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PubMed1983

Behaviour therapy and psychodynamic psychotherapy: basic conflict or reconciliation and integration?

As recently as 1970 the approaches of behaviour therapy and psychodynamic psychotherapy (especially in the form of psychoanalysis) to the explanation and treatment of disorders of behaviour were acknowledged by most psychologists to be fundamentally different and irreconcilable. Sporadic earlier suggestions that reconciliation between and even integration of the two approaches might be possible have received strong support in the last decade from a number of sources. The literature relating to these developments is reviewed and it is concluded that a strong case appears to have been made out for reconciliation and integration. These 'paths of convergence' have been produced by both general and specific forces. However, critical voices (mainly from sympathetic but unconvinced psychoanalytically oriented therapists) have not been wanting. Their criticisms are reviewed as well as the fundamental issue of the relationship between theory and therapy in the two approaches. It is concluded that the case for the reconciliation and integration of behaviour therapy and psychodynamic psychotherapy has not been satisfactorily established on empirical grounds and is very difficult, if not impossible, to establish on theoretical grounds.

Adolescent↗
PubMed1985

Desensitization treatment of agoraphobia.

Clinical literature on desensitization treatment of agoraphobia is reviewed. The popular belief that in vivo desensitization is generally superior to imaginal exposure is critically examined. Studies which do not support this belief are reviewed, and the implications for clinical practice are considered.

Agoraphobia↗
PubMed1992

A search for contrast effects with fear evoking stimuli.

The occurrence of fear contrast effects was investigated in a laboratory study of fearful people. A total of 65 university students were exposed on separate occasions to two fearful stimuli (spiders and snakes). The first exposure session was manipulated so that experimental groups differed in the amount of fear evoked by the stimulus (high fear, moderate fear and low fear). Exposure to the second animal was designed to produce a moderate level of fear in all subjects. During exposure to the animals, measures of subjective fear and heart rate were taken. Compared to a control group of subjects who experienced moderate fear on two occasions, a prior high fear experience led to a decrease in fear of the second stimulus, and a prior low fear experience led to an increase in fear of the second stimulus. The increase in fear in the latter group was evident in both subjective and physiological indices of fear, but in the high fear group the contrast was evident only in subjective fear.

Adult↗
PubMed1997

Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia.

This study compared two components of a cognitive-behavioural treatment for panic disorder. Thirty-eight individuals with panic disorder and agoraphobia were randomly assigned to (a) cognitive restructuring, interoceptive exposure (i.e. repeated exposure to feared bodily sensations) and in vivo exposure to agoraphobic situations; or (b) cognitive restructuring, breathing retraining and in vivo exposure to agoraphobic situations. Assessments were conducted at pre-treatment, post-treatment and six months later. The treatments were equally effective on many measures. However, treatment that included interoceptive exposure was more effective at post-treatment in terms of panic frequency, overall severity and functioning, and more effective at six-month follow-up in terms of panic frequency, phobic fears and general anxiety and functioning. Follow-up results were limited due to attrition.

Adolescent↗
PubMed1997

Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder.

It has been claimed that the symptoms of post-traumatic stress disorder (PTSD) can be ameliorated by eye-movement desensitization-reprocessing therapy (EMD-R), a procedure that involves the individual making saccadic eye-movements while imagining the traumatic event. We hypothesized that these eye-movements reduce the vividness of distressing images by disrupting the function of the visuospatial sketchpad (VSSP) of working memory, and that by doing so they reduce the intensity of the emotion associated with the image. This hypothesis was tested by asking non-PTSD participants to form images of neutral and negative pictures under dual task conditions. Their images were less vivid with concurrent eye-movements and with a concurrent spatial tapping task that did not involve eye-movements. In the first three experiments, these secondary tasks did not consistently affect participants' emotional responses to the images. However, Expt 4 used personal recollections as stimuli for the imagery task, and demonstrated a significant reduction in emotional response under the same dual task conditions. These results suggest that, if EMD-R works, it does so by reducing the vividness and emotiveness of traumatic images via the VSSP of working memory. Other visuospatial tasks may also be of therapeutic value.

Adult↗
PubMed1997

The effect of one-session treatment for spider phobia on attentional bias and beliefs.

Spider phobics were tested before and after one-session treatment for spider phobia, or a comparable waiting period, using a spider-word Stroop test and questionnaires in which they rated spider-relevant threat beliefs. Compared with untreated spider phobic controls, the treated phobics changed significantly in their negative beliefs about spiders after treatment. Controls and treated phobics showed the same change in their reaction time latencies to spider stimuli in the Stroop test. These data are consistent with the hypothesis that the modification of threat beliefs is crucial in changing the response to phobic stimuli. It is concluded that the threat-specific Stroop test is an ambiguous measure of fear-related cognitive processes.

