Psychophysiological assessment during exposure in driving phobic patients

A comprehensive assessment of fear or anxiety requires measurement of both self-report and physiological responses. Respiratory abnormalities have been rarely examined during real-life exposure, although they are an integral part of fear. Twenty-one women with a specific driving phobia and 17 nonphobic women were psychophysiologically monitored during 2 highway-driving sessions; phobic women completed an additional session. Respiratory movements, end-tidal partial pressure of carbon dioxide, an electrocardiogram, skin conductance, and skin temperature were recorded. Phobic patients differed from control participants both physiologically and experientially before, during, and after exposure. Effect size during exposure was large for the authors' measure of hyperventilation. Discriminant analysis indicated that multiple physiological measures contributed nonredundant information and correctly classified 95% of phobic and control participants. Thus, selected respiratory and autonomic measures are valid diagnostic and therapeutic outcome criteria for this situational phobia.     

Culturally adapted versus standard exposure treatment for phobic Asian Americans: Treatment efficacy, moderators, and predictors

This study is a 6-month follow-up of a randomized pilot evaluation of standard one-session treatment (OST-S) versus culturally adapted OST (OST-CA) with phobic Asian Americans. OST-CA included seven cultural adaptations drawn from prior research with East Asians and Asian Americans. Results from 1-week and 6-month follow-up show that both OST-S and OST-CA were effective at reducing phobic symptoms compared with self-help control. Moreover, OST-CA was superior to OST-S for several outcomes. For catastrophic thinking and general fear, moderator analyses indicated that low-acculturation Asian Americans benefitted more from OST-CA than OST-S, whereas both treatments were equally effective for high-acculturation participants. Although cultural process factors (e.g., facilitating emotional control, exploiting the vertical therapist-client relationship) and working alliance were predictive of positive outcomes, they did not mediate treatment effects. This study offers a potential model for evaluating cultural adaptation effects, as well as the mechanisms that account for such effects.     

Time-limited desensitisation, implosion and shaping for phobic patients: A crossover study

A comparison was made of the short-term time-limited efficacy of three forms of behaviour therapy in phobic patients: Systematic Desensitization (in imagination), Implosion (in imagination) and Shaping, or Reinforced Practice. A block design was used, all patients receiving all treatments in randomised order. Improvement was measured behaviourally and by symptom rating scales. Differences emerged only on the behavioural measures: Shaping was significantly superior to Desensitisation, with Implosion between the two, and not significantly different from either. Comparison of treated with untreated phobias within subjects showed Shaping to be more specific than the other two forms of treatment. It was concluded that Implosion and Shaping are potentially useful types of therapy, worthy of further study and application.     

Fears of phobic patients: Factor analyses of self-report data

Fear questionnaires completed by 171 phobic patients were factor-analysed. Factors previously identified in student and non-phobic patients were replicated, and in addition an agoraphobia factor was found. Separate analyses of (i) a group of psychiatrically diagnosed agoraphobics and (ii) a group of miscellaneous phobics revealed that agoraphobics are generally more fearful and depressed than other phobics, and score more highly on a cluster of items which include ‘breathing difficulties’ and ‘dizziness’. A distinct agoraphobia factor was not identifiable in the group of miscellaneous phobics, pointing to the all-or-none nature of this fear.     

Perception of autonomic reactions and actual heart rate in phobic patients

The relationship between perceived physiological arousal and actual heart-rate reactions was studied in two behavioral test situations. The subjects were 70 phobic patients (34 social phobics and 36 claustrophobics) who were given the general form of the Autonomic Perception Questionnaire about 1 month before the respective behavioral test and the specific form immediately after the test. The results showed significant correlations between APQ and actual heart rate for the social phobics, while the picture was more complicated for the claustrophobics. The implications of these results are discussed.This research was supported by Grant 05452 from the Swedish Medical Research Council.     

A self-rating scale for evaluating memory in everyday life

A memory self-rating scale is described that includes 21 ability-to-remember items, 24 items assessing frequency of occurrence of memory failures, and 4 global rating items assessing overall comparison to others, comparison to the best one's memory has ever been, speed of recall, and concern or worry over memory function. Factor analysis yielded 5 orthogonal Ability to Remember and 5 orthogonal Frequency of Occurrence factors. The factor structure was not affected by age or sex, and level of complaint on the factor scores was not strongly associated with age.     

Use of systematic desensitization in the treatment of airplane phobic patients

There have been several studies of the phenomenon of airplane phobia mostly dealing with professional aviators and aircrews (Goorney, 1960; Aitken, 1970). There has also been a report of the use of penthranization in the in vivo desensitization of an airplane phobic patient (Mildman, 1969). Recently one case of successful in vivo desensitization using flight simulators and flight instruction has been reported (Bernstein and Beaty, 1971).This paper describes the application of Wolpe's (Wolpe, 1969) technique of systematic desensitization for persons with an airplane phobia.     

The prediction of phobic behaviour

A 10-point rating scale, a pair comparison forced choice technique and a repertory grid were used to predict phobic behaviour in a standardized avoidance situation. The rating scale and pair comparison technique were significantly more accurate than the grid, but did not differ from each other. The results were seen to be consistent with others demonstrating that simple and economic self-report measures can often be more useful than apparently more sophisticated instruments. The results can also be taken to underline the need for including a variety of measures in validity studies of the repertory grid, and the caution necessary in the clinical application of this same instrument. The generality of the present conclusions to other situations needs, however, to be demonstrated rather than assumed. Social desirability, for example, is not thought to be an important variable in the present situation.     

The effects of prolonged exposure to phobic situations upon agoraphobic patients treated in groups

Nineteen female agoraphobic patients were treated by exposure to imaginal and real phobic stimulation in groups. There were three groups, including 7, 5 and 6 patients respectively, and each group received 9 hr of treatment spread over three sessions. The first two treatment hours of the first two sessions were arranged as a crossover design, patients being randomly allocated at the first session to imaginal or reality treatment for an hour followed by the other treatment for an hour, and receiving the treatments in reverse order at the second session. On both occasions there was a third hour of treatment after 1 hr unstructured group discussion over lunch. Psychological and behavioural measures were made before and after each part of treatment, and at follow-up 5 months after treatment.

Patients were significantly helped by this procedure. Practice sessions were associated with much more improvement than imaginal ones, and there was also an order effect, the first treatment received on each treatment day being more effective than the second. Group discussion over lunch did not improve the patient's phobias. The implications of these findings are discussed.     

A view of aggression in phobic states

This article attempts to apply a theory of aggression as motivation to overcome obstacles to the understanding of phobic states and their formation. The role of aggression in the genesis of phobic conditions is discussed, and the traditional analytic view of aggression as instinctual drive is contrasted with a motivational approach. The motivational view offers the advantage of a clearer understanding of the stimulus contexts, representational connections, and both real and imaginary object connections that are lacking in the more traditional understanding of aggression as a biological drive.