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The U.S National Institute of Mental Health had stated that there were about 10% of people who suffered from specific phobia, 7.1% from social phobia and 0.9% from agoraphobia. Phobia, an anxiety disorder, if being retarded from its treatment, would become uncontrollable which results to the incompetent in carrying normal routine and become socially isolated. This is because phobia accounts to the avoidance of particular places, situations, or objects due to its irrational fear. Generally, people have difficulties to distinguish between phobia and normal fear. Thus, psychologists had specified that fear is an unpleasant feelings and will be experienced by every human beings in response to danger (Marks, 1987) whilst phobia is beyond the ordinary fear in which it is more intense and long-lasting in nature (Turner and Romanczyk, 2012).

The majority of people are diagnosed with anxiety disorder prior to age 21, and it can be studied through the average age of phobias’ onset in which specific phobias are in the early childhood and adolescence for the complex phobia such as social phobia (social anxiety disorder) and agoraphobia. According to a report from Office National Statistics Psychiatric Morbidity, 2011, men are half times less likely to be diagnosed with anxiety disorders or only about 40% from phobias compared to women. Both men and women who suffer from phobias would experience several physical and psychological symptoms. The physical symptoms includes chest pain, faster heart beat, losing one’s balance, excessive shaking, etc while the feelings of fear, panic, ill and likely to die soon are the psychological symptoms.

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A talk therapy that has showed to have high success rate in dealing with phobias is Cognitive Behavioral Therapy (CBT) which works by incorporating both cognitive and the behavioral therapies. This therapy is available to treat patients individually, in groups, via computer or internet in a short time by involving several techniques during the sessions such as Socratic questioning, behavioral experiments, thought records, situational exposure hierarchies, etc. Thus, this treatment tend to be carried in structure so that the sessions time can be used efficiently and lead to successful collaborations between patients and therapists in order to achieve its goals which are for cognitive restructuring and behavioural activation. Furthermore, the most important and the main CBT concept that patients and therapists should understand is that thoughts, feelings and behaviors are interconnected so if one modality is changed, others will be affected (Ellis, 2001).

In this paper, the discussion on how far does CBT effective in treating phobia will be explored find out when it is effective or not to treat its phobia as well as to inform decision makers and clinicians that CBT may help patients to reduce its phobia but just to an extent as according to David A.Yusko, not all phobias can be cured with CBT. Hence, this essay will be examining: “How effective is cognitive behavioral therapy play a role in the treatment of phobias”?

The psychological studies above support the discussion on the effectiveness of CBT in the treatment of phobias and have suggested that CBT is effective as it helps to alter the patients negative thoughts or beliefs by motivating them to think about the positive statements that may assist them to handle themselves when they are exposed to phobic places or other behavioral experiments requested, thereof, this makes them tend to have strong good feelings that leads to better self-efficacy or possibilities of no longer possess its phobia. From the biological perspective, the patients may also acquire several changes such as the decreasement in volume of amygdala’s grey matter unto how a healthy amygdala supposed to be and since their amygdala which responsible for emotions or the fear are being controlled, therefore they tend to respond positively to the stimuli. When comparing both CBT and treatment as usual, CBT is considered to be better especially on the treatment planning because the involvement of parental education outside the treatment sessions may help to catalyse the patients’ rate of improvement as they could be trained not only in the settings by the therapists but instead anytime with their parents. Moreover, few studies also showed that CBT has succeeded in achieving its goals of modifying the patient’s distorted thinking after going through homework assignments, behavioral experiments, and the evaluating or identifying the dysfunctional thinking or belief techniques, which lead them to become less likely experiencing unreasonable fears to their phobic situations as they could behave accordingly to what they think.

