We may have had some extreme fears or phobias while growing up. Sometimes it's confusing why we have them or what might have triggered such scary responses, sometimes laced with an anxiety rush. But have you ever been so fearful of something; that just thinking about it can lead to a panic attack? If you have, you might have a phobia. Typically the behavioural approach principles are used for phobia treatment techniques.
- First, we are going to look at the causes of phobias.
- Next, we are going to review the social phobia disorder treatment.
- Then, we will look at other behavioural treatments for phobia, such as systematic desensitisation and flooding, also focusing on phobia treatment exposure therapy.
- Finally, we will look at the biological approach for phobias.
Causes of Phobia
Before we dive into treatments for phobias, let's first look at this disorder.
A phobia is an illogical fear of an object or activity that does not actually pose a threat.
While many people are scared of objects or events, phobias take them to another level. When someone has a phobia, they refuse to enter a situation where they could interact with their phobia. Sometimes, even thinking about it can give them anxiety.
There is not one specific cause of phobias. Stressful events, social anxiety, or abuse can all impact the development of a phobia. Existing mental health disorders can be a precursor to the development of a phobia, but they do not have to be.
Let's pretend when you were taking a nap as a child, multiple spiders were crawling all over you. When you woke up, you were covered in spiders. This is an example of a traumatic event that could cause someone to develop a phobia of spiders.
Phobias: Behavioural Approach
According to the behavioural approach, phobias can be learned through individual experiences. Mowrer's (1960) two-process model explains this idea, suggesting that phobias are learned through association (classical conditioning).
Classical conditioning develops phobias when an anxiety-provoking stimulus is associated with an unpleasant or negative emotion, as this causes the phobic person to associate their anxiety with the stimulus.
In Watson's (1913) Little Albert Experiment, a child was conditioned to fear a white rat. Initially, the child was not scared of the white rat in his hands. Whenever he reached for the rat, a loud noise sounded. Albert eventually associated the noise (and the fear associated with it) with the rat and developed a phobia.
The two-process model also suggests that phobias are maintained through reward and punishment (operant conditioning). Phobias are maintained as the conditioned stimulus evokes strong fear, and the person retains this fear by avoiding the feared object.
A person mugged at night may become scared of the dark and, consequently, only be able to sleep with lights on. Being mugged in the dark would be the conditioned stimulus, and sleeping with the lights on is the negative reinforcement.
Social Phobia Disorder Treatment
Social phobia is the irrational fear of being judged. This phobia typically causes anxiety in social situations because the person is scared they will embarrass themselves or be perceived negatively. Due to this, people with social phobia avoid social situations.
Someone with a social phobia would avoid talking in class or giving presentations. They think these public displays would cause them to be ridiculed by their classmates.
Let's now look at social phobia disorder treatment. Since social phobia stems from the anxiety of being around others in social settings, treatment starts working on that anxiety.
Fig. 1. Someone with a social phobia would not speak in front of a crowd.
The first treatment commonly used for someone with social phobia is psychotherapy. Psychotherapy is a way for someone with social phobia to talk to a therapist about their struggles. By talking with a professional, people can learn about their triggers and ways to calm their anxiety.
Additionally, they can work with their therapist to develop new ways to approach social situations that do not induce a panic attack.
The specific type of psychotherapy recommended for most mental health disorders is cognitive-behavioural therapy, also known as CBT. CBT helps the patient understand the cognitive and behavioural maladaptive ways they respond to situations and how changing those responses can help them.
Cognitive rehearsals allow patients to mentally rehearse effective behaviour, which can be later used in a real-life situation with phobic stimuli. This can reduce the negative thought patterns of a patient.
If CBT alone does not help alleviate the phobia symptoms, some medications can be prescribed to help in conjunction with psychotherapy.
Phobia Treatment: Exposure Therapy
One type of treatment for phobias is exposure therapy. Exposure therapy is a behavioural therapy in which the patient is exposed to the stimulus they are afraid of. It is important to note that the patient is in a completely safe environment while taking part in exposure therapy.
If you have arachnophobia, you would be in a room with your therapist and see a spider in a cage. Since the spider is in its cage, it presents no physical harm. This allows you and your therapist to work through your stress and emotions without you being in legitimate danger.
Exposure therapy works when patients know they are in a completely safe environment. If the space is not safe, it could cause someone's phobia to worsen.
Exposure therapy is often used to treat post-traumatic stress disorder (PTSD) as well.
A type of exposure therapy is systematic desensitisation.
Phobia Treatment: Systematic Desensitisation (Vivo/SD)
Wolpe (1950) was the first person to propose systematic desensitisation. This technique uses classical conditioning to replace the patient's phobia with a new response reaction, unlearning the phobia.
