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Anxiety Level And The Repression-Sensitization Dimension In Desensitization Therapies

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Anxiety Level And The Repression-Sensitization Dimension In Desensitization Therapies

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Content This dissertation has been
microfilmed exactly as received 69-19,368
EDELMAN, Mari, 1942-
ANXIETY LEVEL AND THE REPRESSION-
SENSITIZATION DIMENSION IN DESEN
SITIZATION THERAPIES.
University of Southern California, Ph.D., 1969
Psychology, clinical
University Microfilms, Inc., Ann Arbor, Michigan
© C opyright by
MARI EDELM AN
1969
ANXIETY LEVEL AND THE REPRESSION-SENSITIZATION
DIMENSION IN DESENSITIZATION THERAPIES
fey
Mari Edelman
A D i s s e r t a t i o n P re se n ted to th e
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In P a r t i a l F u lf illm e n t o f th e
Requirements f o r th e Degree
DOCTOR OF PHILOSOPHY
(Psychology)
January 1969
UNIVERSITY O F SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 9 0 0 0 7
This dissertation, written by
____________ MARI EDELMAN____________
under the direction of /lex.... Dissertation Com
mittee, and approved by all its members, has
been presented to and accepted by The Gradu
ate School, in partial fulfillment of require
ments for the degree of
DOCTOR OF P H IL O S O P H Y
.........
Dean
Date. .....
DISSERTATION COMMITTEE
C m trm an
TABLE OP CONTENTS
LIST OP TABLES . . .
LIST OP ILLUSTRATIONS
C hapter
I . THE PROBLEM...............................................................
P re fa c e
I n t r o d u c t io n to the Problem
S tatem ent o f th e Problem
I I . REVIEW OF THE LITERATURE ..................................
S tu d ie s o f System atic D e se n B ltiz a tio n
The Theory and S tu d ie s o f
Im plosiv e Therapy
S upp ressio n and Augmentation
o f A nxiety
The R e p r e s s io n - S e n s itiz a tlo n Dimension
Measures o f Pear and Avoidance
I I I . METHOD ..............................................................................
G eneral Design
S u b je c ts
Procedure
IV. RESULTS .........................................................................
P re lim in a ry .A n a ly se s
S t a t i s t i c a l C o n sid e ra tio n s
Avoidance Scores
F ear Thermometer Scores
C o r r e l a ti o n s between Fear Thermometer
Scores O btained d uring Treatm ent
and P r e - p o s t Therapy Pear
and Avoidance C r i t e r i a
O ther E m p iric a l F indings
V. DISCUSSION . . ...........................................................
A nxiety Level
R e la tio n s h ip between Fear
and Avoidance B ehavior
Chapter Page
L ev el o f Defense
E xperim ental C onditions
T h erapeutic E ff e c t
IV. SUM M A R Y .............................................................................. 95
APPENDIXES.................................................................................................. 99
APPENDIX A. F ear Survey Schedule 100
APPENDIX B. Avoidance Scale . . . 101
APPENDIX C. C r i t e r i o n T e s ts . . . 102
APPENDIX D. Snake Fear H ierarch y 104
APPENDIX E. Treatm ent O rie n ta tio n
105
APPENDIX P. R e la x a tio n C ondition
107
APPENDIX G. Tension C ondition . . 108
APPENDIX H. F in g e r Tapping C ondition ....................
109
APPENDIX I . D e s c rip tio n o f R esearch to
P o t e n t i a l S tudent V o lu n te e rs . . 110
APPENDIX J . Summary o f A naly sis o f
f o r Fear Thermometer
on Scene 2 . . . . ,
V arian ce
Scores
111
APPENDIX K. Summary o f A nalysis o f
f o r Fear Thermometer
on Scene 4 ...................
V arian ce
Scores
112
APPENDIX L. Summary o f A n aly sis o f
f o r Fear Thermometer
on Scene 6 ...................
V arian ce
Scores
113
APPENDIX M. Summary o f A nalysis o f
f o r F ear Thermometer
on Scene 8 ...................
V arian ce
Scores
114
APPENDIX N. Summary o f A naly sis o f
f o r Fear Thermometer
on Scene 10 ...................
V arian ce
Scores
115
i i i
APPENDIX
APPENDIX
APPENDIX
APPENDIX
APPENDIX
APPENDIX
APPENDIX
APPENDIX
APPENDIX
APPENDIX
REFERENCES .
0. O v e ra ll Average F ear Thermometer
R a tin g s during T reatm ent . . . .
P. Average Fear Thermometer R a tin g s
during Treatm ent f o r th e
Low Anxiety C on dition .........................
Q. Average Fear Thermometer R a tin g s
during Treatm ent f o r th e
I n te rm e d ia te A nxiety C o n d itio n
R. Average Fear Thermometer R a tin g s
during Treatm ent f o r th e
High A nxiety C o n d itio n ....................
S. Average F ear Thermometer R a tin g s
during Treatm ent f o r
R epresso r S u b je c ts ..............................
T. Average Fear Thermometer R a tin g s
during Treatm ent f o r
I n te rm e d ia te Defense S u b je c ts . .
U. Average Fear Thermometer R a tin g s
during Treatm ent f o r
S e n B ltiz e r S u b je c ts ..............................
V. Raw Data f o r S u b je c ts i n th e
Low Anxiety C o n d itio n .........................
W. Raw Data f o r S u b je c ts i n th e
In te rm e d ia te A nxiety C ond itio n
X. Raw Data f o r S u b je c ts i n th e
High A nxiety C o n d itio n ....................
Page
116
117
118
119
120
121
122
123
124
125
127
iv
LIST OP TABLES
Table Page
1. Mean P a ir Thermometer Scores R ep o rte d during
V i s u a l i z a t i o n (FTjyj) f o r T reatm ent
and Defense C a te g o rie s .................................................. 58
2. Mean P re -tre a tm e n t Avoidance S cores (ASi)
f o r Each Treatm ent-D efense Com bination . . . 62
3 . Summary o f A naly sis o f V ariance
f o r Avoidance Scores ....................................................... 64
4. Summary o f the A n alysis o f V ariance
o f Pear Thermometer S c o r e s ........................................ 68
5. C o r r e l a ti o n s between Mean Pear Thermometer
R a tin g s during V i s u a l iz a t i o n (PT^)
and P o s t-th e ra p y Pear (PTo) and j
Avoidance Scores (ASg) w ith in
T reatm ent and Defense C a t e g o r i e s 75 i
6 . I n t e r c o r r e l a t i o n s o f Fear Theromometer
and Avoidance Scores ....................................................... 77
v
LIST OF ILLUSTRATIONS
F ig ure
1. Mean Fear Thermometer R a tin g s f o r
R e p re sso rs, S e n s i t i z e r s , and
In te rm e d ia te s on Scene Two ....................
2. Mean Fear Thermometer R a tin g s f o r
RepresB ors, S e n s i t i z e r s , and
In te rm e d ia te s on Scene Four . . . .
3. P r e - and P o s t-th e ra p y Avoidance Scores
f o r R e p resso rs, S e n s i t i z e r s ,
and In te rm e d ia te s ........................................
4. P re - and P o s t-th e ra p y F ear Thermometer
R a tin g s fo r R e p resso rs, S e n s i t i z e r s ■
and I n te rm e d ia te s ........................................
5. P re - and P o s t-th e ra p y Fear Thermometer
Scores fo r Treatm ent-D efense Groups
6. P r e - and P o s t-th e ra p y Fear Thermometer
Scores fo r Treatm ent-D efense GroupB
CHAPTER I
THE PROBLEM
P re fac e
Two tec h n iq u e s f o r th e tr e a tm e n t o f i r r a t i o n a l
f e a r s , System atic D e s e n s i t iz a t i o n (Wolpe, 1958) and Im plo
s iv e Therapy (Stam pfl, 1967)* have been d e riv e d from g e n e r
a l l y accep ted t h e o r i e s o f human le a r n in g . Although the two
th e r a p ie s have much in common, in c lu d in g th e engagement o f
th e p a t i e n t in c o g n itiv e r e h e a r s a l ( " v i s u a l i z a t i o n " ) o f
fe a re d s t i m u l i , t h e i r pro p o n en ts have a t t r i b u t e d the e f f i
cacy o f th e tec h n iq u e s to seem ingly c o n tr a d ic t o r y o p e ra
tio n s .
The most fundam ental re q u ire m e n t o f tre a tm e n t a c
cording to Wolpe i s the su p p re ss io n o f a n x ie ty , by a r e
c i p r o c a l l y i n h i b i t i n g re sp o n se , as the p a t i e n t im agines
the f e a r evoking scenes. The prim ary o b j e c t i v e o f Stampfl's
Im plosive Therapy (IT) i s the e l i c i t a t i o n o f h ig h i n t e n s i t y
a n x ie ty re s p o n se s during t r e a tm e n t. I t i s th e argument o f
the p ro p o sa l to be p re s e n te d t h a t the r e l a t i o n s h i p between
a n x ie ty d uring tre a tm e n t and su c c e ss o f outcome i s c u r v i
l i n e a r r a t h e r than the l i n e a r r e l a t i o n s h i p im p lied by the
pro m u lg a te rs o f the tre a tm e n t t h e o r i e s r e f e r r e d to above.
1
2
The second argument o f th e p ro p o sa l I s t h a t I n d i
v id u a l d if f e r e n c e s in mode o f d e fe n siv e a d a p ta tio n to t h r e a t
( s p e c i f i c a l l y , h a b it u a l te n d e n c ie s to c o n fro n t so u rc es o f J
s t r e s s o r suppress a n x ie ty ) w i l l be d i f f e r e n t i a l l y r e l a t e d
to e f f i c a c y o f tre a tm e n ts -which emphasize th e m axim ization
o r m inim ization o f f e a r d u rin g tr e a tm e n t.
I n tr o d u c tio n to th e Problem
1
R e c rlp ro c a l I n h i b it i o n
The' techniq ue o f S y stem atic D e s e n s i t i z a t i o n , d e
veloped by Joseph Wolpe (1958, 1 9 6 2), r e p r e s e n t s an impor
t a n t new approach to p sy c h o th era p y . Since the p u b lic a tio n
o f W olpe's book, Psychotherapy by R e c ip ro c a l I n h i b i t i o n
(1958), a v a s t body o f l i t e r a t u r e has accum ulated su p p o rt
in g the e f f e c t i v e n e s s o f t h i s p a r t i c u l a r form o f b e h av io r
th e ra p y (G rossberg, 1964). I t s u s e f u ln e s s has been demon
s t r a t e d in connection w ith many ty p es o f n e u r o t i c b e h a v io r,
in c lu d in g phobias (L azarus, 1961; Wolpe, 1963), c a se s o f
a n o re x ia nervosa (H a lls te n , . 1 9 6 5), c h ro n ic f r i g i d i t y (Laza
r u s , 1963; Brady, 1966) and o b s e s s io n s (Haslam, 1 9 6 5)•
In Psychotherapy by R e c ip ro c a l I n h i b i t i o n , Wolpe
a p p lie s the p r i n c i p l e s o f l e a r n in g ( p r i m a r il y as form ulated
by Pavlov and H ull) to an e x p la n a tio n o f th e development
and m aintenance o f n e u ro tic b e h a v io r . N euroses a re con
c e p tu a liz e d as "unadaptive le a r n e d h a b i t s o f r e a c t i o n ac
q u ire d in a n x ie ty g e n e ra tin g s i t u a t i o n s w ith a n x ie ty u s u a lly
preem inent among the r e a c t io n s lea rn ed ." W olpe's a n a ly s is
o f the n e u r o tic p rocess has much in common w ith th e p r in
c i p l e s o f the tw o -fa c to r th e o r y o f Mowrer ( i 9 6 0) according j
to which fe a r i s c o n d itio n e d to p r e v io u s ly n e u tr a l stim u li
1
by c o n tig u ity o f the n e u tr a l stim u lu s w ith p a in f u l s tim u li, ;
and the r e s u lt in g d e fe n s iv e maneuvers are r e in fo r c e d by r e -
|
d u ction o f fe a r .
Wolpe (1952) dem onstrated, in a s e r i e s o f e x p e r i- i
ments w ith anim als, th a t i t was p o s s ib le to e lim in a te neu
r o t i c animal behavior by c o u n te r a c tin g a n x ie ty w ith fe e d in g .
Prom h i s animal ex p erim en ta tio n and th e w r itin g s o f Sher
r in g to n the "R eciprocal I n h ib itio n " p r in c ip le o f therapy
was su ggested to him. Wolpe (1958) s t a t e s the R ecip ro ca l
I n h ib it io n (Rl) p r in c ip le fo r m a lly as fo llo w s :
I f a response a n ta g o n is t ic to a n x ie ty can be made to
occur in the presence o f a n x ie ty provoking s tim u li so
th a t i t i s accompanied by a com plete or p a r t i a l sup
p r e ssio n o f the a n x ie ty r e sp o n se , th e bond between
th ese stim u li and the a n x ie ty w i l l be weakened [p. 7 1 ].
Wolpe looked fo r o th e r r e sp o n se s b e sid e fee d in g by
which a n x ie ty could be i n h ib it e d in order to make h is pro
ced ures more s u ita b le to th e treatm en t o f human n e u r o se s.
He was guided by the presum ption th a t r e sp o n se s which
la r g e ly im p lic a te the p arasym p ath etic d iv i s i o n o f the au to
nomic nervous system would be e s p e c i a l l y l i k e l y to be i n
com patible w ith the p red om in ately sym p athetic resp o n ses o f
a n x ie ty . He concluded th a t fo r th ree c a t e g o r ie s o f r e
sp o n ses, " a sse r tiv e r e sp o n se s, se x u a l r e sp o n s e s , and r e la x
a tio n r e sp o n se s— th ere a r e , a s fa r a s the autonomic system
i s concerned, p r e su a siv e i n d ic a t io n s o f parasym pathetic a s
cendency [p. 7 1 ]." With regard to r e la x a t io n and te n s io n ,
Wolpe th e o r iz e d th a t fe a r or a n x ie ty i s alw ays accompanied
by a s t a t e o f te n s io n in th e s k e l e t a l m uscles and con versely
th a t fe a r i s im p o ssib le w h ile the body i s in a s t a t e o f
|
com plete s k e le ta l-m u s c le r e la x a t io n . Wolpe concluded th a t
i t was axiom atic th a t r e la x a t io n i n h i b i t s a n x ie ty and th a t i
the concurrent e x p r e ssio n o f m uscle r e la x a t io n and a n x ie ty
i s p h y s io lo g ic a lly im p o s s ib le .
Wolpe argues t h a t , s in c e r e la x a t io n i s a resp onse
which i s in com p atib le w ith f e a r , c o n d itio n in g the resp onse
o f r e la x a tio n to the a n x ie ty arou sin g stim u lu s should a u to
m a t ic a lly p reven t the occu rren ce o f the fe a r resp o n se.
That i s , the c o n d itio n e d resp o n se o f r e la x a t io n should j
r e c ip r o c a lly I n h ib it the r e a c tio n o f fe a r o r a n x ie ty and
thus weaken, the bond between th e s tim u li and the a n x ie ty
r esp o n se.
In attem p tin g to s p e c i f y a le a r n in g th eory exp lan a
t io n fo r R ecip ro cal I n h i b it i o n , Wolpe invoked the H u llian
concep t o f c o n d itio n e d i n h i b i t i o n . Wolpe p o s tu la te d th a t
on every o cca sio n in which a n x ie ty r e sp o n se s are in h ib it e d
by an a n ta g o n is tic r e sp o n se , a measure o f c o n d itio n e d i n
h i b it i o n i s produced, and th a t w ith the r e p e t i t io n , the
c o n d itio n e d in h ib it io n accum ulates so th a t the a n x ie ty
evoking p o t e n t i a l o f the stim u lu s s i t u a t i o n p ro g re s s iv e ly
d im in ish e s. He argued t h a t :
I f c o n d itio n e d i n h i b i t i o n i s b u i l t up d u rin g e x tin c tio n ;
because t r a c e s o f th e c o n d itio n e d s t i m u l i a re contem
poraneous w ith r e a c t i v e i n h i b i t i o n o f th e co n d itio n ed
resp o n se , i t i s re a s o n a b le to ex p ect t h a t i f some o th e r i
cause where to i n h i b i t th e c o n d itio n e d resp o n se , con
d itio n e d i n h i b i t i o n co uld lik e w is e be b u i l t up [Wolpe,
1958, p. 2 9 ].
The tr e a tm e n t r e f e r r e d to as S y stem atic D e s e n s iti-
z a tio n c o n s i s t s o f th r e e s e t s o f o p e r a tio n s : ( l ) The pa- |
t i e n t iB given t r a i n i n g in J a c o b s o n 's p r o g r e s s iv e muscle
r e l a x a t i o n (Jaco bso n, 1938). (2) With th e a id o f the t h e r
a p i s t , the p a t i e n t c o n s t r u c t s a h ie r a r c h y o f fe a re d s i t u a
t i o n s , from l e a s t to most a n x ie ty p rov oking. ( 3 ) The p a
t i e n t , in a s t a t e o f deep muscle r e l a x a t i o n i s asked to
imagine scenes from th e h i e r a r c h y as th e y a re d e scrib e d to
!
him by the t h e r a p is t . V is u a liz a t io n b e g in s w ith the l e a s t |
th rea ten in g scen e on the h ie r a r c h y ("bottom o f th e h ie r
archy") and p roceed s upward o n ly when i t i s e s ta b lis h e d
th a t p reviou s sceneB can be v is u a liz e d w ith o u t any a n x ie ty .
The R e c ip ro c a l I n h i b i t i o n p ro ced u re d e sc rib e d above
f i t s the g e n e ra l o p e r a t io n s d e fin in g "c o u n te rc o n d itio n in g "
by v i r tu e o f th e f a c t t h a t th e e lim in a tio n o f unwanted b e
h a v io r (a n x ie ty o r avoidance) i s achieved by the su pp res
sio n o f th a t b e h a v io r by a newly c o n d itio n e d response
(London, 1964). The o b j e c t o f th e p ro c e d u re , i t should be
emphasized i s n o t to te a c h a p r e - s e l e c t e d new p a tt e r n o f
b e h a v io r, b u t o n ly to b rea k th e o ld p a t t e r n s . The co ndi
6
tio n in g of the new re sp o n se ( r e l a x a t io n ) i s the o n ly o p e ra
tio n which d i s t i n g u i s h e s W olpe's procedure from t h a t of
c l a s s i c a l e x ti n c t i o n . B o th p ro ce d u res in v o lv e the re p e a te d ;
exposure o f the s u b je c t to th e c o n d itio n e d s tim u li fo r
a n x ie ty w ithout r e i n f o r c i n g punishm ent.
Because o f the s i m i l a r i t y in o p e r a tio n s between j
R eciprocal I n h i b it i o n a n d c l a s s i c a l e x t i n c t i o n , th e question
has a ris e n (Lomont, 1965a) a s to w hether th e su c ce ss of
W olpe's methods i s a t t r i b u t a b l e , as he c la im s , to th e r e
c ip ro c a l i n h i b i t i o n of a n x i e t y o r to c l a s s i c a l e x ti n c t i o n .
Wolpe r e j e c t s t h e p o s s i b i l i t y t h a t th e r e s u l t s o f
h i s treatm en t may be due to e x t i n c t i o n , because he concludes
t h a t the e lim in a tio n o f n e u r o t i c a n x ie ty In anim als i s r e
ta rd e d when the anim als a r e s u b je c te d to o r d in a r y e x ti n c -
1
tio n p rocedures. A ccording to Wolpe, r e l a x a t i o n during
v i s u a li z a t io n i s e s s e n t i a l , and damage ( i . e . , In cre ased
s e n s i t iz a t i o n ) w i l l r e s u l t i f r e l a x a t i o n 1 b d is r u p te d by
the occurrence o f larg e "doses" o f a n x ie ty . In P sy ch o th er
apy by R eciprocal I n h i b i t i o n , he c a u tio n s p r a c t i t i o n e r s as
follow s:
A stim ulus (scene) t h a t i s too s tro n g may a c t u a l l y
in c re a s e s e n s i t i v i t y and, e s p e c i a l l y d u rin g e a r l y
experim ents w ith th e method I have o c c a s io n a lly pro
duced major se tb a c k s in p a t i e n t s by prem atu re p re s e n
t a t i o n to them of s t i m u l i w ith high a n x ie ty evoking
p o t e n t i a l [p. 140].
A l a t e r a r t i c l e by L azarus (1964) r e i t e r a t e s the same
p r i n c i p le and d e s ig n a te s the p re v e n tio n o f undue a n x ie ty
7
as one o f the " c r u c i a l p r o c e d u r a l f a c t o r s " i n System atic
D e s e n s i t i z a t i o n :
I t i s a c t u a l l y a d v is a b le to conclude by p r e s e n tin g j
s e v e r a l n e u t r a l sc en e s i n o r d e r to p re v e n t the d e s e n s i
t i z a t i o n p ro c e s s p e r se from assuming a n x ie ty g e n e r a t
in g p r o p e r t i e s . The h i e r a r c h y can then be d i l u t e d so
t h a t d e s e n s i t i z a t i o n can recommence a t a l e s s noxious
s t a r t i n g p o in t [p. 6 8 ].
The p r o p o s i t io n t h a t f a i l u r e to a t t a i n l e s s than j
complete r e l a x a t i o n d u rin g d e c o n d itio n in g w i l l le a d to an ;
i
e x a c e rb a tio n o f symptoms h as been d i s c r e d i t e d (Wolpin and i
R aines, 1966; C a u te la , 1 9 6 6; Rachman, 1 9 6 5; M yerhoff, 1967;
Cook, 1966). The c o r o l l a r y to th e l a t t e r , t h a t su p p ressio n
o f a n x ie ty by r e l a x a t i o n i s in d is p e n s a b le to th e r a p e u tic
su ccess has been t e s t e d w ith c o n t r a d i c t o r y r e s u l t s (Lomont
and Edwards, 1967); Rachman, 1 9 6 5j 1966; M yerhoff, 1967;
Wolpin and R aines, 196 6 ) . The body o f l i t e r a t u r e which ,
I
p r e s e n ts th e most s e r i o u s c h a lle n g e to t h i s n o tio n , however,!
d e riv e s not from s t u d i e s o f S y stem atic D e s e n s i t iz a t i o n p e r
se, b u t from the work o f Thomas Stam pfl and h i s a s s o c i a t e s
(S tam pfl, 1965; S tam pfl and L e v is, 1967; K irch n er and Ho
gan, 1966; Hogan, 1963^ 1966; Hogan and K irch n e r, 1967;
L evis and Carrera, 1967) whose Im p lo siv e Therapy d e r iv e s
from c l a s s i c a l e x t i n c t i o n .
Im plosive Therapy
The theory o f n e u r o s is proposed by Stam pfl (1965)
i s s t r ik in g ly s im ila r to the one s e t fo r th by Wolpe. Neu
r o t i c b eh aviors are c o n c e p tu a liz e d a s m aladap tive learn ed
resp on ses to p r e v io u s ly in n o ce n t cues which have been a s s o
c ia te d w ith the o ccu rren ce o f a traum atic in c id e n t . Stampfl
reason s th a t c o n d itio n e d a n x ie ty resp o n ses occur in a con
t e x t where a s e r i e s o f p r e v io u s ly n e u tr a l cueB become con
nected w ith the o r ig i n a l source o f pain or punishment.
Since avoidance re s p o n s e s a re t y p i c a l l y made to the cues
remote from the o r i g i n a l source o f f e a r , th e in d iv i d u a l i s
r a r e l y c o n fro n te d w ith th e s t i m u l i c l o s e r and more r e l e v a n t |
to the f e a r so u rc e. The tre a tm e n t s t r a t e g y c o n s i s t s o f ex
posing the i n d iv i d u a l e x t e n s i v e l y to th e more proxim al
s tim u li ( i n f e r r e d by th e t h e r a p i s t ) as w e ll as to the d i s t a l
s tim u li ( r e p o r te d by th e p a t i e n t ) i n s i t u a t i o n s where the
a n x ie ty i s not r e i n f o r c e d and w i l l th u s e x tin g u is h .
In o r d e r to accom plish th e d e s ir e d e x tin c tio n .,
I
Stampfl u t i l i z e s a te c h n iq u e which i s th e a n t i t h e s i s o f
W olpe's S ystem atic D e s e n s i t i z a t i o n . In b r i e f , Stampfl
s t r i v e s to f r i g h t e n h i s p a t i e n t s as much and f o r as long as
p o s s ib le . He p e rs u a d e s th e p a t i e n t to Imagine in as v iv id
d e t a i l as p o s s i b l e th e most h o r r i f y i n g s t o r i e s t h a t the
t h e r a p i s t can c r e a t e .
In c o n t r a s t to Wolpe, Stam pfl c o n s id e rs tre a tm e n t
most e f f e c t i v e when he i s a b le to f r i g h t e n h i s p a t i e n t s
most th o ro u g h ly . He b e l i e v e s th e e f f e c t s o f e x ti n c t i o n
w i l l g e n e r a liz e from s tim u li ( v i s u a li z e d scenes) o f g r e a t e r
to s tim u li o f l e s s e r a n x ie ty p o t e n t i a l . Thus, i f a n x ie ty
i s e x tin g u is h e d to a v e ry f r i g h te n in g s i t u a t i o n th e re i s no
9
need to t r y to a ro u s e and e x tin g u is h i t to a l e s s f r i g h t e n
ing one.
Since the b a s i c o b j e c t i v e o f th e tre a tm e n t i s the j
a ro u s a l o f a n x ie ty , and s in c e th e e f f e c t s o f e x ti n c t i o n are
thought to g e n e r a l i z e , i t m a tte r s r e l a t i v e l y l i t t l e to the
Im plosive t h e r a p i s t w h e th e r o r n o t he o b t a i n s a c c u ra te i n - ,
i
form ation about th e p a t i e n t o r h i s problem . According to
London (1964):
As long as th e m a t e r i a l p r e s e n te d i s f r i g h te n in g enough,
even i f i t i s f a l s e o r w holly u n r e l a te d to the a c tu a l
c o n te n t of th e p a t i e n t ' s l i f e , th e b e n e f i c i a l e f f e c t s
o f e x tin c tio n w i l l g e n e r a l i z e to a l l o t h e r g ro u n d less
sou rces o f a n x ie ty o f eq ual o r l e s s p ro v o c a tiv e s t a t
u re [p. 104].
Comparison o f R e c ip ro c a l I n h i
b i t i o n and Im plosive Therapy
The th e r a p e u t i c s u c c e s s e s r e p o r te d by Im plosive !
i
t h e r a p i s t s are e q u a l ly im p re s s iv e as th o se r e p o r te d by
Wolpe. Stampfl c la im s Improvement in n e a r l y 100 p e rc e n t o f
p a t i e n t s in h is c l i n i c a l p r a c t i c e (London, 1964). In d e
pendent c o rro b o ra tio n h a s been p ro v id ed by. K irch n er and
Hogan (1966, 1967) i n c o n t r o l l e d la b o r a to r y s tu d ie s .
W olpe's c la im to s u p e r i o r c r e d i b i l i t y o f h is t r e a t
ment techniq ues b e c a u se o f th e f a c t t h a t th e y may be de
r iv e d as e x te n sio n s from H u l l 's p r i n c i p l e s o f le a rn in g i s
e a s i l y countered by a d h e r e n t s o f the Im p lo siv e tec h n iq u e .
The c o n te n tio n o f S tam p fl t h a t resp o n se I n t e n s i f i c a t i o n
le a d s to response d ecrem ent i s su pp orted b o th by G u th r ie 's
a s s e r ti o n t h a t re s p o n se e li m in a ti o n may be accom plished by
r e p e a tin g th e s tim u lu s o r B ignal u n t i l th e o r i g i n a l re s p o n se
i s fa tig u e d , a s w e ll aB by H u l l 's p o s i t io n t h a t a f a t i g u e
l i k e d riv e o c c a sio n e d by r e p e a te d responding le a d s to th e
accum ulation o f c o n d itio n e d i n h i b i t i o n and t h e r e f o r e to
response decrem ent (H ilg a rd , 1956).
i
W olpe's argum ent t h a t anim al experim ents demon
s t r a t e the s u p e r i o r i t y o f R e c ip r o c a l I n h i b i t i o n to e x t l n c -
tio n tec h n iq u e s f o r rem oval o f a n x ie ty i s not borne o u t by
th e re c e n t l i t e r a t u r e . On the b a s i s o f h i s ( 1965a) review
o f the r e l e v a n t anim al l i t e r a t u r e , Lomont concludes t h a t
" fo r e x p la in in g r e c i p r o c a l i n h i b i t i o n th e ra p y , i t i s e s s e n
t i a l l y an open q u e s tio n as to w hether th e concept o f r e c i p - j
r o c a l i n h i b i t i o n i s b e t t e r than e x t i n c t i o n [p. 2 1 8] ." j
The c l i n i c a l o b s e r v a tio n by Wolpe and h i s fo llo w e rs j
t h a t the e l i c i t a t i o n o f i n t e n s e a n x ie ty during tre a tm e n t i s
u n d e s ira b le i s c o n t r a d i c t o r y to an o p p o site c l i n i c a l ob
s e rv a tio n by S tam p fl as w e ll as a d h e re n ts o f v a rio u s t h e r a
p e u tic p e rs u a s io n s t h a t c a t h a r s i s and a b re a c tio n (G endlin,
1962), both o f which in v o lv e th e e l i c i t a t i o n o f stro n g emo
t i o n a l re s p o n s e s , a r e h ig h ly e f f e c t i v e th e r a p e u tic phenome
na.
S ta te m en t o f th e Problem
Problem I i A nxiety L evel
du rin g Treatm ent
I t i s d i f f i c u l t to f in d a b a s i s on which Wolpe
11
m ight argue t h a t S ta m p f l1s .r e s u l t s a re a t t r i b u t a b l e to a
R e c ip ro c a l I n h i b i t i o n phenomena. I n s te a d o f su p p re ssin g
th e c o n d itio n e d a n x ie ty re sp o n se , Stampfl makes a d elib era te!
e f f o r t to maximize i t . On th e o th e r hand, i t a p p e a rs
e q u a l ly u n te n a b le f o r Stam pfl to m aintain th e p o s i t i o n t h a t :
a n x ie ty i n t e n s i f i c a t i o n i s a th e r a p e u tic e s s e n t i a l i n l i g h t :
j
o f th e im p re ssiv e r e s u l t s o f Wolpe. The f a c t t h a t th e two
|
t h e o r i s t s emphasize what ap p ea rs to be c o n t r a d i c t o r y p r i n - j
c i p l e s w ith r e s p e c t to the management o f a n x ie ty d uring
v i s u a l i z a t i o n r a i s e s th e g e n e r a l q u e stio n s o f th e im por
ta n c e o f a n x ie ty m odulation in d e c o n d itio n in g p ro c e d u re s as
w e ll a s th e v a l i d i t y o f the t h e o r e t i c a l f o r m u la tio n s from
which th e r e s p e c t i v e p ro c e d u re s are d e riv e d .
