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Effect of false autonomic feedback on self-reported anxiety, pain perception, and pulse rate
BEHAVIOR THERAPY 7, 330-334 (1976)
Effect of False Autonomic Feedback on Self-Reported Anxiety, Pain Perception, and Pulse Rate DAVID S. HOLMES AND RANDY O. FROST
University of Kansas In two experiments, evaluating the effect of false autonomic feedback, subjects received two identical electrical shocks separated by 2 rain. During the interval between the shocks, the subjects received false feedback showing that fear either increased or decreased. Both experiments revealed that relative to subjects in the decreased arousal feedback condition, subjects in the increased arousal feedback condition reported greater increases in anxiety and judged the second shock to be stronger than the first shock. There was no difference in physiological arousal (pulse rate) between the subjects in the two conditions. The influence of false feedback on emotion and pain perception was discussed.
Considerable attention has focused on whether giving persons false feedback about their physiological arousal influences attitudes and behavior (e.g., Bramel, Bell, & Margulis, 1965; Valins, 1966). Recently, attention has been given to the potential therapeutic value of false feedback. In four experiments, snake-phobic subjects were given false feedback indicating that they were not afraid while they looked at slides of snakes (Kent, Wilson, & Nelson, 1972; Rosen, Rosen, & Reid, 1972; Sushinsky, & Bootzin, 1970; Valins, & Ray, 1967). Unfortunately, only Valins and Ray (1967) found an avoidance reduction, but this experiment suffered from methodological problems (see Gaupp, Stern, & Galbraith, 1972). Recently, however, false feedback given to speech-anxious subjects influenced both subjective and behavioral indicies of speech anxiety (Borkovec, Wall, & Stone, 1974). Thus far, there have not been any reports concerning the potential influence of false feedback on pain perception. Because pain perception could be an important applied area, the present experiments determined whether false feedback could influence pain perception and the anxiety attendant upon pain. This research also obtained additional evidence assessing whether false physiological feedback changes physiological arousal. Schachter and Singer (1962) stated that "the individual will react emotionally or describe This research was supported by United States Public Health Services Grant MH-20819 to
the first author. Requestsfor reprints should be sent to either author, Department of Psychology, The University of Kansas, Lawrence, KS 66045. 330 Copyright © 1976by Associationfor Advancementof Behavior Therapy. All rights of reproduction in any form reserved.
EFFECT OF FALSE A U T O N O M I C FEEDBACK
331
his feelings as emotions only to the extent that he experiences a state of physiological arousal" (p. 382). Consequently, for false feedback to have an emotional relabeling effect, Schachter and Singer would hypothesize an accompanying change in physiological arousal, what Goldstein, Fink, and Mettee (1972) called the "mimic effect." On the other hand, Valin (1966) contends that the belief of physiological arousal alone is sufficient for an emotional relabeling effect. The evidence on a"mimic effect" is contradictory (Borkovec & Glasgow, 1973; Borkovec, Wall, & Stone, 1974; Gaupp et al., 1972; Goldstein et al., 1972; Koenig & Del Castillo, 1969; Rosen, Rosen, & Reid, 1972). In the present experiments, subjects' base levels of anxiety and physiological arousal were first measured. Subjects then were given an electrical shock and informed that they would be given a second shock after a 2-min interval. During the next 2 min the subjects received false physiological feedback indicating that they were becoming either more or less afraid while waiting for the second shock. Their levels of anxiety and physiological arousal were assessed again and then the subjects received the second shock which was the same intensity as the first. Finally, subjects indicated whether the second shock was more or less painful than the first. EXPERIMENT I
Method Subjects.
Thirty-two female introductory psychology students at the University of Kansas participated in the experiment to fulfill a course requirement. The subjects were run in pairs and were randomly assigned to one of two conditions: Increased Arousal Feedback (IAF) and Decreased Arousal Feedback (DAF). Each of two experimenters ran an equal number of subjects in each condition.
