- Email: [email protected]
An inexpensive automated desensitization procedure for clinical application
AN INEXPENSIVE PROCEDURE
AUTOMATED DESENSITIZATION FOR CLINICAL APPLICATION MARTYN
R. THOMAS
Department
of Psychology
MORTON
S. RAPP
Department
of Psychiatry
and WILLIAM Department
of Biomedical
M. GENTLES
Engineering, Sunnybrook Toronto, Canada
Medical Centre,
Summary-A fully automated imaginal desensitization procedure which has been used successfully for five years in a clinical behaviour therapy practice is described. The procedure is discussed in terms of its high degree of clinical flexibility, low cost and simplicity of operation. Two case histories exemplifv its use in the treatment of both simple and complex anxiety . related problems.
Why then, has automated desensitization not been used more widely? Evans and Kellam (1973) suggest “an element of resentment that a mechanical method of treatment should be allowed such a success rate”. Less speculative is the high cost of most fully automated logiccontrolled devices. Furthermore, most reported procedures lack the flexibility needed for successful clinical application. For example, individual hierarchies and last-minute changes in hierarchies cannot easily be accommodated. This paper reports on a fully automated procedure and apparatus which retains the flexibility needed in clinical settings, is inexpensive, requires minimal monitoring and technical knowledge, and has, in fact, been used successfully for five years.
Systematic desensitization (Wolpe, 1958) is effective in a variety of anxiety-related disorders (Paul, 1969). In vivo desensitization may be superior to the imaginal procedure (Garfield et al., 1967) but in vivo treatment is often impractical. An effective commonly-used routine is the combination of systematic desensitization in the office, with graded “homework” assignments. This combination obviates excessive therapist time-commitment, and places considerable responsibility for the success of treatment on the patient. However, repeated use of the imaginal procedure may become tedious, militating against its use (Cameron, 1977). Automation is a possible solution to the problem of tedium. Automated desensitization procedures have been described and shown to be therapeutic (Kahn and Baker, 1968; Krapfl, 1968; Donner and Guerney, 1969; Lang et al., 1970; Denholtz and Mann, 1974, 1975). Evans and Kellam (1973) in fact concluded that automated desensitization in no way diminishes the effectiveness of therapy.
PRINCIPLES The feature of this automated procedure which provides the clinical flexibility, is that the word-description of the stimulus scene to be
Request for reprints should be addressed to Martyn R. Thomas, Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Canada 317
Co-ordinator, M4N 3M5.
Behaviour
Therapy
Unit
(FG745),
MARTYN
318
R. THOMAS,
S RAPP and WILLIAM
MORTON
cassette recorders (with remote start/stop) and a slide projector.* One cassette recorder contains the main treatment program (Tape A) and the other, an “anxiety-response” program (Tape B). The slide projector contains the printed hierarchy slides. The first five minutes of Tape A consists of relaxation instructions. Then a high frequency beep from Tape A is detected by the apparatus, which advances the slide projector, bringing the first hierarchy item on the screen. Tape A then presents the visualization instructions. In this setting, the format and timing are as follows: (a) “Open your eyes and read to yourself what you see on the screen.” Five second pause. (b) “Now, I want you to close your eyes and try to visualize that scene as clearly as you can.” Ten second pause.
visualized is presented to the patient visually rather than vocally. Each scene from the hierarchy is printed with: “magic marker” on a Kodak Ektagraphic Write-On slide, and is projected on a screen in front of the patient. A pre-programmed audio-tape instructs the patient to open his eyes and read the slide, close his eyes and visualize, and then dissolve the image and continue relaxing. Thus a single audio tape can be used, because the content and order of the hierarchy can be changed simply by adding, subtracting or rearranging the Write-On slides to suit the clinical needs of the day.
APPARATUS
AND SPECIFIC
The apparatus that coordinates
M. GENTLES
FORMAT
is a simple controlling device the operation of two ordinary
1
A”C )I(
r
_A
Tr -
-__
1 I I
i-l
I I
I I
I I
I I I --__-
_
I
_
I I I I I I I I I 1 TAPE
I
A AUDIO
I I I ib VOLTS
I
, OUT
I
ON
, BEEP
ADI Controller
I L__-------------------_________1
Fig. *For information
1. Block diagram
on availability
of the apparatus,
of the automated desensitization and peripheral equipment. write to the senior author.
