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Effects of false heart-rate feedback on avoidance behavior: An investigation of “Cognitive desensitization”
BEHAVIORTHERAPY (1972) 3, 1--6
Effects of False Heart-Rate Feedback on Avoidance Behavior: An Investigation of "Cognitive Desensitization"1 RONALD N. KENT, G. TERENCE WILSON,-~ AND I~OSEMERY NELSON State University of New York at Stony Brook Valins and Ray (1967) report a procedure in which subjects, presented with bogus heart-rate recordings indicating an absence of fear arousal in the presence of the feared object (i.e., a snake), subsequently exhibited a reduction in behavioral avoidance of a snake. An attempt was made to replicate these findings employing a more conventional and stringent criterion of behavioral avoidance. Contrary to Valins and Ray, results showed no significant behavioral or attitudinal effect of the cognitive manipulation. A preliminary clinical application of this false feedback procedure was described. Although systematic desensitization (SD) has been shown to be a reliable technique for reducing unrealistic fear/avoidance in both experimental subjects and the clinical population (Paul, 1969), there is still debate as to the effective process mechanisms involved. Valins and Ray (1967) have challenged the customary conditioning explanations of SD (Davison, 1968) by suggesting that the modification of avoidance behavior by SD may be the result of the manipulation of key cognitions about one's internal reactions to the feared object. The belief that one is relaxed in the presence of a fear arousing stimulus, and the consequent relabeUing of that stimulus as non-threatening are held to be sufficient conditions for fear/avoidance reduction. This attributional process is predicted irrespective of whether or not the client is physiologically less aroused. Valins and Ray reported two experiments in which subjects were provided with false heart-rate feedback, indicating a lack of autonomic arousal, while they were viewing slides of snakes (experiment 1) or an actual snake (experiment 2). Exposure to this feared stimulus was alternated with the projection of the word "SHOCK," during which subThis research was supported in part by NIMH grant MH 14557 to Stuart Valins, to whom we are indebted for his impartial advice and generous assistance. Reprint requests should be sent to G. Terence Wilson, The Psychological Clinic, Rutgers University, New Brunswick, NJ 08903. 2Now at Rutgers University, New Brunswick, NJ. 1 © 1972 by Academic Press, h~c.
c2
KENT, *~VILSON, AND NELSON
jeets received a mildly painful shock and were led to believe that their heart-rate increased. These experhnental subjects showed a greater amount of approach behavior towards a snake after treatment than a control group which had heard the identical feedback but with the instructions that it w a s irrelevant background noise. Valins and l~ay argue that their false feedback acted in a manner analagous to the role of relaxation in SD, presumably inducing the belief that arousal had not occurred. This study has attracted considerable attention as an alternative explanation of SD. In a cavalier overgeneralization, Murray and Jaeobson (1971) state that this study strongly suggests "that the critical factor in desensitization therapy is a change in beliefs about the self--similar to that occurring in traditional therapy--rather than the mechanics of relaxation, hierarchies, images, and so on" (p. 739). Valins and Ray more properly point out that 'ht is not passible to conclude that successful desensitization therapy is based upon the induction of these cognitions," but they do conclude that "cognitions about internal reactions are important modifiers of behavior," and suggest that the same kind of cognitions might be responsible for successful desensitization. In view of the significance attributed to the Valins & Ray report, it is unfortunate that several factors preclude an unequivocal interpretation of the findings. In experiment l, Valins and Ray found it necessary to perh~rm an internal analysis on the data, discarding subjects who reported previously touching a snake, in order to demonstrate a significant experimental effect. This confounds the cognitive manipulation with self-selection factors. In experiment 2 significant treatment effects were observed, but on the basis of the amount of money required to induce subjects to touch the snake rather than the conventional behavioral avoidance test utilized in other studies of SD (Lang, 1969) and rejected by Valins and Ray because it might have been "too frightening." The Valins and Ray dependent measure represents a relatively weak behavioral requirement (Bandura, 1969), and makes it diffleult to compare these data to other studies on fear reduction methods. Sushinsky and Bootzin (1970) reported a "conceptual replication" of the Valins and Ray study in which they failed to demonstrate an attribution effect on avoidance behavior. These investigators eliminated the use of shock which was employed as a contrast stimulus bv Valins and Ray, and instead provided subjects with feedback that th~4r heart-rate was increasing when slides of rats were proieeted , but not when slides of snakes were shown. As Sushinsky and Bootzin note in their discussion, there are a number of procedural differences between their study and the Valins and Ray experiments, such as the use of a pretest, which could
FALSE FEEDBACK AND AVOIDANCE
3
h a v e a c c o u n t e d for t h e differences in results. T h e p r e t e s t , for e x a m p l e , m a y h a v e r e s u l t e d n o t o n l y in m o r e f e a r f u l subjects t h a n t h e Valins a n d R a y s t u d y , b u t m i g h t also h a v e m a d e t h e l r s u b s e q u e n t r e l a b e l l i n g p r o c e s s m o r e difficult b y e m p h a s i z i n g t h e i r f e a r f u l r e a c t i o n t o w a r d s snakes. G i v e n t h e difficulties in i n t e r p r e t i n g this c o n c e p t u a l r e p l i c a t i o n of t h e Valins a n d R a y findings, it was felt t h a t t h e first step in s y s t e m a t i c a l l y i n v e s t i g a t i n g t h e v a l i d i t y a n d g e n e r a l i t y of such findings w o u l d b e to r e p l i c a t e t h e Valins a n d R a y p r o c e d u r e per se. T h e o n l y d i f f e r e n c e w o u l d b e in s u b s t i t u t i n g a c o n v e n t i o n a l p o s t - t r e a t m e n t b e h a v i o r a l a v o i d a n c e test for t h e i n c e n t i v e c o n d i t i o n u s e d b y Valins a n d Ray, so as to a l l o w m o r e m e a n i n g f u l c o m p a r i s o n s w i t h p r e v i o u s l y r e p o r t e d m e t h o d s of f e a r reduction. METHOD Subjects. 26 students in an introductory psychology course at Stony Brook served as subjects. They were selected on the basis of their self-rating of fear of snakes as 4 or 5 on a five point scale ranging from "no fear at all" to "very nmch fear." Subjects were randomly assigned to feedback or non-feedback conditions using a withinsample matching procedure to equalize level of fear and sex of subjects in the two matching groups. Procedure. The Valins and Ray procedure (1967, experiment 1 ) was followed as closely as possible. The experiment was described to all subjects as an experimental investigation of fear behavior in which physiological measures would be recorded. All subjects heard a prerecorded tape recording closely resembling heart-beat sounds which was synchronized with a slide projector. To 10 slides of snakes (the ones used by Valins and Ray) the "heart beat" was constant; to the other 10 slides of the word "'SHOCK," which were accompanied by a mild electric shock to the first and third fingers of the right hand, the "heart-rate" increased noticeably. Instructions to the feedback subjects led them to believe that they were listening to their own heartrate; instructions to the control subjects indicated that the sounds were irrelevant background noise. Instead of taping a dummy microphone to the subject's chest, feedback subjects were told that their heart-rate was being monitored by pulse changes recorded via photoelectric cell in an ear clip and then recorded on a tape recorder. Nonfeedback subjects were told that their GSR was being measured. A more detailed description of the procedure is to be found in Valins and Ray (1967). The post-treatment avoidance test was conducted immediately following the experimental session. Subjects were instructed to approach a 3 ft common boa contained in a glass cage as closely as possible. The scale on this test was adapted directly from that used by Nawas and his colleagues (Miller & Nawas, 1970), and consisted of 20 items. Following the completion of the behavioral test subjects filled out a questionnaire consisting of the S-R Inventory of Anxiety (Endler, Hunt, & Rosenstein, 1962), the Semantic Differential as used by Bandura, Blanehard, & Ritter (1969), and a series of questions designed to cheek on the cognitive manipulation employed. These were as follows: (a) "Did you notice any differences in the heartrate (sounds)?"; (b) "Can you describe these changes?"; (e) "What did these changes mean to you?" Subjects were also given a forced choice between the following alternatives to the question "what did this experiment tell you about your fear of snakes. " ~"
