PSYA4 PSYCHOPATHOLOGY
PHOBIAS
WORKBOOK

WW 2013

1
Specification 2012

3.4 Unit 4 Psychopathology, Psychology in Action and Research
Methods
Candidates will be expected to:
...
Student checklist for Phobias PSYA4
Sub-sections

A. Clinical
characteristic
s and issues
of diagnosis

Class
notes?

Unde...
A. Classification and Diagnosis of Phobias
Clinical characteristics











General Introduction to anxiety disor...
Blood-injection types: blood, injections, needles
(Other type: anything else that does not fit into the 4 major sub-types)...
Summary – Diagnostic criteria
DSM-IVr criteria include:
 Marked and persistent fear that is excessive, cued by the presen...
Reasons for low reliability
Kendler et al (1999)

VALIDITYIS?

Comorbidity

Demonstrating validity of methods of diagnosis...
Diagnosis by computer

Cultural differences in Diagnosis

EXAMINATION QUESTIONS
Specimen paper
4.Outline clinical characte...
B. EXPLANATIONS OF PHOBIC DISORDERS(old TB p 192)
BIOLOGICAL EXPLANATIONS
1. GENETIC INHERITANCE
Family studies:

Twin Stu...
EVALUATION/COMMENTARYp 193
-Few studies, conflicting evidence and no adoption studies

Family and twin studies –

provide ...
What is inherited?

But there is an uneven distribution of phobias – some are more common than others
and this needs expla...
2. EVOLUTIONARY APPROACH

– there are 3 elements to this:

A) Ancient fears and modern minds

B) Prepotency

C) Preparedne...
COMMENTARY/EVALUATION
There is evidence to support the prepotencyand preparedness element of the
theory. Prepotency:
Ohman...
Make notes on Behavioural Inhibition (green box) and Cultural Differences (yellow box)
on p 193.

Behavioural Inhibition

...
PSYCHOLOGICAL EXPLANATIONS OF PHOBIC DISORDERS
PSYCHODYNAMIC EXPLANATIONS
Freud explained phobias using his idea of Ego De...
BEHAVIOURIST EXPLANATIONS
Phobias can be seen as learnt behaviour, either through classical conditioning, operant
conditio...
COMMENTARY/ EVALUATION
Evidence to support behaviourism
1. Watson and Raynor (– don‟t just describe – say how)
2. Barlow a...
Social learning

Conclusion

COGNITIVE EXPLANATION
 A phobic person develops irrational, distorted and negative thinking ...
EVALUATION see p 195

DYSFUNCTIONAL ASSUMPTIONS

COGNITIVE BEHAVIOUR THERAPY IS SUCCESSFUL

Additional notes p 195

Socioc...
Examinations questions
Specimen paper
6.Outline and evaluate one or more explanations of the anxiety disorder outlined in ...
BIOLOGICAL TREATMENTS FOR PHOBIC DISORDERS
If mental illness is seen as having biological, neurochemical, genetic factors,...
Monoamine OxidaseInhibitors(MAOIs)inhibit the destruction of norepinephrine,
serotonin and dopamine but this can have seri...
ADDICTION

ETHICS(yellow box)

Real life application – Fearful memories – green box p 197

23
PSYCHOSURGERY
Psychosurgery is surgical intervention to treat an area of the brain which is believed to
be malfunctioning,...
BEHAVIOURAL THERAPIES BASED ON CLASSICAL CONDITIONING
Behaviour therapy – Classical Conditioning.
Behaviour therapy is oft...
feared item and move on once they feel relaxed and unafraid in its presence. This
confrontation may be real or imagined. T...
APPROPRIATENESS
Strengths: p 199
1. Behavioural therapies are relatively quick and require little effort on behalf of the
...
COGNITIVE (BEHAVIOUR) THERAPY
Cognitive Behavioural Therapy CBT uses the cognitive approach to restructuring
cognitions, b...
EVALUATION p 199
CBT is a very popular form of psychological therapy. It is straightforward, practical and
has proved succ...
Examination questions
June 2010
4 Outline clinical characteristics of one anxiety disorder. (4 marks)
5.Briefly describe o...
Upcoming SlideShare
Loading in …5
×

