A phobia is defined as an irrational and intense fear of a specific object or situation. In DSM-IV-TR phobias fall under the broader category of anxiety disorders. DSM-IV indicates that the fear experienced is intense & persistent & that individuals are compelled to avoid the object or situation. DSM-IV identifies 3 categories of phobia: specific, agoraphobia and social phobias. Symptoms of phobias often involve feelings of panic, dread, or terror, despite recognition that those feelings are excessive in relationship to any real danger – as well as physical symptoms like shaking, rapid heartbeat, trouble breathing, and an overwhelming desire to escape the situation that is causing the phobic reaction.
Anxiety is an adaptive emotion. It places people in a state of arousal ready to deal with any threat & it means we approach certain situations cautiously. However, anxiety can become disabling if it becomes disproportionate to any problem experienced. Anxiety disorders are a group of mental disorders characterised by levels of fear & apprehension that are disproportionate to any threat posed.
Fears/phobias become a clinical problem when they affect the person’s life in a significant way & thus can be described as: ‘… a disrupting, fear-mediated avoidance, out of proportion to the danger posed by a particular object or situation & recognised by the sufferer as groundless.’ The term phobia usually implies subjective distress or social/occupational impairment.
Specific phobias: fears of particular items/objects or situations e.g. Snakes, heights, darkness, blood or death. For example, Agoraphobia: refers to a cluster of fears involving public places, crowds and open spaces and being unable to escape or find help should the individual suddenly become incapacitated. The severity of the restrictions & anxiety may vary for the individual & leaving the house with someone can sometimes help.
Social phobias: any activity which involves social situations & the presence of others can elicit extreme anxiety e.g. eating in public or using a public toilet.
Although the symptoms of each type will vary, there are some symptoms common to all phobias. These include: irrational fear, physical symptoms: e.g. shaking, obsessive thoughts, anticipatory anxiety, desire to flee, know it is irrational.
Although phobics tend to perceive their disorder as beyond their control and wish to get rid of it, with the exception of agoraphobics, the phobics everyday functioning is often unimpaired.
Learning explanation of phobias
There are several explanations for phobias from the learning approach. In terms of classical conditioning a phobia may be learned through an association forming between fear and a particular object or situation. In terms of Social Learning theory, phobias may be learned through observation and imitation of role models.
Learning theory: Behaviourists explain phobias as a product of maladaptive learning.
Classical conditioning – from this perspective it is proposed that phobias occur due to an association between anxiety & a situation or object e.g. if a person has a panic attack due to being trapped in a lift. This anxiety becomes generalised to all lifts. Hence the person will then avoid lifts.
Thus an originally neutral stimulus becomes associated with an unpleasant or traumatic experience and so becomes a fear-eliciting conditioned stimulus. This was demonstrated in Watson and Rayners study of Little Albert
The Little Albert case is an example of ‘avoidance-conditioning’ where a stimulus becomes anxiety inducing because it is paired with another stimulus that already leads to anxiety.
The avoidance-conditioning model can be applied to social phobias e.g. related to public toilets. Someone may experience paruresis once (inability to urinate because of the presence of others) and suffer the resulting anxiety, they then become conditioned to avoid the situation of being in a public toilet.
The persistence of phobias is explained by Mowrer’s ‘Two-factor’ theory. It suggests that phobias are acquired through classical conditioning but are maintained through operant conditioning (because the avoidance of unpleasant phobic situation and the reduction in anxiety is negatively reinforced).
Operant conditioning – This theory can explain the maintenance of phobias for example if someone has a phobia of lifts, avoidance of lifts is reinforced by the reduction in anxiety experienced when the person adopts alternative strategies, e.g. using the stairs.
Social learning theory: From an early age we may observe role models avoiding particular objects or situations. Through modelling our behaviour on others such as our parents (& also may be part of our culture) we learn the avoidance behaviour and the fear of an object or situation. If the observer sees the model being rewarded for their behaviour, E.g. Through attention from a loved one, (vicarious reinforcement) imitation is even more likely. Social learning theory holds that behaviour can also be learned at the cognitive level through observing the actions of other people. Once learned the behaviour may be reinforced or punished by its consequences like any operant behaviour.