(ADi) controller
I I
AN INEXPENSIVE
AUTOMATED
(c) “Now, I want you to dissolve that image and turn your thoughts to how relaxed you are. Just think about the various muscle groups of your body . . . etc.” (The precise verbalization instructions are slightly varied from visualization, to visualization, though the message rpmains the same.) The above instructions are called a “visualizaEach visualization unit lasts 60 tion unit”. seconds. It is followed by a second unit, and this in turn is followed by another high frequency beep which instructs the slide projector to bring the second hierarchy item on to the screen. This format of two successive visualization units followed by a beep is repeated until ten scenes have been presented. Then a black slide comes on the screen, dimming the room, and the session ends with a few general relaxation instructions. The total treatment time is 25 minutes. The criterion for moving from one item in the hierarchy to the next is two successive visualizations of the scene without perceived anxiety. Where no anxiety is perceived during the 20 visualizations, the session proceeds automatically to its conclusion. If the patient does experience anxiety during the visualization, he pushes a button which switches the program from Tape A to Tape B. Tape B instructs the patient to dissolve the image, and then provides deep-breathing and muscular relaxation instructions sufficient to return the patient to his baseline relaxation level. While this is going on, Tape A continues to play (though it cannot be heard by the patient) through to the next high frequency beep which would normally advance the projector, as described above. However, in the situation where Tape B is playing, this beep does not advance the slide projector, but simply stops Tape A. Thus, Tape A automatically cues itself up to the next point where two successive visualization units will occur. The scene which caused patient-anxiety remains on the screen ready to be tried again. When Tape B is finished (two minutes), a high frequency beep on Tape B instructs the
DESENSITIZATION
PROCEDURE
319
apparatus to stop Tape B and start Tape A, and the procedure continues as described above. The patient must still successfully visualize the scene twice before the next slide is advanced. It is apparent then that if a patient experiences anxiety frequently, he will receive a therapy which is logical for that situation. Since Tape A continues to play through even when anxiety is signalled, and since the slide advances only after two successful (non-anxiety provoking) visualizations, the very anxious patient who presses the “panic button” frequently will have more time on relaxation instruction and be exposed to fewer different hierarchy scenes. He will advance up the ladder more slowly. The automated procedure thus mimics closely the behavior of a therapist practicing desensitization personally. Although this description may sound complicated, the actual operation of the equipment is simple. All that is required is for the slides to be loaded in the projector, and then for the two tape recorders to be started. Once this has been done the procedure continues fully automatically and requires no therapist involvement. At the end of the session the two tapes simply need to be rewound and they are ready to start again. The cost of the controller unit is between $200 and $300. To this must be added the cost of two inexpensive cassette machines and a projector. Many clinical settings will already have available these latter devices.
ILLUSTRATIVE
CASE REPORTS
Two cases are reported to illustrate application of automated desensitization clinical setting.
the in a
Case 1 A 29-year-old lawyer had a two and a half year history of flying anxiety. The problem began with two very turbulent flights, which occurred in close succession. He had been tense and nervous about flying ever since. A behavioral and psychological assessment (Rapp and Thomas, 1973; Thomas and Rapp, 1977) indicated other
320
XZARTYN
sources
of
anxiety,
but
flying
anxiety
solely
of automated
daily
for first
ments.
Immediately
a successful
taken
off,
ten
minutes
the
improvement
after
another
eat the
he was
His
again
was
in-flight
Six
meal.
tion. was
wife
later,
with
with
good
antici-
had
jetting
been
between
to
of
she
dated,
case
illustrates
desensitization
the
use
of
automated
informed CLIsr 2
sexual
A 25year-old of social ing
single
anxiety
and
to vaginismus.
achieced which Af‘tcr given
attempts
three
riding
ordinary
life
considcrablc po\itivc
public cvcntj
consijtcd
of
Gtic.ation
hierarchy
Gtuation\
(e.g.
with practice
dating, The
of
of
5i/es in
using
lzi\jo
anxiety.
more
later
had enjoyable after
the
moving,
treatment’s
case
use of
of
is
a multiple
complex
presented
automated
to
treatment
clinical
demon-
desensitization
as
program
fol
cases.
