A grade seven student – an 11-year-old boy is experiencing irrational fear of his history classes. His behavior directed at escaping the object of his fear reduces the anxiety through negative reinforcement. The treatment should be aimed at overcoming the child’s avoidance tendency, exposing him to the feared object step by step, until the child will be able to finally tolerate his history classes, as the phobia will be extinguished by the anxiety-causing stimulus. Systematic desensitization is a cognitive-behavioral therapy based on classical conditioning that can be used to treat this type of phobia. The child is administered seven sessions with his guidance counselor. Before the patient is exposed to the stimulus, he should be taught how to cope with his anxiety through one of several cognitive strategies. This will provide the child with the ability to control the phobia and prevent it from being built up until it cannot be tolerated. One type of strategy that could be taught in order to cope with such anxiety is muscle relaxation. During the first session, the boy should be introduced to the treatment and to the principle of progressive muscle relaxation. At the end of the first session, homework must be assigned by means of an audiotape with muscle relaxation instructions so that the patient would be able to practice during his free time on a daily basis. During the second and the third session, the boy must be taught to modify his skill of progressive muscle relaxation to cued relaxation and relaxation by the recall. Gradual exposure to the object of the phobia will be the second step of systematic desensitization. For this, the patient has to develop a hierarchy that would describe the unpleasantness of each feared situation.
At the end of the third session, the counselor shall give the child a test of anxiety hierarchy that consists of 10-11 items. The purpose of this test would be to determine the situation range that led to the patient’s history class anxiety, for example, being called to the blackboard by the history teacher, or being asked a history question, the answer for which is uncertain. The fourth, fifth, sixth, and seventh sessions will be dedicated to using imagination in order to picture the situation from the anxiety hierarchy test while the patient is in a state of muscle relaxation. The situations should be presented in order of their increasing unpleasantness. Those ones with a higher rating should not be presented to the child until he is able to certainly tell that the current situation of lower hierarchy causes a minimal amount of anxiety when it is imagined. When the patient advances one step in the progression, he shall be desensitized to the previous step by realizing that nothing happens to him. Therefore his fear will be extinguished gradually.
However, there is no evidence that systematic desensitization is the perfect solution for treating phobias; on this account, in order to succeed, different types of cognitive treatment approaches may be combined depending on each case. The social learning theory claims that observing and imitating others primarily determines human behavior. This means that the boy’s fear of history classes may be associated with the observation of other students who are displaying phobic behavior towards this same object. In order to combat the phobia, the counselor may suggest a strategy of observing and modeling the behavior of those individuals who feel comfortable at the history classes. However, according to the theory of social learning, the other children fearful of this class may be imitating the behavior of our patient. Therefore it is crucial that this child learns to overcome his unjustified phobia by modeling the behavior of individuals who are not fearful of the current stimulus so that others with a similar problem may observe him and learn to model his behavior that does not demonstrate signs of fear.
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