Behaviour therapy for phobias is as an example of the ‘first wave’ of the modern psychotherapies. Describe some of the therapeutic principles and their theoretical and empirical origins.

Phobias are amongst the most common of psychological issues. They are generally regarded as less severe than other anxiety disorders as they seldom arise beyond the vicinity of the stimulus which triggers them (Hood, H., & Antony, M. 2012). However, they can become particularly problematic when they deprive the individual of living a normal life or impact their health and wellbeing. In such cases, behaviour therapy can provide an effective means to reduce or even eliminate the fear response (Cover-Jones, M. 1924).

The first wave of modern psychotherapies was heavily influenced by the work of Pavlov, Watson and Skinner, with parallel developments in USA and UK. It was based on empirical evidence unlike the psychoanalytical methods which preceded. The learning theory and behaviourism based work of Pavlov, Watson and Skinner lacked clinical research evidence, but were integral to the formation of methodologies underlying behavioural therapy.

The operant approaches of Skinner aimed to reduce challenging behaviour and increase desired behaviour. In behavioural therapy for phobia reduction, the focus was narrowed down to eliminate fear and anxiety induced from specific stimuli.

Mary Cover-Jones was a pioneer of behavioural therapy for reducing fear responses seen in patients with phobia. Using principles underlined by classical conditioning, she built upon Watson’s conditioned fear response model in an attempt to devise methods for deconditioning such responses. Her methods aimed at conditioning the patient such that their fear inducing stimulus would eventually elicit a neutral or positive response. She constructed a degree of toleration scale for phobias as an exposure hierarchy system for measuring fear response in patients, which rated from A) greatest fear response to Q) positive response and maintained her behavioural analysis background by basing these on observations of physiological responses such as heart rate measurement, rather than emotional characteristics (Cover-Jones, M. 1924). She also added an element of classical conditioning by introducing a positive unconditioned stimulus such as candy, paired with the conditioned fear stimulus such as a rabbit, which proved to accelerate the deconditioning of the fear response.

Systematic desensitization to the fear response is a routine method used for phobias such as that of dentists and insects. Wolpe is credited for its conception, which he developed through experiments on animals to condition then subsequently decondition them to fear. In human subjects, he employed stimulus or fear hierarchy scales to grade the subjects fear response via visual descriptions listed in order of least to most fearsome. The patient would then imagine the anxiety inducing images sequentially, beginning with least fearful. Once they could remain relaxed with a particular image they could move on to the next more fearful image, and this process was repeated until the most fearful image could be visualized with patient feeling relaxed. Indicating that the conditioned emotional response was extinguished. This method of vitro exposure, which utilizes imagination of a scenario to evoke fear, showed limited efficacy compared with in vivo exposure. Its main advantage being that in vivo exposure was often difficult or impossible to replicate in the clinical setting. In recent years, computer simulations are increasingly used to expose the patient to a simulation of their specific phobia, enhancing the therapeutic capacity of in vitro methods (Parsons, T. D., & Rizzo, A. A. 2008).

Observational social learning became an integrated into behavioural therapy and highlighted the transmission of fear through observing fear response in others. It can be subdivided into coping and mastery modelling. The former being when the observed individual also possesses the fear as opposed to the later when the observed individual lacks fear of the stimulus. Coping modelling has proven to be of greater influence therapeutically.

The various principles in behavioural therapy for phobias clearly have their roots in prior models of classical conditioning, learning theory and operant models. With developments becoming based more upon empirical evidence and direct physiological measurement than in preceding models. With many therapeutic approaches still used for treatment today.

 

Parsons, T. D., & Rizzo, A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behaviour Therapy and Experimental Psychiatry, 39, 250–261.

 

Hood, H., & Antony, M. (2012): Evidence-based assessment and treatment of specific phobias in adults, Chapt.2. Intensive one-session treatment of specific phobias. Edited by: Davis T, Ollendick T, Öst L-G. 2012, New York: Springer, 19-42. Autism and Child Psychopathology Series

 

Mary Cover Jones (1924). A Laboratory Study of Fear: The Case of Peter. Pedagogical Seminary 1924, 31, 308-315.