Chapter Five
Desensitization
Although defined in
various ways, desensitization (also called systematic
desensitization) is basically the gradual counter- conditioning of anxiety
using relaxation as the incompatible response. The procedure, originally developed
by Wolpe (1958), is one of the most powerful tools in behavior modification. it
is not uncommon for a severe phobia or source of anxiety of long-standing to be
removed in a few weeks. It is also one of the most researched procedures,
resulting in a continual honing down of the approach, as well as the
development of specialized variations and theoretical accounts (Bandura, 1969;
Davison & Wilson, 1973; Kazdin & Wilcoxon, 1976; Paul, 1969; Rachman,
1967; Wilson & Davison, 1971). Desensitization has three basic components:
training in relaxation, construction of hierarchies, and counterconditioning.
This chapter assumes the reader has a good understanding of the relaxation and
counterconditioning procedures discussed in Chapter 3.
Since relaxation is
to be used as the incompatible response in counterconditioning anxiety, one of
the first steps is teaching the client how to relax, usually using a shortened
version of Jacobson’s (1938) muscle relaxation method (see Chapter 3). If this
is not effective, then relaxation may be trained or elicited by some other
means such as biofeedback, hypnosis, or drugs. Or the practitioner may decide
to countercondition the anxiety with one of many other incompatible responses.
In practice, the
amount of relaxation produced by muscle-relaxation training is usually more
than is necessary for desensitization. in fact, some evidence exists that
desensitization can be effective if the person can just ; maintain
a general feeling of calmness or mental relaxation (Marshall et al., 1972;
Rachman, 1968). However, training in something like muscle relaxation is still
desirable because it provides learning a useful self-control skill and provides
a level of relaxation that allows for the client’s gradually becoming less
relaxed during a counterconditioning session.
During assessment
(see Chapter 2), it is necessary to determine what stimuli (situations and
thoughts) elicit anxiety. This is accomplished through a variety of assessment
procedures, possibly including interviews, daily logs, questionnaires (such as
the Fear Survey Schedule), approach-avoidance behavior (how close the client
will come to the feared situation), and physiological measures.
After the anxiety-eliciting
stimuli have been determined, they are divided into groups according to common
elements. Some stimuli can be grouped according to a central theme, as in
a thematic hierarchy. For example, one person may feel anxious about
being criticized, about being self- conscious, and about being misunderstood.
For this person these fears may center around the general theme of fear of
adverse social evaluations. Some stimuli may be grouped according to a specific
event, such as a death of a loved one or a divorce. Such a group would be
the basis for a spatiotemporal hierarchy.
The main pitfall
is that the behavior modifier may group stimuli according to an inappropriate
theme or event. Fears of being in filled buses, crowded elevators, and rush-hour
traffic jams may be grouped according to a theme of a fear of crowds of people.
The real theme, however, may be a fear of being confined in a small area.
Determining the common elements or themes is a problem-solving skill that
comes with practice and is aided by supervision.
After the fears and
sources of anxiety have been generally grouped, it is necessary to decide
which need to be treated. Some fears are adaptive fears and need to be left
alone. A high school client of mine felt anxious about smoking marijuana with
friends in the school bathrooms. This fear should not be decreased, primarily
because of the local laws and enforcement at the time. Some fears can be left
alone or treated later because they are not of immediate importance to the
client’s main problems. Some fears are based on misconceptions or faulty perceptions
and are best handled by an educative approach. This arises often in areas
related to sexual behavior and causes of mental illness. Other fears are unadaptive
fears, based more on experiences and emotional associations than misconceptions.
These are the fears for desensitization. In most cases there will probably
not be more than one or two categories or themes of anxiety that require fairly
immediate desensitization. Wolpe suggests that it is unusual for a client
to have more than four such categories.
The next step is
to take each category of anxiety stimuli and arrange them into a hierarchy,
a rank ordering of the stimuli according to the amount of anxiety they elicit,
with the items producing the most anxiety at the top of the hierarchy. Physiological
measures are useful in doing this ranking, but most practitioners rely on
the client’s subjective estimate about how much anxiety he would experience
in each actual situation. To facilitate this subjective report, Wolpe uses
an anxiety scale in which the top of the scale (100) corresponds to the worst
anxiety the subject can imagine and the bottom of the scale (0) corresponds
to no anxiety. The unit of the scale is a sad (subjective unit of disturbance).