Only one i n v e s t i g a t i o n has d i r e c t l y compared the
e f f e c t i v e n e s s o f a n x ie ty m inim ization w ith a n x ie ty augmen
t a t i o n as t h e r a p e u t i c a g e n ts (Rachman, 1966) . Rachman com
p a re d th r e e Ss which he d e s e n s itiz e d by a R e c ip r o c a l I n h i
b i t i o n te c h n iq u e i n 1965 to th r e e Ss d e s e n s i ti z e d by him
s e l f i n 1966 u s in g a " flo o d in g " or a n x ie ty m axim ization
te c h n iq u e . He p r e s e n t s s t a t i s t i c a l l y unanalyzed cu rves
which su g g e st t h a t th e RI Ss improved while the " flo o d in g "
Ss d id n o t. The Rachman study h a rd ly q u a l i f i e s a s a c r i t i
c a l t e s t o f th e W olpe-Stam pfl paradox, because o f th e sm all
number o f Ss, and th e p o s s i b i l i t i e s o f e x p e rim e n te r and
sam pling b i a s e s i n h i s stu d y .
12
C o n sid erin g th e o u tstan d in g su c c e ss o f both Im plo- J
|
s io n and S y stem atic D e s e n s itiz a tio n as w e l l as the c o n tr a - |
d i c t i o n s in th e exp erim en tal l i t e r a t u r e , i t seems u n l ik e l y i
t h a t e i t h e r o f th e two th e o rie s w i l l be s u p p o r te d in i t s
e n t i r e t y , i ; e . , t h a t d e s e n s i ti z a t io n can be accom plished
o n ly by R e c ip ro c a l I n h i b it i o n or by a n x ie ty i n t e n s i f i c a
t i o n . I t i s c o n c e iv a b le , n o n e th e le ss, t h a t b o th the R ecip
r o c a l I n h i b i t i o n and Im plosive tech n iq u es f a c i l i t a t e im
provem ent as compared w ith d e c o n d itio n irg p ro c e d u re s which
I
om it th e o p e r a t io n s o f an x ie ty su p p re ssio n o r i n t e n s i f i c a
t i o n . That i s , t h e r e may be a c u r v i l i n e a r r e l a t i o n s h i p b e
tween a n x ie ty l e v e l during treatm en t and improvement. The
f a i l u r e o f p re v io u s s tu d ie s to in clu d e more th a n two e x p e r-
i
!
im e n ta l c o n d itio n s p re v e n ts one from c o n c lu d in g whether o r j
n o t such a r e l a t i o n s h i p e x i s t s . i
I
The h y p o th e s is of a c u r v i l in e a r r e l a t i o n s h i p gainB
s u p p o rt from th e f a c t th a t both R e c ip ro c a l I n h i b i t i o n t e c h
n iq u e s and te n s io n and Im plosive te c h n iq u e s h a v e, w ith
o n ly one e x c e p tio n (P o lk in s, in p re s s) p ro v e d t o be more
e f f i c a c i o u s th an d e s e n s l t l z a t l o n in the a b se n c e of any a t
tem pt to m odulate a n x ie ty (Myerhoff, 1967; Rachman, 1966;
Lang, 1964; D avison, 1966).
T h e o r e ti c a l arguments based on L e a rn in g Theory may
a l s o be p r e s e n te d to support the s p e c u la tio n t h a t e i t h e r
h ig h o r low l e v e l s o f response e l i c i t a t i o n may le a d to i t s
d is a p p e a ra n c e . G u th rie has a s s e r te d ( H llg a rd , 1956) t h a t
13
re sp o n se e lim in a tio n may be accom plished most e f f e c t i v e l y
by e i t h e r p r e s e n tin g the stim u lu s i n such f a i n t d e g re es
t h a t i t w i l l not c a l l out the re sp o n se and on o c c a s io n s in j
which o t h e r f e a tu r e s in the s i t u a t i o n i n h i b i t th e u n d e s i r
a b le re sp o n se (as i s c o n s i s t e n t w ith th e o p e r a tio n s i n Re
c i p r o c a l I n h i b i t i o n ) , or by r e p e a tin g th e stim u lu s o r s i g n a l
u n t i l th e o r i g i n a l response i s f a t i g u e d (th e o b j e c t i v e o f
Im p lo siv e T h e ra p y ).
From H u l l 's th eo ry Wolpe a rg u e s t h a t i t i s p l a u s i b l e
t h a t the i n t e r f e r e n c e w ith th e o c c u rre n c e o f a resp o n se to
a s tim u lu s w ith which i t i s h a b i t u a l l y a s s o c i a t e d may aug
ment th e tendency fo r the Btimulus to n o t e l i c i t the r e
sp onse. However, i t may a lso be arg u ed from H ull t h a t r e
p e a te d e l i c i t a t i o n o f an in te n s e re s p o n se b u i l d s up an a c - j
i
cum ulation o f c o n d itio n ed i n h i b i t i o n b ecau se o f th e magni- j
tu d e o f th e f a t i g u e - l i k e d riv e en gendered , and th e in c re a s e d
m agnitude o f th e d r i v e 's r e in fo rc e m e n t power on resp o n se
c e s s a t i o n .
No stu d y to date has s a t i s f a c t o r i l y compared th e
e f f i c a c y o f tre a tm e n t under c o n d itio n s desig ned to minimize
a n x ie ty (Rl) w ith procedures which maximize a n x ie ty (Im plo
sio n ) and sim ple c o g n itiv e r e h e a r s a l w ith o u t a n x ie ty modu
l a t i o n (r e p r e s e n tin g a c o n tr o l group a t an in te r m e d ia te
a n x ie ty l e v e l ) . In the absence o f such an i n v e s t i g a t i o n ,
i n f e r e n c e s re g a rd in g the v a l i d i t y o f th e t h e o r e t i c a l p o s i
t i o n s s e t f o r t h by Wolpe and S tam p fl, a s w e ll a s th e r e l a
tio n s h ip between a n x ie ty and treatm en t e f f i c a c y , cannot be
e v a lu a ted . The proposed in v e s t i g a t io n , th e r e fo r e , plan s to
study the e f f e c t s o f th e above trea tm en ts on the red u ction
o f fe a r and avoidance to phobic o b je ctB .
H ypotheses. Two s e p a r a te s e t s o f h y p o th eses may be
d e riv e d from the t h e o r e t i c a l fo rm u la tio n s o f Wolpe and j
Stam pfl and a t h i r d s e t b ased on the p r o p o s i t io n t h a t both j
th e m inim izatio n and m axim ization o f a n x ie ty d uring t r e a t
ment a re s u p e r io r to o p e r a t io n s a s s o c i a t e d w ith the main
tenance o f a n x ie ty a t i n te r m e d ia te l e v e l s .
Prom a s t r i c t Wolpean p o s i t i o n , i t fo llo w s th a t:
1. E lim in a tio n o r m in im iz atio n o f th e a n x ie ty r e -
i
sponse during tr e a tm e n t w i l l r e s u l t i n l e s s f e a r and a v o id -j
ance than o p e r a tio n s a llo w in g e i t h e r in te r m e d ia te o r aug- I
mented f e a r d u ring tr e a tm e n t.
2. O p e ratio n s p ro d u cin g in te r m e d ia te amounts of
f e a r o r , p a r t i c u l a r l y , augmented f e a r d u rin g tre a tm e n t w i l l
in c r e a s e the f e a r and avo idance a s s o c i a t e d w ith phobic
s t i m u l i .
3. The s m a lle r th e amount o f f e a r r e p o r te d by Ss
d uring tre a tm e n t, the s m a lle r th e amounts o f f e a r and
avoidance t h a t w i l l be e l i c i t e d by th e pho bic stim u lu s .
From S ta m p f l's p o s i t i o n , i t fo llo w s t h a t :
1. Maximizing o f th e a n x ie ty d u rin g tre a tm e n t w i l l
r e s u l t i n l e s s f e a r and avoid ance o f a phobic stim u lu s than
15
o p e ra tio n s p ro d u cin g in te r m e d ia te amounts o f f e a r o r m ini
mizing f e a r d u rin g t r e a tm e n t.
2. The g r e a t e r the amount o f f e a r re p o rte d by Ss j
;during tre a tm e n t, th e s m a lle r the amounts o f f e a r and a v o id
ance t h a t w i l l be e l i c i t e d by the phobic stim u lu s.
A t h i r d s e t o f hyp o th eses su g g e ste d by th eo ry and j
th e l i t e r a t u r e i s aB fo llo w s:
1. Both m in im iz a tio n as w e ll a s m axim ization o f i
the a n x ie ty re s p o n s e d u rin g tr e a tm e n t w i l l r e s u l t in le s s
f e a r and avoidance o f a phobic s tim u lu s than o p e ra tio n s a l
lowing in te r m e d ia te amountb o f a n x ie ty to occur.
2. The s m a ll e r th e amounts o f f e a r re p o rte d by Sb
during a n x ie ty m in im iz a tio n tr e a tm e n t, and the g r e a t e r the
amount o f f e a r r e p o r t e d by Ss d uring a n x ie ty maximization
tre a tm e n t, th e s m a lle r th e amounts o f f e a r and avoidance j
t h a t w i l l be e l i c i t e d by the phobic s t i m u l u s . ’ 1 '
Problem I I : A n xiety
Coping P r e d i s p o s i t i o n s
A second problem which m e r i ts study i s t h a t o f the
r e l a t i o n s h i p betw een h a b i t u a l p r e f e r e n c e s f o r methods of
coping w ith a n x ie ty and th e e f f i c a c y o f d i f f e r e n t trea tm e n t
o p e ra tio n s . The more g e n e r a l case i s th e r e l a t i o n s h i p o f
p e r s o n a l i ty c h a r a c t e r i s t i c s and tre a tm e n t outcome and the
■ '’The h y p o t h e s is , B tated in t h i s way, -is based on the
assumption t h a t R e c ip r o c a l I n h i b i t i o n and E x tin c tio n may
r e p r e s e n t q u a l i t a t i v e l y d i f f e r e n t p r o c e s s e s each having a
: se p a ra te r e l a t i o n s h i p w ith a n x ie ty l e v e l .
16
i n t e r a c t i o n o f such v a r i a b l e s w ith the d i f f e r e n t form s o f
d e c o n d itio n in g .
P re v io u s a tte m p ts to i d e n t i f y p ro g n o stic i n d i c a t o r s j
o f su c c e s s in d e c o n d itio n in g have c e n te re d m ainly around
the v a r i a b l e s o f a n x ie ty (Lang and Lazovik, 1963; Cook,
1966; Lang, Lazovik and R eynolds, 1965)^ s u g g e s t a b i l i t y
I
(Lang, L azovik and R eynolds, 1965)* and i n t r o v e r s i o n (L aza
ru s , 1 9 6 5; Wolpin and R a in e s , 1966) and have y i e l d e d equivo-i
c a l and c o n t r a d i c t o r y r e s u l t s . None o f th e s e s t u d i e s have
e x p lo re d th e p o s s i b i l i t y t h a t the e f f e c t i v e n e s s o f d e c o n d i
tio n in g p ro c e d u re s m ight v a ry as a fu n c tio n o f th e Ss u s u a l
manner o f h a n d lin g a n x ie ty .
I n d e s c r ib in g a S 's c h a r a c t e r i s t i c manner o f r e d u c -
!
ing a n x i e t y th e c o n cep ts "R epressor" and " S e n s i t iz e r " have !
been u s e d r e p e a t e d ly in r e c e n t y e a r s . C o n sid erab le e m p ir i
c a l s u p p o r t (E rik s e n , 1 9 6 3; Byrne, 1961, 1964; Ullman,
1962) h a s been g iven th e c l i n i c a l no tion t h a t R ep ressorB ,
l ik e h y s t e r i c s , a tte m p t to red uce a n x ie ty by avoidance o r
d e n ia l, w h ile S e n s i t i z e r s , l i k e p sy c h asth en ic n e u r o t i c s ,
cope w ith a n x ie ty by i n t e l l e c t u a l l y c o n fro n tin g and ru m in a t
ing ab o u t th e source o f d is tu r b a n c e .
P re v io u s s t u d i e s , u s in g a v a r i e ty o f " tre a tm e n ts "
to red u c e 'film induced t h r e a t (Speisman e t a l ., 1964; L aza
r u s and A l f e r t , 1964; Piorko w sk l, 1967) have shown an i n t e r
a c tio n betw een tre a tm e n t e f f e c t i v e n e s s and the R e p re s s io n -
S e n s i t i z a t i o n dim ension. S p e c i f i c a l l y , th e f in d in g h a s been
t h a t R e p re ss o rs show g r e a t e s t a n x ie ty r e d u c tio n fo llo w in g
tr e a tm e n ts b ased on d i s t r a c t i o n o r d e n ia l w h ile S e n s i t i z e r s i
d e riv e most b e n e f i t from tre a tm e n ts making use o f c a t h a r s i s ■
and i n t e l l e c t u a l i z a t i o n .
I t i s p l a u s ib l e t h a t th e r e l a t i o n s h i p s which have
been found between mode o f d e fe n siv e a d a p ta tio n to t h r e a t
■ i
and e f f i c a c y o f tre a tm e n t in c a se s o f e x p e r im e n ta lly i n
duced s t r e s s would a ls o hold t r u e i n c a s e s o f lo n g e r s ta n d - j
ing c o n d itio n e d f e a r , or p h o b ia s. In th e c o n te x t o f de
c o n d itio n in g p ro ce d u res, i t m ight be s p e c u la te d t h a t th e
R e c ip ro c a l I n h i b i t i o n procedure o f Wolpe, which in v o lv e s a
d e l i b e r a t e su p p re ssio n of a n x ie ty would be moBt com patib le
w ith th e d e fe n siv e s t r a t e g i e s o f R e p re s s o rs , who c h a r a c t e r
i s t i c a l l y avoid c o n fro n ta tio n w ith th e so u rc es o f t h r e a t .
By th e same l i n e o f rea so n in g , i t would appear p l a u s i b l e
t h a t Im p lo siv e Therapy, c a l l i n g f o r a c o n f r o n t a ti o n o f
a n x ie ty and s t r e s s , would be b e s t s u i t e d to th e d e fe n siv e
o r i e n t a t i o n o f S e n s i t i z e r s .
H y p o th eses. On the assum ption t h a t the p ro ced u re
o f R e c ip ro c a l I n h i b i t i o n b e a rs g r e a t e s t resem blance to th e
h a b i t u a l d e fe n siv e o r i e n t a t i o n s o f R e p re ss o rs and t h a t th e
Im p lo siv e tec h n iq u e i s most c o n s i s t e n t w ith th e d e fe n siv e
p r e d i s p o s i t i o n s o f S e n s i t i z e r s , and f u r t h e r , t h a t the e f f e c
tiv e n e s s o f tre a tm e n t i s , in p a r t , a f u n c tio n o f i t s com
p a t i b i l i t y w ith th e Ss' c h a r a c t e r i s t i c s t r a t e g i e s fo r
18
coping w ith s t r e s s , the fo llo w in g h y p o th eses may be formu
l a t e d :
1. S e n s i t iz e r s w i l l im prove more fo llo w in g t r e a t
ment by Im plosion than fo llo w in g tre a tm e n t by R I.
2. R epressors w i l l Improve more fo llo w in g t r e a t
ment by RI than follow ing t r e a tm e n t by Im p lo sio n .
I
CHAPTER I I
REVIEW OP THE LITERATURE
Studies o f S y stem atic D e s e n s i t iz a t i o n
C l in i c a l r e p o r t s o f the u se o f S ystem atic D esensi
t i z a t i o n by b o th Wolpe and a number o f o t h e r p r a c t i t i o n e r s
i n d ic a t e i t s p o t e n t i a l u s e f u l n e s s i n a wide v a r i e ty o f b e
h a v io r a l and psychosom atic d i s o r d e r s . In Psychotherapy by
R e c ip ro c a l I n h i b i t i o n ( 1 9 5 8) Wolpe p ro v id e s d e ta il e d ac
co unts o f the a p p l i c a t i o n o f h i s te c h n iq u e s to cases of
duodenal u l c e r , im potence, and p a ra n o id d e lu s io n . In d e
pendent c o rro b o ra tio n f o r h i s f in d in g s has been re p o rte d
i n cases o f e x h ib itio n is m (Bond and H utchinson, i 9 6 0),
s t u t t e r i n g (L azarus, i 9 6 0) , c h o n rlc f r i g i d i t y (L azarus,
1963; Brady, 1966), a n o r e x i s n e rv o sa ( H a lls te n , 1965), ob
s e s s io n a l p e r s o n a l i t y (HaBlam, 1 9 6 5), and chronic a n x ie ty
s t a t e s (O autela, 1966) . The tre a tm e n t has been a p p lie d to
phobic c h ild re n (L azarus and Abromowltz, 1962) , employed
in th e a l l e v i a t i o n o f pho b ic symptoms in sc h izo p h re n ic s
(Cowden and Ford, 1 9 6 1) and a d m in is te re d i n groupB (Laza
r u s , 196l j Paul and Shannon, 1966) .
19
C o n tro lle d l a b o r a t o r y s tu d ie s have most o f te n been
u n d e rta k e n I n c o n n e c tio n w ith r e l a t i v e l y c irc u m s c rib e d
i
phobias and have drawn s u b je c ts p rim a rily from u n d e rg ra d - j
u a te c o ll e g e p o p u la tio n s . By f a r th e g r e a t e s t number of
s t u d i e s have been done w ith snake or animal phobic s u b j e c t s ;
(Lang, Lazovik and R eynolds, 1965J Lang and L azov ik, 1963j
!
Lang, 1964j M yerhoff, 1967j Rachman* 1965* 1966 j Lomont and:
Edwards, 1 9 6 6; Cook, 1966j Wolpln and Raines, 1966; Ramsey j
e t a l . , 1 9 6 6; Davison, 1 9 6 5). The e ffic a c y of tr e a tm e n t
has a ls o been d e m o n stra te d f o r t e s t a n x iety (Emory and
Krum boltz, 1 9 6 7)* perform ance o r p u b lic speaking p h o b ias
(P aul, 1 9 6 6, 1 9 6 7)* and i n th e s h o r t - c i r c u i t i n g of e x p e r i
m e n ta lly Induced s t r e s s (P o lk in s, e t a l ., i n p r e s s ) .
Although th e above-m entioned ( c o n tr o lle d ) s t u d i e s
1
have d i f f e r e d c o n s id e r a b ly i n such r e s p e c ts a s number of
tre a tm e n t s e s s io n s , e x te n t of r e l a x a t i o n t r a i n i n g , ty p e s
and l e n g th s of h i e r a r c h i e s , exp erience of t h e r a p i s t s , as
w e ll as i n th e d e t a i l s of c r i t e r i o n measures, a l l have r e
p o rte d s u b s t a n t i a l Improvement f o r Ss t r e a t e d by S y stem atic
D e s e n s l t l z a t l o n as compared w ith no trea tm e n t c o n t r o l s ,
p lacebo groups (D avison, 1965j Lang et a l . , 1965J P aul,
1 9 6 6), o r t r a d i t i o n a l p sy c h o th e ra p ie s (Paul, 1 9 6 6; L azaru s,
1 9 6 1). Follow -up s t u d i e s ra n g in g from s e v e r a l months (Wol
p ln and R a in e s, 1964j Lang and Lazovik,—1963; Rachman, 1965*
1 9 6 6) t o a s long as two y e a rs a f t e r trea tm e n t (Paul and
21
Shannon, 1 9 6 7) have a t t e s t e d t o th e s t a b i l i t y o f Im prove
ment ,
D e s p ite t h e f a c t t h a t t h e r e I s s u b s t a n t i a l e v i d e n c e ,
f o r t h e e f f e c t i v e n e s s o f th e S y ste m a tic D e s e n s l t l z a t l o n
p r o c e d u re , d isa g re e m e n t s t i l l e x i s t s as t o w h e th e r t h e e f
f i c a c y I s c o r r e c t l y e x p la in e d by th e R e c ip r o c a l I n h i b i t i o n
1
p r i n c i p l e o r more s p e c i f i c a l l y , by th e s u p p r e s s io n o f a n x i
e t y by m u sc u la r r e l a x a t i o n . Both an im al and human s t u d i e s ;
hav e a d d re s s e d th e m se lv e s t o th e above prob lem .
1
Lomont ( 1 9 6 5) p ro v id e s th e most r e c e n t re v ie w o f
t h e l i t e r a t u r e p e r t a i n i n g t o d e c o n d itio n in g o f c o n d itio n e d
f e a r s i n a n im a ls . Out o f fo u r s t u d i e s com paring R e c ip ro c a l
I n h i b i t i o n and E x t i n c t i o n , p ro c e d u re s , o n ly one showed a
s u p e r i o r i t y f o r R e c ip r o c a l I n h i b i t i o n (v ia f e e d i n g ) . A I
l a t e r co m p ariso n i s r e p o r t e d by Gale e t a l . ( 1 9 6 6 ), who ;
fo u n d R e c ip r o c a l I n h i b i t i o n t o be s i g n i f i c a n t l y more e f
f e c t i v e th a n E x t i n c t i o n i n re d u c in g a c o n d itio n e d f e a r t o
sh o c k ,
D avison ( 1 9 6 5 ) was among th e f i r s t t o t e s t t h e im
p o r ta n c e o f t h e v a r io u s com ponents o f W olpe1s p ro c e d u re i n
f a c i l i t a t i n g a r e d u c t i o n i n human f e a r s . He fo und th e com
p l e t e R e c ip r o c a l I n h i b i t i o n p ro c e d u re t o p ro d u ce s i g n i f i
c a n t d e c re m e n ts i n sn ak e f e a r , w h ile c o n t r o l c o n d it i o n s
w ere t o t a l l y i n e f f e c t i v e . The c o n tr o l s c o n s i s t e d o f ; ( l )
r e l a x a t i o n ( " p s e u d o - d e s e n s it l z a tl o n " ) i n w hich m u sc u la r
r e l a x a t i o n was p a ir e d w ith im a g in a l s t i m u l i i r r e l e v a n t t o
22
sn a k e s ; (2) S y s te m a tic D e s e n s l t l z a t l o n w ith o u t r e l a x a t i o n
(" E x p o s u re " ); and ( 3 ) no tre a tm e n t c o n tro l., w hich r e c e iv e d
o n ly p r e - and p o s t - t r e a tm e n t c r i t e r i o n t e s t i n g . S in c e t h e
number o f h i e r a r c h y ite m s com pleted h a s b een p r e v i o u s ly
d e m o n s tra te d t o r e l a t e t o improvement and b e c a u se Ss who '
w ere r e l a x e d d u rin g v i s u a l i z a t i o n m ight be e x p e c te d t o p r o - |
ceed more r a p i d l y up th e h ie r a r c h y , D avison yoked th e num- ;
b e r o f v i s u a l i z a t i o n s p e r scene i n h i s c o n t r o l c o n d itio n s |
(E xposure and R e la x a tio n ) w ith th e number r e q u i r e d t o c r i
t e r i o n (no r e p o r t e d a n x ie ty ) i n h i s R e c ip r o c a l I n h i b i t i o n
c o n d it i o n . One o f th e consequences o f t h i s p ro c e d u re was
t h a t Ss i n t h e e x p e rim e n ta l group had th e a d v a n ta g e o f r e
c e iv in g r e p e t i t i o n s g e a re d s p e c i f i c a l l y t o t h e i r i n d i v i d u a l
r e q u ir e m e n ts w h ile Ss i n th e E xposure group may o r may n o t
have r e c e iv e d r e p e t i t i o n s w hich c o in c id e d w ith th e sc e n e s
w hich th e y p e r c e iv e d as most t h r e a t e n i n g . D a v is o n 's f i n d
in g o f a s u p e r i o r i t y o f R e c ip ro c a l I n h i b i t i o n o v e r S y s
te m a tic D e s e n s l t l z a t l o n w ith o u t r e l a x a t i o n may be p a r t i a l l y
a t t r i b u t a b l e t o t h i s f a c t o r .
Rachman (19 6 5)> whose stu d y i s s i m i l a r i n many r e
s p e c t s t o D avison.’ s , th oug h n o t as w e l l - c o n t r o l l e d , ob
t a i n e d r e s u l t s com parable t o th e l a t t e r i n v e s t i g a t o r . One
o f t h e m ost o b j e c ti o n a b le a s p e c ts o f h i s s tu d y i s t h e u se
o f o n ly t h r e e Ss p e r g ro u p .
F o lk in s e t a l . ( i n p r e s s ) com pared t h e e f f i c a c y o f
th e R e c ip ro c a l I n h i b i t i o n w ith th e s e p a r a t e com ponents,
23
R e la x a tio n and "C ognitive R ehearsal" (sy ste m a tic d e s e n s i t i - j
z a tio n w ith ou t r e la x a t io n ) i n s h o r t - c ir c u i t in g fe a r to a
subsequent s t r e s s o r . These in v e s t i g a t o r s f a i l e d to show
any s u p e r io r it y fo r com plete R ecip ro ca l I n h ib it io n when
compared w ith i t s components, and on s e v e r a l m easures found :
C o g n itiv e R ehearsal to be th e most e f f e c t i v e th r e a t red u cer,
!
The auth ors In te r p r e t t h e i r fin d in g as h i g h - lig h t in g th e
im portance o f c o g n itiv e p r o c e ss e s i n th r e a t r e d u c tio n and
s p e c u la te th a t c o g n it iv e p r e p a r a tio n i t s e l f , w ith or w ith
out r e la x a t io n , may fa v o r th e developm ent o f a p s y c h o lo g i
c a l coping mechanism, They a re, n o n e th e le s s , c a u tio u s in
g e n e r a liz in g t h e i r fin d in g s to th e treatm en t o f phobias
i
w here t h e f e a r i s g e n e r a l l y o f g r e a t e r m ag n itu d e. !
1
I n a r e c e n t d o c t o r a l d i s s e r t a t i o n , M yerhoff (19&7) I
com pared t h e e f f e c t o f d e s e n s i t i z a t i o n u n d e r a c o n d it i o n o f j
m u sc u la r t e n s i o n w ith th e same tr e a tm e n t when s u b j e c t s were
n e i t h e r r e la x e d n o r t e n s e . S u b je c ts i n t h e T e n sio n group
r e p o r t e d c o n s i s t e n t l y h ig h e r a n x ie ty th a n s u b j e c t s i n t h e
n e u t r a l c o n d it i o n d u rin g v i s u a l i z a t i o n . C o n tra ry t o
W olpe1s p r e d i c t i o n s , th e T e n sio n (h ig h a n x ie ty ) group dem
o n s t r a t e d th e g r e a t e s t r e d u c t io n i n s u b j e c t i v e f e a r and
a v o id a n c e b e h a v io r fo llo w in g t r e a tm e n t. B oth e x p e rim e n ta l
g ro u p s showed s i g n i f i c a n t Im provem ent when com pared t o a
No T re a tm e n t c o n t r o l , a f i n d in g w hich i s a ls o c o n tr a r y t o
Wolpe*-s t h e o r y . The m ajo r c r i t i c i s m w hich m ight be l e v e le d
a g a i n s t t h i s s tu d y i s t h a t i t d id n o t a d e q u a te ly c o n t r o l
f o r u n in te n d e d b i a s in g by t h e e x p e rim e n te r d u rin g t r e a t
ment., s in c e b o th g ro u p s w ere t r e a t e d by t h e a u th o r . M yer-
h o f f 's s tu d y s u b s t a n t i a t e s t h e f i n d in g s o f p r e v io u s s t u d i e s j
by W olpin and P e a r s a l l (1965) and W olpin and R a in e s (1966)
u t i l i z i n g a v e ry sm a ll number o f s u b j e c t s .
C o n tr a d ic to r y f i n d in g s a r e r e p o r t e d by Lomont and
t
l
Edwards ( 1 9 6 7) , who compared S y s te m a tic D e s e n s i t i z a t i o n witbl
m u sc u la r t e n s i o n (SD) w ith a R e c ip r o c a l I n h i b i t i o n p r o c e - |
d u re ( R I). The Lomont and Edwards s tu d y d i f f e r s from th e
s tu d y by M yerhoff i n t h a t b o th e x p e rim e n ta l g ro u p s r e c e i v e d
r e l a x a t i o n and t e n s i o n i n s t r u c t i o n s ; th e RI group r e l a x e d
im m e d ia te ly fo llo w in g each v i s u a l i z a t i o n and th e SD group
te n s e d a f t e r each p r e s e n t a t i o n . I n c o n t r a s t t o th e u s u a l
R e c ip r o c a l I n h i b i t i o n p ro c e d u re i n w hich r e l a x a t i o n i s
1
i n i t i a t e d p r i o r t o and m a in ta in e d th ro u g h o u t v i s u a l i z a t i o n ,
b o th g ro u p s i n th e Lomont and Edwards s tu d y w ere i n s t r u c t e d
t o re m a in te n s e d u rin g a c t u a l v i s u a l i z a t i o n . The c o n c lu
s i o n drawn by th e s e I n v e s t i g a t o r s , t h a t RI i s " c l e a r l y "
s u p e r i o r t o SD w ith o u t r e l a x a t i o n , seems h i g h ly d e b a t a b l e .
F i r s t , a co m parison o f p r e - and p o s t - t r e a t m e n t c r i t e r i o n
s c o r e s f a i l e d t o r e v e a l s i g n i f i c a n t im provem ent i n e i t h e r
g ro u p ; th e RI group was s u p e r i o r t o th e SD -Tension g ro up
on o n ly one o f f i v e c r i t e r i o n m easu res a t t h e .05 l e v e l o f
s i g n i f i c a n c e . Second, t h e r e was no R e c ip r o c a l I n h i b i t i o n
o f a n x ie ty d u rin g v i s u a l i z a t i o n i n e i t h e r g ro u p . The o n ly
p a i r i n g o f r e l a x a t i o n w ith f e a r e d s t i m u l i i n t h e RI group
25
w ould have had t o o c cu r a f t e r t h e Ss had b e en i n s t r u c t e d t o j
|
d i s c o n ti n u e t h e i r im ag ery . |
I n t h e o n ly i n v e s t i g a t i o n o f i t s k in d , Rachman
( 1 9 6 6 ) com pared th e R e c ip r o c a l I n h i b i t i o n p ro c e d u re ( r e
s u l t s from h i s 1965 s tu d y ) with:.! a " f lo o d in g " c o n d i t i o n d e
s ig n e d t o I n t e n s i f y f e a r r e a c t i o n s d u rin g v i s u a l i z a t i o n .
i
The f lo o d in g c o n d itio n d i f f e r e d from t h e s ta n d a r d R e c ip ro -
1
c a l I n h i b i t i o n p ro c e d u re s i n t h a t b o th r e l a x a t i o n and h i e r - i
a r c h i e s were o m itte d and d e s c r i p t i o n s w ere d e l i b e r a t e l y
made a s t e r r i f y i n g as p o s s i b l e , Rachman p r e s e n t s s t a t i s
t i c a l l y u n a n a ly z e d c u rv e s w h ich s u g g e s t t h a t th e t h r e e Ss
i n h i s R e c ip ro c a l I n h i b i t i o n c o n d i t i o n im proved w h ile th e
" f lo o d in g " group d id n o t. How ever, t h e r e s u l t s c an h a r d l y j
be c o n s id e r e d c o n c lu s iv e i n view o f h i s f a i l u r e t o c o n t r o l i
i
f o r e x p e rim e n te r and sam p lin g b i a s e s a s w e ll as t h e sm a ll
s i z e o f h i s g ro u p s.
