Therapeutic rationale,monetary incentive and fear behavior: a methodological note on analogue research

Analogue research has been questioned as a means of evaluating clinical procedures (e.g. Cooper, Furst and Bridger, 1969). A major criticism has been the failure to include adequate controls. Placebo conditions have varied markedly in their similarity to active treatment procedures (Caputo, Nau and Borkovec, 1973), have not provided equally credible therapeutic rationales (Borkovec and Nau, 1972), and have thus generated differing expectancies and demands for improvement.To evaluate a therapy procedure, a comparison condition is needed in which no treatment intervenes between pre- and post-test measures, yet which provides adequate incentive for improvement. Rimm and Mahoney (1969) used a ‘contingent reinforcement’ placebo condition in which tokens, exchangeable for money, were dispensed for improvement in a graded approach to a feared stimulus. Little improvement occurred, suggesting a lack of effectiveness of money alone in improving approach behavior. However, as no therapeutic rationale was presented, it is likely that little expectancy for improvement occurred.The present study provided a ‘no treatment’ condition in which Ss participated in three test sessions with no intervening treatment procedure. Unlike Rimm and Mahoney (1969), two conditions provided a rationale explaining why Ss had maintained their fear and why no real therapy was needed to eliminate it. Also, monetary reward (a $5.00 bill rather than tokens) was dispensed only upon picking up the feared object. A follow-up session assessed the lasting effects of rationale and monetary incentive in the absence of extrinsic reinforcement. Thus, the present study attempted to determine the effect of therapeutic rationale and/or the possibility of receiving money, in the absence of ‘therapy’, on subclinical fear.     

Processing of fearful and neutral information by obsessive-compulsives

Eighteen obsessive-compulsive and non-obsessive-compulsive outpatients provided data for a study of thinking processes in obsessive-compulsives. First we explored whether the concepts of obsessive-compulsives are excessively complex and over-specific (complex concepts) or, conversely, whether they are excessively ‘simple’, so that items that non-obsessive-compulsives would view as different from one another are classed together by obsessives. Secondly, we examined whether the cognitive mechanisms underlying obsessional fears are specific to the content of the fear, or whether they reflect a general deficit in information processing. To this end, obsessive-compulsive and non-obsessive-compulsive patients sorted four decks of cards into piles; two decks were sorted using ‘neutral’ principles, and two using ‘feared’ principles (contamination and serious mistakes). Results indicated that obsessive thinking is characterized by ‘complex concepts,’ and suggested that this deficit is general, not specific to obsessives' thinking about feared topics. Results also suggested the existence of an additional thinking deficit that is specific to fear-associated topics.     

A comparison of systematic desensitization and reinforced practice procedures in fear reduction

At least two strategies of behavior modification seem possible in the treatment of neurotic disorders. In the first, systematic desensitization is used to reduce the anxiety associated with the avoidance behavior, thus reducing avoidance of the feared stimulus. In the second, anxiety is ignored and approach behavior is shaped by direct reinforcement according to operant conditioning principles. Each procedure enjoys a literature of successful application in both laboratory and clinical settings. Systematic desensitization has been effective in treating fears of small animals (Lang and Lazovik, 1963) interpersonal anxieties (Paul, 1966), and classic phobias (Lazarus, 1961). Operant approaches involving reinforced practice have proved successful in treating agoraphobia (Agras et al., 1968), anorexia nervosa (Bachrach et al., 1965), and various types of behavior of psychotic patients (Risley and Wolf, 1967; Ayllon and Azrin, 1968).The present study was designed to examine the relative therapeutic effectiveness of systematic desenzitization and reinforced practice in the treatment of snake phobia. Although Barlow et al. (1970) have suggested that “shaping” is more effective than systematic desensitization in the reduction of avoidance behavior, Ss in their “shaping” condition were given more experience with the aversive stimulus than desensitization Ss. The present study avoids such confounding.     

Synchronous and desynchronous changes during fear reduction.

