of Phobias:
Anxiety
Phobias are classed as anxiety disorders because they involve an extremely emotional response of anxiety, which is unpleasant state of high arousal.
Fear
Fear is the immediate and extremely unpleasant response when when we encounter or think about that phobic stimulus.
Emotional Response is Unreasonable
The emotional response is greater than normal and disproportionate to any threat that is posed.
Behavioural Characteristics of Phobias:
Panic
A person with a phobia will show panic in response to the presence of that phobic stimulus. This might include crying screaming or running away. It can also lead to the freeze response
Avoidance
The person will make a conscious effort to avoid any situation that might involve them coming into contact with the phobic stimulus. For example example if someone has a fear of public toilets they may limit the time they spend outside so that they don’t need to use a public toilet.
Endurance
An alternative behavioural response to a phobic stimulus is endurance. If the person is unable to get away from the phobic stimulus, they simply have to endure being in its presence. For example they might see a spider in the room but might not be able to leave.
Cognitive Characteristics of Phobias:
Selective Attention to the Phobic Stimulus
This happens when a person sees a phobic stimulus but cannot look away from it. They spend time selectively attending to the phobic stimulus. Keeping our attention and our eye on something is good because it makes us able to react to that potential threat.
Irrational Beliefs
A person with a phobia might have irrational beliefs about the phobic stimuli that has no basis in reality. For example, they might believe that if they stutter in public whilst speaking people will think they are weak.
Cognitive Distortions
The perception of the phobic stimulus might be inaccurate and unrealistic. They might see a spider as being aggressive looking and more dangerous then it is.
The Behavioural Approach to Explaining Phobias
The Two Process Model
The two process model was proposed by Mowrer in 1960. It is based on the behavioural approach which considers both classical and operant conditioning.
Acquisition by Classical Conditioning
This suggests that the person acquires the phobia by associating the phobic stimulus with an unpleasant experience which triggers the fear response. Initially the phobic stimulus would be considered to be a neutral stimulus, which eventually becomes the conditioned stimulus. The fear response would initially be unconditioned as it links to the unconditioned stimulus but eventually will become a conditioned response to the phobic stimulus.
This was demonstrated in a study which was conducted by Watson and Rayner in 1920.
Watson and Rayner created a phobia in a nine month old baby who was called little Albert. At the beginning of the study, Albert showed no anxiety towards the neutral stimulus which was a white rat. However, Watson & Rayner then created a phobia of rats in little Albert by presenting the rat to the little boy at the same time as making a loud frightening noise by hitting a steel bar. The loud noise was the unconditioned stimulus, which created the unconditional response of fear and anxiety in the young boy. The rat was initially a neutral stimulus, but then became associated with the loud noise, and therefore became a conditioned stimulus, producing the conditioned response of fear. Eventually, Watson and Rayner did not have to make the loud noise at the same time as presenting the boy with the rat, as the rat alone created a fear response.
It was found that little Albert also generalised his fear to similar objects. They showed little Albert other furry objects such as a rabbit, a fur coat and Watson wearing a Santa Claus beard. Little Albert show generalisation as he displayed distress and a fear response at the sight of all these similar objects.
Maintenance by Operant Conditioning
In Mowrer’s two process model, the fear response is maintained by operant conditioning. Operant conditioning occurs when the behaviour is reinforced or rewarded in some way. In terms of the fear response, it is found that many people will go to extremes to avoid being near the fear stimulus. This avoidance response is considered to be negatively reinforcing, as the person learns to avoid going near the feared stimulus and as a result feels relief. This relief is therefore positively reinforcing as the person no longer has to experience the tension and fear of being near the phobic stimulus. Therefore Mowrer explains how phobias are maintained by using operant conditioning.
Evaluation
1. One strength of the two process model is that it has good real world application. The main therapies that are used in order to cure phobias include systematic desensitisation and flooding. Both of them are considered to be exposure therapy and work through counter conditioning. The fear response is replaced with relaxation, either gradually (systematic desensitisation) or all at once (flooding).
2. One limitation of the two process model is that it doesn’t fully take into account the cognitive aspects of behaviour. Both classical and operant conditioning link to the behaviourist approach which fails to consider the cognitive aspect which also accompanies phobias. The behavioural explanations can explain the behaviour but it does not explain why people holding irrational beliefs about the phobic stimulus, for example, example thinking that a spider is dangerous. Therefore the cognitive process model does not give a complete explanation for phobias.
3. Another strength of the two process model is there is lots of research evidence for the link between between bad experiences and phobias. For example, the little Albert study shows how experiencing a frightening experience can lead to the development of a phobia. A further study by Ad De Jongh et al (2006) found that 73% of people with a fear of dental treatment had also experienced a traumatic experience involving dentistry. This was in comparison to a control group of people with low dental anxiety, and only 21% had experienced a traumatic event.
4. One weakness of the two process model is that it does not take into account that not all phobias appear following a bad experience. There are a number of common phobias such as phobias of snakes and spiders, where very few people have had a bad experience . Therefore this explanation cannot explain the development of phobias where the person has not had a bad experience.
