SPECIFICATION: THE BEHAVIOURAL: The behavioural, emotional, and cognitive characteristics of phobias; the behavioural approach to explaining and treating phobias includes the two-process model, which includes classical and operant conditioning; systematic desensitisation, which includes relaxation and the use of hierarchy; and flooding.

THE BEHAVIOURAL, EMOTIONAL AND COGNITIVE CHARACTERISTICS OF PHOBIAS

This section focuses on the characteristics of 3 mental disorders: phobias, depression and OCD, with the focus being on their emotional, behavioural and cognitive characteristics.

So, breaking this down, each disorder has a total of 3 questions, which means there are possible questions you need to know.

Let’s break each section down:

The emotional characteristics of phobias

Irrational, persistent and excessive fear with high levels of anxiety in the anticipation or presence of the feared object or situation.

It may produce panic attacks once presented with the object or situation.

The behavioural characteristics of phobias

Avoidance/anxiety-based response is demonstrated when confronted by feared objects or situations.

A person may be seen to make efforts to avoid this, e.g., a person who fears social situations is seen to avoid groups of people actively. A disruption of functioning may also affect the ability to work or social functioning.

The individual may also freeze or faint due to the situation or object.

The cognitive characteristics of phobias

This relates to a person's irrational thinking/thought processes, which are resistant to rational perspectives.

The individual may also recognise their fear as unreasonable or excessive, which helps distinguish them from having a mental disorder such as schizophrenia.

THE BEHAVIORAL APPROACH TO EXPLAINING PHOBIAS

THE TWO-PROCESS MODEL

Attention: Do not describe what a phobia is!!! You will gain no marks

OUTLINE

One popular behavioural explanation for the cause of phobias combines the two elements underpinning learning theory: operant and classical conditioning, known as “The two-process model”.

The first part of the two-process model is concerned with acquiring the phobia and uses the theory of classical conditioning to explain this acquisition. A phobia is acquired through an association between a neutral stimulus (e.g. a dog) and an unconditioned stimulus (e.g. noise), which results in a new stimulus-response being learned. For example, if a dog phobia is given as an example, a person at first sees the dog as a neutral stimulus. The dog barks loudly, and the person feels anxiety, which is an unconditioned response to an unconditioned stimulus (noise). The person then associates the anxiety with the dog so that the dog has become a conditioned stimulus and anxiety a conditioned response.

COMMENTARY: Although classical conditioning can explain why we develop a phobia, it struggles to explain why our phobias do not decay over time.

For example, it is unlikely that you will be bitten by every dog you encounter, so it would be reasonable to assume that your phobia should weaken with every friendly dog you encounter. However, most phobias are long-term, and according to Mowrer, our phobias are maintained through operant conditioning.

OUTLINE: According to operant conditioning, phobias can be negatively reinforced. This is where behaviour is strengthened because an unpleasant consequence is removed.

For example, if a person with a phobia of dogs sees a dog whilst walking, they might try to avoid the dog by crossing the road. This avoidance reduces the person’s feelings of anxiety and negatively reinforces their behaviour, making the person more likely to repeat this behaviour (avoidance) in the future. As a result, a person will continue to avoid dogs and maintain their phobia.

Therefore, according to the two-process model, phobias are initiated through classical conditioning (learning through association) and maintained through operant conditioning (negative reinforcement).

SUPPORTING RESEARCH:

One strength of the behaviourist explanation of phobias comes from research evidence. Watson & Raynor (1920) demonstrated the process of classical conditioning in forming phobias in Little Albert, who was conditioned to fear white rats. This and similar experimental research on animals support the idea that classical conditioning is involved in acquiring phobias.

Another strength of the behaviourist explanation is its application and success in therapy. Behaviourist ideas have been used to develop effective treatments, including systematic desensitisation and flooding. Both flooding and Systematic desensitisation help people to unlearn their fears, using the principles of classical conditioning, Consequently, these therapies have been successfully used to treat people with phobias, providing further support to the behaviourist explanation.

However, these treatments are not successful with all phobias, namely social phobias, leading some critics to deem the theory reductionist and overly simplistic. For example, the behaviourist approach ignores the role of cognition (thinking) in forming phobias and cognitive psychologists suggest that phobias may develop due to irrational thinking, not just learning.  For example, sufferers of claustrophobia (a fear of confined space) may think: ‘I am going to be trapped in this lift and suffocate’, which is an irrational thought and not taken into consideration in the behaviourist explanation. Furthermore, the cognition approach has also led to the development of cognitive behavioural therapy (CBT), a more successful treatment than behaviourist treatments. This is a problem because the behavioural approach to explaining phobias can be seen as too simplistic as it ignores other factors, such as our childhood experiences, everyday stressors and the role of biology (e.g. genes, neurotransmitters) in developing abnormality.

