The behavioural treatment of sexual inadequacy: A comparative study

Thirty-six couples complaining of sexual difficulties were treated with one of three methods: (1) systematic desensitisation plus counselling. (2) directed practice—based on that of Masters and Johnson—plus counselling. (3) directed practice with minimal contact. Both members of each couple were seen together, but half in each treatment group were treated by a single therapist and half by a therapist pair. Differences in outcome among the groups were not highly significant, but consistent trends were found which suggested that the combination of directed practice and counselling was associated with most change, particularly when two therapists were involved.     

Cognitions related to anxiety: a pilot study of treatment

In general, where anxiety appears to have a specific external focus, such as the situations which are avoided by phobic patients, treatment involving systematic exposure to those situations seems to be effective. This is less appropriate, or even impossible, where anxiety is not dependent on any external circumstance, but is described by the patient as occurring at any time or place, either chronically over long periods, or acutely in the form of ‘panic attacks’. These patients with ‘generalised’ anxiety often describe internal cues for anxiety either in the form of thoughts (e.g. worry over a current problem) or somatic (e.g. chest sensations interpreted as possible heart disease). Beck et al. (1974) has suggested that on interview, all patients diagnosed as suffering from diffuse or generalised anxiety can report specific ideas or other cognitive cues which are associated with anxiety. These usually concern possible traumatic events, such as illness and death, or social rejection. Clearly Beck has in mind the possibility that these cognitions have the effect of inducing anxiety, although even if the validity of the subjective reports were to be accepted, the problem remains of whether the relationship between mood state and cognitions is causal and if so, in which direction it operates. Obviously a causal relationship may also operate in both directions simultaneously, to form a ‘vicious circle’ in which each exacerbates the other. To establish whether there is a sense in which particular cognitions contribute causally to anxious mood, it would be necessary to find a method of manipulating the type or frequency of cognitions thought to be operating in this way.

One obvious possibility is that of ‘thought-stopping’: that is, patients could be taught to identify thoughts which are associated with anxiety and stop them in the usual way (Wolpe, 1973, p. 211) e.g. by' shouting stop, and substituting an alternative thought. The present study was planned as a pilot experiment to determine (i) if appropriate anxiety related cognitions could be elicited from a series of patients with generalised anxiety, (ii) if the reported frequency of such thoughts could be modified by a thought-stopping technique, and (iii) if any changes in thought frequency were associated with improvements in mood.

Clearly there are many ‘non-specific’ features involved in thought-stopping which could also have therapeutic effects on mood. For this reason it was necessary to include an alternative procedure, not directed at reducing thought frequency, but having the same degree of plausibility to patients, and preferably to therapists. The control procedure chosen for this purpose was modelled on desensitisation, in which patients were encouraged to allow the supposedly anxiety-provoking thoughts into their mind and tolerate them, rather than attempt to stop them. In summary, the study employed a relaxation training phase as a base-line, followed by a cross-over design in which the two treatment phases of thought-stopping and ‘cognitive desensitisation’ were given to each patient, in balanced order.     

Treatment of dental fears by imaginal flooding and rehearsal of coping behaviour

All combinations of high versus low arousal imaginal flooding, and coping versus no-coping imaginal rehearsal, were compared in the modification of dental fear. About one half of all subjects seen successfully completed dental treatment, although significant differences were found between groups in anxiety reduction before and during dental examination, which favoured the low arousal flooding groups. Coping rehearsal did not influence anxiety, but interacted with arousal level of flooding to determine subsequent dental attendance. The results suggest that flooding without coping rehearsal had little effect at high levels of arousal, but good results at low levels. Flooding with coping rehearsal on the other hand, had mixed results. At high arousal levels avoidance was reduced but not anxiety, while at low levels anxiety was reduced but not avoidance. The implications for further research on coping rehearsal are discussed.     

Community applications of instructional technology: training low-income proctors

A community education system might be most effectively implemented in low-income communities if it were deliverable by neighborhood residents. A proctor training manual, designed to teach neighborhood residents how to administer standardized learning units to their peers, was analyzed in two experiments. The results of Experiment I showed that the percentage of occurrence of proctor behaviors increased after completion of the manual. Supplementary data suggest that specified proctor behaviors generalize to actual instructional situations. The results of Experiment II showed that the percentage of occurrence of trainee behaviors was higher when instructional packages were administered by trained proctors than when administered by untrained proctors. This study demonstrates an effective procedure for training low-income community residents to serve as proctors for a community education system.     

Some promising dimensions for behavioral community technology

In recent years, the search for effective and replicable approaches to planned change in communities has escalated. Applied behavior analysts have participated in these efforts to remedy existing community problems and to increase the capacities of community residents to meet their goals. Examples of behavioral technologies for community settings are described and their advantages are noted. Criteria for more contextually appropriate community technologies are suggested and strategies for developing behavioral methods according to these criteria are described. This paper outlines some promising dimensions for behavioral community technology and discusses several possible limitations to a behavioral approach to addressing societal problems.     

Why worry? The cognitive function of anxiety

The phenomenon of worry is considered to arise from cognitive processes involved in anxiety, that serve to maintain high levels of vigilance for personal danger. Rather than rely on self-report alone, the research described here draws on information processing methodology, to investigate this hypothesized cognitive function. Evidence is summarized to show that anxious subjects selectively attend to threatening information, and interpret ambiguous events in a relatively threatening way. However, the evidence on memory suggests that although such information may be easily activated, it is not necessarily more accessible. The allocation of attentional priority to threatening information is seen as a characteristic of anxious (rather than depressed) mood, while the ease with which this processing mode is adopted may underlie trait anxiety and vulnerability to anxiety disorders.     

Implicit and explicit memory bias in anxiety

Previous investigations of recall and recognition for threatening information in clinically anxious subjects have yielded equivocal results. The present study contrasts implicit (word completion) with explicit (cued recall) memory and shows that indices of bias for emotional material derived from the two types of memory are independent of one another. The explicit measure was correlated with trait anxiety scores, but did not clearly distinguish between subjects with clinical anxiety states and normal control subjects. On the implicit memory measure, clinically anxious subjects produced more threat word completions, but only from a set to which they had recently been exposed. These results are taken as evidence that internal representations of threat words are more readily or more persistently activated in anxiety states, although they are not necessarily better elaborated.     

Selective processing of threat cues in anxiety states: a replication

A replication of Mathews and MacLeod's (Behav. Res. Ther. 23, 563-569, 1985) study, using a modified Stroop task, confirmed that threat words selectively interfere with the colour-naming performance of generally anxious patients, compared with normal controls. Clearer evidence was obtained of a highly specific interference effect of threat words that were congruent with the predominant worries reported by anxious patients. However, there was no evidence of a subsequent recognition memory bias for the threat words in anxious Ss. These results are discussed in relation to findings from other recent experiments investigating attentional and memory biases for threat-related information in anxiety states, and their implications for cognitive theories of anxiety are considered.