Flooding therapy: Effectiveness,stimulus characteristics,and the value of brief in vivo exposure

Three analogue experiments examined flooding therapy. Experiment 1 showed that flooding was more effective than standardized desensitization in reducing snake phobia. Experiment 2 examined three different modes of presenting the feared stimuli in flooding: taped auditory presentation, pictorial presentation, and a combination of these two. An additional combination group were given a brief in vivo exposure to the feared object immediately after each of three treatment sessions. Both a behavioral test and subjective estimates of fear showed advantages for the combined group that had the in vivo exposure, although it appeared that auditory instructions to imagine interaction with the snake was the best method for presenting the feared stimuli. Experiment 3 compared the auditory imagined method with and without ‘aversive’ or ‘implosive’ scenes, and with either an immediate or a delayed in vivo exposure. The only procedure to produce marked effects was the one that omitted ‘aversive’ scenes and provided immediate post-treatment in vivo exposure.     

Flooding in imagination vs flooding in vivo: A comparison with agoraphobics

In this investigation of agoraphobic patients, 3 different flooding procedures were compared: (1) prolonged exposure in vivo, (2) flooding in the imagination by a ‘live’ therapist and (3) a combination of flooding in the imagination and flooding in vivo. After an intermediate-test all clients were treated by the self-observation method, with a minimum of therapeutic intervention. Assessments were made at the beginning of treatment, during and at the end of treatment and at the follow-up one month later. Assessments were carried out by the therapist (in vivo measurement; phobic anxiety and avoidance scales; anxious mood and panic), by an independent observer (idem. minus in vivo measurement) and by the client (phobic anxiety and avoidance scales; FSS; social anxiety scale; SDS and I-E scale). Prolonged exposure in vivo plainly proved to be superior to flooding in the imagination. Combined flooding resulted in a greater improvement than flooding in the imagination, though only on the therapist's ratings. Self-observation did not add much to the effect of prolonged exposure in vivo and of flooding combined whereas self-observation, preceded by flooding in the imagination, resulted in a significant improvement on nearly all the variables.     

Massed vs. spaced exposure sessions in the treatment of agoraphobia

The differential effects of massed and spaced sessions of exposure in vivo were investigated with 11 agoraphobics in a crossover design. Clients were randomly assigned to one of the following two groups: (a) 10 daily sessions followed by 10 weekly sessions, or (b) 10 once-weekly sessions followed by 10 daily sessions. The results indicated that both massed and spaced sessions of exposure in vivo effected changes in avoidance behavior and subjective anxiety of agoraphobics, massed practice being superior especially with respect to avoidance. It was suggested that the superiority of massed practice is due to the lack of opportunity to engage in avoidance or escape during short inter-session intervals. The relationship between subjective anxiety and avoidance were considered and the differences between clinical and statistical significance were discussed.     

Cognitive behavior therapy for driving fear: A pilot randomized controlled trial

Fear of driving is common in clinical practice, while its treatment programs are understudied. This is the first randomized controlled trial to evaluate a newly developed protocol for cognitive behavior therapy (CBT) for driving fear compared with a wait list and to use specific assessment scales. 34 participants (30 women, 4 men) in an outpatient psychotherapy clinic were randomly allocated to either 18 sessions of CBT or a wait list (n = 17 each). After treatment, CBT was significantly more efficacious than the wait list with large effect sizes on the Instrument for Fear of Driving (IFD) (Cohen’s d = 2.58) and on the Driving Cognitions Questionnaire (DCQ) (Cohen’s d = 2.14). Driving fear is a condition treatable by CBT and the suggested protocol is safe, feasible and acceptable. Further studies with larger samples and active controls (e.g., virtual reality therapy) are required to draw generalizable conclusions on effect sizes.     

