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.     

Self-directed desensitization for acrophobia

Acrophobic outpatients received therapist- or self-directed (tape-recorded) desensitization in a study of (a) treatment effectiveness with diminished therapist contact ; (b) subject characteristics ‘predicting’ outcome; and (c) generalization of change. At Post-test, treated Ss (N=16) had improved significantly more than Waiting List Ss (N=13) on self-report measures of acrophobia and general anxiety, while the treatment methods were equally effective. An 8-month follow-up found that self-directed Ss had attempted more specific behavioral situations than therapist-directed Ss, and showed additional gains on self-report measures while therapist-directed Ss maintained post-test levels. Results suggested: (a) desensitization provides effective treatment even with reduced therapist contact; (b) some subject characteristics relate to outcome and (c) treatment effects generalize to other anxiety indices.     

Play desensitization of fear of darkness in preschool children.

Systematic desensitization therapy (SDT) is considered to be a technique of established effectiveness in reducing monosymptomatic fears (Paul, 1969a, 1969b), yet little systematic research has been done to investigate the merit of desensitization procedures in modifying children's behavior. The few available controlled studies (Miller et al., 1972; Obler and Terwilliger, 1970; Oliver, 1971) on desensitization with children have produced equivocal results. Although imagery and relaxation have been reported of benefit when used separately (Graziano and Kean, 1971; Lazarus and Abramovitz, 1962), evidence suggests that the usual combination of imagery and relaxation is not effective in reducing children's fears (Miller et al., 1972). Investigators in this area have often modified traditional SDT to include alternatives to imagery such as pictures, drawings, play (Cassell, 1965; Lazarus, 1960; Obler and Terwilliger, 1970; Patterson, 1965), or in vivo exposure to the feared stimulus (Obler and Terwilliger, 1970). Relaxation has often been replaced with other responses thought to be incompatible with anxiety such as eating (Jones, 1924). Another deviation from traditional SDT has been the delivery of positive reinforcement (food, praise, or toys) contingent upon the child's approaching the feared object (Obler and Terwilliger, 1970; Patterson, 1965). On the basis of such varied techniques, it is impossible to determine which of these procedures constitutes an effective treatment method for children. In the following study, three desensitization procedures involving graded exposure to the feared stimulus (darkness) through symbolic play, were compared to no-treatment and placebo control groups under differing instructional sets. Treatments were designed to determine the therapeutic efficacy of play as a method of stimulus presentation with children, and to determine whether reciprocal inhibition, extinction, operant reinforcement, or instructional set contribute to fear reduction in desensitization with children.     

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.     

The effects of two stressors on state anxiety for students who differ in trait anxiety

The role of individual differences in speech trait anxiety as they related to the magnitude of A-State responses in two stressful situations was examined. Measures of anxiety were obtained before, during, and immediately after Ss gave a speech (ego-stressor) and blew up a balloon until it burst (physical stressor). While exposure to each stressor resulted in dramatic changes in A-State, it was found that differential A-State increases for the high and low speech trait anxious Ss occurred only during the ego-stressor condition. These findings were discussed in terms of Trait-State Anxiety Theory with particular reference to the differential stressful effects of ego and physical stressor on A-State for Ss who differ in A-Trait.     

A Pursuit Device for Obtaining both Quantitative and Qualitative Records

Fifth and sixth grade students (N = 87) were divided into High Test Anxious and Low Test Anxious groups on the basis of galvanic skin responses (GSR). Ss identified as High Anxious responded positively to group systematic desensitization procedures, exhibiting significantly (p < .05) lower autonomic indices of test anxiety and significantly (p < .001) improved criterion test scores. Low Anxious Ss exposed to the systematic desensitization program demonstrated no significant change in criterion test scores.     

Stimulus hierarchy generalization in systematic desensitization

A group of snake phobic Ss were desensitized to the first 5 items of a standard 7 item snake fear hierarchy in which the items were ordered on the basis of distance from a snake. This group and a no-treatment control group (which did not receive the desensitization) were treated for fear of all the hierarchy stimuli in terms of ratings both before and after the desensitization. The Ss rated their fear responses to all the stimuli as presented to them in (1) real form (2) by slide, and (3) in imaginal form. The results verified all four experimental hypotheses: (1) The experimental Ss showed greater fear reduction than the control Ss to both the training stimuli (the stimuli on which desensitization done) and the generalization stimuli (the other two stimuli), (2) The systematic desensitization (SD) group showed (a) more fear reduction to the last training stimuli than to the lower generalization stimulus and (b) more to the latter than to the higher generalization stimulus, (3) The SD group showed less fear reduction to the generalization stimuli in their real form than in both the slide and imaginai modalities (in the desensitization each stimulus presentation was done first in slide form and then in imaginal form), and (4) There were significant overall individual differences in generalization of fear reduction to the generalization stimuli.     