The purpose of this experiment, carried out on 27 subjects with intense and circumscribed fears, was to test one main hypothesis and several subsidiary predictions. The prediction that a high-demand in vivo treatment condition produces desynchronous changes and a low-demand treatment condition synchronous changes, was supported by some inter-session findings but not by the intra-session findings. The clear linear relation between heart-rate and reported fear was confirmed, as was the rapid habituation of the heart-rate response to phobic stimulation.The fear-reactions and fear-reductions of psychiatric and non-psychiatric were indistinguishable. High heart-rate responders and low heart-rate responders showed similar patterns of improvement. The constrained laboratory ‘treatment’ procedure used in the experiment produced large and rapid reductions in fear.     

Return of fear: The role of inhibition

In a previous study investigating the relationship between subjective, physiological and behavioural changes during treatment of specific phobias, a marked between-session increase was found in subjective fear after high, but not after low intensity phobic stimulation although the groups showed similar fear ratings and heart rates immediately after treatment (Grey et al, 1979). It was hypothesized that the high intensity stimulation led to ‘treatment fatigue’; a state of deactivation, the recovery from which led to a return of fear.In this study high intensity in vivo stimulation was used for the treatment of phobic subjects under conditions of distributed and massed practice. No differences emerged between treatment conditions. A small group of Ss with a conspicuously high heart rate (mean level 120 bpm) when rating zero fear, showed a significant increase in fear after one week's interval, although they had shown similar improvement to the Ss during treatment. Subjects in both treatment conditions showed lower heart rate at all post-treatment assessments than pre-treatment. The high initial heart rate Ss continued to have higher heart rate than other Ss throughout the experiment, although they showed a decrease after treatment. It was only these Ss with desynchronously high heart rate, i.e. high heart rate with zero fear ratings, who suffered a return of fear, whereas high heart rate during high fear did not predict either response to treatment or return of fear. A further finding was a lack of correlation between the behavioural and physiological indices of fear, namely, between distance and heart rate at high levels of fear.     

The contribution of relaxation to symbolic modeling in the modification of dental fears.

Studies of symbolic modeling suggest that it is a technique which is at least as effective and more efficient (faster) than imaginal desensitization in the treatment of fears (Bandura el al., 1969; Woody and Schaible, 1969). Bandura et al. (1969) assessed the contributions of relaxation to the procedure and found less subjective anxiety and greater positive attitude change with relaxation but no significant differences in oven behavior nor in generalized anxiety reduction. In this study the ‘symbolic modeling only’ subjects received their treatment after they and the other subjects had received the original post-testing assessment. The present experiment was an attempt to assess the contributions of deep muscle relaxation to symbolic modeling without such confounding and with a more nearly clinical population. Dental fear represents a ‘near clinical’ phobia which satisfies Bernstein and Paul's (1971) criteria for analogue desensitization research. That is. dental phobics exhibit a strong, costly and distressing avoidance response which increases in strength as a function of exposure despite high demand.     

Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

Exposure is a necessary condition for fear-reduction: a reply to de Silva and Rachman

de Silva and Rachman (1981) have recently suggested that although non-reinforced exposure of a fear-evoking stimulus constitutes a sufficient condition for unlearning fears, it does not represent a necessary condition. This conclusion was reached, in part, by examples they provide which appeared to them to suggest that fear-reduction can occur in the absence of exposure to the fear stimulus. They then call for an extended search for non-exposure types of intervention, especially those involving ‘sources of information’ and ‘expectations’. After reviewing in detail the arguments advanced, the present authors adopt the position that de Silva and Rachman's conclusions are premature and unwarranted. To abandon or lose sight of one of the most effective and perhaps most important therapeutic principles, CS exposure, would be myopic and detrimental to the advancement of effective behavior change. At this point in time what is needed is a more careful analysis of the extinction process especially at the stimulus level so the effectiveness of this principle can be maximized.     

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.     