5. A further limitation of the two process model comes from Seligman who in 1971 proposed a theory which is referred to as biological preparedness. This theory suggests that there is an evolutionary basis for many phobias. For example, in our evolutionary past it would have made sense to be scared of things like spiders and snakes, the dark and high places because they would have been potential threats to our survival. Therefore, according to Seligman we are biologically prepared, through evolutionary theory to be scared of certain phobic stimuli.
The Behavioural Approach to Treating Phobias
Systematic Desensitisation
Systematic desensitisation is a therapy which has been developed from the behaviourist approach. Essentially during systematic desensitisation the person learns to respond to the phobic stimulus by using a new learned response. This is sometimes referred to as counter-conditioning.
There are three processes involved in systematic desensitisation:
The Anxiety Hierarchy
This is created between the therapist and the client. It is a list of situations which linked to the phobic stimulus which provoke anxiety which are placed in order from the least frightening to the most frightening. For example, a person who has a fear of spiders might place looking at a picture of a spider low down on the anxiety hierarchy, whereas holding a tarantula might be at the top of the hierarchy.
Relaxation
The therapist helps to teach the client relaxation techniques. This might include breathing exercises or even using mental imagery techniques. In some cases, usually when dealing with adult adults and anti-anxiety medication can be prescribed in order to deal with the physical symptoms of anxiety. It is difficult to be afraid and relaxed at the same same time, so that one emotion prevents the other. This is referred to as reciprocal inhibition.
Exposure
In the final part of systematic desensitisation the client is exposed to the phobic stimulus whilst in a relaxed state. This takes place across a number of sessions as they will start at the bottom of the anxiety hierarchy and gradually work the way to the top. It is important during exposure that the client is not moved on too quickly up the hierarchy, as this might make the client more anxious and in extreme cases might make them worse. Therefore, treatment is only successful when the client can stay relaxed in situations high on the anxiety hierarchy after progressing through the items lower in the anxiety hierarchy.
Evaluation
1. One strength of systematic desensitisation is there is research evidence for its effectiveness. For, example Gilroy et al in 2003 studied 42 people who had been given systematic desensitisation for spider phobia over three 45 minute sessions. It was found that three months and 33 months after after the therapy the systematic desensitisation group were less fearful than a control group treated by relaxation alone, without the exposure. Furthermore, Wechsler at al (2019) concluded that systematisation desensitisation is effective for specific phobias, social phobias and agoraphobia.
2. A further strength of systematic desensitisation is that it can be used to help a variety of people. It can be used with younger people as well as people with learning disabilities. Children and people with learning difficulties may struggle to use flooding but systematic desensitisation is seen as a more ethical treatment, because it is gradual. Additionally, there is no need to consider the cognitive element of the phobia. People with learning disabilities often struggle with cognitive therapy because it requires complex rational thought, which may be confusing. Flooding may not be suitable as it can be extremely traumatic. This means that systematic desensitisation can be used with range of people.
3. A further strength of using traditional systematic desensitisation is that it involves exposure to the phobic stimulus in a real world setting. However, it can also be used in virtual reality and some psychologist have suggested that this might be a better scenario to use when there are dangerous situations involved, e.g. a fear of heights. This is a strength as it may be more cost-effective using VR, as the psychologist and the client do not need to leave the consulting room. However, however there has been some research which suggests that VR expose may be less effective then real exposure for social phobias because it lacks realism.
Flooding
Flooding involves exposing the person to the phobia all at once without the gradual build up. So if the person has a fear of spiders and is receiving flooding, they might be expected to be in a situation where a large spider crawls over them for an extended period of time. Flooding sessions tend to be longer than systematic desensitisation sessions and it might only take one session in order for the therapy to work.
Flooding stops the fear response very quickly; this is referred to as extinction. Extinction is when a learned response is extinguished when the conditioned stimulus (dog) is encountered without the unconditioned stimulus (being bitten). Therefore, the conditioned stimulus no longer produces the conditioned response of fear. In some cases the client may achieve relaxation just because they become exhausted by their own fear response.
One of the main issues with flooding is the ethical issues it creates, so the person using this has to give full informed consent before this therapy can be used.
Evaluation
1. One strength of flooding is that it is highly cost-effective. This is because potentially it only takes one session (albeit an extended session) to work. Therefore this can be highly effective and inexpensive and preferred for use within the NHS because of the money it saves. This means that more people can be treated at the same cost with flooding rather than using systematic desensitisation or other therapies.
2. One limitation of flooding is that it is a highly unpleasant experience. Confronting a phobia can be extremely distressing for an individual and provoke tremendous anxiety. Schumacher et al (2015) found that participants and therapists rated flooding as significantly more stressful than systematic desensitisation. Therefore this raises many ethical issues issues for the psychologist as they are actually causing stress to the clients. However, there are safeguards for the client as they have to be aware of the nature of the therapy and give full informed consent. The dropout rates for this traumatic type of therapy i.e. attrition rates are much higher for flooding compared to systematic desensitisation. This means that therapist might avoid using this as a type of treatment.
3. A further limitation of behavioural therapies, including systematic desensitisation and flooding is that they only treat the symptoms and do not tackle the underlying cause of the phobia. In some cases symptom substitution occurs, as the original phobic stimulus is replaced by a different one. For example, the person might be cured of a fear of spiders, but then this is replaced by a fear of wasps.