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.     

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.     

An investigation of the decrement of anxiety responses during systematic desensitization therapy

A clinical and psychophysiological study of the decrement of anxiety responses during systematic desensitization of six phobic patients revealed the phenomenon of spontaneous recovery. Quantitative results are presented and the relevance of these to relapse following therapy suggested.     

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.     

‘Preparedness’ and ‘arousability’ as determinants of electrodermal conditioning

‘Arousability’, as defined through spontaneous electrodermal responses, has been empirically linked to anxiety, phobic symptoms and outcome of systematic desensitization. Previous data from our laboratory indicate that ‘preparedness’, as defined through potentially phobic vs. fear-irrelevant or ‘neutral’ conditioned stimuh, is an important determinant of electrodermal conditioning. The present experiment compared groups selected to be high or low in spontaneous responding during differential conditioning to potentially phobic or neutral stimuh. It was found that the effects of these two factors were essentially additive, i.e. conditioning and resistance to extinction were better for phobic stimuli and for high-arousal groups. The high-aroused group with phobic stimuh showed diffuse responding during acquisition, not differentiating between reinforced and unreinforced cues. However, it was the only group that failed to extinguish during 20 trials, which indicates that high arousal gives superior resistance to extinction particularly for phobic stimuli.     

Systematic desensitization: a technique worth trying

Systematic desensitization is a limited form of behavior therapy used in the treatment of anxiety attached to specific objects or situations. The principles underlying the technique as developed by Wolpe and others are described briefly in this article. The author also relates his experiences in using a modified form of systematic desensitization in a public school setting with counselees whose success and development are hampered by test anxiety and fear of public speaking.     

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.     

An investigation of the effectiveness of desensitization and flooding with two types of phobias.

Thirty-two university undergraduates, sixteen complaining of specific phobias and sixteen suffering from social phobia, were treated using either desensitization or flooding procedures. The effectiveness of therapy was evaluated using physiological, self-report, and objective test data. Heart rate and GSR responses to both phobic and neutral slides and images, and habituation rate to neutral tones, were obtained for each subject. Physiological changes were greatest using flooding, especially with specific phobies, while other measures, including therapist and client satisfaction, supported desensitization. Results are consistent with a model stressing the need for a repeated exposure to specific fear cues.     

Effects of diazepam on approach, self-reported fear and psychophysiological responses in snake phobics

The effects of diazepam was assessed on a number of measures of phobic anxiety. Snake-phobic subjects underwent two sessions on either diazepam or placebo in a crossover design. In addition to a habituation series, a slide with the phobic object was displayed as well as a live snake which subjects were asked to approach. The anxiolytic effect of diazepam was manifest in only one measure of fear, namely self-rated fear at the point of closest approach when it also attained the highest level. The result would indicate that diazepam has an anxiolytic only on high levels of subjective anxiety. The magnitude of the phasic cardiac reaction to the slide was highly and positively correlated with self-rated fear of the slide.     

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.     

Sensitization and habituation regulate reinforcer effectiveness

We argue that sensitization and habituation occur to the sensory properties of reinforcers when those reinforcers are presented repeatedly or for a prolonged time. Sensitization increases, and habituation decreases, the ability of a reinforcer to control behavior. Supporting this argument, the rate of operant responding changes systematically within experimental sessions even when the programmed rate of reinforcement is held constant across the session. These within-session changes in operant responding are produced by repeated delivery of the reinforcer, and their empirical characteristics correspond to the characteristics of behavior undergoing sensitization and habituation. Two characteristics of habituation (dishabituation, stimulus specificity) are particularly useful in separating habituation from alternative explanations. Arguing that habituation occurs to reinforcers expands the domain of habituation. The argument implies that habituation occurs to biologically important, not just to neutral, stimuli. The argument also implies that habituation may be observed in “voluntary” (operant), not just in reflexive, behavior. Expanding the domain of habituation has important implications for understanding operant and classical conditioning. Habituation may also contribute to the regulation of motivated behaviors. Habituation provides a more accurate and a less cumbersome explanation for motivated behaviors than homeostasis. Habituation also has some surprising, and easily testable, implications for the control of motivated behaviors.     

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.     

