An evaluation of outcome variables in the systematic desensitization of test anxiety.

This study investigated the effects of group systematic desensitization and group counseling on anxiety and academic performance. Fifty-four undergraduates who requested help for debilitating test anxiety were randomly assigned to Desensitization. Group Counseling, or No-treatment control groups. Measures of test anxiety, trait anxiety, and academic achievement were obtained for all students' pre- and post-treatment. The Desensitization group showed a significant decrease in test anxiety; the Counseling and No-treatment groups showed no changes in these measures. None of the groups showed any change in trait anxiety or academic achievement. The results provided evidence that systematic desensitization was an effective treatment for reducing test anxiety, but not for improving grades.     

The contribution of relaxation and expectancy to fear reduction via graded, imaginal exposure to feared stimuli

Speech phobic subjects received five treatment sessions under either positive or neutral expectancy set. Therapy conditions included hierarchy exposure with contiguous relaxation (desensitization), exposure with noncontiguous relaxation, exposure only, and no-treatment. Expectancy had virtually no outcome effects. Desensitization was superior to the other conditions on subjective outcome measures. In contrast to the two exposure conditions without contiguous relaxation, desensitization resulted in increased imagery vividness, greater cardiovascular response to the first visualization of the initial hierarchy scene, and greater declines in cardiovascular response within repetitious visualizations of scenes and across initial visualizations of increasingly anxiety-provoking scenes. Expectancy significantly influenced both fear ratings and cardiovascular response to scenes during the first session, the latter effect disappearing after the first session. The results are discussed in terms of recent theorizing regarding the role of relaxation and expectancy in desensitization.     

Using humor in systematic desensitization to reduce fear

Effectiveness of systematic desensitization for fear reduction, using humorous hierarchy scenes without relaxation, was tested. Participants were 40 students highly fearful of spiders. Using a 24-item behavioral approach test with an American tarantula, participants were matched on fear level and randomly assigned to 1 of 3 treatment groups: (a) systematic desensitization, (b) humor desensitization, and (c) untreated controls. Each participant was seen for 6 sessions, including pretest and posttest. Analyses of covariance of posttest scores revealed that the 2 treatment groups showed greater reduction in fear than the controls on 3 measures but did not differ from each other. Therefore, humor in systematic desensitization reduced fear as effectively as more traditional desensitization. This finding may have therapeutic applications; however, it may also be applicable in advertising to desensitize fear of a dangerous product, such as cigarettes.     

Psychophysiological responses during analogue systematic desensitization and non-relaxation control procedures

This investigation tested the hypotheses than an analogue systematic desensitization procedure (SD) would be both more effective and more efficient than a comparable non-relaxation control procedure (NRC) with respect to subjective report, behavioral and psychophysiological variables. Phobic subjects responded to slides depicting a feared aversive stimulus. The SD procedure resulted in significantly less reported fear, fewer trials to a criterion level of decrease in subjective fear, and significantly greater decreases in ANS baseline measures. However, measures of behavioral avoidance and measures of decrease in psychophysiological responsivity to the aversive stimuli revealed significant changes within both SD and NRC groups, and no significant differences between the groups, whether or not the groups were equated for number of stimulus presentations. The results, indicating equivalent efficacy and efficiency for the SD and NRC procedures, suggested a limited role for relaxation in systematic desensitization. An extinction or habituation hypothesis was supported at the expense of a counterconditioning hypothesis.     

Endemic images and the desensitization process

Forty-eight test-anxious subjects were selected and randomly assigned to one of three treatment conditions. The subjects in the first group were asked to imagine a series of images that reflected relaxing motifs and these images were counterposed with a series of items from a test-anxiety hierarchy. The second group received a course of group systematic desensitization. The third group (control) was asked to “think about relaxing” as recorded chamber music was played. Two one-way Analyses of Variance (ANOVAs) and a series of Scheffé multiple comparisons revealed that the subjects' post-therapy levels of anxiety as measured by the Suinn Test Anxiety Behavior Scale (STABS), as well as their grade point averages (GPA) were significantly different under the endemic image and control procedures. Significant differences were also observed for these measures when the scores of the systematic desensitization and control groups were compared. No significant differences were observed between the post-therapy scores of the endemic image and systematic desensitization groups. The utility of the endemic imagery treatment for clients who are unable to undergo deep muscle relaxation because of physical infirmities, for example, cerebral palsy, is noted and a call for more extensive research is made.     

