Is horror a necessary component of flooding (implosion)?

Experimental results indicate that presentation of horrifying scenes is not necessary to obtain a favorable outcome in the treatment of phobias by flooding. Prolonged exposure to the feared object, even under relatively pleasant conditions is sufficient. Subjects were college students who rated highly fearful of rats. They were randomly assigned to one of three experimental groups and to a no treatment-control group. Treatment groups differed along the dimension of harshness of scene presentation. Control group subjects received no treatment but were assessed repeatedly as were experimental subjects. All experimental subjects showed improvement irrespective of treatment received-after treatment they were all willing to come closer to a live rat and experienced less anxiety at the closest point. However, subjects exposed to horrid scenes were judged by an independent evaluator as less likely to avoid fearful situations. The discussion centers on the discrepancy between rater's evaluation and other measures, implications of the results for treatment, and on the generalizability of findings to a patient population.     

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.