Does anxiety sensitivity correlate with startle habituation? An examination in two independent samples

Individuals with anxiety disorders have previously demonstrated abnormal habituation to aversiveness over time. As anxiety sensitivity (AS), or an individuals' propensity to fear of anxiety-related sensations, has been shown to be a risk factor for anxiety disorders (particularly panic disorder), the present study examined whether AS was also associated with abnormal habituation. This association was examined in two independent samples of undergraduates (N_total=178). Habituation was operationalised as the reduction in startle response to multiple startle probes presented over 2.5 minutes and three definitions of this reduction were employed. Results indicated that individuals with higher levels of AS evidenced deficits in startle habituation, but the strength of this relationship was somewhat dependent on the definition of startle habituation, with the most robust definition being an analysis of participants' individual slopes across all nine blinks. The present findings suggest that startle habituation is a key mechanism underlying AS, and may help elucidate the role this risk factor plays in the pathogenesis of anxiety disorders.     

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.     

Habituation of the hiding response to cat odor in rats (Rattus norvegicus)

Cat odor-induced hiding was examined in rats (Rattus norvegicus) using an apparatus with a "hide box" at one end and a piece of a worn cat collar at the other end. Rats spent most of their time hiding on exposure to the cat collar, but this response gradually habituated over repeated daily exposures. Hiding was reversed by administering the anxiolytic drug midazolam (0.375 mg/kg). Rats showed increased anxiety on the elevated plus-maze after exposure to the collar. This response was absent in habituated rats, suggesting that habituation of hiding reflects decreased odor-induced anxiety. It was established that rats located in the hide box of the apparatus might not have detected the odor of the cat collar placed at the other end of the apparatus. This implies that habituation occurs after relatively modest levels of odor exposure. Overall, the results cast some doubt on claims that predatory odors in rats are akin to phobic stimuli in humans.     

Psychophysiological aspects of systematic desensitization: some outstanding issues

Nine psychophysiological propositions generated by systematic desensitization theory were examined in the light of recent research. Four propositions were substantially confirmed, four partially confirmed and one was not confirmed. Facts reviewed did no agree with the prediction from desensitization theory that less threatening stimuli decondition faster than more threatening stimuli. With the exception noted above, desensitization theory was generally supported. A scheme for distinguishing four types of autonomic response change (habituation, reciprocal inhibition, counterconditioning and extinction) was presented.     

Vicarious desensitization of test anxiety

students fail in the university environment due to an inability to perform in testing situations because of anxiety associated with tests (Suinn, 1968). Systematic desensitization has been found to be effective in the treatment of test anxiety, and attempts are being made to improve both the efficiency and effectiveness of this procedure (Mann and Rosenthal, 1969; Suinn and Hall, 1970). This study evaluates the relative effectiveness of four methods of systematic desensitization in the treatment of test anxiety. Specifically, two changes were investigated which may lead to: (a) more rapid forms of treatment (massed treatment versus distributed treatment); (b) more easily administered forms of treatment (vicarious desensitization versus active desensitization).     

Recall bias for stimulus and response anxiety words in spider phobics

Abstract

Experiments on memory bias in patients with anxiety disorders have produced inconsistent results. It is suggested that results may depend on whether the words studied relate to anxiety-inducing stimulus features or to the anxiety response. It was predicted, following previous results, that phobic subjects would show diminished recall of stimulus words, but that recall of response words might be enhanced. In fact, for both stimulus and response words, phobics showed better recall of phobia-related words than of control words. The results are consistent with the hypothesis that phobic anxiety is associated with a bias towards recall of phobia-related words. However, it seems likely that phobic anxiety has several potentially conflicting effects on recall, and that this accounts for the inconsistent results in literature.     

Attitudes Toward Civil Liberties: A Cross-Cultural Study

In a test of the hypothesis that irrational thinking is associated with phobic anxiety, the Rational Behavior Inventory and the Fear Survey Schedule were administered to 128 undergraduates. Although a statistically significant correlation between irrationality and phobic anxiety was found, the result appears to have little clincial meaning. Other evidence is cited which suggests that rational emotive therapy is best suited for the treatment of generalized anxiety, whereas deconditioning treatments are appropriate for most cases of phobic anxiety.