O th e r s t u d i e s , a lth o u g h n o t a d d re s s e d p r i m a r i l y to
an e v a l u a t i o n o f th e R e c ip r o c a l I n h i b i t i o n p r i n c i p l e , have
a t l e a s t p e r i p h e r a l r e le v a n c e t o th e i s s u e . Cook ( 1 9 6 6 )
com pared th e e f f e c t i v e n e s s o f t h e u s u a l R e c ip r o c a l I n h i
b i t i o n te c h n iq u e s w ith an " i n v iv o " d e s e n s i t i z a t i o n i n
w hich th e a c t u a l f e a r s tim u lu s was u se d i n p la c e o f th e
im a g in a l r e p r e s e n t a t i o n . D e s p ite t h e f a c t t h a t t h e r e was
"much l e s s th a n com p lete r e l a x a t i o n i n t h e i n v iv o g ro u p "
and much l e s s i n t h a t g roup t h a n i n th e im a g in a l tr e a tm e n t
g ro u p , t h e r e w ere no s i g n i f i c a n t d i f f e r e n c e s i n p o s t -
26
tr e a tm e n t f e a r b etw een t h e two groups., and each showed s i g
n i f i c a n t im provem ent a s com pared w ith c o n t r o l S s. B oth
f i n d i n g s a r e d i f f i c u l t t o r e c o n c i l e w ith th e p o s i t i o n ta k e n j
by Wolpe t h a t r e l a x a t i o n 1b i n d i s p e n s a b l e t o t h e r a p e u t i c
outcom e.
C a u te la ( 1 9 6 6) em ployed a m o d if i c a t io n o f W olpe*s
}
p ro c e d u re s i n w hich he aBked p a t i e n t s t o r e p o r t t h e d l s - ;
I
a p p e a ra n c e r a t h e r th a n t h e o n s e t o f a n x ie ty d u r in g v i s u a l i - j
z a t i o n , A co nsequence o f h i s p ro c e d u re was t h a t Ss w ere
ex posed t o "d o se s" o f a n x i e t y l a s t i n g up t o f i f t e e n se co n d s
a t a tim e b e f o r e a r e i n s t a t e m e n t o f r e l a x a t i o n was u n d e r
ta k e n . D e s p ite th e h e ig h te n e d l e v e l s o f f e a r w hich pa-r
t i e n t s e x p e rie n c e d d u rin g t r e a t m e n t , im provem ent o c c u rr e d ,
and i n a p p ro x im a te ly th e same g e n e r a l p r o p o r t io n s a s r e -
j
p o r t e d by Wolpe, A gain, t h e c o n c lu s io n i s s u g g e s te d t h a t
t h e s u p p r e s s io n o f a n x ie ty i s n o t n e c e s s a r i l y i n d is p e n s a b l e
t o outcom e.
A ttem p ts t o i d e n t i f y t h e s u b j e c t v a r i a b l e s w hich
r e l a t e t o tr e a tm e n t outcom e h av e b een i n c o n c lu s iv e and,
l i k e t h e r e s t o f t h e l i t e r a t u r e on d e c o n d itio n in g , o f t e n
c o n t r a d i c t o r y , Lang (1964) and o t h e r s (Lang and L a z o v ik ,
1963; Lang, L azo v ik an d ^R ey n o ld s, 1965) r e p o r t a m o d e ra te ly
h ig h n e g a tiv e c o r r e l a t i o n b etw een g e n e r a l a n x i e t y l e v e l and
im provem ent. However, Cook ( 1 9 6 6 ) f a i l e d t o f i n d any r e
l a t i o n s h i p betw een a n x ie ty and im provem ent i n h i s d i r e c t
( i n v iv o ) g ro u p , and i n an Im a g in a l tr e a tm e n t group found
a n x ie ty l e v e l (Bendig E m o tio n a lity S c a le ) t o be p o s i t i v e l y
r e la t e d to su c c e ss i n treatm ent,, th e r e v e r se o f th e r e l a
t io n s h ip rep orted by o th e r i n v e s t i g a t o r s .
I n i t i a l ap p ro ach s c o r e (AS). haB a l s o b een c o r r e
l a t e d w ith f i n a l c r i t e r i o n s c o r e s and i n a l l c a s e s (Lang,
1964j Lang, L azovik and R e y n o ld s, 19&5J Lang and L a z o v ik ,
1963j Cook, 1 9 6 6) h a s y i e l d e d n o n - s i g n i f i c a n t and o f t e n low
n e g a tiv e r e l a t i o n s h i p s ,
W olpin and R a in e s ( 1 9 6 6) and L a z a ru s (1963) have
s p e c u la te d on th e b a s i s o f c a s e s t u d i e s t h a t I n t r o v e r s i o n
(M audsley P e r s o n a l it y I n v e n to r y ) may be a f a v o r a b l e p r o g
n o s t i c i n d i c a t o r i n t r e a t m e n t , A l a t e r s tu d y (L a z a ru s ,
1 9 6 5) h a s f a i l e d t o s u b s t a n t i a t e t h i s o b s e r v a tio n .
W olpin and R a in e s have a l s o s u g g e s te d t h a t t h e
a b i l i t y t o p r o f i t from t r e a tm e n t may, a t l e a s t i n p a r t , be
a f u n c t i o n o f co m p lian ce and s u g g e s t a b l l l t y , b u t i n th e
o n ly s tu d y w hich m easured s u g g e s t a b i l i t y (Lang, L az o v ik and
R e y n o ld s, 1 9 6 5), th e presum ed r e l a t i o n s h i p was n o t b o rn e
o u t .
The Theory and S tu d ie s
o f Im p lo siv e Therapy
S ta m p fl’s Im p lo s iv e T h era p y (S ta m p fl and L e v is ,
1 9 6 7) , a s i s W olpe1s R e c ip r o c a l I n h i b i t i o n T h era p y , 1b
fo rm u la te d w ith in a l e a r n i n g th e o r y c o n te x t and a l s o a d v o
c a t e s a d i r e c t a t t a c k on symptoms th ro u g h sym bolic r e
h e a r s a l s , However, th e f l a v o r o f Im p lo s iv e T h erap y , when
d e s c r i b e d i n S t a m p f l ^ lan g u ag e, d i f f e r s m ark ed ly from th e
s t e r e o t y p e w hich h as sprung up a ro u n d i t . S ta m p fl s e e s h i s
m ain c o n t r i b u t i o n a s th e developm ent o f an a p p ro a c h w hich
" i n c o r p o r a te s fo rm u la tio n s i n h e r e n t t o dynam ic sy stem s of
t r e a tm e n t r e t r a n s l a t e d and r e a p p l i e d i n te rm s of l e a r n in g
p r i n c i p l e s [ p . 4973 ."
S ta m p fl a s s e r t s t h a t , i n g e n e r a l , t h e d e fe n s iv e
m aneuvers and symptoms o f th e p a t i e n t r e s u l t from h i s a t
te m p ts t o a v o id o r te rm in a te i n t e r n a l s t i m u l i (im a g ery ,
t h o u g h ts , im p u ls e s ) which f u n c t i o n m a in ly as I n t e r n a l d a n
g e r s i g n a l s , S tam p fl s p e c u la te s t h a t t h e p a s t h i s t o r y o f
th e p a t i e n t h a s in v o lv e d numerous c o n d it i o n in g e x p e r ie n c e s
where p a in h a s been a s s o c ia te d w ith I n i t i a l l y n e u t r a l s tim
u l i . T hese e x p e rie n c e s a re r e p r e s e n t e d a s m em ories o r a s
s o c i a t i o n s , and, a lth o u g h th e I d e a t i o n a l r e p r e s e n t a t i o n o f
th e e x p e r ie n c e s may sometimes b e i n h i b i t e d by a n x ie ty ( r e
p r e s s i o n ) , any a c t i o n o r mechanism w hich e n a b le s th e p a
t i e n t t o a v o id th e a n x ie ty w hich w ould en su e on t h e e l i c i
t a t i o n o f th e memory o r a s s o c i a t i o n w i l l be le a r n e d and
m a in ta in e d on th e b a s i s o f a n x ie ty r e d u c t i o n . S ta m p fl a r
g u e s f u r t h e r t h a t th e phobic o b j e c t o r a g g re sB iv e im p u lse
( i n t e r n a l s t i m u l a ti o n ) i s not a v o id e d b e c a u s e i t h a s b een
a s s o c i a t e d w ith p a in , b u t r a t h e r b e c a u s e o f i t s p o t e n t i a l i
t y f o r r e a c t i v a t i o n o f th e a n x ie ty - a r o u s i n g d an g ero u s a s
s o c i a t i o n s o r m em ories.
29
Stam pfl contends th a t m u ltip le p a tte r n s o f c o n d i
tio n e d s t im u li become ordered s e q u e n t ia lly i n term s o f
a v e r s iv e n e s s , and th a t th e most a n x ie ty -p r o d u c in g p a tte r n s j
( o r ig in a l memories) p e r s i s t e n t l y m a in ta in t h e i r a v e r s iv e
p o t e n t i a l because th e y are c o m p lete ly avoid ed and p r o te c te d
from exposure by th e preced in g p a tte r n s i n th e s e r i a l ,
i
L e v is (1965) rep o rts an in g e n io u s s e r i e s o f e x p e r l-;
1
ments by Stam pfl and h im se lf to dem onstrate th e p o ten cy o f i
th e s e q u e n t ia l ord erin g o f avoidance c u e s. In one t y p i c a l
experim en t, an avoidance c o n d itio n in g paradigm was s e t up
i n which anim als were p laced in a b la c k box and shocked i f
th e y d id n ot escape in t o a w h ite box i n e ig h te e n seco n d s.
During th e e ig h te e n second p erio d i n th e shock box a g a te
1
was r a is e d , fo llo w e d by s i x seconds o f s i l e n c e , fo llo w e d by!
s i x seconds o f f la s h in g l i g h t s , fo llo w e d by s i x secon ds o f
bu zzer sound. Animals learn ed to escap e a f t e r about th r e e
shock t r i a l s ad m in istered at th e end o f th e e ig h te e n -se c o n d
p e r io d . Although no fu r th e r shock t r i a l s were a d m in iste r e d
th e average number o f t r i a l s r eq u ire d t o e x tin g u is h th e
running resp o n se during th e f i r s t s ix - s e c o n d p e r io d v a r ie d
betw een two and th r e e hundred. However, an a d d it io n a l 500
to 600 t r i a l s were needed to e x tin g u is h th e avoidan ce r e
sponse to th e fla s h in g l i g h t s , and a t 100 t r i a l s per day,
most anim als had not made one resp o n se o f two m inutes l a
te n c y i n over 1 ,0 0 0 t r i a l s . I n t e r e s t i n g l y , th e b e s t e v i
dence fo r Wolpe*s c a u tio n s regard in g th e e f f e c t o f s e n s i -
t l z a t i o n may be found in th e se s t u d ie s by L e v is and Stam pfl,
who rep o rted th a t th e f i r s t exposure o f t h e i r s u b je c ts to j
an a n x ie ty stim u lu s tem p orally c lo s e r t o th e p r e v io u s shock
"recharged" th e avoidance resp o n ses t o p r e v io u s ly e x t i n
g u ish ed and tem p o ra lly more remote s t i m u l i , and r e i n i t i a t e d
sh ort la te n c y avoidance r esp o n se s.
i
Stam pfl d iv id e s th e H ypothesized A voidance S e r ia l
Cue H ierarchy o f p a te n ts in to two c a t e g o r i e s . The Symptom :
C ontingent Cues are th e s it u a t io n a l and en viron m en tal cues
h ig h ly c o r r e la te d w ith th e occu rren ce o f th e p a t i e n t ' s
symptoms, and o r d in a r ily r e p o r ta b le by him. The Hypothe
s iz e d S e q u e n tia l Cues are o r d in a r ily I n t e r n a l, more a v e r -
s iv e and not i n i t i a l l y a c c e s s ib le to th e p a t i e n t . Stam pfl
I
l i s t s th e t e n u su a l areas which in c o r p o r a te such cu es as j
A g g ressio n , Punishment, O ral, Anal, S e x u a l, R e je c tio n ,
B o d ily In ju r y , Loss o f C ontrol, and A cceptance o f Con
s c ie n c e .
On t h e b a s i s o f i n te r v ie w m a t e r i a l (and p resu m ab ly
know ledge o f th e g e n e r a l s o c i a l c o n te x ts i n w hich a n x ie ty
d e v e lo p s ) t h e t h e r a p i s t c o n s t r u c t s a h i e r a r c h y o f sc e n e s
w hich c o n ta in th e H y p o th e size d S e q u e n tia l Cues (S ta m p fl and
L e v is , 1 9 6 7) . He p r e s e n t s th e s e sc e n e s i n a d ra m a tic man
n e r t o th e p a t i e n t w ith i n s t r u c t i o n s t o " p la y a c t , . . .
l o s e h im s e lf i n th e p a r t . . , and l i v e t h e sc e n e s w ith
g e n u in e em o tio n and e f f e c t [p . 5 0 0 ] ," The t h e r a p i s t u s e s
s ig n s o f I n t e n s e a n x ie ty ( p h y s i o l o g ic a l o r b e h a v i o r a l )
31
d u r in g p r e s e n t a t i o n s a s e v id e n c e t h a t th e cues b e in g p r e
s e n te d have in d e e d had a n x ie ty c o n d itio n e d t o them p r e
v i o u s l y . O r d i n a r i l y t h e sc e n e s c o n ta in in g t h e Symptom
i
C o n tin g e n t Cues a r e p r e s e n t e d f i r s t , a lth o u g h some o v e rla p
o c c u r s .
A lthough W olpe*s th e o r y seems to p la c e more empha-
i
s i s on th e Symptom C o n tin g e n t Cues th a n does S t a m p f l 's , i t
i
i s a p p a re n t from r e a d in g h i s c a se m a t e r i a l t h a t Wolpe i s
I
n o t unaw are o f th e im p o rta n c e o f i n t e r n a l and sy m b o lic c o n
d i t i o n e d f e a r s t i m u l i . W eitzman ( 1967) i s more e x p l i c i t
t h a n Wolpe i n th e u s e o f t h e r e l a x a t i o n te c h n iq u e t o re d u c e
t h e a n x ie ty a s s o c i a t e d w ith sym bolic s t i m u l i .
S tam p fl (S ta m p fl and L e v is , 1967) d i f f e r s m ost from
Wolpe i n h i s a s s e r t i o n t h a t "a s u f f i c i e n t c o n d i t i o n f o r t h e
1
e x t i n c t i o n o f a n x i e t y i s t o r e p r e s e n t , r e i n s t a t e , o r sym
b o l i c a l l y re p ro d u c e t h e s t i m u l i (cu e s) t o w hich t h e a n x i e t y
re s p o n s e h a s been c o n d itio n e d i n th e absence o f p rim a ry r e
in fo rc e m e n t [ p . 4 9 9 ] ." I n c o n t r a s t t o Wolpe, S ta m p fl a d
v i s e s t h a t a t each s t a g e o f th e p ro c e s s , th e t h e r a p i s t
a tte m p t t o a t t a i n a m axim al l e v e l o f a n x ie ty e v o c a tio n , and
t h a t " th e g r e a t e r t h e a n x ie ty e l i c i t e d , th e g r e a t e r t h e
r e a s o n f o r c o n tin u in g t h e p r e s e n t a t i o n [ p . 4 9 9 ] ." When a
h ig h l e v e l o f a n x i e t y i s a c h ie v e d , th e p a t i e n t i s h e ld on
t h i s l e v e l u n t i l some s ig n s o f sp o n tan eo u s r e d u c t i o n (e x
t i n c t i o n ) o c c u r. New v a r i a t i o n s a re th e n I n tr o d u c e d t o
32
r e - a r o u s e f e a r , and t h e p r o c e s s 1 b r e p e a te d u n t i l s i g n i f i
c a n t d im in u tio n o f a n x ie ty i s a t t a i n e d . .
S in c e S ta m p fl i n te n d s t o a ro u s e maximal f e a r , i t i s !
i
n o t c l e a r why he a d v o c a te s a h l e r a r c h a l p r e s e n t a t i o n o f
ite m s : "S cen es a r e p r e s e n t e d from l e a s t t o most f e a r e d i n
te rm s o f t h e H y p o th e siz e d ASCH [ p . 5 0 2 ] ." E x tin g u is h in g
i
th e h i g h e s t a v e r s i v e s t i m u l i i n t h e h i e r a r c h y s h o u ld evoke :
i
th e m ost f e a r , and, a c c o rd in g t o S tam p fl* s p o s i t i o n , he t h e j
most e f f e c t i v e p ro c e d u r e . S ta m p fl c la im s t h a t t h e h i e r a r -
c h a l p r e s e n t a t i o n makes t h e n e x t s e t o f cues "more a c c e s
s i b l e . " I t 1 b n o t c l e a r f o r th e c o n te x t w h e th er a c c e s s i b l e
may be i n t e r p r e t e d a s r e f e r r i n g t o more a c c u r a t e l y r e p o r t -
a b le by t h e p a t i e n t , o r more am enable t o t r e a tm e n t. How-
f
e v e r , S ta m p fl a l s o a rg u e s t h a t com p lete a c c u ra c y o f th e
HSC i s n o t e s s e n t i a l . He o f f e r s no p a r t i c u l a r l y c o g e n t
t h e o r e t i c a l j u s t i f i c a t i o n f o r th e r o l e o f th e h i e r a r c h y i n
h i s tr e a tm e n t p r o c e d u re , 'The h l e r a r c h a l p r e s e n t a t i o n may
f u n c t i o n Sim ply a s a p r a c t i c a l d e v ic e t o keep p a t i e n t s from
d e v e lo p in g an i n i t i a l s tr o n g a v o id a n ce re s p o n s e t o th e
th e r a p y s i t u a t i o n .
A number o f s t u d i e s have e x p lo re d th e e f f e c t i v e n e s s
o f Im p lo s iv e T h e ra p y . Hogan (1966) t r e a t e d t w e n ty - s ix e x
p e r im e n ta l and tw e n ty - f o u r c o n t r o l N e u r o p s y c h la trlc p a
t i e n t s , e q u a te d f o r i n i t i a l d is tu r b a n c e on th e MMPI, by
Im p lo s iv e and t r a d i t i o n a l m ethods o f p sy c h o th e ra p y , r e
s p e c t i v e l y . E v a lu a tio n s a f t e r s h o r t - t e r m (f o u r m onths)
33
trea tm en t and upon one y ea r fo llo w -u p showed s i g n i f i c a n t
improvement o f e x p erim en ta l Ss in terms o f f i v e M M PI s c a l e s
and number o f r e l e a s e s from th e s t a t e h o s p it a l s e t t l n g j im
provement i n th e c o n tr o l group was dem onstrated on o n ly one
M M PI s c a l e .
Hogan and K ir c h n e r ( 1 9 6 7) r e p o r te d t h a t f o u r t e e n
o u t o f tw e n ty -o n e r a t p h o b ic s u b j e c t s t r e a t e d by im p lo s iv e
te c h n iq u e s as opposed t o o n ly two o u t o f tw e n ty -tw o c o n t r o l
Ss who l i s t e n e d t o s o o th in g m u sic, p ic k e d up a r a t f o l lo w
in g one tr e a tm e n t s e s s i o n ,
K irchner and Hogan ( 1 9 6 6) t e s t e d th e h y p o th e s is
th a t i t i s p r im a r ily th e p s y c h o lo g ic a l exp erien ce th a t th e '
c l i e n t undergoes and not h i s r e la t io n s h ip w ith th e t h e r a
p i s t , th a t most in f lu e n c e s h i s su c c e ss i n tr e a tm en t. S ix
te e n exp erim en tal Ss r e c e iv e d one treatm ent s e s s io n in
in d iv id u a l booths i n which taped m a ter ia l d esig n ed to e l i c
i t h ig h l e v e l s o f a n x ie ty was p r e sen ted . S in ce th e Ss were
stu d en t v o lu n te e r s , th e more o b je c tio n a b le ( i . e . , th e dy
n a m ic a lly d e r iv e d ) m a te r ia l had to be d e le te d from th e
Im p lo siv e p r e s e n t a t io n s . P o st-trea tm en t com parison o f ap
proach b eh a v io r i n th e Im ploBive group w ith a c o n tr o l group
which sp en t th e hour l i s t e n i n g to s o f t music y ie ld e d a c h i
square s i g n i f i c a n t at th e .03 l e v e l o f c o n fid e n c e , i n d i c a t
in g th a t improvement i s r e l a t i v e l y Independent o f th e t h e r
a p e u tic r e l a t io n s h ip .
L e v is and Carrera ( 1 9 6 7 ) compared th e e f f e c t iv e n e s s
of an average o f te n hours o f Im p lo siv e Therapy w ith th ree
c o n tro l c o n d it io n s , corresp on d in g t o ten -h ou r t r a d it io n a l
psychotherapy, lo n g -term (average o f t h ir t y -s e v e n s e s s io n s )
t r a d it io n a l p sych otherap y and no tre a tm en t. Using ten
s e v e r e ly d is tu r b e d p sy c h o n e u r o tic s per group and th e M M PI
as a c r i t e r i o n f o r Improvement, th e y found s u b s ta n tia l
(though g e n e r a lly n o n s ig n if ic a n t ) improvement in th e Im
p lo s iv e group as compared w ith th e c o n tr o l groups. The
authors I n t e r p r e t t h e i r f in d in g s as p rovid in g support fo r
the c o n te n tio n th a t th e e f f e c t i v e n e s s o f Im p losive Therapy
i s not due t o th e number o f th era p y s e s s io n s , to the s k i l l s
or p e r so n a l q u a l i t i e s o f th e t h e r a p i s t , to the term in ation
of treatm en t or to e f f e c t s r e s u l t i n g from the commitment to
and e x p e c ta tio n o f p r o f e s s io n a l tr e a tm en t.
S u p p re s s io n and A u g m en tatio n o f A n xiety
P re v io u s s t u d i e s s u g g e s t sim p le and d epend able t e c h
n iq u e s by w hich t h e l e v e l o f a n x ie ty d u rin g v i s u a l i z a t i o n
may be m o d ifie d . The m ethod m ost f r e q u e n t l y used to sup
p r e s s a n x i e t y d u rin g tr e a tm e n t i s t h e m u scu lar r e l a x a t i o n
te c h n iq u e d e v e lo p e d by Ja c o b so n (1 9 3 8 ). I t i s W olpe's con
t e n t i o n t h a t a n x ie ty i s p h y s i o l o g i c a l l y im p o s s ib le when th e
organism i s i n a s t a t e o f deep m u scle r e l a x a t i o n . The
" p e r l p h e r a l i s t " a ssu m p tio n t h a t a n x i e t y n e v e r o c c u rs i n th e
absence o f ( a f f e r e n t ) p r o p r i o c e p t i v e feed b ao k from th e
35
s k e l e t a l m u sc u la tu re h a s b een s e r i o u s l y c h a lle n g e d by Da
v is o n ( 1 9 6 5). N e v e r t h e l e s s , t h e c o n s i s t e n c y o f th e f i n d
in g t h a t m uscle r e l a x a t i o n re d u c e s s u b j e c t i v e f e a r d u rin g
v i s u a l i z a t i o n (Wolpe, 1958; Lang and L a z o v ik , 1 9 6 3) su g
g e s t s i t t o be a h i g h l y f e a s i b l e te c h n iq u e f o r re d u c in g
a n x ie ty d u rin g t r e a t m e n t .
T here a re b o th t h e o r e t i c a l and e m p ir ic a l c o n s id e r a
t i o n s w hich su p p o rt t h e c h o ic e o f s e l f - i n d u c e d m u sc u la r
t e n s io n as a c o n d it i o n t o f a c i l i t a t e a n x i e t y . Wolpe ( 1 9 5 8)
p o i n ts o ut t h a t m u s c u la r t e n s i o n alw ay s accom panies f e a r
and a n x ie ty . A lth o u g h t h e c o n v e rse ( t h a t a n x ie ty o r f e a r
alw ays accom panies m u s c u la r t e n s i o n ) need n o t n e c e s s a r i l y
be t r u e , i t seems l i k e l y t h a t i f t e n s i o n and a n x ie ty c o
o c c u r as u b i q u i t o u s l y a s Wolpe clalm B , a n x ie ty would become
a re s p o n s e c o n d itio n e d t o th e s t i m u l i p ro d u ced by m u scu lar
t e n s i o n . Such c o n d i t i o n i n g would be e s p e c i a l l y p ro b a b le
among th o s e i n whom t h e r e i s l i k e l y t o be a h ig h fre q u e n c y
of c o n tig u o u s o c c u r r e n c e s o f t e n s i o n and a n x ie ty , such as
n e u r o t i c i n d i v i d u a l s .
S tu d ie s by W olpin ( 1 9 6 6 ) and W olpin and M yerhoff
( 1 9 6 6) p ro v id e e m p i r ic a l s u p p o rt f o r th e c o n c lu s io n t h a t
m u sc u la r t e n s io n i n human s u b j e c t s I n c r e a s e s th e a n x ie ty
w hich i s e x p e rie n c e d w h ile im a g in in g s c e n e s . I n th e s tu d y
by W olpin, nonphoblc v o l u n t e e r s u b j e c t s w ere a sk ed t o im
a g in e e ig h t d i f f e r e n t s c e n e s u n d e r t h r e e s e t s o f e x p e r i
m en tal c o n d itio n s : R e la x a t i o n , M u scu lar T e n s io n , and Normal
S ta te . In order to in d u ce a s t a t e o f m uscular te n s io n , Ss
were in s tr u c t e d to t e n s e up s p e c i f i c m uscle groups which
were h ig h ly v i s i b l e t o E during th e t r i a l s . The procedure
in v o lv ed havin g Ss c le n c h t h e i r f i s t s , l i f t t o e s but not
h e e ls in th e a i r , b e e t l e th e brows, c le n c h th e t e e t h , and
squeeze e y es sh u t. I t was found th a t f e a r was s i g n i f i c a n t
l y g r e a te r (p. < .0 1 ) under T en sion than under R ela x a tio n
and s i g n i f i c a n t l y g r e a t e r ( p . < .0 5 ) under T en sion than un
der N atu ral c o n d itio n s .
W olpin and M yerho ff (19 6 6 ) u t i l i z e d t h e same o p e ra
t i o n s as W olpin (1966) t o in d u c e t e n s i o n i n p h o b ic s u b j e c t s .
They com pared r a t i n g s o f f e a r from s u b j e c t s who v i s u a l i z e d
f e a r -e v o k in g sc e n e s w h ile i n a s t a t e o f m u sc u la r t e n s io n
w ith r a t i n g s from s u b j e c t s v i s u a l i z i n g th e same sc e n e s i n
a n a t u r a l s t a t e . The r e s u l t s w ere c o n s i s t e n t w ith W olpin1s
i n d e m o n s tra tin g s i g n i f i c a n t l y g r e a t e r f e a r u n d e r c o n d i
t i o n s o f t e n s i o n t h a n u n d e r n a t u r a l c o n d i t i o n s .
The c h o ic e o f m uscular t e n s io n as an a n x ie ty -
f a c i l i t a t i n g c o n d itio n i s p a r t i a l l y d ic t a t e d by th e d e c i
sio n to u se m uscular r e la x a t io n as a means o f red ucin g
a n x ie ty . Muscular t e n s io n i s to be favored over o th er con
c e iv a b ly more e f f e c t i v e means o f a ro u sin g a n x ie ty which
would m odify a n x ie ty l e v e l by a c e n tr a l r a th e r than p e r i
pheral or s k e le ta l-m u s c u la r mechanism.
The R e p r e s s i o n - S e n s l t i z a t i o n D im ension
The R e p r e s s l o n - S e n s i t i z a t i o n d im e n sio n h a s b e en r e
l a t e d t o d i f f e r e n t i a l r e c o g n i t i o n t h r e s h o l d s f o r e m o tio n
a l l y to n e d v e rs u s n e u t r a l s tim u lu s m a t e r i a l (L az aru s e t a l .,,
1 9 5 1) s p o s i t i v e l y r e l a t e d t o d e v ia n t r e s p o n s e s on a d j e c t i v e
check l i s t s (Byrne, 1 9 6 1) , t o d i f f e r e n t i a l r e c a l l o f s u c
c e s s v e rs u s f a i l u r e (E ric k s o n , 1952) and t o d i f f e r e n t i a l
d e fe n s e mechanism p r e f e r e n c e s on t h e B lack y D efense P r e f
e re n c e I n q u ir y . S e v e ra l i n v e s t i g a t o r s have s u p p o rte d th e
c l i n i c a l n o tio n t h a t R e p r e s s o r s , l i k e h y s t e r i c s , u se a v o id
ance mechanisms i n co p in g w ith a n x i e t y , w h ile S e n s i t i z e r s ,
l i k e p s y c h a s th e n ic n e u r o t i c s , a tte m p t t o re d u c e a n x ie ty by
c o n f r o n tin g and ru m in a tin g on t h e s o u rc e o f c o n f l i c t .
Byrne (1964), whose R-S s c a l e i s d e r i v e d from t h e MMPI,
s t a t e s :
At th e r e p r e s s io n end o f t h i s con tinuum of d e f e n s iv e
b e h a v io rs a re th o s e r e s p o n s e s w hich In v o lv e a v o id a n c e
o f th e a n x ie ty - a r o u s in g s t i m u l u s and i t s c o n s e q u e n ts .
In c lu d e d h e r e a r e r e p r e s s i o n , d e n i a l , and many ty p e s o f
r a t i o n a l i z a t i o n . At t h e s e n s i t i z i n g extrem e of t h e
continuum a re b e h a v io r s w h ich I n v o lv e an a tte m p t t o r e
duce a n x ie ty by a p p ro a c h in g o r c o n t r o l l i n g t h e s tim u lu s
and i t s c o n se q u e n ts. The l a t t e r m echanism s i n c l u d e i n -
t e l l e c t u a l i z a t l o n , o b s e s s iv e - c o m p u ls iv e b e h a v io r s , and
ru m in a tiv e w o rry in g [ p . 1 6 9 ].