Studies in desensitization—I: The separate effects of relaxation and desensitization

The purpose of the study was to investigate the separate effects of desensitization and relaxation in Wolpe's technique of “systematic desensitization”. Four small groups of spider-phobic, normal subjects were allocated to the following treatments: desensitization with relaxation, desensitization without relaxation, relaxation only, no-treatment controls. The effects of treatment were assessed by subjective reports, avoidance tests and fear estimates. Marked reductions in fear were obtained only in the desensitization-with-relaxation group and it was concluded that the combined effects of relaxation and desensitization are greater than their separate effects.     

Cognitive restructuring treatment: A controlled trial with anxious patients

Cognitive restructuring, modified systematic desensitization and a combined treatment (cognitive behaviour modification) were compared with a no-treatment control group, using a simple randomized design. Twenty seven general anxiety out-patients selected from the hospital waiting list were used as subjects. Assessments were made at the beginning and end of treatment, and at follow-up 1 month later. The assessments included two subjective anxiety measures, the Zung self-rating anxiety scale and fear thermometer scores, a behavioural anxiety measure, a measure of cognitive anxiety as estimated by a diary recording of thinking time, fear survey schedule scores and I/E scores.Cognitive behaviour modification was found to be a superior form of treatment, relative to the no-treatment control and the other active treatment groups as assessed by FSS intensity score. The cognitive behaviour modification group showed greater improvement than the cognitive restructuring group on the diary anxiety scores. The results also demonstrated a relationship between outcome and initial severity of condition. The higher the subjects' initial scores on neurotic symptoms and subjective anxiety level, the greater the degree of positive change after treatment. Moreover, subjects with high levels of internal control prior to treatment responded most to therapy.     

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.     

Systematic desensitization, relaxation-training and suggestion in the treatment of test anxiety.

In investigations that have examined the component procedures in traditional desensitization treatment, desensitization was more effective than relaxation-training alone in several studies (Freeling and Shemberg, 1970: Davison, 1968; Rachman, 1968). while these treatments were equally effective in other studies (Benjamin, Mark and Huson, 1972: Aponte and Aponte, 1971; Johnson and Sechrest, 1968). One possible determinant of these inconsistent findings may be the presence of uncontrolled differences in therapeutic suggestion due to the fact that desensitization treatment typically includes a specific ‘rationale’ that explains the expected course and outcome of treatment while comparable authoritative guidelines for providing the rationale for relaxation treatment are not available.The present study compared the relative effectiveness of desensitization and relaxation-training in the treatment of test anxiety under conditions in which suggestion concerning the nature and outcome of treatment were essentially the same for both procedures. To examine systematically the role of suggestion in the treatment of test anxiety, instructions that were high and low in suggestion were given. Treatment outcomes were assessed in terms of changes in measures of anxiety and in performance on objective ability tests. A no-treatment group controlled for the effects of using the same pre- and post-treatment measures.     

The effect of duration of exposure on systematic desensitization and extinction.

An important variable which has only recently received attention (Proctor, 1968; Watts, 1971) is the influence of intra-item exposure time to aversive stimuli on systematic desensitization. Long single exposure to hierarchy items was more effective in reducing avoidance behavior than short exposure (Ross and Proctor, 1973). It is possible, therefore, for duration of exposure to be a confounding variable in previous desensitization research.In studies where exposure only conditions were ineffective (Davison, 1968; Lomont and Edwards, 1967), the visualization time was less than 15 sec. Successful utilization of extinction-like procedures employed longer exposure times (Vodde and Gilner, 1971 for 20–30 sec; Crowder and Thornton, 1970 for 30 sec; Sue, 1972 for 20 sec; Nawas, Welsch and Fishman, 1970 for 60 sec: Wolpin and Raines, 1966 for up to 10 min).Intra-item exposure time may also account for the discrepant findings on the influence of cognitive variables on the efficacy of systematic desensitization. In the studies where expectations or therapeutic instructions were important (Leitenberg et al., 1969; Valins and Ray, 1967), subjects were exposed to aversive stimuli for 10–15 sec. Where positive expectations were unimportant, the exposure time was longer (McGlynn and Mapp, 1970 for 20–30 sec; McGlynn, Gaynor and Puhr, 1972 for 20–30 sec; McGlynn, Reynolds and Linder, 1971 for 20–40 sec; Lomont and Brock, 1971 for 60 sec). Therapeutic expectations, relaxation, and other variables may assume importance during periods of short exposure.So far, there has been no adequate investigation of intra-item exposure time on both extinction and desensitization. The procedures employed by Watts (1971) and Proctor (1968) do not allow such a comparison to be made. The purpose of the present study is to examine the influence of short (5 sec) and lengthy (30 sec) exposure to aversive stimuli on extinction and desensitization conditions.In line with the results of Davison (1968) and Lomont and Edwards (1967), it was predicted that exposure of short duration would be less effective than exposure of longer duration under the extinction condition (Vodde and Gilner, 1971 ; Crowder and Thronton, 1970; Nawas et al., 1970; Wolpin and Raines, 1966). No specific predictions were made on the desensitization groups. There were four experimental groups: (1) two exposure only groups (visualization for either 5 sec or 30 sec), and (2) two systematic desensitization groups (visualization for 5 sec or 30 sec). A no-treatment control group was also employed.     

