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.     

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.     

Attachment,Anxiety, and Agoraphobia

No abstract available for this article.     

Biological vs experiential factors in phobic conditioning

The present study was performed as a test of phobic conditioning being a case of prepared learning (Seligman, 1971). Skin conductance responses were conditioned in three groups of subjects to either slides of snakes and spiders; electric outlets; or geometric shapes, as conditioned stimuli (CSs) with shock to the forearm as the unconditioned stimulus (UCS). The purpose of the experiment was to compare electrodermal conditioning to potentially phobic CSs, i.e. snakes and spiders, with conditioning to fear-relevant, but non-phobic, CSs, i.e. electric outlets.Each subject saw two pictures, either a snake or a spider; or two different slides of electric outlets; or two different geometric shapes. Only one of the two cues (the CS + ) was immediately followed by the shock-UCS during the acquisition phase. Thus, a differential paradigm was used. There were 4 habituation, 12 acquisition, and 16 extinction trials. The duration of the pictures was 8 sec with an intertrial interval of between 35–45 sec.The results showed reliable effects of conditioning in all three groups during the acquisition phase. Furthermore, a significant interaction during extinction is reported, indicating responses to potentially phobic CSs to be more resistant to extinction than responses to the other two classes of stimuli. It is concluded that the present results favor an interpretation of phobic conditioning in terms of biologically prepared learning.     

Adolescent pregnancy: contributing factors, consequences, treatment, and plausible solutions

Adolescence, although not always necessarily a period of extreme stress, is a time of profound physical changes which increase the adolescent's awareness of and interest in sexual behavior. This issue of sexuality, which begins in early adolescence, creates new challenges to personal and gender identity formation as the person matures. Sexual maturation is a three-fold process, requiring growth in understanding of oneself as a sexual being, in the ability to handle interpersonal relationships effectively, and in the capacity to plan behavior in view of future outcomes and present problems. A current concern is that today's adolescents, including early adolescents, may be making important life choices such as parenthood before they are developmentally ready for such roles (Chilman, 1980). This paper deals with pregnancy in adolescents and modes of responding to this phenomenon by those in the counseling and other helping professions.     

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.     

Embodied Domestics,Embodied Politics: Women,Home, and Agoraphobia

Agoraphobia is commonly considered to be a fear of outside, open, or crowded spaces, and is treated with therapies that work on acclimating the agoraphobic to external places she would otherwise avoid. I argue, however, that existential phenomenology provides the resources for an alternative interpretation and treatment of agoraphobia that locates the problem of the disorder not in something lying beyond home, but rather in a flawed relationship with home itself. More specifically, I demonstrate that agoraphobia is the lived body expression of a person who has developed an inward-turning tendency with respect to being-at-home, and who finds herself, as a result, vulnerable and even incapacitated when attempting to emerge into the public arena as a fully participatory agent. I consider this thesis in light of the fact that since World War I agoraphobia has been diagnosed significantly more in women than in men; indeed, one study found women to be 89% more likely than men to suffer from agoraphobia. I conclude that agoraphobia is a disorder that stands as an emblematic expression of the ongoing pathology of being a woman in contemporary society–a disorder that reflects that even today women belong to a political world in which they are not able to feel properly at-home.     

Seeking urgent pediatric treatment: factors contributing to frequency, delay, and appropriateness

The present study explored the factors that contribute to mothers' decisions to seek urgent medical attention for their children when symptoms are not of a traumatic nature. One hundred mothers seeking treatment for their children at a prepaid clinic completed a questionnaire eliciting their expectations regarding the course of their children's problems, seriousness of the problems, perceived responsibility for the symptoms, and extent to which a variety of factors contributed to their decisions to seek treatment. Demographic data and information about each child's symptoms and medical history were also obtained. Four major "reasons for seeking treatment" factors were identified: family history of the presenting complaint, worry regarding the symptoms, situational variables, and the extent of the child's illness behavior. The appropriateness of the visit, delay in seeking treatment, and frequency of mothers' use of the pediatric clinic were predicted by the nature of the presenting symptoms (particularly the presence of fever), the ages of the mother and child, and two of the reasons for seeking treatment factors (i.e., family history and child's illness behavior). The present study suggests that mothers pay more attention to presenting symptoms and to the children's behavior than to psychosocial stressors in deciding to seek urgent care.     

The determination of optimal exposure to phobic stimuli in flooding therapy

The present study compared the value of various criteria for determining exposure duration to phobic stimuli in flooding therapy. Results indicated that basing exposure termination on a return to resting ranges of HR was not effective in increasing approach behavior, whereas basing termination on observer's judgements was quite effective. Employing self-reported anxiety reduction as the termination criterion was no more effective than using either the HR criterion or a procedure that combined all three criteria (HR, self-report, and observer's judgements). Self-reported fear data showed similar trends with the HR criterion again failing to produce any greater benefits than control procedures. Nine-weeks follow-up indicated a persistence of the behavioral changes with some loss of the gains in subjective anxiety, and a reduction in the differences between groups.     

