ADZ

Abnormal Psychology

Z
AD
Anxiety Disorders
ADZ

Systematic desensitisation
– Wolpe
• Systematic desensitisation is a way of reducing
undesirable responses to particular situations.

Z
•

AD
This makes it a particularly appropriate way of
managing phobias, such as agoraphobia.
• Its principles are based within behavioural
psychology; it holds the assumption that nearly
all behaviour is a conditioned response to
stimuli in the environment.
• If a phobia can be learned as in the case of
Little Albert (Watson & Rayner, 1920), then it
can also be unlearned.
ADZ

Systematic desensitisation – Wolpe

• This is referred to as counterconditioning.

• Systematically desensitising a patient requires that a

once frightening stimulus should eventually become
neutral and provoke no real anxiety.

Z
AD
• Wolpe (1958) introduced the idea of ‘reciprocal
inhibition’, which is the impossibility of feeling two
strong and opposing emotions simultaneously.

• The key to unlearning phobic reactions through systematic

desensitisation is to put the fearful feelings associated
with a phobic stimulus directly in conflict with feelings
of deep relaxation and calm.
ADZ

Systematic desensitisation – Wolpe

• A therapist practising systematic desensitisation follows
particular stages that are outlined next:
• •The therapist teaches the patient relaxation techniques. These
can be progressive muscle relaxation exercises, visualisation or
even anti-anxiety drugs.
• •The patient and therapist work together to create an anxiety
hierarchy (see Table 6.6 for an example relating to agoraphobia).
• This is a list of anxiety-provoking situations relating to the

Z
specific phobia that increase in severity.

AD
• The list is unique to the individual who works through in
vitro or in vivo exposure to each stage in turn.
• the patient begins with in vitro exposure – imagining the
scenarios – and then moves on to in vivo exposure – facing the
stimuli in real life
• At each stage of the anxiety hierarchy, the patient is assisted to
remain in a calm, relaxed state using their chosen technique.
• The patient does not move on to the next stage in the hierarchy
until they report feeling no anxiety in relation to their current
stage.
ADZ

Z
AD
ADZ

Systematic desensitisation – Wolpe

• As the two emotions of fear and calm are
incompatible, the fearful response to the stimuli
is gradually unlearned and will no longer produce
anxiety in the patient.

• There is good research evidence to support the

effectiveness of systematic desensitisation in

Z
treating phobias such as agoraphobia (Agras,

AD
1967) and fear of snakes (Kimura et al., 1972).

• However, since the 1970s and 1980s, this form of

therapy has declined in popularity and other
treatments which involve more direct forms of
exposure are now more commonly used.

• Joseph Wolpe on Systematic Desensitization -

YouTube
ADZ

• 1 Urzila has been

diagnosed with agoraphobia.
She is unable to walk
beyond the end of her
street, has not used
public transport for ten

Z
AD
years and the thought of
going on holiday makes
her feel sick.
• Outline how a behavioural
therapist might treat
Urzila's phobia. [4]
ADZ

Mary Cover Jones and the case of

Little Peter
• Four years after Watson and Rayner (1920) demonstrated that fears
could be learned through classical conditioning, a New York-based
developmental psychologist reported the case of Little Peter, a child
with a phobia of small animals.
• Inspired by Watson's research, Mary Cover Jones conducted her own
research into behavioural therapy for children with phobias (Jones,

Z
1924).

AD
• Initially, Jones encouraged three-year-old Peter to play with other
children in the presence of a rabbit.
• He tolerated the animal well but, following some time in hospital,
his fears returned.
• Jones decided to try something new, which has become known as
counter-conditioning. She sat Peter in a highchair and allowed him
to eat some candy, his favourite treat.
• Next, she placed a caged rabbit near his highchair while he ate.
Over the course of several visits to her laboratory, she moved the
rabbit closer as he ate, until eventually he ate the candy with
the uncaged rabbit sitting next to him.
ADZ

Using
classical
conditioni

Z
ng to

AD
treat
learned
fear
ADZ

Evaluating systematic desensitisation

for agoraphobia
• it is supported by animal experiments. For example, Wolpe (1976) conditioned
cats to fear (CR) a specific cage (CS) using electric shocks (UCS).

• He then counter-conditioned them by giving them food pellets (UCS) in a

Z
series of cages that were increasingly similar to the original feared cage.

AD
• At first, the cats showed some fear towards the similar cages due to
generalisation but gradually they began to eat the food. Over time, the
previous fear response became extinct.

• The cats now entered the original cage without fear due to its new
association with food in contrast to the earlier electric shocks.

• This is an important study as animal experiments can be more tightly

controlled than human experiments, increasing the validity of the findings.
ADZ

Evaluating systematic desensitisation

for agoraphobia
• there have been many experiments with longitudinal designs using humans to demonstrate
the efficacy of this therapy.

• For example, Lipsedge et al. (1973) compared the efficacy of SD with and without
the use of barbiturate drugs to create deep relaxation during the exposure sessions.

Z
The participants were 60 outpatients with severe agoraphobia

AD
• Self-reported and clinician-rated measures of anxiety and avoidance were collected
before and after eight weeks of treatment.

• The greatest improvements were seen in people who received the barbiturate drug
before exposures, although the standard SD treatment was also more effective in
reducing anxiety and avoidance than no treatment.

• These findings suggest that SD can be an effective treatment for agoraphobia as well
as specific object/situation phobias (e.g. spiders, flying).
ADZ

Evaluating systematic
desensitisation for
agoraphobia
• the fear hierarchy may be unnecessary,
meaning it takes longer than other forms
of therapy and may therefore not be

Z
as cost-effective.

AD
• For example, flooding (implosive therapy)
therapy involves confronting the person
with the most distressing situation with
no gradual build-up and can be highly
effective in just one session.

• This said, SD is arguably more ethical

as it does not cause the client as
much distress.
ADZ

Reductionism versus holism

• it is reductionist.
• Some might argue that this therapy ignores the role of conscious and unconscious
beliefs about the world and one's place within it.

Z
• For example, Cynthia Shilkret believes that avoidant behaviour is maintained

AD
due to irrational beliefs, such as 'the world is a dangerous place' and I
don't deserve a better life' [Shilkret, 2002).
• She explains that. although behavioural therapies involving exposure fas in SO
and flooding) are important, many people are left with residual symptoms and
only 50 per cent show substantial improvement.
• To this end, she advocates the use of cognitive behavioural and psychodynamic
therapies over the longer term to reduce the residual symptoms.
• This is an important alternative perspective that demonstrates that a more
holistic approach to therapy may lead to longer-lasting outcomes.
ADZ

Z
AD
• 2. Explain one ethical strength of using systematic desensitisation
as a treatment for agoraphobia. [2]