DISCUSSION The
job-
produced provided
aim
dcsen-
at
personal
social
dancing,
petting,
was
aljo
dilator{
desensitization
sexual
supplied for
homcfor
her
of
automated which
of
of
anxiety-related
minutes available introduces
clinical
the
of
practice.
apparatus
low two
cost
case
both
a fully
procedure are
The it\
high
and
simplicity
histories
illustrate
simple
and
complex
problems.
Automated It
for of
The
is to describe
desensitization
flexibility,
treatment
tages.
paper
suitable
features
operation.
the
this
imaginal
is
notable degree
treatment
a W-item
of
moved
rnonths
wa5
sessions,
which
automated
patient
second the
down
performing
treatment
aimed
graduated
penetration
focus
walking
of improvement.
37 sessions
intercour5c).
the
(e.g.
cxpcriencc,
phase
This strate
was
with
occasions,
results.
been
she
five
she had
pleased
whom
patient
on a few occasions
quite
to the
subsequently
several The
but that
related man
she
on
to
gather-
Toward
a young
anxiety.
point,
relations
and
anxiety
whom
there
related
intercourse.
she met
found
phase,
anxiety
(parties
intercourse
was
she
of impersonal
desen
automatically
practice
and
in
with
us by mail
a part
relaxation,
transit,
Between
second
never
intcrcoursc,
where
situations
feedback
The
of
hierarchy.
duties).
extcnd-
had
of automated
social
related
inadequacy,
her further.
sessions
u5in.g a 46item the street,
a history
at sexual
rensititcd
1Y sessions
impersonal
sexual
gave
Penetration
during merely
secretary
~hc
support,
the second
sexual
this
of
discussion
therapy,
in anticipatory
significant at
was
hour
dc\cnsiti/a-
of
of
situations
and
;I hall‘
in a variety
During
phase
sexual
without away
in a monophobia.
this
of
sessions session
restructuring.
reduction
about
end
Each
psychological
relaxed
and a fall
the two
dating,
treatment,
hour
phase
social
thinking
wa5
some
automated
half
first
initial
personal
had
This
the
no cow
flights.
the
more
ings)
relaxation
He was able
b)
and cognitive
an
of
considerable
situations.
was
with
cotisi5tcd
followed
After social
he
phases and
During
herself
confirmed
phase,
COW
situation,
011ce a wcch.
long
gi\,cn
ad\icc.
plane
comfortable
again
‘There
the treatment
he took Florida
treatment,
activity.
conducted hour
of
pro\,ohing
fir-st
both
discussion
the
month\
under-Lvay.
one
pre-flight
once
quite
to Florida,
but
flight
with
relax
take-off.
flight
to
were
phase
anxiety
in the
During no
hl. (iENTI.lzS
second
the
assign-
ended,
considerable to
in him.
anxiety, the
tact
and
he had
Toronto
this
with
but no sexual
The
bcha\iour
therapy
from
tact
days.
“home\vorh”
after
he began
had
once
no
During
the
explained
that,
and WIl.I.IAXl
le5s than
cognitive
He reported
but
patory
and
S. RAPP
conducted were
after
no
flight
return.
anxiety,
onI>
consisted
working format
but
sessions, sessions,
took
agreement Treatrncnt
and
session,
therapy
MORTON
desensitization,
rationale
discussion
and
by
was treated.
13 consecutive
treatment at the
R. THOblAS.
desensitization
not of
only
frees
tedium, for
more
an element
but
has other the
clinician
also
makes
constructive of
procedural
advanfrom
that
uses.
It
25 time also
consistency
AN INEXPENSIVE
AUTOMATED
which is irreproducible by a therapist. Unlike a therapist, the apparatus is never tense, bored, or preoccupied. Thus automated desensitization lends itself to the spirit of behavior therapy by eliminating one of the variables which influence treatment results. This comment applies even more strongly to research designs. Finally, the natural fear that the procedure might somehow “dehumanize” the entire treatment milieu simply has not materialized, after 5 years of clinical use. On the contrary, the reliable feedback about progress obtained by the procedure, and the time saving nature of the procedure itself, encourage and motivate both patient and therapist, and make the discussion time with the patient an interesting and warm experience, as well as a productive one. REFERENCES Cameron P. (1977) Personal communication. Denholtz M. S. and Mann E. T. (1974) An audiovisual program for group desensitization, J. Eehav. Ther. & Exp. Psychiat. 5,27-29. Denholtz M. S. and Mann E. T. (1975) An automated audiovisual treatment of phobias administered by nonprofessionals, 1. Behav. Ther. & Exp. Psychiat. 6, lll115.