Moreover, some Psychologists think there is an evolutionary basis for the acquisition of phobias. For example, fearing snakes, spiders, heights, open spaces, etc., is adaptive and increases the chances of survival. For example, an innate phobia of snakes could protect a young child from being bitten.

This is problematic for the two-process model as it fails to involve evolutionary reasons for acquiring phobias. However, some behaviourists, such as Seligman (1971), thought biological preparedness should be involved in explaining phobias.

 The behavioural approach/two-process model of phobias can be criticised for being deterministic. For example, the Two-Process model suggests that when an individual experiences a traumatic event and uses this event to draw an association between a neutral stimulus and an unconditioned response, they will go on and develop a phobia.  This is a weakness because this theory of phobias suggests that our environmental experiences program us and ignore individual free will (for example, if a dog bites a person, this negative experience may not cause them to develop a phobia of dogs.

However, a large problem of the behaviourist explanation of phobias is it's seemingly dependent on the idea of developing a phobia from some past trauma or bad experience; for example, in Little Albert’s case, the experience of loud noises associated with rats would have been very distressing for a young child. Being bitten by a dog as a young child may cause a person to have a phobia of dogs as an adult. However, certain phobias cannot be explained by trauma. For example, a person may have a phobia of crocodiles or sharks but have never encountered them. This is an aspect the approach fails to consider and could reduce its explanatory powers. However, social learning theory, a very similar approach in many respects to behaviourism, might explain how some people develop phobias without seeing the object or experiencing it, e.g., through the process of vicarious reinforcement, a child sees its Mother run from a spider or a child sees an actor being attacked by a crocodile. This means that an eclectic approach to explaining phobias may be more helpful, encompassing individual differences, such as age and biology, evolution and cognition. This may explain why some phobias involve complicated thought processes and acquisitions and are, therefore, better treated and explained by more complex treatments, such as CBT.

The Two-Process Model (Mowrer 1947)

Mowrer (1947) proposed the two-process model, which attempts to explain phobias through the behaviourist explanation of either classical or operant conditioning.

Behaviourists propose phobias are learned through experience and association, and in classical conditioning, phobias are acquired by a stimulus associated with a negative outcome.

An example is Watson (1920) and the Little Albert study.

A child was introduced to a loud noise (unconditioned stimulus), which produced the fear response (unconditioned response). A white rat (neutral stimulus) was introduced and paired with this loud noise, which over time became paired with the fear response towards this white rat (conditioned response). The rat then becomes a conditioned stimulus, producing the conditioned response of fear.

This same concept applies to other phobias that develop for particular objects, animals or situations. Traumatic events produce negative feelings, which then become conditioned responses to objects, animals, or situations that are conditioned stimuli. Operant conditioning then maintains phobias, explaining why people remain fearful or avoid the object or situation. This proposes that behaviour is likely to be repeated if the outcome is rewarding, known as positive reinforcement.

If the behaviour avoids something unpleasant, this is known as negative reinforcement. In the case of phobias and through negative reinforcement, the avoidance of the object/situation in question reduces anxiety or fear, which the individual finds rewarding. This then reinforces the avoidance behaviour further.

Another behavioural explanation is social learning theory, which explains phobias as having been acquired through modelling behaviours observed by others. An individual may see a phobic response and emulate the reaction as it appears rewarding in some form, i.e. attention.

Two-Process Model Evaluation

The two-process model is generally supported by phobia sufferers being able to recall a traumatic or specific event which triggers it.

However, a weakness is that not everyone can link their phobia to a specific event they recall. This is not to say it never occurred; however, as Ost (1987) suggests, it may have been forgotten over time.
A case study by Bagby (1922) supports classical conditioning. It explains her phobia of running water, which caused her extreme distress. The sound of running water had become associated with her fear and distress, demonstrating how the two-process model has validity in some explanations of phobias.

However, with single case studies, we may not necessarily be able to generalise the findings to the wider population as the circumstances for that phobia development may lack external validity to other people's conditions. In addition, such case studies are time-consuming and almost impossible to replicate to test the reliability of findings and confirm they occurred as patients may describe.