Spelsm an e t a l . (1964) and L a z a ru s and A l f e r t (1964)
have d e m o n stra te d t h a t t h e e f f e c t i v e n e s s o f v a r io u s o p e r a
t i o n s d e sig n e d to re d u c e e x p e r im e n ta lly - in d u c e d t h r e a t i s
a f u n c t i o n o f c o m p a t i b i l i t y o f " tr e a tm e n t" w ith t h e d e fe n
s i v e p r e d i s p o s i t i o n s o f t h e s u b j e c t s . I t was fo u n d t h a t
d e f e n s iv e com m unications c o n s i s t i n g o f d e n i a l s ta te m e n ts
w ere more s u c c e s s f u l when used w ith Ss o r i e n t e d p r i m a r i l y
to w a rd d e n i a l , w h ile Ss d is p o s e d more t o i n t e l l e c t u a l i z a -
t i o n d e r iv e d th e g r e a t e s t b e n e f i t from d e f e n s iv e communi
c a t i o n s b a se d on l n t e l l e c t u a l i z a t i o n s .
A nother s tu d y w hich i n v e s t i g a t e d th e r e l a t i o n s h i p
b e tw een a n x ie ty - r e d u c in g te c h n iq u e s and d e f e n s iv e p r e d i s
p o s i t i o n i s t h a t o f P io ro w sk l ( 1 9 6 7 ) . U sing t h e R-S S c a le
d e r iv e d by Byrne ( 1 9 6 1) and a s t r e s s f u l f i l m t o a ro u s e
a n x ie ty , P io ro w sk l t e s t e d th e h y p o t h e s is t h a t R e p re s s o rs
w i l l show l e s s d is tu r b a n c e fo llo w in g e x p o su re t o a d i s
t r a c t i o n " tr e a tm e n t" th a n c a t h a r s i s o r r a t i o n a l i z a t i o n and
c o n v e r s e ly , t h a t S e n s i t i z e r s w i l l d e r i v e g r e a t e r b e n e f i t
from tr e a tm e n ts b a se d on r a t i o n a l i z a t i o n and c a t h a r s i s th a n
a t r e a tm e n t b a sed on d i s t r a c t i o n . W hile t h e r e l a t i o n s h i p
was n o t s i g n i f i c a n t , th e d i r e c t i o n a l i t y o f t h e r e s u l t s was
c o n s i s t e n t w ith t h e h y p o th e s is and t h e f i n d i n g s o f p re v io u s
s t u d i e s by Spelsm an e t a l . (1964) and L a z a ru s and A l f e r t
(1 9 6 4 ).
A p o t e n t i a l problem i n s tu d y in g R-S i n c o n n e c tio n
w ith d e c o n d itio n in g i s t h e r e s t r i c t i o n I n ra n g e o f s c o r e s
w hich m ight m a n ife s t i t s e l f i n a p o p u l a t i o n o f p h o b ic S s.
An i s s u e w hich has r e c e iv e d c o n s i d e r a b le a t t e n t i o n a s w e ll
a s one w hich i s r e l e v a n t t o t h e e x p e c te d d i s t r i b u t i o n o f
R-S s c o r e s w ith in a p h o b ic p o p u l a t i o n i n v o lv e s t h e r e l a t i o n - ,
s h ip o f R e p r e s s i o n - S e n s l t l z a t l o n t o m ea su re s o f a d ju s tm e n t.
39
One o f th e most c o n s i s t e n t f i n d i n g s i s t h a t R e p re s
s o r s o b t a i n c o n s i s t e n t l y h i g h e r s c o r e s on s e l f - r e p o r t a d
ju s tm e n t s c a l e s th a n B e n s i t i z e r s . B yrne ( 1 9 6 5 ) , u s in g th e
C a l i f o r n i a P s y c h o lo g ic a l I n v e n to r y a s a m easure o f a d j u s t
m ent, foun d t h a t a p p ro x im a te ly h a l f t h e CPI s c a l e s y i e l d e d
s i g n i f i c a n t , n e g a tiv e c o r r e l a t i o n s w ith th e R-S s c a l e 1 and
t h a t R e p re s s o rs ap p ea re d t o be th e b e s t a d ju s te d , S e n s i
t i z e r s t h e m ost m a la d ju s te d , w h ile N e u t r a l s f e l l b etw een
t h e two g ro u p s . S im ila r f i n d i n g s a r e r e p o r t e d w ith a d j u s t
ment m easured by a t t i t u d e q u e s t i o n n a i r e s and t h e In c o m p le te
S e n te n c e B lank (Tempone and Lamb, 1 9 6 7 )^ by s e l f - i d e a l d i s
c re p a n c y (Byrne e t a l . , 1 9 6 3 )* and s u b j e c t i v e r e p o r t s o f
a n x i e t y (B yrne, 1 9 6 4 ). The m ost o b v io u s o b j e c t i o n s t o such
s t u d i e s have b een t h a t R e p re s s o r s by d e f i n i t i o n deny emo
t i o n a l d is tu r b a n c e and so w i l l p r e s e n t th e m s e lv e s more
f a v o r a b l y when q u e s tio n e d on e m o tio n a l a d ju s tm e n t.
The-problem s surrounding th e i n t e r p r e t a t io n o f s e l f -
rep o rt adjustm ent sc o re s are h ig h lig h t e d by Peder (1 9 6 7 ).
T h is in v e s t i g a t o r c o r r e la te d sc o r e s on th e R-S s c a l e w ith
adjustm ent on th e C ornell Index, as w e l l as w ith s t a t u s as
m e d ic a l-s u r g ic a l versu s n e u r o p s y c h ia tr ic p a t i e n t . Taken as
a whole th e r e was a c le a r p o s i t i v e r e l a t i o n betw een R-S and
adjustm ent on both c r i t e r i a . However, when th e R ep ressors
were an alyzed s e p a r a te ly , p s y c h ia t r ic and m ed ical p a t ie n t s
^Hlgh Bcores on the R-S sc a le in d ica te s e n s it iz a
tio n .
40
were indistinguishable. Clearly, the defensive set of Re
pressors must be taken into account in interpreting meas
ures of adjustment.
An alternative conception of Repression-Sensitiza-
tion scores is that they are curvilinearly related to ad
justment. The Interpretation seems to make sense if one
conceives of extreme scores as representing inordinate
amounts of defensiveness. That is, Individuals scoring at
the extremes on the R-S scale would be equally maladjusted,
but utilizing different defense mechanisms, while individu
als scoring in the middle of the scale would be "well ad
justed." Support for this position is given by Lomont
( 1965b ) , who asserts that, although Repressors report less
anxiety, they are actually more "anxiety prone" when as
sessed by non self-report measures. Using thirty-five
neuropsychiatric patients, Lomont found a moderately high
negative correlation between R-S and signs of disturbance
on a word association test (this, in contrast to the high
positive correlation between R-S and self-report anxiety).
Lomont bases his argument further on the clinical obser
vation that Repressors react with more anxiety than Sensi
tizers when confronted in interviews or therapy with dis
turbing material, and on the behavior theory deduction that
Repressors, being avolders, have less opportunity to be
extinguished to conditioned fear stimuli.
4 l
Kaplan ( 1 9 6 7) Investigated the accuracy of Repres
sor, Sensitizer, and Neutral Judges in predicting the ad
jective check list responses of a neutral target on the
basis of both minimal and maximal information. While the
accuracy of Neutral judges Increased with added informa
tion, Repressor and Sensitizer accuracy decreased. If one
aspect of adjustment is the ability to make flexible use of
stereotypes in conjunction with situational determinants,
then it may be concluded that both Repressors and Sensi
tizers are less adjusted than Neutrals.
Further support may be found from Ullman ( 1 9 6 2) ,
who found significantly larger variances on R-S (both di
rections) and on his related inhibition-facilitatlon scale
in a neuropsychlatrlc population than in a college popula
tion.
However, even if the most accurate description of
the relationship between R-S and adjustment is curvilinear
and if it is true, as Lomont ( 1965b ) suggests that Repres
sors are in fact equally or more anxiety prone than Sensi
tizers, the question remains whether RepressorB can be
expected to admit to phobic symptoms as frequently as Sen
sitizers, thus providing a range of scores large enough to
study the variable in connection with treatment outcome.
A number of considerations suggest that Repressors will, in
fact, report phoblaB. First, the range of scores on a
number of variables (MAS, Extroversion, Suggestabllity) has
n o t b een c o n s t r i c t e d In p r e v io u s s t u d i e s , i n d i c a t i n g a good
d e a l o f v a r i a b i l i t y i n p e r s o n a l i t y a t t r i b u t e s o f p h o b ic
s u b j e c t s . S eco n d ly , th e p h o b ia s a s s o c i a t e d w ith sm a ll a n i
m als and sn a k es a re r a t h e r p r e v a l e n t among c o l l e g e fem a le s
(Lang and L azo v ik , 1963) and p r o b a b ly a re n o t r e l a t e d as
l d i o s y n c r a t i c a l l y t o s p e c i f i c p e r s o n a l i t y t r a i t s a s o th e r
a n x i e t i e s . T h ird , th e s o c i a l a c c e p t a b i l i t y o f an im al pho
b i a s among fem a le s i s su ch t h a t d e fe n s iv e d e n i a l may be
l e s s f r e q u e n t . F o u rth , a s tu d y by Merkaum and B adia (19&7)
r e v e a l s a c u r v i l i n e a r t r e n d i n sh o ck a v o id a n c e i n r e l a t i o n
to R-S s c o re s i n fe m a le s , i n d i c a t i n g t h a t b o th (fe m a le ) Re
p r e s s o r s and S e n s i t i z e r s te n d t o a v o id n o x io u s s t i m u l a t i o n
as com pared w ith Ss s c o r in g i n t h e m id d le r a n g e . F i n a l l y ,
th e o b s e r v a tio n o f b e h a v io r t h e r a p i s t s e n g a g in g t h e System
a t i c D e s e n s i t i z a t i o n te c h n iq u e w ith an im al p h o b ic fem a le s
h a s b een t h a t s i z a b l e p r o p o r t i o n o f t h e i r Ss f i t t h e g e n
e r a l d e s c r i p t i o n o f R e p re s s o rs (W olpin, 1 9 6 8 ) .
The m ost r e c e n t and th o ro u g h a sse ss m e n t o f t h e r e
l i a b i l i t y o f t h e R-S s c a l e i s r e p o r t e d i n B yrne e t a l . ,
1 9 6 3 . Byrne c o n d u cted an ite m a n a l y s i s o f t h e o r i g i n a l
R-S s c a l e . He d iv id e d i n t o two p a r t s a g ro u p o f 7^0 s t u
d e n ts who w ere drawn from th e i n t r o d u c t o r y p sy c h o lo g y
c o u rs e a t th e U n iv e r s ity o f T exas o v e r a tw o - y e a r p e r io d
and who had b e en g iv e n t h e R-S s c a l e as a p a r t o f v a r io u s
r e s e a r c h p r o j e c t s , and r a n b l s e r i a l c o r r e l a t i o n s betw een
i n d i v i d u a l r e s p o n s e s and t o t a l R-S s c o r e s . Ite m s y i e l d i n g
43
c o r r e l a t i o n s s i g n i f i c a n t bey ond t h e ,001 l e v e l i n b o th
gro u p s w ere a d m in is te re d t o a new group o f 134 Ss e n r o l l e d
i n a sophomore c o u rse i n a d ju s tm e n t. The c o r r e c t e d s p l i t
h a l f r e l i a b i l i t y c o e f f i c i e n t o f i n t e r n a l c o n s is te n c y was
,9 4 , F o r s e v e n ty -e ig h t Ss i n t h e group who w ere a v a i l a b l e
f o r a r e t e s t t h r e e months l a t e r t h e c o e f f i c i e n t o f s t a b i l i
t y was .8 2 . Byrne a ls o r e p o r ts , an u n p u b lis h e d v a l i d i t y
stu d y by Tempone who a d m in is te r e d th e R-S s c a l e t o n in e
s t a f f members and I n t e r n s a t a M en tal H e a lth c e n t e r , a sk in g
them t o resp o n d as th e y th o u g h t a R e p re s s o r w o u ld . Seven
o u t o f t h e n in e Judges a g re e d w ith t h e s c o r in g k e y on 90
p e r c e n t o f th e 127 ite m s , and on none d id th e ju d g e s a g re e
on a re s p o n se o p p o s ite t o t h e k e y . The R-S s c a l e t h e r e f o r e
h a s a d e q u a te r e l i a b i l i t y , and h a s h ig h v a l i d i t y as d e fin e d
by agreem ent w ith e x p e rts* ju d g m e n t.
M easures o f F e a r and A voidance
M easures o f F e a r
The "F e a r Therm om eter" (W alk, 1956) i s t h e one i n
stru m e n t most commonly u s e d t o m easure f e a r i n b e h a v io r
th e r a p y s t u d i e s . I t i s a member o f th e c l a s s o f m easures
r e f e r r e d t o as g ra p h ic r a t i n g s c a l e s . As d e v e lo p e d by
Walk, i t c o n s is te d of a th e r m o m e te r - lik e f i g u r e a c r o s s
w hich s u b j e c t s were i n s t r u c t e d t o draw a l i n e t o i n d i c a t e
how much f e a r was e x p e r ie n c e d . S c o rin g c o n s i s t e d o f d i v i d
in g t h e s c a le i n t o t e n e q u a l p a r t s , and a s s i g n i n g s c o r e s
44
from one t o t e n t o re s p o n s e s o c c u r r i n g a t v a r io u s p o i n t s
a lo n g t h e s c a l e . O th er I n v e s t i g a t o r s have c o n s t r u c t e d s u b
j e c t i v e f e a r s c a l e s w ith g u i d e p o s ts , c o n s i s t i n g o f d e s c r i p
t i o n s o f amount a n d /o r num bers, a s i n t h e c a s e o f t h e P e a r
S u rv ey S chedule (Wolpe and Lang, 1 9 6 4 ).
Walk v a l i d a t e d h i s s c a l e on p a r a c h u te ju m p ers,
u s in g such c o n c u rre n t and c o n s t r u c t v a l i d i t y c r i t e r i a aB
r e t r o s p e c t i v e r e p o r t s of f e a r o f to w e r jum ping, r e p o r t s o f
p h y s i o l o g i c a l p ro c e s s e s su ch as h e a r t p o u n d in g , and s u c c e s s
i n to w e r jum ping. Pew r e p o r t s o n t h e P e a r T herm om eter r e
l i a b i l i t y have been p u b lis h e d , t h e e x c e p ti o n b e in g a t e s t -
r e t e s t r o f .75 a f t e r what i s r e p o r t e d a s f i v e s e s s i o n
p e r i o d o f t r a i n i n g i n r e l a x a t i o n b a s e d on n i n e t e e n s u b j e c t s
(Lang and L a z a v lk , 1963).
A d d itio n a l v a l i d i t y f o r s e l f - r a t i n g f e a r s c a l e s may
be i n f e r r e d from Geer (1 9 6 5) , who d e m o n s tra te d s i g n i f i c a n t
d i f f e r e n c e s i n ap p ro ach tim e ( l a t e n c y t o a p p ro a c h ), s u b
j e c t i v e f e a r , o b s e r v e r 's f e a r r a t i n g and ACL s c o r e s betw een
s u b j e c t s r e p o r t i n g h ig h and low f e a r s t o a number o f ob
j e c t s . A nother s tu d y which g i v e s v a l i d i t y e v id e n c e i s t h a t
o f M yerhoff ( 1967)> who r e p o r t s s e v e n t y - e i g h t o f e i g h t y -
f o u r s u b j e c t s r e p o r t i n g much o r v e r y much f e a r o f Bnakes
a r e u n w illin g t o to u c h a sn a k e .
A lthough i t m ight b e e x p e c te d t h a t o t h e r s e l f -
r e p o r t m easures such as t h e Zuckerm an A f f e c t ACL and Sub
j e c t i v e S t r e s s S c a le (a ls o an ACL) w ould c o r r e l a t e w e ll
w ith r a t i n g s , i t i s r e p o r t e d by F o lk ln s e t a l . ( i n p r e s s )
t h a t t h e ACL's c o r r e l a t e h ig h ly w ith e ac h o t h e r ( r = . 8 9 )
b u t low w ith n u m e ric a l r a t i n g s c a l e s ( r = . 2 9 ) .
A g e n e r a l problem i n t h e u se o f s e l f - r a t i n g s o f
a n x i e t y i s th e s o c i a l u n d e s i r a b i l i t y o f a d m is s io n o f s p e
c i f i c o r g e n e r a l f e a r s (Lanyon and M o n o sev itz, 1 9 6 6 ) . Be
h a v io r th e r a p y s t u d i e s f i n d a g r e a t e r a d m is s io n o f f e a r and
p h o b ia among fe m a le s th a n m ales draw n from c o l l e g e p o p u la
t i o n s , w hich i s c o n s i s t e n t w ith r e s e a r c h and s p e c u l a t i o n
r e g a r d in g se x r o l e s t e r e o t y p e s and t h e g r e a t e r r e l u c t a n c e
o f t h e m ale t o adm it f e a r . G eer (1965) fo u n d s i g n i f i c a n t
c o r r e l a t i o n s b etw een F e a r S urvey S c o re s and a S o c i a l De
s i r a b i l i t y s c a l e , i n d i c a t i n g a low n e g a tiv e r e l a t i o n s h i p .
O th e r m easures w hich h av e b e e n u se d a s o p e r a t io n s
f o r d e f i n i n g f e a r s t a t e s a r e :
1 . P h y s io lo g ic a l
2. Judged o r o b se rv e d by o t h e r s
3. D eriv ed o r i n f e r r e d .
P h y s io lo g ic a l i n d i c e s a r e o f t e n p ro p o se d a s m eas
u r e s o f a n x ie ty and hav e th e m arked a d v a n ta g e o f b e in g
r e l a t i v e l y u n a f f e c t e d by s o c i a l d e s i r a b i l i t y f a c t o r s .
H e a rt r a t e , GSR, and e l e c t r i c m yograph r e s p o n s e s h av e been
commonly u s e d . R e l i a b i l i t i e s a r e n o t o f t e n r e p o r t e d , and
i n g e n e r a l i t i s found t h a t t h e I n t e r c o r r e l a t i o n s b etw een
m e a su re s o f d i f f e r e n t p h y s i o l o g i c a l r e s p o n s e s (G ro ssb e rg ,
46
1 9 6 5) as well as their relationship to self-report and
•other behavioral responses (Folkins et al., in press; La-
mont and Edwards, 1967; Paul, 1 9 6 6 ) is low. When such con
clusions are added to the technical problems of availabili
ty and maintenance, one concludes that, unless one is
interested in studying physiological responses, there is
little to recommend the physiological approach to anxiety
measurement.
Behaviors judged or rated by others are also a pos
sible operation for defining fear states, and are one of
the most common in clinical use. A good example of their
use in the behavior therapy situation is Gordon Paul’s
( 1 9 6 6 ) Check List for Performance Anxiety used as a pre
test and post-teBt with subjects high in performance (pub
lic speaking) anxiety. Twenty behaviors such as knee
trembling and face pale, are rated during the first four
minutes of a speech. After six hours of training inter-
observer reliability is reported at .9 5 . Correlations are
low and nonsignificant with physiological responses, and
moderate with verbal reports of performance anxiety; change
scores on the check list correlate significantly with both
physiological and self-report change scores. Paul’s Check
List appears to be a useful Instrument for performance anx
iety but not particularly well adapted to a study of animal
phobia. Geer ( 1965) also reports that observer ratings
(on a seven-point scale of magnitude of anxiety) separate
' ' 47
significantly the subjects reporting high and low anxiety
of feared objects, but reports no reliability data.
In view of the above, behavioral observations ap
pear to be a potentially useful technique for assessing
anxiety. In the absence of extensive information regarding
reliability and some indication of its superiority to the
self-report it does not appear particularly desirable to
embark on the development of such an instrument.
Derived measures such as projective techniques for
measuring fear are based on presumed conceptual properties
of fear states, i.e., that fear states lower the threshold
for the perception of or responding to stimuli previously
or habitually associated with fear. Derived measures
(e.g., the Rorschach) are ordinarily low in reliability,
although they are thought to diminish- the influence of so
cial desirability variables. Derived measures would appear
to have no particular advantage in the experimental situ
ation being discussed.
Measures of Avoidance
Behavior^
Measures of phobic behavior are the second major
class of dependent variables in the experiment. In. the
proposed comparison of treatments in snake phobic behavior,
an obvious type of content validity exists in using a cri
terion measure of having subjects who previous to treatment
maintain various degrees of distance between themselves and
48
t h e p h o b ic o b je c t and who a b s t a i n from v a r io u s b e h a v io r s
r e l a t e d t o t h e o b je c t* and who* a f t e r tre a tm e n t* d e c r e a s e
t h e d i s t a n c e and p e rfo rm p r e v i o u s ly i n h i b i t e d r e s p o n s e s .
One pro blem i n th e commonly u s e d a v o id a n c e s c a l e i s
th a t* a lth o u g h th e m agnitude o f p h o b ic re s p o n s e i s m easured
f o r t h e m ajo r e x te n t o f th e s c a l e by d i s t a n c e from a p h o b ic
o b je c t* a number o f q u a l i t a t i v e l y d i f f e r e n t r e s p o n s e s a re
o r d i n a r i l y in v o lv e d such a s w alking* re a c h in g * and p ic k in g
up. I t h a s b een r e p o r te d (Wolpe, 1963) t h a t d i f f e r e n t
am ounts o f t r a i n i n g a re n e c e s s a r y t o m o d ify t h e v a r i o u s
r e s p o n s e s . I t may t h e r e f o r e be p a r t i c u l a r l y i m p l a u s i b le t o
m a in ta in th e a ssu m p tio n o f an e q u a l I n t e r v a l s c a l e .
The r e l i a b i l i t y o f th e A voidance S c a le h a s n o t been
f r e q u e n t l y r e p o r t e d . Lang and L a z a v ik (1963) r e p o r t a t e s t -
r e t e s t c o r r e l a t i o n o f ^ .6 3 b a se d on n i n e t e e n s u b j e c t s . Un
p u b lis h e d d a ta from M yerhoff (1967) shows t h a t o f s e v e n ty -
e i g h t s u b j e c t s r e t e s t e d a f t e r one h o u r o f I n s t r u c t i o n s *
t h r e e s u b j e c t s d e c re a s e a v o id a n c e two p o in ts * n i n e t e e n su b
j e c t s d e c r e a s e one p o in t and f i f t y - s i x re m a in t h e same.
The d i r e c t i o n o f change s u g g e s ts t h e o p e r a t i o n o f some s y s
te m a tic e f f e c t r a t h e r th a n e r r o r v a r i a n c e and t h e g e n e r a l
s t a b i l i t y of th e AS i s c l e a r l y s u b s t a n t i a l .
O th e r m easures o f p h obic b e h a v io r w hich m ight be
em ployed in c lu d e la t e n c y o f i n i t i a t i o n o f a p p ro a c h b eh av io r*
te m p o ra l d u r a t i o n o f a p p ro a ch b e h a v io r* r e s i s t a n c e t o ex
t i n c t i o n o f a p p ro a ch b eh av io r* and e a s e o f r e i n s t a t i n g th e
av o idance b e h a v io r. Temporal d u r a t i o n (tim e ta k e n t o a p
p ro ac h ) was measured by Geer w ith e q u iv o c a l r e s u l t s . F o l
low-up s tu d i e s o f m aintenance o f b e h a v io r m o d if ic a tio n over
tim e (P au l, 1967 j Lang and L az av ik , 1963) have a l s o been
u n d e rta k e n . There appears t o be no p a r t i c u l a r t h e o r e t i c a l
o r p r a c t i c a l advantage of o t h e r m easures, ex ce p t f o r fo llo w
up, over th e Avoidance S c a le .
CHAPTER I I I
METHOD
General Design
F i f t y - f o u r s u b je c ts were a s s ig n e d t o t h r e e eq ual
groups on th e b a s i s of sc o res on th e Byrne R-S sc ale * One
t h i r d of t h e e ig h te e n Ss w ith low est R-S s c o re s were a s
sig n e d i n a random fa s h io n to each o f t h e t h r e e tre a tm e n t
c o n d i t i o n s : High, Medium, and Low A n x ie ty A ro u sal. One
t h i r d of th e Ss w ith th e h ig h e s t R-S s c o r e s , and one t h i r d
o f th e rem ain d er (in te rm e d ia te R-S s c o r e s ) were s i m i l a r l y
random ly a ssig n e d to each of th e t h r e e tr e a tm e n t c o n d itio n s .
S u b je c ts i n th e Low A nxiety c o n d i t i o n m a in ta in e d a
s t a t e of m uscular r e l a x a t i o n d u rin g v i s u a l i z a t i o n of a p
p ro a c h in g th e f e a r f u l o b je c t. Ss i n t h e I n te r m e d ia te Anx
i e t y c o n d itio n performed a r o u t in e m otor t a s k d u rin g v i s u
a l i z a t i o n * Ss i n th e High A nxiety c o n d i t i o n m a in ta in e d a
s t a t e of m uscular te n s io n d u ring v i s u a l i z a t i o n . A ll t h r e e
groups t h e r e f o r e engaged i n motor a c t i v i t i e s — r e l a x i n g ,
t e n s i n g , o r ta p p in g j c o n tr o l was t h e r e b y p ro v id e d f o r th e
p o s s i b l e d i s t r a c t i n g e f f e c t s of engagin g i n m u scular a c t i v
i t y d u r in g tre a tm e n t.
50
51
The amount of s u b je c tiv e f e a r r e p o r t e d a t th e p o in t
of c l o s e s t approach to th e f e a r e d s tim u lu s was d eterm in ed
f o r a l l Ss and th e p o in t of c l o s e s t a p proach re c o rd e d b e
f o r e and a f t e r tr e a tm e n t. A ll Ss r e c e iv e d i n s t r u c t i o n and
p r a c t i c e i n r e l a x a t i o n , i n m a in ta in in g m u scular t e n s i o n ,
and f i n g e r ta p p in g a t a ste a d y r a t e b e f o r e tr e a tm e n t was
i n i t i a t e d .
S u b je c ts v i s u a l l y re h e a rs e d ite m s i n a s ta n d a r d
f e a r h i e r a r c h y d u rin g two s e s s io n s s e p a r a t e d by n o t l e s s
th a n one, n o r more th a n fo u r days. A ll Ss r e p o r t e d su b
j e c t i v e f e a r e s tim a te s of th e maximum a n x ie ty e l i c i t e d d u r
in g each v i s u a l i z a t i o n on a t e n p o in t s c a l e o f s u b j e c t i v e
f e a r .
S u b je c ts
V o lu n te e r Ss who r e p o r te d f e a r s o f snakes and r a t s
were r e c r u i t e d from fo u r I n t r o d u c to r y psychology c l a s s e s a t
C a l i f o r n i a S t a te C ollege a t Los A ngeles. The P e a r Survey
Schedule (FSS) which appears i n Appendix A was a d m in is te r e d
t o th e c l a s s e s and s tu d e n ts were re a d th e sta te m e n t a p p e a r
in g i n Appendix I . ThoBe s tu d e n ts who r e p o r t e d Much o r
Very Much f e a r o f r a t s , mice, o r snakes were c o n ta c te d by
phone and asked t o v o lu n te e r f o r th e e x p erim e n t, Ss were
o f f e r e d f i v e d o l l a r s as an i n c e n ti v e f o r p a r t i c i p a t i n g i n
th e e x p erim en t. A ll but one of th e Ss c o n ta c te d by phone
appeared f o r t h e i r f i r s t t e s t i n g ap p o in tm en t.
Procedure
During th e f i r s t s e s s io n a l l Ss were g iv e n a p r e -
t r e a tm e n t c r i t e r i o n t e s t i n which av o idance b e h a v io r and '
s u b j e c t i v e f e a r were a s s e s s e d i n th e p re se n c e o f th e f e a r e d
a n im al. Both p r e - and p o s t - t r e a tm e n t c r i t e r i o n t e s t s were
co n ducted by th e a u th o r (E) who had no knowledge o f th e
group t o which any S had been a s s ig n e d . Ss were accom
p a n ie d i n d i v i d u a l l y by th e exam iner i n t o a room where th e
f e a r e d anim al was e x h ib ite d i n a g l a s s c ag e. E r e a d th e
i n s t r u c t i o n s ap pearin g in Appendix C which encourage th e
S t o approach th e anim al. An av o idan ce sc o re (A Si), c o r
re sp o n d in g t o th e p o in t a t which S r e f u s e d t o approach
f u r t h e r (Appendix B) was a s s ig n e d t o each S. Ss were asked
t o make a r a t i n g of th e s u b j e c t iv e f e a r (FTi) e x p e rie n c e d
a t th e c l o s e s t approach p o i n t. F iv e Ss who p ick e d up th e
anim al d u rin g th e p r e - t e s t were e x clu d ed from th e e x p e r i
m ent. The R ep ressio n S e n s i t i z a t i o n t e s t was a d m in is te re d
t o a l l Ss who met th e c r i t e r i a f o r p a r t i c i p a t i n g i n th e ex
p e rim en t i n o rd e r t o o b ta in a b a s i s f o r assignm ent of th e
S t o th e a p p r o p r ia te l e v e l of th e R-S dim ension b e f o r e th e
n e x t s e s s io n .
Follow ing th e f i r s t t e s t i n g s e s s io n , Ss were d i v i d
ed i n t o t h r e e groups co rre sp o n d in g t o High, Medium, and Low
s c o re s on th e R-S dim ension. Ss from each of th e t h r e e
groups were a ssig n e d a t random t o one o f th e t h r e e t r e a t
ment c o n d itio n s and a ls o a t random t o one of th e two
s tu d e n t t h e r a p i s t s . In th e week fo llo w in g i n i t i a l t e s t i n g ,
Ss were te le p h o n e d by th e t h e r a p i s t t o whom th e y had been
a s s ig n e d (T i o r T2 ) and scheduled f o r two f u r t h e r a p p o in t
m ents, None of th e Ss f a i l e d t o r e a p p e a r f o r an a p p o in t
ment once t h e y had begun th e ra p y , a lth o u g h two s u b j e c t s
co u ld n o t be scheduled f o r th e ra p y a p p o in tm en ts a f t e r th e
i n i t i a l t e s t i n g s e s s io n because of d is c o n n e c te d te le p h o n e s .
These l a t t e r Ss were r e p la c e d by two o t h e r s w ith s i m i l a r
p o s i t i o n s on th e R-S s c a le .