The subject can then report his feeling of anxiety in terms of suds. A report
of 25 suds would correspond to the point on the scale one-quarter of the way
between no anxiety and maximum anxiety.
For desensitization,
the items in the final hierarchy should not be too far apart in terms of the
anxiety they elicit. Wolpe suggests that the difference between successive
items should not be more than 5 to 10 suds. Thus it will often be necessary
to add more items to the hierarchy than were originally found in the first
assessment. The following is a hierarchy that Emery (1969) used in treating
a 27-year-old law student with a fear of eating in a public place:
|
Suds
|
|
Items
|
|
(95) |
1. |
Having dinner
at a girlfriend’s house with her parents present |
|
(85) |
2. |
Having dinner
out with a girl |
|
(80) |
3. |
Having breakfast
out with a girl |
|
(70) |
4. |
Having dinner
out with your parents |
|
(60) |
5. |
Having dinner
alone at an unfamiliar restaurant |
|
(50) |
6. |
Having dinner
at the university cafeteria with some classmates |
|
(45) |
7. |
Having dinner
at the university cafeteria by yourself |
|
(40) |
8. |
Having dinner
alone in a familiar restaurant |
|
(35) |
9. |
Having dinner
at an old friend’s house |
|
(30) |
10. |
Having lunch
at the cafeteria |
|
(25) |
11. |
Having breakfast
at the cafeteria |
|
(15) |
12. |
Having breakfast
at a familiar restaurant on Saturday morning |
|
(10) |
13. |
Having lunch
with a long-time friend |
|
(5) |
14. |
Having lunch
in your apartment |
After the
appropriate hierarchies have been constructed and the client has learned to
relax to the extent that he can relax relatively well and quickly, then the anxiety
may be reduced through counterconditioning (see Chapter 3). This consists of
slowly moving up through the hierarchy while keeping the client relaxed. The
items in the hierarchy may be approached by putting the client in the actual
situations (in vivo); but generally in desensitization the client merely
imagines being in the situation, “living” it as realistically as possible.
Usually the practitioner begins by describing the scene in some detail while
the client imagines the scene. One reason for using imagined situations is that
they generally produce less anxiety than the in vivo ones and hence are a
better starting point. A second reason is that the use of imagined scenes gives
the practitioner greater flexibility, for any situation can be created in the
imagination, while for many situations it may be impractical or inefficient to
go out to them or simulate them in the clinic.
Desensitization involving
only imagined scenes generalizes well to in vivo situations. The client may
then experience no anxiety in vivo, or he may experience a small amount of
remnant anxiety, which he counterconditions or lets extinguish. Therefore,
many practitioners use only imagined scenes during desensitization. An alternative
is to have the client, after he has gone through most or all of the hierarchy
in his imagination, go through the hierarchy in vivo using the same gradual
counterconditioning approach he learned in the clinic using imagined scenes.
Some problems occur
in using imagined scenes, for ideally the client is able to live the situation
as if actually in it, rather than merely visualize it as if watching a movie.
Although many clients can do this readily, a few cannot and need a different
approach. A second problem is that the client may not visualize the scene
presented—perhaps imagining a scene more, or less, anxiety producing. Finally
when a person is imagining a scene he is not holding a constant image in his
mind. Rather a continuous flow of imagery occurs (Barrett, 1969; Weitzman,
1967). Thus the counterconditioning involves themes and associations within
the client’s cognitive system, rather than simple specific stimuli.
Assuming we have a
client who can relax and visualize scenes, we are ready to begin the actual
counterconditioning. During counterconditioning it is necessary to have a
measure of how much anxiety an item from the hierarchy elicits; this measure is
the basis for deciding when to move to the next item. The two most common
measures are physiological measures and subject reports. When the client is
reporting anxiety, it is important that he not disrupt the relaxed state. Wolpe
has the client report anxiety by lifting a finger. The amount of anxiety can be
determined by asking the client to lift his finger to questions about how many
suds the item elicited.
The first item presented
is a neutral item, If the client reports anxiety to this item, there probably
is something about the particular desensitization setting that is producing
anxiety. And this anxiety will have to be dealt with before continuing with
the specific hierarchies.
