Phobias

Explaining Phobias

Behavioural approaches suggest that abnormal behaviour is learned somehow.

Two-process model: Developed by Mowrer (1960), this suggests that phobias are acquired through learning. Phobias are acquired initially by classical conditioning (learning by association). If an unpleasant emotion is paired with a stimulus, then the two become associated with each other through conditioning. For example, a child being knocked over by a dog associates the unpleasantness of falling over with dogs. Phobias are maintained through operant conditioning (learning through rewards/punishments)- the person avoids the phobic stimulus, and gains a reward for doing so. For example, constantly avoiding situations involving dogs. This maintains the phobia because the feared association is never ‘unlearned’.

Evaluation:

• This explanation is useful for developing therapies, as it explains that in order to overcome the fear, the person must be exposed to the phobic stimulus. This has led to successful therapies for phobias, strengthening the explanation
• Some phobias don’t follow a traumatic experience, for example a person may have a fear of snakes without ever having encountered a snake. This suggests some phobias have not been acquired through learning, weakening this explanation
• We may be pre-disposed to some phobias, such as snakes or spiders, which would have given human ancestors a survival advantage. This means the capacity for certain phobias is ‘hard-wired’, and therefore not learnt. Phobias of guns and cars, which are far more dangerous to most human today, are very rare, perhaps because these things were not present in humans’ evolutionary past. This weakens the behavioural explanation.

Treating Phobias

Systematic desensitisation (SD): Developed in the 1950s, this is based on principles of classical conditioning, and the idea that it is not possible for two opposite emotions, such as relaxation and anxiety, to co-exist (‘reciprocal inhibition’). The therapist and client work together to set an aim (for example, to be able to touch a snake without panic). This is the ‘target behaviour’. Relaxation techniques are taught and practised – a person cannot be relaxed and afraid at the same time. (This may take some time) Then, an anxiety hierarchy is drawn up. The target behaviour is the aim of therapy, but this is way too difficult at first. Therefore, small steps are identified and worked through, using scale of 1-10 for estimating fear/challenge. These steps can be real or imaginary. Only once the client has mastered one step can they move on to the next, finishing with the target behaviour. For example (there may be more stages than this):

1. Looking at a photograph of a snake
2. Looking at a video of a snake
3. Being in a room with a snake in a box at the opposite corner
4. Moving the snake to the middle of the room in the box
5. Standing next to the snake in the box
6. Taking the lid off the box
7. Touching the snake for 1 second
8. Touching the snake for 5 seconds
9. Touching the snake for 1 minute
10. Touching the snake for 5 minutes

Evaluation:

• Gilroy et al (2003) found SD was effective in treating spider phobias, when compared with a control group who only received relaxation training. This shows the treatment does work.
• SD can be used with a wide range of patients, as it is based on basic behavioural techniques. For example, it can be used on patients with learning difficulties. This means it can help more people.
• Patients are likely to engage with it, as it does not seem too daunting a treatment. This is shown in the low drop-out rates for the treatment. Therefore, it is effective for a lot of people.

Flooding: This is like systematic desensitisation, but without the build-up. The patient goes straight to the target behaviour or the situation which would cause maximum anxiety, for example being locked in a small room with lots of spiders. The patient will become extremely anxious, but will eventually come to see that the phobic stimulus is not, and will not, cause them harm- humans cannot remain in a state of extreme, heightened anxiety indefinitely. They therefore unlearn the feared association. Alternatively, they may become exhausted by their reaction so will calm down eventually. This can work in just one session.

Evaluation:

• It can work very quickly, for example in as little as an hour or so. This means it has little impact on people’s day-to-day life (no need to spend hours in therapy sessions) so is a useful treatment.
• Some phobias are hard to treat with it- perhaps because they have cognitive elements- for example, a fear of public speaking is caused by the thought that the person will say things wrong. This may not be treatable by flooding, so weakening this treatment.
• It is very traumatic for patients. They will give consent, but they will experience extreme anxiety, and the treatment might not even work. Therefore, it will not be appropriate for some people.

