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A Level · Cambridge (CIE) · 9990

Evaluate treatment for fear-related disorders and Chapman and DeLapp

Compare systematic desensitisation with CBT and applied tension, then evaluate Chapman and DeLapp’s single adult case without turning it into treatment advice.

Section Paper 3 · Specialist Options: Approaches, Issues and Debates

Cambridge International AS & A Level Psychology 9990 · Clinical Psychology · 2028–2030 · Version 1 · OPTION-CL-1.4.3
Exam scope and assessment notes

Original StudyForA educational content mapped to Cambridge 9990 Psychology 2028–2030 Version 1. Chapman and DeLapp (2013) is a single adult case report, not a controlled trial or universal treatment recommendation. Systematic desensitisation and applied tension are described for examination study only; no self-treatment or exposure exercises are provided. This is not medical advice, a diagnosis, Cambridge material, an official mark scheme or an awarded grade. Human subject-expert review and full timed-paper grading remain pending.

Before you begin

  • This lesson covers Cambridge 9990 Clinical Psychology topic 1.4.3 and follows the 1.4.1 diagnostic and 1.4.2 explanation lessons. It evaluates treatment evidence for study; it is not a self-help guide or treatment recommendation.

Work on paper. Try each question before revealing help, and explain why your method works.

Quick readiness check

What was distinctive about Chapman and DeLapp’s (2013) case?

What you will learn

  • Describe systematic desensitisation as a graduated behavioural treatment for fear-related disorders
  • Explain how CBT can combine psychoeducation, cognitive restructuring, monitoring and exposure
  • Explain the purpose of applied tension for blood-injection-injury phobia when fainting is a concern
  • Summarise Chapman and DeLapp (2013) and evaluate its case-study evidence, follow-up and generalisability

Systematic desensitisation pairs a graded hierarchy with a competing response

Cambridge 9990 Clinical 1.4.3 includes behavioural systematic desensitisation for fear-related disorders. In the classical method, a clinician and client construct an ordered hierarchy of feared situations from lower to higher anxiety. The client learns relaxation and gradually encounters or imagines each step while using that response. The theory is counterconditioning: relaxation is intended to compete with the fear response as the cue is approached.

A hierarchy makes the sequence explicit and can be adapted to the individual. It is a treatment framework, not a list for a student to apply to a classmate. Modern exposure therapies also use graded or sustained contact with feared cues, and relaxation is not a required part of every exposure approach; distinguish the syllabus method from all CBT or exposure therapy.

When evaluating the account, separate the proposed mechanism from the observed result. Reduced avoidance or distress after a programme may be consistent with new learning, but a single outcome does not prove reciprocal inhibition was the only mechanism.

CBT and applied tension address different parts of the blood-injury response

CBT can combine accurate information, monitoring of thoughts and symptoms, cognitive restructuring and carefully planned exposure. For blood-injection-injury (BII) phobia, applied tension is an additional behavioural component used in some treatment protocols when fainting is a concern. It uses muscle tension during clinician-supervised exposure with the aim of helping manage a vasovagal fainting response.

Applied tension is not the same as the relaxation response in systematic desensitisation. It is also not a general treatment for every fear-related disorder, nor a technique students should practise on themselves or others. In care, a qualified clinician assesses the presentation, risk, goals and suitable procedure; this lesson gives no steps for self-treatment.

BII presentations can differ: some people experience fear or avoidance without fainting, and a fainting response can have more than one physiological contributor. Do not claim every person with BII phobia has a single ‘diphasic’ pattern or needs applied tension. Cambridge’s study is a treatment example, not a universal protocol.

Chapman and DeLapp (2013): a nine-session adult case

Chapman and DeLapp described one adult man who sought care for longstanding fear of medical procedures. Across nine sessions, the manualised CBT programme included psychoeducation, cognitive restructuring, symptom monitoring, applied muscle tension and graduated exposure to medical cues. It therefore illustrates a combination of treatment components rather than a test of applied tension alone.

The case report described reduced anxiety and renewed use of medical care after treatment. At the 12-month questionnaire follow-up, the patient’s Beck Anxiety Inventory (BAI) score had fallen from 41 to 7, and he reported reduced fear across medical-related cues. The authors also reported follow-ups at four and ten months. These are observations about one adult case and include self-report; they are not a controlled estimate of average treatment effect.

Detailed records and follow-up help show the sequence, context and reported change in one case. There was no comparison group, random assignment or dismantling design, so the report cannot establish which component caused the improvement or how often similar outcomes would occur. The patient’s other anxiety and treatment context also limit generalisation. The authors themselves call for controlled research to identify active components.