Resourcd File

643 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Resourcd File

  1. 1. PSYA4 PSYCHOPATHOLOGY PHOBIAS WORKBOOK WW 2013 1
  2. 2. Specification 2012 3.4 Unit 4 Psychopathology, Psychology in Action and Research Methods Candidates will be expected to: • develop knowledge and understanding of theories and studies relevant to the content for each area of psychology in this unit • analyse and evaluate theories, explanations and studies relevant to the content for each area of psychologyin this unit • undertake practical research activities involving collection, analysis and interpretation of qualitative andquantitative data. This unit is divided into three sections. Section A: Psychopathology Candidates will be expected to: • develop knowledge and understanding of one of the following disorders: o schizophrenia o depression o phobic disorders o obsessive compulsive disorder • apply knowledge and understanding of models, classification and diagnosis to their chosen disorder. GUIDE TO CHANGES (from 2008) i.e. very little has changed except marksChanges to the mark allocations – on PSYA3 and PSYA4 (Sections A and B), each topic will now be worth 8 AO1 marks and 16 AO2/3 marks, making the total for PSYA3 72 marks and the total for PSYA4 83 marks 2
  3. 3. Student checklist for Phobias PSYA4 Sub-sections A. Clinical characteristic s and issues of diagnosis Class notes? Underst and this? Revised this? Types of phobias Diagnostic criteria Reliability of diagnosis Validity of diagnosis B. Biological explanations And Psychological explanations Genetics Biochemistry Behavioural explanations Psychodynamic explanations Cognitive explanations C. Biological and psychological therapies Socio-cultural explanations Biological therapies Drugs and psychosurgery Behavioural therapies Systematic desensitisation Cognitive therapies Including evaluation in terms of appropriateness and effectiveness. 3
  4. 4. A. Classification and Diagnosis of Phobias Clinical characteristics       General Introduction to anxiety disorders DSM IV breaks down anxiety disorders into 5 subdivisions: phobias, general anxiety, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder (ICD 10 is very similar) All of these share one thing in common: anxiety (Anxiety is at the heart of what used to be called “neurosis” – extensively studied by Freud) Fear and anxiety are complex reactions to a threat or danger. Anxiety is an important adaptive response to ensure survival. In certain circumstances it is important for an animal to experience anxiety because it places it in a state of heightened arousal ready to respond to danger. We experience anxiety on several levels: Emotionally – a sense/feeling of panic Cognitively – worry about what will happen, dire consequences Physiologically – dry mouth, palpitations, tensed muscles, perspiration etc Behaviourally – freeze or flight Whilst anxiety and fear responses are normal reactions to a threat or danger, anxiety can become a chronic and disabling response. A person with an anxiety disorder experiences anxiety that is quite disproportionate to any threat or danger that is posed. Phobias are the most common of anxiety disorders (and among the most common of all mental disorders) PHOBIAS  6 – 7 % of the population suffer from phobias(13% in one US survey, Stern, 1995)  Females outnumber males by 2 to 1 Definition An aversion or fear of something is only classified as a phobia when the aversion becomes excessive or unreasonable, and when there is no other possible physiological cause (e.g. substance abuse), or if the symptoms can‟t be accounted for by another disorder. Even then most people can adapt their life to avoid the feared stimulus. It is only when the phobia interferes with a functional life (“failure to function”) that it is classified as a mental disorder. The phobia is often accompanied by depression and panic attacks. 3 Types – the most disabling are social phobia and agoraphobia 1. Specific Phobias (there are 100‟s) 4 major sub-types: Animal types: spiders, dogs (usually begins in childhood) Situational types: flying, enclosed spaces (claustrophobia) Natural environment types: heights, water 4