However, it becomes insignificant if it was being delivered individually, briefly and traditionally to SAD or agoraphobia patients as in brief CBT, there is no psychoeducation offered and the treatment was only carried for 6 sessions therefore their phobia tend to relapse because they were treated in short period of time as well as their families did not receive information on how to interact with the patients and knowledge on what the patients can do or should avoid. In comparison with VRET, VRET is far more effective because the patients get to undergo same behavioral experiment as the traditional CBT with the addition of exposure to various reality environments therefore they tend not to have big concerns if the treatment was over as they had learnt how to overcome their discomfort in various real-life environments. Furthermore, if the CBT therapist and patient has cross-cultural issue, the outcome obtained after treatment may not be maximal, although the treatment was delivered individually, because their language barrier as well as the difference in cultural dimensions do play a major contribution during the treatment. Thus, they might have an odd collaboration because an individualists tend to be independent and have an open communication during discussions while a collectivists would feel uncomfortable to open oneself freely as individual especially to the outgroup member because they have the sense of interdependence and prefer to have indirect communication to maintain harmonious interpersonal relations (Adair ; Brett 2005).

Nevertheless, the above results cannot be fully relied upon as the studies were limited with similar limitations. From its methodology, there are two correlational study that showed CBT and phobia are only related as there are no manipulation in independent variable affects the dependent variables so cause-and-effect relationship cannot be demonstrated in which it would be difficult to determine whether CBT treatment really effective to treat phobia or not because there might be third variables exists between them and cause CBT to be effective. Also, most studies had used more than one questionnaires in gathering facts to make conclusion because the researchers could collect many data in short time and obtained objective response from the patients as it is a standardised survey. However, questionnaire may lead to social desirability effect as the patients may answer it not based on facts because they think those answers are what the researchers expected therefore it would decrease the results’ accuracy. To reduce this bias, the questions or instructions should be modified in more positive ways that could make them to answer honestly. Another noticeable, since the patients have known the aim of the study so they may display demand characteristics throughout the experiment or when answering the self-reported questionnaires which leads to less accurate results being obtained.
Moreover, there was a research that was conducted in laboratory where the situation involved is somewhat artificial and well-controlled therefore it has low ecological validity which means the results may not be generalised to natural settings as different outcome may be obtained. Since, in those studies, the patients were needed to undergo interview to ensure that their phobia met its phobia’ criteria therefore the studies only contained small sample size. Having small sample size tend to establish lack of population validity, which means the findings may not represent the wider population as few studies showed to only involved the eastern culture so it may not be relevant if it was used to represent the western culture as well as since the age range used were restricted therefore different outcome might be obtained if different ages of patients were being examined. To make the findings become more representative, large groups of patients with different ages and cultures would be required depending on who the research objectives are.

