Discuss systematic desensitisation as a behavioural treatment for phobias
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Question 10 Mark Scheme
Discuss systematic desensitisation as a behavioural treatment for phobias. Refer to an unfamiliar phobia in your answer.
[16 marks]
What is expected in the answer?
The command word “discuss” requires students to explain how systematic desensitisation treats phobias and then evaluate its appropriateness and effectiveness. Because the question requires reference to an unfamiliar phobia, students should apply the stages of treatment to a specific example, particularly when constructing the anxiety hierarchy and explaining gradual exposure.
The current specification requires systematic desensitisation, including relaxation and use of a hierarchy, as a behavioural treatment for phobias. It also requires students to evaluate therapies and treatments in terms of their appropriateness and effectiveness.
Marks for this question: AO1 = 6, AO2 = 4, AO3 = 6
As this is an original 16-mark question requiring application to an unfamiliar phobia, an appropriate allocation is AO1 = 6, AO2 = 4 and AO3 = 6, following the structure used for 16-mark phobia questions that combine knowledge, application and discussion.
Level | Marks | Description |
4 | 13–16 | Knowledge of systematic desensitisation is accurate and generally well detailed. Application to the unfamiliar phobia is effective. Discussion of the appropriateness and effectiveness of the treatment is thorough and effective. The answer is clear, coherent and focused, with effective use of specialist terminology. |
3 | 9–12 | Knowledge of systematic desensitisation is evident but there are occasional inaccuracies or omissions. Application and/or discussion is mostly effective. The answer is generally clear and organised but may lack development in places. |
2 | 5–8 | Limited knowledge of systematic desensitisation is present. The response is mainly descriptive. Application to the unfamiliar phobia and/or discussion is of limited effectiveness. |
1 | 1–4 | Knowledge of systematic desensitisation is very limited or muddled. Application and/or discussion is limited, poorly focused or absent. Specialist terminology is absent or used inaccurately. |
0 | 0 | No relevant content. |
Indicative content
AO1: Systematic desensitisation
Credit relevant knowledge such as:
Systematic desensitisation is a behavioural treatment for phobias.
It involves gradual exposure to the phobic stimulus rather than immediate exposure to the most feared situation.
The person learns relaxation techniques.
The therapist and client construct an anxiety hierarchy.
Situations involving the phobic stimulus are ranked from least anxiety-provoking to most anxiety-provoking.
The client gradually works through the hierarchy.
At each stage, the person practises remaining relaxed while encountering the feared stimulus or situation.
Progression occurs gradually until the individual can tolerate more anxiety-provoking situations.
Treatment aims to reduce the learned association between the phobic stimulus and fear and to reduce avoidance.
The specification explicitly requires relaxation and use of a hierarchy.
Relaxation
Credit relevant knowledge such as:
The client is taught techniques that help them reduce physical and psychological anxiety.
These may involve controlled breathing or deliberate muscular relaxation.
Relaxation is practised before and during exposure to feared situations.
The client attempts to remain calm while confronting each stage of the hierarchy.
Once one stage can be experienced without excessive anxiety, the client can move to a more difficult stage.
A detailed answer should make clear that relaxation is part of the exposure process, rather than simply a separate technique taught at the start.
Anxiety hierarchy
Credit relevant knowledge such as:
The hierarchy is constructed specifically around the individual’s phobia.
Situations are arranged from least feared to most feared.
The first stages should provoke relatively little anxiety.
Later stages involve progressively closer or more intense contact with the phobic stimulus.
The final stage normally involves confronting a situation that would previously have produced substantial fear.
Exposure can therefore be introduced gradually at a pace the client can tolerate.
The June 2022 mark scheme confirms that systematic desensitisation involves relaxation, gradual exposure and multiple stages in a hierarchy of phobic stimuli.
AO2: Application to an unfamiliar phobia
Any plausible unfamiliar phobia can be used if the treatment is applied accurately.
For example, consider someone with a phobia of escalators.
An anxiety hierarchy might include:
looking at a photograph of an escalator;
watching a video of someone using one;
standing inside a shopping centre where an escalator can be seen;
standing near the bottom of an escalator;
watching other people step onto the escalator;
standing beside an escalator while practising relaxation;
stepping onto an escalator with the therapist or trusted person;
travelling one floor on an escalator;
using an escalator independently.
The person would not immediately begin with the most frightening stage. They would practise relaxation while working progressively through the hierarchy.
Effective AO2 should be integrated into the explanation, not added as a single example at the end.
AO3: Discussion and evaluation
Gradual exposure can make the treatment more acceptable
One strength is that systematic desensitisation introduces the phobic stimulus gradually.
The person begins with relatively manageable situations rather than being immediately confronted with the most frightening form of the stimulus.
For someone with an escalator phobia, looking at a photograph is likely to be much less distressing than being required to travel on a crowded escalator immediately.
