Behavioral indices of habituation and sensitization during exposure to phobic stimuli.
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Adult↗
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Applied tension, applied relaxation, and the combination in the treatment of blood phobia.
Thirty patients with phobia for blood, wounds and injuries were treated individually with applied tension, applied relaxation, or the combination of these two methods for 5, 9 and 10 sessions, respectively. They were assessed on self-report, behavioral and physiological measures before and after treatment, and at a 6-month follow-up. All groups improved significantly on 11/12 measures, and the improvements were maintained at follow-up. Applying stringent criteria, 73% of the patients were clinically improved at the end of treatment and 77% were so at follow-up. Despite a failure to find between-group differences, on many measures there was a trend favoring applied tension. Since this method is as effective as the other treatments in only half the time, applied tension should clinically be the treatment of choice for blood phobia.
Adolescent↗
Relationships among measures of communication, marital satisfaction and exposure during couples treatment of agoraphobia.
The goals of this study were to examine the relationships among measures of couples interactions (satisfaction and communication), and response to treatment within a group of agoraphobic clients and their partners. The treatment included the clients' partners in structured, graduated in vivo exposure practices. Twenty-two clients and their partners completed pre-, mid- and post-treatment assessments. Treatment responders rated themselves and their partners as more communicative regarding the client's fears, at pre- and mid-assessments in comparison to nonresponders; measures of communication related inversely to levels of anxiety reported during exposures, but marital satisfaction did not relate to any measure of exposure. In addition, level of anxiety during exposure differentiated responders from nonresponders; responders experienced a significant reduction in their levels of anxiety. Finally, ratings of frequency of communication at mid-assessment were highly predictive of treatment outcome at post-assessment. The implications from these findings for communication skills training for a subset of couples who enter couples treatment for agoraphobia are discussed.
Adult↗
The effect of an aversive event on the return of fear.
An experiment on the return-of-fear (ROF) was carried out on 40 snake- or spider-phobic subjects in order to determine whether an arousing event that occurs shortly before retest influences the magnitude of the ROF. Additionally, we attempted to produce a reinstatement of fear by introducing an unrelated aversive event (shock) after the fear had been reduced. The arousal manipulation successfully increased subjective arousal but not heartrate responsiveness. The increases in subjective arousal were not followed by increases in ROF, and the attempt to produce a reinstatement of fear did not succeed. A significant correlation between speed of fear-reduction and ROF was obtained.
Adult↗
Cardiac and neuroendocrine responses to exposure therapy in height phobics: desynchrony within the 'physiological response system'.
Subjective, behavioral, cardiovascular and neuroendocrine responses were intensively monitored in two height phobics over a full course of exposure therapy and at follow-up. Both subjects showed rising cortisol responses and stable, non-extinguishing norepinephrine responses to height exposure over the course of treatment, while improvement occurred in subjective and behavioral response systems. They had differing heart rate responses. Despite desynchrony amongst anxiety response systems and within the physiological 'system' at treatment conclusion, both subjects had successful outcomes which were preserved at follow-up. Implications for the measurement of the 'physiological response system' in behavioral research are discussed.
Adult↗
Home-based treatment of obsessive-compulsive patients: intersession interval and therapist involvement.
In a 2 x 2 factorial design massed vs spaced and therapist vs self-controlled exposure were compared with obsessive-compulsive patients. Intersession interval was varied keeping constant the length of exposure time and number of exposure sessions. Treatment in all conditions was home based. Treatment led to highly statistical and significant improvements on all measures. Massed exposure was as effective as spaced exposure; self-controlled exposure proved to be as effective as therapist-controlled exposure.
Adolescent↗
Fast, slow and sudden reductions in fear.
An experiment was carried out on 30 spider-fearful and 30 snake-fearful subjects in an attempt to replicate the finding of a correlation between the rapid reduction of fear and the reduced likelihood of significant fear returning after an interval (low return of fear). It was also hoped to observe and closely examine the occurrence of sudden and enduring reductions in fear. The results from the two groups of fearful subjects were reassuringly similar. The fears of both groups were significantly reduced in a relatively brief session, and small but significant returns of fear were observed after a 2 week interval, with the slow responders reporting a higher return of fear than fast responders. The time taken to reduce the fear correlated 0.36 with the return of fear. A minority of subjects did experience a subjectively important, abrupt change in their fears, these 'glass-jar' experiences were associated with faster (overall) reductions in fear, a lower return of fear, and subjective estimates of permanent and generalized reductions of the fear.
Arousal↗
Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia.