Procedure Upon arriving at the laboratory, the subjects were seated at desks separated by a partition. Mounted on each desk was a large meter and an audio speaker. When a subject was comfortably seated, a Beckman plethysmographic transducer was attached to the index finger of the subject's nondominant hand and two Narco Bio lead electrodes were attached to the little finger of the same hand after the area was prepared with Beckman Offner paste. After the devices had been attached, the experimenter left the control room where he started the tape recorded instructions and the physiological recording apparatus. Each subject was first asked to indicate how she felt by checking the appropriate adjectives on a 21-item Affect Adjective Checklist (AACL; Zuckerman, 1960). After completing the AACL, she was told that the experiment dealt with "the relationship between physiological responses and the experience of pain," and that changes in her physiological responses would be measured by a variety of sensing devices in the transducer on her finger, The instructions described the apparatus in the control room that combined the independent measures to yield one overall measure, "the Harvard Fear Index." The accuracy of this measure and the fact that it was not under voluntary control was stressed. The subject was then told that she would be able to see her Fear Index Scores on the meter mounted on the desk in front of her. The subject was told that the stimulation she would receive would be electrical shocks administered through the electrodes attached to her little finger. It was stressed that the shock
332
HOLMES AND FROST
intensity would vary, that they would last less than 1/10 of 1 sec, and that none would be dangerous. The subject was informed that she would receive two shocks separated in time by about 2 min and that the second shock would be either weaker or stronger than the first. The subject then received a Fear Index score sheet and was instructed concerning how and when she was to record her scores from the meter. The subject was told that a score of five represented a base rate. If her physiological responses revealed that she was becoming more aroused the meter would indicate higher scores. If her physiological responses revealed that she was becoming less aroused the meter would indicate lower scores. The meter was actually controlled by the experimenter in an adjoining room. When all procedures were explained, the subject was informed that she could withdraw from the experiment at any time and still receive credit for participation. 1 If a subject consented to continue and signed a consent form, she was then given the first shock. She was then asked to record her first fear score on the form provided and to record her second and third fear scores 15 and 30 sec later. After recording the third fear score, the subject was asked to indicate her present feelings on an AACL and then record her fourth fear score. In the IAF condition, the fear scores recorded by the subjects were approximately 6, 7, 8, and 9.5 while in the DAF condition they were approximately 4, 3, 2, and 0.5. The subject then received her second shock. Immediately after receiving the second shock, the subject indicated whether the second shock was more or less intense than the first. The subject was interviewed by the experimenter concerning her belief in the dial readings, 2 completely debriefed concerning the deception, and dismissed. Pulse rates were recorded continuously during the experiment, and the measures of physiological arousal were beats in the 30-sec periods during which the subjects responded to the two AACLs.
Results and Discussion
Analyses determined the degree to which the false autonomic feedback influenced self-report of anxiety as measured by AACLs, pulse rates, and perception of pain. In the case of the AACL and pulse rate data, the difference scores were compared to the change in self-reported anxiety or pulse rates from the baseline period (i.e., before receiving shock or feedback) to the stress period (i.e., after receiving feedback and immediately before the second shock). The change scores for the two groups were compared with analyses of covariance in which the covariate was the baseline measure. A 2 x 2 analysis ofcovariance comparing the AACL change scores of the subjects run in the two conditions by the two experimenters revealed a significant groups effect, F (1, 27) = 8.51, p = .007; subjects in the IAF condition (x = 12.55) reported greater increases in self-reported anxiety than subjects in the DAF condition (x = 9.32). However, a similar analysis carried out on the pulse rate indicated no significant effect, F (1, 27) = .02. That subjects in the IAF condition showed greater increases in anxiety than subjects in DAF condition without a corresponding difference in changes in 1 In Experiment I, two subjects elected not to continue while in Experiment II three subjects elected not to continue. In both cases these subjects were replaced. In Experiment I, six subjects were suspicious of the feedback while this was the case with four subjects in Experiment II. In both cases those subjects were replaced.