This makes systematic desensitisation potentially more appropriate and tolerable for clients who might refuse a more intense exposure treatment.
The gradual structure may therefore increase the likelihood that a person is willing to begin and continue treatment.
The hierarchy can be individualised
Another strength is that the anxiety hierarchy can be adapted to the individual client.
Two people with the same broad phobia may fear different situations.
For example, one person with an escalator phobia might fear stepping on, whereas another might particularly fear stepping off at the top.
A personalised hierarchy allows therapy to target the person's own fear pattern and proceed at an appropriate pace.
This makes systematic desensitisation a flexible treatment rather than applying exactly the same exposure sequence to every client.
Systematic desensitisation is time-consuming
A major practical limitation is that systematic desensitisation can require considerable time.
The client must first learn relaxation techniques and then progress gradually through several levels of the hierarchy. This can require multiple therapy sessions.
The June 2022 mark scheme explicitly identifies this as a limitation when compared with alternatives such as flooding.
For an escalator phobia, the person might need several sessions before progressing from imagining or viewing escalators to actually using one.
Therefore, gradual exposure may make treatment more acceptable, but this advantage comes at the cost of a longer treatment process.
It may therefore be more expensive
The greater amount of therapist time can also make systematic desensitisation relatively expensive.
If treatment involves relaxation training and repeated gradual exposure over many sessions, both the client and healthcare provider may face greater costs than with a treatment completed in fewer sessions.
The June 2022 mark scheme accepts expense as a limitation when it is properly justified.
This means effectiveness alone is not enough when evaluating a treatment. Its cost-effectiveness also matters.
Improvement may not generalise outside therapy
Another limitation is that successful progress in therapy may not always transfer to real-world situations.
The June 2022 mark scheme specifically identifies the possibility that progress may not generalise when the person later faces the feared situation without the support of the therapist.
For example, someone may learn to ride an escalator successfully while accompanied by their therapist but still experience substantial fear when they later encounter a crowded escalator alone.
This limits treatment effectiveness if improvement is restricted to the therapeutic setting.
A stronger treatment programme would therefore need to encourage successful exposure across a range of realistic situations.
It is better suited to some phobias than others
Systematic desensitisation may be particularly appropriate when there is a clear and identifiable phobic stimulus around which a hierarchy can be constructed.
An escalator phobia is suitable because the exposure stages can be easily organised from pictures through to actual use.
However, the June 2022 mark scheme states that systematic desensitisation may be less appropriate for more generalised or “free-floating” phobias, such as social phobia, where there is no single obvious target behaviour and constructing a clear hierarchy may be more difficult.
Therefore, systematic desensitisation should not be assumed to be equally useful for every type of phobia.
Comparison with flooding
Flooding provides a useful comparison when evaluating systematic desensitisation.
Systematic desensitisation uses gradual exposure, whereas flooding involves confronting a highly feared situation much more directly.
The current specification includes both treatments.
One advantage of systematic desensitisation is that gradual exposure may be less distressing and therefore more acceptable.
However, the gradual hierarchy can require many sessions, while flooding can potentially be carried out more quickly. The June 2022 mark scheme explicitly identifies flooding as a relevant alternative when discussing the time required for systematic desensitisation.
This creates a trade-off:
systematic desensitisation may be easier for the client to tolerate, but flooding may require less treatment time.
Treatment directly targets avoidance
A strength of systematic desensitisation is that it addresses one of the main behavioural features that maintains a phobia, avoidance.
People with phobias often avoid the feared object or situation because avoidance reduces anxiety.
Systematic desensitisation requires the person gradually to confront the stimulus instead.
For someone afraid of escalators, repeatedly choosing stairs means they never experience using an escalator safely. Gradual exposure provides opportunities to remain in contact with the stimulus without escaping.
This gives systematic desensitisation a logical behavioural basis and connects it with the behavioural explanation of phobias.
The earlier two-process model mark scheme specifically recognises systematic desensitisation as a therapy based on behavioural principles.
It focuses on behaviour rather than the origin of the phobia
A possible limitation is that systematic desensitisation aims primarily to reduce the phobic response.
It does not necessarily require the therapist to identify exactly why the person originally developed the fear.
This can be a practical advantage because treatment can focus on changing current behaviour.
However, if a person's difficulties involve broader thoughts or emotional problems rather than a clearly defined phobic stimulus, behavioural exposure alone may be less appropriate.
This again supports the conclusion that treatment choice should depend on the nature of the phobia and the individual client.
Example answer
Systematic desensitisation is a behavioural treatment for phobias that uses relaxation and gradual exposure to the feared stimulus. The client does not immediately confront their greatest fear. Instead, they work through a hierarchy of increasingly anxiety-provoking situations.