  5. 5. Blood-injection types: blood, injections, needles (Other type: anything else that does not fit into the 4 major sub-types) Use the Internet to research weird and wonderful phobias. What is yours called? See Tb p 190 for DSM diagnostic criteria. 2.Social Phobias This is an excessive fear of social situations, based on a fear of exposure/humiliation. Some sufferers fear eating in restaurants or using public toilets, others fear meeting strangers or public speaking. They are afraid that someone will see them expressing their fear – by blushing, a trembling hand or a quavering voice and think badly of them. As a result they try to avoid certain social activities and situations. The feared social situation induces extreme anxiety and may be accompanied by anxiety attacks Onset: around 15 years of age- most prevalent in 18 -19 yr olds 70% of cases are female 3.Agoraphobia – with panic attack The most common of phobias. This is a great fear of open or public places, but it is rare in its own. It is usually accompanied by panic disorder which often precedes the condition. Generally there is a fear of public places – of shopping malls, crowded streets or travelling on public transport, but it manifests itself as a fear of leaving the home. At first sight agoraphobia appears to be another social phobia. However, in most cases it begins with a series of panic attacks. The sufferer has a feeling of impending doom and often fears dying, going mad or losing control. As a result they are afraid of having a panic attack in a place where they don‟t feel safe and where there may be nobody around to help the. Where social phobics are afraid of others watching them, agoraphobics are fearful for themselves. Safety, rather than embarrassment is their main concern. Onset: early adulthood 75% are female Diagnostic criteria: DSM IV “Panic disorder with Agoraphobia” Recurrent, unexpected panic attacks At least one panic attack has been followed by at least one month of worry about the attack, concern about having attacks or changes in behaviour resulting from the attack. Agoraphobia – anxiety about being in situations from which escape might be hard or embarrassing in the event of a panic attack. The panic attacks are not due to the use of some substance Definition of a panic attack: DSM IV Intense fear or discomfort with 4 or more bodily symptoms suddenly appearing, including: palpitations, shortness of breath, accelerated heart rate, feeling of choking, nausea, chest pain, feeling dizzy and fear of dying. Exercise: task 1case studies of phobias. 5
  6. 6. Summary – Diagnostic criteria DSM-IVr criteria include:  Marked and persistent fear that is excessive, cued by the presence or anticipation of a specific object or situation.  The phobic object/situation is avoided or endured with intense anxiety or distress  The avoidance interferes significantly with the person‟s normal routine  Diagnosis of phobic disorder is only made if no other physiological cause or disorder could account for the fear e.g. drug abuse. Types of Phobia SPECIFIC PHOBIAS, of animals, events (flying), bodily (blood), and situations (enclosed places). SOCIAL PHOBIAS, of social situations, public speaking, parties, meeting new people. AGORAPHOBIA, of public crowded places (not open spaces), of leaving safety of home All phobias are more common in women than men, in particular Agoraphobia. Social Phobia is most prevalent in adolescence and agoraphobia in middle age. Issues of reliability and validity in the diagnosis of phobiasp191 RELIABILITY What is reliability? Inter-rater reliability Test re-test reliability Research Evidence Skyre et al (1991) Inter-rater R Hiller et al (1990) test re-test R Kendler (1999) test re-test R 6
  7. 7. Reasons for low reliability Kendler et al (1999) VALIDITYIS? Comorbidity Demonstrating validity of methods of diagnosis 1. Concurrent validity 2. Construct validity IMPLICATIONS OF LOW RELIABILITY AND/OR VALIDTY 7
  8. 8. Diagnosis by computer Cultural differences in Diagnosis EXAMINATION QUESTIONS Specimen paper 4.Outline clinical characteristics of one anxiety disorder (5 marks) 5.Explain issues associated with classification and diagnosis of anxiety disorders. (10 marks) June 2010 4.Outline clinical characteristics of one anxiety disorder. (4 marks) Jan 2011 5.Outline clinical characteristics of either phobic disorders or obsessive compulsive disorder. (5 marks) 6.Explain issues associated with the classification and/or diagnosis of either phobic disorders or obsessive compulsive disorder. (10 marks) 8