A preliminary investigation of cognitive and relaxation treatment of panic disorder: effects on intense anxiety vs 'background' anxiety

In this study, three adult males complaining of Panic Disorders were treated with cognitive therapy followed by relaxation training combined with cognitive therapy in a multiple-baseline across Ss design. All Ss demonstrated a decrease in the number and duration of episodes of heightened or intense anxiety, which was maintained at 3-month follow-up. Daily time-sampled ratings of ‘background’ anxiety, not necessarily associated with periods of intense anxiety, showed a substantial decrease for S2, which was maintained at 3-month follow-up. However, S 1 and S 3 evidenced an increase in background anxiety during the combined treatment phase in contrast to the effects of treatment on periods of ‘intense’ anxiety. These results suggest that psychological treatments for patients classified as suffering from Panic Disorder are effective and lend some support to the differentiation of panic from ‘general’ anxiety. Recent observations of relaxation-induced anxiety were also replicated in this clinical setting. These data also illustrate the advantages and difficulties of self-monitoring anxiety over a period of time.     

The relationship between expressed social fears and assertiveness and its treatment implications

Behavior therapists have speculated about the relationship between social fears or social anxieties and lack of assertive behavior. Wolpe (1958) perhaps most clearly suggested such a relationship. “If he [the patient] has been ineffectual in such situations—unable, for instance, to return a faulty garment—I explain how unadaptive fears are at the bottom of this ineffectualness. … p. 116.” Wolpe further assumed that engaging in assertive behavior reciprocally inhibited fear in these same social situations and that assertive responses can be programmed for use in overcoming these fears.In later writings (Wolpe. 1969; Wolpe and Lazarus, 1966) Wolpe seems to have broadened his position concerning the cause of non-assertive behavior. Specifically, he now allows that an individual also may be non-assertive, “… not because of anxiety but because they have never had the opportunity of acquiring the necessary habits. p. 40” (Wolpe and Lazarus, 1966). For these individuals direct efforts in assertive training such as behavior rehearsal, operant conditioning or direct instruction are in order. For these individuals whose lack of assertiveness is due to a ‘phobic reaction’ or strong extrinsic fears, systematic desensitization is recommended in addition to assertive training.Despite this apparent change in position, the intuitively appealing notion that the more socially fearful an individual is the more non-assertive he is likely to be has not received the empirical attention it deserves. Rathus (1973) seems to have provided some indirect evidence pertaining to the relationship between social fears and assertiveness. In the context of evaluating the efficacy of an assertive training method he administered both the 100-item Temple Fear Survey Inventory (TFSI) (Braun and Reynolds, 1969) and the Rathus Assertiveness Schedule (RAS) (Rathus, 1973) to groups of female students receiving either assertive training, a placebo treatment or no treatment. He found that at post-test the assertive training group scored significantly higher than either the placebo or no treatment groups on the RAS and that there were no significant differences in post-test Full Scale TSFI Scores. Fear of Social Criticism Factor Scores or Fear of Social Incompetence Factor Scores although in each case the mean changes toward less fear were greater for the group receiving assertive training. This finding gives little support to the reciprocal relationship between social fears and assertiveness. What is needed is a direct determination of the degree to which social fears and assertiveness are related in a sizeable sample of subjects.     

What is the Revised Fear Survey Schedule for Children measuring?

The Fear Survey Schedule for Children-Revised (FSSC-R) is a widely used self-report questionnaire that purports to measure the number of fears and the overall level of fearfulness in children. A number of studies have shown that the ten most common childhood fears can be found on the Danger and Death subscale of the FSSC-R, with upwards of 50% of children endorsing such fears. However, some researchers (e.g., H. McCathie & S.H. Spence, 1991; Behaviour Research and Therapy, 29, 495-502) have questioned the validity of these findings, suggesting that these items do not reflect actual childhood fears that children have or experience on a daily or regular basis. Rather, they suggest that children are responding to these fear items as if they were actually occurring to them in the here and now. The current study examined the occurrence of five Danger and Death fears from the FSSC-R (i.e., "Not being able to breathe", "Being hit by a car or truck", "Falling from high places", "Bombing attacks or being invaded", and "Fire or getting burned") in a sample of normal school children aged eight to 12 years (N=102). More specifically, we used three different methods to asses these fears: (1). prevalence as determined by the standard FSSC-R procedure, (2). prevalence as determined by a fear list procedure, and (3). actual occurrence or prevalence of these fears in the past week, as determined by a diary method. Results indicated that while these fears ranked high when using the standard FSSC-R procedure, they were considerably less common when using the fear list procedure, and had a low probability of actual occurrence on a daily basis, as well as possessing a short duration and low intensity. Implications for the assessment of fears and the use of self-report measures like the FSSC-R are briefly discussed.     