Covert sensitization, stimulus relevance and the equipotentiality premise

Covert sensitization and related cognitive aversive techniques have been widely used and reviewed but, to date, the issue of the quality and relevance of the aversive imagery selected has yet to be investigated. In the present study, Ss were given a target substance to consume and then presented with narratives designed to elicit either nausea, anxiety or relaxation. The nausea and anxiety scenes were rated as equally aversive but there was a significant reduction in consumption only within the taste-nausea imagery group. These results are consistent with those obtained from the study of taste aversion in infra-human Ss where taste has been shown to associate preferentially with nausea. The present results call into question the validity of the ‘equipotentiality premise’ in cognition. The implications of these findings for the clinical application and evaluation of covert sensitization are discussed.     

Eye movements and visual imagery in free recall

The relationship between eye movements and visual imagery has almost exclusively been studied by treating eye movements as the dependent variable while an imagery task is being performed. In the present experiment three eye-movement treatment conditions were manipulated, within Ss, as the independent variable in order to study their effects on the free recall of nouns which Ss had to store by means of imagery. The imagery-evoking capacity (I) of nouns was varied over three levels within lists of Dutch nouns (Low, Medium and High I). Ss were instructed to generate a visual image to each separate noun under the following treatment conditions: (a) while they looked over and scanned their image as if they were looking at the real object: (b) while they received concurrent visual stimulation from a checkerboard pattern; (c) while they fixated on a target. Reliable, but minor effects of treatment conditions on the recall scores were found. The results were discussed in terms of possible theories about the nature of the relationship between eye movements and visual imagery.     

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 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.     

Usefulness of emotive imagery in the treatment of childhood phobias: Clinical guidelines,case examples and issues

Emotive imagery is a variant of systematic desensitization that has been developed for use in the treatment of children's excessive fears. We outline clinical guidelines for the use of emotive imagery and present several case examples. Although emotive imagery appears to be useful and cost efficient, controlled studies are needed to establish the efficacy of emotive imagery and explore the active treatment ingredients or mechanism.     

The Problem of the Meaning of Words Based upon Observation of Aphasic Patients

Research has indicated that massed systematic desensitization can be effective. There is no definite evidence, however, of the superiority of massed or spaced therapy. The present study investigated the effects of massed and distributed systematic desensitization upon a spider phobia. Eighteen Ss were given a fear hierarchy before therapy and then after therapy. Analysis of the results suggests that massed and distributed sessions do not differ significantly in effectiveness, which supports Suinn and Hall (5).     

The role of imagery in incidental learning of educable retarded and normal children

Forty-five educable retarded and 45 normal children were given an orientation task in which noun- and picture-paired associates were presented once or four times under one of three instructional conditions: intentional imagery, incidental imagery, or intentional control (no imagery). An immediate associative recall test showed both imagery conditions to be superior to the intentional control condition. Furthermore, imagery instructions facilitated incidental recall of the retarded Ss equal to the recall of normal children in the intentional condition. Four presentations of pairs in contrast to one presentation during the orientation task improved the learning of both groups. The recall of retarded Ss in contrast to normal Ss, however, was greater with four presentations under imagery instructions than under intentional control instructions. The results were discussed in terms of imagery processes and their educational implications.     

Evaluation apprehension and response withholding in solution of anagrams

Sixty male Ss who were classified as high or low scorers on the Sarason Test Anxiety Scale performed a difficult anagrams task either alone, before a passively observing experimenter or in the presence of an experimenter who both observed and evaluated the S's performance. Ss who were high in test anxiety attempted fewer anagrams and had fewer correct solutions in the Evaluated condition than in the Alone condition, but also had a higher proportion of correct solutions out of total attempts. Low test-anxiety Ss did not show variable performance across conditions for any measure. Follow-up studies showed that when Ss were encouraged to attempt partial solutions neither test anxiety nor experimental treatment influenced any of the measures of performance. State anxiety change scores from baseline to post-treatment assessment showed a generally negative correlation between anxiety and number of anagrams attempted. The results indicate that fear of failure engendered by test anxiety and experimenter evaluation caused Ss to withhold responding.     

