Understanding Psychology (10th Ed)

550 Chapter 
16 
Treatment of Psychological Disorders
The next step would involve constructing a hierarchy of fears —a list in order of 
increasing severity of the things you associate with your fears. For instance, your 
hierarchy might resemble this one:
1. Watching a plane fl y overhead
2. Going to an airport
3. Buying a ticket
4. Stepping into the plane
5. Seeing the plane door close
6. Having the plane taxi down the runway
7. Taking off
8. Being in the air
Once you had developed this hierarchy and learned relaxation techniques, you 
would learn to associate the two sets of responses. To do this, your therapist might 
ask you to put yourself into a relaxed state and then imagine yourself in the fi rst 
situation identifi ed in your hierarchy. Once you could consider that fi rst step while 
remaining relaxed, you would move on to the next situation. Eventually you would 
move up the hierarchy in gradual stages until you could imagine yourself being in 
the air without experiencing anxiety. Ultimately, you would be asked to make a visit 
to an airport and later to take a fl ight. 
Exposure Treatments.
Although systematic desensitization has proven to be a suc-
cessful treatment, today it is often replaced with a less complicated form of therapy 
called exposure.  Exposure  is a behavioral treatment for anxiety in which people are 
confronted either suddenly or gradually with a stimulus that they fear. However, 
unlike systematic desensitization, relaxation training is omitted. Exposure allows the 
maladaptive response of anxiety or avoidance to extinguish, and research shows that 
this approach is generally as effective as systematic desensitization (Havermans et 
al., 2007; Hoffmann, 2007; Bush, 2008). 
In most cases, therapists use graded exposure in which patients are exposed to a 
feared stimulus in gradual steps. For example, a patient who is afraid of dogs might 
fi rst view a video of dogs. Gradually the exposure escalates to seeing a live, leashed 
dog across the room and then actually petting and touching the dog (Berle, 2007; 
Means & Edinger, 2007). 
Exposure has proved to be an effective treatment for a number of problems, 
including phobias, anxiety disorders, and even impotence and fear of sexual contact. 
Through this technique, people can learn to enjoy the things they once feared (Choy, 
Fyer, & Lipsitz, 2007; Franklin, March, & Garcia, 2007; Powers & Emmelkamp, 2008).