Applied Behavior Analysis as Therapy for Treating Fears and Phobias

Applied behavior analysis is used in the treatment of fears and phobias to systematically train the sufferer to extinguish learned defensive behaviors associated with the fear through techniques such as exposure therapy and cognitive behavior therapy. As behaviors that have served to reinforce the fear are eliminated, the phobia itself will fade away.

Entomophobia isn’t a particularly common condition, but it was a debilitating one for Mike, a 14-year-old boy in Omaha. Entomophobia is a fear of insects, and as anyone suffering from this phobia will tell you, insects are everywhere. In the classroom, Mike had difficulty functioning anytime a fly buzzed through or a spider was spotted on the wall.

Worse, the frequent and obvious reactions he had to such insects led to taunting and teasing by classmates, which disrupted Mike’s studies even when no actual insects were present. When a classmate pointed and said “Mike, there is a bug under your chair!” he would flinch, cover his head and yell.

The effects on Mike’s academic progress were obvious and the disruptions to the rest of the class were untenable. Mike’s principal contacted an applied behavior analyst for help.

The analyst first established methods of judging progress, based on Mike’s ability to complete academic tasks while insects were present, or even just when he was told that insects were present. By putting together a performance baseline, the analyst could assess the progress of the therapies that would be used.

In Mike’s case, the treatment of choice was a graduated exposure therapy. Over the course of a month, the therapist introduced Mike to a gradually increasing pattern of insect contact in safe, controlled conditions, where no negative consequences could occur. Mike was walked through:

  • Holding a jar of crickets
  • Touching a cricket with his foot
  • Standing in a room with crickets for 60 seconds with his eyes close
  • Picking up a cricket with first a piece of paper, then a gloved hand, then a bare hand
  • Holding a cricket in his bare hand for 20 seconds
  • Allowing a cricket to crawl on him

The therapy never quite got Mike to the point where he could take a test with a cricket in the room, but it did succeed in decreasing his susceptibility to taunts and teasing. With further treatment over a longer period, he could likely extinguish the phobia entirely.

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Fighting the Body’s Natural Fear Responses

One of the things that makes dealing with phobias so difficult for ABAs is that they are fighting reinforcement offered by the body’s own engrained learning mechanisms. The defensive behaviors that phobia patients engage in are wired deeply into the autonomic nervous system as legitimately protective behaviors designed to help the human organism survive. The anxiety that accompanies the fear creates an expectation of hurt or pain.

So even in cases where those behaviors are irrelevant to survival—such as recoiling from harmless bugs—the brain interprets the lack of damage as a positive outcome, reinforcing the behavior.

This leads people with phobias to avoid putting themselves in situations where the fear can ever be shown to be irrational. Behavior analysts have a number of techniques for forcing patients to come to the realization that the fear is not a rational one:

  • Exposure therapy
  • Stimulus fading
  • Flooding therapy
  • Contact desensitization

Behavior Analysts Help Patients Manage Fear That Is Debilitative

Behavior analysts working with fears and phobias have a large toolbox of techniques available to help people like Mike. Fear itself is a normal and often healthy human emotion, and ABAs do not quash the experience of fear itself.

But when fear becomes unreasonable, excessive, and unhealthy, it finds expression through various disruptive or self-destructive behaviors, and it is those behaviors that ABAs work to suppress and replace with more normal reactions.

Few behavior analysts specialize in phobia treatment but many encounter patients with various fears and phobias in the course of their work in other areas. Childhood fears are common and ABAs working in both general and special education are likely to have patients with excessive fear responses. Private clinicians who provide therapy to a variety of clients are likely to have several who manifest phobia responses that need to be addressed in the course of treatment.

Like every other aspect of applied behavior analysis, phobia treatment begins with a careful analysis of the antecedents, or situations in which it arises; the behaviors that are problematic; and the consequences of those behaviors that tend to reinforce them. These are the so-called ABCs of behavior analysis, and understanding them is critical to successful treatment.

In Mike’s case, the presence of bugs or the announcement of their presence by teasing classmates provided the antecedent. The yelling and hiding were the problem behaviors. And the consequence was a perceived relief from the imagined terrors of the bugs.

By applying exposure therapy, the ABA focused primarily on the consequences, demonstrating that the actual consequences of having a bug nearby or even on him just weren’t all that bad. The perception of relief was shown to be false, and a new one could be engineered.

Contact desensitization with positive reinforcement is another, related type of exposure therapy used by behavior analysts. Rather than simply providing exposure with no negative consequences, ABAs actively introduce positive reinforcement during the exposure. For instance, Mike might have been rewarded with verbal encouragement or a treat when being exposed to the crickets, helping develop a positive, rather than negative, perception of the bugs.

One challenge for many types of fears is the difficulty of creating adequate exposure or flooding scenarios. It’s just not all that easy to get a room full of snakes these days. One modern innovation to make this type of therapy more effective and widespread is virtual reality. By programming VR simulations to replicate fear scenarios, patients can get exposure right in the therapist’s office.

Preparing for a Career in Applied Behavior Analysis Treating Fears and Phobias

Most professionals who use advanced applied behavior analysis techniques to deal with fears and phobias are in fact practicing psychologists who specialized in treating phobia patients. Becoming a psychologist involves obtaining a doctoral degree and becoming licensed in the state you wish to practice in.

Psychologists specializing in behavioral analysis techniques to treat phobias usually receive advanced training and certification specifically in applied behavior analysis. This is usually through the Behavior Analyst Certification Board (BACB), which offers the Board Certified Behavior Analyst (BCBA®) certification. Obtaining a BCBA® involves taking specialty courses focused on behavior analysis and passing a national test on the subject matter.

It’s possible to become a BCBA® with a master’s degree and to practice as an applied behavior analyst and therapist without becoming a full-fledged psychologist. ABAs who practice in therapy do not typically specialize in phobia treatment but they may still treat patients with phobias from time to time. ABAs working in education or private practice are most likely to encounter these issues. Master’s degrees in psychology, education, or applied behavior analysis are good preparation for such positions.

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Further Resources Related to Treating Fears and Phobias with Applied Behavior Analysis

The Phobia List – A comprehensive list of psychological phobias.

Phobia Support – A resource for phobia sufferers including self-help resources, local and regional support groups, and psychological information on fears and phobias.

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