Anxiety and fear-related disorders: treatment and management

Psychology A2 · Clinical Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

Systematic desensitisation is a behavioural therapy based on classical conditioning. The client learns to relax, builds a list of feared situations from least to most frightening, and then faces each one while staying relaxed. Fear and relaxation cannot happen together, so relaxation takes the place of fear.

Blood-injection-injury phobia needs something different, because blood pressure falls and the person may faint. In applied tension the client tenses the large muscles to push blood pressure up. Chapman and DeLapp (2013) reported a case study of one adult man treated with nine sessions of manualised CBT with applied tension. His fear and avoidance fell and the gains were still present at follow-up.

Rules to remember

Systematic desensitisation, in order: relaxation training, anxiety hierarchy, gradual exposure while relaxed.
Reciprocal inhibition: two opposite states (fear and relaxation) cannot exist at the same time.
The client moves up the hierarchy only when relaxed at the present step.
Applied tension: tense the arm, leg and body muscles for several seconds, release, and repeat; this raises blood pressure and prevents fainting.
CBT for this phobia: psychoeducation, challenging fearful thoughts, graded exposure with applied tension.
Manualised therapy: each session follows a written plan, so the treatment can be replicated.
A single case with self-report ratings and no control condition is idiographic and cannot be generalised.

Common mistake

Students recommend relaxation for blood-injection-injury phobia. Relaxation lowers blood pressure further and makes fainting more likely; applied tension is used because it raises blood pressure.

Worked example

Lina faints whenever she sees blood. A therapist plans graded exposure to pictures of blood and then to a blood test. Which technique should Lina use during the exposure, and why?

Fainting at the sight of blood shows the sudden fall in blood pressure typical of blood-injection-injury phobia.
Relaxation would lower blood pressure even more, so it is unsuitable.
Tensing the large muscles raises blood pressure and keeps blood flowing to the brain.

Answer: Applied tension, because it raises blood pressure and stops her fainting during exposure.

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