The present study investigates the differential effectiveness of three treatment packages for agoraphobia. Patients suffering from panic disorder with agoraphobia (DSM-III-R) received one of three treatments: Breathing Retraining with Cognitive Restructuring (BRCR), graded self-exposure in vivo (EXP), or a combination of BRCR and EXP. Treatments consisted of 8 sessions. Assessment consisted of self-report measures for panic, phobic anxiety and avoidance, depression, general anxiety, somatic complaints and fear of body sensations, and of two respiratory measures (respiratory rate and alveolar pCO2). The treatments resulted in a reduction in symptomatology on all self-report measures, except panic frequency, and in a decrease in respiratory rate. There was no evidence for a differential efficacy for any of the treatments on any of the variables. Contrary to expectation, and at odds with findings from earlier studies, BRCR had no significant effect on panic frequency. A detailed comparison of sample characteristics of patients in our study and previous studies, did not yield insight into possible causes for the failure to replicate earlier results. The limited effectiveness of breathing retraining in reducing panic, as observed in the present study, leads us to conclude that the role of hyperventilation in panic is less important than previously thought.
Adult↗
Instructions to focus upon or distract from internal cues during exposure treatment of agoraphobic avoidance.
Instructions to focus upon feared somatic sensations were compared to instructions to engage in distracting tasks, while practising in vivo exposure to feared agoraphobic situations. Thirty individuals assigned a primary diagnosis of Panic Disorder with moderate to severe Agoraphobia were assigned randomly to one of the two treatment conditions. Assessments were conducted pre, post and 6 months following treatment completion, using subjective, behavioral and clinician-rated measures of change. Composite outcome criteria indicated a trend for distracted exposure to yield a higher percentage of improvement than focused exposure, at post assessment. However, focused exposure group members improved to a greater extent over the follow-up interval than members of the distracted group. These trends were relatively weak, given the absence of significant group by time interactions in terms of individual variable analyses. The results were discussed with reference to the role of distraction in fear reduction.
Adolescent↗
Exposure in vivo vs social skills training for social phobia: long-term outcome and differential effects.
This study examined the long-term effectiveness of specific exposure in vivo (individual IE or group GE) and of office-based social skills training (group SST) in two groups of patients with social inhibition (primary social skills deficits or primary social phobia). Seventy-eight outpatients were divided into these two subgroups according to clinical assessment. Twenty-seven patients received SST which consisted of 25 twice a week 90-min group sessions: 32 patients received GE and 17 IE. Exposure in vivo consisted of 4 weekly (8-hr in the group condition included 2 hr discussion; 3 hr in the individual condition included 1 hr discussion) sessions. Self-rating-assessments were carried out at pre- and post-treatment, at 3 months- and 2.5 yr follow-up. The general results indicate that all three treatment modes led to clinically and statistically-significant improvements in the main problem area (social anxiety, skills deficits), in other neurotic complaints (depression, obsessions, psychosomatic complaints) and in attribution-style. Patients with the diagnosis of primary phobia seemed to get the same profit from either treatment and showed slightly better gains (in all treatment modalities) than patients with skills deficits at long-term follow-up. Within the subgroup with skills deficits there was a tendency for superior outcome of group exposure. These results and recommendations for future research are discussed.
Adult↗
Examination of a backchaining/counterconditioning process during the extinction of conditioned fear.
Two experiments using rat subjects are reported which attempt to delineate the theoretical mechanisms involved in exposure/extinction procedures that are used to eliminate conditioned fear. In Experiment 1, a within-subjects design was employed to study the temporal course of the extinction process by examining the relationship among three separate measures of classically conditioned fear--suppression of an ongoing, operant behavior during the nonreinforced fear-eliciting CS presentation, the time to the first response during this CS presentation, and the time to recover responding following termination of the CS. The results indicated a temporal relationship among these measures, both within and across nonreinforced CS trials, which were considered to reflect a backchaining of a fear-antagonistic response during extinction, and provided an empirical demonstration of an extinction process consistent with Denny's (Behaviour Therapy and Experimental Psychiatry, 7, 315-321, 1976) elicitation/backchaining explanation of extinction. Experiment 2 attempted to manipulate the course of extinction and the temporal relationship among these three fear measures through the paired presentations of the fear CS with a palatable substance (maltose). This procedure produced greater extinction apparently by facilitating the backchaining process. These results are discussed with implications for exposure-based therapies.
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Effects of diazepam on approach, self-reported fear and psychophysiological responses in snake phobics.
The effects of diazepam was assessed on a number of measures of phobic anxiety. Snake-phobic subjects underwent two sessions on either diazepam or placebo in a crossover design. In addition to a habituation series, a slide with the phobic object was displayed as well as a live snake which subjects were asked to approach. The anxiolytic effect of diazepam was manifest in only one measure of fear, namely self-rated fear at the point of closest approach when it also attained the highest level. The result would indicate that diazepam has an anxiolytic only on high levels of subjective anxiety. The magnitude of the phasic cardiac reaction to the slide was highly and positively correlated with self-rated fear of the slide.
Adolescent↗
Is agoraphobia harder to treat? A comparison of agoraphobics' and simple phobics' response to treatment.