Following a no-anxiety
presentation of the neutral item, the client is presented with the lowest
item on the hierarchy. He imagines this until he signals, as by lifting his
right index finger, that he is beginning to feel anxious. When he signals
anxiety, he is told to “Stop the scene and relax.” Relaxation here may be
facilitated by having the client shift to imagining a personally pleasurable
scene. If the client imagines the hierarchy scene for about ten seconds without
signaling anxiety, he is again told to “Stop the scene and relax.” Because
great individual differences occur between people concerning how quickly they
can begin imagining scenes, some practitioners have clients signal, as by
lifting the left index finger, when they begin clearly imagining the scene.
The ten seconds, or whatever amount of time is appropriate, is then measured
from this point.
After a scene has
been stopped and the client has relaxed briefly, the same scene, or a variation
of it, is presented to the client again. Each item on the hierarchy is presented
repeatedly until it no longer elicits anxiety, a common criterion being for
clients to be able to imagine the scene two successive times without signaling
anxiety. At this point, the next item on the hierarchy is presented until
it is counterconditioned and so on through the whole hierarchy. Through his
signaling the client determines the rate at which he goes through the hierarchy,
a very reassuring fact to many clients who do not want to be pushed into unpleasant
situations too fast. A safe and sure approach is to stay with each item until
it elicits no anxiety. However, desensitization may be accomplished by substantially
reducing the anxiety associated with each item, but not to 0 (e.g., reducing
it from 40 to 15 suds), before moving to the next item. This probably depends
on generalization of the counterconditioning down the hierarchy as well as
up. In one case, reducing the anxiety of each item by only 50 percent was
found effective (Rachman & Hodgson, 1967).
The following is
part of the first counterconditioning session that Emery (1969) had with the
subject whose hierarchy is given above:
First, I’d like you
to imagine as vividly as possible that you are having lunch in your apartment
(pause of 5 seconds—no signal). Stop imagining that and continue relaxing,
just enjoying the calm, soothing feelings associated with relaxation (pause
of 10 seconds). O.K., once again, imagine yourself, as realistically as possible,
having lunch in your apartment (pause of 10 seconds—no signal). Stop imagining
that and now imagine yourself in one of your personal forms of relaxation
just letting yourself relax further and further (pause of about 20 seconds). Now, stop imagining that and imagine
yourself as vividly as possible in the following situation . . . you are having lunch with a long-time friend (pause of 3 seconds—no signal).
Stop imagining that and continue relaxing while concentrating on the looseness
and heaviness of your body (pause of 10 seconds). O.K., once again, imagine
yourself eating lunch in your apartment (pause of 20 seconds—no signal). Stop
imagining that now and switch over to one of your personal forms of relaxation
while you continue to relax and enjoy yourself (pause of 20 seconds). O.K.,
stop picturing that and imagine yourself as vividly as possible having lunch
with a long-time friend (pause of 8 seconds—client signals). Stop imagining
that; in order to help you relax even further I am going to count from 1 to
10 and with each count you’ll feel yourself sinking into a deeper, more complete
state of relaxation, further and further, so that when I reach the count of 10 you’ll feel completely relaxed.
The length of
counterconditioning sessions and the number of sessions per week vary greatly
and should be geared to the client. Some clients have been desensitized in one
session lasting several hours. However, it is usually wise to start with short
sessions (15 to 30 minutes) and gradually build up to longer sessions (45 to 60
minutes) with about two sessions per week. It is usually suggested to end a
session with the successful completion of a scene. Also at the beginning of a
session, it is best to start lower on the hierarchy than where you left off the
session before. This allows for some therapeutic loss or spontaneous recovery
between sessions. Finally, to help the client maintain attention, it is
desirable during a session to slightly alter the scenes and switch back and forth
between different hierarchies.
The practitioner
needs to be flexible during desensitization. Feedback from the client during
or after a session may alter how the practitioner presents scenes or how much
time he allows the client to imagine a scene before stopping. It is also common
to alter or add to the hierarchy along the way. For example, a client may
rate one item as 50 suds; but when imagining it during desensitization, it
is 80 suds. With experience the whole desensitization procedure can become
fluid.