Bandura (1977) suggested that there are three main influences on people’s behaviour:
1. External reinforcement (as in operant theory) – positive reinforcement, negative reinforcement and punishment
2. Vicarious reinforcement – the observation of other people being rewarded or punished for their behaviour. An example of vicarious learning: If a child sees someone steal from a shop and leave with the item without being punished then he or she may be motivated to copy this behaviour. If a child sees the same behaviour being punished they would be unlikely to copy.
3. Self-reinforcement – gaining internal satisfaction from an activity, which therefore motivates the individual to behave in a similar way in the future.
According to Bandura observational learning can occur spontaneously without any deliberate effort on the learner’s part or any intention to teach on the model’s part. For behaviour to be learned and modelled: – The learner must pay attention to the important parts of the action. – The learner has to store & retain the memory e.g. via rehearsal. – The learner must have the physical ability to be able to copy the behaviour. – The learner must be motivated to reproduce the behaviour. – They must reproduce it for themselves following seeing the model. – They should be motivated to perform the action e.g. via reinforcement. Thus phobias may be modelled and learned through attention, retention, motivation and reproduction. A person may observe phobic behaviour either directly or indirectly in real life or in the media.
Evaluation of the learning explanation of phobias:
| Strengths | Weaknesses |
| + Barlow and Durand found that 50% of people with a specific phobia of driving recalled a traumatic experience of driving that was linked to the onset of the phobia. – However Clark and Menzies found that only 2% of water phobias were due to a trauma in water.
+ The study Mineka et al, 1984, demonstrated that monkeys could develop a snake phobia simply by watching another monkey experiencing fear in the presence of a snake, which supports SLT, however SLT cannot explain why the monkeys only learned fear to dangerous stimuli (which suggests there may be an evolutionary link to the development of phobias in animals). -/+ Merckelbach et al, 1996, argued that there is little evidence that phobias such as claustrophobia are due to modelling or information transmission but there is quite a lot of evidence for these explanations in relation to small animal phobias and blood and injection type phobias. + Unlike Psychodynamic explanations the learning explanations are supported by objective, empirical research eg. Watson and Rayner, Mineka et al. + The success of treatments such as systematic desensitisation and flooding in removing phobias suggests that phobias may be learned. |
– In conflict with social learning theory, phobics who seek treatment do not often report that they became frightened after witnessing someone else’s distress. In addition some phobics are unable to recall a distressing incident involving the feared object or situation which poses problems for classical and operant conditioning. – The learning theories only consider the influence of nurture and neglect the possible effects of nature. Phobias can occur within families which may suggest learning however often family members fear different stimuli. Fyer et al (1990) conducted a family study of 49 first-degree relatives of people with specific phobias. They found that 31% of relatives were also diagnosed with phobias, but only two people had the same type. |
Learning approach treatment for phobias – Systematic Desensitisation
Based on classical conditioning, systematic desensitisation makes use of counter-conditioning to help the client ‘unlearn’ their phobia. The treatment, developed by Wolpe, is based on the notion of reciprocal inhibition. Systematic desensitisation involves three stages: development of an anxiety hierarchy, relaxation training and graduated exposure – gradually pairing relaxation with the situations described in the anxiety hierarchy.
Background: Within the Learning Approach it is assumed that psychological abnormality is the result of learning from the environment. It is believed that learning occurs via classical and operant conditioning and social learning. Consequently, the model suggests that psychological abnormality can be treated by getting the person to unlearn the abnormal behaviour, and learn more adaptive ways of responding.
Systematic Desensitisation: This treatment uses the concept of classical conditioning. It is used mainly in the treatment of phobias. It is based on the idea of reciprocal inhibition, that a person cannot be anxious and relaxed at the same time. This idea is that the person is put in a situation whereby they learn to produce a relaxation response to a situation where previously they produced an anxiety response. Through his experience in the late 1950s in extinguishing laboratory-induced neuroses in cats, Wolpe developed the treatment programme for anxiety that was based on the principles of counter-conditioning. Wolpe found that anxiety symptoms could be reduced (or inhibited) when the stimuli to the anxiety were presented in a graded order and systematically paired with a relaxation response. Hence this process of reciprocal inhibition came to be called systematic desensitisation. Although his theoretical assumptions about the role of the sympathetic and parasympathetic nervous systems in extinguishing anxiety were actually erroneous, his Systematic Desensitisation program, as a practical application of his theories, proved to be highly successful and it revolutionised the treatment of neurotic anxiety.