  9. 9. B. EXPLANATIONS OF PHOBIC DISORDERS(old TB p 192) BIOLOGICAL EXPLANATIONS 1. GENETIC INHERITANCE Family studies: Twin Studies What is inherited? 9
  10. 10. EVALUATION/COMMENTARYp 193 -Few studies, conflicting evidence and no adoption studies Family and twin studies – provide modest support The diathesis stress model The Diathesis-Stress Model It is likely that genetic factors predispose an individual to develop phobias, but experience plays a role in triggering the response. 10
  11. 11. What is inherited? But there is an uneven distribution of phobias – some are more common than others and this needs explaining – this is done by the evolutionary approach 11
  12. 12. 2. EVOLUTIONARY APPROACH – there are 3 elements to this: A) Ancient fears and modern minds B) Prepotency C) Preparedness 12
  13. 13. COMMENTARY/EVALUATION There is evidence to support the prepotencyand preparedness element of the theory. Prepotency: Ohman and Soars (1994) Preparedness: Ohman et al (1976) conditioned fear into a group of Ps using various prepared (spiders, snakes) and unprepared stimuli (flowers, pictures) being paired with an electric shock. Fear conditioning occurred rapidly in the prepared stimuli group (many after one trail) whereas it took at least 5 trials in the unprepared stimuli group. In extinction trials, the unprepared stimuli were extinguished immediately, but the prepared stimuli took much longer. However,McNally (1987) states that although there is firm evidence to show that extinction to prepared stimuli is difficult, the evidence for rapid learning was at best equivocal. This led Davey (1995) to propose expectancy biases: Clinical Phobias: do the concepts of prepotency and preparedness explain clinically diagnosed disorders? 13
  14. 14. Make notes on Behavioural Inhibition (green box) and Cultural Differences (yellow box) on p 193. Behavioural Inhibition Cultural Differences 14
  15. 15. PSYCHOLOGICAL EXPLANATIONS OF PHOBIC DISORDERS PSYCHODYNAMIC EXPLANATIONS Freud explained phobias using his idea of Ego Defence mechanisms.Anxiety provoking thoughts or desires coming from the ID are REPRESSED into the unconscious where the anxiety is DISPLACED(by the ego) onto another neutral object which becomes the subject of the phobia. In the case of Little Hans the ID‟s desire was to kill his father (Oedipus Complex) and the fear of castration was displaced onto horses - the link was big “widdlers”! Hans phobia was only resolved when he had overcome his Oedipus complex. EVALUATION The case study of little Hans is regarded as poor evidence because it – expand.. Lacks objectivity Cannot be generalised Classical conditioning explains Hans phobia better However, research has also supported the psychodynamic explanation Bowlby (1973): agoraphobia and separation anxiety Whiting et al (1966): cross cultural studies Therapies that target symptoms only are not 100% effective: e.g. SD 15
  16. 16. BEHAVIOURIST EXPLANATIONS Phobias can be seen as learnt behaviour, either through classical conditioning, operant conditioning or social learning theory. It is suggested that phobias are learnt in 2 stages: first by Classical Conditioning andthen “stamped in”, or maintained by Operant C. CLASSICAL CONDITIONING – Watson & Raynor (1920) conditioned a baby boy known as Little Albert to fear white rats. For several weeks, Albert played happily with a white rat showing no fear. One day, while he was playing with the rat, the experimenters struck a steel bar with a hammer close to Albert‟s head. Albert was very frightened by the noise. This was repeated each time he reached for the rat. Albert then developed an intense fear of white rats (and Dr. Watson!). UCS (Noise) UCS (Noise) + CS (Rat) CS (Rat) UCR (Fear) UCR (Fear) CR (Fear) OPERANT CONDITIONING. This refers to learning to behave in certain ways because the behaviour is reinforced, by some sort of positive outcome or removal or avoidance of something