Massed vs. spaced exposure sessions in the treatment of agoraphobia

The differential effects of massed and spaced sessions of exposure in vivo were investigated with 11 agoraphobics in a crossover design. Clients were randomly assigned to one of the following two groups: (a) 10 daily sessions followed by 10 weekly sessions, or (b) 10 once-weekly sessions followed by 10 daily sessions. The results indicated that both massed and spaced sessions of exposure in vivo effected changes in avoidance behavior and subjective anxiety of agoraphobics, massed practice being superior especially with respect to avoidance. It was suggested that the superiority of massed practice is due to the lack of opportunity to engage in avoidance or escape during short inter-session intervals. The relationship between subjective anxiety and avoidance were considered and the differences between clinical and statistical significance were discussed.     

Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers

The combined effects of imaginal exposure to feared catastrophes and in vivo exposure to external stimuli were compared with the effects of in vivo exposure alone in 15 obsessive-compulsives with checking rituals. The first group received 90 min of uninterrupted exposure in imagination, which concentrated mainly on disastrous consequences, followed by 30 min of exposure in vivo to stimuli-situations which triggered rituals. The second group was given 2 hr of exposure in vivo only. Both groups were prevented from performing rituals. Treatment consisted of 10 daily sessions within a 2 week period.Assessments were conducted before and after treatment and at follow-up ranging from 3 months to 2.5 yr with a mean of 11 months. At post-treatment both groups improved considerably and did not differ. But at follow-up those who received imaginal and in vivo exposure maintained their gains, whereas the group who were treated by exposure in vivo alone evidenced partial relapse on four of the six dependent measures. The results tend to indicate that a closer match between a patient's internal fear model and the content of exposure enhances long term treatment efficacy.     

Habituation of subjective anxiety during flooding in imagery

Patterns of habituation of subjective anxiety during flooding in fantasy are delineated for eleven obsessive-compulsive and six agoraphobic patients. The majority showed a curvilinear pattern of subjective anxiety response, while three patients showed a linear decelerating pattern. Habituation was found both within and across sessions. The results are compared with habituation patterns in physiological responses during flooding in fantasy and in vivo.     

Behavioral training for myopia: long term maintenance of improved acuity

Two female myopic students participated in a behavioral training program designed to improve uncorrected visual acuity. Following a 3-day baseline, each subject underwent 12 days of training involving stimulus fading and feedback. Acuity measures were taken daily during baseline and training phases and weekly for more than 2 months following the termination of training. Both subjects showed improved acuity as a function of the training program and this improvement was maintained throughout the follow-up period. The results are discussed with respect to the growing body of research evaluating behavioral training for myopia.     

Exposure in vivo vs applied relaxation in the treatment of blood phobia

Eighteen patients with phobia for bloodt, wounds and injuries were treated with exposure in vivo or applied relaxation. They were assessed on different self-report, behavioral and physiological measures before and after treatment. The patients were treated individually for 9 sessions, 1 per week. The within-group comparisons showed that both groups had improved significantly on most of the measures and that these improvements were sustained or furthered at the 6-month follow-up. Furthermore, 10 of the 16 who completed the treatment became blood donors. The between-group comparisons showed exposure to be better than applied relaxation on three of the self-report measures at post-treatment assessment, but not at follow-up. The groups did equally well on the behavioral and physiological measures. The conclusion that can be drawn is that the coping-orientated method of applied relaxation is as effective as exposure in vivo in the treatment of blood phobia.     

Cognitive-behavioral treatment of agoraphobia: paradoxical intention vs self-statement training

Twenty-six agoraphobics were randomly assigned to either Paradoxical Intention (PI) or Self-Statement Training (SST) which consisted of 12 weekly 90-min group sessions with 4–5 patients per group. Major assessments were carried out at pre-treatment, 6th week and 12th week of treatment, and at 1- and 6-month follow-ups. Measures included clinical ratings of severity of condition, phobia, anxiety and depression. Furthermore, a behavioral test was administered during which changes in subjective units of discomfort and cognitions were assessed. The results indicated statistically-significant improvement over time with both treatments. ANCOVAs performed revealed superior effects on several agoraphobia measures for the PI condition at post-treatment. However, by the 6-month follow-up assessment, the groups were equivalent due to marked improvement during the follow-up phase in the SST condition. Cognitive changes were marked by a decrease in self-defeating statements without concomitant increase in coping statements. These results and recommendations for future research are discussed.     

