The behavioural approach to treating phobias
Systematic desensitisation
Systematic desensitisation is a behavioural therapy designed to gradually reduce phobic anxiety
through the principal of classical conditioning. If a person can learn to be relaxed in the presence of a
phobic stimulus they will be cured. Essentially new response to the phobic stimulus is learned. The
learning of a new response is called counterconditioning.
Three processes involved in systematic desensitisation:
1) The anxiety hierarchy is put together by a client with a phobia and the therapist. A list of
situations related to the phobic stimulus that provoke anxiety arranged in order from least
to most frightening. For example, a person with arachnophobia might identify a picture of a
small spider as low on the anxiety hierarchy in holding a tarantula at the top of the anxiety
hierarchy.
2) Relaxation. The therapist teaches the client to relax as deeply as possible as it is impossible
to be afraid and relaxed at the same time so one emotion prevents the other. This is called
reciprocal inhibition. Relaxation may involve breathing exercises or client might learn mental
imagery techniques. Relaxation can also be achieved using drugs such as Valium
3) Exposure. Finally, the client is exposed to the phobic stimulus while in a relaxed state this
takes place across several sessions starting at the bottom of the anxiety hierarchy. When the
client can stay relax in the presence of the lower levels of phobic stimulus they move up the
hierarchy. Treatment is successful in the client can stay relaxed and situations high on the
anxiety hierarchy.
Evidence of effectiveness
One strength of systematic desensitisation is the evidence based for its effectiveness. Gilroy et al
2003 Followed up 42 people who had systematic desensitisation for a spider phobia in 3 45 minute
sessions. At both three and 33 months the systematic desensitisation group were less fearful than a
control group treated by relaxation without exposure. Wechsler et al 2019 concluded that
systematic desensitisation is effective for specific phobia social phobia and agoraphobia. This means
that systematic desensitisation is likely to be helpful for people with phobias.
People with learning disabilities
One strength of systematic desensitisation is that it can be used to help people with learning
disabilities. Some people require treatment for five years also have learning disabilities. However,
the main alternatives to systematic desensitisation are not suitable. People with learning disabilities
often struggle with cognitive therapies that require complex and rational thought. They may also feel
confused under stress by the traumatic experience of flooding. This means that the systematic
desensitisation is often the most appropriate treatment for people with learning disabilities who
have phobias.
Flooding
Flooding also Involves exposing people with a phobia to the phobic stimulus but without a gradual
buildup in anxiety hierarchy. Instead it involves the immediate exposure to a very frightening
situation. Flooding sessions are typically longer than systematic desensitisation sessions one session
often lasting 2 to 3 hours. Sometimes only one long session is needed to cure a phobia.
Systematic desensitisation
Systematic desensitisation is a behavioural therapy designed to gradually reduce phobic anxiety
through the principal of classical conditioning. If a person can learn to be relaxed in the presence of a
phobic stimulus they will be cured. Essentially new response to the phobic stimulus is learned. The
learning of a new response is called counterconditioning.
Three processes involved in systematic desensitisation:
1) The anxiety hierarchy is put together by a client with a phobia and the therapist. A list of
situations related to the phobic stimulus that provoke anxiety arranged in order from least
to most frightening. For example, a person with arachnophobia might identify a picture of a
small spider as low on the anxiety hierarchy in holding a tarantula at the top of the anxiety
hierarchy.
2) Relaxation. The therapist teaches the client to relax as deeply as possible as it is impossible
to be afraid and relaxed at the same time so one emotion prevents the other. This is called
reciprocal inhibition. Relaxation may involve breathing exercises or client might learn mental
imagery techniques. Relaxation can also be achieved using drugs such as Valium
3) Exposure. Finally, the client is exposed to the phobic stimulus while in a relaxed state this
takes place across several sessions starting at the bottom of the anxiety hierarchy. When the
client can stay relax in the presence of the lower levels of phobic stimulus they move up the
hierarchy. Treatment is successful in the client can stay relaxed and situations high on the
anxiety hierarchy.
Evidence of effectiveness
One strength of systematic desensitisation is the evidence based for its effectiveness. Gilroy et al
2003 Followed up 42 people who had systematic desensitisation for a spider phobia in 3 45 minute
sessions. At both three and 33 months the systematic desensitisation group were less fearful than a
control group treated by relaxation without exposure. Wechsler et al 2019 concluded that
systematic desensitisation is effective for specific phobia social phobia and agoraphobia. This means
that systematic desensitisation is likely to be helpful for people with phobias.
People with learning disabilities
One strength of systematic desensitisation is that it can be used to help people with learning
disabilities. Some people require treatment for five years also have learning disabilities. However,
the main alternatives to systematic desensitisation are not suitable. People with learning disabilities
often struggle with cognitive therapies that require complex and rational thought. They may also feel
confused under stress by the traumatic experience of flooding. This means that the systematic
desensitisation is often the most appropriate treatment for people with learning disabilities who
have phobias.
Flooding
Flooding also Involves exposing people with a phobia to the phobic stimulus but without a gradual
buildup in anxiety hierarchy. Instead it involves the immediate exposure to a very frightening
situation. Flooding sessions are typically longer than systematic desensitisation sessions one session
often lasting 2 to 3 hours. Sometimes only one long session is needed to cure a phobia.