negative. In terms of phobias, avoidance of the phobic object or situation is reinforced by the reduction of anxiety. (Mowrer, 1974) Avoidance maintains the fear and preserves the phobia (an example of negative reinforcement). Frequent contact with a phobicobjectmay reveal that it is harmless, which will lead to the extinction of the phobia. However, people with phobias go to great lengths to avoid the object of their fears, often planning ahead and putting up with all manner of inconvenience, thus making the phobia resilient to extinction. SOCIAL LEARNING THEORY. Bandura (1986) developed social learning theory by showing the importance of observational learning and imitation as a form of learning – especially from parents. If, from an early age, we observe others being frightened or avoiding certain objects/situations we are likely to observe and imitate, because the behaviour is rewarding – it gets attention. We call this vicarious learning. This behaviour may then be reinforced directly through OC. 16
  17. 17. COMMENTARY/ EVALUATION Evidence to support behaviourism 1. Watson and Raynor (– don‟t just describe – say how) 2. Barlow and Durand (1995) report that 50% of those with a specific phobia remember a specific past traumatic experience – e.g. those with a driving phobia remember a car accident, and those with a choking phobia had an unpleasant choking incident in the past. In ADDITION ADD NOTES ON Sue et al (1994) and Ost (1987) Evidence contradicting behaviourism. 1.Not all phobics have had a specific frightening experience with the phobic object. Menzies and Clarke (1993) carried out a study on child phobics with a water phobia and found that only 2% had had a direct conditioning experience with water! 2. DiNardo et al (1988) found that 50% of dog phobics and 50% of normal controls had had an anxious encounter with a dog – this suggests that dog phobias do not depend on previous encounters with dogs, supporting the diathesis stress model – only those with a genetic vulnerability go onto develop a phobia In defence of behaviourists, children often have poor recall for events in childhood under 3 years of age. Also the memory may have been repressed in Freudian terms, or the traumatic event may have been associated with a neutral object (later phobic) without the P knowing it (e.g. a traumatic event near a stream with running water which the P was unaware of at the time). Make further notes p 195 Biological preparedness 17
  18. 18. Social learning Conclusion COGNITIVE EXPLANATION  A phobic person develops irrational, distorted and negative thinking about an object or situation  This causes them to exaggerate the threat posed  Phobic people realise their fear is irrational  When they are at a distance from their feared object they can cope, but as it comes closer, they show symptoms such as raised heartbeat, panic etc.  For example, a social phobic fears social situations. They believe they will make a fool of themselves when in meetings etc. and that other people will see them as stupid. They will therefore stay in, and avoid meeting new people Cognitive Bias(Beck 1985) The Emotions we feel are the result of our interpretations of our experiences according to our existing SCHEMAS. Phobics are likely to  over exaggerate the negative consequences  Under estimate their ability to cope.  show “Catastrophic Misinterpretation” It’s poisonous ! I can’t escape ! I’m going to die! 18
  19. 19. EVALUATION see p 195 DYSFUNCTIONAL ASSUMPTIONS COGNITIVE BEHAVIOUR THERAPY IS SUCCESSFUL Additional notes p 195 Sociocultural explanations Reductionism and determinism 19
  20. 20. Examinations questions Specimen paper 6.Outline and evaluate one or more explanations of the anxiety disorder outlined in your answer to Question 0 4 . Refer to research evidence in your answer. (4 marks + 6 marks) Jan 2010 3(a) Outline one psychological explanation and one biological explanation for either phobic disorders or obsessive compulsive disorder. (9 marks) (b) Evaluate explanations for either phobic disorders or obsessive compulsive disorder. (16 marks) Jan 2011 4. Outline and evaluate one psychological explanation for either phobic disorders orobsessive compulsive disorder. (4 marks + 6 marks) June 2011 3. Outline and evaluate one or more biological explanations for either phobic disorders or obsessive compulsive disorder. (4 marks + 8 marks) 4. Discuss one or more psychological explanations for either phobic disorders or obsessive compulsive disorder. (5 marks + 8 marks) June 2012 3 Discuss explanations for phobic disorders. (8 marks + 16 marks) June 2013 6 Outline and evaluate one psychological explanation for phobic disorders. (4 marks + 8 marks) 20
