Reciprocal inhibition or extinction?

Since reciprocal inhibition therapy techniques involve the procedure for classical extinction, it is reasonable to consider the possibility that it is extinction, rather than counterconditioning, that is responsible for their efficacy. Certain experiments increase the plausibility of this possibility by suggesting that a certain feature of the extinction procedure involved in the reciprocal inhibition techniques makes it more effective than free response avoidance extinction. This feature is the fact that the subject's escape from the anxiety stimuli is delayed by the therapist's instructions. Only one experiment clearly indicates any feature of any reciprocal inhibition technique which could not be attributed to extinction, this characteristic being a superiority of a reciprocal inhibition procedure to extinction in eliminating fear in rats. Thus for explaining reciprocal inhibition therapy, it is still essentially an open question as to whether the concept of reciprocal inhibition is better than extinction.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

Caffeine does not modulate inhibitory control

The effects of a 3mg/kg body weight (BW) dose of caffeine were assessed on behavioral indices of response inhibition. To meet these aims, we selected a modified AX version of the Continuous Performance Test (CPT), the stop task, and the flanker task. In three double-blind, placebo-controlled, within-subjects experiments, these tasks were administered to healthy participants. While the results for the AX-CPT were indicative of improved response inhibition after caffeine, they might also reflect caffeine-induced changes in mechanisms other than response inhibition (e.g., attentional processes). The results for the stop task and flanker task were more straightforward. That is, the effects of caffeine on overall flanker performance and selective response suppression as revealed by distribution-analytical techniques were negligible. In the stop task a global effect of caffeine on processing speed was seen, rather than specific effects on response inhibition. Taken together, these experiments showed that both active and reactive inhibition were not significantly modulated by caffeine. The present results are linked to neural circuits that underlie inhibitory control and the role of caffeine-induced strategic changes.     

A case report on the use of flooding in stuttering therapy

The last several years have seen the development and use of anxiety-reduction procedures in stuttering therapy. Among these types of methods, systematic desensitization and reciprocal inhibition have been employed almost exclusively. Emotional de-conditioning by means of flooding or implosive techniques has been attempted far less often. This article presents a case report on the utilization of the flooding tactic. Results are offered and discussed relative to the question of whether the elimination of anxiety is a realistic goal in therapy. The suggestion is offered that what many stutterers may really need to develop is the ability to generate fluency-enhancing behaviors in spite of the presence of heightened emotionality.     

准备状态对反应抑制的影响

从事件因素和时间因素两个方面探讨了准备状态对反应抑制的影响。事件准备可降低反应模式的不确定性 ,而时间准备则与降低反应时间的不确定性有关。线索、反应概率以及刺激呈现时间等因素不仅导致反应时间出现变化 ,还可引起反应力、心跳间期以及LRP和CNV等脑电指标发生变化。传统的反应抑制研究以反应时为指标 ,不能揭示反应抑制的内部过程 ,而心理生理学方法能弥补这一缺陷。生理指标与行为指标的结合 ,以及生理指标之间的结合 ,可更有效地探讨准备状态对反应抑制的效应。     

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.     

不同反应重复量对反应抑制后效应的影响*

研究不同反应重复量对反应抑制后效应的影响。采用停止信号范式,让被试完成不同反应重复量的反应抑制任务。结果显示,总的来说反应重复量因素和重复类型因素的主效应都显著;信号抑制条件下重复一次后比重复三次后无信号试次反应时要显著地长,但都与总的无信号试次反应时没有显著差异;信号反应条件下重复三次后与重复一次后无信号试次反应时没有显著差异,但都比总的无信号试次反应时显著地长。结果表明,不同反应重复量反应抑制后效应在信号抑制条件下既有认知控制调整也有自动化记忆提取,在信号反应条件下仅存在认知控制的执行加工。     

An Acceptance-Based Behavioral Therapy for Individuals With Generalized Anxiety Disorder

In response to clinical observations and research findings that individuals with generalized anxiety disorder are reactive to their internal experiences, avoid and suppress painful emotions, thoughts, and sensations, and limit their involvement in meaningful activities, an Acceptance Based Behavioral Therapy (ABBT) was developed to specifically target these responses. ABBT incorporates acceptance and mindfulness strategies with more traditional behavior therapy techniques. Specifically, ABBT uses mindfulness and acceptance approaches as an alternate response to the rigid, avoidant responses characteristic of GAD. Likewise, therapy focuses on identifying and enacting behaviors that are congruent with what is personally meaningful to the client rather than engaging in actions that are motivated by avoidance of anxiety. This article provides a case conceptualization from an ABBT perspective for “William,” the composite client presented in Robichaud (2013a--this issue). The article goes on to demonstrate how an ABBT approach to treatment may unfold session-by-session for “William.”     

The treatment of an obsessional patient by reciprocal inhibition

A case is described of a phobic anxiety state in an obsessional personality. Treatment was successfully carried out using reciprocal inhibition techniques. Follow-up at nearly a year showed continued remission. Other treatment in the past, including E.C.T., insulin coma therapy, a variety of drugs, and finally leucotomy had failed to effect a satisfactory cure.     