The three-systems-model of fear and emotion—A critical examination

The ‘Three-Systems-Model’ of fear and emotion (Lang, 1968; Rachman. 1978b) is reviewed and discussed. The paper is centered on four topics relevant to such a view of fear; The definitional focus; Measurement and quantification of components; Implications for etiology; Implications for treatment of phobias. Definitional problems with the radical operationalist view implied by the Tree-Systems-Model are identified and discussed. In addition problems with measurement and quantification of the various components are discussed. Implications for etiology of phobic fears are noted. Finally, it is suggested that treatment methods be individually tailored to the particular component response-profile displayed by each patient, and that the identification of such a profile is included in standard behavioral diagnosis procedures when fear is clinically assessed.     

On the psychological reality of a natural rule of syllable structure

If natural rules in phonology, such as the rule which deletes a word final consonant before a consonant, are frequently found in unrelated languages, it must be because they tap universal features of production and/or perception. The present experiment employed a learning task to see whether naive subjects have a predisposition for the natural rule as opposed to its converse (consonant deletion before a vowel). The Ss first learned four novel words (nouns) - two beginning with a consonant, two with a vowel - as paired associates to English ‘translations’. Then three novel adjectives were combined with each of the four nouns, following the natural rule for one group of Ss, the unnatural rule for the other. The twelve phrases were cued by their English translations and the S had to respond to each with the phonologically correct sequence of adjective and noun; confirmation followed each response. The Ss learning the unnatural corpus had a strong tendency to give natural responses, whereas the converse was not true. Consequently they made many more errors en route to mastery than their natural counterparts, even when the operative rule was displayed on the first trial by presenting in turn each adjective with its four following nouns. It appears that our Ss had implicit knowledge of the natural rule, even though it does not operate to any significant extent in English.     

Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation?

Relations among peritraumatic dissociation, PTSD severity, event-related fear (i.e. fear experienced during traumatic event) about death, and event-related fear about losing control were examined in the current study. Particular emphasis was placed on testing whether or not fears about death and losing control mediate the relation between peritraumatic dissociation and PTSD severity in a sample of 146 nontreatment-seeking university women. Results indicated that event-related fears about death and losing control accounted for the relation between peritraumatic dissociation and PTSD severity; that is, the effect of peritraumatic dissociation on PTSD severity was eliminated after controlling for these fears. Speculations about findings are discussed.     

What we fear most: A developmental advantage for threat-relevant stimuli

Fear is one of our most basic emotions. It is an important social signal and alerts us to when a situation is safe or risky. Interestingly, not all fears are created equal: Several researchers have proposed that humans develop specific fears, such as fear of threatening stimuli, more readily than others. Here we discuss three major theories of fear acquisition, and consider the possibility that some fears are privileged in learning. Second, we review a growing literature that suggests that humans have perceptual biases that quickly draw attention to threatening stimuli in the environment. In particular, we highlight recent developmental work that shows that even infants and young children respond rapidly to the presence of threat well before they acquire any threat-relevant fears. Finally, we argue that such biases may play a causal role in privileging fear learning for certain threats, and we suggest directions for future work that can clarify whether early biases in perception indeed facilitate the development of our most common fears.     

