Cognitive modification versus prolonged exposure in vivo: a comparison with agoraphobics as subjects.

Cognitive restructuring and prolonged exposure in vivo were compared in a cross-over design with 21 agoraphobics.Assessments were made at the beginning of treatment, at cross-over, at the end of treatment and at the follow-up one month later. Assessment were carried out by an independent observer (phobic anxiety and avoidance scales and anxious mood) and by the client (measurement in vivo, phobic anxiety and avoidance scales. FSS, ASES, SDS and 1-E scale). Prolonged exposure in vivo proved to be a definitely superior form of treatment to cognitive restructuring, as measured by the behavioral in vivo measurement and the phobic anxiety and avoidance scales.     

Therapist-controlled exposure in vivo versus self-controlled exposure in vivo: A comparison with obsessive-compulsive patients

Fourteen obsessive-compulsive clients were given treatment consisting of ten sessions of gradual exposure in vivo With half the clients, the exposure in vivo was therapist-controlled; with the other half, the exposure in vivo was self-controlled.

The results of the posttest showed that both versions of the treatment resulted in a significant improvement on the in vivo measurement, anxiety and avoidance scales, Leyton Obsessional Inventory, Self-Rating Depression Scale and anxious mood. Neither the posttest nor the follow-ups one month and 3.5 months later indicated a difference between the effects of the two conditions. Self-controlled exposure in vivo proved to be as effective as therapist-controlled exposure in vivo, in spite of the fact that in the latter condition each treatment session lasted twice as long as in the former condition.     

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.     

Bethanechol chloride as a suggested adjunct to prolonged in vivo exposure therapy in the treatment of paruresis

A major difficulty in treating paruresis (psychogenic urinary retention) by prolonged in vivo exposure therapy involves the individual's inability to initiate urination in response to anxiety-provoking stimuli easily and frequently enough to generalize the desired behavior to everyday situations. Administration of bethanechol chloride, a parasympathomimetic compound that facilitates urination by prompting contraction of the detrusor muscle of the bladder, prior to therapeutic sessions is suggested to enhance the efficiency and effectiveness of in vivo desensitization procedures in the treatment of paruresis.     

Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia

The aim of the present study was to evaluate the effectiveness of low-budget virtual reality (VR) exposure versus exposure in vivo in a between-group design in 33 patients suffering from acrophobia. The virtual environments used in treatment were exactly copied from the real environments used in the exposure in vivo program. VR exposure was found to be as effective as exposure in vivo on anxiety and avoidance as measured with the Acrophobia Questionnaire (AQ), the Attitude Towards Heights Questionnaire (ATHQ) and the Behavioral Avoidance Test (BAT). Results were maintained up to six months follow-up. The present study shows that VR exposure can be effective with relatively cheap hardware and software on stand-alone computers currently on the market. Further studies into the effectiveness of VR exposure are recommended in other clinical groups as agoraphobics and social phobics and studies in which VR exposure is compared with more emerging virtual worlds as presented in CAVE-type systems.     

Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder

This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols.     

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.     

A note on the interference between verbal output and a cognitive task

Verbal output has been shown to depress cognitive performance. Examining the durations of speech and silence in a secondary verbal task suggests that the processing load even of practiced speech is sufficient to limit the parallel processing of a cognitive task forcing serial processing during the silent gaps in speech.     

A note on a cognitive probability model incorporating the serial position effect

A generalization of a cognitive probability model is proposed utilizing the serial position effect to account for decay in probability of recall. The general nature of the model permits the incorporation of almost any of the recent free-recall serial position curve results. Two examples, hypothesizing different serial position curves, are given.