DESENSITIZATION
PROCEDURE
321
Donner, L. and Guerney B. G. (1969) Automated group desensitization for test anxiety, Behav. Rex Thu. 7, I-13. Evans P. D. and Kellam A. M. P. (1973) Semi-automated desensitization: A controlled clinical trial, Behav. Res. Ther. 11,641-646. Garfield Z. H., Darwin P. L., Singer B. A. and McBreaty J. F.(1967) Effect of in vivo training on experimental desensitization of a phobia, Psycho/. Rep. 20,515. Kahn M. and Baker B. (1968) Desensitization with minimal therapist contact, J. Abnorm. Psycho/. 73, 556-558. Krapfl J. E. (1968) Differential ordering of stimuli presentation and semi-automated vs. live treatment in the systematic desensitization of snake phobia, Din. Absts. 28B, 3878. Lang P. J., Melamed B. G. and Hart J. (1970) A psychophysiological analysis of fear modification using an automated desensitization procedure, J. Abnorm. Psychol. 76.220-229. Paul G. L. (1969) Outcome of systematic desensitization II: Controlled investigations of individual treatment, technique variations and current states. In Behavior Therapy: Appraisal and Status (Ed. by Franks C. M.), pp. 105-159, McGraw-Hill, New York. Thomas M. R. and Rapp M. S. (1977) Physiological, behavioral and cognitive changes resulting from flooding in a monosymptomatic phobia, Behav. Res. Ther. 15, 304-306. Rapp M. S. and Thomas M. R. (1973) Behaviour therapy in a general hospital. Presented to the annual meeting of the Canadian Psychiatric Association. Wolpe J. (1958) Psychotherapy by Reciprocal Stanford University Press, Stanford.
Inhibition.
AUTOMATED DESENSITIZATION FOR CLINICAL APPLICATION MARTYN
R. THOMAS
Department
of Psychology
MORTON
S. RAPP
Department
of Psychiatry
and WILLIAM Department
of Biomedical
M. GENTLES
Engineering, Sunnybrook Toronto, Canada
Medical Centre,
Summary-A fully automated imaginal desensitization procedure which has been used successfully for five years in a clinical behaviour therapy practice is described. The procedure is discussed in terms of its high degree of clinical flexibility, low cost and simplicity of operation. Two case histories exemplifv its use in the treatment of both simple and complex anxiety . related problems.
Why then, has automated desensitization not been used more widely? Evans and Kellam (1973) suggest “an element of resentment that a mechanical method of treatment should be allowed such a success rate”. Less speculative is the high cost of most fully automated logiccontrolled devices. Furthermore, most reported procedures lack the flexibility needed for successful clinical application. For example, individual hierarchies and last-minute changes in hierarchies cannot easily be accommodated. This paper reports on a fully automated procedure and apparatus which retains the flexibility needed in clinical settings, is inexpensive, requires minimal monitoring and technical knowledge, and has, in fact, been used successfully for five years.
Systematic desensitization (Wolpe, 1958) is effective in a variety of anxiety-related disorders (Paul, 1969). In vivo desensitization may be superior to the imaginal procedure (Garfield et al., 1967) but in vivo treatment is often impractical. An effective commonly-used routine is the combination of systematic desensitization in the office, with graded “homework” assignments. This combination obviates excessive therapist time-commitment, and places considerable responsibility for the success of treatment on the patient. However, repeated use of the imaginal procedure may become tedious, militating against its use (Cameron, 1977). Automation is a possible solution to the problem of tedium. Automated desensitization procedures have been described and shown to be therapeutic (Kahn and Baker, 1968; Krapfl, 1968; Donner and Guerney, 1969; Lang et al., 1970; Denholtz and Mann, 1974, 1975). Evans and Kellam (1973) in fact concluded that automated desensitization in no way diminishes the effectiveness of therapy.