Rachman 1984) offered an alternative view through the Safety signals hypothesis, which undermines the two-process model. This proposed that avoidance behaviour towards the object/animal in question is not motivated by negative reinforcement and the reduction in anxiety as the two-process model proposes but by the positive feelings the person associates with safety. Support for this comes from agoraphobics who travel to work on certain routes, as these are the ones they see as trusted and representative of safety signals.

Another major weakness of the two-process model is the fact that not everyone who suffers a traumatic event then goes on to develop a phobia. This suggests that the two-process model is overly simplistic and does not offer a holistic explanation, as other factors must be considered.
The diathesis-stress model may offer a better explanation which combines both psychological factors, such as the two-process model, and combines this with a genetic vulnerability. This suggests that some people may inherit a genetic vulnerability for developing mental disorders such as phobias, provided the right environmental stressors trigger this. This would explain why phobias develop in some people but not necessarily in others. However, again, this would be incredibly difficult to validate for certain.

Possible exam questions for the behavioural approach to explaining phobias:

• Outline the two-process model as an explanation of phobias

• Explain how classical conditioning can be used to explain the development of phobias

• Give one criticism of the two-process model

• Outline and evaluate the behavioural approach to explaining phobias (12 marks AS, 16 marks A-level

DISCUSS BEHAVIOURAL TREATMENT FOR PHOBIAS, INCLUDING FLOODING AND SYSTEMATIC DESENSITISATION

FLOODING AND SYSTEMATIC DESENSITISATION

A01 (6 marks)

POINT:

The Behavioural Approach to treating phobias assumes that phobias are learned through classical conditioning and maintained through avoidance behaviour and operant conditioning.

FIRST TREATMENT: Flooding (3 marks)

EXPLAIN:

A faulty association between a conditioned stimulus and a conditioned response can be treated by applying the principles of classical conditioning and exposing the patient to fear-provoking stimuli.

Exposure therapies can be in vivo, in vitro, or using computer simulations. Flooding is based on extinguishing the CR. The patient is exposed to the CS but in a safe environment, e.g., in a room with snakes. After an often long period of intense anxiety, the patient’s bodily arousal is exhausted, and he realises that the snakes do not cause harm, and the CR is extinguished.

SECOND TREATMENT: Systematic desensitisation (3 marks)

EXPLAIN:

Systematic desensitisation is a process of counterconditioning based on the idea that anxiety and relaxation cannot be experienced simultaneously (reciprocal inhibition). If the patient is taught to use relaxation techniques to replace the fear, the phobia will be cured. The process involves the patient and therapist creating a hierarchy of anxiety-provoking things associated with the phobia. The patient is taught relaxation techniques, e.g. deep breathing and mental imagery, then exposed to the least fear-provoking thing on the hierarchy whilst relaxing. When able to remain relaxed at this level in the hierarchy, the patient is exposed to the next level. Over a series of sessions, the anxiety response to the phobic stimuli is replaced by relaxation.

A03 supporting research: Findings and conclusions only:

Point:

The behavioural approach is particularly effective in treating specific phobias. Gilroy found that compared with a control group given relaxation without exposure, the systematic desensitisation group was given relaxation training, and progressive exposure to spiders showed less fear after treatment. The counterconditioning worked.

Explain:

However, behavioural therapies have been less effective in treating phobias that involve irrational thinking or are partly due to the patient’s poor social skills. CBT has been found to work better for those with a fear of public speaking.  Evidence: Ougrin found that flooding was more effective and quicker than cognitive therapies for specific phobias, but it was not better for social phobias. Evaluate: Compared with CBT, behaviourist therapies merely treat the symptom, whilst CBT focuses on the thinking that underpins the phobia.

Point:

The appropriateness of flooding has been debated. Explain: If the patient cannot endure prolonged exposure and exits the process before the anxiety level falls to baseline level, the fear is not extinguished and may even become stronger. Evidence and Evidence: Evaluate: Although flooding is more traumatic and the dropout rate is higher than for systematic desensitization, Choy also reported dropout as a problem within vivo systematic desensitisation when a patient exits before working through the full hierarchy. The effectiveness of systematic desensitisation depends on the type of phobia and type of systematic desensitisation; e.g., virtual reality systematic desensitisation seems effective for height and flying phobias but is less effective for animal phobias. Also, a patient’s ability to learn and use relaxation skills and imagine fearful situations will influence the effectiveness of systematic desensitisation.

The behavioural approach to explaining phobia focuses on the two-process model, which includes classical and operant conditioning.

The behavioural approach in treating phobias focuses on systematic desensitisation and a technique known as flooding.

Systematic Desensitisation

Systematic desensitisation assumes that phobias can be unlearned if they are a learned response, as classical and operant conditioning suggests.

