Describe both systematic desensitisation and flooding,including how these are different with respect to a patient's anxiety hierarchy.

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--Systematic desensitization is an excellent example of how behaviour therapists apply learning principles to treatment.Psychiatrist Joseph Wolpe developed systematic desensitisation (SD)in 1958 to help patients manage phobias (see Chapter 2).Systematic desensitization gradually exposes patients to anxiety-producing situations through the use of imagined scenes.Systematic desensitization is based on the principle of reciprocal inhibition,which says that patients can't experience two conflicting responses simultaneously.We can't be anxious and relaxed at the same time because relaxation inhibits anxiety.Wolpe described his technique as a form of classical conditioning and called it counterconditioning.By pairing an incompatible relaxation response with anxiety,we condition a new and more adaptive response to anxiety-arousing stimuli.A therapist begins systematic desensitisation by teaching the patient how to relax.She might imagine pleasant scenes,focus on breathing and maintaining a slow breathing rate,and alternately tense and relax her muscles (Bernstein,Borkovec,& Hazlett-Stevens,2000;Jacobson,1938).Next,the therapist helps the patient to construct an anxiety hierarchy-a "ladder" of situations or scenes that climb from least to most anxiety provoking.The therapy proceeds in a stepwise manner.The therapist asks the patient to relax and imagine the first scene,and moves to the next,more anxiety-producing scene only after the patient reports feeling relaxed while imagining the first scene.
--Flooding therapies provide a vivid contrast to systematic desensitization.Flooding therapists jump right to the top of the anxiety hierarchy and expose patients to images of the stimuli they fear the most for prolonged periods,often for an hour or even several hours.Flooding therapies are based on the idea that fears are maintained by avoidance.For example,because height phobics continually avoid high places,they never learn that the disastrous consequences they envision won't occur.Ironically,their avoidance only reinforces their fears by means of negative reinforcement (see Chapter 6).The flooding therapist provokes anxiety repeatedly in the absence of actual negative consequences,so that extinction of the fear can proceed.A crucial component of flooding is response prevention,in which therapists prevent patients from performing their typical avoidance behaviours (Spiegler,1983).A therapist may treat a person with a hand-washing compulsion by exposing her to dirt and preventing her from washing her hands.

Describe Both Systematic Desensitisation and Flooding,including How These Are Different