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.     

The efficacy of progressive relaxation in systematic desensitization and a proposal for an alternative competitive response--the relaxation response.

The theoretical basis of systematic desensitization is reciprocal inhibition in which an alternative, competitive response to anxiety is conditioned to arousal-producing, phobic stimuli. Abbreviated training in progressive relaxation is believed to serve as a competitive response to anxiety by decreasing autonomic nervous system activity. However, physiologic studies of progressive relaxation have not substantiated that its practice is associated with such decreased autonomic activity. Consequently, the use of progressive relaxation has been a confounding factor in the determination of the function of reciprocal inhibition in systematic desensitization. To confirm and refine the theoretical constructs of reciprocal inhibition, it is necessary to test the effects of a response which is competitive to the anxiety response. Such a response may be the relaxation response which is characterized by physiologic changes consistent with decreased autonomic nervous system activity. Derived from meditational practices, techniques which ehcit the relaxation response incorporate the element of focused attention which has been implicated as a critical factor in systematic desensitization. Thus, the use of the relaxation response should be a more appropriate method than progressive relaxation if the therapeutic usefulness of systematic desensitization is indeed due to reciprocal inhibition.     

Traditional group therapy and computer-administered treatment for test anxiety

Abstract

Traditional group therapy for test anxiety, modelled after Weissberg (1976), was compared with the computer-administered treatment of Thoresen, Insel, Roth, Ross, and Seyler (1986). Both treatments contained cognitive and behavioral elements including systematic desensitization and Jacobsonian relaxation techniques. The participants were 36 test-anxious students seeking treatment within a university counseling center. Effectiveness of each treatment was assessed by studying changes in test anxiety (total, worry, emotionality), as measured by the Test Anxiety Inventory (Spielberger, 1980). and changes in grade point average (GPA). There was a statistically significant reduction in the three test anxiety measures for both treatments. No significant differences in GPA, as a result of the treatment, were found. There was no significant difference in reduction of test anxiety between the treatments. These findings support the efficacy of the computerized treatment which may be a suitable alternative to group therapy and, in some situations, may be the treatment of choice.     

Sensitivity to phobic imagery: a sensory decision theory analysis

The effects of deep muscle relaxation on anxiety were studied in a systematic desensitization context. A Sensory Decision Theory analysis of anxiety ratings to controlled imagery showed that relaxed Ss were significantly more sensitive to phobic properties of the controlled imagery than nonrelaxed Ss. The results are discussed in terms of Wolpe's theoretical basis for systematic desensitization. Sensory Decision Theory is presented as a useful technique for measuring the effects of therapy on emotional states.     

The role of physiological attention-focusing in the relaxation treatment of sleep disturbance,general tension,and specific stress reaction

Three experiments comparing the effects of muscle tension-release relaxation with vs without physiological attention-focusing and no-treatment on (a) sleep disturbance, (b) general tension, and (c) a variety of time estimation, heart rate perception, and stress reaction measures, are reported. The two relaxation conditions produced equivalent reductions in latency to sleep onset reports, suggesting the importance of tension-release in the relaxation treatment of sleep disturbance. Relaxation without physiological attention-focusing was unexpectedly superior to the other relaxation condition in reducing reported daily tension, supporting Denny's (1976) hypothesis that pervasive anxiety may be a function of anxiety conditioned to relaxation-produced cues. Sleep disturbed subjects over-estimated elapsed time, and relaxation training improved accuracy of time estimation. Several additional differences between sleep and tension subjects and among the three treatment conditions on physiological activity during stress are reported and discussed.     

