Now the patient is asked to produce a phobic hierarchy this is making a list of things, situations or places they are least scared of working there way to the things they are most scared of. The patient usually does this by them selves.
Hierarchy for agoraphobia
Once all these are met then the treatment can begin, the phobia is already identified so the first stage is to induce the relaxed state, the patient is then relaxed and calm. The next stage is to induce the first level of the hierarchy which is arranging to go out, once this is done the patient is induced to the relaxed state again, feeling calm the patient does the next level of there hierarchy, being home alone, the relaxed state starts again and the patient will keep alternating between stimulus exposure and relaxation until they have completed there hierarchy and cured there phobia. The patient is in control at all times and can stop the treatment at anytime.
This treatment works on the basis of you cannot feel two feelings at the same time i.e. fear and relaxation therefore you change the link from fear to relaxation.
The ethical issues with systemic desensitisation are the therapist may push the patient to far, the patient may be induced to there phobia to soon and not be able to deal with the situations, this could cause panic attacks or the patient running away, medication given to relax patient may have side affects and can cause the patient to be drowsy and not in the right state of mind for the treatment, trust can be lost between patient and therapist or the patient could discontinue there treatment and never treat there phobia.
Another way of treating agoraphobia is flooding treatment, this treatment is quite an extreme approach and is usually used when other treatments have failed. In treating agoraphobia the patient would be directly exposed to the scariest situation they could be in, which would be being alone in the town centre. The patient then feels fear and anxiety the patient is then left in this situation until there anxiety is over.
This treatment works as a human cannot feel a feeling indefinitely, the patient can’t be afraid forever, eventually the patient will stop feeling scared and realise the situation is not that scary.
There are a few ethical issues with flooding treatment a lot of people see the treatment as cruel and feel it does more damage then good. inducing someone directly to there phobia can cause a major panic attack which could lead to a heart attack and even death, this is the major ethical issue which should be taken into consideration when thinking about this treatment. This treatment won’t work on all patients, they require a huge amount of motivation. Another issue is when a patient is induced to the phobia at this rate and is not ready, a reaction could be that they are more scared of the situation then before which will make the phobia worse.
The last treatment I will be discussing is the somatic approach to treating phobias, this approach relies on the fact that there is a physical cause for the phobia, there will be a cause with symptoms which they can treat like anxiety, stress or panic attacks with medication or therapy and finally cure the phobia. This treatment works by using chemotherapy (medication), prescribing the patient with medication to help treat the phobia, this medication could be anti depressants or anti psychotics. Tranquilisers like Valium and Librium are the main drug used to treat phobias, they make the patient happier, relaxed and feel safe so they can forget about their fear. They do this by causing the patient to feel drowsy and helping their muscles relax, so their fear doesn’t bother them if they feel relaxed and safe.
Ethical considerations involved in chemotherapy are that all drugs are poison, people don’t want to take medication unless they have to. Also medication can have side effects and these side effects may be worse then dealing with the actual phobia, some people may build a tolerance to the medication and it will stop working and they will have to take more to work. Most patients will usually have to take the medication for life and find that hard or some may have a course of medication and become addicted to it. Is the treatment for the symptoms or the cause of agoraphobia?
(Moxon, d, Et el, 2003)
Systemic desensitisation, flooding therapy and the somatic theory have sort of the same approach, making the patient feel relaxed enough to deal with agoraphobia and they all can use medication to help the patient feel relaxed and deal with the situation. Flooding therapy is very different the patient has to go through huge amounts of fear, it’s the only treatment that can literally scare the patient to death. Systemic desensitisation induces the treatment slowly and deals with agoraphobia step by step, and the somatic approach just uses chemotherapy to help deal with the situation.
All treatments are very different but have the same effects and show that you must be relaxed to deal with your phobia. There are lots of treatments to help people deal with agoraphobia many include therapy and finding the cause of the phobia, different treatments work for different people and phobias. Some people may have to try a few before one works. Some people may never find something that works.
Agoraphobia is becoming a very common phobia for people with mental illnesses and more help is becoming available. Undergoing treatment has been very beneficial for most sufferers.
Different perspectives on treatments can lead to two patients with the same phobia given different treatments as the person who referred them for treatment feels more strongly for one treatment or doesn’t feel the others work.
References
Books
HOLLANDER, E, and BAKALAR, N, (2005) Coping with Social Anxiety: The Definitive Guide to Effective Treatment Options, owl books.
MOXON, D Et el, 2003, Psychology, AS for AQA A ,Heinemann publishing.
Websites
http://mentalhelp.net/poc/view_doc.php?type=doc&id=470&cn=1
Bibliography
Books
DAVENPORT, GC. (2002), Essential Psychology. 2nd Ed. London, Collins Educational.
Websites
http://www.phobialist.com/treat.html