Adult↗
PubMed1986

Colour naming of phobia-related words.

A version of the Stroop test was developed which requires colour naming of spider words. Spider phobics were severely retarded on this task, but not on the conflicting colour-word Stroop or a Stroop with more general threat words. Desensitization of phobics significantly reduced interference on the Spider Stroop. A third experiment examined the retest properties of the Stroop and the value of equivalent forms. The explanation of the Spider Stroop effect and its usefulness as an outcome measure are discussed.

Adult↗
PubMed1985

Relationships between spider constructs in phobics.

An index of tight construing was derived from a Kelly grid in which the elements were spiders. This index, the coefficient of concordance, corresponds to the average correlation between constructs. Concordance was significantly higher in spider phobics than controls, in line with the hypothesis that emotional disorders are associated with higher correlations between symptom-related constructs (i.e. 'tight' construing). Desensitization, though it reduced phobic anxiety, had no effect on concordance.

Adult↗
PubMed1985

Skin conductance changes and psychotherapeutic content in the treatment of a phobic patient.

This study examined the relationship between skin conductance response (SCR) and psychotherapeutic content in a single case study. Four SCR conditions of one minute's duration each, reflecting maximal increase (amplitude) and least amount of change as well as one-minute periods preceding these criterion conditions, were measured for each psychotherapy session across 12 consecutive sessions. Psychotherapeutic content corresponding to these SCR conditions was evaluated according to 14 categories by five judges. There were significant relationships between SCR conditions and four psychotherapeutic content categories. Increases in SCR corresponded to a decreasing sense of mastery, increased symptom experience, increased symptom occurrence, and increased negative affects. This study suggests that there was a relationship between a responsive physiological measure and relevant psychotherapeutic content categories in an individual patient.

Adult↗
PubMed1976

Effects of two desensitization techniques, biofeedback and relaxation, on intractable epilepsy: follow-up study.

Two techniques of desedsitization, biofeedback and relaxation, were employed in a crossover design for the treatment of three young female patinets suffering from drug resistant epilepsy associated with anxiety and phobic symptoms. The patients were followed up for 15 months after the six months of treatment. The results indicate that both relaxation and biofeedback improved the patients' control of their seizures and the effects were maintained during the follow-up period.

Adolescent↗
PubMed1978

Hospital phobia: a rapid desensitization technique.

The less disabling phobias do not normally present a problem in that the stimulus may be avoided. This would also apply to hospital phobia until an acute medical or surgical problem might arise, when avoidance could constitute a direct threat to life. Although phobic illness is a common problem the small number of cases of hospital phobia recorded may represent the tip of the iceberg beneath which could be many phobic patients who deny their symptoms and risk their health because of their irrational fear. A case of hopsital phobia in a pregnant patient with suspected disproportion was treated by a rapid desensitization technique using hypnosis. After five sessions of 30 min each, the patient was symptom free. This simple method of desensitization, if more widely known would considerably minimize the risk caused by concealment of the phobic problem.

Adult↗
PubMed2002

Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo.

Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive-behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant-behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant-behavioural treatment with or without pain-coping skills training produced very modest and clinically negligible decreases in pain-related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain-related fear. Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.

Adult↗
PubMedDate not supplied

Cognitive and behavioural treatment of hypochondriasis.

BACKGROUND: This study investigates the feasibility and effectiveness of time-limited treatment protocols based upon cognitive and behavioural interventions. METHOD: Seventeen patients with DSM-IV diagnoses of hypochondriasis were offered 12 1-hour sessions of either 'pure' cognitive or 'pure' behavioural (i.e. exposure in vivo and response prevention) treatment. Patients were used as their own controls by observing a 4-week period without interventions before and after treatment. RESULTS: Patients in both treatment conditions improved on specific measures of hypochondriasis (Kellner's Illness Attitude Scales) and depression. These changes took place during the active treatment period, whereas in the control periods scores remained unchanged. Furthermore, no differential treatment effectiveness could be demonstrated. CONCLUSIONS: Cognitive and behavioural interventions seem to be active ingredients in the treatment of hypochondriasis, although the contribution of nonspecific factors (e.g. patient motivation, therapist attitudes, and the therapeutic relationship) requires further study.

Adolescent↗