Reinforced practice and reduction of different kinds of fears in adults and children

The purpose of this study was to determine whether or not fears with different origins, course and chronicity could be reduced by a common treatment program. A number of therapeutic procedures that had been experimentally demonstrated to be individually important in prior behavior modification studies with neurotic disorders were combined into a single therapeutic program called ‘reinforced practice.’ The combined elements were: graduated and repeated practice in approaching actual phobic stimuli: reinforcement for gains in performance; feedback of measurable progress; and instructions designed to arouse expectations of gradual success. In each of four experiments involving four different fears, namely fear of heights, snakes and electric shock in adults, and fear of darkness in young children, Ss who expeienced the ‘reinforced practice’ procedure improved their performance by a significant and substantial margin as compared to untreated control Ss. These results suggest that regardless of different etiologies, regardless of whether or not the fears are ‘rational’ or ‘irrational,’ and regardless of whether or not the fears are transitory or long lasting, the same treatment procedure can be equally effective in reducing escape-avoidance behavior.     

On the Meaning of Being Real: Fantasy and ‘the Real’ in Personal Identity-Formation

Abstract

With the help of Lacanian psychoanalytic theory, this article addresses certain perplexities concerning personal identity that emerge from different kinds of interpersonal encounters. Lacan’s notion of the ‘fundamental fantasy’ incorporates the insight that phantasmic projections (of both self and other) form the basis of personal identity and interpersonal relations are a complex interplay between such projections. Nevertheless, in face of disconcerting pretence phenomena, the notion of a real self plays a profoundly important part in interpersonal relations. To call some phantasmic projections ‘pretensions’ or ‘delusions’ is simultaneously to admit that some must, by contrast, embody or express a real self. Lacan’s paradoxical answer to the question of whether the fundamental fantasy embodies the real self is ‘yes and no’. To explain this, I unpack the notion of the fundamental fantasy insofar as it is construed as the basis upon which we construct a complex identity (a semblance) imperfectly shielded from the traumatic Real. I offer an indirect account of the Real, via a critique of Rowlands on absurdity. I then sketch the developmental formation of a complex semblance, guided at its core by the fundamental fantasy, which structures the comportment of the self with a three-fold other. While the fundamental fantasy forms the core of a person’s identity and might be named the basis of the real self, Lacan warns that one must traverse it to acknowledge the Real in oneself. I elaborate on this via Derrida’s conception of the parergon. My aim is to demonstrate the irreducible complexity of identity formation and to show that to be real is to accept the uncertainty associated with acknowledging the Real in me that exceeds both my pretensions and the phantasmic reality that structures my identity.     

Interrogative suggestibility,delayed memory and self-concept

This study investigates the relationship between interrogative suggestibility as measured by the Gudjonsson Suggestibility Scale (GSS) and variables related to memory recall and self-esteem. There were 30 Ss, tested twice 1 week apart. After completing the GSS they were required to fill in a number of Semantic Differential scales relating to the concepts: Myself as I am generally, Myself during the experiment and The experimenter. Ss were generally more suggestible during the second interview when their memory about the context of the interrogation context had deteriorated. The exception was that negative feedback appeared to have most effect on suggestibility and self-esteem the first time it was applied. Self-esteem related to ‘competence’ and ‘potency’ correlated significantly with suggestibility, especially during the first interrogative session. Perceptions of the experimenter were generally not found to be significantly related to suggestibility.     

The reduction of anxiety in children: a comparison of the effects of 'systematic desensitization in vitro' and 'systematic desensitization in vivo'

Twenty-four children between the ages of 5 and 10. selected on the basis of fear of water, as determined by parents and swimming teachers, were divided into two experimental groups and one control group. One of the experimental groups was treated with four sessions of in vitro desensitization (gradual imaginal exposure to fear evoking stimuli plus relaxation), followed by four sessions of in vivo desensitization (real-life exposure to fear evoking stimuli plus relaxation). The other group received eight sessions of in vivo desensitization. The control group took part only in the tests, which were administered at the commencement of treatment, after four sessions, and at the end of the course of treatments. In testing, a behavior observation record was used to score the subject's behavior in the given situation; in addition, two teacher's records were used, in which swimming teachers recorded their evaluation of the subject's anxiety in each situation.Better results were achieved by desensitization in vivo than by desensitizalion in vitro or by the control procedure. No differences were found between the latter two groups. It could not be demonstrated that desensitization in vitro increased the effectiveness of subsequent desensitization in vivo     