EFFECT OF FALSE A U T O N O M I C FEEDBACK
333
physiological arousal raises doubts about the assertion of Schachter and Singer (1962) that for emotional labeling to take place there must first be a change in the physiological arousal. A 2 x 2 chi-square analysis comparing the frequencies that subjects perceived the second shock as either of greater or lesser intensity than the first shock revealed an effect which approached significance, X2 (1) = 3.14, p = .073.3 This was due to the fact that 73.5% of the subjects in the IAF condition perceived the second shock as stronger, while only 37.5% of the subjects in the DAF condition perceived it as stronger. This finding indicates that the false autonomic feedback not only influenced the subjects' self-reported anxiety but also their reported experience of pain. One possible explanation for the lack of a mimic effect lies in the fact that in this experiment subjects saw scores reflecting their physiological responses while in other experiments the subjects actually saw or heard their responses. For example, in the Goldstein et al. (1972) experiment in which there was some evidence for a mimic effect, the subjects heard their heart rates. Hearing or seeing one's own responses may have greater impact than seeing scores derived from the responses and therefore a second experiment was conducted in which subjects heard false heart rates in addition to observing their scores. EXPERIMENT
II
Method Subjects. Forty female introductory psychology students at the University of Kansas participated in the experiment to fulfill a course experiment. The subjects were run in pairs and were randomly assigned to one of two conditions: Increased Arousal Feedback (IAF) and Decreased Arousal Feedback (DAF). Each of two experimenters ran an equal number of subjects in each condition. Procedures. The procedures in this experiment were identical to those of Experiment 1, except that the subject wore earphones and was told that in addition to seeing her Fear Index score she could listen to her own heart rate. The false heart rates began immediately after t h e first shock. In the IAF condition the tones which the subjects were told represented heart beats showed a distinct increase in rate as the time for the second shock approached while in the DAF condition the tones showed a distinct decrease.
Results and Discussion
The analysis of covariance comparing the AACL change scores revealed a significant groups effect, F (1, 35) = 23.30,p = .0001; subjects in the IAF condition (x = 14.82) reported greater increases in anxiety than did subjects in the DAF condition (x = 9.78). There were no differences in pulse rate due to feedback, F (1,35) = .09. Finally, the 2 x 2 chi-square analysis comparing the frequencies with which subjects in the two conditions perceived the 3 In view of the work of Grizzle (1967), the chi-square tests reported in this paper were not corrected for continuity.
334
HOLMES AND FROST
second shock as stronger or weaker than the first indicated was not significant, X 2 (1) = 2.67, p = .099.
Conclusions and Implications Although the potential bias in self-reports cannot be completely dismissed, from the present results it appears that false feedback affects subject's perception of pain and their anxiety associated with that perception. Contrary to what has been sometimes assumed about the effect of false feedback on actual physiological functioning, these experiments indicate that the false feedback did not influence the subjects' actual level of autonomic arousal as measured by pulse rate. The strength and consistency of these results concerning the reports of pain and anxiety suggest that false physiological feedback deserves more attention as a potential therapeutic technique.
REFERENCES Borkovec, T. D., & Glasgow, R. E. Boundary conditions of false heart-rate feedback effects on avoidance behavior: A resolution of discrepant results. Behaviour Research and Therapy, 1973, 11, 171-177. Borkovec, T. D., Wall, R. L., & Stone, N. M. False physiological feedback and the maintenance of speech anxiety. Journal of Abnormal Psychology, 1974, 83, 164-168. Brammel, D., Bell, J., & Margulis, S. Attributing danger as a means of explaining one's fear. Journal of Experimental Social Psychology, 1965, 1, 267-281. Gaupp, L. A., Stern, R. M., & Galbraith, G. G. False heart-rate feedback and reciprocal inhibition by aversion relief in the treatment of snake avoidance behavior. Behavior Therapy, 1972, 3, 7-20. Goldstein, D., Fink, D., & Mettee, D. R. Cognition of arousal and actual arousal as determinants of emotion. Journal of Personality and Social Psychology, 1972, 21, 41-51. Grizzle, J. Continuity correction in the X2 test for 2 × 2 tables. American Statistician, 1967, 21, 28-32. Kent, R. N., Wilson, G. T., & Nelson, R. Effects of false heart-rate feedback on avoidance behavior: An investigation of "cognitive desensitization." Behavior Therapy, 1972, 3, 1-6. Koenig, K. P., & Del Castillo, D. False feedback and longevity of the conditioned GSR during extinction: Some implications for aversion therapy. Journal of Abnormal Psychology, 1969, 74, 505-510. Rosen, G. M., Rosen, E., & Reid, J. B. Cognitive desensitization and avoidance behavior: A reevaluation. Journal of Abnormal Psychology, 1972, 80, 176--182. Schachter, S., & Singer, J. E. Cognitive, social and physiological determinants of emotional state. Psychological Review, 1962, 69, 37%399. Sushinsky, L. M., & Bootzin, R. R. Cognitive desensitization as a model of systematic desensitization. Behaviour Research & Therapy, 1970, 8, 2%33. Valins, S., & Ray, A. A. Effects of cognitive desensitization on avoidance behavior. Journal Psychology. 1966, 4, 400-408. Valins, S., & Ray, A. A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 345-350. Zuckerman, M. The development of an affect adjective check list for the measurement of anxiety. Journal of Consulting Psychology, 1960, 24, 457-462.