Anxiety and cognitive-task performance

The performance of individuals high and low in trait anxiety was compared on a cognitive task involving letter transformation. This task was performed in the presence or absence of monetary incentive for superior performance. Adverse effects of anxiety on performance were apparent only on the more complex versions of the letter-transformation task. Analysis of the microstructure of the task indicated that anxiety impaired the rehearsal and storage of task-relevant information. Motivation in the form of monetary incentive improved the performance of low-trait-anxiety Ss, but had no effect on high-trait-anxiety Ss. The findings were discussed with reference to the working memory system and the theory proposed by Eysenck (1979).     

Objective vs subjective assessment of relaxation compliance among anxious individuals

Previous relaxation outcome research has lacked means to empirically determine how well Ss comply in home-practice assignments. This study reports on a relaxation assessment device (RAD) used by 21 adults who received 4 weeks of relaxation therapy for generalized anxiety. The RAD consists of a digital wristwatch, with a stopwatch function, surreptitiously placed within Ss' tape-players to monitor the amount of relaxation practice at home. Comparison of self-reported and RAD-determined practice found that Ss exaggerated their actual practice by an average overestimation of 126%. Only one-fourth of the Ss performed relaxation daily. Anxiety reductions were significantly correlated with RAD-determined but not with self-reported practice. Self-efficacy judgments significantly correlated with relaxation compliance only when percent overestimation in self-reports was controlled. The need for objective compliance measures in relaxation outcome studies was discussed.     

Social skills training and systematic desensitization in reducing dating anxiety.

Cooper et al. (1969) have criticized the types of target behavior chosen for therapy analogue studies for being irrelevant to clinical practice. A potential target behavior which appears to be pervasive, complex and directly relevant to clinical practice is interpersonal anxiety. Of special concern to college students is the interpersonal anxiety elicited by members of the opposite sex. especially in dating situations (Martinson and Zerface, 1970).An individual may experience interpersonal anxiety because of a deficit in social skills (reactive anxiety) or because of prior conditioning (conditioned anxiety) or because of some combination of both reactive and conditioned components. While it is possible that a treatment program aimed at a reduction of either of these anxiety components may be instrumental in ameliorating the other component, it would appear that a comprehensive treatment program would attempt to teach social skills as well as reduce conditioned anxiety.Desensitization procedures have demonstrated success in alleviating conditioned anxiety for a wide variety of clinical problems (Paul, 1969a. 1969b) and appears to be a logical choice for the conditioned component of dating anxiety. A number of outcome studies have reported some success in the use of in vivo desensitization (Rehm and Marston, 1968; Martinson and Zerface, 1970) and systematic desensitization (Stark, 1970) in reducing anxiety in date anxious subjects.The literature on treatment programs aimed at social skills training for date anxious subjects is meager. Melnick (1973) reported success in improving the appropriateness of the social behavior of subjects who had experienced a minimal dating history by the use of modeling, behavioral rehearsal and self-observation techniques.The present study was designed to test the relative effectiveness of two different types of treatment programs in alleviating interpersonal dating anxiety. The two experimental groups consisted of a systematic densensitization program which focused on the condition anxiety component and a social skills training program which focused on the reactive anxiety component.     

The effects of language conditioning on various aspects of anxiety

Staats' three-function learning theory provides the basis for investigating the effects of emotionally-relevant self-verbalizations (SV) on the physiological, subjective-affective and behavioural aspects of anxiety. Using aversive electric UCSs and slides of snakes (CS), anxiety was classically conditioned in 88 volunteer Ss. In 20 subsequent language-conditioning trials (without aversive electric UCSs), the same snakes slides were paired with UCS verbalizations having either positive or negative connotative meanings. Half of the Ss were exposed to a living snake prior to language conditioning. The results show a complete extinction of the conditioned anxiety response in groups with positive SV whereas negative SV impeded extinction; the latter effect could only be found in groups without exposure to snakes prior to language conditioning. In general, the affective evaluation of snakes improved in groups with positive SV and deteriorated in groups with negative SV. However, these effects were more pronounced in groups without exposure to snakes. Although the results indicate that Ss in all groups with positive SV exhibited more approach behaviours than Ss with negative SV, this trend was not statistically significant. The possible relevance of the results for a language-conditioning approach to anxiety reduction is briefly discussed.