Antidepressant medication in the treatment of agoraphobia: A critical review

The present article critically examines research on the use of antidepressants in treating agoraphobia. A number of studies have shown certain classes of antidepressant medication, namely tricyclic antidepressants and MAO inhibitors, to have beneficial effects on certain aspects of the agoraphobic syndrome. However, these studies must be interpreted with caution in light of two major methodological shortcomings, i.e. sole reliance on paper and pencil outcome indices and the confounding of the pharmacological effects of the drug with exposure to feared situations. Recent research, aimed at correcting for these methodological problems, seriously question the efficacy of antidepressant pharmacotherapy by itself as a treatment for agoraphobia. Moreover, it is argued that the disadvantages of drug treatments namely agoraphobics' reluctance to take medication, physical side effects and relapse upon withdrawal of the medication, caution against their routine use in clinical practice.     

Assertion training: the effectiveness of a comprehensive cognitive--behavioral treatment package with professional nurses

The purpose of the study was to evaluate the effectiveness of a comprehensive cognitive-behavioral treatment package with a professional population of registered nurses using multiple self-report and role-play measures. Twenty-six self-referred registered nurses were randomly assigned to either a Treatment or Control group. The treatment package consisted of five weekly 2-hr sessions of group assertion training using the cognitive-behavioral model of Lange and Jakubowski. The Assertiveness Self-statement Test, the Rathus Assertiveness Schedule, the Adult Self-expression Scale, two Likert scales and role-play were used to evaluate changes over time. The results indicated: (1) the nurses in both groups at Pretreatment were clearly subassertive; (2) by Posttraining the Treatment-group members increased significantly their assertiveness as indicated on the self-report tests; (3) Treatment-group members had successfully maintained their improved assertiveness by the 2-month Follow-up; (4) the role-play ratings paralleled and supported the self-report results, but not at significant levels; (5) there was strong empirical support for the social validity of the treatment package; and (6) there was a high degree of treatment credibility for the cognitive-behavioral Assertion-training group. Overall, the results indicate clear support for the effectiveness of a broad-based cognitive-behavioral treatment package for treating subassertive behavior in a professional population of registered nurses.     

Rhythmical body movement in sleep: a brief review and treatment study

Vigorous and damaging head-banging and head and body-rocking can occur in normal subjects of average intelligence before and during sleep. Reports of behavioural treatments for this are reviewed. Data from the present case and others suggest that waking plus efficient response prevention is sufficient to substantially reduce or eliminate the activity even when the treatment has been withdrawn for up to one year. The aetiology of the activity is not understood. However, this case suggests that head- and body-rolling, when long-established, need not enhance the quality of sleep since this was unimpaired on completion of treatment and was possibly even improved by the elimination of the movements. The present case also demonstrates that the behaviour can be treated successfully even when considerable environmental stresses occur.     

Effects of repeated exposure to sexually violent or nonviolent stimuli on sexual arousal to rape and nonrape depictions

The major purpose of this investigation was to examine the effects of repeated exposure to sexually violent stimuli (SVS) in relatively ‘naturalistic settings’ on sexual arousal to rape and nonrape stimuli. Repeated exposure effects using nonviolent erotica were also examined. Sixty-nine male Ss participated in the study. A preexposure session was conducted in which Ss were exposed to written and pictorial depictions of rape and mutually-consenting intercourse. Based on Ss' penile tumescence to these depictions, they were classified as either Force-oriented, Nonforce-oriented or Unclassifiable. Subsequently, Ss were randomly assigned to sexually violent (SVS), sexually nonviolent (SNVS) or control conditions within each force-orientation group. Those assigned to the SVS condition were then exposed to 10 SVS including feature-length films and written and pictorial depictions over a period of 4 weeks. Ss in the SNVS condition were exposed to 10 similar media presentations depicting sexually nonviolent activities only. Ss in the control condition were not exposed to any stimuli during this 4-week period. Soon after completion of the exposure phase, Ss returned for a postexposure laboratory session in which they were presented with four depictions that were similar in theme to those in the preexposure session. Penile tumescence scores and self-reports of sexual arousal were obtained. Results revealed that, for Force-oriented Ss, those exposed to either SVS or SNVS were less aroused to the rape depictions in the postexposure session than those in the control condition. A similar pattern occurred with the nonrape depictions for these Ss, though it was considerably less pronounced. No evidence of a similar ‘satiation’ pattern was obtained for either Nonforce-oriented or Unclassifiable Ss, with these Ss showing no significant differences among the three exposure conditions. The findings are discussed in the context of cognitions, personality differences, conditioning processes, stimulus parameters and response habituation theories. Social and clinical implications are also discussed.     