After the client
has completed most of the hierarchy using imagined scenes, he may be instructed
to gradually go through the hierarchy in vivo. For a person with a fear of
flying an item low on this hierarchy might be simply driving up to the front
of the airport terminal. When doing this in vivo, the client would keep himself
relaxed while driving up to the terminal. If he starts to feel anxious, he
would merely stop and relax or drive away if necessary. This would be continued
until he could drive up to the front of the terminal without feeling anxiety.
Drugs are sometimes
used to facilitate relaxation for counterconditioning using imagined scenes
(e.g., Friedman, 1966) or in vivo situations (e.g., Munjack, 1975). In these
cases it is best if the client is gradually phased off the drugs, another
form of hierarchy. In some cases this is the only hierarchy:
The client, while
relaxed via drugs, is allowed to encounter anxiety-producing situations in
the natural order they arise. Then the medication is gradually reduced.
One problem in
carrying out desensitization is that the client may not learn muscle relaxation
sufficiently for counterconditioning. If this is the case, relaxation may be
produced by other means such as drugs or hypnosis. Or it may be better to use a
counterconditioning approach based on an incompatible response other than
relaxation.
A second possible
problem may be that the client cannot visualize scenes well enough to use
imagined scenes. This can sometimes be helped by having the client practice
imagining neutral scenes or by presenting the scenes via hypnosis. If not,
then it may be desirable to switch from imagined scenes to slides, videotapes,
or in vivo stimuli. In some cases, these alternatives may be preferable to
imagined scenes even if the client can visualize well.
Sometimes the client
may visualize all right, but it is suspected he is visualizing incorrect scenes
(perhaps you find that none of the scenes elicit anxiety). In these cases
it is often desirable to have the client verbalize what he is imagining for
a few times. It may be necessary to pace the client through the whole scene
rather than just tell him basically what to imagine.
Another problem is
the use of an unsuitable hierarchy, often noticed when desensitization goes
too slow or too fast. Possible problems include a hierarchy based on the wrong
theme, an insufficiently weak starting point, or a client that does not consider
this an irrational fear, but rather something truly dangerous.
Desensitization is
described in this text in terms of counterconditioning. Relaxation is
conditioned to stimuli that previously elicited anxiety. The overall effect of
this conditioning is gradual, moving from anxiety through neutral toward
relaxed. Conditioning is generally terminated when the client feels neutral,
that is, no anxiety (0 suds). The purpose of the hierarchy is to maintain
relaxation dominant to anxiety.
However, as discussed
in Chapter 3, any counterconditioning procedure can also be interpreted as
respondent extinction. Wilson and Davison (1971) have made such an argument
for desensitization. They suggest that desensitization is basically extinction,
the client approaches feared situations, in imagination or in vivo, without
adverse effect. This results in respondent extinction-of the anxiety. However,
desensitization research has suggested the important facilitative effects
of relaxation training and the use of hierarchies, neither of which is needed
for extinction (e.g., McGlynn, 1973). Wilson and Davison suggest that the
facilitative effects of relaxation and use of hierarchies are because of the
fact that they encourage the client to approach and be exposed to the feared
stimuli. If this is the case, then we can use other types of incentives to
get the client to approach feared stimuli. These may include money or praise.
In fact, there are several reports (e.g., Leitenberg & Callahan, 1973)
in which fears are reduced by operant procedures (see Chapter 7) that consist
of rewarding the client for gradually approaching a feared situation. A counterconditioqing
theorist would see these rewards as having a counterconditioning effect in
addition to the incentive effect.
There are also several
other sources of reward that occur during desensitization and may be incorporated
into a theoretical explanation. The practitioner may reward the client with
attention or praise for progress in desensitization. (Remember that if the
practitioner is not careful here he may only be changing the client’s report
of progress of no anxiety, rather than more general changes.) Also in desensitization,
as in many other change programs, the client’s perception of his own progress
is often a powerful source of reward. This reward
probably facilitates carry-over from the clinic to other settings.