Agoraphobia is reputed to be more difficult to treat than simple phobia. In a test of this supposition, 38 agoraphobics and 19 simple phobics were each given 10 sessions of graduated in vivo exposure. They were assessed before and after therapy using a behavioral avoidance test, behavioral diaries, and self-report measures. Analysis of covariance revealed unequivocal posttest differences only on self-assessed disability level; agoraphobics had changed less in their report of global disability immediately following treatment but not at follow-up. Sixty-eight percent of the simple phobics showed clinically significant improvement on avoidance of the Main Phobia, compared with 34% of the agoraphobics. On three other outcome measures, including more precise behavioral measures of phobia, agoraphobics and simple phobics responded equivalently to treatment. Given clinicians' impression about the comparative difficulty in treating agoraphobic clients, fewer differences in treatment response were obtained than were expected. Several possible explanations for this discrepancy are discussed.
Adult↗
Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia.
Thirty patients with phobia for blood, wounds and injuries were treated individually with applied tension (AT), exposure in vivo (E), or tension-only (T) for 5 sessions. They were assessed on self-report, behavioral and physiological measures before and after treatment, and at a 1 yr follow-up. All groups improved significantly, and the improvements were maintained at follow-up. Applying stringent criteria, 90% of the AT-, 80% of the T-, and 40% of the E-patients were clinically improved at the end of treatment. The corresponding figures at follow-up were 100, 90 and 50%, respectively. AT differed significantly, and T marginally from E at both assessments. Applied tension, or tension-only should, from a clinical point of view, be considered the treatment of choice for blood phobia.
Adult↗
The effect of concordance in the treatment of clients with dental anxiety.
This study followed from an earlier case study in which an agoraphobic client was treated daily for a period of four weeks by in vivo exposure. Ratings of his perceived anxiety responses in the behavioural, cognitive, and physiological systems were monitored throughout treatment. Concordance between these ratings was associated with positive outcome. This study was an attempt to replicate some of these findings. A group programme involving four sessions in which clients were taught anxiety management skills, exposed in imagination to situations relating, to dentistry, and given homework assignments was carried out with clients presenting with disproportionate dental anxiety. The subjects were obtained by means of local newspaper and radio advertisements and randomly assigned to a massed or spaced treatment condition. It was predicted that the massed condition involving shorter intersession intervals would be superior at producing habituation and concordance than the spaced condition. The results failed to show differences between the massed and spaced treatment condition with regard to concordance and outcome. However, it was confirmed, once more, that concordance between the three modes of anxiety responding was positively related to outcome.
Adult↗
Acquisition of blood and injection phobia and anxiety response patterns in clinical patients.
The ways in which blood phobics (N = 81) and injection phobics (N = 56) had acquired their phobias were retrospectively investigated. The patients were required to answer a questionnaire concerning: (a) the origin of the phobia, with items relevant for conditioning experiences, vicarious experiences and experiences of negative information/instruction; (b) physiological reactions; (c) anticipatory anxiety; and (d) negative thoughts while in the phobic situation. In addition background data on marital and occupational status, family history of phobia, fainting history, and severity of the phobia were obtained. Furthermore, the patients' behavioral, physiological, and cognitive-subjective reactions during the behavioral test were assessed. The results showed that a majority (52%) of the patients attributed the onset of their phobias to conditioning experiences, while 24% recalled vicarious experiences, 7% instruction/information and 17% could not remember any specific onset circumstances. There was no significant relationship between ways of acquisition and anxiety components, nor did conditioning and indirectly acquired phobias differ in severity.
Adolescent↗
Conditioning experiences in spider phobics.
Using the Phobic Origin Questionnaire (Ost, L. G. & Hugdahl, K. Behaviour Research and Therapy, 19, 439-477, 1981), the present study examined the extent to which severe spider phobics (N = 42) attributed their phobia to conditioning experiences, modeling experiences and/or informational learning experiences. Modeling was most often reported (71%), followed by conditioning (57%), and informational learning experiences (45%). It was also found that patients with a conditioning background reported less extreme cognitive symptoms when confronted with the phobic stimulus than patients with an indirect mode of acquisition (modeling and/or informational learning).
Adolescent↗
Cognitive therapy with obsessive-compulsive disorder: a comparative evaluation.
After a 4-week waiting period 21 obsessive-compulsives were randomly allocated to two treatment conditions (1) Rational Emotive Therapy (RET) and (2) exposure in vivo. RET consisted of analysing irrational thoughts; exposure in vivo was self-controlled. After six sessions and another 4-week waiting period all patients received six sessions of exposure in vivo. Both treatments resulted in significant improvement on anxiety/discomfort, Maudsley Obsessional Compulsive Inventory, and Dutch Obsessional Compulsive Questionnaire and in a reduction of scores on the Irrational Beliefs Test. Results were maintained to a follow-up 6 months later. No significant differences were found between the two conditions.
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