  21. 21. BIOLOGICAL TREATMENTS FOR PHOBIC DISORDERS If mental illness is seen as having biological, neurochemical, genetic factors, disease or injury as a cause then it follows that treatment should also be based on biological or medical practices. There are three types of medical intervention for dealing with disturbed thinking or behaviour: - Psychosurgery, electroconvulsive therapy (ECT) and chemotherapy (drugs). Chemotherapy is largely used (sometimes psychosurgery). 1. Chemotherapy(p196) MINOR TRANQUILLISERS or ANXIOLYTIC DRUGS Benzodiazepines (BZs) such as Valium and Librium reduce anxiety by inhibiting neural activity in parts of the brain by enhancing the activity of GABA (gamma-amino-butyric-acid), a neurotransmitter that has a quieting effect on neurons in the brain. Details… They can be useful in treating phobias, problems with sleeping and other somatoform (body) disorders, and stress. Valium is thought to be the most widely prescribed drug in many countries. Beta-blockers (BBs): reduce sympathetic nervous system arousal, rather than affect the brain, and reduce the effects of adrenaline and noradrenaline (part of the SAM system response to stress).Details… As SNS arousal is a central feature of stress, beta-blockers can be very effective against symptoms such as raised heart rate and blood pressure, and increased levels of cortisol. (Beta blockers are often used by sports people to reduce arousal because ANS arousal can have a negative effect upon performance).(SeeBlue box p 197 on BBs and memory erasing)) ANTIDEPRESSANTS These are used to treat anxiety disorders as well as other disorders (moderate to severe depressive illnesses, panic attacks and obsessional problems; they may also be used to treat eating disorders). Selective Serotonin Reuptake Inhibitors (SSRIs) include Seroxat and Prozac and are the most commonly prescribed types of anti-depressants. SSRIswork by blocking the reuptake of serotonin(and norepinephrine), increasing the quantity of serotonin available to excite neighbouring cells. The neurotransmitter serotonin regulates mood and anxiety, and thus helps with anxiety disorders. 21
  22. 22. Monoamine OxidaseInhibitors(MAOIs)inhibit the destruction of norepinephrine, serotonin and dopamine but this can have serious side-effects and although not widely used now, these can still be effective for some patients. Details… EVALUATION make further notes p 197 EFFECTIVENESS OF CHEMOTHERAPY  Kahn (1986) found BZ‟s more effective than placebo.  Hildalgo (2001) found that BZ‟s were more effective than antidepressants.  Liebowitz (1985) found BZ‟s good for anxiety control. X BUT Turner (1994) found no difference between a BB and a placebo in reducing heart rate etc.  Liebowitz (1992)found MAOIs to be more effective than placebos + BBs  SSRI’s found effective against placebo for anxiety reduction & social phobias.  SSRI’ssimilar effectiveness to BZs, but preferred to BZ‟s as fewer side effects What happened to Barbara Streisand? APPROPRIATENESS OF CHEMOTHERAPY NOT A CURE SIDE EFFECTS 22
  23. 23. ADDICTION ETHICS(yellow box) Real life application – Fearful memories – green box p 197 23