Another interpretation
of desensitization is that it is based to some degree on learning controlled
attention shifts (Wilkins, 1971; Yulis et al., 1975). That is, the desensitization
procedure teaches the client how to shift his attention away from the feared
object. Currently little research delineates the role of this variable, although
it seems of minimal importance, for most phobics are already skilled at shifting
away from anxiety sources, and this often impairs their work in desensitization
when they should attend to the anxiety scene.
Finally, several
theorists suggest that desensitization is best interpreted and carried out
as a form of self-control of anxiety (Goldfried, 1971; Zen- more, 1975). That
is, desensitization is not counterconditioning to specific situations which
then generalizes to other situations. Rather, it is learning a general coping
skill for dealing with anxiety situations. The client learns how to sense
anxiety and switch into a more relaxed state. The use of the hierarchy is
merely providing the client gradual practice in his self-control skill with
a relevant and important anxiety source. Thus it is better during desensitization
to emphasize the self-control approach rather than rely on couflterconditioning;
and evidence exists to suggest this is the case (e.g., Spiegler et al., 1
976). However, even if adding a self-control component or emphasis to desensitization
does improve treatment effectiveness, this does not mean that the results
are not due to counterconditioning or extinction.
Working from the
self-control approach, Suinn and Richardson (1971) developed a procedure called
anxiety-management training that uses no hierarchies. Anxiety is treated
as stimuli to which the client learns to respond with responses that reduce
or remove the anxiety. This is done by having the client visualize past events
that arouse anxiety and learn to detect the onset or increase in anxiety.
He then learns to reduce the anxiety with competing responses such as relaxation
or feelings of success or competency caused by an imagined scene.
Despite the different
theoretical interpretations of desensitization, what the practitioner should do seems to be the following: During relaxation
training emphasis should be put on the client learning to discriminate fine
differences between relaxation and non-relaxation (e.g., anxiety, tension).
The client should learn how to use relaxation as a self-control skill in dealing
with anxiety. This should be done in a variety of ways, including during counterconditioning
with imagined scenes and later in vivo assignments. Otherwise, desensitization
should be carried out as described above.
There are many
variations of desensitization and combinations with other procedures. The
following sample of variations includes group desensitization, mechanization of
desensitization, self-desensitization, dealing with pervasive anxiety, and
contact desensitization.
Group desensitization
An advantage of
behavior modification is that in many situations it can be applied to groups of
people at a time, thus saving time and expense. To apply desensitization in
groups it is necessary to have a hierarchy common to all the clients. This is
usually easiest accomplished if the fear is relatively common, specific, and
not complicated with other psychological problems. The second requirement is
that the rate through the hierarchy should be geared toward the slowest client for
each item; you do not advance to the next item until everyone in the group has
been desensitized to the current item Lazarus (1961) was
one of the first to do group desensitization of a variety of phobias, including
acrophobia (fear of heights), claustrophobia (fear of enclosed places), and
sexual fears. Other group desensitization includes treatment of fear of public
speaking (Paul & Shannon, 1966) and fear of spiders (Robinson & Suinn,
1969).
Mechanization
of desensitization
Several researchers have
devised procedures for mechanizing various parts of desensitization and thereby
freeing more of the practitioner’s time. Migler and Wolpe (1967) describe a
case in which the client, under the behavior modifier’s supervision, made a
tape of the hierarchy items and relaxation instructions. Then with a slightly
modified tape recorder, the client was able to desensitize himself at home.
Donner and Guerney (1969) were able to treat test anxiety in a group of clients
by administering the desensitization through a tape-recorded set of
instructions.
Lang (Lang et al.,
1970) has computerized much of desensitization with equipment called DAD (Device
for Automated Desensitization). DAD presents, via tapes, instructions in hypnosis
and relaxation and a pre-recorded hierarchy of items. When the client becomes
anxious, DAD gives instructions to stop visualizing the scene and relax. DAD
carries out desensitization effectively and the clients do not object to working
with DAD.
Self-desensitization
Related to mechanizing
desensitization are a variety of studies in which the client carries out much
of the desensitization procedure on himself. We have already seen some of this
above in the use of tape recorders and in vivo assignments.