For example, consider someone with a phobia of escalators. The therapist would first help the person construct an anxiety hierarchy. A low stage might involve looking at a photograph of an escalator. Later stages could include watching an escalator from a distance, standing beside one, stepping onto one with a therapist and finally travelling on an escalator independently.
The client would also learn relaxation techniques, such as controlled breathing and muscular relaxation. They would practise remaining relaxed while experiencing each stage of the hierarchy. Once they could manage one stage without excessive anxiety, they would progress to a more difficult one. Eventually they should be able to confront situations that previously caused intense fear.
One strength of systematic desensitisation is that exposure is gradual. A person with a severe escalator phobia might refuse treatment if they were immediately required to travel on one. Beginning with a photograph and moving gradually towards real exposure is less threatening and may make the person more willing to continue therapy.
The hierarchy can also be individualised. Someone might be particularly frightened of stepping off an escalator, while another person might fear being trapped on one. The hierarchy can be designed around the individual's own fears, making treatment flexible and appropriate to the client.
However, systematic desensitisation can be time-consuming. The person has to learn relaxation techniques and then work through several levels of exposure, often over a number of sessions. A treatment such as flooding may be completed more quickly because it does not use such gradual progression. This means systematic desensitisation may also be more expensive because it requires more therapist time.
Another limitation is that improvement in therapy may not always generalise to everyday life. The person with the escalator phobia might eventually use an escalator while accompanied by their therapist but still become very anxious when they have to use a crowded escalator alone. Treatment therefore needs to produce change outside the clinical setting if it is to be genuinely effective.
Systematic desensitisation may also be more suitable for some phobias than others. An escalator phobia has a clear stimulus, so it is straightforward to create a hierarchy from low to high anxiety. More generalised fears, such as some forms of social phobia, may not have one obvious target situation, making it more difficult to construct a clear hierarchy.
A further strength is that the treatment directly reduces avoidance. Someone with an escalator phobia may normally use stairs or lifts, which prevents them from discovering that they can use an escalator safely. Systematic desensitisation gradually requires them to confront the feared situation rather than avoiding it. This makes the treatment consistent with the behavioural explanation that avoidance helps maintain phobias.
Compared with flooding, systematic desensitisation therefore involves a trade-off. Flooding may be quicker, but immediate intense exposure could be highly distressing and may be unacceptable to some clients. Systematic desensitisation takes longer but its gradual approach may make it more tolerable.
Overall, systematic desensitisation is particularly appropriate for specific phobias where a clear hierarchy can be constructed. Its gradual and individualised nature can make exposure easier to tolerate, and it directly tackles avoidance. However, it can require substantial time and expense, improvement may not always generalise beyond therapy, and it may be less appropriate for more generalised phobias. Its usefulness therefore depends partly on the type of phobia and the individual receiving treatment.
Indicative mark: 16/16
Examiner-style commentary
This would be a strong Level 4 response because the student explains both named elements of systematic desensitisation, relaxation and the anxiety hierarchy, and then applies them throughout to a genuinely unfamiliar phobia.
The AO2 is particularly effective because the escalator example is not simply mentioned once. The student constructs a realistic hierarchy:
photograph → observe from distance → stand beside → use with support → use independently
and explains how relaxation would be used during progression.
The discussion is also focused on appropriateness and effectiveness:
gradual exposure may make the treatment more acceptable;
the hierarchy can be individualised;
treatment may be time-consuming and consequently expensive;
improvements may not generalise beyond the therapeutic setting;
it may be less suitable for generalised or free-floating phobias;
comparison with flooding identifies a meaningful trade-off between client acceptability and treatment time.
These points closely reflect the June 2022 mark scheme, which identifies time, multiple sessions, relaxation, gradual exposure, limited generalisation, difficulties with free-floating phobias, expense and comparison with alternative treatments as relevant limitations.
The examiner report for that question is especially useful. The most popular successful limitation was the time issue, but full marks required students to elaborate it through reference to multiple sessions, relaxation training and movement through a hierarchy. Some students also became confused about which phobias were less suitable for systematic desensitisation. The report specifically identifies social and other free-floating phobias as the relevant examples.
How a weaker answer could be improved
A weaker response might write:
"The person makes a fear hierarchy and learns to relax. They gradually face their fear. A strength is that it is less scary and a weakness is that it takes a long time."
That is relevant, but it lacks enough explanation and application.
A stronger applied chain is:
person fears escalators → hierarchy begins with looking at a photograph → client uses relaxation until this produces little anxiety → progresses to standing beside a real escalator → eventually rides one → gradual exposure reduces avoidance and allows increasingly difficult situations to be faced.
Evaluation also needs development:
systematic desensitisation takes many sessions → the client must first learn relaxation and then move gradually through several hierarchy stages → this requires more therapist time than flooding → therefore it may be more expensive and less time-efficient.
The key is to avoid simply naming “relaxation” and “hierarchy”. Students need to show exactly how those elements would be used to treat the unfamiliar phobia.
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