Mental health articles

Behaviour therapies are based on classical conditioning. Four main approaches will be discussed here: systematic desensitisation; aversion therapy and covert sensitisation; exposure therapy (implosion and flooding); and positive conditioning. Systematic desensitisation is based on the finding of Watson and Rayner (1920) that they could classically condition fear of a pet rat in an infant they called ‘Little Albert’, by making a loud noise whenever he was playing with the animal (see Chapter 1 for details).

Subsequently, Jones (1925) found with a child he called ‘Little Peter’ that fears like this could be alleviated by associating the feared object instead with a pleasant response such as eating. Wolpe (1958) developed this procedure into what he called reciprocal inhibition, using stronger antagonistic responses such as relaxation to overcome fear. It relied on the antagonistic response being stronger than the fear, and this was achieved in two ways. First, training was given in relaxation. Second, fear was introduced using a graded series of stimuli (known as an anxiety hierarchy), starting with the least fearful and only moving on to a more fearful stimulus when the current one was no longer frightening. An example of an anxiety hierarchy for examination phobia consists of a list of stimuli that evoke increasing amounts of anxiety, as follows:

1 A month before an examination

2 Two weeks before an examination

3 A week before an examination

4 Three days before an examination

5 One day before an examination

6 The night before an examination

7 Waiting for the examination paper to be given out

8 Waiting to go into the examination room.

9 Answering the examination paper

10 On the way to college on the morning of the examination

Wolpe began with ‘in vivo’ or real-life exposure, and moved on to use imaginary situations to further reduce the initial levels of fear. This became known as systematic desensitisation, and developed into a popular and successful treatment for phobias. For example, McGrath et al. (1990) found that it was effective for around 75 per cent of specific phobias (i.e. phobias in which fear can be related to a specific object or event, rather than a more general fear such as agoraphobia). Even with disorders such as agoraphobia, improvement has been found in 60–80 per cent of cases (Craske and Barlow 1993). A recent system introduced by Greist et al. (1997), called B.T.Steps, uses desensitisation procedures to provide self-treatment over the telephone for obsessivecompulsive disorder. Once registered by a specialist, the client is linked to a computerised system which establishes what triggers their fears and how severe the fears are. Goals can then be established (for example, not hand-washing for two hours after touching a toilet seat), and these can be gradually made more challenging until the fear is conquered. Such procedures have the advantage of being extremely cost-effective.

Tags: behaviour, behaviour therapies, therapies