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The most effective treatment for a phobia

The word ‘phobia’ derives from the Greek word for ‘fear’: φόβος (fobos). A phobia is a common form of anxiety disorder that involves the sufferer experiencing fear or panic when confronted with a particular object or situation. Such forms of anxiety can range from a minor feeling of unease, to a highly maladaptive or disabling terror. It is estimated that 13% of the world’s population suffers from at least one clinically significant phobia in their lifetime. Some types of phobia are more common in certain age groups, but specific phobias affect all age groups (though they tend to arise in childhood or early adulthood). Although the magnitude of a specific phobia is said to lessen with time, it can persist throughout the individual’s lifetime if left untreated.

A person’s fear must match certain criteria that are outlined in classificatory systems before they can be diagnosed with, and subsequently be treated for, a specific phobia. Some criteria taken from the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are as follows:

A. ‘Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation’.

B. ‘Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response which may take the form of a situationally bound or situationally predisposed Panic Attack’.

C. ‘The person recognizes the fear is excessive or unreasonable.’

D. ‘The phobic situation(s) is avoided or else endured with intense anxiety or distress.’

E. ‘The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the person’s normal routine’

Criterion E is especially important as it marks a considerable difference between a phobic individual, and a person who simply has a fear of a particular object or situation (one that is irrelevant to their everyday life). If an individual with a fear of sharks lives in an urban environment, and does not perform any activities where they would have to confront a shark, does not take frequent holidays to shark-infested oceans, nor does this person feel personal distress associated with their fear, they would not be classified as suffering from a specific phobia.

Numerous treatments have been proposed for this type of anxiety disorder by the various models in psychology. For instance, the medical model works under the assumption that psychological disorders arise as a result of physiological factors, therefore a therapist from this model might propose chemotherapy as a treatment course. The cognitive approach would most likely attempt to alter the patient’s faulty mediational processes that are believed to lie beneath the surface of a phobia – a technique known as ‘cognitive restructuring’. Despite the wide range of treatments offered by the perspectives, the focus of this essay will be the behavioral and the psychodynamic model. The psychodynamic model focuses on bringing the unconscious mind and its repressed conflicts to the surface, whereas the behavioral model aims to modify abnormal behavior so that the phobic individual ceases to produce maladaptive behavior. Realistically speaking, it is infrequent for a treatment to fully cure a psychologically impaired individual, especially when dealing with severe disorders such as schizophrenia. What all the models in psychology seek to achieve with the treatments they have to offer, is to ease any distress and hasten recovery. Nevertheless, a specific phobia is considered to be somewhat mild as a disorder, allowing more room for a partial (if not a full) recovery as a result of effective therapy.

The behavioral model focuses on the study of objective, observable behavior; and therapists working under this model believe that abnormality, like normal behavior, arises as a product of learning. The etiology of phobic disorders can be explained using theories that stem from the behavioral model, such as classical conditioning.

Behavioral psychologists believe that an emotional disorder can be instilled through classical conditioning. A simple phobia of animals may arise from a personal experience, where a formerly non-threatening animal has been paired with a fear-provoking situation, creating a conditioned fear towards the subject. For example, if an individual links a guinea pig with the unpleasant event of being bitten, upon future encounters with this animal (whether or not it bites) an emotional fear response will be exhibited. Specific phobias are said to be maintained through a learning technique known as negative reinforcement (a sub-category of operant conditioning), whereby a conditioned avoidance develops in the phobic individual. Upon encounter of the phobic stimulus, high levels of anxiety are reached, but upon escape, they are reduced, leading the avoidance response to become highly insusceptible to extinction.

Joseph Wolpe (1958) introduced a type of therapy known as systematic desensitization, which has notable efficacy when dealing with phobias. He argued that if a state of relaxation is achieved in the presence of the anxiety-evoking stimulus, the anxiety caused by the stimulus will be reduced because the two responses (anxiety and relaxation) are antagonistic. Treatment begins with relaxation training for the phobic individual, followed by the formation of a hierarchy of fears, from the least to the most anxiety provoking. Therapy may be partly based on imagery (in-vitro); however, this carries with it a substantial amount of artificiality. The client is required to systematically progress through the anxiety hierarchy while remaining in a state of relaxation. Desensitization can also take place in vivo (real-life) where the same process is carried out but the client is physically exposed to the feared situations. This method is more ecologically valid than in-vitro exposure as it more similar to a situation the phobic individual may encounter outside therapy. Systematic desensitization’s superiority over psychoanalysis has been depicted in studies conducted that concern themselves with specific phobias. When dealing with phobias in children, ‘nonpharmacological intervention’ is generally agreed upon as being the best course of treatment to follow. Further, Ollendick and King (1998) described the status of in-vitro and in-vivo systematic desensitization as being ‘probably efficacious’.

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