Transfer of fear reduction through systematic desensitization

Systematic desensitization therapy involves the presentation of fear-provoking situations through visualization As the visualizations cease to evoke emotional responses, the fear-provoking potential of the real situations decreases. Research has clearly shown that such transfer does indeed occur with a wide variety of fears. Transfer has been demonstrated, for example, with fear of small animals (Lang and Lazovik, 1963), interpersonal performance anxiety (Paul, 1966), classic phobias (Lazarus, 1961), test anxiety (Katahn, Strenger and Cherry, 1966), impotence (Wolpe, 1958) and frigidity (Lazarus, 1963). However, the nature of transfer has received little attention. Wolpe (1963) has claimed that transfer from therapy to the real life situation is almost complete and direct: “There is almost invariably a one-to one relationship between what the patient can imagine without anxiety and what he can experience in reality without anxiety”. This claim has received support from Rachman (1966) who found that fear reduction transferred immediately to the real situation in 82 per cent of his observations. Hoenig and Reed (1966) reported that after a brief delay, transfer effects were observed in the case of words representing fearful stimuli but were inconsistent in the case of the real stimuli. Agras (1967) found transfer to be delayed in all his cases. He further reported that, though all patients improved, a direct relationship between therapeutic progress and symptom reduction was not found. Both Hain et al. (1966) and Meyer and Crisp (1966) have described the failure of therapeutic effects to transfer to real life.These somewhat inconsistent reports may stem in part from the measurement of transfer effects at different times. Another possibility is that more fearful Ss may evidence less transfer than less fearful Ss. Lang and Lazovik (1963) reported that Ss who completed less than 75 per cent of the hierarchy showed little improvement although direct transfer effects were observed for less fearful Ss (those who complete 75 per cent or more hierarchy items). The present study of transfer effects was designed to remove confoundingof level of fear with extent of progress in systematic desensitization.     

Specificity of interoceptive fear to panic disorders

It has been argued that fear of interoceptive sensations is a maintaining factor in panic disorders. This study investigated whether interoceptive fears are specific to panic disorders or whether they are a feature of neurosis in general. Twenty-nine panic patients, 28 nonpanicking neurotic controls, and 29 normal controls were compared for their scores on a 14-item questionnaire intended to measure interoceptive fears. Indeed it was found that panic patients scored considerably higher than both control groups, whereas no significant differences emerged between the two control groups. It is concluded that interoceptive fear is diagnostically specific to panic disorders.This study was partly supported by the Dutch Organization for Fundamental Research (ZWO/Psychon., 560-268-001) and was carried out at the unit for clinical behavior therapy at Vijverdal Mental Hospital, Maastricht, The Netherlands.     

Recalling courage: An initial test of a brief writing intervention to activate a ‘courageous mindset’ and courageous behavior

ABSTRACT

Though theoretical models propose that courage can be ‘activated,’ little experimental work exists to support this idea. The current study examines a writing intervention that asks individuals to reflect on experiences in which they faced their fears (thus demonstrating courage) to determine if such reflection would promote more approach-oriented cognition (Study 1) and behavioral intentions (Study 2). As expected, when asked to decide if they could/would engage in various approach behaviors related to their fear, participants in the courage condition chose ‘yes’ more often and were comparatively faster to choose ‘yes’ and slower to choose ‘no.’ Furthermore, participants in the courage condition demonstrated greater intentions of approach behavior toward feared situations in the laboratory. These results, though small in effect, suggest that the writing intervention can activate a ‘courageous mindset’ and can promote more courageous behavioral intentions.     

Fear of ‘failure’ and ‘tissue damage’ in police recruits,constables, sergeants and senior officers

This study investigates the effects of occupational experiences on the pattern of fears among groups of British male police officers. Two categories of fears were studied: (1) fear of failure and negative evaluation; (2) fear of tissue damage and bodily harm. The former was expected to increase with police experience and seniority, whereas the latter should decrease due to greater exposure in vivo and limited opportunities for avoidance behaviour. The Ss comprised 72 police recruits, 62 constables, 30 sergeants and 93 senior officers. The hypotheses were confirmed, suggesting clear group differences among police officers in the pattern of fears which was related to police experience and seniority. The Fear scores were found to correlate significantly with neuroticism as measured by the EPQ.