PRINCIPLES The feature of this automated procedure which provides the clinical flexibility, is that the word-description of the stimulus scene to be
Request for reprints should be addressed to Martyn R. Thomas, Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Canada 317
Co-ordinator, M4N 3M5.
Behaviour
Therapy
Unit
(FG745),
MARTYN
318
R. THOMAS,
S RAPP and WILLIAM
MORTON
cassette recorders (with remote start/stop) and a slide projector.* One cassette recorder contains the main treatment program (Tape A) and the other, an “anxiety-response” program (Tape B). The slide projector contains the printed hierarchy slides. The first five minutes of Tape A consists of relaxation instructions. Then a high frequency beep from Tape A is detected by the apparatus, which advances the slide projector, bringing the first hierarchy item on the screen. Tape A then presents the visualization instructions. In this setting, the format and timing are as follows: (a) “Open your eyes and read to yourself what you see on the screen.” Five second pause. (b) “Now, I want you to close your eyes and try to visualize that scene as clearly as you can.” Ten second pause.
visualized is presented to the patient visually rather than vocally. Each scene from the hierarchy is printed with: “magic marker” on a Kodak Ektagraphic Write-On slide, and is projected on a screen in front of the patient. A pre-programmed audio-tape instructs the patient to open his eyes and read the slide, close his eyes and visualize, and then dissolve the image and continue relaxing. Thus a single audio tape can be used, because the content and order of the hierarchy can be changed simply by adding, subtracting or rearranging the Write-On slides to suit the clinical needs of the day.
APPARATUS
AND SPECIFIC
The apparatus that coordinates
M. GENTLES
FORMAT
is a simple controlling device the operation of two ordinary
1
A”C )I(
r
_A
Tr -
-__
1 I I
i-l
I I
I I
I I
I I I --__-
_
I
_
I I I I I I I I I 1 TAPE
I
A AUDIO
I I I ib VOLTS
I
, OUT
I
ON
, BEEP
ADI Controller
I L__-------------------_________1
Fig. *For information
1. Block diagram
on availability
of the apparatus,
of the automated desensitization and peripheral equipment. write to the senior author.
(ADi) controller
I I
AN INEXPENSIVE
AUTOMATED
(c) “Now, I want you to dissolve that image and turn your thoughts to how relaxed you are. Just think about the various muscle groups of your body . . . etc.” (The precise verbalization instructions are slightly varied from visualization, to visualization, though the message rpmains the same.) The above instructions are called a “visualizaEach visualization unit lasts 60 tion unit”. seconds. It is followed by a second unit, and this in turn is followed by another high frequency beep which instructs the slide projector to bring the second hierarchy item on to the screen. This format of two successive visualization units followed by a beep is repeated until ten scenes have been presented. Then a black slide comes on the screen, dimming the room, and the session ends with a few general relaxation instructions. The total treatment time is 25 minutes. The criterion for moving from one item in the hierarchy to the next is two successive visualizations of the scene without perceived anxiety. Where no anxiety is perceived during the 20 visualizations, the session proceeds automatically to its conclusion. If the patient does experience anxiety during the visualization, he pushes a button which switches the program from Tape A to Tape B. Tape B instructs the patient to dissolve the image, and then provides deep-breathing and muscular relaxation instructions sufficient to return the patient to his baseline relaxation level. While this is going on, Tape A continues to play (though it cannot be heard by the patient) through to the next high frequency beep which would normally advance the projector, as described above. However, in the situation where Tape B is playing, this beep does not advance the slide projector, but simply stops Tape A. Thus, Tape A automatically cues itself up to the next point where two successive visualization units will occur. The scene which caused patient-anxiety remains on the screen ready to be tried again. When Tape B is finished (two minutes), a high frequency beep on Tape B instructs the
DESENSITIZATION
PROCEDURE
319
apparatus to stop Tape B and start Tape A, and the procedure continues as described above. The patient must still successfully visualize the scene twice before the next slide is advanced. It is apparent then that if a patient experiences anxiety frequently, he will receive a therapy which is logical for that situation. Since Tape A continues to play through even when anxiety is signalled, and since the slide advances only after two successful (non-anxiety provoking) visualizations, the very anxious patient who presses the “panic button” frequently will have more time on relaxation instruction and be exposed to fewer different hierarchy scenes. He will advance up the ladder more slowly. The automated procedure thus mimics closely the behavior of a therapist practicing desensitization personally. Although this description may sound complicated, the actual operation of the equipment is simple. All that is required is for the slides to be loaded in the projector, and then for the two tape recorders to be started. Once this has been done the procedure continues fully automatically and requires no therapist involvement. At the end of the session the two tapes simply need to be rewound and they are ready to start again. The cost of the controller unit is between $200 and $300. To this must be added the cost of two inexpensive cassette machines and a projector. Many clinical settings will already have available these latter devices.