Systematic desensitisation is mainly driven by the idea that two opposite emotions cannot coexist, such as anxiety and calmness.
The patient gets gradually exposed to their phobia through a fear hierarchy. The hierarchy goes from 1 to 10, with each number increasing in potential fear. When exposed, relaxation techniques are practised to break down a patient's negative association with the feared object, gradually replacing it with a positive association of calmness.
Let's continue with the arachnophobia example. The patient starts at a 1 on the fear hierarchy and is asked to imagine a spider. Next, they are asked to watch a video of spiders. They are then left in a room with a spider in a cage. Later, they hold the cage with the spider. Finally, they hold the spider.
Virtual Reality Exposure Therapy (VRET)
Virtual reality exposure therapy (VRET) uses the principle of systematic desensitisation but in a virtual setting.
During the therapy, the patient uses a virtual reality headset that immerses them in their phobic stimulus with sensory cues such as navigating their way through and moving their hands in the air.
The therapist has a computer monitor showing what the patient is seeing.
Fig. 2. VRET therapy uses a headset as a tool when conducting systematic desensitisation.
Phobia Treatment: Flooding
Flooding is a type of exposure therapy that may take only one session.
During this treatment, the patient is directly exposed to their phobic stimulus.
For example, a patient with claustrophobia (a fear of confined spaces) is locked in a small room for 3 hours without any step-by-step exposure process.
The patient initially experiences a surge of anxiety due to direct exposure. Still, they will give in to exhaustion and realise the phobic object caused no physical harm to them.
Naturally, humans cannot sustain a state of anxiety for a long period, so longer periods of exposure can help unlearn the fear by forming a new association with the feared object, such as calm instead of anxiety.
Flooding is a great technique for more situation-based phobias such as claustrophobia and agoraphobia.
Behavioural Treatments for Phobias: Evaluation
Now that we've reviewed some of the behavioural phobia treatments. Let's look at the advantages and disadvantages of those treatments.
Exposure therapy is an effective way to treat phobias. Research shows that the systematic desensitisation method is effective 75% of the time when treating various phobias (McGrath et al. 1990).
However, while there has been success in these behavioural treatments, it may not always be successful for people whose phobias did not develop from a personal experience since they do not treat the root of the phobia.
VRET can be a safe alternative to exposure therapy, systematic desensitisation, and flooding since it is virtual. Despite its convenience, the necessary equipment is expensive, making it inaccessible to all therapists.
Flooding, despite sounding radical, can be extremely effective in terms of treatment and cost. Flooding is a one-time treatment and can save the patient money. However, flooding may compromise the mental health of the patient and cause trauma. It can sometimes strengthen the phobia rather than reduce it, as some might end up quitting in the middle of the treatment reinforcing their behaviour by avoiding the stimulus.
Flooding can be too dangerous for patients suffering from health conditions such as heart issues and does raise some ethical concerns.
Biological Treatment for Phobias
Along with behavioural and psychotherapy approaches to treatment, there are also medicinal options. Sometimes therapy is not successful on its own, but when combined with medicine, it can be extremely effective.
The biological treatments for phobias involve prescribing patients medication to help them relax and slow down the effects of anxiety. However, medications for phobias are seldom used as a stand-alone treatment for phobias.
Instead, they are always combined with other treatment methods, such as behavioural or cognitive therapy. Biomedical therapy is mostly the last resort for most phobia cases.
Two kinds of medicines are prescribed as a phobia treatment to patients: benzodiazepine tranquillisers and antidepressants.
Benzodiazepine tranquillisers are considered a sedative drug. One of the main aims of these sedative drugs, such as Xanax, is to reduce the severe effects of anxiety. They are known to increase GABA levels, an inhibitory neurotransmitter. These are minor-category tranquillisers used in small doses as adjusted by professionals.
However, once the patient has recovered from their phobia, they need to be slowly weaned off to avoid withdrawals.
Antidepressants or selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety disorders, panic disorders, and depression.
Lower levels of serotonin are related to underlying depression and anxiety. Some SSRIs, such as Prozac, block the reuptake or serotonin absorption in the synapse, allowing more serotonin prevalence.
Phobia Treatment - Key takeaways
The causes of phobia are based on classical and operant conditioning principles.
Some examples of phobia treatment are exposure therapy, flooding and systematic desensitisation.
Flooding is a type of exposure therapy in which the patient is fully exposed to their fear.
Systematic desensitisation gradually exposes the patient to their fear and allows them to use relaxation techniques.
If psychotherapies are not working, adding biological treatment for phobias (such as benzodiazepine tranquillisers and antidepressants) can help.
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