Accuracy, Sincerity and Capabilities in the Practice of Teaching

This paper examines the relative strengths of two conceptions of teaching. The thinner conception, which underpins a report of the Ministerial Committee on Teacher Education in South Africa, takes the definitive purpose of teaching as the organization of systematic learning. The thicker conception draws on work by Martha Nussbaum and Bernard Williams and comes from my ongoing thinking about the conditions for trustworthy practice. I propose that educative teaching is a practice whose definitive purpose is to enable people’s flourishing by developing their capabilities as these are connected to what Williams calls ‘the virtues of truth’—‘Accuracy’ and ‘Sincerity’. I consider the case for claiming (i) that the purpose of educative teaching is to enable learners to develop the virtues of truth and (ii) that trustworthy practice depends on teachers having these virtues themselves. En route I challenge MacIntyre’s grounds for refusing to admit teaching as a practice.     

Personality,dream content and dream coping style

One hundred and thirty Ss completed the Eysenck Personality Questionnaire and a Dream Analysis Questionnaire (DAQ), based on retrospective recall. Differential dream content was self-rated on three parameters: frequency, duration and intensity. Factor analyses identified three specific dimensions of dreaming: ‘Personal Avoidance’, ‘Eroticism’ and ‘Adventuresomeness’. It was clear that, on the frequency and image-intensity categories, dream content related overwhelmingly to Neuroticism. Personality , as measured, was clearly related to the salience (e.g. clarity of imagery, emotionality) of dreams. Given the specificity of dream content, the results suggest the presence of a person-specific coping style, primarily affective in nature. The findings are discussed in light of the continuum or parallel model of the dream-waking cycle. Implications for the cognitive modification of aberrant dream images or fantasy processes are briefly reviewed.     

Restoration of Intimacy and Connection in the Treatment of Couples with Substance Abuse Issues

SUMMARY

Addictions destroy both individuals and in particular their intimate relationships. Couples remain together for many reasons and when one partner has an addiction, the spouse has the fantasy that when the addiction is addressed the couple relationship will return to ‘normal.’ This article focuses on couple issues that have not been addressed in addiction treatment facilities and examines the role of the couple therapist versus the addiction counselor. Techniques and clinical interventions with this population are discussed and illustrated by case examples.     

Treatment of obsessive-compulsive patients: The contribution of self-instructional training to the effectiveness of exposure

Fifteen obsessive-compulsive patients were given treatment consisting of ten sessions of gradual exposure in vivo. For half of the patients gradual exposure in vivo was preceded by self-instructional training.Treatment resulted in significant improvement on anxiety and avoidance scales, Leyton Obsessional Inventory, Self-rating Depression Scale and on ratings for anxious mood and depression. Neither the post-test nor the follow-ups 1 month and 6 months later indicated a difference between the effects of the two conditions. Self-instructional training did not enhance the effectiveness of gradual exposure in vivo.     

Primary school teacher outcomes from online professional development for physical literacy: A randomised controlled trial