The U.S political structure, like most countries, is divided along the very basics: the rules of taxation and government expenditure. The two parties are miles apart in their approach to dealing with annual budgetary challenges and such decisions are significantly politicized at the expense of sound and effective long-term decision making. Moreover, as reported by the Wall Street Journal, the U.S Treasury is expected to shore up much of the revenue of Fiscal 2018 on interest repayments of the ballooning deficit than even on defense and other social programs like Medicaid and Social Security. In the light of the aforementioned issues, a Balanced Budget amendment to the US constitution would play a crucial role in providing much needed economic stability, reduce unnecessary and irresponsible spending and waste fraud and help lower the risks associated with a disproportionate deficit.
To put it simply, a Balanced Budget amendment would make it mandatory on the Federal Congress to come up with a set of taxation rules and government spending that results in an equilibrium between operating revenues and expenditures thereby reducing the annual borrowing requirements to pay up for the deficits. In other words, it will force Washington to live within its means.
There are many reasons to support this amendment. Recent political fights over the Federal budget reinstates the focus on the political gridlock that accompanies Washington. Firstly, as we saw in 2013, the fight over funding for Obamacare and in 2017, the clash over Immigration, caused government shutdowns as the two parties failed to reach consensus because of issues not directly related to everyday spending. This amendment would make it a constitutional prerogative for both parties to reach a deal without compromising other non partisan areas of government. Another benefit stems from the ever-increasing debt-ceiling problem in the way Congress appropriates spending. A debt-ceiling creates a limit on how much the Treasury can borrow to fund the deficit in the budgets. According to statistics by Business Insider, over the past ten years, the national debt of the United States government has grown from $9.4 trillion to over $21 trillion over the past ten years-a whopping 123%. With this amendment, Congress would eliminate the need to raise the debt-ceiling which will be integral also to the national security and sovereignty of the U.S. as most debt is owed to other countries. Furthermore, the crux of the amendment lies with healthy economic policy construction. Currently, almost forty-nine of the fifty states have some form of balanced-budget rules. The impetus to this reform views an economic model that is sustainable and does not limit successive governments with the debts of the previous ones. The amendment would impose on Congress the legal barriers in budgetary decisions which will result in bipartisanship in the legislature as both parties would be constitutionally obliged to follow the rule.
To enshrine this as a constitutional amendment is required for several key reasons. To begin with, as President Lincoln used with the passage of the thirteenth amendment for the abolition of slavery, anything which is a part of the constitution becomes universal. This means that it stands the test of time, political and social change and even the changing power structures in government. Coupled with this rationale, the process to amend the constitution is long and tiresome compared to a legislative bill which can be easily repealed with a majority vote. Something which is as crucial as the economic mechanism of the country should not be passed by Congress because it would deprive it of the stability that it was meant to establish in the first place. Moreover, to answer the critics question of constitutional outreach in policy making, we have already seen significant Supreme Court cases where the judiciary regulated the economic landscape such as the use of the Commerce clause for inter-state trade. Hence, a balanced budget amendment would only achieve its purpose with a constitutional mandate.
We all know that Congress is broken. And this is the reason that this amendment, despite being brought up several times, has never passed. This is also because the issue is inherently political in nature with economic conservatives supporting it widely unlike those on the left. The movement for this amendment started with the ‘Great Society’ program of President Johnson and even today, fiscal conservatives champion it especially after the passage of Tax Cuts and Jobs Act 2017 under President Trump. Meanwhile, Democrats like Minority Leader Pelosi said in reference to Republicans and the amendment, ‘Their real goal is to end Medicare, Medicaid, and Social Security as we know it.’ The budget is the foundation of all legislative outcomes in any government and a call to rein in spending will always have critics no matter what. Moreover, the latest amendment to the constitution passed almost three decades ago. Those were less divisive times.The rise of the tea party and the Trump Republicans and even the Democratic Socialists means that extremist agendas have infiltrated our government making reform less likely. In addition, the economic collapse in 2008 and the massive hurricanes in 2017 required swift flow of additional expenditure, meaning that unexpected events which require sudden government spending make it difficult to pass this amendment. Congress needs to act soon.If such deficits and debts continue to grow, we are not far from another economic catastrophe similar to 2008-9.


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Davidson, Kate & Kruger, Daniel. “U.S. on a Course to Spend More on Debt Than Defense.”
The Wall Street Journal. 11 November 2018.
Will, George F. “America needs a balanced-budget amendment.” The Washington Post. 3 January 2018

King, Colbert I. “A debt-ceiling crisis is on its way. Yes, again.” The Washington Post. 4 August 2017
Berman, Russell. “The Real Reasons Why the Government Shut Down.” The Atlantic. 20 January 2018

Collins, Michael. “The national debts and the federal deficit are skyrocketing. How it affects you.” USA Today. 16 October 2018

Black, Simon. “The US’ national debt is rising 36% faster than the economy.” Business Insider. 21 March 2018

Samito, Christian. “Lincoln’s Struggle with The Thirteenth Amendment. Forbes.” 6 December 2015

Golshan, Tara. “House Republicans are voting to make deficits unconstitutional after their $1.5 trillion tax cut.” Vox. 12 April 2018.


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