The behaviourist approach to treating phobias

Behaviourism views phobias as learned responses that can be unlearned using principles from learning theories. Behaviourists do not assume that sets of symptoms reflect single underlying causes or hidden meanings.

Flooding and implosion therapy

Flooding and implosion are direct exposure therapies used to treat phobias by confronting the feared object or situation at full intensity. These methods are based on the idea that intense anxiety cannot be sustained forever and will eventually subside, leading to extinction of the fear response. In classical conditioning terms, the conditioned stimulus (CS), such as a spider, triggers a conditioned response (CR) of anxiety. By preventing escape, the therapy breaks this link, as the person realises no harm occurs.

This process acts as forced reality testing, where the individual experiences high anxiety initially, but exhaustion sets in, and the fear diminishes. A new association forms between the phobic object and a sense of calm, replacing the old fear-based one. These therapies also stop reinforcement through avoidance behaviours, which normally maintain the phobia by reducing anxiety in the short term.

Flooding therapy

Flooding, also known as in vivo exposure, involves real-life confrontation with the phobia at maximum strength. For instance, someone with arachnophobia (fear of spiders) might be placed in a room full of spiders without the option to leave. This leads to peak anxiety, followed by realisation that the spiders are harmless, extinguishing the fear.

Key features of flooding therapy:

• Rationale - Anxiety is time-limited; prolonged exposure without escape creates positive associations, like calmness.
• Potential drawbacks - It can be highly traumatic, causing extreme distress during the session.

Implosion therapy

Implosion is an alternative, imaginal (imaginary) form of exposure that avoids real-life trauma. The person vividly imagines scenarios involving the phobia, including exaggerated cues related to the fear.

How implosion therapy works:

• For someone with germophobia (fear of germs), they might imagine being covered in germs and facing related outcomes like illness or loss of control.
• This mental exposure builds to high anxiety, which then fades, leading to extinction.
• Less physically intense than flooding, making it suitable for those who cannot handle real exposure.

Systematic desensitisation

Systematic desensitisation (SD) is a gradual exposure therapy based on the principle of incompatible responses: a person cannot feel anxious and relaxed simultaneously. Behaviourists view phobias as learned anxiety responses, so SD unlearns them by pairing the phobic stimulus with relaxation techniques.

This therapy occurs over multiple sessions, tailored to the phobia's severity and the person's relaxation skills. It begins with identifying fears and progresses slowly to avoid overwhelming the individual. Success is measured by achieving an agreed therapeutic goal, such as comfortably encountering the phobic object.

Stages of systematic desensitisation

1. Functional analysis - The therapist questions the client to understand the anxiety's nature, triggers, and specific fears.
2. Construction of an anxiety hierarchy - Together, they create a ranked list of fear-provoking situations, from least to most anxiety-inducing (e.g., for a fear of heights: thinking about a tall building at the bottom, standing on a skyscraper at the top).
3. Relaxation training - The client learns techniques like deep breathing or progressive muscle relaxation to induce calm.
4. Gradual exposure - Starting with the lowest hierarchy item, the client practises relaxation while imagining or encountering it. Once anxiety is extinguished, they move to the next item, building tolerance step by step.

As each level's anxiety response fades, the overall fear reduces, making the final confrontation with the phobia much less intense.

Modelling as a treatment for phobias

Modelling draws from social learning theory, which posits that people learn behaviours by observing and imitating others. In treating phobias, especially in children, it involves watching someone else interact calmly with the feared object, allowing the observer to vicariously learn that it is safe. This reduces fear through imitation and positive reinforcement from seeing no harm occur.

For example, a child with a dog phobia might watch another child play happily with a dog, leading them to approach dogs more confidently.

Research study: Bandura and Menlove (1968)

• Aim - This study examined modelling's effectiveness in treating dog phobias in young children.
• Participants - 48 nursery school children with dog phobias.
• Method - Children were divided into three groups. Group 1 watched films of a single boy interacting boldly with a cocker spaniel, progressing from mild to intense encounters. Group 2 viewed films with multiple children and various dogs of different sizes. The control group watched unrelated films about theme parks.
• Procedure - Sessions involved brief film clips, repeated over time to build exposure.
• Results - Groups 1 and 2 showed increased confidence around dogs compared to the control group, with effects lasting long-term.
• Conclusions - Modelling reduces phobias by demonstrating safe interactions, supporting social learning theory.