IntroductionPrimary (or elementary) school teachers are often relied upon to provide children with opportunities for physical literacy development; however, many of these teachers feel they lack the skills to effectively promote or ‘teach’ physical literacy. We examined the effects of an online physical literacy professional development program—relative to receiving widely-available online resources or continuing with ‘normal’ practice—on primary school teachers’ physical literacy knowledge and application.MethodsA parallel three-arm randomised controlled trial in which 92 primary school teachers were assigned to (a) an online professional development program designed to support teachers’ physical literacy instructional skills (‘intervention’), (b) receive widely-available online physical literacy resources (‘comparison’), or (c) a typical practice ‘control’ condition. Data were collected at baseline and following the four-week intervention period. The primary outcome was teachers’ physical literacy knowledge and application; secondary outcomes included teachers’ self-reported perceptions of confidence, values, and barriers. Between-group differences were assessed using the intention-to-treat principle with analysis of covariance accounting for demographic factors and baseline differences in the focal outcome.ResultsTeachers in the intervention arm scored significantly higher on post-intervention physical literacy knowledge and application than their counterparts in both the control (d = .47, p = .044) and comparison (d = 0.87, p = .007) arms. This pattern of differences was also observed for teachers’ value of physical literacy, autonomy support, and perceived personal barriers.ConclusionTo the best of our knowledge, this is the first adequately powered randomised controlled trial to demonstrate improvements in physical literacy instructional outcomes as a result of primary school teacher participation in targeted online professional development.     

Spiritual practices children understand: an analysis of Madeleine L’Engle’s fantasy,A Wind in the Door

The following essay is a close reading of Madeleine L’Engle’s science fantasy novel, A Wind in the Door, in which young Meg Murry travels first to outer space and then into her younger brother’s ailing cells. The novel is a fine example of high fantasy (also known as heroic fantasy) wherein a humble protagonist is called to a quest to fight a cosmic battle between good and evil. The essay analyzes specific expressions of evil in the novel: impersonality, narcissism, despair and blind empiricism. Meg’s quest demonstrates particular spiritual practices that promote spiritual maturation and the ability to overcome evil: ‘kything’, Naming, deepening and holding. L’Engle portrays these practices in a fresh way that can help both children and adults incorporate them into their day‐to‐day lives. Moreover, there are links between kything and holding and the metta and tonglen, two types of Buddhist meditation. L’Engle affirms children’s innate relational consciousness and presents spiritual practices that are relational, non‐sectarian, practical, and eminently hopeful.     

Framing,Reciprocity and the Grounds of Egalitarian Justice

John Rawls famously claims that ‘justice is the first virtue of social institutions’. On one of its readings, this remark seems to suggest that social institutions are essential for obligations of justice to arise. The spirit of this interpretation has recently sparked a new debate about the grounds of justice. What are the conditions that generate principles of distributive justice? I am interested in a specific version of this question. What conditions generate egalitarian principles of distributive justice and give rise to equality as a demand of justice? My paper focuses on relationalist answers to this question. Advocates of relationalism assume that ‘principles of distributive justice have a relational basis’, in the sense that ‘practice mediated relations in which individuals stand condition the content, scope and justification of those principles’. To say that principles of justice are ‘based’ on and ‘conditioned’ by practice mediated relations is ambiguous. I will here be concerned with advocates of what I call the relationalist requirement, viz. positions which assume that ‘practice mediated relations’ constitute a necessary existence condition for principles of egalitarian distributive justice. Relationalists who endorse this view come in different varieties. My focus is on relationalists that view social and political institutions as the relevant ‘practice mediated relation’. The question at stake, then, is this: Are institutionally mediated relations a necessary condition for equality to arise as a demand of justice? Strong relationalists of the institutionalist cast, call them advocates of the institutionalist requirement, differ in important respects. They argue about what set of institutions is foundationally significant, and they disagree on why only that institutional relation gives rise to egalitarian obligations of justice. My paper engages two ways of arguing for the institutionalist requirement: Julius’s framing argument and Andrea Sangiovanni’s reciprocity argument. The issue at stake are the grounds of egalitarian justice and I will argue that the institutionalist requirement is mistaken. It is not the case that egalitarian obligations of distributive justice arise only between and solely in virtue of individuals sharing a common institution.     