  24. 24. PSYCHOSURGERY Psychosurgery is surgical intervention to treat an area of the brain which is believed to be malfunctioning, by severing connections to that part of the brain. These days stereotactic psychosurgery is used: surgeons use computer based stereotactic imaging to locate the precise point. They may then either burn the area using the tip of a hot electrode or use a non-invasive tool like a gamma knife to focus beams of radiation on the targeted site. The operations used to treat anxiety disorders are capsulotomy and cingulotomy. See p 196 Deep brain stimulation: safer as it involves no destruction of tissue – wires are inserted permanently in target areas of the brain and are connected to a battery in the patient’s chest. When the current is on this interrupts the target circuits in the brain. EFFECTIVENESS Ruck et al (2003) study of capsulotomy for 26 patients with non-OCD anxiety disorders 13 generalised anxiety, 8 panic disorder and 5 with social phobia. There was a significant reduction in anxiety scores a year later for 25 of them. However, adverse side effects were extreme, including suicide attempts and epileptic seizures. APPROPRIATENESS Psychosurgery is more often used with OCD sufferers and rarely with phobias, and then only in very extreme cases. Treatment needs to be weighed against possible adverse side effects. Ethics – yellow box Make notes on the bits relevant to psychosurgery also p 211 24
  25. 25. BEHAVIOURAL THERAPIES BASED ON CLASSICAL CONDITIONING Behaviour therapy – Classical Conditioning. Behaviour therapy is often used to treat Phobias. It assumes that: 1. Phobias are learnt by classical conditioning and 2. They can be unlearnt by a similar process. Phobias can be removed by counter-conditioning: learning a new association that runs counter to the original association. This is the principle behind Systematic Desensitisation. (Behaviour therapies based on classical conditioning work best on behaviours that are not undervoluntary control (an inappropriate association has been made between an instinctual fear response and a previously neutral stimulus, such as fear of supermarkets, snakes or clocks). Typically these are phobias and anxiety disorders as well as addictions.) SYSTEMATIC DESENSITISATION(see hand-out for other types) This approach was developed by Joseph Wolpe (1958). MODE OF ACTION: Many individuals who are (non-rationally) afraid of a stimulus could learn that the stimulus is not so fearful if they could re-experience the feared stimulus; in other words “reality test”. But the anxiety it creates blocks this from happening. SD enables individuals to overcome their anxieties by introducing them to the feared stimulus gradually and by teaching relaxation techniques, so that a relaxed state is paired with the fearful stimulus in a progressive manner. These are the steps: Step 1 – Clients are taught relaxation techniques Step 2 – With the help of a therapist, clients construct a fear hierarchy – a list of feared objects or situations ranked from the least to the most feared. E.g. a person with arachnophobia might imagine a spider in various situations from a picture in a book (least feared) to crawling over their hand (most feared). Step 3– In the presence of the therapist, the client then confronts each item in the hierarchy while they are in a state of deep relaxation. They start with the least 25
  26. 26. feared item and move on once they feel relaxed and unafraid in its presence. This confrontation may be real or imagined. The process continues until they reach the top of the hierarchy and feel relaxed in the presence of all the items. If the systematic desensitisation works, clients have been counter-conditioned – they have learnt a new response to a stimulus. They no longer associate the object or situation with fear. Task: Imagine you are a therapist helping a client overcome a fear of flying. Construct a fear hierarchy for flying, with at least 6 items. Explain how you would help a client through their fear using this hierarchy. What is your fear? Design a fear hierarchy for your own phobia. http://www.youtube.com/watch?v=3E9GCpc4QjI Behavioural treatment for Phobias Dr Jeffrey Wood from San Francisco (no relation!) talks about phobias, avoidance, flooding, graduated exposure (systematic desensitisation).  http://www.youtube.com/watch?v=pqc7iAPsCzU  Aversion Therapy and Homosexuallity The sissy boy experiments?????   