Self-desensitization carries it a little further, and several manuals have been
written for this purpose (e.g., Rosen, 1976; Wenrich et al., 1976). A common
approach is the client learns to relax primarily from tapes, the practitioner
helps the client construct the hierarchies and instructs him in the
desensitization procedure, and then the client desensitizes himself perhaps
with the aid of tapes (Baker et al., 1973; Morris & Thomas, 1 973). One
study with highly fearful snake phobics (Rosen et al., 1976) found that clients
could successfully desensitize themselves using only a desensitization manual
and a record of relaxation instructions. In this study, the self-
desensitization was as effective (moderate treatment effects) as therapist
administered desensitization.
The research on group
desensitization, mechanization of desensitization, and self-desensitization
shows that in at least some situations a one-to- one relationship with a human
practitioner is not necessary and perhaps inefficient or undesirable.
Pervasive anxiety
Desensitization
requires being able to specify the stimulus situations that elicit anxiety.
Sometimes a client seems to be anxious most of the time. This is often called pervasive
anxiety or free-floating anxiety. When such a state is not caused by
organic disorder, there are two basic possibilities: (1) There are a few common
situations or stimuli that elicit anxiety, which are easily dealt with by
desensitization. (2) There are many different stimuli that elicit anxiety,
perhaps making standard desensitization impractical. The most common way of
dealing with this latter situation is to emphasize general self-control
approaches to anxiety control, perhaps aided at first by drugs that facilitate
relaxation. This then amounts to self-control training, plus in vivo counterconditioning.
Cautela’s (1966a)
more general approach to pervasive anxiety consists of four procedures:
|
1.
|
REASSURANCE.
The client is reassured that the practitioner will always be ready to
help. |
|
|
2.
|
DESENSITIZATION.
The client is desensitized to abstract concepts (e.g., people or responsibility)
related to the anxiety. |
|
|
3.
|
IN VIVO RELAXATION.
The client is taught how to relax himself and to use this in situations
that cause anxiety. |
|
|
4.
|
ASSERTIVE TRAINING.
The client is taught to assert himself in situations in which he was
inappropriately passive (see Chapter 8). |
|
Contact desensitization
A variation of
desensitization called contact desensitization is a combination of in
vivo desensitization and modeling (see Chapter 8). It is also called participant
modeling and modeling with guided participation. Since
desensitization and modeling are both effective ways of dealing with fears,
their combination is quite powerful. Contact desensitization, which was
developed by Ritter (1 968), consists of three basic steps:
|
1.
|
The
client watches someone else (the model) approach the feared object. |
|
2.
|
The
model helps the client approach the object. |
|
3.
|
The
model is gradually faded out as the client approaches the feared object. |
In an unpublished
report of 1965, Ritter described her treatment program for a female
undergraduate (S) who was unable to perform the required dissections in a
biology course:
PHASE I. The
subject made no attempt to perform during the first phase of treatment, but
merely observed the dissection procedures of her classmates. S located herself
as far from the activities as was comfortable and watched for brief periods
while occasionally reminding herself that the dissection animal, a foetal
pig, was a dead nonsensing object. S gradually extended the time she observed
and also gradually moved closer to the dissection scene as she became more
comfortable.
PHASE II.
S obtained the assistance of a sympathetic female student who served as a
co-therapist (T). S momentarily placed her hand on T’s while T was performing
a dissection movement; S gradually extended the time she rested her hand on
T’s. When the foregoing could be done with ease, S progressively slid her
hand forward on T’s thereby approaching contact with the dissection instrument.
This was continued until S had her fingers directly on the dissection instrument
while I was also still holding it. Finally, when S was comfortable with this
arrangement she asked T to remove her hand but to remain watching in case
assistance was needed.
PHASE III.
S practiced dissecting alone, first while T observed and then independently.
Research on contact desensitization
suggests that it is often more effective than just modeling (e.g., Lewis, 1974;
Roper et al., 1975) and often faster and as effective as standard
desensitization (e.g., Bandura et al., 1969; Litvak, 1969). A limitation is
that contact desensitization can only be applied in situations which can be
readily modeled and gradually phased into. Thus some cases, such as fear of
childbirth, are better treated by other approaches. Research to date that has
attempted to factor out the relative importance of the different components of
contact desensitization (modeling, contact with feared object, participation,
active versus passive treatment, verbal instructions) has yielded mixed results
that need further clarification (Blanchard, 1970; Lewis, 1974; Murphy &
Bootzin, 1 973).