The Cornered Object of Psychoanalysis: Las Meninas, Jacques Lacan and Henry James

Long recognised as a painting ‘about’ painting, Velázquez’s Las Meninas comes to Lacan’s aid as he explicates the object a in Seminar XIII, The Object of Psychoanalysis (1965–1966). The famous seventeenth century painting provides Lacan with a visual mapping of the ‘ghost story’ he discovers in the Cartesian cogito, insofar as it depicts the unravelling of the Cartesian representational project at the moment of its founding gesture. This article traces Lacan’s argument as he turns to art, linear perspective and topology to model how the object a persistently eludes the grasp of scientific knowledge. Following a discussion of distance-point perspective in Renaissance Italy and the role this innovation played in enabling distorted depictions of objects in space, I propose Henry James’s ghost story, “The Jolly Corner,” as the sequel to Lacan’s reading of Las Meninas. In James’s tale, we obtain a narrative account of what the figures in Velasquez’s painting might ‘see’ as they return our gaze towards us.     

Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers

The combined effects of imaginal exposure to feared catastrophes and in vivo exposure to external stimuli were compared with the effects of in vivo exposure alone in 15 obsessive-compulsives with checking rituals. The first group received 90 min of uninterrupted exposure in imagination, which concentrated mainly on disastrous consequences, followed by 30 min of exposure in vivo to stimuli-situations which triggered rituals. The second group was given 2 hr of exposure in vivo only. Both groups were prevented from performing rituals. Treatment consisted of 10 daily sessions within a 2 week period.Assessments were conducted before and after treatment and at follow-up ranging from 3 months to 2.5 yr with a mean of 11 months. At post-treatment both groups improved considerably and did not differ. But at follow-up those who received imaginal and in vivo exposure maintained their gains, whereas the group who were treated by exposure in vivo alone evidenced partial relapse on four of the six dependent measures. The results tend to indicate that a closer match between a patient's internal fear model and the content of exposure enhances long term treatment efficacy.     

Unconscious fantasy (or phantasy) as clinical concept

A clinical phenomenology of the concept ‘unconscious fantasy’ attempts to describe it from a ‘bottom‐up’ perspective, that is, from the immediate experience of the analyst working in session. Articles of psychoanalytic authors from different persuasions are reviewed, which taken as a whole would shed some light on how the concept of unconscious fantasy takes shape in the analyst's mind during the session with the patient. A clinical phenomenology in three steps is described. Each step is illustrated by clinical material. Current controversies around the concept of unconscious fantasy (or phantasy) are still trapped in the discussion about if and how they are really unconscious. The strategy to describe from a ‘bottom‐up’ perspective the process of how the analyst's mind embraces the idea that an emerging phenomenon in the relationship with the patient can be defined as ‘unconscious fantasy’, allows us to elude the question as to whether or not we believe that unconscious fantasies exist at all, since we are neither required to assert or deny such a prior existence in order to describe the process of elaboration which, in the end, does formulate a fantasy as fantasy.     

Monitoring the effects of adult psychotherapy in routine practice in Switzerland: A feasibility trial

Background: Several studies have been published on the effects of psychotherapy in routine practice. Complementing traditional views summarised as ‘dose‐effect models’, Stiles et al. put forward data consistent with the responsive regulation model underlining the importance of the client's active participant role in defining length of treatment. One may ask what level of change reached by a patient is considered to be the ‘good enough level’ (GEL) and if it is related to the duration of psychotherapy. Aims: The main objective of the present feasibility trial was to monitor the patient's session‐by‐session evolution using a self‐report questionnaire in order to define the GEL, i.e. the number of sessions necessary for the patient to reach significant change. Method: A total of N=13 patients undergoing psychotherapy in routine practice participated in the study, completing the Outcome Questionnaire – 45.2 (OQ‐45), which assesses the symptom level, interpersonal relationships and social role after every psychotherapy session. The data was analysed using multi‐level analyses (HLMs). Results: High feasibility of fine‐grained assessment of effects of psychotherapy in routine practice in Switzerland was shown; response rates being acceptable; however, detailed analysis of the GEL was not feasible within the short study time‐frame. Conclusions: Reflections on the political context of monitoring in the specific case of routine psychiatric practice in Switzerland are discussed.