P ro cedure d u rin g tre a tm e n t s e s s i o n s . At th e b e g in
ning of th e f i r s t tre a tm e n t s e s s io n each S r e c e i v e d tw en ty
m inutes o f r e l a x a t i o n i n s t r u c t i o n a c c o rd in g t o th e p ro c e d
u re s p ro v id e d by Paul ( 1966). Ss were t h e n g iv e n b r i e f
p r a c t i c e i n assuming a s t a t e of m uscular t e n s i o n . The
p ro c e d u re s (Appendix G) were used by Wolpln and R aines
( 1966) and W olpln and Myerhoff (1966), who found th e r e
s u l t i n g t e n s i o n t o be e a s i l y and r e l i a b l y o b serv ed , q u ic k ly
Induced, and t o r e s u l t i n r e p o r t s by Ss o f a g r e a t e r amount
of f e a r i n re s p o n se to f e a r f u l sc en e s. A ll Ss p r a c t i c e d
+ * -
m a ln ta ln ln g _’t h e i r te n s io n f o r 3 p r a c t i c e t r i a l s , dach f o r a
p e r io d of t h i r t y seconds. F i n a ll y , Ss p r a c t i c e d ta p p in g
t h e i r f i n g e r s on th e t a b l e i n f r o n t of them a t a c o n s ta n t
two second r a t e d u rin g t h r e e p r a c t i c e t r i a l s , each o f
t h i r t y seconds d u r a tio n .
The t h e r a p i s t concluded th e muscle t r a i n i n g p e rio d
by p ro v id in g a s h o r t e x p la n a tio n o f th e r a t i o n a l e and the
co u rse o f tr e a tm e n t (Appendix E ), and answ ered any q u e s
t i o n s from Ss. Ss were then i n s t r u c t e d to assume th e a p
p r o p r i a t e m u scu lar s t a t e (Appendixes F, G, and H) and asked
to v i s u a l i z e scenes from a s ta n d a rd h i e r a r c h y m o d ifie d from
Davidson ( 1965) w h ic h _d e s c rib e s th e Ss going th ro u g h ten
s te p s i n appro ach in g and h a n d lin g th e f e a r e d o b j e c t (Appen
dix D ). V i s u a l i z a t i o n s were te rm in a te d by i n s t r u c t i o n s
from T f i f t e e n s e c o n d s. a f t e r the c o n c lu sio n o f T 's d e s c r i p
t i o n o f th e h i e r a r c h y item .
The c o n d itio n s may be summarized a s f o llo w s :
R e la x a tio n c o n d i t i o n . The r e l a x a t i o n c o n d itio n was
conducted a c c o rd in g to th e su g g e stio n s o f P au l ( 1966) . Ss
were g iv en r e l a x a t i o n e x e r c is e s f o r f i v e m in u tes p r i o r to
th e p r e s e n t a t i o n o f a l l h ie r a r c h y item s and r e l a x a t i o n was
r e i n s t a t e d by b r i e f (tw enty seconds) i n s t r u c t i o n p r i o r to
each v i s u a l i z a t i o n (Appendix P ) . A f te r each p r e s e n t a t i o n
Ss were r e q u e s te d to r a t e th e maximum a n x ie ty e x p e rie n c e d
on th e t e n - p o i n t Fear Thermometer.
T ension c o n d i t i o n . Ss i n the te n s io n c o n d itio n
were i n s t r u c t e d to te n s e t h e i r m uscles im m e d ia te ly p r i o r to
each v i s u a l i z a t i o n and were asked to m a in ta in t h a t s t a t e
u n t i l a p p ro x im a te ly f i v e seconds a f t e r v i s u a l i z a t i o n was
55
com pleted. An a d d i t i o n a l f i f t e e n seconds i n which Ss r e
main in t h e i r n a t u r a l body s t a t e b ro u g h t th e t o t a l i n t e r
t r i a l i n t e r v a l to tw enty seconds (Appendix G ). R a tin g s o f
maximum a n x ie ty were o b ta in e d fo llo w in g each p r e s e n t a t i o n .
F in g e r tap p in g c o n d it i o n . The f i n g e r ta p p in g p r o
cedure was i d e n t i c a l to t h a t employed i n th e te n s io n con
d i t i o n , e x c e p t t h a t Ss performed a f i n g e r ta p p in g e x e r c is e
i n s t e a d o f te n s in g t h e i r m uscles. (See Appendix H.)
Sample D i s t r i b u ti o n o f R-S S cores
The mean R-S score in th e sample p o p u la tio n was
44 .8 9 (S.D. = 2 0 .6 6 ), s u b s t a n t i a l l y low er th an the mean o f
6 l (S.D. = 17.71) o b ta in e d by Byrne ( 1961) i n h i s o r i g i n a l
sample o f i n t r o d u c t o r y c o lle g e s t u d e n t s . The rang e o f
s c o re s in t h i s stu d y (12-95) was s i m i l a r to th e Byrne range
o f 10-110, b u t ag ain r e f l e c t s the f a c t t h a t Ss s c o rin g i n
th e e x tre m e ly h ig h ran g es of the s c a l e were n o t a s w e ll
r e p r e s e n te d a s in th e o r i g i n a l Byrne p o p u la tio n .
A number o f e x p la n a tio n s may be prop osed to a cco u n t
f o r th e d i f f e r e n c e s between the two p o p u l a t i o n s . F i r s t ,
Ss i n th e p r e s e n t stu d y had the d i s t i n c t i o n n o t o n ly o f
b ein g v o lu n te e r s f o r a p s y c h o lo g ic a l e x p e rim e n t, b u t a ls o
o f e x p re s s in g a f e a r o f sm all a n im a ls. In e i t h e r o f th e s e
r e s p e c t s , th e y a re p o t e n t i a l l y d i f f e r e n t from Ss in th e
Byrne p o p u la tio n . That i s , i t i s p o s s i b l e t h a t Ss s c o rin g
in th e v e ry h ig h ranges o f th e R-S s c a l e a re l e s s w i l li n g
to p a r t i c i p a t e in p sy c h o lo g ic a l e x p e rim e n ts, o r a l t e r n a
t i v e l y t h a t th e y a re not as l i k e l y to d e v elo p a f e a r o f
sm all a n im a ls . A f u r t h e r e x p la n a tio n d e r i v e s from th e f a c t
t h a t B y rn e 's d a ta were o b ta in e d from s t u d e n t s anonymously,
w hereas Ss i n the p re s e n t study were r e q u i r e d to i d e n t i f y
th em selv es by name, age, and o th e r p e r t i n e n t d a ta . I t i s
p l a u s i b l e t h a t Ss are l e s s w illin g to adm it to extreme
p ath o lo g y when t h e i r names a re a s s o c i a t e d w ith th e t e s t r e
s u l t s . F i n a l l y , i t should be p o in te d o u t t h a t B y rn e 's
norms were o b ta in e d in Texas, w hile th e p r e s e n t d a ta were
o b ta in e d in Los Angeles. The s i g n i f ic a n c e o f r e g i o n a l d i f
f e r e n c e s i n r e l a t i o n to perform ance on th e R-S s c a le i s n o t
known.
The d is c r e p a n c ie s I n norms, w h ile n o tew o rth y , a re
n o t p a r t i c u l a r l y p e r t i n e n t in the c o n te x t o f the p r e s e n t
e x p e rim e n t. Since th ere i s no evidence t h a t th e R-S s c a le
i s a no ncon tinu ous measure, the sm a lle r r e p r e s e n t a t i o n in
t h i s stu d y o f the h ig h e s t ranges o f R-S s c o re s should n o t
p r e s e n t any problems in th e d e m o n stratio n o f a r e l a t i o n s h i p
between s c a l e v a lu e s and c r i t e r i o n m easu res.
CHAPTER IV
RESULTS
P re lim in a ry Analyses i
A b a s i c assum ption o f the p r e s e n t stu d y was t h a t j
th e th r e e e x p e rim e n ta l c o n d itio n s , muBcular r e l a x a t i o n ,
f i n g e r ta p p in g , and te n s io n , would be a s s o c i a t e d w ith d i f
f e r e n t i a l l e v e l s o f a n x ie ty during tr e a tm e n t. A second
m ajor assum ptio n was t h a t the le v e l o f a n x ie ty e x p e rie n c e d
d uring v i s u a l i z a t i o n o f f e a r evoking scen es would d e c re a se
w ith r e p e t i t i o n s o f th e v i s u a l i z a t i o n o f s c e n e s . A sim u l
ta n e o u s t e s t o f b o th assum ptions was p ro v id e d by a s e r i e s j
o f mixed d e s ig n , th re e way a n a ly se s o f v a r ia n c e o f F ear
Thermometer s c o re s (FT) during tr e a tm e n t. S e p a ra te a n a ly
s e s o f v a ria n c e were conducted on scenes 2, 4, 6, 8, and
10, w ith th e t h r e e dim ensions r e p r e s e n te d i n th e a n a l y s i s
by T reatm en t, R e p e t it i o n s , and Level o f D efense main e f
f e c t s . Appendixes J-N show t h a t f o r each o f th e f i v e a n a ly
se s o f v a r ia n c e , b o th Treatm ent and R e p e t i t i o n s main e f
f e c t s a re h i g h ly s i g n i f i c a n t ( p C .O l ) . M oreover, i n each
a n a l y s i s , th e F r a t i o f o r th e Treatm ent X R e p e t i t i o n i n t e r
a c tio n was l e s s than 1 .0 , i n d ic a t i n g t h a t th e d e c re a s e in
57
58
F e a r Thermometer sc o re s o v e r r e p e t i t i o n s o f scenes was i n
dependent o f th e type of tr e a tm e n t.
T able 1 p r e s e n t s th e mean F ear Thermometer s c o re s
f o r th e v i s u a l i z a t i o n d u ring each c o n d itio n o f m uscular
a c t i v i t y , and d em o n stra te s t h a t , as e x p e c te d , th e R e la x a
t i o n c o n d itio n i s a s s o c ia te d w ith th e lo w est F ear Thermome
t e r sco re (M = 3 . 56) , the Tension c o n d itio n w ith th e h ig h
e s t F e a r Thermometer sco re (M = 6 . 6 6 ) , and the F i n g e r - t a p
p in g c o n d itio n w ith Fear Thermometer s c o r e s in te r m e d ia te
between th e two (M = 5*28).
TABLE 1
MEAN PAIRJTHERMOMETER SCORES REPORTED DURING VISUALIZATION
( f tm) FOR TREATMENT AND DEFENSE CATEGORIES
T reatm ents Defense
Low A n xiety 3.56 R e p re ss o rs
5 .8 9
In te rm . A nxiety 5.28 I n t e r m e d ia te s 4 .8 1
High A nx iety 6 .66 S e n s i t i z e r s 4 .8 1
The downward p ro g re s s io n o f F ear Thermometer s c o re s
o v e r r e p e t i t i o n s o f scen es i s shown c l e a r l y in Appendixes
0-U. D e sp ite th e s i g n i f i c a n t d e c re a se i n f e a r r a t i n g s
ov e r t r i a l s , i t i s notew orthy t h a t o n ly f o r scenes 1 and
2 d id th e averag e le v e l o f a n x ie ty drop to th e b a se l e v e l
o f a n x ie ty r e p o r te d j u s t p r i o r to tr e a tm e n t.
59
A s i g n i f i c a n t i n t e r a c t i o n o c c u rre d between R e p e ti
t i o n s and L evel o f Defense in the a n a l y s i s o f v a ria n c e f o r
i
scene 2 (F = 2 .7 6 ; d f = 8,180; p c'.O l) and scene 4 (F = !
1 .8 7 ; d f = 12,270; p < . 0 5 ) . F ig u re s 1 and 2 i l l u s t r a t e
t h a t th e f e a r r a t i n g s o f S e n s i t i z e r s , which l i e in te r m e d ia te
between th e f e a r r a t i n g s o f R e p resso rs and I n te r m e d ia te s ,
i
drop lower th an th o se o f e i t h e r th e R e p re s s o rs o r I n t e r
m e d ia te s by th e f i f t h r e p e t i t i o n . On b o th sc en e s, th e Re- I
p r e s s o r group o b ta in e d h ig h e r f e a r r a t i n g s than S e n s i t i z e r s
and I n te r m e d ia te s th ro u g h o u t a l l r e p e t i t i o n s . The s m a lle s t
d e c re a se i n f e a r ov er r e p e t i t i o n s , however, i s found in
th e I n te r m e d ia te group. I t i s notew orthy t h a t th e l a t t e r
group a c t u a l l y in c r e a s e d t h e i r f e a r r a t i n g s o v e r r e p e t i
t i o n s o f scene 4.
I
S t a t i s t i c a l C o n s id e ra tio n s
The b a s i c d esig n o f the exp erim ent may be c on sid ered
a 3 X 3 X 2 X 2 f a c t o r i a l , w ith 3 Ss p e r c e l l . The 3 f a c
t o r v a r i a b l e s r e p r e s e n t the th r e e T reatm ent c o n d itio n s and
th e th r e e L ev e ls o f Defense, and th e 2 f a c t o r v a r i a b l e s
r e p r e s e n t th e T h e r a p is t and P re -p o s t t e s t i n g on c r i t e r i o n
m easu res. The P r e - p o s t dimension was in tr o d u c e d as an a l
t e r n a t i v e to th e a n a l y s i s o f d i f f e r e n c e s c o r e s . The use
o f d i f f e r e n c e sc o re s i n th e p r e s e n t stu d y would be c o n t r a
i n d i c a t e d i n view o f the f a c t t h a t s u b s t a n t i a l d i f f e r e n c e s
in avoid an ce and s u b je c tiv e f e a r s c o re s (T able 2) e x is te d
M e a n Pear Thermometer Scores
during Treatment
2.0
R epressors
Interm ediates
1.0
S e n s itiz e r s
4 2
5
1
P ig . 1. Mean Fear Thermometer ra tin g s fo r R epressors,
S e n sitiz e r s,, and Interm ediates on scene two.
M ean Pear Thermometer Scores
during Treatment
6 . 0 j—
5 .0
-C k
-a
■ o -
O R epressors
£ Interm ediates
Q S e n s itiz e r s
2.0
1.0
k 6
7
2 1
5
R ep etitio n s on Scene Four
F ig . 2 . Mean Fear Thermometer r a tin g s fo r R epressors,
S e n s itiz e r s , and Interm ediates on scene fo u r.
62
TABLE 2
MEAN PRE-TREATMENT AVOIDANCE SCORES ( A S t ) FOR
EACH TREATMENT-DEFENSE COMBINATION
D efense
T reatm ent C o n d itio n s
Low Anx. In te rm . Anx. High Anx.
R e p re ss o rs 3.50
5.83
4 .5 0
i
I n te r m e d ia te s 6 .6 7 4.50 7 .0 0
S e n s i t i z e r s 6.50 4.84
5 .1 7
i
p r i o r to tre a tm e n t in th e v a r io u s c e l l s o f th e e x p erim e n t
d e s p i t e random assignm ent to g ro u p s. Since d i f f e r e n c e
s c o re s c o r r e l a t e d m oderately h ig h (TableB 6 and 7) w ith
i n i t i a l f e a r and avoidance s c o r e s , such d i f f e r e n c e s c o r e s
would be b ia s e d by the d i s c r e p a n c i e s between groups which
e x i s t e d p r i o r to th erap y and t h e r e f o r e would co ntam in ate
an e v a lu a tio n o f tre a tm e n t e f f e c t s b ased on d i f f e r e n c e
s c o r e s .
The d a ta l e n t i t s e l f to a fo u r way, mixed d e sig n
a n a l y s i s o f v a ria n c e w ith 3 betw een s u b j e c t s (T reatm en t,
D efense, T h e ra p is t) and 1 w i t h in s u b j e c t s ( P re - p o s t) v a r i
a b l e s . Three o f th e v a r i a b l e s (T re atm en t, D efense, P re
p o s t) were t r e a t e d as fix e d i n th e a n a l y s i s o f v a r ia n c e ,
w h ile a f o u r th (T herapist) was c o n s id e re d random.
Since the p re lim in a ry a n a ly s e s su p p o rt th e assum p
t i o n s t h a t th e d i f f e r e n t tr e a tm e n ts p ro g re s s e d a t d i f f e r e n t
a n x ie ty l e v e l s , and t h a t f e a r d id d e c re a se w ith r e p e t i t i o n s
o f scen es, an an aly se s o f th e e f f e c t s o f tr e a tm e n t I s p r e
se n te d n e x t.
I
I
Avoidance Scores !
The a n a ly s is o f v a r ia n c e f o r Avoidance Scores
(T able 3) f a i l e d to s u b s t a n t i a t e any o f th e m ajor h y p o th e
s e s . The most d i r e c t t e s t o f t h e h y p o th eses co n cern in g j
tr e a tm e n t d if f e r e n c e s and th e e f f e c t s o f d i f f e r e n c e s in i
'
a n x ie ty le v e l during v i s u a l i z a t i o n i s g iv en i n th e a n a ly s is
o f v a ria n c e by the T reatm ent X P r e - p o s t i n t e r a c t i o n . The
F r a t i o f o r t h i s i n t e r a c t i o n i s leBs than 1 .0 , s u g g e stin g
t h a t any d if f e r e n c e s i n a v o id a n ce o f the f e a r e d stim u lu s
r e s u l t i n g from type o f th e r a p y a r e n o t r e l i a b l e .
A ll tre a tm e n t g ro u p s showed s u b s t a n t i a l , though not
s t a t i s t i c a l l y s i g n i f i c a n t , im provem ent. O v e ra ll improvement
i s e v a lu a te d in the a n a l y s i s o f v a ria n c e i n th e main e f f e c t
f o r P r e -p o s t. The F r a t i o (4 2 .9 7 ; d f 1 ,1 ) i s a s s o c i a t e d
w ith a p r o b a b i l i t y o f l e s s th an .10. The n e c e s s i t y o f
c o n s id e rin g the T h e ra p is t v a r i a b l e a s random and consequent
r e d u c tio n i n degrees o f freedom (from 36 to l ) makes the
achievem ent o f s t a t i s t i c a l s i g n i f i c a n c e e x c e e d in g ly d i f f i
c u l t . The o b ta in e d F o f 4 2 .9 7 would have been s i g n i f i c a n t
a t w e ll beyond th e .01 l e v e l had the T h e r a p is t v a r i a b l e
been t r e a t e d as fix e d .
The s e t s o f h y p o th e s e s c o n ce rn in g T reatm ent-D efense
i n t e r a c t i o n was e v a lu a te d i n th e a n a l y s i s o f v a r ia n c e by
TABLE 3
SUM M ARY OP ANALYSIS OP VARIANCE POR AVOIDANCE SCORES
Source
d f SS M S
F
P ;
Therapy ( l) 2 6.3 5 2 3.176 < 1 .0 0 0 NS |
Defense (2) 2
7.90 7 3.954 32.846
< .05 |
T h e r a p is ts ( 3) 1
7.259 7.259
< 1 .0 0 0 NS
P re -p o s t (4) 1 128.926 128.926 42.970 < .10
1 X 2 4
56.759
1 4 .190 1.936
NS
1 X 3
2 47.018
23.509
2.952 < .10
1 X 4 2
0.68 5 0 .3 4 3
< 1.0 0 0 NS
2 X 3
2 0.2 4 1 0.120 < 1.0 0 0 NS
2 X 4 2 14.130
7.065 36.371 <.05
3 X 4 1. 3.000 3.000
1.653
NS
1 X 2 X 3
4
29.315 7 .329
< 1.00 0 NS
1 X 2 X 4 4
8.759
2.190 1.088 NS
1 X 3 X 4 2 5.722 2.860
1.577
NS
2 X 3 X 4 2 0.388 0.194 < 1.00 0 NS
1 X 2 X 3 x 4 4 8.05 2 2.013 1.109
NS
T o ta l
107
676.511
E r r o r , between
36 286.667
E r r o r , w ith in 36 65.330
th e Treatm ent X D efense X P r e - p o s t i n t e r a c t i o n . Here too,
s t a t i s t i c a l s i g n i f i c a n c e was n o t a c h ie v e d , nor d id the
s iz e o f the r a t i o (F = 1 .0 9 j d f 4 ,4 ) su p p o rt th e e x is te n c e j
!
o f any tr e n d s o r te n d e n c ie s .
Two e f f e c t s , n o t d i r e c t l y r e l e v a n t to th e m ajor hy- 1
potheBes, d id r e a c h s t a t i s t i c a l s i g n i f i c a n c e . The f i r s t ,
!
th e main e f f e c t f o r L ev els o f Defense y i e l d e d an F r a t i o o f >
32.85 (d f 2,2) which i s s i g n i f i c a n t a t th e .05 l e v e l , and
r e f l e c t s th e f a c t t h a t s u b j e c t s who sc o re d in th e middle
ranges o f th e R-S s c a le o b ta in e d o v e r a l l avoidance sc o res
which are h ig h e r than S e n s i t i z e r s o r R e p re s s o r s . R eference
to the p r e - p o s t th e ra p y avoidance c u rv e s (F ig u re 3 ) i n d i - .
c a te s t h a t th e m agnitude o f d i f f e r e n c e s in avoidances
sc o res between d e fe n se groups i s d r a m a ti c a l ly reduced f o l
lowing th e ra p y . I t i s n otew orthy t h a t th e R e p resso r group
o b ta in e d p r e - t h e r a p y av o idance s c o re s which were lower than
tho se o f th e o th e r two g ro u p s, b u t o b ta in e d p o s t- th e r a p y
sc o res which were a c t u a l l y h ig h e r than th o se o f o th e r sub
j e c t s . R e f l e c t i v e o f th e l a t t e r o b s e r v a tio n i s the s i g n i f
i c a n t ( p < . 0 5 ) D efense X P r e - p o s t i n t e r a c t i o n (F = 3 6 . 37;
d f 2,2), which I n d i c a t e s a d i f f e r e n t i a l d e c re a se in a v o id
ance sc o re s depending on th e s u b j e c t s ’ l e v e l o f d e fe n se .
F igure 3 shows th e s lo p e s f o r In te r m e d ia te Defense s u b je c ts
and S e n s i t i z e r s to be s t e e p e r than t h a t o f R e p re ss o rs, sug
g e s tin g a g a in , l e s s p r e - p o s t change o r improvement f o r Re
p r e s s o r s than f o r S e n s i t i z e r s o r In te r m e d ia te s u b j e c t s .
Avoidance Scores
66
7-0
Repressors
S e n s itiz e r s
Interm ed iates
6.0
k.O
3 .0 -
2.0
P re-th erapy P ost-th erap y
F ig . 3 . P re- and p ost-th erap y Avoidance scores
fo r R epressors, S e n s itiz e r s , and In ter
m ed iates.
The d i f f e r e n c e betw een p r e - and p o s t - t h e r a p y avoidance
sc o re s f o r th e R e p re ss o rs was found to be s i g n i f i c a n t l y
sm a lle r th an f o r th e S e n s i t i z e r s (th e second l a r g e s t d i f - |
fe re n c e ) by a t t e s t ( t = 3 .0 5 ; d f 34; p < .0 1 ) and t h e r e
fo re a ls o s m a lle r th an th e I n te r m e d ia te group. 1
F e a r Thermometer Scores I
The a n a l y s i s o f v a r ia n c e f o r Fear Thermometer sc o re s
(Table 4) f a i l e d to y i e l d any s i g n i f i c a n t e f f e c t s . The F
r a t i o f o r T reatm ent X P r e - p o s t i n t e r a c t i o n (2 .6 5 ; d f 2,2)
f a l l s f a r s h o r t o f s t a t i s t i c a l s i g n i f ic a n c e and th u s f a i l s
to v a l i d a t e th e h y p o th e s is o f d i f f e r e n c e s between t r e a t
ments in th e r a t e o f d e c re a se i n f e a r r e p o r te d to th e f e a r
f u l s tim u lu s . Again, t h e r e i s s tro n g i n d i c a t i o n o f an o v e r-,
a l l tre a tm e n t e f f e c t , a lth o u g h th e F r a t i o f o r P r e - p o s t ,
(141.30; d f — 1,1 ) re a c h e s o n ly th e .10 l e v e l o f s i g n i f i c a n c e .
Here to o , th e l o s s i n d e g re e s o f freedom as a consequence
o f c o n s id e rin g th e t h e r a p i s t v a r i a b l e as random should be
tak en i n t o a c c o u n t.
The Defense X P r e - p o s t i n t e r a c t i o n (F = 11.15;
d f 2 ,2) f e l l s l i g h t l y s h o r t o f th e .05 l e v e l o f s i g n i f i
cance, b u t su g g e ste d d i f f e r e n t i a l improvement f o r s u b je c ts
i n the t h r e e d e fe n se g ro u p s. R eferen ce to F ig u re 4 shows
t h a t s u b j e c t s sc o rin g in th e m iddle ra n g e s o f the R-S s c a le
tended to improve (d e c re a s e f e a r ) l e s s than R e p re sso rs and
S e n s i t i z e r s . T his i s i n c o n t r a s t to th e fin d in g f o r a v o id -
TABLE 4
SUM M ARY OF THE ANALYSIS OP VARIANCE
OP PEAR THERMOMETER SCORES
Source d f s s M S p
p
Therapy ( l ) 2 10.167 5.083
< 1 .0 0 0 NS !
Defense (2) 2
19.389
9.694 < 1 .0 0 0 NS
T h e r a p is t ( 3 ) 1 4.898 4.898 < 1.00 0 NS
P r e - p o s t (4) 1 106.008 106.008 141.298 < .10
1 X 2 4 45.778 11.444
2.199
NS
1 X 3
2 33.018
16.509 2.677
NS
1 X 4 2 2.796 1.398 2.650 NS
2 X 3
2
21.351
10.676
1.731
NS
2 X 4 2 5.574 2.787
11.154 < .10
3 X 4 1 0.750 0.750
< 1.000 NS
1 X 2 X 3
4
20.815
5.204 <1.000 NS
1 X 2 X 4 4
19.037 4.759
4.288 < .10
1 X 3 X 4 2
1.055
0.528 < 1.000 NS
2 X*3 X 4 2 0.50 0 0.250 < 1.000 NS
1 X 2 X 3 X 4 4 4.440 1.110 < 1.0 00 NS
T o ta l
107
618.910
E r r o r , between 36 226.999 6.167
E r r o r , w ith in 36
101.332
2.815
Fear Therometer E atings
7 .0
Eepressors
Interm ediates
□ S e n sitiz e r s
6.0
5 .0
4.0
P re-therapy Post-therapy
F ig . 4. P re- and post-therap y Fear Thermometer
ra tin g s ib r R epressors, S e n sitiz e r s
and Interm ed iates.
70
ance s c o r e s , where R e p re ss o rs showed l e s s change th an I n t e r
m e d ia te s and S e n B itiz e r s .
The h y p o th eses concerning an i n t e r a c t i o n betw een i
l e v e l o f d e fe n se and tre a tm e n t e f f i c a c y a re t e s t e d i n th e
a n a l y s i s o f v a ria n c e by th e Treatm ent X Defense X P r e - p o s t
i n t e r a c t i o n . The F r a t i o o f 4.288 (d f 4 ,4 ) i s s i g n i f i c a n t
a t th e .10 l e v e l . F ig u re 5 p r e s e n ts the p r e - p o s t c u rv e s
f o r Ss in th e th r e e d e fe n se g ro ups. The h y p o th e s is t h a t
R e p r e s s o r s would show g r e a t e s t improvement from th e Low
A n x ie ty T reatm ent f a i l e d to r e c e iv e any su p p o rt. The I n t e r
m e d ia te A nxiety T reatm ent appeared to be a t l e a s t a s e f f i c a
c io u s as th e Low A nxiety Treatm ent f o r th e s e Ss, a lth o u g h
i n a cco rd an ce w ith th e p r e d i c t i o n , the High A n xiety T r e a t
ment was th e l e a s t e f f e c t i v e fo r the R e p re ss o rs. The d i f -
I
f e r e n c e s betw een tr e a tm e n ts w ere, in any e v e n t, too sm a ll
to v a l i d a t e th e h y p o th e s is o f a d i f f e r e n t i a l re s p o n s e to
t r e a tm e n t.
The second h y p o th e s is , t h a t S e n s i t i z e r s would im -
,p ro v e more fo llo w in g th e High A nxiety T reatm ent th an f o l
low ing Low A nxiety T reatm ent was a ls o not borne o u t . Con
t r a r y to e x p e c ta ti o n , th e Low Anxiety c o n d itio n was a s s o c i
a te d w ith a g r e a t e r r e d u c tio n in f e a r than was th e High
A n x ie ty c o n d itio n . As was found in the caBe o f R e p r e s s o rs ,
th e I n te r m e d ia te A nxiety c o n d itio n appeared to be th e most
e f f e c t i v e .
Fear Thermometer R atings
O R elaxation
□ F inger Tapping
A Tension
7 .0
6.0
5 .0
4 .0
3-0
2 .5
Pre-therapy P ost-th erap y [
R epressors Interm ediates
F ig . 5* P re- and p ost-th erap y Fear Thermometer scores fo r Treatm ent-Defense groups.
Pre-therapy Post-therapyj
S e n s itiz e r s
Pre-therapy P ost-therapy
I
- < t i
M I
" ■ .............................. 72
For b o th R e p re ss o rs and S e n s i t i z e r s , th e In te r m e d i-
f
a t e A nxiety c o n d itio n was a s s o c ia te d w ith th e most s u b s ta n - |
I
t i a l p r e - p o s t change in F ear Thermometer s c o r e s , w h ile th e
High A nxiety T reatm en t was a s s o c ia te d w ith th e s m a lle s t
change. The sequence was r e v e rs e d f o r I n te r m e d ia te Defense :
Ss, f o r whom th e High A nxiety Treatm ent was most e f f e c t i v e ,
i
and th e I n te r m e d ia te A nxiety Treatm ent the l e a s t e f f e c t i v e
o f th e t h r e e .
t
A second p o s s ib l e e v a lu a tio n o f th e T reatm en t X
D efense X P r e - p o s t i n t e r a c t i o n i s given i n F ig u re 6 . In
th e case o f High and I n te rm e d ia te A nxiety T re a tm e n ts , th e
S e n s i t i z e r s show th e g r e a t e s t r e d u c tio n in F e a r Thermometer
s c o r e s , w h ile th e In te r m e d ia te Defense s u b j e c t s show th e
s m a ll e s t r e d u c tio n i n Fear Thermometer s c o r e s . In th e case
o f th e Low A nxiety T reatm ent, however, i t i s th e I n te r m e d i- j
i
a t e Defense s u b j e c t s who dem onstrate the most s u b s t a n t i a l
Improvement, and th e S e n B itlz e rs who show th e s m a ll e s t r e
d u c tio n i n F ear Thermometer sc o re s .