Phobics may avoid the stimulus that causes them to fear, so they never learn the irrationality of this fear. Through a process of classical conditioning, systematic desensitisation teaches patients to replace their fearful feelings through a process of hierarchal stages, gradually introducing the person to their feared situation one step at a time.

The hierarchy is constructed before treatment, starting from the least feared to the most feared situation, working towards contact and exposure. Throughout these stages, patients are taught relaxation techniques that help manage their anxiety and distress levels to help them cope but also to associate these feelings of calmness towards the phobia. Earlier stages may involve pictures of the phobic situation (a picture of a snake, for example, if this is their fear), which may then lead to the goal of holding one. As patients master each step, they move on to the next. For another scenario, covert desensitisation is used, which involves imagining contact instead.

Relaxation techniques taught may help the patient focus on their breathing and take slower, deeper breaths, as anxiety often results in faster, shallow breathing, which helps manage it. Mindfulness techniques such as “here and now” may also be used, which involves focusing on a particular object or visualising a relaxing scene. Progressive muscle relaxation involves straining and relaxing muscle groups gently, which can help relax the body from tension.

Counter-conditioning involves classical conditioning and may also be used as part of systematic desensitisation by creating a new association that runs alongside the current phobic situation. For example, the patient may be taught to associate relaxation instead of fear with their phobic situation, and as fear and relaxation are incompatible, anxiety is reduced.

Systematic desensitisation evaluation

A weakness of systematic desensitisation is that it is not appropriate for all patients; only those who can learn relaxation strategies and those who have vivid imaginations enough to imagine the feared situations in question. There is no guarantee learning to imagine and cope with phobic situations will translate into working in the real world either.

Another weakness is that systematic desensitisation is time-consuming and costly, which may make it inappropriate. Patients need to attend numerous appointments and build trust with their practitioner, who is a stranger, which can be difficult in itself. Also, the strategy is dependent on the skill set of the practitioners themselves, which can affect how long this treatment takes or if it works at all.

A strength, however, is that there is strong evidence that suggests systematic desensitisation is effective, with numerous research studies finding it a success. McGrath et al. (1990) reported that 75% of patients responded positively with S, and exposure to the feared stimulus (Vivo techniques) was believed to be one of the main reasons. Vitro techniques, which involve patients imagining the feared stimulus, were less effective in comparison (Choy et al. 2007).
There are ethical issues which arise with SD as it deliberately exposes patients to their fears, which can cause psychological harm as there is no guarantee they will cope with it well. They may go on to have nightmares, or their fear may even get worse to the point where their life become dysfunctional. With this in mind, it may not always be appropriate for all patients, and a cost-benefit analysis may be needed to weigh the benefits and costs with both short-term and long-term in mind.

A strength of systematic desensitisation over CBT is it requires relatively little insight from the patient. Where CBT requires a person to have a good level of insight and self-awareness into their thinking to challenge their irrational thoughts, systematic desensitisation relies on simple conditioning, which patients easily learn.

Systematic desensitisation: Flooding

Flooding is an alternative approach to systematic desensitisation and either expose the patient directly to their phobia or they are asked to imagine an extreme form of it.

The client is also taught and encouraged to use relaxation techniques before exposure to the phobic situation, which continues until the patient can relax fully.

In fear-based situations, the patient releases adrenaline; however, this will eventually cease, and relaxation will be associated with the feared stimulus as the patient cannot use their normal avoidance methods. The procedure can also be conducted using virtual reality.

Systematic desensitisation: Flooding evaluation

Flooding raises serious ethical issues as it deliberately exposes patients to their fears, which can cause severe psychological harm as there is no guarantee they can eventually cope with the situation. They may go on to have nightmares or even make their phobia worse to the point that their life becomes dysfunctional. With this in mind, it may not always be appropriate for all patients, and a cost-benefit analysis may be needed to weigh the benefits and costs with both short-term and long-term in mind.

Not everyone may be able to cope with this form of treatment, and its effectiveness may depend on individual differences. Not everyone enjoys good physical health, and subjecting such individuals to highly stressful situations through flooding may risk health problems, such as heart attacks.

A benefit of flooding, however, is that the treatment is relatively quick to administer and effective, with Choy et al. (2007) reporting it to be more effective than SD.

Possible exam questions for the behavioural approach to treating phobias:

• Outline and evaluate how systematic desensitisation can be used to treat phobias

• Outline and evaluate how flooding is used to treat phobias

• Outline and evaluate the behavioural approach to treating phobias (12 marks AS, 16 marks A-level).