Cognitive Approach to Explaining Depression

Cognitive approaches suggest abnormal behaviour arises from faulty/incorrect though processes.

Beck’s cognitive theory: Faulty thinking/information processing (not thinking rationally) will lead to depression. Faulty thinking strategies include:

• All or none thinking (dichotomous thinking)- A tendency to classify everything into one of two extreme categories, e.g. success and failure.
• Arbitrary inferences- drawing negative conclusions without having the evidence to support them.
• Overgeneralisation- incorrect conclusions are drawn from little evidence (e.g. a single incident).
• Catastrophising- where relatively normal events are perceived as disasters.
• Selective abstraction- when a person only pays attention to certain features of an event and ignores other features which might lead to a different conclusion.
• Excessive responsibility- excessively taking responsibility and blame for things which happen.

In addition to this, depressed people have a negative self-schema- they interpret all information about themselves in a negative way. This negative way of thinking is caused by the ‘negative triad’- automatic, negative thoughts about three aspects of existence:

Ellis’s ABC model: Focuses on irrational (negative) thoughts in response to an event to explain depression:

A= Activating event (failing a Psychology exam)

B= Beliefs about the event (‘I failed the exam, so I am unintelligent and useless’)

C= Consequences of these beliefs (low self-esteem, not working for other exams, continued poor results, depression)

Evaluation:

• Grazioli and Terry (2000) found that women assessed to be cognitively vulnerable to depression were more likely to go on to develop post-natal depression, supporting that negative thoughts do lead to depression.
• Cognitive behavioural therapy (CBT) has been developed as a result of these explanations, which has been effective at treating depression. This strengthens the usefulness and validity of the explanations.
• Cognitive theories can’t explain all of the symptoms of depression, for example the extreme anger and hallucinations that some patients experience. Therefore, it is only a partial explanation for depression.

Cognitive Approach to Treating Depression

Cognitive behaviour therapy (CBT): This works by the therapist and patient identifying the negative, irrational thoughts the patient may have. Strategies are then used to challenge these thoughts, with the therapist disputing the validity of the beliefs. Negative thoughts are therefore rejected and more positive strategies used instead.

• Beck’s therapy: Automatic thoughts about the self, world, and future are identified, then the therapist challenges these thoughts (are they actually true?). Patients are tasked to test the reality of these beliefs, for example recording positive experiences in a diary. These findings are used to challenge negative beliefs in the future.
• __Ellis’s rational emotive behaviour therapy (REBT): __The idea of the therapy is to make the patient understand that their thoughts are irrational, and substitute these thoughts for more effective cognitions. This is done by extending the ABC model:
• A – Activating Event (Fiona fails her driving test)
• B – Belief (Fiona thinks this is a disaster and that she is a failure at life as she did not pass)
• C – Consequence (Fiona starts to become depressed as she feels that she is worthless and incompetent)
• D – Dispute (Fiona’s beliefs would be challenged- see below)
• E – Effect (Fiona should think in a more positive way)

Strategies to challenge these beliefs include logical disputing- does it make sense to think in this way? Empirical disputing- what evidence is there that this belief is true? Pragmatic disputing- how is thinking like this going to help? Patients may also be encouraged to take part in more enjoyable day-to-day activities to help them feel more positive.

Evaluation:

• March et al (2007) found that 81% of depressed adolescents showed improvement after undergoing CBT, compared to 81% using drugs and 86% using both treatments. This shows that CBT is effective at reducing depression.
• For some patients CBT may not work, because it requires a great deal of cognitive effort to engage with the therapy. This may be beyond severely depressed patients. This means the treatment cannot be used for everyone.
• It has been suggested that by emphasising cognition, environmental factors may be ignored, for example abusive relationships or unfulfilling jobs. This weakens the use of CBT because changing the patient’s thoughts will not change their negative environments, which may actually be the cause of the depression.

Outline and evaluate the cognitive approach to depression. (16 marks - 6 outline, around 3 paragraphs; 10 evaluate - around 3-4 evaluation points)

Your answer should include: Beck / Thinking / Strategies / Self-schema / Triad / ABC / Ellis / Evidence