C o r r e l a t i o n s between F ear Thermometer S cores
O btain ed d u ring 'treatm ent and P r e - p o s f
Therapy F ear and Avoidance C r i t e r i a
The s e t s o f h y p o th eses drawn from th e t h e o r i e s o f
Wolpe and Stanipfl co n cerning a r e l a t i o n s h i p betw een l e v e l
o f a n x ie ty d u rin g tre a tm e n t and tre a tm e n t e f f e c t i v e n e s s
were n o t borne o u t. The Wolpe c o n te n tio n t h a t tr e a tm e n t
e f f i c a c y i s dependent upon th e su p p re ssio n o f a n x ie ty d u r-
Fear Thermometer Scores
7-5
O R epressors
Q Interm ed iates
& S e n s itiz e r s
6.0
5-0
4.0
3.0
2.5
P re-th erapy P ost-th erap y P re-th erapy P ost-th erap y P re-th erapy P ost-th erap y
R elaxation F in ger Tapping Tension
F ig . 6 . P r e - and p ost-th era p y Fear Thermometer sco res fo r Treatm ent-Defense groups. [jo
in g tr e a tm e n t would be s u b s t a n t i a t e d by a s i g n i f i c a n t p o s i
t i v e c o r r e l a t i o n between mean F e a r Thermometer sc o re s d u r
in g tr e a tm e n t (FT^) and p o s t - t h e r a p y Avoidance s c o re s (AS2 )
;and between mean F ear Thermometer s c o re s d u rin g tr e a tm e n t
(FTm) and p o s t- t h e r a p y F e a r Thermometer s c o re s (FT2 ) i n the
Low A nxiety T reatm ent. The -0 .0 6 c o r r e l a t i o n betw een FT^
and FT2 c l e a r l y did n ot v a l i d a t e th e Wolpe h y p o th e s is (see
T able 5 ) .
The Stam pfl based h y p o th e s is t h a t t r e a tm e n t e f f e c
t i v e n e s s i s enhanced by th e e l i c i t a t i o n o f a n x ie ty d uring
tr e a tm e n t p r e d i c te d a s i g n i f i c a n t n e g a tiv e c o r r e l a t i o n b e
tween s u b j e c t i v e f e a r d u rin g tr e a tm e n t (FT^) and p o s t t h e r
apy avoidance s c o re s (AS2 ) and betw een s u b j e c t iv e f e a r d u r
in g tr e a tm e n t (FT^) and p o s t th e ra p y F ear Thermometer r a t
in g s (FT2 ) • The o b ta in e d c o r r e l a t i o n s o f .26 between FT^.
and AS2 and .18 between FTM and FTg were i n d i r e c t c o n t r a
d i c t i o n to th e Stam pfl p o s i t i o n .
The c u r v i l i n e a r h y p o th e s is , which p o s i t e d t h a t the
Wolpe p r e d i c t i o n would h o ld tr u e f o r th e Low A n xiety T r e a t
ment c o n d itio n and t h a t th e Stam pfl p r e d i c t i o n would be
su p p o rte d i n th e High A nxiety T reatm ent was lik e w is e n o t
borne o u t. Only in the case o f th e I n te r m e d ia te A nxiety
T reatm ent c o n d itio n d id any s i g n i f i c a n t c o r r e l a t i o n s o b ta in
betw een s u b j e c t iv e f e a r d u rin g tr e a tm e n t and a p o s t - t h e r a p y
c r i t e r i o n m easure. In the l a t t e r c o n d i t i o n .a .44 c o r r e l a
t i o n was found between mean F ear Thermometer r a t i n g s d u rin g
75
TABLE 5
CORRELATIONS BETWEEN M EAN PEAR THERMOMETER RATINGS DURING
VISUALIZATION (5% ) AND POST-THERAPY PEAR (PT2 ) AND
AVOIDANCE SCORES (AS2 ) WITHIN TREATMENT
AND DEPENSE CATEGORIES
C o r r e la tio n s o f P e a r Thermometer R a tin g s
d u rin g V i s u a l i z a t i o n s w ith :
Avoidance S c o re 2 Pear Thermometer2
T reatm ent
Low A nxiety .06 .20
In te rm . A nxiety
.45 .05 ,
High A nxiety
.27
.18
i
D efense
R e p re ss o rs .47* • 39
I n te r m e d ia te s - .1 6 •
- .0 9
S e n s i t i z e r s - .0 2
.19
■^Significant a t th e .05 l e v e l .
tre a tm e n t and p o s t - t h e r a p y Avoidance scores., a fin d in g
which i s i n accordance w ith th e Wolpe p o s i t i o n .
I
F u rth e r l im i te d s u p p o rt f o r th e Wolpe h y p o th e s is o f i
an in v e rs e r e l a t i o n s h i p betw een s u b j e c t i v e f e a r d u rin g
tre a tm e n t and p o s t - t h e r a p y c r i t e r i o n m easures i s seen among
th e Repressors., where p o s i t i v e and s i g n i f i c a n t c o r r e l a t i o n s
ap p ea r between mean F e a r Thermometer r a t i n g s d u ring t r e a t - '
ment and p o s t- th e r a p y av o id an ce sc o re s ( r = .47) and between
mean Fear Thermometer r a t i n g s d u rin g tr e a tm e n t and p o s t
th e ra p y F ear Thermometer r a t i n g s ( r = .39)* The c o r r e l a
t i o n s between s u b je c tiv e f e a r d u rin g tr e a tm e n t and p o s t
th e ra p y avoidance s c o re s and betw een s u b j e c t iv e f e a r during
tre a tm e n t and p o s t - t h e r a p y f e a r r a t i n g s f o r b o th S e n s i t i z e r s
i
and I n te rm e d ia te Defense s u b j e c t s were low and n o n - s i g n i f i - I
c a n t. j
i
i
I
O ther E m p iric a l F in d in g s
Complete i n t e r c o r r e l a t i o n s o f F e a r Thermometer and
avoidance sc o re s a re g iv en i n Table 6. M oderately high
c o r r e l a t i o n s were found betw een p r e - and p o s t- th e r a p y
avoidance sc o re s ( r = .6 2 ) and between p r e - and p o s t- th e r a p y
F e a r Thermometer r a t i n g s - ( r = .48). The f e a r r a t i n g ob
t a i n e d a t the f i n a l approach p o i n t d u rin g p o s t- th e r a p y
t e s t i n g (FT^) c o r r e l a t e d .66 w ith p o s t - t h e r a p y f e a r r a t i n g
(FT2 ) and .35 w ith th e p r e - t h e r a p y f e a r r a t i n g (FT^).
The c o r r e l a t i o n betw een i n i t i a l F e a r Thermometer
r a t i n g (FT^) and i n i t i a l av o id an ce Bcore (AS^) was .01.
TABLE 6
!
IKTERCORHELAIIONS O F FEAR T H E R M O M E T E R A N D A V O ID A N C E SCO RES
f t 2
(FDx-FTa)
f t 3 ASX
as2 (ASx-AS2 )
FTx
. 48**
. 3 5 ** . 3 5 **
•18
. 0 1 .26 -.29*
f t 2 - . 65** .66** . 2 1 .07 .52** -.47**
(FTx-FTa) - . 40** - . 1 0 -.0 7 .55*
.27*
f t 3 .26 . 4o** . 3 9 **
.06
^M
.16 .14 .o 4
ASX
.62** .54**
as 2
-.53 *
* S ig n ifle a n t a t th e .05 l e v e l .
* * S lg n ifle a n t a t th e .0 1 le v e l .
78
T his was i n c o n t r a s t to th e .52 c o r r e l a t i o n o b ta in e d b e
tween p o s t - t h e r a p y F ear Thermometer r a t i n g (FTg) and p o s t
th e ra p y av o id an ce sco re (AS2 ) . Mean f e a r r a t i n g s d u rin g
tre a tm e n t (FT^) showed no s i g n i f i c a n t i n t e r c o r r e l a t i o n s
w ith any o t h e r m easures.
A s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n (.35) i s ob
t a i n e d betw een p r e - t h e r a p y F e a r Thermometer sc o re s (FT^)
and p r e - p o s t - t h e r a p y F ear Thermometer d if fe r e n c e s c o r e s
.(FT^— FT2 ) . A somewhat h i g h e r c o r r e l a t i o n (. 5 * 0 was found
between p r e - t h e r a p y avoidance sc o re s (AS-^) and p r e - p o s t -
th e ra p y avoidance d i f f e r e n c e sc o re s (AS^—ASg). Such c o r
r e l a t i o n s would seem to be a consequence o f the r e s t r i c t e d
range o f v a lu e s ( l — 10) i n th e Fear Thermometer and Avoid
ance Scales., sin c e th e range and magnitude o f p o s s i b l e d i f
fe re n c e s c o r e s n e c e s s a r i l y v a r i e s d i r e c t l y as a f u n c t i o n o f
the m agnitude o f th e i n i t i a l , p re - th e ra p y sc o re. As an
example, a p r e - t h e r a p y sc o re as h igh as 8 might be a s s o c i
a te d w ith d i f f e r e n c e s c o re s ran g in g from 0 —8, w hereas an
i n i t i a l sc o re o f 3 c o u ld be a s s o c ia te d w ith d i f f e r e n c e
sc o re s ra n g in g o n ly from 0 — 2.
CHAPTER V
DISCUSSION
A nxiety Level
The r e s u l t s o f th e p r e s e n t study f a i l e d to co nfirm
th e p r e d i c t i o n s a s d e riv e d from th e t h e o r i e s o f Wolpe and
S ta m p fl. These p r e d i c t i o n s had to do w ith th e e f f e c t o f
c o g n it i v e r e h e a r s a l o f approaches to f e a re d s t i m u l i on the
r e d u c t io n o f s u b j e c t iv e f e a r and a v o id a n t b e h a v io r . No
s i g n i f i c a n t d i f f e r e n c e s i n f e a r o r avoidance o f th e fe a re d
s t i m u l i were produced by th re e d i f f e r e n t tr e a tm e n t c o n d i
tio n s., d em o n stra te d to d i f f e r r e l i a b l y in th e l e v e l o f
f e a r p r e s e n t d u rin g tr e a tm e n t. F u r th e r , no c o n s i s t e n t r e
l a t i o n s h i p s were r e v e a le d between the m agnitude o f f e a r r e
p o r t e d d u rin g tr e a tm e n t and c r i t e r i o n m easures. One m ust,
t h e r e f o r e , s e r i o u s l y q u e s tio n th e presum ption t h a t a n x ie ty
m od u latio n i s in d e e d as c r u c i a l a f a c t o r In d e s e n s i t i z a t i o n
t h e r a p i e s a s Wolpe and Stam pfl have a s s e r t e d .
The c u r v i l i n e a r h y p o th e s is p o s i t e d t h a t b o th High
and Low A nxiety T reatm en ts would be more e f f e c t i v e th an
I n te r m e d ia te A nxiety T reatm ent; and t h a t a n e g a tiv e r e
l a t i o n s h i p would o c c u r between a n x ie ty d u rin g tr e a tm e n t and
improvement in th e Low A nxiety T reatm ent, and a p o s i t i v e
79
" " " " 80
r e l a t i o n s h i p , between a n x ie ty d u rin g t r e a tm e n t and im prove
ment i n the High A nxiety T reatm en t. None o f th e p r e d i c - J
t i o n s from th e c u r v i l i n e a r h y p o th e s is were borne o u t.
The r e s u l t s o f t h i s stu d y a re i n c o n t r a d i c t i o n w ith
t h a t o f M yerhoff ( 1 9 6 8) which found a T ension c o n d itio n
(hig h a n x ie ty r e p o r te d d u rin g tr e a tm e n t) to be s u p e r io r to
I
a low er a n x ie ty C o n tro l c o n d itio n i n re d u c in g avoid an ce o f
a f e a r f u l o b j e c t , as w e ll as w ith e a r l i e r s t u d i e s by Davison
( 1 9 6 5)^ Rachman ( 1 966), and Lomont and EdwardB ( 1 9 6 7) which
found th e c o n v e n tio n a l R e c ip ro c a l I n h i b i t i o n te c h n iq u e to
be more e f f e c t i v e than C o n tro l c o n d it i o n s i n which a n x ie ty
was n o t su p p re ssed .
However, r e s u l t s c o m p atib le w ith th e p r e s e n t f i n d
in g s are. r e p o r t e d by P o lk in s e t a l . ( in p r e s s ) which u t i l
iz e d d e s e n s i t i z a t i o n p ro c e d u re s to red u c e e x p e r im e n ta lly
in d u ce d s t r e s s . In th e P o lk in e t a l . s tu d y , sim ple c o g n i
t i v e r e h e a r s a l , analogous to th e I n te r m e d i a t e A n xiety c o n d i
ti o n i n th e p r e s e n t stu d y , was a t l e a s t a s e f f e c t i v e a s ,
and, on one c r i t e r i o n , more e f f e c t i v e th an th e s ta n d a rd
R e c ip r o c a l I n h i b i t i o n te c h n iq u e . The a u th o r s s p e c u la te d
on th e b a s i s o f t h e i r f in d in g s t h a t th e e f f e c t i v e elem ent
in d e s e n s l t l z a t l o n p ro c e d u re s was th e c o g n it i v e r e h e a r s a l
o f t h r e a te n i n g m a t e r i a l . London (1964) and Wolpin and
R aines ( 1966) a ls o have em phasized th e c o g n it i v e a s p e c t o f
d e s e n s i t i z a t i o n p ro c e d u re s and have q u e s tio n e d th e re le v a n c e
o f th e Im p lo siv e and R e c ip ro c a l I n h i b i t i o n t h e o r i e s to th e
s u c c e ss o f t h e i r r e s p e c t i v e t r e a tm e n ts . London s p e c u la te s
t h a t f u tu r e r e s e a r c h may in d ee d i s o l a t e th e elem ent o f cog- j
n i t i v e r e h e a r s a l as the e s s e n t i a l t h e r a p e u t i c a g e n t. The
r e s u l t s o f th e p r e s e n t study., which show a uniform t r e a t
ment e f f e c t f o r t h r e e v a r i a t i o n s o f th e d e s e n s i t i z a t i o n
p ro c e d u re , a l l hav in g in common th e elem ent o f c o g n itiv e
{
r e h e a r s a l , add s t r e n g t h to th e p o s i t i o n taken hy London and :
P o lk in s e t a l . I
R e la ti o n s h ip between Pear
and Avoidance B ehavio r
An assum ption i m p l i c i t to th e t h e o r i e s o f Wolpe and
Stam pfl i s t h a t f e a r i s an a n te c e d e n t o r cause o f avoidance
b e h a v io r. The u b iq u ito u s n e s s o f th e r e l a t i o n s h i p between
s u b je c tiv e f e a r and a v o id a n t b e h a v io r i s o fte n taken f o r
g r a n te d . E m p iric a l s t u d i e s o f th e r e l a t i o n s h i p a re con- {
s p ic u o u sly la c k in g . The r e s u l t s o f th e p r e s e n t study argue
a g a i n s t the p o s i t i o n tak en by Wolpe and Stam pfl t h a t f e a r
and avoidance b e h a v io r a re i n t i m a t e l y and i n e v i t a b l y r e
l a t e d , and in d ee d su g g e st t h a t th e two b e h a v io rs may o p e ra te
q u ite In d e p e n d e n tly o f one a n o th e r.
I t was d em o n stra te d t h a t e x p e rim e n ta l m anip u latio n
o f a n x ie ty d u rin g tr e a tm e n t b e a r s l i t t l e r e l a t i o n s h i p to
changes i n v e r b a l r e p o r t s o f f e a r o r avoidance, o r to th e
magnitude o f p o s t - t h e r a p y m easures o f f e a r o r avoidance.
That i s , th e th r e e tr e a tm e n ts , d i f f e r i n g from one an o th er
i n th e amount o f e x p e r im e n ta lly a ro u se d a n x ie ty , did n ot
p ro d u ce d i f f e r e n t i a l l e v e l s o f p o s t- th e r a p y f e a r o r a v o id
ance o r d i f f e r e n t i a l changes i n f e a r o r a v o id a n c e . The F
r a t i o s e v a lu a tin g th e d if f e r e n c e s between t r e a tm e n t c o n d i- !
i
t i o n s on b o th avoidan ce and s u b je c tiv e f e a r c r i t e r i a (T ab les
3 and 4) f e l l f a r s h o r t o f s t a t i s t i c a l s i g n i f i c a n c e . I n
deed., th e F r a t i o e v a lu a tin g tre a tm e n t d i f f e r e n c e s in th e
a n a l y s i s o f v a ria n c e o f avoidanoe sc o res was l e s s than 1 .0 . !
I n d i v id u a l r e p o r t s o f fe a r during v i s u a l i z a t i o n j
i
w ere, l ik e w is e , n o t r e l a t e d to p o s t- th e r a p y a v o id a n c e b e
h a v io r o r f e a r r a t i n g s o r to p r e - p o s t d i f f e r e n c e s c o r e s on
th e a v o id an ce o r f e a r s c a l e s . S u b je ctiv e f e a r d u rin g t r e a t
ment c o r r e l a t e d .14 w ith p o s t- th e r a p y avo idance s c o r e s and
.04 w ith avoidance d i f f e r e n c e scoreB. The c o r r e l a t i o n s b e
tween s u b j e c t i v e f e a r d u rin g tre a tm e n t and p o s t - t h e r a p y
f e a r c r i t e r i a were a ls o n o ta b ly low. A c o r r e l a t i o n o f .21
o b t a i n e d betw een f e a r d u rin g tre a tm e n t and p o s t - t h e r a p y f e a r
r a t i n g s , and a c o r r e l a t i o n o f -.1 0 o c cu rred betw een f e a r
d u rin g tr e a tm e n t and p r e - p o s t d iffe re n c e s c o r e s on the P ear
Thermometer.
T h ird , r e p o r t s o f s u b je c tiv e f e a r in th e p re s e n c e
o f t h e fe a re d anim al p r i o r to th erap y bore no r e l a t i o n s h i p
to t h e amount o f a v o id an ce b e h av io r p r i o r to th e r a p y . The
c o r r e l a t i o n betw een p r e - t h e r a p y f e a r and av o id an ce sc o re s
was .0 1 .
The o n ly ev id e n ce to sup port a r e l a t i o n s h i p between
f e a r and avoidance i s found on p o s t- th e r a p y m e a su re s, where
83
a .5 2 c o r r e l a t i o n o c c u rre d betw een p o s t - t h e r a p y f e a r and
avoidan ce s c o re s .
The r i s e in c o r r e l a t i o n betw een f e a r and avoidance
from p r e - to p o s t- th e r a p y (.01 to . 52) i s in d eed d ra m a tic .
A number o f s p e c u la tio n s may be r a i s e d to account f o r the
s h i f t . One e x p la n a tio n p o s i t s t h a t d i s c r im i n a t io n le a r n in g ;
i
o c c u rs during th e ra p y . I t i s c o n c e iv a b le t h a t , p r i o r to
t h e r a p y , s u b je c ts f a i l to a s s o c i a t e t h e i r a v o id a n t re sp o n se s
i n th e p resen ce o f the f e a r e d s tim u lu s w ith t h e i r i n t e r n a l
cues o f f e a r o r a n x ie ty . D e s e n s i t i z a t i o n th e ra p y , which
p r o v id e s re p e a te d p a ir i n g o f c o g n it i v e r e p r e s e n t a t i o n s o f
approach b e h a v io r w ith i n t r o s p e c t i o n s co n cern in g th e i n
t e r n a l cues o f f e a r , may f a c i l i t a t e th e d is c r im in a tio n o f
l
a r e l a t i o n s h i p between f e a r and av o idance about which sub
j e c t s were p re v io u s ly unaw are.
Another e x p la n a tio n f o r th e r i s e i n c o r r e l a t i o n b e
tween f e a r and avoidance In v o lv e s th e f a c t o r o f n o n s p e c if ic
a n x ie ty emanating from th e e x p e r im e n ta l s e t t i n g . At the
o n s e t o f th e experim ent s u b j e c t s may be e x p e rie n c in g a
g e n e r a l i z e d a n x ie ty a s s o c i a t e d w ith t h e i r ap p re h en sio n s and
p r e c o n c e p tio n s about th e e x p e rim e n t. The s u b je c tiv e a n x ie ty
r e p o r t e d in the i n i t i a l t e s t i n g s e s s io n may, t h e r e f o r e , r e
f l e c t n o t o nly the f e a r evoked by th e snake o r r a t , b u t
a ls o th e more g e n e ra l f e a r o f b e in g in a n ov el and p o te n
t i a l l y th re a te n in g s i t u a t i o n . The masking o f anim al a s s o
c i a t e d f e a r by th e more n o n s p e c i f i c a n x ie ty might p a r t i a l l y
acco unt f o r th e f a i l u r e to dem o n strate a p o s i t i v e c o r r e l a
tio n between p r e - t h e r a p y f e a r and avoidance b e h a v io r.
The p re c e d in g e x p la n a tio n s d e riv e from th e p rem ise
t h a t a c lo s e r e l a t i o n s h i p betw een f e a r and avoidance b e h a v
i o r r e p r e s e n t s th e t r u e s t a t e o f a f f a i r s and t h a t th e r e
l a t i o n s h i p was somehow o b sc u re d on p r e -th e ra p y t e s t i n g .
i
Since th e b u lk o f d a ta from th e study being r e p o r te d sug
g e s t s t h a t f e a r and av o id an ce b e h a v io r a re independent b e
h a v io r s o r h a b i t s , one m ight a l t e r n a t i v e l y sp e c u la te t h a t
the p o s t - t h e r a p y c o r r e l a t i o n between f e a r and avoidance h a s
been s p u r i o u s l y r a i s e d . One mechanism by which t h i s m ight
have o c c u rre d i s th ro u g h th e a c q u i s i t i o n by s u b je c ts o f a j
s e t to a s s o c i a t e r e p o r t s o f f e a r and avoidance. I t i s plau-j
s i b l e t h a t th e r e p e a te d p a i r i n g d u rin g trea tm e n t o f c o g n i- j
t i v e r e p r e s e n t a t i o n s o f approach b e h av io r and s u b je c tiv e
I
f e a r e v a l u a t i o n s c r e a t e d an e x p e c ta tio n o f a r e l a t i o n s h i p
between f e a r and avoidance b e h a v io r .
L evel o f Defense
The most s i g n i f i c a n t p o s i t i v e c o n tr ib u tio n o f th e
study b e in g r e p o r t e d d e riv e s from th e dem o nstration o f an
e m p ir ic a l r e l a t i o n s h i p between a p e r s o n a l i t y v a r i a b le and
avoidance and f e a r c r i t e r i o n m easures. Previous s t u d i e s
(Lang, 1964; Lang and L azovik, 1963; Lang, Lazovik and
R eynolds, 1965; Cook, 1 9 6 6) have f a i l e d to i s o l a t e any
v a r i a b l e s which a r e r e l i a b l y r e l a t e d to trea tm e n t e f f e c t i v e -
n e s s . The R e p re s s io n -S e n B itiz a tio n (R-S) dim ension was
d e m o n stra te d by th e p re s e n t study to r e l a t e n o t only- to
t h e e f f e c t i v e n e s s o f tre a tm e n t, b u t a ls o to d i f f e r e n c e s j
i n p r e - t h e r a p y av o id ance b e h a v io r. The R-S dim ension
t h e r e f o r e a p p e a rs to be a p ro d u c tiv e avenue to p u rsu e in
th e stu d y o f f e a r s and f e a r re d u c tio n te c h n iq u e s .
i
The h y p o th e s iz e d i n t e r a c t i o n s betw een d e fe n se l e v e l
and type o f t r e a tm e n t were n o t borne o u t. S p e c i f i c a l l y , j
t h e r e was no c o n c lu s iv e evidence t h a t R e p re s s o r s p r o f i t e d
more from th e Wolpe s t y l e d (Low A nxiety) tr e a tm e n t than
from th e o t h e r tr e a tm e n ts , nor t h a t S e n s i t i z e r s r e c e iv e d
more s u b s t a n t i a l b e n e f i t from the im p lo s iv e ly b a sed (High
A nxiety) t r e a tm e n t. A number o f o th e r i n t e r a c t i o n s , how
e v e r , d id o c c u r.
P re -T h e rap y M easures
One o f th e most i n t e r e s t i n g f i n d i n g s was t h a t sub
j e c t s s c o rin g i n th e middle ran g es o f th e R-S s c a le ob
t a i n e d h ig h e r av o idance sc o res (showed more a v o id a n t b e
h a v io r) th an R e p re s s o rs o r S e n s i t i z e r s . I f one s p e c u l a te s
t h a t th e r e l a t i o n s h i p between R-S sc o re s and p s y c h o lo g ic a l
a d ju s tm e n t i s c u r v i l i n e a r ( t h a t s u b je c ts s c o r in g in th e
m iddle ra n g e s o f th e s c a le a re b e t t e r a d j u s t e d than th o se
s c o r in g in th e 'e x tr e m e r a n g e s ) , then one may be le d to q u e s
t i o n th e "p ath o lo g y " o f the phobic b e h a v io r i n q u e s t i o n .
In d ee d , i t m ight be argued t h a t th e more marked avoid an ce
' 86
b e h a v io r o f th e I n te r m e d ia te D efense s u b j e c t s r e f l e c t s an
a d a p tiv e resp o n se to danger i n th e e x p e rim e n ta l s e t t i n g .
Another c o n s id e r a tio n d e r iv e s from th e i s s u e o f de
mand c h a r a c t e r i s t i c s o f th e e x p e rim e n t. In a stu d y i n - |
i
v o lv in g th e u se o f p sy c h o th e ra p y i t i s q u i t e co n ce iv a b le
i
t h a t th e e x p e c ta tio n i s conveyed to s u b j e c t s t h a t p r e - t h e r - ;
apy symptomatology i s d e s i r a b l e , s in c e th e purpose o f such
an experim ent would alm ost c e r t a i n l y be to dem o nstrate im
provem ent from th e ra p y . I t i s p o s s i b l e t h a t such demand
c h a r a c t e r i s t i c s a re communicated d i f f e r e n t i a l l y to s u b je c ts
i n th e th r e e defense g ro u p s, o r a l t e r n a t i v e l y t h a t c e r t a i n
s u b j e c t s a re more w i l l i n g to comply w ith th e demands. An
e x p la n a tio n based on d i f f e r e n t i a l r e s p o n s iv e n e s s to u n in
ten d ed cues i s not I m p la u s ib le i n view o f th e fin d in g by
Kaplan (1967) t h a t I n te r m e d ia te Defense s u b j e c t s make b e t
t e r use o f s i t u a t i o n a l cues th an R e p re ss o rs o r S e n s i t i z e r s
i n p r e d i c t i n g b e h a v io r o f o t h e r s . The q u e s tio n o f com pli
ance and s u g g e s t a b i l i t y as a f a c t o r in tr e a tm e n t h as been
r a i s e d a ls o by Wolpln and R aines (1 9 6 6 ) in c o n n ectio n w ith
tre a tm e n t outcome.
I t i s notew orthy t h a t th e r e l a t i o n s h i p between
s e v e r i t y o f symptomatology and R-S l e v e l which was found
f o r avoidance sc o re s d id n o t h o ld tr u e f o r s u b j e c t iv e f e a r .
On th e l a t t e r measure t h e r e was a t l e a s t a tendency f o r
th e R e p re sso rs to r e p o r t h i g h e r f e a r th an o t h e r g rou ps, and
................................................... 8 7
f o r the I n te r m e d ia te Defense group to e x p re ss lower f e a r
r e l a t i v e to o t h e r s u b j e c t s . T his was th e r e v e r s e o f what
was found f o r av o id an ce scores., where th e R e p resso rs demon-1
sjbrated th e l e a s t marked a v o id a n t b e h a v io r and th e I n t e r
m ediate D efense group th e g r e a t e s t a v o id a n t b e h a v io r. The
d is c r e p a n c ie s i n th e r e l a t i o n s h i p s o f f e a r and avoidance
!
c r i t e r i a w ith th e Defense v a r i a b l e c h a lle n g e th e n o tio n
i
t h a t f e a r and av o id an ce a re i n t i m a t e l y and i n e v i t a b l y r e - i
l a t e d .
R e la tio n s h ip betw een Defense
and T reatm ent E f f e c t i v e n e s s ''
When t r e a tm e n t e f f e c t i v e n e s s i s averaged over the
th r e e forms o f th e r a p y , R e p re s s o rs ap p ear to dem onstrate
l e s s s u b s t a n t i a l improvement th an o t h e r s u b j e c t s . This J
c o n c lu sio n i s d e riv e d p r i m a r i l y from th e f a c t t h a t R epres
s o rs o b ta in h ig h e r s c o re s on b o th s u b j e c t iv e f e a r and
avoidance s c a l e s fo llo w in g tr e a tm e n t. One c o n tr a d ic tio n
to the above i s found i n th e p r e - p o s t d i f f e r e n c e sc o res on
th e Fear Thermometer, where R e p re s s o rs show g r e a t e r change
i n f e a r r a t i n g s than I n te r m e d ia te D efense s u b je c ts (though
l e s s change th a n S e n s i t i z e r s ) . However, the l a r g e r d i f f e r
ence Bcores c h a r a c t e r i z i n g th e R e p re sso r group may be a t
t r i b u t e d i n p a r t to th e f a c t t h a t t h i s group o b ta in e d i n i
t i a l ( p r e - th e r a p y ) r a t i n g s which were h ig h e r than o th e r
gro u p s, and to th e f a c t t h a t d i f f e r e n c e s c o re s c o r r e l a t e d
p o s i t i v e l y w ith such i n i t i a l B cores.
88
The R e p re s s o r group a ls o r e p o r t e d g r e a t e r s u b je c tiv e
f e a r during sc en e s 2, 4, and 6 th an o t h e r s u b j e c t s . Pear
I
r a t i n g s by R e p re s s o rs d u rin g tr e a tm e n t c o r r e l a t e d h ig h e r j
w ith p o s t- th e r a p y f e a r and av o idance c r i t e r i a than did the
f e a r r a t i n g s d u rin g tr e a tm e n t o f o t h e r s u b j e c t s . The Re-
pressorB a re , i n f a o t , th e o n ly group to p ro v id e su p p o rt I
f o r th e Wolpe h y p o t h e s is o f a p o s i t i v e and s i g n i f i c a n t c o r- i
j
r e l a t i o n between l e v e l o f a n x ie ty d u rin g tre a tm e n t and poBt i
th e ra p y f e a r o r a v o id a n c e m easures. The m o d erately h igh
and s i g n i f i c a n t c o r r e l a t i o n (.4 7 ) between s u b je c tiv e f e a r
during tre a tm e n t and p o s t - t h e r a p y a v o id a n c e , a s w e ll as the
moderate b u t n o n - s i g n i f i c a n t c o r r e l a t i o n (.3 9 ) between f e a r
during tre a tm e n t and p o s t - t h e r a p y F e a r Thermometer ra tin g B
su p p o rts the n o tio n t h a t , a t l e a s t f o r R e p re ss o rs, h ig h |
l e v e ls o f a n x ie ty d u rin g v i s u a l i z a t i o n may d e t r a c t (as
Wolpe suggested) from th e e f f e c t i v e n e s s o f tre a tm e n t.
