1. Brain Warmer
What can you add to a bucket full of sand to make it lighter?

2. Brain Warmer
Throw it off the highest building, and I'll not break. But put me in the ocean, and I will. What am I?

3. Brain Warmer
I'm light as a feather, yet the strongest man can't hold me for much more than a minute. What am I?
Breath

4. Treating phobias 4.1.4 Psychopathology
The behavioural approach to treating phobias: systematic desensitisation, including relaxation and use of hierarchy; flooding.

5. Behavioural Treatments
Psychologists are interested in explaining why phobias develop but also in understanding how to treat them
The specification identifies two behavioural methods used in the treatment of phobias:
systematic desensitisation
flooding

6. Behavioural Treatments
In his two-process model of phobia acquisition, Mowrer suggests that phobias are acquired as a result of classical conditioning and maintained by operant conditioning.
Behavioural treatment therefore aims to:
reduce phobic anxiety through the principle of classical conditioning whereby a new response to the phobic stimulus is paired with relaxation instead of anxiety - counterconditioning
reduce phobic anxiety through the principle of operant conditioning whereby there is no option for avoidance behaviour

7. Systematic Desensitisation (SD)
Wolpe (1958) – two competing emotions cannot occur at the same time so if fear is replaced with relaxation the fear cannot continue
Systematic desensitisation aims to teach a patient to learn a more appropriate association and is designed to reduce an unwanted response, such as anxiety, to a stimulus
Reciprocal inhibition is the process of inhibiting anxiety by substituting a competing response.

8. Systematic Desensitisation (SD)
There are three processes involved in SD
The anxiety hierarchy is constructed by the patient and the therapist. This is a stepped approach to getting the person to face the object or situation of their phobia from least to most frightening
The patient is trained in relaxation techniques, so that they can relax quickly and as deeply as possible
The patient is then exposed to the phobic stimulus whilst practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.

9. The client learns relaxation techniques.
How does it work?
The client learns relaxation techniques.
in vitro
the client imagines exposure to the phobic stimulus
in vivo
the client is actually exposed to the phobic stimulus
Systematic desensitisation
Fear Hierarchy

10. Example of an anxiety hierarchy
Step 1: Learn relaxation techniques
Step 2: Create a hierarchy of what you fear
Step 3: Engage each level of the hierarchy while using relaxation techniques
Behaviour
Think about a spider
Look at a photo of a spider
Look at a real spider in a closed box
Hold the box with the spider
Let a spider crawl on a table in front of you
Let a spider crawl on your shoe
Let a spider crawl up your leg
Let a spider crawl on your sleeve
Let a spider crawl on your bare arm

12. Evaluation – page 147 It is effective
These techniques have proven most effective with specific phobias when a particular phobic object/situation can be identified- less effective with agoraphobic and social phobias.
It is suitable for a diverse range of patients
As this is a simple process that the patient controls, it is often the most suitable form of treatment
It is acceptable to patients
When given the choice between SD and flooding, more often patients choose SD as it does not cause the same degree of trauma and actually involves a pleasant aspect (the relaxation techniques)

13. Effectiveness.
Research has found that SD is successful for a range of anxiety disorders.
E.g. McGrath et al (1990): 75% of patiets with phobias respond to SD.
Capafons et al (1998): reposted tht when used with aerophobics (fear of flying) those who had undergone SD reported lower levels of fear compared to a control group & lower physiological signs of fear during a flight simulation.

14. Effectiveness.
- Ohman et al (1975) suggest that SD may not be as effective in treating anxieties that have an underlying evolutionary survival component (e.g.. Fear of the dark or fear of dangerous animals) than in treating phobias that have been acquired as a result of personal experiences.

15. Task
Create a systematic desensitisation programme for a person suffering with a phobia of your choice. You will need to have read the evaluation to make sure that your treatment is successful.
Patient’s name
Patients phobia
A diagram to show how the phobia arose
A diagram to show how the phobia will be treated
An outline of the anxiety hierarchy
A description of how relaxation will be achieved
The number of sessions that will be needed
Any other details

16. Flooding
This involves overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur.
No relaxation techniques or step by step build up.
Individual is exposed repeatedly and in an intensive way with their phobia.
Individual has their senses flooded with thoughts, images and actual experiences of the object of their phobia.

17. How does flooding work? Flooding stops phobic responses very quickly
Without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless – this process is called extinction
A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten)
The result is that the conditioned stimulus no longer produces the conditioned response (fear)

19. Ethics
Flooding is not unethical as patients give their informed consent so they know exactly what is involved
It is of course an unpleasant experience and a patient has to be properly prepared
A patient would normally be given the choice of systematic desensitisation or flooding

20. Evaluation – page 147 It is cost-effective
The quick effect that flooding can have means that patients are free of their symptoms as soon as possible and this makes the treatment cheaper than alternatives
It is less effective for some types of phobia
Flooding is less effective for treating more complex phobias like social phobias. This may be because social phobias have cognitive aspects – an individual does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation
The treatment is traumatic for patients
Flooding produces high levels of fear and this can be very traumatic and as a result many patients refuse to start or complete treatment

21. Review How are flooding and systematic desensitisation similar?
How are flooding and systematic desensitisation different?

22.
1. Snake phobia is a specific phobia. What other specific phobias are mentioned at the start of the clip?
2. The type of therapy used in this clip involves exposing the phobic individual to the feared object. Is this type of therapy as used here a form of flooding or systematic desensitisation?
3. According to the principles underlying this type of treatment, why does the patient need to experience directly the feared object rather than experience it only virtually?
4. What is the catastrophic belief that the patient has? How does this make the treatment partly cognitive as well as behavioural?
5. According to behavioural principles, how does avoidance behaviour maintain this (catastrophic)belief?
6. Why does this treatment not include relaxation techniques?
7. What psychological principles are mentioned by Osts and the narrator to account for the success of the treatment?
8. After the treatment programme, what behaviour is encouraged in order to maintain the improvement?

23. 1. Claustrophobia; fear of flying; fear of thunder.
2. It is systematic desensitisation.
3. The patient needs to experience the feared object directly in order to see that it is not overwhelming or threatening.
4. The catastrophic belief is that if the snake is loose she will have heart failure. It is partly cognitive because it is the belief that is being challenged (albeit by behavioural means).
5. It is maintained by never having the belief challenged so it never goes away.
6. By not learning relaxation thereby experiencing the anxiety, the person can learn that anxiety is not dangerous.
7. Habituation; positive reinforcement; modelling (these are the behavioural ones). Increased confidence and the acceptance of new information are also mentioned.
8. To maintain the improvement she must expose herself to snakes (or the possibility that she will encounter snakes) by, for example, watching a nature programme and going to the zoo.

26. Reminder: An anxiety hierarchy is a list of situations that provoke anxiety arranged in order from least to most frightening.

27. Exam Questions
Outline one behavioural method for treating phobias. (4 marks)
Evaluate flooding as a way to treat phobias. (4 marks)
Explain one limitation of using systematic desensitisation to treat phobias (4 marks)
Stuart has had a phobia of horses since he tried riding as a child whereupon his horse bolted and threw him, leaving him with a broken collarbone. As a young adult, Stuart has now decided to tackle his fear of horses. Having researched alternative treatments, he has opted for systematic desensitisation. Explain how you might put together an anxiety hierarchy to treat Stuart's phobia of horses. (4 marks)