Desensitisation and media violence.
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Aggression↗
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Results for “Desensitization, Psychologic”
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Hypochondriacal fears and beliefs in agoraphobia.
In order to evaluate hypochondriacal fears and beliefs in agoraphobia, the authors administered the self-rated Illness Attitude Scales to 18 agoraphobic patients. The patients reported hypochondriacal concerns similar to those of patients with hypochondriasis. After agoraphobia had been treated with exposure therapy in ten patients, hypochondriacal concerns did not differ significantly from those of normals. The findings suggest that hypochondriacal concerns are substantial in agoraphobia and that these wane when anxiety decreases.
Adult↗
Mechanisms of change of panic attacks with exposure treatment of agoraphobia.
In vivo exposure homework was applied to a consecutive series of 30 outpatients suffering from DSM-IIIR panic disorder with agoraphobia. Assessment of the characteristics of panic attacks (the prodromal phase immediately preceding the attack, acute peak anxiety, and the residual phase immediately afterwards) was done by an independent rater before treatment, after six sessions and at the end of therapy (12 sessions). Twenty-five of the 30 patients completed treatment. All of them still reported panic attacks after six sessions, even though the characteristics of panic partially improved. At the end of therapy, panic attacks disappeared in 21 of the 25 patients (84%) and these gains were maintained to 1 year follow-up thereafter by the majority (81%) of subjects.
Adult↗
Pre-treatment predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure.
Pre-treatment predictors of treatment outcome were examined in a group of 144 patients with panic disorder and agoraphobia randomly allocated to alprazolam+exposure (AE), placebo+exposure (PE), alprazolam+relaxation (AR), and placebo+relaxation (PR). First-time psychotropic medication use, severity of agoraphobic disability, and longer duration of illness predicted less global improvement at post-treatment. Pre-treatment severity of agoraphobia predicted less improvement both in the short- and the long-term. Predictors of poorer outcome at 6-month follow-up were older age, past history of depression, severity of phobia targets, and longer duration of illness. Sex, source of referral, pre-treatment depression-anxiety-panic, and expectancy from treatment did not relate to outcome.
Adult↗
Behavioural and combined therapy in panic states.
This review will focus only on those paradigms for treatment of panic states with agoraphobia. Until recently the behaviour therapy literature has completely ignored panic disorder and has focused exclusively on the agoraphobic aspect of this syndrome. To summarize the behavioural therapy of panic disorder and agoraphobia, it appears that exposure is in the short run the most effective behavioural paradigm in agoraphobia. However, when contrasted with cognitive approaches it does not appear to be as effective in the treatment of panic disorder. In conclusion, it is unclear whether we can speak of antiphobic medications. Certainly studies of imipramine, chlomipramine, monoamine oxidase inhibitors, and alprazolam have demonstrated an anti-panic affect of medications and a subsequent improvement in phobic avoidance. However, when exposure is not made a part of the treatment, there is a much poorer resolution and a tendancy for the patient to relapse.
Agoraphobia↗
Imaginal response events in systematic desensitization: a pilot study.
The primary focus of systematic desensitization (SD) is physiological responsivity in the presence of a conditioned aversive stimulus. However, SD also effects changes in motorapproach behavior and self-report. This study explores the possibility that SD directly affects the motor response system by way of conditioning covert approach responses in the presence of the imaginal aversive stimulus. Two independent variables were investigated: the content of instructions and actual covert motor responses during SD. Twenty-four subjects were classified as high- or low-responders on the basis of electromyographic responsiveness to instructions to imagine movement. Half the high- and half the low-responders were given a series of instructions to imagine-motor-approach behavior toward snakes. The remaining subjects received instructions to imagine only the snakes themselves with no reference to motor response. Imaginal scenes of 30-sec duration were alternated with relaxation periods of the same length. A significant difference was found between the posttreatment scores of high- and low-responders on performance measures, the high-responders performing better. The difference between the two instruction groups was not statistically significant. Self-report data suggested some subjects given instructions to imagine only snakes actually imagined themselves approaching snakes. Therefore, data were re-analyzed after instruction groups were reconstructed accordingly. A statistically significant difference was found on both factors. Continued investigation may further support imagery as covert behavior, open to empirical study.
Behavior Therapy↗
Stress-related, posttraumatic chronic pain syndrome: behavioral treatment approach.
Chronic pain syndromes are often the result of traumatic injury. The life threatening nature of a substantial number of these traumata precipitates the development of posttraumatic stress disorder in a sizable percentage of accident incurred chronic pain conditions. The present study presents evidence that systematic desensitization, a behavioral technique, can provide significant resolution of posttraumatic stress when this disorder occurs in the chronic pain population.
Adult↗
Cue exposure and learning theory.
The implications are discussed for cue exposure treatment of four theoretical issues; (a) spontaneous recovery, (b) response competition, (c) generalization, and (d) the cognitive basis of conditioning. It is suggested that practical cue exposure treatment will not be as straight-forward as initial trials have suggested.
Alcoholism↗
An evaluation of a behaviour therapy programme as an intervention treatment for the fear of withdrawal with heroin-dependent persons.