Effect of False Autonomic Feedback on Self-Reported Anxiety, Pain Perception, and Pulse Rate DAVID S. HOLMES AND RANDY O. FROST
University of Kansas In two experiments, evaluating the effect of false autonomic feedback, subjects received two identical electrical shocks separated by 2 rain. During the interval between the shocks, the subjects received false feedback showing that fear either increased or decreased. Both experiments revealed that relative to subjects in the decreased arousal feedback condition, subjects in the increased arousal feedback condition reported greater increases in anxiety and judged the second shock to be stronger than the first shock. There was no difference in physiological arousal (pulse rate) between the subjects in the two conditions. The influence of false feedback on emotion and pain perception was discussed.
Considerable attention has focused on whether giving persons false feedback about their physiological arousal influences attitudes and behavior (e.g., Bramel, Bell, & Margulis, 1965; Valins, 1966). Recently, attention has been given to the potential therapeutic value of false feedback. In four experiments, snake-phobic subjects were given false feedback indicating that they were not afraid while they looked at slides of snakes (Kent, Wilson, & Nelson, 1972; Rosen, Rosen, & Reid, 1972; Sushinsky, & Bootzin, 1970; Valins, & Ray, 1967). Unfortunately, only Valins and Ray (1967) found an avoidance reduction, but this experiment suffered from methodological problems (see Gaupp, Stern, & Galbraith, 1972). Recently, however, false feedback given to speech-anxious subjects influenced both subjective and behavioral indicies of speech anxiety (Borkovec, Wall, & Stone, 1974). Thus far, there have not been any reports concerning the potential influence of false feedback on pain perception. Because pain perception could be an important applied area, the present experiments determined whether false feedback could influence pain perception and the anxiety attendant upon pain. This research also obtained additional evidence assessing whether false physiological feedback changes physiological arousal. Schachter and Singer (1962) stated that "the individual will react emotionally or describe This research was supported by United States Public Health Services Grant MH-20819 to
the first author. Requestsfor reprints should be sent to either author, Department of Psychology, The University of Kansas, Lawrence, KS 66045. 330 Copyright © 1976by Associationfor Advancementof Behavior Therapy. All rights of reproduction in any form reserved.
EFFECT OF FALSE A U T O N O M I C FEEDBACK
331
his feelings as emotions only to the extent that he experiences a state of physiological arousal" (p. 382). Consequently, for false feedback to have an emotional relabeling effect, Schachter and Singer would hypothesize an accompanying change in physiological arousal, what Goldstein, Fink, and Mettee (1972) called the "mimic effect." On the other hand, Valin (1966) contends that the belief of physiological arousal alone is sufficient for an emotional relabeling effect. The evidence on a"mimic effect" is contradictory (Borkovec & Glasgow, 1973; Borkovec, Wall, & Stone, 1974; Gaupp et al., 1972; Goldstein et al., 1972; Koenig & Del Castillo, 1969; Rosen, Rosen, & Reid, 1972). In the present experiments, subjects' base levels of anxiety and physiological arousal were first measured. Subjects then were given an electrical shock and informed that they would be given a second shock after a 2-min interval. During the next 2 min the subjects received false physiological feedback indicating that they were becoming either more or less afraid while waiting for the second shock. Their levels of anxiety and physiological arousal were assessed again and then the subjects received the second shock which was the same intensity as the first. Finally, subjects indicated whether the second shock was more or less painful than the first. EXPERIMENT I
Method Subjects.
Thirty-two female introductory psychology students at the University of Kansas participated in the experiment to fulfill a course requirement. The subjects were run in pairs and were randomly assigned to one of two conditions: Increased Arousal Feedback (IAF) and Decreased Arousal Feedback (DAF). Each of two experimenters ran an equal number of subjects in each condition.