Attention to phobic stimuli during exposure: the effect of distraction on anxiety reduction, self-efficacy and perceived control

To replicate and extend the finding that distraction facilitates between session anxiety reduction (), 27 spider phobics underwent three 10-min sessions of in vivo exposure followed by one 10-min exposure session at a 4-week follow-up, while having either stimulus-relevant focused conversation or stimulus-irrelevant distracting conversation with the experimenter. Physiological arousal and subjective anxiety were measured during exposure, and self-efficacy, perceived control and performance on a behavioural task were measured at pre-treatment, post session-3, and follow-up. Monitoring and blunting coping styles were also measured at pre-treatment to assess their impact on treatment outcome. Despite equal physiological activation between the groups, those who underwent distracted exposure showed greater reductions in subjective fear within and between sessions, and showed greater increases in self-efficacy ratings, internal perceived control and performance on a behavioural task. Coping style did not interact with the effect of distraction or focusing during exposure, however blunters had less subjective anxiety reduction overall, particularly when they underwent focused exposure. Results are discussed in terms of the emotional processing model and self-efficacy theory.     

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.     

Adolescent pregnancy: contributing factors and strategies for prevention.

A questionnaire was administered to pregnant adolescents and adolescent mothers to assess both basic needs and factors that may have contributed to their becoming teen parents. Family background and composition, history of sexual abuse, vocational plans and aspirations, and self-esteem were examined. Results and implications for prevention programs and counseling are discussed.     

Very brief exposure II: the effects of unreportable stimuli on reducing phobic behavior

This experiment compared the effects of exposure to masked phobic stimuli at a very brief stimulus-onset asynchrony on spider-phobic and non-phobic individuals. Participants were identified through a widely used questionnaire and a Behavioral Avoidance Test (BAT) with a live, caged tarantula to establish baseline levels of avoidance. One week later, they were individually administered one of two continuous series of masked images: spiders or flowers. Preliminary masking experiments showed that independent samples of participants from the same populations failed to recognize these stimuli. Participants in the main experiment reported ratings of subjective distress immediately before and after the exposure manipulation. Then they engaged in the BAT once again. Very brief exposure to images of spiders reduced phobic participants' avoidance of the tarantula. No effects were evidenced on subjective distress, or on non-phobic participants. Theoretical implications for the non-conscious basis of fear are discussed.     

Veterinary use of exposure techniques in the treatment of phobic domestic animals

Exposure techniques as a treatment for human phobias are reviewed, as well as exposure's use in the extinction of avoidance behavior in laboratory animal studies. A third arena in which exposure is employed is reconsidered--in the veterinary treatment of phobic domestic animals. Veterinary use of exposure is illustrated, and the advantages and disadvantages of the veterinary study of exposure are discussed.     

Moderating factors explaining stress reactions: comparing chronic-without-acute-stress and chronic-with-acute-stress situations

The author compared patterns of moderating factors explaining stress reactions during 2 states: chronic-without-acute-stress and chronic-with-acute-stress. She hypothesized that personal dispositions would contribute more to understanding stress reactions during a prolonged stress state than during an acute state. The participants were Israeli Jewish adolescents living in West Bank settlements during the prolonged (chronic-without-acute-stress) state of the intifada (the Palestinian uprising against Israeli occupation) and during the chronic-with-acute-stress state, immediately after the assassination of Prime Minister Rabin. The author examined 5 variables as moderating factors--trait anxiety, sense of coherence, cognitive appraisal of the political situation, family sense of coherence, and sense of community--and measured 2 stress reactions--state anxiety and psychological distress. Data were collected from 266 8th-grade students during the chronic-without-acute-stress state and 448 students at the same grade level at the chronic-with-acute-stress state. The overall magnitude of variance explanation was different at each state: The author found a relatively high explained variance of state anxiety and psychological distress in the chronic-without-acute-stress situation but not in the chronic-with-acute stress state. These data support the value of developing a model that would recognize the different types of stress situations for moderating the effects of stress.     

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.     

Covariation bias,classical conditioning,and phobic fear

The present study investigated whether phobics show an illusory correlation (IC) between phobia-relevant stimuli and aversive events. Nineteen treated and 19 untreated spider phobics were exposed to a series of 72 slides. Three different categories were used: Phobia-relevant slides (spiders), alternative fear-relevant slides (weapons), and neutral slides (flowers). Slides were randomly paired with either a shock, a siren, or nothing at all. All slide/outcome combinations occurred equally frequently. A posteriori recorded contingency estimates indicated that untreated phobics dramatically overestimate the covariation of spiders and shock. On-line recorded outcome expectancies revealed that the bias to overestimate the spider-shock contingency is highly resistant to extinction. The covariation bias was accompanied by differentially heightened electrodermal first interval responses (FIR) and unconditioned electrodermal responses (third interval responses: TIR) on phobia-relevant trials. Treated phobics did not show a covariation bias, indicating that such bias can be modulated by behavioral treatment. The present findings sustain the hypothesis that phobic subjects process information in a fear-confirming way.