Vicarious and direct counterconditioning of test anxiety through individual and group desensitization

Vicarious and direct desensitization were compared for individual and group treatment of test anxiety. Fifty seventh-graders were assigned by stratified random sampling to the following treatment conditions: direct-individual; vicarious-individual; direct-group; group-observing-group; group-observing-model. Twenty-one eighth-graders served as no-treatment controls. Upon completion of the experimental phase, all subjects were administered a measure of test anxiety and a reading test. As predicted, experimental subjects improved significantly, relative to controls, on both outcome measures; as further expected, the experimental variations did not produce significantly different outcomes among treatment conditions. Neither sex of subject nor assignment to alternative therapists qualified the findings.     

Fading vs systematic desensitization in the treatment of snake and spider phobia

Fading, a new technique for the treatment of phobias, was compared to systematic desensitization and a waiting-list control group for clients with snake and spider phobia. The fading technique used slides of the phobic stimulus instead of imagery, and slides of positive scenes capable of arousing a calm positive feeling as anxiety-antagonists. The clients were assessed on different self-report, behavioural and physiological measures before and after treatment. The clients were treated individually and received eight sessions, one per week. The within-group comparisons showed that both the fading and the desensitization group changed significantly on most, of the dependent measures, but the control group did not. The between-group comparisons yielded fewer significancies but on four of the 12 dependent measures both treatment groups were significantly better than the control group, while there were no differences between the fading and desensitization groups.     

Fading—A new technique in the treatment of phobias

Phobias have been subject to more research by behavior therapists than any other psychiatric disorder. In 1975 Marks described more than 20 different techniques that have been developed for or used in the treatment of phobias.The technique to be described in this paper—fading—was first used by Barlow and Agras (1973) as an alternative to aversive techniques for homosexuals. Originally the technique was designed to change the stimulus control of sexual responsiveness by introducing or “fading in” heterosexual stimuli during periods of sexual arousal elicted by homosexual stimuli.One purpose of the single-case studies presented here was to explore the possibility of achieving a similar result with phobic clients. In other words, the aim was to create a state of calmness and positive sensations in the client and then to gradually “fade in” phobic stimuli. The hypothesis was that the stimulus control of anxiety exerted by the phobic stimuli would decrease and finally be extinguished due to the antagonistic effects of observing and imagining positive scenes.A second purpose of this application of fading was to develop a technique for reducing phobic anxiety which could give more control to the client than is the case in, for example, systematic desensitization.     

Play desensitization of fear of darkness in preschool children.

Systematic desensitization therapy (SDT) is considered to be a technique of established effectiveness in reducing monosymptomatic fears (Paul, 1969a, 1969b), yet little systematic research has been done to investigate the merit of desensitization procedures in modifying children's behavior. The few available controlled studies (Miller et al., 1972; Obler and Terwilliger, 1970; Oliver, 1971) on desensitization with children have produced equivocal results. Although imagery and relaxation have been reported of benefit when used separately (Graziano and Kean, 1971; Lazarus and Abramovitz, 1962), evidence suggests that the usual combination of imagery and relaxation is not effective in reducing children's fears (Miller et al., 1972). Investigators in this area have often modified traditional SDT to include alternatives to imagery such as pictures, drawings, play (Cassell, 1965; Lazarus, 1960; Obler and Terwilliger, 1970; Patterson, 1965), or in vivo exposure to the feared stimulus (Obler and Terwilliger, 1970). Relaxation has often been replaced with other responses thought to be incompatible with anxiety such as eating (Jones, 1924). Another deviation from traditional SDT has been the delivery of positive reinforcement (food, praise, or toys) contingent upon the child's approaching the feared object (Obler and Terwilliger, 1970; Patterson, 1965). On the basis of such varied techniques, it is impossible to determine which of these procedures constitutes an effective treatment method for children. In the following study, three desensitization procedures involving graded exposure to the feared stimulus (darkness) through symbolic play, were compared to no-treatment and placebo control groups under differing instructional sets. Treatments were designed to determine the therapeutic efficacy of play as a method of stimulus presentation with children, and to determine whether reciprocal inhibition, extinction, operant reinforcement, or instructional set contribute to fear reduction in desensitization with children.