Procedure Upon arriving at the laboratory, the subjects were seated at desks separated by a partition. Mounted on each desk was a large meter and an audio speaker. When a subject was comfortably seated, a Beckman plethysmographic transducer was attached to the index finger of the subject's nondominant hand and two Narco Bio lead electrodes were attached to the little finger of the same hand after the area was prepared with Beckman Offner paste. After the devices had been attached, the experimenter left the control room where he started the tape recorded instructions and the physiological recording apparatus. Each subject was first asked to indicate how she felt by checking the appropriate adjectives on a 21-item Affect Adjective Checklist (AACL; Zuckerman, 1960). After completing the AACL, she was told that the experiment dealt with "the relationship between physiological responses and the experience of pain," and that changes in her physiological responses would be measured by a variety of sensing devices in the transducer on her finger, The instructions described the apparatus in the control room that combined the independent measures to yield one overall measure, "the Harvard Fear Index." The accuracy of this measure and the fact that it was not under voluntary control was stressed. The subject was then told that she would be able to see her Fear Index Scores on the meter mounted on the desk in front of her. The subject was told that the stimulation she would receive would be electrical shocks administered through the electrodes attached to her little finger. It was stressed that the shock
332
HOLMES AND FROST
intensity would vary, that they would last less than 1/10 of 1 sec, and that none would be dangerous. The subject was informed that she would receive two shocks separated in time by about 2 min and that the second shock would be either weaker or stronger than the first. The subject then received a Fear Index score sheet and was instructed concerning how and when she was to record her scores from the meter. The subject was told that a score of five represented a base rate. If her physiological responses revealed that she was becoming more aroused the meter would indicate higher scores. If her physiological responses revealed that she was becoming less aroused the meter would indicate lower scores. The meter was actually controlled by the experimenter in an adjoining room. When all procedures were explained, the subject was informed that she could withdraw from the experiment at any time and still receive credit for participation. 1 If a subject consented to continue and signed a consent form, she was then given the first shock. She was then asked to record her first fear score on the form provided and to record her second and third fear scores 15 and 30 sec later. After recording the third fear score, the subject was asked to indicate her present feelings on an AACL and then record her fourth fear score. In the IAF condition, the fear scores recorded by the subjects were approximately 6, 7, 8, and 9.5 while in the DAF condition they were approximately 4, 3, 2, and 0.5. The subject then received her second shock. Immediately after receiving the second shock, the subject indicated whether the second shock was more or less intense than the first. The subject was interviewed by the experimenter concerning her belief in the dial readings, 2 completely debriefed concerning the deception, and dismissed. Pulse rates were recorded continuously during the experiment, and the measures of physiological arousal were beats in the 30-sec periods during which the subjects responded to the two AACLs.
Results and Discussion
Analyses determined the degree to which the false autonomic feedback influenced self-report of anxiety as measured by AACLs, pulse rates, and perception of pain. In the case of the AACL and pulse rate data, the difference scores were compared to the change in self-reported anxiety or pulse rates from the baseline period (i.e., before receiving shock or feedback) to the stress period (i.e., after receiving feedback and immediately before the second shock). The change scores for the two groups were compared with analyses of covariance in which the covariate was the baseline measure. A 2 x 2 analysis ofcovariance comparing the AACL change scores of the subjects run in the two conditions by the two experimenters revealed a significant groups effect, F (1, 27) = 8.51, p = .007; subjects in the IAF condition (x = 12.55) reported greater increases in self-reported anxiety than subjects in the DAF condition (x = 9.32). However, a similar analysis carried out on the pulse rate indicated no significant effect, F (1, 27) = .02. That subjects in the IAF condition showed greater increases in anxiety than subjects in DAF condition without a corresponding difference in changes in 1 In Experiment I, two subjects elected not to continue while in Experiment II three subjects elected not to continue. In both cases these subjects were replaced. In Experiment I, six subjects were suspicious of the feedback while this was the case with four subjects in Experiment II. In both cases those subjects were replaced.
EFFECT OF FALSE A U T O N O M I C FEEDBACK
333
physiological arousal raises doubts about the assertion of Schachter and Singer (1962) that for emotional labeling to take place there must first be a change in the physiological arousal. A 2 x 2 chi-square analysis comparing the frequencies that subjects perceived the second shock as either of greater or lesser intensity than the first shock revealed an effect which approached significance, X2 (1) = 3.14, p = .073.3 This was due to the fact that 73.5% of the subjects in the IAF condition perceived the second shock as stronger, while only 37.5% of the subjects in the DAF condition perceived it as stronger. This finding indicates that the false autonomic feedback not only influenced the subjects' self-reported anxiety but also their reported experience of pain. One possible explanation for the lack of a mimic effect lies in the fact that in this experiment subjects saw scores reflecting their physiological responses while in other experiments the subjects actually saw or heard their responses. For example, in the Goldstein et al. (1972) experiment in which there was some evidence for a mimic effect, the subjects heard their heart rates. Hearing or seeing one's own responses may have greater impact than seeing scores derived from the responses and therefore a second experiment was conducted in which subjects heard false heart rates in addition to observing their scores. EXPERIMENT
II
Method Subjects. Forty female introductory psychology students at the University of Kansas participated in the experiment to fulfill a course experiment. The subjects were run in pairs and were randomly assigned to one of two conditions: Increased Arousal Feedback (IAF) and Decreased Arousal Feedback (DAF). Each of two experimenters ran an equal number of subjects in each condition. Procedures. The procedures in this experiment were identical to those of Experiment 1, except that the subject wore earphones and was told that in addition to seeing her Fear Index score she could listen to her own heart rate. The false heart rates began immediately after t h e first shock. In the IAF condition the tones which the subjects were told represented heart beats showed a distinct increase in rate as the time for the second shock approached while in the DAF condition the tones showed a distinct decrease.
