Assessing the process of desensitization therapy: Five practical measures

Assessment of phobic behavior has included self-report, physiological, and in vivobehavioral measures. While self-report measures are convenient, they suffer from subject bias and a low predictive validity. Physiological and in vivobehavioral measures are often too cumbersome to implement in standard clinical practice. The current study investigated the validity of five convenient measures of phobic behavior during the process of desensitization therapy. Responses of 14 clinically phobic patients were compared on phobic and neutral scenes presented within the context of systematic desensitization therapy. Phobic scenes resulted in less clarity of scene visualization, a longer latency to clear scene visualization, higher subjective units of discomfort (SUDs) at clear visualization, a longer latency to relaxation, and higher SUDs at relaxation. The measures seemed to reflect accurately the process and stages of desensitization therapy and showed low to high intercorrelations. The pragmatic value of these measures is discussed, as well as suggestions for future validational research.     

Some images of the analyst's participation in the analytic process

This paper was originally presented at a workshop (with G. Atwood and S. Parks) on The analyst's participation in the analytic process'. The analyst's 'vulnerability' is highlighted, with specific reference to the ideas of Winnicott, Searles and Jung. Some personal metaphors for the nature of the analytic engagement are offered, as is the image of the 'troubled analyst' from a patient's dream. The burden and necessity of the analyst's participation are emphasized.     

Short-term desensitization therapy

R has raised the possibility that behavior therapy procedures can benefit from even further departures from traditional psychotherapy formats. Although behavioral approaches such as desensitization therapy are distinctive departures from the verbal psychotherapies, there is still an implicit commitment to one traditional approach: the reliance upon one or two weekly appointments. Clients being treated for phobias, for example, are typically seen for desensitization sessions twice weekly. Yet, both theory and current research argue for more frequent meetings as being more effective. Robinson and Suinn (1969) saw clients with spider phobia daily for five consecutive days, meeting one hr per day. Clients were tested on a behavioral task prior to and following massed treatment. Results showed that prior to therapy, none of 20 clients were able to place their hands near the spider; following massed treatment, all clients improved, 13 clients placed their hands within 12 in. of the spider, 2 touched the spider and 1 client stroked the 4 in. spider twice as it moved across the cage. Suinn and Hall (1970) relied upon an even shorter treatment period: students with test-taking anxiety were desensitized completely within 24 hr. These clients were trained to relax and exposed to hierarchy items from 1–4 p.m. on Friday and 8–12 noon the next day. Results showed that the marathon treated clients showed recoveries to the same degree as that achieved in a group treated over a course of 4 weeks. Theoretically, massed treatment should be more effective than spaced treatment. This is based on the view that massed practice would lead to the extinction of fear or anxiety responses since this method capitalizes upon two factors: (1) counterconditioning, whereby the fear stimulus becomes conditioned to relaxation instead of anxiety, and (2) conditioned inhibition, whereby the anxiety responses become ‘fatigued’ and non-responding is reinforced. Implosive therapy (Stampfl and Levis, 1967) appears to be basically a type of massed practice in which the client is continuously exposed to extremely frightening scenes to extinguish the fear. In implosive therapy the client is kept anxious during the treatment; in massed or marathon desensitization, the client is relaxed throughout the sessions. The purpose of this report is to summarize some results achieved through massed desensitization.     

Motor and cognitive relaxation in the desensitization of anger

Three procedures were assessed to determine their effectiveness in reducing anger. The procedures were: desensitization, desensitization with cognitive relaxation, and desensitization with the absence of relaxation training. Anger was aroused by exposing white males, selected for their reports of anger toward blacks, to black racial stimuli. The desensitization group reported reductions in anxiety and disgust relative to a no-treatment control group. Therapist ratings indicated reductions in anger for Ss in both the desensitization and desensitization with cognitive relaxation groups. In addition the latter group reported reductions in anger concurrently with increases in diastolic and systolic blood pressure. Post-hoc analyses indicated that Ss for whom desensitization was most effective reported less anger after the pretreatment anger arousal procedure, greater depth of relaxation during treatment, and were liked more by their therapists. These Ss also reported a greater reduction in ethnocentrism and a trend toward lower overt hostility following treatment.     

Self-directed desensitization for acrophobia

Acrophobic outpatients received therapist- or self-directed (tape-recorded) desensitization in a study of (a) treatment effectiveness with diminished therapist contact ; (b) subject characteristics ‘predicting’ outcome; and (c) generalization of change. At Post-test, treated Ss (N=16) had improved significantly more than Waiting List Ss (N=13) on self-report measures of acrophobia and general anxiety, while the treatment methods were equally effective. An 8-month follow-up found that self-directed Ss had attempted more specific behavioral situations than therapist-directed Ss, and showed additional gains on self-report measures while therapist-directed Ss maintained post-test levels. Results suggested: (a) desensitization provides effective treatment even with reduced therapist contact; (b) some subject characteristics relate to outcome and (c) treatment effects generalize to other anxiety indices.