The Development of Phobias and How They Are Treated

A phobia is defined in the DSM-V (Diagnostic and Statistical Manual, 5th Ed., 2013) as a type of anxiety disorder. When defining phobias, consideration must be taken to analyse the nature of anxiety, and how the intensity of the anxiety experienced by the individual surrounding the stimulus depends on the categorisation of the phobia. All individuals suffer from anxiety to a degree, for example through a stimulating event such as an exam, argument or interview and so forth.

This anxiety can sometimes even be considered useful to encourage desired behaviours.

However, individuals can become disordered if this anxiety becomes intense and debilitating. This is how specific phobia develops – an anxiety surrounding a stimulus that is excessively intense to the point where the response is ‘out of proportion’ to the stimulus. This essay will focus on how effective the behavioural approach, one of the five models of psychopathy, explains the development of phobias and how they are treated, while using appropriate studies and academic journals as evidence.

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Firstly, the behavioural approach explains phobias through the ideology that both normal and abnormal behaviours are learned, and the anxiety ‘fight or flight’ response is a conditioned reflex to a stimulus. The behavioural model itself is outlined by the works of two main psychologists, John Watson 1878-1958 and B F Skinner 1904-1990, who followed on from Pavlov’s work on conditioned reflexes. They believe that psychologists should study the behaviour exerted by the client when explaining phobias, not the cognitive mechanisms involved. This idea forms the basis that the behavioural approach uses when explaining phobias - that behaviour is not the symptom, but the root causal factor.

The behavioural approach also uses the classical and operant conditioning paradigms as a way of understanding phobic behaviour.

The behavioural model believes that the developmental nature of fears relies on the theory of classical conditioning – phobias develop through learned behaviours. This conditioning theory as an explanation for phobias was created by Rachman (1978, 1990, 1991). This theory was apparent in Watson and Rayner’s 1920 study of ‘Little Albert’. Little Albert was exposed to the traditional method of classical conditioning – combining fear and a stimulus to develop a phobic response. This classical conditioning explanation adapted by the behavioural model was used for many years, however it was apparent that there was an issue with this explanation.

Classical conditioning follows repeated exposure to a feared stimulus, yet prolonged repeated exposure to the stimulus would over time lessen the effects and the feared emotion felt, lessening the intensity of the phobia. Following this advancement, the main explanation for phobias taken by the behavioural approach was Mowrer’s two factor theory (1947). The two factor theory states that initially, the phobia is acquired through classical conditioning. Subsequently, the individual avoids the feared stimulus. This prevents the classical conditioning process of extinction while providing feelings of relief through avoidance of the phobia, and therefore is reinforcing operant conditioning processes. The anxiety is then maintained and the phobia never actually is distinguished, then strengthen the avoidance response.

Though these behavioural models do attempt understand the nature of fear and the acquisition of phobias, they do not provide a completed understanding of phobic tendencies. Support for the two factor model is limited as it does not account for the fact that the conditioned response can be extinguished if the conditioned stimulus is presented without the reinforcer. This shows an incomplete explanation as to why people develop phobias. Secondly, other perspectives of the acquisition of phobias contradict the behavioural model’s explanation. For example, the evolutionary perspective believes that we as humans are born with the fear of certain situations and objects – and the instinct has been learned over time.

This theory does not believe that fear is innate but it does stand by the idea that fear can be easily acquired. Ohman et al’s (2007) study on the evolutionary perspective on the psychology of fear showed that fear – relevant stimuli evokes more reactions than others, eg spiders, snakes etc. Another contradictory theory to the behavioural theory is Bandura’s social learning theory. Bandura found from a study that observed people pretending to be shocked by a buzzer, the participants developed a fear of the buzzer without even having any prior experience to the shock developed by the recipients. This outlines the idea of vicarious learning – how the observation of a model character in a panic situation with a neutral stimulus can lead to the phobic response.

The behavioural approach into understanding phobias has also successfully lead to the advancement of different treatments for phobias. Systematic Desensitisation (SD) was introduced by Wolpe (1961) and follows a hierarchy structure where the client works through their fears starting off with excercises at a minor scale and gradually building up to combatting their ultimate phobia. Relaxation techniques, such as deep muscle relaxation, breathing exercises and mindfulness are taught, and are then incorporated alongside a mixture of in vivo and in vitro methods of exposure. This treatment has shown to be successful in numerous different studies, and has been used widely to treat varying levels of phobia. For example, Capafons et al. (1998) treated 20 out of 41 aerophobia sufferers with systematic desensitisation, and had 21 members in a control group. Results of this study showed 80 percent of those who had SD treatment reported lower levels of anxiety and lessened fear. However, as only 80 percent of those experienced lower levels of anxiety, it is clear that SD is not 100% effective in the treatment of phobias.

Whereas Systematic Desensitisation allows the client to gradually work through their fear hierarchy and tackle small increments of their much larger fear, another behavioural treatment for phobias that was founded by Wolpe (1973) , Flooding, counters this the client is exposed immediately to their most feared situation. This is the treatment of choice for social phobias specifically and is especially good at helping with environmental and situational phobias. Marshall, Gauthier, Christie, Currie, Gordon (1976) showed that flooding was more effective than standardized desensitization in reducing snake phobia.

However, a limitation to this is that flooding was only found successful when the use of in vivo exposure was used as opposed to in vitro exposure, meaning it can be less effective as a therapy depending on the exposure rate. Samuel M. Turner, Deborah C. Beidel, and Rolf G. Jacob found when comparing behavioural therapy flooding to drug treatment, flooding was superior to the drug treatment on behavioural measures. In contrast, the disadvantage of flooding as therapy for phobias is the highly traumatic nature of it. The term ‘Flooding’ indicates that going straight into the situation you are phobic of can be detrimental ot the client and potentially have lasting effects.

Another alternative behavioural therapy for phobias is Modelling, introduced by Bandura. This follows the idea of vicarious learning, where a phobic watches someone who does not have the phobia themselves complete the phobic behaviour. This in turn is highlighting to the client that the phobioa is able to do. The client is then introduced to the behaviour and gradually involved. For example this could be introducing a social phobic to a social situation they are afraid of to observe the ‘normality’ of it.

Freeman (1997) proved the effectiveness of modelling as a therapy when treating dog phobia in a person with Down’s syndrome. The study showed that anxiety levels dropped drastically through graded steps of modelling therapy for the individuals. An issue with the use of Modelling as a therapy for phobias is the cognitive element of it. Psychologists believe that when the phobic individual realises that their model can complete the task and they are experiencing ‘irrational thoughts’ the therapy becomes more cognition based. This creates the argument that behavioural therapies are more effective when a cognitive element is introduced and combatted, such as these irrational thought processes.