Results and Discussion
The analysis of covariance comparing the AACL change scores revealed a significant groups effect, F (1, 35) = 23.30,p = .0001; subjects in the IAF condition (x = 14.82) reported greater increases in anxiety than did subjects in the DAF condition (x = 9.78). There were no differences in pulse rate due to feedback, F (1,35) = .09. Finally, the 2 x 2 chi-square analysis comparing the frequencies with which subjects in the two conditions perceived the 3 In view of the work of Grizzle (1967), the chi-square tests reported in this paper were not corrected for continuity.
334
HOLMES AND FROST
second shock as stronger or weaker than the first indicated was not significant, X 2 (1) = 2.67, p = .099.
Conclusions and Implications Although the potential bias in self-reports cannot be completely dismissed, from the present results it appears that false feedback affects subject's perception of pain and their anxiety associated with that perception. Contrary to what has been sometimes assumed about the effect of false feedback on actual physiological functioning, these experiments indicate that the false feedback did not influence the subjects' actual level of autonomic arousal as measured by pulse rate. The strength and consistency of these results concerning the reports of pain and anxiety suggest that false physiological feedback deserves more attention as a potential therapeutic technique.
REFERENCES Borkovec, T. D., & Glasgow, R. E. Boundary conditions of false heart-rate feedback effects on avoidance behavior: A resolution of discrepant results. Behaviour Research and Therapy, 1973, 11, 171-177. Borkovec, T. D., Wall, R. L., & Stone, N. M. False physiological feedback and the maintenance of speech anxiety. Journal of Abnormal Psychology, 1974, 83, 164-168. Brammel, D., Bell, J., & Margulis, S. Attributing danger as a means of explaining one's fear. Journal of Experimental Social Psychology, 1965, 1, 267-281. Gaupp, L. A., Stern, R. M., & Galbraith, G. G. False heart-rate feedback and reciprocal inhibition by aversion relief in the treatment of snake avoidance behavior. Behavior Therapy, 1972, 3, 7-20. Goldstein, D., Fink, D., & Mettee, D. R. Cognition of arousal and actual arousal as determinants of emotion. Journal of Personality and Social Psychology, 1972, 21, 41-51. Grizzle, J. Continuity correction in the X2 test for 2 × 2 tables. American Statistician, 1967, 21, 28-32. Kent, R. N., Wilson, G. T., & Nelson, R. Effects of false heart-rate feedback on avoidance behavior: An investigation of "cognitive desensitization." Behavior Therapy, 1972, 3, 1-6. Koenig, K. P., & Del Castillo, D. False feedback and longevity of the conditioned GSR during extinction: Some implications for aversion therapy. Journal of Abnormal Psychology, 1969, 74, 505-510. Rosen, G. M., Rosen, E., & Reid, J. B. Cognitive desensitization and avoidance behavior: A reevaluation. Journal of Abnormal Psychology, 1972, 80, 176--182. Schachter, S., & Singer, J. E. Cognitive, social and physiological determinants of emotional state. Psychological Review, 1962, 69, 37%399. Sushinsky, L. M., & Bootzin, R. R. Cognitive desensitization as a model of systematic desensitization. Behaviour Research & Therapy, 1970, 8, 2%33. Valins, S., & Ray, A. A. Effects of cognitive desensitization on avoidance behavior. Journal Psychology. 1966, 4, 400-408. Valins, S., & Ray, A. A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 345-350. Zuckerman, M. The development of an affect adjective check list for the measurement of anxiety. Journal of Consulting Psychology, 1960, 24, 457-462.