The treatment of sleep-maintenance insomnia with stimulus-control techniques

Sleep-maintenance insomniacs received either a stimulus-control (n = 7) or a credible placebo treatment (n = 8), administered in small groups for 4 weeks. Self-reports of time awake after sleep onset, total number of arousals and number of arousals exceeding 10 min were collected at baseline, at termination of treatment (post-treatment), and at a 3-month follow-up. Results showed a statistically- and clinically-significant reduction on all three dependent measures from baseline to post-treatment for both groups; these gains were maintained through the follow-up period. However, the results achieved with stimulus-control procedures were not significantly different from reductions found with a credible placebo condition. These findings compare favorably with other reports of behavioral treatments of both onset and maintenance insomnia.     

Spouse involvement in the treatment of obsessive-compulsive patients

Twelve married obsessive-compulsive patients were randomly allocated to either selfcontrolled exposure or partner-assisted exposure. Treatment in both conditions consisted of homepactice.The results at the Post-test showed that both versions of exposure in vivo resulted in significant improvements but the partner-assisted group improved more. After a 1-month treatment-free period no significant differences between conditions were found due to a continuing improvement in the selfcontrolled exposure condition. Results were maintained at a 6-month follow-up.It was concluded that home-practice is a cost-effective treatment procedure for obsessive-compulsives and that couple training may be useful with selected patients.     

Exposure and communications training in the treatment of agoraphobia

Twenty-one agoraphobics participated in a 6-month study designed to (a) compare imaginal flooding under high- (no sedation) and low- (sedation used) anxiety conditions: (b) examine the long-term effects of imaginal flooding in the absence of further exposure treatment; and (c) explore the impact of communications training on chronic anxiety and panic attacks. A reevaluation of the effects of sedation is presented in this report.Imaginal flooding without sedation was, on the whole, superior to the attention control placebo and imaginal flooding with sedation on therapists' and clients' ratings of fear and avoidance. However, the superiority of the non-drug flooding group cannot be attributed (as was concluded in an earlier report) to higher levels of anxiety across flooding sessions. Rather the drug (methohexitone sodium) appears to have impeded across-session habituation, perhaps by interfering with long-term memorial processes.The effects of imaginal flooding without sedation were stable over 4 months without further exposure treatment. These clients did receive training in solving important interpersonal problems through self monitoring and increased expressiveness. Contrary to hypotheses, not only was no further improvement obtained on fear and avoidance with this treatment, but also anxious mood and panic attacks remained unaffected. It is surprising to note that in-vivo treatment was no more effective than imaginal flooding on fear and avoidance. These and other findings suggest imaginal flooding well warrants further study.     

Prognostic utility of Locus of Control in treatment of agoraphobia

The purpose of the present study was to examine the prognostic utility of the Rotter Internal-External Locus of Control Scale with agoraphobics undergoing behavioral and pharmacological treatments. Fifty subjects meeting DSM-III criteria for agoraphobia, completed the instrument at pre- and post-assessments. Despite marked pre-post improvements, the scale was found to be lacking in discriminative power and clinical sensitivity to detect these changes. However, the scale was found to have utility as a prognostic index of post-treatment levels of improvement, with ‘externality’ being strongly associated with improvement. These findings and related issues are discussed.     

Expectations of sensations,discomfort and fear in dental treatment

A hundred dental patients and 40 dentists were asked to describe the sensations, discomfort and fear which they associated with a number of dental treatments. A number of patients were also asked to describe their experiences immediately after routine conservation procedures. It was concluded that although patients could accurately anticipate the pattern of sensations involved in treatment (even if they had not experienced some of the procedures), they expected more intense sensations and greater discomfort and apprehension than they were likely to experience. Dentists expressed more realistic ideas about the sensations produced by dental treatment. The discrepancy in patients' expectations appears to persist in spite of many discontinuing experiences, the fear of treatment being fostered by discomfort and the intensity of sensations expected, by lack of experience and, to a modest degree, by uncertainty about the sensations anticipated. Cognitive theories of fear do not appear to explain all these influences adequately. These observations support the need for information about sensations in treatment to help not so much with the experience of dentistry but rather with its anticipation.     

Intermittent low-calorie regimen and booster sessions in the treatment of obesity

The present study investigated two new weight-control strategies: an intermittent low-calorie regimen and intermittent scheduling of booster sessions. A new approach to predicting patient weight loss, based on a pretreatment assessment with a highly-structured eating regimen, was also studied. Forty-eight obese patients were randomly assigned to either a Standard Behavioral weight-control condition or to an Intermittent Low-calorie Regimen (< 750 cal for 2 days/week) condition and to one of two maintenance schedules: a Spaced schedule in which the six booster sessions were held at monthly intervals, or a Massed schedule, in which four of the six meetings were held during the third month. Neither the intermittent low-calorie regimen nor the intermittent scheduling of booster sessions significantly affected weight loss. However, weight loss at 1 year was related to compliance to self-monitoring and to self-reported change in eating habits and exercise. In addition, weight loss at 1 year was related to weight loss during the initial pretreatment assessment period.