EVALUATION EFFECTIVENESS + Research has found that that SD is successful for a range of anxiety disorders. McGrath et al (1990) reported 75% of patients with phobias responding to SD. Capafons et al (1998) successfully treated 20 patients for fear of flying. After a programme of SD, Ps displayed less fear in a flight simulator and were more likely to fly than a control group of patients awaiting therapy. (See green box p 199) - However, spontaneous recovery from phobias has been found to be as high as 50-60% after 1 year (McMorran et al, 2001). Ohman et al (1975) suggests that SD may not be effective for treating phobias which have an underlying evolutionary component (snakes, heights etc.) in comparison to phobias which are acquired through personal experience. Assessing success is problematic because often a variety of techniques are used – in vivo, covert and even modelling. Menzies and Clarke, (1993)state that the actual key to success is contact with the feared stimulus, therefore in vivo techniques are more successful than covert ones. 26
  27. 27. APPROPRIATENESS Strengths: p 199 1. Behavioural therapies are relatively quick and require little effort on behalf of the patient in comparison to other psychotherapies such as REBT. Details… 2. Behaviour therapies may be the only treatment possible for certain types of people, e.g. those with learning difficulties and/or brain damage. Weaknesses 1. Inspiration for SD came from animal research. See orange box p 199. To what extent can we generalise from animals to humans? How are human different? 2. Because behaviour therapies target symptoms only, symptom substitution may occur. This is where new symptoms replace those that have been unlearned because the underlying problem has not been treated. However, Langevin (1983), claims there is no support for this objection 3. New behaviours may be learned in the therapist‟s office but these may not be generalised to the real world, (context-dependent learning). 4. Is relaxation necessary? 27
  28. 28. COGNITIVE (BEHAVIOUR) THERAPY Cognitive Behavioural Therapy CBT uses the cognitive approach to restructuring cognitions, but it also has aspects of behaviourism. Ellis developed REBT (Rational-Emotive Behaviour Therapy) in the 1950s. The aim of REBT is to help the client identify their negative, irrational thoughts and to replace these with more rational and positive ways of thinking. In the case of Phobias, it is not the stimulus which is the problem, but the irrational beliefs that it is based on. If the belief is tackled and replaced with rational thinking then the behaviour and emotion will also change for the better. A therapy session includes both cognitive and behavioural elements with homework in-between. 1. Irrational thoughts are identified using the ABC model: p 198 for e.g. s A-activating event B-beliefs C-consequences 2. Challenging the irrational beliefs, through effective disputing, and replacing them with rational beliefs Logical disputing Empirical disputing Pragmatic disputing These do what…… 3. Behavioural Element: The therapist and client decide together how the client‟s belief can be reality tested through experimentation, either as role play or as homework assignments. The aim is that by actively testing out possibilities, clients will themselves come to recognise the consequences of their faulty cognitions. The therapist and client then work together to set new goals for the client in order that more realistic and rational beliefs are incorporated into ways of thinking. These are usually graded stages of difficulty so that clients can build upon their own success (becomes reinforcing). 28
  29. 29. EVALUATION p 199 CBT is a very popular form of psychological therapy. It is straightforward, practical and has proved successful in treating a wide range of problems. EFFECTIVENESS: REBT has done well in outcome studies APPROPRIATENESS Not suitable for all Questioning of the theoretical basis of the therapy Ethical concerns 29
  30. 30. Examination questions June 2010 4 Outline clinical characteristics of one anxiety disorder. (4 marks) 5.Briefly describe one psychological therapy for the anxiety disorder that you outlined inyour answer to 4 . (5 marks) 6.Evaluate psychological therapies for this anxiety disorder. (16 marks) Jan 2012 Jan 2013 0 4 „Biological therapies are useful for the short-term treatment of phobic disorders, butpsychological therapies are more effective in the long-term.‟ Outline one biological and one psychological therapy for phobic disorders. Evaluate these therapies in terms of their effectiveness. (8 marks + 16 marks) 30

×