The R e p re s s o rs a re d i s t i n g u i s h e d from o th e r s u b je c ts
a ls o by v i r t u e o f t h e i r p o s i t i v e and s i g n i f i c a n t c o r r e l a
t io n s (R = .72) betw een p o s t - t h e r a p y f e a r and p o s t- th e r a p y
avoidance m easures. One may s p e c u la te on the b a s i s o f the
p o s i t i v e c o r r e l a t i o n s betw een p o s t - t h e r a p y f e a r and a v o id -
. ance and between s u b j e c t i v e f e a r d u rin g tr e a tm e n t and p o s t
th era p y avoidance t h a t among R e p re ss o rs f e a r and avoidance
b e h av io r a re i n t i m a t e l y r e l a t e d . That i s to say, R epressor
s u b je c ts r e a c t to f e a r by a v o id in g th e f e a r f u l stim u lu s .
This c o n clu sio n i s su p p o rte d by th e c h a r a c t e r i s t i c d e lin e a -
4
t i o n o f R e p resso rs a s i n d i v i d u a l s who w ithdraw o r r e t r e a t
from so u rces o f s t r e s s .
I
The S e n B itiz e r s ap p ea r to d e riv e th e g r e a t e s t "bene- !
f i t from tr e a tm e n t. T h is i s r e f l e c t e d b o th by t h e i r lower
p o s t- th e r a p y av o idance and s u b j e c t iv e f e a r s c o re s , and by
t h e i r g r e a t e r p r e - p o s t change ( d i f f e r e n c e sc o re s) on th e
j
P ear Thermometer. The o n ly c o n t r a d i c t o r y evidence occu rs
w ith r e s p e c t to d i f f e r e n c e s c o re s on th e Avoidance S cale.
On t h i s l a t t e r v a r i a b l e , th e S e n B itiz e r s show s l i g h t l y l e s s
change than I n te r m e d ia te Defense s u b j e c t s (a lth o u g h sub
s t a n t i a l l y g r e a t e r change than R e p r e s s o r s ) . Again, th e
f a c t t h a t i n i t i a l f e a r r a t i n g s o f S e n s i t i z e r s were lower
than I n te r m e d ia te s , a s w e ll a s vth e f a c t t h a t d i f f e r e n c e
i
sc o re s c o r r e l a t e d p o s i t i v e l y w ith p r e - t h e r a p y s c o re s , must j
be taken i n to a c c o u n t.
Another f in d in g which d i f f e r e n t i a t e s S e n s i t i z e r s
from o th e r s u b je c ts i s t h e i r more marked r e d u c tio n in sub
j e c t i v e f e a r o v e r r e p e t i t i o n s o f v i s u a l i z a t i o n on Beenes 2,
4, and 6. I t i s p l a u s i b l e t h a t S e n s i t i z e r s , by v i r t u e o f
t h e i r tendency to c o n f r o n t r a t h e r th an r e t r e a t from a n x ie ty ,
have developed more e f f i c i e n t means o f h a n d lin g and re d u c
in g a n x ie ty . One m ight s p e c u la te t h a t t h i s s p e c i a l c a p a c ity
to cope w ith and red u c e a n x ie ty b re a k s down when a n x ie ty
becomes more i n t e n s e , a s i n th e l a t e r s ta g e s o f tre a tm e n t
(scen es 8 and 10) where S e n s i t i z e r s show no g r e a t e r re d u c
t i o n in f e a r o v e r r e p e t i t i o n s o f scen es th a n o t h e r s u b j e c t s .
90
The c o r r e l a t i o n s between p o s t - t h e r a p y f e a r and
avoidance s c o re s and betw een f e a r d u rin g tr e a tm e n t and
p o s t- th e r a p y f e a r and avoidance c r i t e r i a a re low and non
s i g n i f i c a n t i n th e S e n s i t i z e r gro u p . I t would a p p ea r,
th e r e f o r e , t h a t f e a r and avoidance b e h a v io r a re l a r g e l y
in dependent o f one a n o th e r in th e S e n s i t i z e r p o p u la tio n .
That i s to say, av oidance b e h a v io r i s n o t n e c e s s a r i l y the
consequence o f f e a r o r a n x ie ty among S e n s i t i z e r s . Such a
co n clu sio n i s i n accordance w ith th e c l i n i c a l d e s c r i p t io n s
o f S e n s i t i z e r s as i n d i v i d u a l s who c o n fro n t r a t h e r than r e
t r e a t from th e so u rce o f a n x ie ty .
S u b je c ts i n th e I n te r m e d ia te Defense group appear
to b e n e f i t from tr e a tm e n t to a g r e a t e r e x t e n t than do Re
p r e s s o r s , b u t to a l e s s e r e x te n t th an S e n s i t i z e r s . The
I n te rm e d ia te Defense s u b j e c t s o b t a i n p o s t- t h e r a p y f e a r and
avoidance s c o re s which l i e in te r m e d ia te betw een th o s e o f
S e n s i t i z e r s and R e p r e s s o r s . On one c r i t e r i o n , p r e - p o s t
d i f f e r e n c e s c o re s on th e P ear Thermometer, In te r m e d ia te s
dem onstrate l e s s Improvement th an o t h e r g ro u p s, b u t again,
t h e i r i n i t i a l l y lower s u b j e c t iv e f e a r s c o r e s must be taken
in to .account. The low c o r r e l a t i o n s between p o s t- th e r a p y
f e a r and avoidance b e h a v io r and between s u b je o tiv e f e a r
during tre a tm e n t and p o s t - t h e r a p y f e a r and avoidance c r i
t e r i a f o r the I n te r m e d ia te Defense group su g g e st avoidance
b e h a v io r to be in d e p e n d e n t o f f e a r . As i n th e case o f the
S e n s i t i z e r group, av o id an ce b e h a v io r would n o t ap p ear to be
91
th e i n e v i t a b l e nor custom ary re s p o n se to a n x ie ty . I t i s
p l a u s ib l e t h a t the absence o f any s i g n i f i c a n t r e l a t i o n s h i p
between f e a r and avoidance b e h a v io r among I n te r m e d ia te De-
j
fe n se s u b je c ts i s r e f l e c t i v e o f th e c a p a c i ty o f th e s e p re
sumably more w e ll a d ju s te d s u b j e c t s to r e a c t p r i m a r i l y by
env iro nm ental as opposed to i n t e r n a l cu es.
j
The I n t e r r e l a t i o n s h i p s between l e v e l o f d e fe n se and !
i
th e e f f e c t i v e n e s s o f th e v a r i o u s ty p e s o f t r e a tm e n t p r e s e n ts
some i n t e r e s t i n g t h e o r e t i c a l c o n s i d e r a t i o n s . The i n t e r a c - j
t i o n d e s ig n a tin g the r e l a t i o n s h i p between D efense Level,-
type o f th era p y (T reatm ent) and changes in s u b j e c t i v e fe a r
(P re -p o s t) r e f l e c t s th e f a c t ’ t h a t , f o r S e n s i t i z e r s and Re
p r e s s o r s , the In te rm e d ia te A n x iety T reatm ent i s th e most
e f f e c t i v e and the lm p lo s iv e ly b ased (High A nxiety) t r e a t - j
ment the l e a s t e f f e c t i v e i n re d u c in g s u b j e c t iv e f e a r . In J
i
th e case o f the I n te r m e d ia te D efense s u b j e c t s , by c o n t r a s t ,
th e lm p lo siv e ly o r ie n te d tr e a tm e n t i s th e most e f f e c t i v e ,
w h ile the In te rm e d ia te A n x ie ty T reatm ent i s the l e a s t e f f e c
t i v e . I f one a c c e p ts th e p rem ise t h a t b o th h ig h and low
s c o re s on the R-S s c a le a re r e f l e c t i v e o f an i n o r d in a n t de
fe n s iv e n e s s and t h a t i n te r m e d i a t e s c o re s a re i n d i c a t i v e o f
em otio nal s t a b i l i t y , th en i t may be s p e c u la te d t h a t Implo
s iv e Therapy i s e s p e c i a l l y s u i t a b l e to "normal" s u b j e c t s ,
b u t in a p p r o p r ia te f o r th e more p a th o l o g i c a l s u b j e c t s . I t
I s p l a u s ib l e t h a t the more h e a l t h y s u b j e c t s can t o l e r a t e
and make a d a p tiv e use o f th e e x p e rie n c e o f h ig h l e v e l s o f
9 2
a n x ie ty during tr e a tm e n t, b u t t h a t f o r more d is t u r b e d sub
j e c t s th e e v o c a tio n o f h ig h l e v e l s o f a n x ie ty h a s a d i s r u p
t i v e e f f e c t on th e ra p y . The mechanism by which th e a n x ie ty ;
m ight f a c i l i t a t e o r i n t e r f e r e w ith th e e x t i n c t i o n p ro c e ss
i s open to s p e c u la tio n . One s p e c u la tio n which d e se rv e s
f u r t h e r e x p lo ra tio n i s t h a t a n x ie ty o p e r a t e s d i r e c t l y on
!
th e c l a r i t y o f im agery, en h an cin g th e q u a l i t y o f im agery f o r
s u b j e c t s whose c o g n itiv e f u n c t i o n s a re a c c e l e r a t e d by an - j
i
x i e t y , and I n t e r f e r i n g w ith th e im agery o f s u b j e c t s who
c h a r a c t e r i s t i c a l l y b lock o r become d i s t r a c t e d i n resp o n se
to a n x ie ty . I t m ight a ls o be i n t e r e s t i n g to t e s t th e gen
e r a l i t y o f the d i f f e r e n t i a l re s p o n se to t r e a tm e n t on o th e r
forms o f p sy ch o th erap y . For exam ple, i n view o f the p r e s e n t
f in d in g s , one m ight p r e d i c t t h a t h ig h p r e s s u r e , e m o tio n a lly
i n te n s e t h e r a p ie s such as m arath o n s and e n c o u n te r groups .
would be o f most value to r e l a t i v e l y w e ll a d ju s te d s u b je c ts
and t h a t more n e u r o tic s u b j e c t s would d e riv e a g r e a t e r p r o f
i t from slower paced, lesB i n t e n s e forms o f tr e a tm e n t.
The f in d in g o f th e p r e s e n t stu d y , t h a t R e p re sso rs
and S e n s i t i z e r s r e a c t s i m i l a r l y to each o t h e r and d i f f e r
e n t l y from I n te rm e d ia te D efense s u b j e c t s in re sp o n se to
p sy c h o th era p y c o n tra d ic tB th e f i n d in g s o f p re v io u s s tu d i e s
by Speisman e t a l . (1964) and P io raw sk i ( 1 9 6 7) which sug
g e s te d t h a t R e p resso rs and S e n s i t i z e r s s u b j e c t s responded
d i f f e r e n t i a l l y to v a rio u s te c h n iq u e s o f s t r e s s r e d u c t io n .
E x p e rim e n ta l C o n d itio n s
I t i s c l e a r .from th e a n a l y s i s o f v a ria n c e o f the
i
P e a r Thermometer S co res o b ta in e d d u rin g tr e a tm e n t (FT) t h a t I
th e e x p e rim e n ta l m a n ip u la tio n s accom plished th e d e s ir e d e f
f e c t o f c r e a t i n g d i f f e r e n t i a l l e v e l s o f a n x ie ty . That i s
to say, the use o f m u scu lar te n s io n produced a l e v e l o f
a n x ie ty h ig h e r th a n t h a t o f f i n g e r ta p p in g and t h a t the u s e !
i
o f m uscular r e l a x a t i o n c r e a t e d a c o n d itio n c h a r a c t e r i z e d b y '
an a n x ie ty l e v e l low er th an t h a t o f e i t h e r o f th e o th e r two
tr e a tm e n ts .
A word needs to be s a i d abo ut th e r e l a x a t i o n o f the
req u ire m e n t in th e Wolpean b a se d (Low A nxiety) tre a tm e n t
t h a t a n x ie ty to a g iv en scene be c o m p le te ly e x tin g u is h e d
b e fo re subsequent sc en e s a re p r e s e n te d . In th e s t r i c t e s t
se n se , the p ro c e d u re s fo llo w ed i n th e Low A nxiety c o n d itio n
d id n o t meet th e c r i t e r i a f o r th e S y stem atic D e s e n s l t iz a -
t i o n by R e c ip ro c a l I n h i b i t i o n te c h n iq u e , sin c e on o n ly th e
f i r s t two scenes was th e a v erag e l e v e l o f a n x ie ty brou g h t
down to the a v erag e (b ase) l e v e l r e p o r t e d by s u b j e c t s j u s t
p r i o r to t r e a tm e n t. P re c e d e n t e x i s t s , however, f o r the
abandonment o f th e s t r i c t a n x ie ty s u p p re s s io n re q u ire m e n t.
C a u te la ( 1966) i n tr o d u c e d a v a r i a t i o n o f W olpe's procedu re
which had the e f f e c t o f expo sing s u b j e c t s to doses o f a n x i
e t y l a s t i n g up to 15 seconds b e f o r e r e i n s t a t i n g r e l a x a t i o n ,
and re p o r te d r e s u l t s com parable to W o lp e 's. Rachman ( 1965)
and Davison ( 1 9 6 5) lik e w is e abandoned th e s t r i n g e n t r e -
” ....... 9b
quirem ent o f com plete a n x i e t y s u p p re s s io n i n o r d e r to f o l
low a s ta n d a rd iz e d h i e r a r c h y and p r e s e n t a t i o n sc h e d u le .
A nother assum ption b a s i c to b o th th e Wolpe and
Stam pfl methods of t r e a tm e n t i s t h a t t h e r e be a r e d u c tio n
o f a n x ie ty w ith r e p e t i t i o n s o f v i s u a l i z a t i o n . In th e p r e s
e n t stud y, r e d u c tio n o f f e a r w ith r e p e t i t i o n o f scenes was
!
d em o nstrated s t a t i s t i c a l l y i n f i v e o u t o f th e f i v e a n a ly s e s ‘
u n d e rta k e n .
T h e r a p e u tic E f f e c t
Although th e F r a t i o f o r a P r e - p o s t e f f e c t f e l l
s l i g h t l y s h o rt o f th e .0 5 l e v e l o f s i g n i f i c a n c e , th e r e i s
evidence o f s u b s t a n t i a l improvement on b o th f e a r and a v o id
ance c r i t e r i o n m easures f o r a l l t h r e e tr e a tm e n t c o n d itio n s , j
!
I
The two s e s s io n s u se d i n th e p r e s e n t stu d y i s c o n s id e r a b ly
j
lesB than the custom ary number u se d i n most o t h e r R e c ip ro c a l
I n h i b i t i o n ex perim en ts (D avison, 1965; Rachman, 1 9 6 5; Wolpe,
i 9 6 0) which have d e m o n s tra te d u n e q u iv o c a l t r e a tm e n t e f f e c t s ,
alth o u g h a number o f o t h e r s t u d i e s (M yerhoff, 1 9 6 8; Hogan
and K irch n er, 1967; K irc h n e r and Hogan, 1 9 6 6) have demon
s t r a t e d a s i g n i f i c a n t change w ith in two o r t h r e e s e s s io n s
u sin g im p lo siv e ly b a se d t h e r a p i e s .
CHAPTER IV
SUMMARY
The r e la t io n s h ip betw een the l e v e l o f a n x ie ty which j
occu rs during v i s u a l i z a t i o n in d e s e n s it i z a t io n therapy and j
th e e f f e c t i v e n e s s o f trea tm en t was in v e s t i g a t e d . Three
hyp oth eses were sim u lta n e o u sly t e s t e d . A ccording to the
R e cip ro ca l I n h ib itio n th eo ry o f Joseph Wolpe i t was p r e
d ic te d th a t the g r e a t e s t improvement would occu r when a n x i
e ty was most thorough ly su p p ressed . The Im ploBive theory
o f Thomas Stam pfl, on the o th e r hand, p r e d ic te d th a t t r e a t - j
ment would be op tim al when a n x ie ty was m axim ized. A th ir d ;
i
h y p o th e sis p r e d icte d th a t th e r e la t io n s h ip between a n x ie ty J
and improvement was c u r v il i n e a r , or th a t trea tm en ts which
cause e it h e r a su p p ressio n or i n t e n s i f i c a t i o n o f a n x ie ty
during v i s u a liz a t io n would be a s s o c ia te d w ith g r e a te r im
provement than a trea tm en t in which a n x ie ty i s m aintained
a t an in term ed ia te l e v e l .
A secondary problem o f the stu d y concerned the r e
la t io n s h ip between an i n d i v i d u a l ' s d e fen se o r ie n t a t io n , as
measured by the Byrne R e p r e s s io n - S e n s it iz a t io n S c a le , and
h i s a b i l i t y to p r o f i t from th e v a r io u s forms o f d e s e n s i t i
z a tio n therapy. S p e c i f i c a l l y , i t was p r e d ic te d th a t Re- .
95
96
p resso rs would b e n e f i t more from Low A n xiety treatm en t than
from In term ed ia te or High A n xiety tr e a tm e n ts, and th a t
S e n B itiz e r s would im prove more w ith High A n xiety treatm ent j
than wlthrLow or In ter m ed ia te A n xiety tre a tm en ts.
F if t y - f o u r snake and r a t ph obic su b je c ts were r e
c ru ite d from undergraduate p sy ch o lo g y c l a s s e s . P rior to ;
therapy each s u b je c t was a d m in istered th e R-S te B t, and
i
measures o f fe a r and avoidance were o b ta in ed in the presen ce
o f the fea r e d anim al. S u b je cts were a ssig n e d to ^ th ree equal
groups on th e b a s i s o f :t h e i r ;s c o r e s on the R-S t e s t . Sub
j e c t s from each group were then a s s ig n e d a t random to a
High, Medium, or Low A n x iety treatm en t c o n d itio n . In the
Low A nxiety c o n d itio n s u b je c ts were in s tr u c t e d to r e la x
during v i s u a l i z a t i o n . In the In ter m ed ia te A n xiety co n d i
tio n s u b je c ts perform ed a r o u tin e motor task|[during v i s u a l
i z a t i o n ./ S u b je c ts in th e High A n x iety c o n d itio n ten sed
t h e ir m uscles .during v i s u a l i z a t i o n . A ll s u b je c ts v i s u a l
iz e d scen es in v o lv in g approach to th e fea r ed animal from a
stan d ard ized h ie r a r c h y , and r ep o rted e s tim a te s o f t h e ir
fea r fo llo w in g each v i s u a l i z a t i o n .
None o f th e h y p o th eses con cern in g the e f f e c t o f
a n xiety on trea tm en t e f f e c t i v e n e s s were borne o u t. Sub
j e c t s in th e th r ee trea tm en t c o n d it io n s did not d i f f e r w ith
r esp ec t to improvement on fea r or avoidance c r i t e r i a , nor
w ith r e s p e c t to d e c r e a s e s in th e f e a r r a t in g s which were
taken during trea tm en t i t s e l f . Contrary to the p r e d ic tio n s
97
drawn from th e t h e o r i e s o f Wolpe and S ta m p fl, a s w e ll as
the c u r v i l i n e a r h y p o t h e s is , th e r e was no r e l a t i o n s h i p b e
tween the m agnitude o f f e a r r e p o r te d d u rin g v i s u a l i z a t i o n
i
and p o s t- th e r a p y f e a r and avoidance c r i t e r i a .
The s p e c i f i c h y p o th e se s c o n ce rn in g an i n t e r a c t i o n
between defense o r i e n t a t i o n and type o f th e ra p y were l i k e -
i
wise n ot borne o u t . There was no ev id e n ce t h a t R epressors
improved more from th e Low A nxiety tr e a tm e n t than from j
o th e r tr e a tm e n ts , n o r t h a t S e n s i t i z e r s p r o f i t e d more from
th e High A nxiety t r e a tm e n t. A s i g n i f i c a n t i n t e r a c t i o n b e
tween defense and ty p e o f th e ra p y d id o c c u r, however, and
r e f l e c t e d th e f a c t t h a t S e n s i t i z e r s and R e p re sso rs improved
more from th e Low and I n te r m e d ia te A n xiety c o n d itio n s than
from th e High A nxiety tr e a tm e n t, and t h a t th e In te rm e d ia te
Defense s u b je c ts im proved most from th e High A nxiety t r e a t
ment. An e x p la n a tio n b ased on a d i f f e r e n t i a l to le ra n c e fo r
a n x ie ty was pro p o sed to acco u n t f o r th e o b ta in e d i n t e r a c
t i o n s .
The e m p ir ic a l r e l a t i o n s h i p betw een f e a r and a v o id
ance m easures was a ls o d is c u s s e d . The u b iq u ito u s , in tim a te
r e l a t i o n s h i p betw een f e a r and avoidance b e h a v io r which i s
im p lied in th e w r i t i n g s o f Wolpe and S tam pfl was challen g ed
by th e f in d in g s o f th e p r e s e n t stu d y , which suggested t h a t
th e two b e h a v io rs may be q u i te i n d e p e n d e n f o f one a n o th e r.
The p r e - th e r a p y c o r r e l a t i o n between f e a r and avoidance
m easures was .01, a s c o n t r a s t e d to th e .5 2 c o r r e l a t i o n
which o c c u rre d fo llo w in g th e r a p y . E x p la n a tio n s f o r th e
r i s e in c o r r e l a t i o n b ased on d i s c r im i n a t io n l e a r n in g , s e t
form atio n, and n o n s p e c i f i c , e x p e rim e n ta l a n x ie ty were pro
posed.
A P P E N D I X E S
99
APPENDIX A
PEAR SU R V E Y SC H E D U L E
Name: Age M ale: Fem ale: i
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - j
T his q u estion n aire co n ta in s a l i s t o f some o f the many th in g s and ;
s itu a tio n s th a t can make peop le uncomfortable., fe a r fu l, or a n x io u s.
P lea se check, in th e app rop riate column to th e r ig h t o f each statem en t, !
th e amount o f fe a r or a n x ie ty th a t each produces in you. I f you are
n ot su re, make a gu ess. P lea se answer every item . :
Thank you fo r your coop eration .
: i
i
1 . Crawling in s e c ts
None A L it t le
A F a ir
Amount Much
Very
Much
2 . F ly in g In se c ts
3 . F ire
4 . Mice
5 . Going up in an a ir lin e
6 . L izards
7- H igh.-places on land
8 . Being in a sm all, c lo se d room
9* The dark
1 0 . Snakes
H . The unknown
12. Frogs
1 3 . S u rg ica l op eration s
lif . Spiders
1 5 . Rats
100
APPENDIX B
AVOIDANCE SCALE
Score B e h av io r !
1...........................................removing the anim al from c ag e, h o l d i n g s
10 seconds o r more
2...........................................l i f t i n g the anim al w ith h a re h a n d s, b u t
n o t removing i t from cage
3..............................................re a c h in g in to cage, poking an im al w ith
b a re hands
4....................................... re a c h in g in to cage, poking an im al w ith
r u b b e r glove
5...........................................r e a c h in g in to cage, b u t n o t to u c h in g
an im al, ru b b er glove on hand
6.............................................. to u ch in g o u ts id e o f cage w ith b a re handj
S lo o k in g down a t anim al
7 sta n d in g over open cage, lo o k in g down
a t anim al
8.............................................. s ta n d in g w ith in two f e e t o f th e open
cage w ith anim al v i s i b l e i n s i d e
9 sta n d in g w ith in fo u r f e e t
10.............................................. s ta n d in g six f e e t o r more from cage
101
APPENDIX C
CRITERION TESTS
P re -T re a tm e n t C r i t e r i o n T e s t s :
1. As S s t e p s i n t o th e room, stop him a t th e door* and
p o i n t to th e cage a c r o s s th e room., and say: !
"You i n d i c a t e d by the item s you checked on th e Pear j
Survey t h a t you a re a f r a i d o f ________________ . We
have h e re a h a rm less i n t h a t cage.
You can see i t throu gh the f r o n t o f th e c ag e. I
would l i k e you to approach as c l o s e l y aB you c a n ."
2. I n s u r e t h a t th e anim al i s v i s i b l y moving in th e cage.
i
As S moves clo ser, wait u n til he reaches hiB c lo se st
point, wait 15 seconds, then say:
"I a s s u r e you t h a t the ________________ i s h a rm le ss and
t h a t i t w i l l n o t jump out o f th e c ag e. May I urge
you to approach a s c lo s e a s you c a n ."
3 . As long a s S moves to th e next c l o s e s t avo idance sc o re
p o i n t w i th in 15 seconds, r e q u e s t a g ain t h a t he move y e t
c l o s e r o r engage in th e n e x t h ig h e r b e h a v io r on th e
Avoidance S c a le . Assign th e a p p ro p r ia te sc o re (AS)
when S r e f u s e s to move any c lo s e r ( i . e . , say s "no") o r
rem ains where he i s f o r 15 seconds, a f t e r y o u r l a s t r e
q u e s t. Begin tim ing a f t e r each s ta n d a rd u r g in g r e q u e s t .
102
I f S r e t r e a t s from a c lo s e r to a more d i s t a n t p o i n t ,
b u t was a t a c l o s e r p o i n t f o r 15 second s, h i s avoidance j
!
sc o re i s ta k e n a t th e c lo s e r p o i n t. I f he r e t r e a t s j
b e fo re th e 15 second w a itin g p e rio d , th e n a sk him ag ain
to app ro ach a s c lo s e l y as p o s s ib l e , as above.
4. While S i s a t h i s c l o s e s t approach p o i n t , o r im m ed iately
|
a fte r w a r d s i f he r e t r e a t s , ask him to r a t e h i s s u b je c
t i v e f e a r on th e F ear Thermometer as f o llo w s :
"Try to r a t e your f e e l in g as a c c u r a t e l y as p o s s i b l e
by a s s ig n in g i t a number from 1 -1 0 where 1 r e f e r s
to f e e l i n g as calm as you have ev er been and 10
r e f e r s to f e e l in g aB fr ig h te n e d as you have e v er
been b e f o r e . "
P o s t-T re a tm e n t C r i t e r i o n T e s t s :
Perform th e p o s t - t r e a tm e n t c r i t e r i o n t e s t i n an i d e n t i
c a l manner as d e s c r ib e d f o r the p r e - t r e a t m e n t c r i t e r i o n
t e s t . Begin a t th e c l o s e s t p o in t o f approach a c h ie v e d in
th e p r e - t r e a t m e n t c r i t e r i o n t e s t and r e q u e s t a f e a r r a t i n g
a t t h a t p o i n t .
APPENDIX D
SNAKE PEAR HIERARCHY
1. Looking a t a p i c t u r e o f a snake.
2. Standing a t the door w atching the snake e n c lo s e d in the
g l a s s cage.
3. Standing s ix f e e t from the cage, seeing th e snake moving
around a l i t t l e . !
I
I
1
4 . Standing r i g h t in f r o n t o f th e cage, lo o k in g down a t the
snake moving around a l i t t l e .
5. P la cin g y o u r b a re palm a g a in s t the g l a s s n e a r th e snake.
6 . Wearing a ru b b e r g lo v e , reach in g in to the cage a l i t t l e ,
b u t n o t tou ch in g th e snake, moving a l i t t l e b i t .
7 . Wearing a g lo v e , re a c h in g in and poking th e sn ak e.
8 . Barehanded, r e a c h in g in and poking th e snake a l i t t l e
b i t .
9. Barehanded, r e a c h in g in and l i f t i n g th e Bnake i n h i s
cage, j u s t s l i g h t l y . You can f e e l th e s c a l e s o f h i s
sk in and f e e l h i s m uscles as he moves in y o u r hand s.
He d o e s n 't b i t e .
10. Removing th e anim al from the cage, h o ld in g him i n y our
b a re h ands. P i c tu r e y o u r s e l f s tro k in g him a c r o s s h i s
back as he c raw ls o v e r your hands and arms.
T reatm ent s e s s io n 1 w i l l c o n s i s t o f f iv e r e p e t i t i o n s
o f ite m s 1 and 2; s i x o f item 3; seven o f ite m 4;
e i g h t o f ite m 5 \ and nine o f item 6.
Treatm ent s e s s io n 2 w i l l c o n s i s t o f one p r e s e n t a t i o n
o f item s 1-6; and te n each o f item s 7-10.
APPENDIX E
TREATMENT ORIENTATION
T h e 'f o llo w in g g e n e r a l i n s t r u c t i o n s w i l l h e g iv e n !
e a c h S by th e t h e r a p i s t a t th e b e g in n in g o f th e f i r s t t r e a t - |
m ent p r o c e d u re :
D u rin g th e n e x t two s e s s io n s we w i l l b e e n g ag in g i n a
B et o f p r o c e d u r e s w hich a r e d e riv e d from b e h a v io r t h e r
a p y . P re v io u s r e s e a r c h i n d i c a t e s t h a t th e te c h n iq u e s
w hich we a r e u s in g a re h i g h ly e f f e c t i v e i n re d u c in g
f e a r s . D uring th e e x p e rim e n t f o r w hich you have v o lu n
t e e r e d , th e te c h n iq u e s w i l l be u se d to re d u c e y o u r f e a r
o f ______________. . In th e f u t u r e you may be a b le to a p p ly
th e p r i n c i p l e s w hich you l e a r n d u rin g t h i s e x p e rim e n t
to o t h e r f e a r s b e s id e _____________ s . At th e p r e s e n t !
tim e , how ever, we a re i n t e r e s t e d o n ly i n w orking w ith j
y o u r f e a r o f _________ . I w ish to em p h asize t h a t a t ,
no tim e d u r in g ’ t h e ’ e x p e rim e n t w i l l you be a sk e d t o do j
a n y th in g w hich you do n o t w a n t. T here i s no. h id d e n !
agenda i n th e e x p e rim e n t; you w i l l n o t be d e c e iv e d o r
e m b a rra s s e d i n any way. You may le a v e th e e x p e rim e n t
a t any tim e i f i t sh o u ld become too u n p le a s a n t.— a lth o u g h
I am s u re t h a t t h i s w i l l n o t o c c u r. B ecause c o n s i d e r
a b le tim e and p r e p a r a t i o n w i l l be s p e n t i n w orking w ith
y o u , we e x p e c t t h a t you w i l l be c o n s c i e n ti o u s in k e e p in g
y o u r a p p o in tm e n ts . I s t h i s s a t i s f a c t o r y w ith you? The
p ro c e d u r e w i l l be e x p la in e d f u l l y a s we c o n tin u e .
