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PubMed1977

A case of homosexuality treated by in vivo desensitization and assertive training.

Sexual deviation is not a unitary condition, amenable to a single treatment approach. Deviant sexual arousal has been overemphasized while inadequate attention has been given to associated behavioural problems such as deficient heterosexual arousal, deficient heterosexual skills and gender role deviation. A client with homosexual arousal and requesting aversion therapy was treated successfully and rapidly using in vivo desensitization and assertive training. The treatment is described and the importance of the behavioural analysis in directing the course of therapy is stressed.

Adult↗
PubMed1977

Desensitization therapy for body image anxiety.

A newly devised therapy technique to desensitize individuals for body image anxiety arising from conversion symptoms and psychophysiologic disorders is outlined. One application involves the projective use of inkblots with high anatomical content which provide a source of visual input to stimulate somatic images in consciousness. When these are activated in a state of relaxation the anxiety content of the pathologic anatomical imagery is reduced. A case history involving desensitization treatment for a psychoneurotic patient's psychophysiologic symptom of premature ejaculation is cited. It is primarily designed to alert interested clinical investigators to this technical innovation in treatment.

Adult↗
PubMed1990

Anticipatory nausea and vomiting: a form of chemotherapy phobia?

This paper proposes that the phenomenon of anticipatory nausea and/or vomiting is a component of a phobic response to chemotherapy. Two cases are presented to highlight the clinical aspects of chemotherapy phobia. The evidence confirming such a diagnosis is put forth as it relates to anticipatory anxiety, phobic response, avoidance behaviour and treatment.

Adult↗
PubMed1991

A psychotherapist engages in behaviour therapy.

The article reviews clinical findings that led an experienced psychotherapist to favour behaviour therapy over psychotherapy for patients who have anxiety disorders involving avoidance of specific situations or avoidance of specific activities. It is maintained that anxiety disorders are best treated through psychotherapy when they are demonstrably connected to disturbances in interpersonal relations. Three basic procedures in behaviour therapy are described: desensitization, direct exposure, and cognitive restructuring. Transference patterns in each of these procedures are delineated. A fourth procedure, "clinical bargaining," helps patients relinquish avoidances by experimenting with new behaviours outside the consulting room. Selected aspects of transferase and counter-transference in clinical bargaining are discussed. In dealing with single patients, it is recommended that clinicians separate the non directive position of the psychotherapist from the directive role of the behaviour therapist, since these two roles are largely irreconcilable.

Adult↗
PubMed1975

Symptomatic treatment of agoraphobia and social phobias: a follow-up study.

1. Twenty-six out of 28 out-patients with agoraphobia and social phobias who had originally been treated with phenelzine or placebo in a double-blind clinical trial were followed up for a mean period of one year. During the follow-up period patients received further pharmacotherapy or behaviour therapy, except that those patients originally receiving placebo were not allowed therapy with monoamine oxidase inhibitors. 2. Ratings of phobic and additional symptoms, social adjustment and degree of personality disorder were made after one year by one of the authors (D.S.) who had no prior knowledge of the treatment each patient had received. 3. There were no significant differences in any of the ratings between the patients of the two groups, but those originally receiving placebo had more additional treatment in the follow-up period. Patients continuing to receive phenelzine frequently experienced a return of symptoms if the drug was withdrawn before six months treatment had elapsed. 4. Degree of personality disorder showed a significant negative correlation (p = -0.6) with improvement in the phenelzine group but not in those receiving placebo originally. 5. Improvement in social adjustment items was less than improvement in symptoms at follow-up. The implications of this are discussed. 6. The results suggest that phenelzine is of comparable efficacy to other symptomatic treatments for agoraphobia and social phobias, but that it acts mainly by symptom suppression. Prolonged treatment in patients with personality disorders is not indicated, for improvement is less likely and the dangers of dependence are greater.

Agoraphobia↗
PubMed1975

Treatment of chronic obsessive-compulsive neurosis by in-vivo exposure. A two-year follow-up and issues in treatment.

Twenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4-12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up. Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up. Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach. The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication. The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or anti-depressant treatment. One quarter refused behavioural treatment after it was offered. Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.

Adult↗
PubMed1976

Imaginal flooding and exposure to real phobic situations: treatment outcome with agoraphobic patients.

Each of thirty-six female agoraphobic out-patients were treated by one of three methods: 8 sessions of imaginal flooding followed by 8 sessions of practice in the real situation; 16 sessions of combined flooding and practice; or 16 sessions of practice alone. Three therapists treated equal numbers of patients in each group, and there was some evidence that patients' response varied according to the therapist seen, irrespective of treatment group. There were no significant differences between treatment groups after 8 sessions, 16 sessions or on six-month follow-up. It is concluded that there are no long-term differences between the effects of treatments involving exposure to either imaginal or real phobic situations or to a combination of both, provided that patients are encouraged to practise between sessions.

Agoraphobia↗
PubMed1976

Imaginal flooding and exposure to real phobic situations: changes during treatment.

This paper reports the results of measures taken during treatment in the study of imaginal flooding and exposure to real phobic situations previously described by Mathews, Johnston, Lancashire, Munby, Shaw and Gelder (1976). On weekly measures of change of similar reduction in phobic behaviour in all treatments was found, confirming the previous findings. Differences in therapist effectiveness were also confirmed. On measures of the immediate effects of treatment, exposure to the phobic situation had consistent positive effects, imaginal flooding had little or no detectable effect. It is proposed that the treatments studied differ in their immediate effects on phobic behaviour but also have the common effect of facilitating counterphobic behaviour outside the treatment situation, and that this is the main agent of therapeutic change.

Anxiety↗
PubMed1976

Fresh symptom emergence after intensive behaviour therapy.

The outcome of a standard four-day intensive symptomatic treatment programme with 39 agoraphobics is examined in relation to the incidence of fresh symptom emergence. Twenty-six patients suffered fresh symptom emergence during follow-up, and there was a significant association of fresh symptom emergence with poorer outcome at one-year follow-up. About 18 percent of patients were adversely affected by the treatment programme, as judged on a wide range of symptoms and measures of inter- and intra-personal adjustment. Sixteen individually treated patients are then compared with the 39 group-treated patients and differences in drop-out rate are discussed.

Agoraphobia↗
PubMed1976

Behavioural treatment of orgasmic dysfunction: a controlled study.

Twenty-two anorgasmic women received 20 sessions of a multiple-technique behavioural therapy. The design included blind ratings by two independent assessors, multiple assessment instruments, and a waiting list control group. Treatment was significantly better than no treatment in terms of: (1) the percentage of patients experiencing orgasm during at least 50 per cent of sexual relations; (2) the percentage of women reporting satisfactory sexual relations at least 50 per cent of the time; (3) patients' ratings of positive reactions to various sexual behaviours; and (4) assessors' global clinical ratings. Significant improvement was also noted on the MMPI, IPAT, and Symptom Check List. Improvement was maintained at a follow-up average 9 months later. These results support the impression that a behavioural approach offers much promise in treating female orgasmic dysfunction.

Adult↗
PubMed1977

A simple and effective treatment for flight phobia.

Seventeen patients were treated by group desensitization and autohypnotic training over a period of six weeks for flight phobia, with a highly significant reduction of fear for the group. Expectation of benefit correlated positively with fear reduction.

Adolescent↗
PubMed1977

The role of social anxiety in social interaction difficulties.

Social anxiety was found to be the most common complaint in a sample of psychiatric patients reporting social interaction difficulties. High social anxiety was shown to be associated with impairments to social behaviour in socially anxious psychiatric patients and non-psychiatric volunteers. A comparison was made of systematic desensitization and a form of social skills training in the treatment of social interaction difficulties associated with high social anxiety. This indicated that while both therapies were effective in the reduction of social anxiety, the training programme was the more effective in reducing problem behaviour, but desensitization appeared to lead to a wider generalization of improvement as indicated by increases in social participation.

Adolescent↗