ILLUSTRATIVE
CASE REPORTS
Two cases are reported to illustrate application of automated desensitization clinical setting.
the in a
Case 1 A 29-year-old lawyer had a two and a half year history of flying anxiety. The problem began with two very turbulent flights, which occurred in close succession. He had been tense and nervous about flying ever since. A behavioral and psychological assessment (Rapp and Thomas, 1973; Thomas and Rapp, 1977) indicated other
320
XZARTYN
sources
of
anxiety,
but
flying
anxiety
solely
of automated
daily
for first
ments.
Immediately
a successful
taken
off,
ten
minutes
the
improvement
after
another
eat the
he was
His
again
was
in-flight
Six
meal.
tion. was
wife
later,
with
with
good
antici-
had
jetting
been
between
to
of
she
dated,
case
illustrates
desensitization
the
use
of
automated
informed CLIsr 2
sexual
A 25year-old of social ing
single
anxiety
and
to vaginismus.
achieced which Af‘tcr given
attempts
three
riding
ordinary
life
considcrablc po\itivc
public cvcntj
consijtcd
of
Gtic.ation
hierarchy
Gtuation\
(e.g.
with practice
dating, The
of
of
5i/es in
using
lzi\jo
anxiety.
more
later
had enjoyable after
the
moving,
treatment’s
case
use of
of
is
a multiple
complex
presented
automated
to
treatment
clinical
demon-
desensitization
as
program
fol
cases.
DISCUSSION The
job-
produced provided
aim
dcsen-
at
personal
social
dancing,
petting,
was
aljo
dilator{
desensitization
sexual
supplied for
homcfor
her
of
automated which
of
of
anxiety-related
minutes available introduces
clinical
the
of
practice.
apparatus
low two
cost
case
both
a fully
procedure are
The it\
high
and
simplicity
histories
illustrate
simple
and
complex
problems.
Automated It
for of
The
is to describe
desensitization
flexibility,
treatment
tages.
paper
suitable
features
operation.
the
this
imaginal
is
notable degree
treatment
a W-item
of
moved
rnonths
wa5
sessions,
which
automated
patient
second the
down
performing
treatment
aimed
graduated
penetration
focus
walking
of improvement.
37 sessions
intercour5c).
the
(e.g.
cxpcriencc,
phase
This strate
was
with
occasions,
results.
been
she
five
she had
pleased
whom
patient
on a few occasions
quite
to the
subsequently
several The
but that
related man
she
on
to
gather-
Toward
a young
anxiety.
point,
relations
and
anxiety
whom
there
related
intercourse.
she met
found
phase,
anxiety
(parties
intercourse
was
she
of impersonal
desen
automatically
practice
and
in
with
us by mail
a part
relaxation,
transit,
Between
second
never
intcrcoursc,
where
situations
feedback
The
of
hierarchy.
duties).
extcnd-
had
of automated
social
related
inadequacy,
her further.
sessions
u5in.g a 46item the street,
a history
at sexual
rensititcd
1Y sessions
impersonal
sexual
gave
Penetration
during merely
secretary
~hc
support,
the second
sexual
this
of
discussion
therapy,
in anticipatory
significant at
was
hour
dc\cnsiti/a-
of
of
situations
and
;I hall‘
in a variety
During
phase
sexual
without away
in a monophobia.
this
of
sessions session
restructuring.
reduction
about
end
Each
psychological
relaxed
and a fall
the two
dating,
treatment,
hour
phase
social
thinking
wa5
some
automated
half
first
initial
personal
had
This
the
no cow
flights.