The b a s i c t r e a tm e n t p ro c e d u re c o n s i s t s o f r e p e a t e d l y im
a g in g th e s i t u a t i o n s w hich you a re a f r a i d o f . D uring
t r e a tm e n t I w i l l a sk you to p r a c t i c e im a g in in g th e
s c e n e s i n t h i s l i s t . The l i s t i s i n th e c o r r e c t o r d e r
f o r m ost p e o p le , w ith th e m ost f e a r f u l s c e n e s a t th e
b o tto m o f th e l i s t . . . ( E p r e s e n t s a copy o f th e a p p r o p r i
a t e h i e r a r c h y ) . . . 1 would l i k e to make s u r e th e l i s t i s
i n th e c o r r e c t o r d e r f o r you, so I w ould l i k e you to
105
a s s ig n to e ac h o f th e 10 ite m s a number on t h e 10 p o i n t
f e a r s c a l e w hich r e p r e s e n t s how f e a r f u l you w ould be
a b o u t p e rfo rm in g e ac h a c t i v i t y on th e l i s t . Remember,
1 r e p r e s e n t s b e in g a s calm a s you have e v e r b e e n , and
10 b e in g a s f r i g h t e n e d a s you have e v e r b e e n . ' j
T ra n k s th e h i e r a r c h y ite m s in o r d e r o f m ag n itu d e
o f f e a r r a t i n g s and r e s o l v e s t i e s by a s s ig n in g t h e h ig h e r
ra n k a c c o rd in g to p o s i t i o n i n th e o r i g i n a l l i s t . T th e n
!
t e s t s Ss a b i l i t y to v i s u a l i z e by a sk in g S to im a g in e a fami-r
l i a r scen e su c h a s Ss house o r a u to m o b ile . T d e te rm in e s |
w h e th e r th e im age i s a t l e a s t a s c l e a r a s a v i v i d memory
and w h e th e r S can s t a r t and s to p th e im age upon r e q u e s t .
I f S haB d i f f i c u l t y i n e i t h e r r e s p e c t , he w i l l be g iv e n
a d d i t i o n a l p r a c t i c e w ith a few o t h e r f a m i l i a r s c e n e s . T
i s to make n o te o f Ss comments and c o n tin u e as f o llo w s :
One o f th e p u rp o s e s o f th e e x p e rim e n t i s to compare
th e e f f e c t o f c e r t a i n body c o n d itio n s on t r e a t m e n t . ,
These c o n d it i o n s i n c lu d e r e l a x a t i o n , t e n s i o n , and
d i r e c t e d m u sc u la r a c t i v i t y . D i f f e r e n t t h e o r i e s su g
g e s t t h a t e ac h one o f th e c o n d itio n s s h o u ld be b e n e
f i c i a l to t r e a tm e n t. We wiBh to d e te rm in e w h ich co n
d i t i o n i s , i n f a c t , th e b e s t . The e v id e n c e and t h e o
r e t i c a l r a t i o n a l e b e h in d th e s e p ro c e d u re s w i l l be
e x p la in e d a f t e r th e e x p e rim e n t i f you a r e i n t e r e s t e d .
APPENDIX F
RELAXATION CONDITION
T w i l l b e g in t r e a tm e n t by e x p la in in g th e f o llo w in g to S:
S in c e you have b een chosen a s a S in th e m u sc u la r r e l a x - ;
a t i o n c o n d it i o n , I am g o in g to b e g in by a s k in g you to
r e p e a t some o f th e e x e r c i s e s you le a r n e d d u rin g th e l a s t
s e s s io n i n o r d e r to p ro d u c e a s t a t e o f deep r e l a x a t i o n . |
The p ro c e d u re w i l l be s l i g h t l y d i f f e r e n t t h i s tim e s in c e !
I w i l l n o t a sk you to te n s e y o u r m u sc le s. I w ant you to ;
fo c u s y o u r a t t e n t i o n on th e d i f f e r e n t m u sc le s a s I r e f e r i
t o them and c o n c e n tr a te on r e l a x i n g them. CloBe y o u r j
e y e s . j
Now c o n c e n tr a te on r e l a x i n g th e m uscles i n y o u r r i g h t
hand and fo re a rm . A tte n d o n ly to th o se m u s c le s , and
n o te how th e y f e e l a s th e r e l a x a t i o n takeB o v e r , becom
in g more and more r e l a x e d .
(P ro c e e d to o t h e r m u scle g ro u p s w ith s i m i l a r i n s t r u c t i o n s s i
b i c e p s , l e f t hand and fo re a rm , s h o u ld e rs , t h r o a t , e t c . ) I
'W hile S re m a in s r e l a x e d , T o b t a i n s a r a t i n g from S on
t h e P e a r T herm om eter. (B ase L ev el o f a n x i e t y . ) |
l
T p ro c e e d s w ith t r e a tm e n t a s f o llo w s ;
a . R e i n s t a t e s r e l a x a t i o n i n s t r u c t i o n s and a s k s S to
rem a in r e l a x e d d u rin g v i s u a l i z a t i o n .
b . Reads f i r s t p r e s e n t a t i o n , i n q u ir i n g i n t o ad eq u acy
o f v i s u a l i z a t i o n .
c . T e rm in a te s v i s u a l i z a t i o n a f t e r 15 seco n d s and
r e q u e s t s f e a r r a t i n g .
d . R e p e a ts r e l a x a t i o n f o r 20 seconds b e f o r e n e x t
p r e s e n t a t i o n .
e . R e p e a ts e ach v i s u a l i z a t i o n o f a h ie r a r c h y ite m th e
number o f tim e s s p e c i f i e d by th e s c h e d u le , th e n
p ro c e e d s w ith th e n e x t h ig h e r ite m .
107
APPENDIX G
TENSION CONDITION
1. T w i l l b e g in t r e a tm e n t by e x p la in in g th e f o llo w in g to S:
S in c e you have b een chosen a s a S i n th e m u sc u la r t e n
s io n c o n d it i o n , I am go in g to b e g in by a s k in g you to
r e p e a t some o f th e e x e r c i s e s you le a r n e d d u rin g th e
l a s t s e s s i o n .
S i t q u a r e ly i n y o u r c h a i r w ith y o u r legB t o g e t h e r , f e e t
f l a t on th e f l o o r , h e e l s and to e s t o g e t h e r . Now r a i s e
y o u r t o e s a s h ig h a s you can o f f th e f l o o r w h ile k e e p in g
y o u r h e e l s on th e f l o o r . Now c le n c h y o u r f i s t s t i g h t l y .
Now hunch up y o u r s h o u ld e r s . Now g r i t y o u r t e e t h by
c le n c h in g y o u r jaw s t o g e t h e r . C lose y o u r e y e s t i g h t l y .
2. W hile S re m a in s t e n s e , T o b t a i n s a r a t i n g from S on th e
F e a r Therm om eter (B ase L ev el o f a n x i e t y ) . S may assum e
n o rm al p o s i t i o n .
3. T p r o c e e d s w ith tr e a tm e n t a s fo llo w s :
a . R e i n s t a t e s t e n s io n and a s k s S to rem ain te n s e d u rin g
v i s u a l i z a t i o n .
b . R eads f i r s t p r e s e n t a t i o n , i n q u i r i n g i n t o ad eq u acy o f
v i s u a l i z a t i o n .
c . T e rm in a te s v i s u a l i z a t i o n a f t e r 15 seco n d s and r e q u e s t s
f e a r r a t i n g ; a f t e r an a d d i t i o n a l 5 s e c o n d s , te r m in a t e s
m uscle t e n s i o n .
d . A llow s 15 se c o n d s o f nonm uscle t e n s io n and p r e s e n t s
n e x t v i s u a l i z a t i o n .
e . R e p e a ts e a c h v i s u a l i z a t i o n o f a h i e r a r c h y ite m th e
number o f tim e s s p e c i f i e d by th e s c h e d u le , th e n p r o
c e e d s w ith n e x t h ig h e r ite m .
1 0 8
APPENDIX H
FINGER TAPPING CONDITION
1. T w i l l b e g in tr e a tm e n t by e x p la in in g th e f o llo w in g to Ss
S in ce you have been chosen a s a S i n th e m o to r a c t i v i t y
c o n d it i o n , I am g o in g to b e g in by a s k in g you t o r e p e a t
some o f th e e x e r c i s e s you le a r n e d d u rin g th e l a s t s e s
s io n .
S i t c o m fo rta b ly i n y o u r c h a i r and p la c e b o th y o u r hands
on th e t a b l e . Now s t a r t w ith th e l i t t l e f i n g e r o f y o u r
l e f t hand and ta p each f i n g e r on y o u r l e f t h a n d on th e
t a b l e i n s u c c e s s io n a t a two second I n t e r v a l . W ith o u t
s to p p in g go on to th e thumb o f y o u r r i g h t hand and ta p
each o f th e f i n g e r s on th e t a b l e a t th e two seco n d i n
t e r v a l . When you have fin lB h e d , s t a r t w ith t h e l i t t l e
f i n g e r o f y o u r l e f t hand a g a in .
2. W hile S t a p s , T a s k s f o r a r a t i n g from S on t h e F e a r
Therm om eter (B ase L e v e l o f a n x i e t y ) .
3 . T p ro c e e d s w ith tr e a tm e n t a s fo llo w s :
a . R eads ta p p in g i n s t r u c t i o n s .
b . R eads f i r s t p r e s e n t a t i o n , i n q u i r i n g a s to ad eq u acy
o f v i s u a l i z a t i o n .
c . A f t e r 15 secondB t e r m in a te s v i s u a l i z a t i o n j a f t e r an
a d d i t i o n a l 5 se c o n d s, te r m in a te s t a p p in g .
d. Twenty se c o n d s a f t e r te r m in a tio n o f v i s u a l i z a t i o n ,
p r e s e n t s th e n e x t v i s u a l i z a t i o n .
e . RepeatB e a c h ite m th e number o f tim e s s p e c i f i e d by
th e sc h e d u le and th e n p ro c e e d s to th e n e x t h ig h e r
ite m i n th e h i e r a r c h y .
APPENDIX I
DESCRIPTION OF RESEARCH TO
POTENTIAL STUDENT VOLUNTEERS i
The p u rp o se o f t h i s stu d y i s to e v a l u a t e t h e e f f e c t i v e
n e s s o f v a r io u s form s o f p sy c h o th e ra p y i n r e d u c i n g f e a r s o f j
c e r t a i n s t i m u l i . S tu d e n ts who have f e a r s o f s m a ll a n im a ls , !
i n c l u d i n g r a t s , l i z a r d s , sn a k es, and s p i d e r s w i l l be a sk e d !
to v o l u n t e e r f o r th e e x p e rim e n t. There i s no h id d e n agenda
i n th iB s tu d y and you w i l l n o t be d e c e iv e d o r m is le d in any
way.
I w ant to s t r e s s t h a t Bince we a re a s k in g f o r s u b j e c t s
who have fe a rB , no one w i l l be fo rc e d to do a n y th in g he doee
n o t w ant to o r i s a f r a i d o f d o in g . No one w i l l b e t r e a t e d
d i s c o u r t e o u s l y o r d i s r e s p e c t f u l l y , o r w i l l b e a s k e d to do
a n y th in g e m b a rra s s in g o r h u m ilia tin g . A ll q u e s t i o n s w i l l
b e an sw ered a f t e r c o m p le tio n o f th e e x p e r im e n ta l task B .
The e n t i r e e x p e rim e n t w i l l r e q u i r e a p p ro x im a te ly
h o u rs o f y o u r tim e . S tu d e n ts who p a r t i c i p a t e w i l l be p a id
$ 5 -00 a t th e c o n c lu s io n o f th e e x p e rim e n t. T hose stu d e n tB
who have q u a l i f i e d f o r th e ex p erim e n t w i l l b e c o n ta c te d b y
phone w ith in th e n e x t two w eeks.
I t sh o u ld be em phasized t h a t most o f t h e p e o p le in o u r
s o c i e t y have some o f th e fearB on th e F e a r S u rv e y S c h e d u le ,
and t h a t no abnorm al c o n d itio n e f f e c t s th o s e who may have
one o r more o f th e f e a r s l i s t e d on th e S c h e d u le .
110
APPENDIX J
I
I
S U M M A R Y OF ANALYSIS O F VARIANCE FOR FEAR T H E R M O M E T E R SCORES O N SCENE 2 j
Source df SS M S F
P
Therapy ( j ) 2 171.25 85 .6 3
■ 5 .5 6
< .01
Defense (k) 2
28.3 1
l 4 . l 6 0 .9 1 NS
R ep e titio n s (L) 4
7 .7 6
1 .9 4 4.69 < .0 1
JXK 4 75.06 18.76 1 .22 NS
JXL 8 2 .0 4 .26 0 .6 1 NS
K X L 8 9.20 1.15
2 .7 9
< .0 1
JX K X L 16 3.87 .24 O.58 NS
Su bjects
45 692.99 15.39
S u bjects X R ep etitio n s 180 74.31 , 4 l
1 1 1
APPENDIX K
I
S U M M A R Y O P ANALYSIS O P V A R IA N C E FOR PEAR T H E R M O M E T E R SCO RES O N SC E N E 4 ;
Source df SS M S F
p
Therapy ( j ) 2 566.26 283.13 11.18 .001
D efense ( k) 2 56 .5 4 2 8.27 1.12 NS
R ep etitio n s (L) 6
31.77
5 .2 9
11.42 .001
JXK 4 87.22 21.80 0 .8 6 NS
JXL 12 4 .0 3 .34 0 .7 2 NS
K X L 12 10.42 .87 1 .8 7 .05
JXKXL 24 1139.03
25 .3 1
Su bjects 45 125.24 .46
S u bjects X R ep etitio n s 270
1 1 2
APPENDIX L
S U M M A R Y O F ANALYSIS O F V A R IA N C E FOR FEAR T H E R M O M E T E R SCO RES O N SC EN E 6
Source i f
SS M S F
P
Therapy ( j ) 2 949.64 474.82
11-55
< .001
;Defense (K) 2 176 A l 88.20
2.15
NS
R ep etitio n s ( l) 8 91.90 11.49 22.16 NS
JXK 4 12T.92 30.48 0.74 < .001
JXL 16 3.28 .20
0.39
NS
K X L 16 7. I K ) .46 O.89 NS
JXK XL 32 12.92 .40 O.78 NS
Su bjects
^5
1849-28 4l . l 0
S u b jects X R ep etitio n s 360 186.63 .52
113
APPENDIX M
SUMMARY OF ANALYSIS OF VARIANCE FOR FEAR THERMOMETER SCORES ON SCENE 8 !
Source df SS M S M
P i
Therapy ( j ) 2 911.48
455.73
7.40 < .001
D efense ( k) 2 87.48
4 3 .7 4 0 .7 1 NS
R ep e titio n s (L)
9
107.90
11.99 2 5 .7 3
< . 0 1 1
JXK 4
71.91
17.88 0 .2 9 NS
JXL 18 6 .4 4 .36
0 .7 7
NS
K X L 18 12.89 .72 1 .5 4 < .10
JXK XL 56 17.14 .48 1.02 NS
Su bjects
45
2772.52 6 1 .6 1
S u b jects X R ep e titio n s 405 188.70 .46
APPENDIX N
i
SU M M A R Y OP ANALYSIS OP VARIANCE FO E PEAR T H E R M O M E T E R SCORES O N SCENE 10!
Source df SS M S F
p
Therapy ( j ) 2 458.23 229.12 5 .0 2 A
•
O
ro
VJJ
Defense ( k) 2 112.24 56.12
1.23 NS
R ep etitio n s (L)
9 183.59
2 0.40 21.86 < .001
JXK 4 120.58 30.15 0 .6 6 NS
JXL 18 8 .9 8
.49 0 .5 3
NS
K X L 18
5.52 •31 0 .3 3
NS
JXK XL 36 24.18
•67
0 .7 2 NS
Su bjects
45
2051.21
45.58
S u b jects X R ep etitio n s 405 378.01
•93
APEENDIX 0
OVERALL AV ER A G E EEAR T H E R M O M E T E R RATINGS DURING TR EA TM EN T
T R E A T M E N T SESSION ONE:
Base Level.: 2 .5
Scene 1: 2 .0 2 .1 2 .1 2 .0 2 .1
Scene 2:
3 .1 2 .9 2 .7 2 .7 2 .6
Scene 3 s if.O 3.8 3.6
3-3
3 .2 3 .0
Scene if:
4 .7 i+.5 if. 3
if.2 if .0
3 .9
3-8
Scene 5 • if. 9
if.6 if .2 if.o
3 .9 3 .9 3 -7
Scene 6: 6.2 6 .1 5.8
5-5 3-5
5 .2
5*1 if.9 if.9
T R E A T M E N T SESSION T W O :
Base Level.: 2 .0
Scene 1: 2 .1
Scene 2: 2 . if
Scene 3:
'3 .1
Scene if:
5 .7
Scene 5 s
3-9
Scene 6:
0
•
ir\
Scene J:
6.3
6 .2 6 .0
5 .9
5 .8
5 .5 5 .3 5 -3 5 -3
5 .2
Scene 8;
6.9
6 .8 6 .6 6.5
6 .2 6 .1
5 .9
5 .8
5 .7
5.6
Scene 9s
7.9 7*8 7 .7
7 .6
7-3 7.1 6 .9 6.5 6.5 6.3
Scene 10: 8 .6 8.5 8.3
8 .0
7-9 7 .5 7 .3
7.2
6.9
6 .8
116
APPENDIX P
A V E R A G E FEAR T H E R M O M E T E R RATINGS DURING T R E A T M E N T
FOR T H E L O W ANXIETY CONDITION !
i
T R E A T M E N T SESSION O N E :
Base L evel: 1.50
Scene 1:
1.39 1.33
1.28 l . l l 1.22
Scene 2: 2 .¥ f 2.11 1.89 1 .8 3 1.78
Scene 3* 3.28 3.0 2.72 2 .3 9 2 .1 1 2 .0
Scene If: 3.67 3.33
3.11 2.9lf 2 .72
2 .5
2 .3 9
Scene 52 3 .¥ f 3.33
3.11 3 .06 2 .8 9 2 .7 8 2 .8 3 2 .6 1
•
Scene 6 : if. 67 if.67 if.50 if. 22 if.17 if.06 3 .78 3 .6 7 3 .6 7
T R E A T M E N T SESSION T W O :
Base L evel: 1.17
Scene 1: I .67
Scene 2: 1.72
Scene 3 J 2.22
Scene 4: 2 .8 3
Scene 5 : 2.83
Scene 6 : 3.72
•
Scene 72 If. 61 if.lflf If.lfif l f . l l if .28 3.83 3.56 3.56 3.1flf 3-ifif
Scene 8 : 5.22 5 .11 3.00
if.89
if. 56 if.50
if. 33
lf.28
3 .9^ 3.89
Scene 9 2
6.39
6.28
6 .33
6 .2 8 6.00 5 .8 3 3 .3 9 5.05
5 .0 0 5 .0 0
Scene 10: 7.22 7.06 6.9lf 6 .7 8 6 .6 7 6 .6 7
6 .3 3
6 .0 6 5 .9k 5 .6 7
117
APPENDIX Q
A V ER A G E PEAR T H E R M O M E T E R RATINGS DURING TR E A TM E N T
FOR THE INTERMEDIATE ANXIETY CONDITION
T R E A T M E N T SESSION ONE:
Base Level: 2 .1 7
Scene 1: 1.9^ 2 .0 2 .0 1.89 2 .0
:
Scene 2: 2 .7 8 2 .7 2 2 .5 0
2.3 3
2 .2 8
Scene J > : 3.72 3.50 3-39
3.22 3 .0 6
2.8 9
i
Scene 4: 4 .0 if. 06 4 .1 1 4 .1 7
3*78
3-56 3 .6 7
Scene 5 '•
4-39 4 .3 9 ^•39
4 .H 4 .0 0 3.67 3.28 3.06
Scene 6: 5 .7 2 5 .5 0 5 .1 1 5 .0 0 5 .0 0 4 .6 1 4 .6 1 4 .2 8 4 .2 2
T R E A T M E N T SESSION T W O :
Base Level: 1.66
I
i
Scene 1: 1 .6 1
I
Scene 2: 1.78
1
I
Scene 3: 2 .2 2
Scene 2 .7 8
Scene 3 « ’ 2 .9 4
Scene 6: if. 67
Scene 7* 6 .2 8 6 .2 2 6 .0 6 5 .9 4 5 .8 3 5 .72 5 .6 7 5 .6 1 3 .7 2 5 .6 7
Scene 8: 7 .1 1 7.06 6 .7 2 6 .7 8 6 .4 4 6 .56 6.22 6 .1 7 5 .9 4 6 .1 1
Scene 9? 8 .0
7.72 7 .50
7.39 7 . U 7.06 7.06 6 .6 7 6 .7 8
6 .3 9
Scene 10: 9 .0
8 . 9^
8 .5 0 8 .1 7 8 .2 2
7 .74 7.78 7.78 7 .3 9 7 .1 7
1 1 8
APPENDIX R
A V ERAG E FEAR TH ER M O M ETER RATINGS DURING TR EA TM EN T
FOR THE HIGH ANXIETY CONDITION
T R E A T M E N T SESSION ONE:
Base L evel:
3-78
Scene 1: 2 .9 4 3 .1 1 2 .9 4 3.2 2
3 .1 7
Scene 2: 4 .0 6 3 .9 4 3 .8 9 3.8 9
3 .83
Scene 3: 4.89
4 .6 1 4 .4 4 4 .4 4 4 .0 4 .0
Scene 4:
6 .3 3
6.22 6 .0
5 .8 3 5 .7 8 5.67 5.56
Scene 5* 6.7 8 6 .6 1 6 .1 1
5 .3 9 5 .1 7
5.22
5*39 5 .3 3
Scene 6: 8 .0 6 7-94 7 .7 8 7.39
7.28 6.83 6.89 6.72 6 .7 8
T R E A T M E N T SESSION T W O :
Base L evel: 3 .1 1
Scene 1: 3.06
Scene 2: 3.72
Scene 4 .7 8
Scene 5.5 0
Scene 55 5 .8 9
Scene 6: 7.06
Scene J: 7.72
7 .4 4 7 .2 8 7 .1 1 7.00 6.66 6.36 6 .6 6
6 .3 9
6 .1 7
Scene 8: 8 .4 4 8.2 2 8 .1 1 7 .6 7 7 .6 1 7.27 7 .1 7
6 .9 4 6 .9 4 6 .8 3
Scene 9 i 9 .4 4 9 .2 8 9.05 8 .8 9 8 .7 8 8.56
8 .3 3
8 . U 7 .9 4 7 .7 8
Scene 10: 9 .6 1 9 .56
9 .3 3 9 .05
8 .8 3 8.22 8 .1 7 8 .0 6
7 .7 8 7.72
119
APPENDIX S
AVERAG E PEAR T H E R M O M E T E R RATINGS DURING TREATM ENT
FOR REPRESSOR SUBJECTS
T R E A T M E N T SESSION ONE:
Base L evel: 2 .3
Scene 1: 2 .1 2 .1 2 .2 2 .1 2 .1
Scene 2: 3 .6 3 .4 3 .1 3-1 3 -1
Scene J > i
4 .9
4 .6
4 .3
4 .1 3 .8 3 .6
Scene 4: 5 .4
5 .1
4 .8 4 .6
4.5
4 .2 4 .1
Scene 5: 5 .6 5 .2 5 .2
4 .9
4 .8 4 .8
4 . 7
4 .4
Scene 6 : 7 .2 7*2
6 .7
6 .4
6 .3 5-9 5 -7 5 -7 5-7
treatment SESSION T W O :
Base L evel: 2 .2
Scene 1: 2 .4
Scene 2 :
2 .9
Scene 3 : 3 .8
Scene 4 .4
'
Scene 5? 4 .6
Scene 6 :
5*7
Scene J: 7 .2 7 .0 6 .8 6 .6 6 .6 6 .4 6 .2 6 .1 6 .2 6 .0
Scene 8 : 7 .2
7*1 7*1
6 .8
6 .5
6 .6 6 .4 6 .4 6 .4 6 .2
Scene 9?
8 .5
8 .4
8 .3
8 .2 8 .0 7 .8
7-5 7 -3 7-2 7-2
Scene 10:
9*1 9 .1
8 .8
8 .7
8 .6 8 .0
7-7 7 -7
7 .6 7-6
1 2 0
APPENDIX T
AV ER A G E EEAR T H E R M O M E T E R RATINGS DURING TR EA TM EN T
FOR INTERMEDIATE DEFENSE SUBJECTS
T R E A T M E N T SESSION ONE:
Base L evel: 3*1
Scene 1: 2 .3 2.5
2 .4 2 .4
2 .5
Scene 2: 2 .7
2 .7 2 .8 2 .7 2 .8
Scene J > \ 3 .4 3-4
3-3
3 .2 3-2
3-1
Scene If: 4 .2 4 .2 4 .2 4 .1 4 .2 4 .1 3 .8
:Scene 5 • 4.5 4.5 4 .3 3-7 3-7
3-4 3-4 3 .2
Scene 6: 5 .6
5-5
5 .4 5 .2
5 -3
4 .8 •4.9 4 .7 4 .7
T R E A T M E N T SESSION T W O :
Base L evel : 2 .2
Scene 1: 2 .1
Scene 2: 2 .2
Scene 3* 2 .8
Scene 4:
3-3
Scene 5*
3-7
Scene 6: 5 .0
Scene "Ji 6 .1 6 .2 6 .0 5 .8 5 .8
5-5
5 -4 5 -4 5-4
5 .3
Scene 8:
7 -1 7*1
7 .0 6 .8 6 .6 6 .4
5 .9
5 .6 5 .6 5 .6
Scene 9*
7-7 7-5 7-3 7-3 7 -1
6 .9 6 .6 6 .1 6 .2 6 .0
Scene 10: 8 .2 8 .0
7-7
7-2 7-2 6 .9 6 .8
6 .7
6 .2
5-9
1 2 1
APPENDIX U
A V ER A G E FEAR T H E R M O M E T E R RATINGS DURING TR EA TM EN T
FOR SENSITIZER SUBJECTS
T R E A T M E N T SESSION O N E :
j ^ c L dc jjcY cJ * ! £ t X
Scene 1:
1-7 1 .7
1 .6
1.5
1 .6
Scene 2: 3 .0 2 .7 2 .3 2 .3 1 .9
Scene 3:
3-7
3-4
3 -1
2 .8
2 .5
2 .4
Scene 4: 4 .4 4.2 4 .0
3-9
3 .4
3-3 3-5
Scene 5 ' • 4.5 4 .3
4 .2
3-9 3-5
3 .6
3-7 3-5
Scene 6:
5-7
5 .6
5-3
5.0 5 -0 4 .8
4 .7 4 .3
4 .2
T R E A T M E N T SESSION T W O :
Base L evel: 1 .6
Scene 1: 1 .8
Scene 2: 2 .2
Scene 2 .8
Scene 4:
3-1
Scene 5 • 3*4
Scene 6: 4 .3
Scene 7*
5-7
5 .4
5 -3
5 .2
5 -1
4 .6 4 .4 4 .4 4 .2
4 .3
Scene 8: 6.3
6 .1
5 -7 5-9
5 .6 5 .4 5-4 5 -4 5-0 5*0
Scene 9: 7 .6
7-5
7 .4 7-2 6 .8 6 .6 6.5 6 .1 6 .1 5 .8
Scene 10: 8 .6 8 .5 8 .3
8 .1 7 .8
7 -7 7-5 7-3
7-0 6 .8
1 2 2
APPENDIX V
BA N D A T A FO R SUBJECTS IN TH E L O W ANXIETY CONDITION
Subject R-S ASX FTi f t 2 a s2
FT3 FT
1 30
3 3
If
3
if
^13 1
2
32
3
7
h
3
if
36O
3 25
3
6 h
3
If 439
If
15 3
if 1
l 1
288
5
13
6 5 3
3 5
356
6
16
3 .
8
3
3 5
3*f6
7
9
6 5
1
2
5
169
8
i»8 10 7 7 10
7
385
9
50 8
8 6
5
8
lW ;
|
10
ho
5
7 3 l
5
2ifif
11
k2
5
5 7
3 7
302
12
38 6
3 3 6
3
208
13
56 6
5 .
2
3 3
258
Ik
61
3
9 5
3 5
lf53
15
73 9
5 3
5 7
239
16
62 6
6 1
3 3
358
17
70 6 3
I
1 2 333
18
93 9
5
h
6 10
217
123
APPENDIX W
E A W D A T A FOR SUBJECTS IN T H E INTERM EDIATE ANXIETY CONDITION
; Subject R-S
ASX FTX
f t 2
AS2 f t 3
1
FT
»
19 12 6 6 2 4
5
584 ;
I
20 3 6 6 8
1
3 3
1
612 !
21
35
10
9
-9" 10
9 534
22
19 5 5
5
3
8
532
23 19 3 7
3 . 1
3
209
24
5 5
4
3
6
391
25
4o
3 5
5 1 8
473
26
43
10
5
3
3
10 758
27 54 3
10 9
3 9 445
28
39
4 2 3 2
5
488
29 54
3 5
4
2
3
246
30 53
4 2
2
3
2
376
31 57 9
6
6
5
1 0 541
32 75 3
1 0 3 2 8
331
33
84 6
5
1
3 5
467
34 64
3 7
5 2 1 0 230
35
56 3 7
2
1 4
279
3 6 69 5 7
2
1 2
370
124
APPENDIX X
R A W D A T A FOR SUBJECTS IN T H E HIGH ANXIETX CONDITION
Subject R-S Asx FTi f t 2
as2 f t 3
FT
37 14
3
4 1 1 2 744
38 22
5 7 9 5 9
521
39 12
3
6
3
2 2 389
1)0
19. 3 9 9 3 9
664
4 l
3.4 10 10 10 10 10 852
42
22
3
8
5
1 8 548
4?
42 6
7
1
3
2 450
44
44 4
5
4
5
4 622
45
55
6
3 3
l
7
652
46
46 6
5
2
3
10
571
47
4o 10
5 3
1 8
473
48
48 10
5
2
5 7 347
4 9
63 4 8 6
3 7
617
50
86 6 6 l
3 5 697
51
68 4 4 8 4 8 408
52
63
3 5 5
1
5
481
33 56
5
6
5 3 7
302
54
81
9 7 5 3 7
698
125
R E F E R E N C E S
i
i
126
*
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Creator Edelman, Mari (author)

Core Title Anxiety Level And The Repression-Sensitization Dimension In Desensitization Therapies

Degree Doctor of Philosophy

Degree Program Psychology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Wilson, Milton (committee chair), Jacobs, Alfred (committee member), Peterson, James A. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-710280

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Legacy Identifier 6919368.pdf

Dmrecord 710280

Document Type Dissertation

Rights Edelman, Mari

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

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