The Procedure: Functional analysis: Working together the client and the psychologist draw up an anxiety hierarchy. This is a list of situations in which the person would feel anxiety, arranged from the least anxiety to the most anxiety produced. For example, in the case of arachnophobia, at the bottom of the scale the client might put ‘hearing the word spider’ and at the top of the list, ‘having a spider crawl across my face’. At this stage, the client decides which treatment goals they want to work towards.
Relaxation training: The client is taught different techniques of relaxation. These would probably include controlling breathing and muscular tension and might include other techniques, like positive self statements and visualization techniques.
Systematic desensitisation and deconditioning phobias Behaviourists believe that phobias are an example of a conditioned reflex. Through some experiences the person has had, they have learned an association between an anxiety provoking stimulus and a previously neutral one (e.g. learning to fear dogs after being bitten by one). Because behaviourists believe that such behaviour is learned, it follows that it can be un-learned. The treatment aims to establish a new association between the phobic stimulus (e.g. a dog) and a non-anxiety response. Through counterconditioning the intensity of a conditioned response (anxiety, for example) is reduced by establishing an incompatible response (relaxation) to the conditioned stimulus (a snake, for example).
Systematic desensitisation can be conducted in vitro which involves imagining the anxiety inducing situations or objects; alternatively it can be in vivo which involves live encounters. Systematic desensitisation can also be paired with modelling, whereby the patient observes others (the “model(s)”) in the presence of the phobic stimulus who are responding with relaxation rather that fear. In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia.
Evaluation of systematic desensitisation:
| Strengths | Weaknesses |
| + Systematic desensitisation is more ethical than some other behavioural treatments such as flooding as patients can control the exposure and they only move onto the next level of the hierarchy when they ready and relaxed.
+/- The treatment has a very high success rate with specific phobias rather than more general phobias such as agoraphobia. McGrath et al found that 75% of patients with specific phobias showed clinically significant improvement following the treatment. + The treatment is relatively quick and cheap as the patient often requires only 6-12 sessions, whereas psychoanalysis can be very time-consuming, sometimes taking years which can become highly expensive. + Empirical research such as Watson and Rayner indicates that phobias can be learned and thus it is logical that they can be unlearnt. + Jones applied systematic desensitisation to infants with phobias, such as the case of Little Peter who had a phobia of rats and rabbits. After 40 sessions Peter was able to stroke a rabbit that was sat on his lap. + Capafons et al showed that the treatment worked with fear of flying which gives evidence of the success of the treatment. +/- The treatment only focuses on observable symptoms which is positive in terms of providing empirical results of its success however deeper, underlying issues are not addressed which may have caused the disorder, unlike with psychoanalysis. |
– Systematic desensitisation has limited application as it only suited to particular disorders such as phobias but is not suitable for conditions such as schizophrenia.
– One problem with systematic desensitisation conducted using only imagination of the anxiety situations is that some people may have difficulty creating vivid images of encounters. However the use of in vivo desensitisation can overcome this problem. – Less success is found with agoraphobics and relapse rates are high. Craske and Barlow found between 60% and 80% of agoraphobics show some improvement after treatment, but it was only slight and osme clients relapsed completely after 6 months. – Classical conditioning principles, on which systematic desensitisation is based, stem mostly from studies using animals and children and thus the principles may not generalise to older humans. Phobias may be more ingrained in adults and thus harder to remove. In addition adults are more cognitively developed which could create an additional element to phobias which is not targeted by systematic desensitisation.
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The Psychodynamic explanation of phobias
According to the psychodynamic approach, phobias occur as a result of the use of defence mechanisms. Unacceptable wishes and fears are repressed and displaced onto a more acceptable source which can be more easily avoided.
The psychodynamic model sees phobias as the surface expression of a much deeper conflict between the id, ego and superego, which has its origins in childhood. Freud suggested phobias are a defence against anxiety produced by repressed id impulses often stemming from unresolved oedipal or electra conflict. Phobias are caused by displacement of unconscious anxiety onto harmless external objects. The anxiety stems from unconscious conflict, which has to be resolved before the phobia can be dealt with. Phobias are associated with unconscious sexual fears & they operate through defence mechanisms e.g. repression & displacement. The original source of fear is repressed into the unconscious & the fear is then displaced onto some other person, object or situation. Thus the fear appears to be irrational because there is no conscious explanation for it. An example can be found in Freud’s study of Little Hans. Freud believed that phobias were expressions of unacceptable wishes, fears and fantasies displaced from their original, internal source onto some external object or situation that can be easily avoided.