Entspannungsverfahren

Autogenic training, progressive relaxation and hypnosis show good empirical evidence as relaxation-therapies and are useful techniques in psychotherapy and also in behavioral therapy and psychiatric treatment. Relaxation therapy can be used on its own in psychosomatic concepts of e.g. internal medicine and it is a well established and scientific-based component in the treatment of psychic, psychosomatic or psychiatric disorders, except psychosis and severe dementia. Though in details somewhat different, the methodology of these techniques creates a framework, in which the psychophysiologically determined relaxation response is easily elicited. However, regular practice of the patients is required. Focussed attention, imagination and new attributions of bodily or mental perceptions play a dominant role.The task of the modern “relaxation-therapist” doesn’t consist in charismatic guided exercises but in enhancing the patient’s motivation for searching his own way of relaxation. Relaxation can be combined with all psychotherapeutic (including psychodynamic) and psychiatric treatments. For our patients’ benefit a widespread application of these techniques should be practiced.     

Automatic and controlled response inhibition: associative learning in the go/no-go and stop-signal paradigms

In 5 experiments, the authors examined the development of automatic response inhibition in the go/no-go paradigm and a modified version of the stop-signal paradigm. They hypothesized that automatic response inhibition may develop over practice when stimuli are consistently associated with stopping. All 5 experiments consisted of a training phase and a test phase in which the stimulus mapping was reversed for a subset of the stimuli. Consistent with the automatic-inhibition hypothesis, the authors found that responding in the test phase was slowed when the stimulus had been consistently associated with stopping in the training phase. In addition, they found that response inhibition benefited from consistent stimulus-stop associations. These findings suggest that response inhibition may rely on the retrieval of stimulus-stop associations after practice with consistent stimulus-stop mappings. Stimulus-stop mapping is typically consistent in the go/no-go paradigm, so automatic inhibition is likely to occur. However, stimulus-stop mapping is typically inconsistent in the stop-signal paradigm, so automatic inhibition is unlikely to occur. Thus, the results suggest that the two paradigms are not equivalent because they allow different kinds of response inhibition.     

Outpatient behavioral management of aggressiveness in adolescents: A response cost paradigm

This study focuses on outpatient behavioral management of oppositional‐defiant teenagers that engage in aggressive behaviors. Sixteen subjects, 13 male and three female, are followed through an alternating treatment, single case design, ABCD: baseline; cognitive therapy coupled with the REST (Real Economy System for Teens) program for parental outpatient behavioral management; combined cognitive, REST, and response cost; and finally REST with response cost to control aggressive behaviors. The response cost was designed to control aggression. Response cost involved the parents identifying seven reinforcers, objects, and activities that are important to the teen. They are rank ordered, with item one being most important and item seven being least important. An aggressive act means the loss of an item for 1 year, beginning with item seven and progressing upward. This study finds that aggressive behaviors do not decrease with cognitive therapy and the REST program. When the more stringent response cost program is implemented in addition to the cognitive and REST techniques, the acts of aggression do respond to treatment. Thus, it is concluded that adding a stringent parent management response cost program offers a tool therapists can use in treating aggressive, oppositional‐defiant teenagers on an outpatient basis without the need for hospitalization. Aggr. Behav. 25:321–330, 1999. © 1999 Wiley‐Liss, Inc.     

Hierarchical simulation: Two case studies of stuttering modification using systematic desensitization

The use of behavior therapy techniques to alleviate stuttering is being extensively applied. Two cases illustrating hierarchical simulation are presented. In the first, a technique incorporating systematic desensitization and reciprocal inhibition was used to reduce the stuttering behavior of a 13-year-old boy while speaking in a classroom situation. The procedure involved the use of color slides to simulate speaking before an actual classroom as an adjunct to systematic desensitization and reciprocal inhibition. Results indicated a reduction in classroom stuttering as reported by the client and his teacher. In the second case, a 5-year-old boy used forceful muscular activity as being reciprocal to anxiety. This procedure involved the use of videotapes to hierarchically simulate anxiety producing classroom situations. Measures of stuttering indicated a mean reduction of 18%. One year after therapy indicated stuttering had been eliminated.     

内生意图性抑制:自我控制研究的新视角

行为抑制的"停止信号"多来自内生意图行为"是否做"决策过程最后时刻内生性否定指示(即内生意图性抑制),而非环境提前设定。因无法用行为指标(错误率、反应时)评估,需将"自由选择"范式结合f MRI、EEG等技术测量与之相关的脑神经、自主神经生理特点;此外,范式中加入的刺激阈下启动、情绪信息影响了内生意图性抑制的加工过程。未来从三个方面拓展研究:(1)明确背内侧额叶皮质的心理机制;(2)探索人格特质的影响;(3)"停止信号"内生日常化。     

The treatment of hysterical spasm and agoraphobia by behaviour therapy

A case of muscular spasm and agoraphobia is described and the techniques of treatment by behaviour therapy outlined. A particular plea is made for the accommodation within the conceptual framework of learning theory, of practices more akin to traditional psychotherapy and it is shown how this may support more specific symptom orientated approaches, such as reciprocal inhibition and systematic desensitization.     

Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response

Tourette syndrome (TS) is characterized by chronic motor and vocal tics. Habit reversal therapy (HR) is a behavioral treatment for tics which has received recent empirical support. The present study compared the efficacy of HRT in reducing tics, improving life-satisfaction and psychosocial functioning in comparison with supportive psychotherapy (SP) in outpatients with TS. In addition, we investigated whether impairments in response inhibition in patients with TS predict response to HR treatment which specifically aims to inhibit tics. Thirty adult outpatients with DSM-IV TS were randomized to 14 individual sessions of HR (n = 15); or SP (n = 15). HR but not SP reduced tic severity over the course of the treatment. Both groups improved in life-satisfaction and psychosocial functioning during active treatment. Reductions in tic severity (HR) and improvements in life-satisfaction and psychosocial functioning (HR and SP) remained stable at the 6-month follow-up. The extent of pre-treatment response inhibition impairment in the HR group predicted reductions in tic-severity from pre- to post-treatment. Our results suggest that HR has specific tic-reducing effects although SP is effective in improving life-satisfaction and psychosocial functioning. Assessments of response inhibition may be of value for predicting treatment response to HR.     

The cognitive therapy of evaluation: Therapeutic techniques-[2]

The main aim of this paper is to introduce the techniques used in cognitive therapy of evaluation. The Cognitive therapy of evaluation is being developed from the theoretical background of general semantics theory and it is a therapy based on language as an instrument of cognitive processes, and on the role it plays, through word-facts identification, in the development and treatment of emotional problems. The main techniques developed (abstraction orders and the extensional devices) and other therapeutic issues are introduced and explained.     

The Pavlovian basis of reciprocal inhibition therapy

While there is a slight disagreement between Wolpe’s views and Pavlov’s statements concerning the application of experimental psychology to the study of psychiatry, Wolpe indicates that he owes much to Pavlov. A Pavlovian analysis of therapy by reciprocal inhibition, which includes the physiological constructs as well as Pavlovian methodology, will increase our understanding of Reciprocal Inhibition therapy. The major techniques of Reciprocal Inhibition therapy are discussed in the terms of Pavlovian method and theory. Desensitization based on systematic relaxation appears to be effective because the excitatory stimulus is presented when the subject’s cortex is predominantly in an inhibitory state while relaxed. Assertive training relies mainly on building up the excitatory process by use of the second signal system. Thought-stopping is analogous to the external inhibition procedure with the use of the second signaling system as the “extra” stimulus. Deductions from Pavlov’s typology predict that an excitable subject will be difficult to desensitize and somewhat easier to train in assertive behavior and thought-stopping. Some implications of relating Pavlovian method and theory to Reciprocal Inhibition therapy are discussed.     

The neural basis of cognitive control: Response selection and inhibition

The functional neuroanatomy of tasks that recruit different forms of response selection and inhibition has to our knowledge, never been directly addressed in a single fMRI study using similar stimulus–response paradigms where differences between scanning time and sequence, stimuli, and experimenter instructions were minimized. Twelve right-handed participants were scanned on two standard cognitive control tasks, a stimulus–response incompatibility task, and a response inhibition task. A compound trial design allowed comparison of preparing to inhibit an upcoming automatic response to wholly inhibiting an automatic response. Furthermore, inhibiting an automatic response to perform an alternative task-relevant response was compared to wholly inhibiting an automatic response. No differences were found in prefrontal activity when preparing to inhibit an automatic response was compared to wholly inhibiting an automatic response, suggesting a mostly common network. The left inferior frontal gyrus was found to be commonly recruited during both tasks when controlled responses were required, likely due to its role in response selection. In contrast, the right inferior frontal gyrus was found to be more involved when task demands were stronger for response inhibition. Our results are largely consistent with models of cognitive control that postulate that separate psychological constructs, such as response selection and inhibition, are related processes largely served by a common prefrontal network. This prefrontal network is recruited to a greater or lesser extent depending on specific task demands.     

Qualifications for Membership in the A.G.P.A.

A model of the development of group therapists is presented. It is proposed that student group therapists proceed through a sequence of stages, each of which is marked by characteristic therapist behavior. During the initial Group shock phase, the student reacts to the novelty of group therapy stimuli with individual therapy or content-oriented approaches. Reappraisal is a period of some therapist inhibition, frustration, or self-doubt. One step behind is a phase characterized by a gradual recognition of the process level of analysis, despite difficulty supplying the interventions autonomously. Using the here-and-now is a period of active intervention about interpersonal phenomena among group members. The techniques for highlighting this material are refined in the Polishing skills phase. The usefulness of models in training is discussed.