Compare the methods and keep clinical boundaries clear

Systematic desensitisation is a named behavioural method: hierarchy plus relaxation paired with graduated encounters. The Chapman and DeLapp case used a broader CBT programme with cognitive work, monitoring, exposure and applied tension tailored to an adult with BII fear and fainting. Both include planned contact with feared cues, but they are not interchangeable labels.

For Paper 3, explain the method and evaluate the evidence using idiographic versus nomothetic explanation, case-study detail, self-report, longitudinal follow-up and generalisation. For Paper 4, an ethical application might analyse a fictional treatment record or compare published reports; it should not induce fear, ask learners to expose themselves, or collect their diagnoses.

Therapy and diagnosis belong to appropriately qualified professionals working with consent and individual assessment. A course summary is not a treatment plan, medical recommendation or substitute for care.

Sources for this lesson

Pause and explain

Why can’t the case report show that applied tension alone caused the improvement?

Put the idea to work

Worked example

A student writes, ‘Chapman and DeLapp proved applied tension cures all blood phobias.’ Improve the claim using the study design and results.

Show the worked solution
  1. Identify the participant and the multi-component treatment used across nine sessions.
  2. State one reported outcome and its follow-up source or measure.
  3. Explain why the case cannot isolate applied tension or establish an outcome for everyone.

Answer Chapman and DeLapp reported improvement for one adult man after nine sessions of manualised CBT combining psychoeducation, cognitive restructuring, monitoring, applied tension and graduated exposure. At 12 months, his BAI score was reported as 41 before treatment and 7 afterwards, alongside reduced self-reported fear and renewed medical care. Because this was one uncontrolled case with several treatment components, it cannot show that applied tension alone caused the change or that the result applies to all people with BII phobia.

Try a topic test

Choose Easy, Normal or Difficult. Save your answers and open worked review after finishing.

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From guided practice to a new situation

Write your answer and reasoning first. Use a hint only if you are stuck. The model solution is for self-checking; your written work is not automatically marked.

1 · Guided

A fictional treatment record describes a graded hierarchy, relaxation practice and gradual work with feared situations. Identify the approach and distinguish it from the applied tension component used in some BII treatments.

Give me a hint

Look for the relaxation response paired with ordered steps; applied tension is intended to address fainting risk rather than provide relaxation.

Compare my reasoning
  1. A hierarchy ordered from lower to higher anxiety, paired with relaxation, identifies the classical systematic-desensitisation approach.
  2. Applied tension is a different component sometimes used during clinician-supervised BII exposure when fainting is a concern; it is not the relaxation response.
  3. A course description does not show that either method is suitable for a real person; treatment requires individual professional assessment.

The record describes systematic desensitisation because it pairs gradual hierarchy steps with relaxation. Applied tension is a separate component used in some BII treatment protocols to address fainting concerns. Neither label tells us what an individual needs; that requires qualified assessment.

Look for these in your work

  • Systematic desensitisation identified
  • Applied tension distinguished from relaxation
  • Clinical boundary stated
2 · Independent

Chapman and DeLapp reported that one adult’s BAI score fell from 41 before treatment to 7 at 12-month follow-up after nine sessions. Evaluate what this result supports and what it cannot establish.

Give me a hint

Include the case design and the several treatment components.

Compare my reasoning
  1. The result records a large change on the reported BAI score for one adult over follow-up and may be discussed alongside his reported return to medical care.
  2. The programme combined psychoeducation, cognitive restructuring, monitoring, applied tension and graduated exposure, so the report cannot isolate one component’s effect.
  3. One uncontrolled adult case with self-report cannot estimate average treatment effectiveness or predict the outcome for every person with BII phobia.

The case documents that one adult reported a BAI score reduction from 41 to 7 at 12 months after a nine-session multi-component programme and also reported renewed medical care. This supports a detailed description of his outcome. Without a comparison group or component analysis, it cannot establish that applied tension alone caused the change or generalise an expected result to other people.

Look for these in your work

  • Outcome and follow-up stated
  • Multi-component treatment considered
  • Causal and generalisation limits explained
3 · Transfer

A class wants to test whether relaxation or applied tension works better by asking students with needle fear to view injection videos. Redesign this as an ethical learning task that still compares the two methods accurately.

Give me a hint

Use fictional, published evidence rather than exposing learners or collecting their health information.

Compare my reasoning
  1. Use two fictional summaries or excerpts from published treatment reports: one describing hierarchy plus relaxation and one describing CBT with applied tension and exposure for a BII case.
  2. Ask students to compare the method, treatment goal, participant group, outcome evidence and design limits from those summaries; do not ask anyone to disclose a fear or view distressing material.
  3. Conclude only what the published evidence supports. The single case cannot identify which component caused the outcome, and the class activity measures understanding rather than treatment effectiveness.