Freud attributed Hans’ fear of horses to an oedipal conflict that was not resolved, and he explained that Hans repressed his sexual feelings for his mother and his wish that his father would die. Freud proposed that Hans feared that his father would discover his wish, repressed his wish to attack his father, and displaced his fear of his father’s aggression onto horses. The young boy resolved the conflict of loving and hating his father by hating horses rather than admitting that he had aggressive feelings towards his father. Hans was better able to avoid the feared horses than his father.
An alternative psychodynamic theory stems from Bowlby who suggested that all anxiety disorders can be explained with reference to attachment. Bowlby (1973) explained that phobias may link to ‘separation anxiety’ in early childhood, especially where parents are overprotective. Bowlby argued that Hans’ phobia could be partially attributed to separation anxiety brought about by his mother’s threats to leave him if he did not behave himself combined with Hans’ separation from her when she giving birth to his sister a year earlier.
Evaluation of the psychodynamic explanation of phobias
| Strengths | Weaknesses |
| + Cross-cultural studies do indicate that anxieties and phobias are more common in cultures characterised by strict upbringing & punishment.
+ Chartier et al (2001) looked for risk factors in the history of 8116 Canadians taken from the National Risk Survey. A number of psychodynamic risk factors for social phobias emerged, including the lack of close relationship in childhood, parental discord and sexual abuse. + Fonagy (1996) found that in anxiety disorders, as in other mental disorders, the majority of patients were classified as having type D attachments. This suggests that anxiety conditions in general have some association with early family experiences. |
– A problem with many psychoanalytic theories is that evidence in support of such views is restricted to conclusions drawn from clinical case reports. Thus the findings may not generalise to the wider population as the studies are unique and they only involve people who have a psychological disorder thus the sample is not representative of the wider population.
– Arieti argues the repression is of a particular interpersonal problem of childhood rather than of an id impulse.
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Psychodynamic approach treatment for phobias – Dream Analysis:
Dream analysis is a technique used within psychoanalysis to identify unconscious sources of disorder which are then brought into the conscious mind so they can be dealt with. The client records their dream which is then reported to the therapist who will analyse the content to find the underlying meaning. This may be combined with free association to give further insight into the underlying issues. The analyst will unravel the disguised symbolism of the manifest content (what was remembered) so that that the latent content (what the dream actually means) could be revealed. It is believed that the latent content will reveal the underlying wishes, fear or desires that are at the source of the problem being displayed by the client.
The source of phobias is believed to be material that has been repressed into the unconscious and emotions that have been displaced onto a particular object or situation. Dream analysis is used to interpret symbols which reveal the latent content to give insight into the unconscious causes, so that the issues can be dealt with.
The Psychodynamic Approach sees mental disorders as coming from the unconscious mind, usually due to repressed thoughts or emotions from childhood. Dream analysis is a technique that is employed within Psychoanalysis. Freud believed that treatment should involve identifying the deeper, underlying unconscious mental causes of disorder and dealing with them as best as possible. The emphasis of the therapy is on exploring the patient’s past and linking it to their current symptoms. Freud discovered the unconscious causes of disorder by interpreting the symbolism of his clients’ behaviour, dream reports and free associations. The process (cathartic and transference) of revealing the hidden causes of their behaviour and the insights Freud provided regarding them gave the relief of anxiety and ego control required to improve their condition.
Dream analysis: During traditional psychoanalysis the therapist would sit slightly behind the client, who lies on a couch. This is to allow the client to focus without the analyst being a distraction. One way to analyse the dream is via free association, where the patient talks about the thoughts and emotions that the dream created. Freud believed that dream analysis could uncover unconscious thoughts and wishes which can influence a person’s behaviour. It was Freud’s view that dreams allow repressed material to leak out in a disguised, symbolic form. Dream analysis involves examining the content of dreams by identifying symbols which require analysis to uncover the unconscious thoughts that the symbols represent. The idea is that if unconscious thoughts can be identified they can be acknowledged and dealt with by the individual.