A methadone withdrawal programme (MWP) and a behaviour therapy programme (BTP) were compared in terms of their effectiveness to prevent relapse of heroin addicts after methadone treatment. The BTP incorporated systematic desensitization to effect a decrease in levels of fear of both physical and environmental withdrawal, in addition to assertive training to effect an increase in coping and social skills.Twenty-three voluntary ambulatory patients were allocated in four groups, one group receiving only the MWP (M), one only the BTP (BT), a third, a combination of the two treatments (MBT), and the fourth, a control group of no treatment (C). Analysis of data revealed a significant difference between the four groups over the duration of the eight-week programmes, both in improvement of social skills and in the decrement of fear levels. On each of the dependent measures clients undergoing the BTP performed significantly better than those receiving the MWP. Relapse was prevented in BT, decreased in MBT, but was not prevented in M. No significant difference occurred between M and C. Associations were revealed between fear of withdrawal, fear of negative evaluation, social avoidance and distress, lack of interpersonal assertiveness and the rate of relapse, giving some indication of the possible factors underlying recidivism.
Adult↗
Aversive therapies for substance abuse: do they work?
More than two decades of research in the use of aversive behavioral interventions for the treatment of drug and alcohol abuse is reviewed. This survey covers only the areas of conditioned aversive states (using chemical or electrical stimuli) and extinction/desensitization. While many of these treatment interventions hold promise, none has been fully explored with properly controlled group studies. Suggestions are offered which may aid in the evaluation of behavioral interventions for substance abuse and increase the clinical impact of this work.
Apomorphine↗
Behavior modification in social work practice.
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Adolescent↗
Fear induced complexity loss in the electrocardiogram of flight phobics: a multiscale entropy analysis.
In this study we explored the changes in the variability and complexity of the electrocardiogram (ECG) of flight phobics (N=61) and a matched non-phobic control group (N=58) when they performed a paced breathing task and were exposed to flight related stimuli. Lower complexity/entropy values were expected in phobics as compared to controls. The phobic system complexity as well as the heart rate variability (HRV) were expected to be reduced by the exposure to fearful stimuli. The multiscale entropy (MSE) analysis revealed lower entropy values in phobics during paced breathing and exposure, and a complexity loss was observed in phobics during exposure to threatening situations. The expected HRV decreases were not found in this study. The discussion is focused on the distinction between variability and complexity measures of the cardiac output, and on the usefulness of the MSE analysis in the field of anxiety disorders.
Adult↗
Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention.
The efficacy of contemporary cognitive therapy for obsessive-compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.
Adolescent↗
Responses to symptom induction exercises in panic disorder.
Exposure to panic symptoms (interoceptive exposure) is often included as part of treatment for panic disorder (PD), although little is known about the relative effects of particular symptom induction exercises. This study describes responses of individuals with PD and nonclinical controls to 13 standard symptom induction exercises and 3 control exercises. Generally, individuals with PD responded more strongly to symptom induction exercises than did controls. The exercises producing the most fear included spinning, hyperventilation, breathing through a straw, and using a tongue depressor. This study also reports findings regarding specific symptoms triggered by each exercise, the percentage of participants reporting fear during each exercise, and predictors of fear.
Adult↗
Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.
Adult↗
The efficacy of videotape feedback for enhancing the effects of exposure-based treatment for social anxiety disorder: a controlled investigation.
Correcting patients' faulty beliefs concerning social evaluative threats is the hallmark of cognitive-behavioral treatment of social anxiety disorder. The current study examined the efficacy of two videotape feedback procedures as adjuncts to exposure-based treatment. Participants suffering from social phobia (N=77) were randomly assigned to one of four conditions: (a) credible placebo treatment (PLA); (b) exposure + no feedback (EXP); (c) exposure + videotape feedback of performance (PER); or (d) exposure + videotape feedback of audience responses (AUD). Contrary to prediction, the videotape feedback procedures did not enhance the effects of exposure-based treatment. Clinical and theoretical implications are discussed.
Adult↗
Emotional exposure in the treatment of substance use disorders: conceptual model, evidence, and future directions.
In this article, we review research on the nature and treatment of panic disorder, and apply these findings to a discussion of the role of internal cue exposure in the treatment of substance use disorders (SUDs). Two features of panic treatment were used as a model for interventions for SUDs: exposure to internal (interoceptive) cues rather than reliance on external (environmental) exposure alone, and use of cue exposure to try to inoculate individuals against future maladaptive patterns. Specifically, we emphasized the role of exposure to internal, largely emotional cues, as a way to enhance resilience to cues for relapse in individuals with SUDs. Hypothesized moderators and mediators of this treatment approach were discussed, as were similarities between this research agenda and an increasing focus on the role of emotional acceptance/tolerance in cognitive-behavioral treatments.
Cognitive Behavioral Therapy↗
Treatment of specific phobia in adults.
This is a comprehensive review of treatment studies in specific phobia. Acute and long-term efficacy studies of in vivo exposure, virtual reality, cognitive therapy and other treatments from 1960 to 2005 were retrieved from computer search engines. Although specific phobia is a chronic illness and animal extinction studies suggest that relapse is a common phenomenon, little is known about long-term outcome. Treatment gains are generally maintained for one year, but longer follow-up studies are needed to better understand and prevent relapse. Acutely, the treatments are not equally effective among the phobia subtypes. Most phobias respond robustly to in vivo exposure, but it is associated with high dropout rates and low treatment acceptance. Response to systematic desensitization is more moderate. A few studies suggest that virtual reality may be effective in flying and height phobia, but this needs to be substantiated by more controlled trials. Cognitive therapy is most helpful in claustrophobia, and blood-injury phobia is uniquely responsive to applied tension. The limited data on medication have not been promising with the exception of adjunctive D-clycoserine. Despite the acute benefits of in vivo exposure, greater attention should be paid to improve treatment acceptance and retention, and additional controlled studies of more acceptable treatments are needed.
Adult↗