Implosion therapy

This is a more extreme approach, which works on the theory that maintaining the level of fear is so demanding, both physically and mentally, that it cannot be sustained indefinitely. By introducing the highest feared element there is the potential to get the client accustomed to the object and then induce further relaxation leading to habituation of the feared object. (Stampfl, 1975)

In 1960 Wolpe treated a teenage girl who had a fear of cars, he forced her into a car and then she was driven around for 4 hours. Her fear attained heights of hysteria but she gradually subsided and relaxed and, by the end of the trip, her fear of cars had gone.

Forty-six patients with spider phobia, were assessed with behavioural, physiological and self-report measures by L G Ost (1997) in the Department of Psychology, Stockholm University, Sweden. They were randomly assigned to three group treatment conditions: (1) direct treatment; (2) direct observation; and (3) indirect observation. All treatments were carried out in large groups of eight patients, and consisted of one 3 hr session of massed exposure. The results showed that on the behavioural test, measures and the specific self-report measures of spider phobia the direct treatment was significantly better than direct observation and indirect observation, which did not differ. On the physiological measures and the psychopathology self-report measures there were significant pre-post improvements, but no differences between the groups. The effects were maintained or furthered at the one-year follow-up assessment. The proportion of clinically significantly improved patients were, at post-treatment, 75% in the direct treatment, 7% in the direct observation, and 31% in the indirect observation group. At follow-up, the corresponding figures were 75, 14, and 44%, respectively.

Aversion therapy

Usually aimed at inducing avoidance of the stimulus rather than habituation to it. This is achieved by getting the client to associate unpleasant experiences with the stimulus; eventually the two are so associated that the client will want to avoid the stimulus. This is not practical for many phobias as clients are usually seeking some form of cure rather than avoidance. Aversion therapy tends to be targeted at people who wish to give up a habit such as smoking or alcohol for example.

Where does hypnosis fit in as a therapy for phobias?

Hypnosis is based upon the principles of addressing the unconscious mind while the client is suitably relaxed. This enables various suggestions and instructions to be given to the client to assist them to achieve their goals.

The majority of phobias are accompanied by physical reactions of anxiety and these determine the level of fear that the client is experiencing. Under hypnosis it is possible to enable the client to control their own anxiety levels in a safe environment, thereby changing their old learning with more appropriate learning. This is best-achieved by using well planned systematic desensitisation or implosive therapy.