Freud believed that some symbols are universal – that they could be translated in the same way for all dreamers. Some of these were sexual in nature, including poles, guns & swords representing penises & horse-riding & dancing representing intercourse. However Freud was cautious about universal symbols & believed that, in general, symbols were unique to the individual & that a dream could not be analysed without knowing about the person’s circumstances. Thus the therapist needs to have details about the person’s life so that interpretation can be tailored to the individual. The analysis can take some time as it is not based on one dream; it requires a number of recorded dreams.
The manifest content is the story line of the dream that the dreamer is aware of – it is what they recall from the dream. The manifest content (which is thought to be a combination of day residue and the repressed wish/fear) appears in a distorted & symbolic form (to protect us) & is what is analysed to find the underlying meaning. As our repressed desires & fears are unacceptable to our conscious mind if they were to be made known to us while we are asleep we may get upset or wake up & so instead these issues appear as symbols. The hidden content of the dream is the latent content – the real meaning of the dream, the underlying wish, which is the analyst aims to uncover.
The process whereby the underlying wish is translated into the manifest content is called dream work. The purpose of dream work is to transform the forbidden wish into a non-threatening form, so reducing anxiety & allowing us to sleep in peace. Four of the processes involved in dream work are: displacement, condensation, concrete representation & secondary elaboration.
Displacement: when someone or something is used as a replacement for an object or a person we are really bothered about. An example comes from one of Freud’s patients who was resentful of his sister-in-law. He used to refer to her as a dog & once dreamed of strangling a small white dog. Freud interpreted this as his wish to kill his sister-in-law which was displaced onto a dog. Dreaming of this directly could be distressing & so Freud believed that the mind transforms this wish to protect the conscious mind from distress & guilt. Condensation: this is when different factors are combined into one aspect of the manifest content, for example a woman who has angry feelings towards her husband & father might dream of punishing a single man who represents them both. Concrete representation: this is the expression of an abstract idea in a very concrete way e.g. a king in a dream could represent concepts such as authority, power or wealth. Secondary elaboration: this occurs when the unconscious mind strings together images into a logical succession of events which can further obscure the latent content.
Psychoanalysis and phobias: Psychoanalysis using dream analysis has been applied to the treatment of phobias. Freud believed that phobias and other psychological disorders are caused by unconscious desires. According to Freud, individuals repress unacceptable desires. A phobia is a symbolic expression of these repressed feelings, such as aggressive impulses or sexual drives, and of the punishment linked with the feelings in the unconscious. It is suggested that repression prevents the expression of unconscious impulses and this leads to anxiety. In psychoanalytic treatment of phobias, dream analysis can be used by the therapist to uncover the repressed feelings believed to be the unconscious source of the problem. Psychoanalysts believe that when a patient fully understands the repressed feelings, the fear will disappear or become manageable.
Evaluation of Dream Analysis:
| Strengths | Weaknesses |
| + There are a number of case studies which provide support for the effectiveness of dream analysis. Freud reported on the case of little Hans who following dream interpretation as part of psychoanalysis was said to have recovered from his phobia of horses which was believed to have resulted from the Oedipal conflict. Cardwell et al reports on the case of Mary whose phobia of vomiting did not improve following systematic desensitisation. However during psychodynamic therapy Mary recalled that she had been sexually abused as a child which had been repressed into the unconscious and had resulted in a phobia.
+ New evidence from neuroscience suggests that Freud may have been correct to link dreaming & wishing. Solms (2000) points to an area of the brain where the limbic system (associated with emotion & memory processes) links to the cortex, the area associated with higher mental functions such as thinking. Damage to this area of the brain leads to the loss of dreaming & wishing. However symbol interpretation still lacks scientific support. |
– Dream analysis is highly subjective as the interpretation of symbols is based on the therapists’ own opinion. – In addition a different therapist could draw different interpretations and conclusions, showing that the technique is unreliable.– Freud supported his theory using case studies which are subjective and hard to generalise from as they are the unique study of only one person. There is little empirical evidence to support his ideas as it is difficult (if not impossible) to objectively study the unconscious (which we don’t actually know exists!).– Dream analysis is based on the belief that phobias stem from unconscious causes and no consideration is given to other explanations such as learning. It has been argued that there are far more rational and logical explanations for phobias such as classical conditioning and thus treatments such as systematic desensitisation may be more appropriate to ‘unlearn’ the phobia. |