A safe class task can compare anonymised fictional summaries of published reports without exposing students to fear cues or collecting health information. Students can distinguish relaxation paired with a hierarchy from applied tension used in a BII treatment programme, and evaluate design and outcomes. The task assesses learning, not therapy or clinical effectiveness.

Look for these in your work

  • No exposure or personal health disclosures
  • Methods compared using published or fictional summaries
  • Learning outcome separated from treatment effect

Common mistakes

  • Confusing applied tension with the relaxation response taught for classical systematic desensitisation
  • Treating applied tension as a treatment for every phobia or as necessary for every person with BII fear
  • Calling Chapman and DeLapp a controlled trial rather than a single adult case report
  • Attributing the case outcome to applied tension alone despite several components being delivered together
  • Treating the BAI score as a direct measure of every feature of BII phobia or as a diagnosis
  • Ignoring that the 12-month outcome includes self-report and one person's follow-up
  • Inviting a learner to practise exposure or applied tension on themselves or another person
  • Turning an educational treatment summary into medical advice or a clinical recommendation
Recall without your notes

What can you explain now?

What is the main limit of Chapman and DeLapp’s (2013) treatment evidence?

Compare with the explanation

It is a detailed report of one adult who received a multi-component CBT programme, with no comparison group to isolate the effect of any one component.

The case supports a description of treatment and reported change, not a causal estimate or universal prediction.

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Make it stick

Explain the difference between systematic desensitisation and applied tension, then give one finding and one methodological limit from Chapman and DeLapp (2013).

If you needed the solution, close it and solve the problem again from a blank page. A correct answer is stronger when you can explain the reason for each step.

Keep learning Psychology

Course scope and assessment

Seven original lessons map all 15 AS research-method and methodological-concept sections to explained Guided, Independent and Transfer practice. All 12 compulsory AS core studies have original study-specific teaching and staged practice; five additional A Level methodology lessons cover research design and validity. All 15 Clinical, all 15 Consumer (2.1.1–2.5.3) and all 15 Health (3.1.1–3.5.3) Psychology sections link to original teaching and staged practice. All 15 Organisational Psychology sections 4.1–4.5 now have original teaching and explained staged practice; the six new 4.4–4.5 lessons bring the planning map to 92 of 92 indexed sections. Consumer lessons cover physical and psychological environments; decision models, heuristics and mistakes; packaging, selling and buying; advertising, self-monitoring, product placement, brand recognition and slogans. Evaluation boundaries are explicit: studies use particular products, samples, tasks and settings; gaze, recall, self-report, EEG indices, ratings, choices and purchases are different outcomes. Health evidence is bounded: Laba et al. measured hypothetical preferences; Riekert and Drotar raise a non-response concern; Chung and Naya's cap tracked openings, not swallowing; Chaney et al. was a short caregiver-reported pilot; Yokley and Glenwick examined immunisation attendance in one public-health setting. MacLachlan et al. report one patient, not a controlled treatment effect; Brudvik et al. compared separate child, parent and physician ratings in one emergency department. Chandola et al. found a cohort association; Wang et al. measured responses during a monitored arithmetic task; Evans and Wener observed commuters; Bridge et al. found mixed self-rated outcomes in radiotherapy. Janis and Feshbach measured short-term self-reports in one school; Lewin et al. tested a rehabilitation package, not information alone. Tapper et al. and Fox et al. studied bounded school and worksite programmes; incentive effects do not establish transfer or rule out reporting effects. Weinstein measured comparative expectations, while Seligman’s framework is conceptual and Shoshani and Steinmetz used a school-level comparison. These findings do not establish universal health effects or diagnose individuals. Need-theory examples use a child measurement study, not a workplace test; SMART is a practical checklist, not a motivational theory. Landry et al. compared reward framing with student volunteers in a lab; this does not establish universal effects in workplaces. Cuadrado et al. (2008) measured undergraduate evaluations of presented leaders, not workplace performance or hiring; this does not establish a universal gender effect. The historical 1995 Munchausen criteria are not a current diagnostic checklist. Cambridge’s 2028–2030 Reference List treats Oruč et al. (1997) as an example of genetic explanation although its participants had bipolar I; gambling disorder is listed in Cambridge’s Clinical topic but classified under addictive behaviours in ICD-11. Candidates choose two options, but all four remain listed so schools can select a route. The 92-section count is a planning index, not a Cambridge score. Remaining work is deeper coverage review, separate-year syllabus reconciliation, timed-paper practice and human subject-expert review. The separate 2027 and 2024–2026 syllabuses are not reconciled into this route. Practice is not official grading, a timed-paper simulation or human subject-expert review.

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