the
more
ings)
relaxation
He was able
b)
and cognitive
an
of
considerable
situations.
was
with
cotisi5tcd
followed
After social
he
phases and
During
herself
confirmed
phase,
COW
situation,
011ce a wcch.
long
gi\,cn
ad\icc.
plane
comfortable
again
‘There
the treatment
he took Florida
treatment,
activity.
conducted hour
of
pro\,ohing
fir-st
both
discussion
the
month\
under-Lvay.
one
pre-flight
once
quite
to Florida,
but
flight
with
relax
take-off.
flight
to
were
phase
anxiety
in the
During no
hl. (iENTI.lzS
second
the
assign-
ended,
considerable to
in him.
anxiety, the
tact
and
he had
Toronto
this
with
but no sexual
The
bcha\iour
therapy
from
tact
days.
“home\vorh”
after
he began
had
once
no
During
the
explained
that,
and WIl.I.IAXl
le5s than
cognitive
He reported
but
patory
and
S. RAPP
conducted were
after
no
flight
return.
anxiety,
onI>
consisted
working format
but
sessions, sessions,
took
agreement Treatrncnt
and
session,
therapy
MORTON
desensitization,
rationale
discussion
and
by
was treated.
13 consecutive
treatment at the
R. THOblAS.
desensitization
not of
only
frees
tedium, for
more
an element
but
has other the
clinician
also
makes
constructive of
procedural
advanfrom
that
uses.
It
25 time also
consistency
AN INEXPENSIVE
AUTOMATED
which is irreproducible by a therapist. Unlike a therapist, the apparatus is never tense, bored, or preoccupied. Thus automated desensitization lends itself to the spirit of behavior therapy by eliminating one of the variables which influence treatment results. This comment applies even more strongly to research designs. Finally, the natural fear that the procedure might somehow “dehumanize” the entire treatment milieu simply has not materialized, after 5 years of clinical use. On the contrary, the reliable feedback about progress obtained by the procedure, and the time saving nature of the procedure itself, encourage and motivate both patient and therapist, and make the discussion time with the patient an interesting and warm experience, as well as a productive one. REFERENCES Cameron P. (1977) Personal communication. Denholtz M. S. and Mann E. T. (1974) An audiovisual program for group desensitization, J. Eehav. Ther. & Exp. Psychiat. 5,27-29. Denholtz M. S. and Mann E. T. (1975) An automated audiovisual treatment of phobias administered by nonprofessionals, 1. Behav. Ther. & Exp. Psychiat. 6, lll115.
DESENSITIZATION
PROCEDURE
321
Donner, L. and Guerney B. G. (1969) Automated group desensitization for test anxiety, Behav. Rex Thu. 7, I-13. Evans P. D. and Kellam A. M. P. (1973) Semi-automated desensitization: A controlled clinical trial, Behav. Res. Ther. 11,641-646. Garfield Z. H., Darwin P. L., Singer B. A. and McBreaty J. F.(1967) Effect of in vivo training on experimental desensitization of a phobia, Psycho/. Rep. 20,515. Kahn M. and Baker B. (1968) Desensitization with minimal therapist contact, J. Abnorm. Psycho/. 73, 556-558. Krapfl J. E. (1968) Differential ordering of stimuli presentation and semi-automated vs. live treatment in the systematic desensitization of snake phobia, Din. Absts. 28B, 3878. Lang P. J., Melamed B. G. and Hart J. (1970) A psychophysiological analysis of fear modification using an automated desensitization procedure, J. Abnorm. Psychol. 76.220-229. Paul G. L. (1969) Outcome of systematic desensitization II: Controlled investigations of individual treatment, technique variations and current states. In Behavior Therapy: Appraisal and Status (Ed. by Franks C. M.), pp. 105-159, McGraw-Hill, New York. Thomas M. R. and Rapp M. S. (1977) Physiological, behavioral and cognitive changes resulting from flooding in a monosymptomatic phobia, Behav. Res. Ther. 15, 304-306. Rapp M. S. and Thomas M. R. (1973) Behaviour therapy in a general hospital. Presented to the annual meeting of the Canadian Psychiatric Association. Wolpe J. (1958) Psychotherapy by Reciprocal Stanford University Press, Stanford.
Inhibition.