Treating phobias or treating people? Of acronyms and the social context

Phobias are some of the most common disorders brought to the attention of treatment agents. Classically, the treatment of choice was SD (systematic desensitisation), sometimes combined with hypnosis. More recently, VR (virtual reality) procedures and EMDR (eye movement desensitisation reprocessing) emerged as exciting alternatives. SD and the VR procedures are operationalisations of CBT (cognitive behaviour therapy) and are based on learning theory, while EMDR is usually viewed from a psychoneurological perspective. The generally good results obtained with the methods known by these acronyms are often taken to confirm the soundness of the particular underlying theory. However, these theories under-represent the interpersonal or social aspects of phobic behaviour. Adding an inter-personal focus to the generally intra-personal view of this behaviour much more fully explains both the success of the usual treatment procedures and the relatively rare failures. Using case illustrations, this paper highlights the way in which phobic behaviour is often embedded in a matrix of interpersonal and social influences and suggests the more deliberate and effective utilisation of these in the treatment of phobic sufferers. Keywords: phobias; systematic desensitisation (SD); virtual reality (VR); eye movement desensitisation reprocessing (EMDR); cognitive behaviour therapy (CBT); memory processing; social constructionism Health SA Gesondheid Vol. 11 (3) 2006: pp. 41-4