Emotional Staging: How To End Childhood Phobias

Phobias are irrational fear reactions to harmless stimuli or to stimuli that are not so harmless, but which are under control; for example, because the person has the necessary resources to cope with it. Phobic responses are maladaptive and can affect people’s daily lives, requiring care and treatment. In this sense, emotional staging has turned out to be a promising intervention in the treatment of phobias.

Although they have not yet been established as an effective treatment, but as probably effective, as we will see throughout the article, the components of the emotional staging suggest that future research will end up considering it an effective treatment for the treatment of childhood phobias . We are going to learn more about this technique.

What are emotional staging?

Emotional staging is a multi-component cognitive-behavioral technique created by Méndez. They emerged as a live alternative to the emotional imagery technique of Lazarus and Abramovitz. They consist of live interactions with phobic stimuli, carried out in a game context. These exposures or interactions should be brief but repeated and, above all, should be done gradually.

There are three explanations for its effectiveness:

• Classical conditioning : emotional staging is a form of systematic live desensitization that uses emotions originating from the game situation as a “neutralizer” of anxiety. A counterconditioning occurs.

• Operant conditioning : emotional staging is considered a mode of shaping or successive approaches, or of reinforced practice, where contingencies are programmed by the therapist.
• Social learning : Emotional role plays incorporate participant modeling. The observation that the performance of the model is not followed by negative consequences, produces the vicarious extinction of fear.

Next, we are going to know what are the phases of application of emotional staging and what each one of them consists of.

Phase 1: preparation

• Construction of the hierarchy. The number of items in it depends on whether it is carried out individually or in a group. In the case that it is carried out individually, it will consist of 20 or 30 items, while if it is carried out individually, it must include between 40 and 50 items .

• Choice of game for role-playing: the therapist presents the procedure as a game and asks the child to choose the characters that he or she likes the most. It is essential that the therapist is familiar with the characters to invent credible plots and fun games.
• Reinforcement system programming. Reinforcements are dispensed in the form of a token economy.

Phase 2: application

The duration of the treatment and of each session varies depending on the type of phobia, the age and the mood of the child. Frequently 2 or 3 sessions are carried out per week, of between 30 and 45 minutes and, preferably, in natural environments.

The therapist explains the game and provides instructions. The first minutes of the session are dedicated to playing until the child “gets into” the plot of the game. The child is then asked to expose or interact with the corresponding stimulus.

The therapist manipulates the antecedents and consequences based on the child’s behavior:

• If the interaction is successful, without showing signs of fear, social, edible and material reinforcement is provided.
• Faced with insufficient interaction and accompanied by signs of fear, the attempt is reinforced.
• If escape responses occur , the child is offered aids such as verbal instigation, physical guidance, competitive responses … When he manages to expose himself, he is provided with social reinforcement.
• If avoidance behaviors occur or if you refuse to interact with the stimulus, the behavior is modeled. When the approach is made, social reinforcement is provided.
• If in spite of everything he does not make the interaction out of excessive fear, intermediate items are introduced in the hierarchy. In the event that difficulties persist, treatment should be interrupted to study the cause of the problem.

The interactions in each of the items are repeated several times until the child performs them satisfactorily in a couple of consecutive trials. The session must end with a passed item. If in the end he is not able to make the last pass, he returns to the previous one to finish with the one passed.

Phase 3: consolidation

In this phase, the collaboration of the parents must be requested. Parents should be taught to extinguish maladaptive behaviors and to reinforce approach behaviors.

In addition, the importance of doing homework between sessions should be noted. These tasks are carried out on the items already worked on and passed in the sessions. And they must agree on a segment d and strengthening to prevent relapse:

• Overlearning sessions: these are sessions in which the passed items in which the child has had the most difficulty are repeated.
• Support sessions: these are several follow-up sessions to assess the maintenance and to solve problems, review, practice and strengthen the interaction behaviors and the acquired coping strategies.

Emotional staging, a more than promising treatment

Studies show that emotional role plays are effective in reducing childhood phobias. Only one unsuccessful case was reported, probably due to lack of family cooperation. In another study comparing the differential efficacy between emotional role-play and play therapy, post-treatment scores on behavioral approach tests were shown to be higher after the application of emotional role-play.

The only reason emotional skits are still rated “probably effective” is because the investigations have been conducted by the same team each time. But hopefully when other teams replicate the studies and run new ones, the results will show that emotional role-play is a well-established treatment for childhood phobias.