In working with snake
phobics, Bandura and his associates (1975) found that they could improve the
effects of contact desensitization by adding an additional hour in which the
subjects continued on their own, interacting with the snake as they did during
treatment. Contact desensitization has also been used with groups for snake
phobias (Ritter, 1968) and fear of heights (Ritter, 1969).
Thus desensitization
and related procedures are powerful ways of dealing with fears and anxiety.
As the practitioner becomes more familiar with this approach he can alter
it and interweave it with other approaches in ways that best fit his client
and treatment approach. Also this chapter should be seen as a detailed example
and perhaps model for the more general counter- conditioning procedures discussed
in Chapter 3.
Desensitization, the
gradual counterconditioning of anxiety with relaxation, basically consists of three
components; (1) teaching the client to be able to relax; (2) constructing
hierarchies, rank orderings of sources of anxiety according to common elements;
and (3) gradually counterconditioning the anxiety by slowly moving through the
items of the hierarchy, in imagination and/or in vivo. Treatment is often most effective if the client also learns to discriminate subtle
differences between being relaxed and not and learns basic self-control skills
for dealing with anxiety. Theoretical interpretations of the desensitization
procedure include such components as counterconditioning, extinction, operant
conditioning, controlled attention shifts, and self-control of anxiety.
Desensitization can often be carried out with a group of people at one time,
can be mechanized in varying degrees, and can often be done by people on
themselves with the help of a practitioner and/or special materials. Contact
desensitization is a powerful change procedure combining modeling and in vivo
desensitization.
|
1.
|
List
the sequence of steps for carrying out desensitization from initial assessment
through use of imagined scenes to in vivo assignments. |
|
2.
|
For each of the following, give two assessment procedures you would use to help identify and specify possible sources of anxiety: a six-year-old with a school phobia, a college student with test anxiety, a non-verbal mental patient who does not like to be touched. |
|
3.
|
Devise and describe a hypothesis-testing procedure to determine the correct theme underlying situations eliciting anxiety in your client, |
|
4.
|
Make
up a possible hierarchy with suds for a person with a fear of being at
home alone. What is the theme of this hierarchy? Give an example of an
alternative theme that would generate some of the items on the hierarchy. |
|
5.
|
List
three possible problems in doing desensitization and what you would do
to try to avoid them. |
|
6.
|
Outline a possible course of self-desensitization you could take to eliminate one of your sources of anxiety. Will you actually do this? Why? |
|
7.
|
Using the desensitization procedure as a model, outline a program for a hypothetical case using emotive imagery to countercondition anger. |
|
8.
|
How
do the following differ procedurally; desensitization, counterconditioning,
flooding, and contact desensitization? |
|
9.
|
As
a behaviorist, discuss the use of suds and imagined scenes in desensitization. |
|
10.
|
What are the advantages and disadvantages of using a computer, with direct input from the client’s physiological responses, rather than a human practitioner to carry out desensitization with a client? |
|
11.
|
List
five common fears that would lend themselves to group desensitization.
Should group desensitization for any of these fears be part of our high
school programs or educational television programming? Why? |
|
12.
|
Describe
an experiment that would differentiate between two of the theories of
desensitization. |
Davison, G. C. &
Wilson, G. T. Processes of fear-reduction in systematic desensitization: Cognitive and social reinforcement factors
in humans. Behavior Therapy, 1973, 4, 1—21.
Goldfried, M. R. & Davison, G. C. Clinical behavior therapy. New York: Holt, Rinehart & Winston, 1976.
Chapter 6.
Paul, G. L. &
Bernstein, D. A. Anxiety and
clinical problems: Systematic desensitization and related techniques. Morristown,
N.J.: General Learning Press, 1973.
Rosen, G. Don’t be afraid: A program for overcoming your fears and phobias. Englewood
Cliffs, N.J.: Prentice-Hall, 1976.
Wenrich, W. W., Dawley, H. H., & General, D. A. Self-directed
systematic desensitization: A guide for the student, client and therapist. Kalamazoo, Mich.: Behaviordelia, 1976.
Wolpe, J. The practice of behavior therapy. 2d ed. Elmsford, N.Y.: Pergamon Press, 1973. Chapters 6 & 7.