4
KENT, WILSON~ AND NELSON
(1) nothing (2) that you were less frightened than you thought you were (3) that you were as frightened of snakes as you thought you were (4) that you were more frightened of snakes than you thought you were (5) that you were maybe less frightened of snakes than you thought you were (6) that you were maybe more frightened of snakes than you thought you were A parallel question asked "'what did this experiment tell you about your fear of shocks?". RESULTS All feedback subjects who participated in the study accepted the heart-rate feedback as veridical and noticed that the heart-rate increased during shock slides but not during slides of snakes. Under these circumstances, attribution theory would predict that feedback subjects would view themselves as less fearful of snakes and more fearfid of shocks than control subjects. As a check on the manipulation, these predictions were compared with the subiect's ratings of what the experimental session had told them about their fear of snakes and shocks. As predicted, significantly more feedback (n = 10) than control (n = 4) subjects indicated that they were "less frightened" or "maybe less frightened" of snakes (Fisher's Exact Probability = .021), as opposed to alternative interpretations of the experimental session. Also as predicted, more feedback (n = 8) than control (n = 2) subjects indicated they were "more frightened" or "maybe more frightened" of shocks (Fisher's Exact Probability = .019). An analysis of variance failed to reveal significant effects of the experimental treatment on any dependent measure ( F < 1). In view of these strikingly negative findings, an internal analysis was performed on the data, employing a more stringent criterion for including subjects in the analysis. Only those feedback subjects who indicated that they were less frightened, or maybe less frightened of snakes (n = 10) were included. Non-feedback subjects who indicated these possibilities (n = 4) were excluded from the data analysis. Despite biasing the results towards a demonstration of group differences, negative results were obtained on the behavioral approach test ( F = 3.59, p = .07), on the Semantic Differential ( F < 1), and the S-R Inventory (F =-- 2.29, p = .14). DISCUSSION In marked contrast to the findings of Valins and Ray (1967), the results from the present experiment show no effect of false heart-rate feedback on behavioral or questionnaire measures of fear. These consistently negative results are all the more remarkable given the fact that the cognitive manipulation during the experimental session was apparently successful and in the direction predicted by Valins and Ray. Thus subjects,
FALSE FEEDBACK AND AVOIDANCE
5
during the experimental feedback session, did believe that their own heart-rate was being monitored, that it did not increase during exposure to a feared object, and that they were apparently not as frightened of snakes as they had thought they were. Yet this cognition h a d no effect on their overt behavior or on their anxiety and attitudes towards snakes as measured b y the S-R Inventory and the Semantic Differential. It seems plausible to attribute the discrepancy between the two studies to the obvious procedural difference, viz., the use of a more stringent behavioral criterion of change in the present study. This would be consistent with the notion that attribution effects are relatively weak and do not hold up where initial level of fear is very high or where the external reality with which subjects are confronted is particularly compelling (cf. Nisbett & Schachter, 1966). Valins and Ray's findings are part of attribution theory, which is currently very fashionable and which is being mined for clinical implications (Ross, Rodin, & Zimbardo, 1969; Jones, Kanouse, Kelley, Nisbett, Valins, & Weiner, in press). Given the lack of definitive research in this area, it would seem p r e m a t u r e to speculate about "attribution therapies" as Ross, Rodin, and Zimbardo (1969) have done. As they themselves point out, misattribution or relabelling would p r o b a b l y b e ineffective in cases of extreme fear more characteristic of the clinical population than mildly fearful college students. A CLINICAL ADDENDUM To further investigate the utility of the Valins and Ray findings, an attempt was made to reduce an extreme fear of spiders by employing their procedure with a client being seen in therapy by GTW. Miss H was a 24 year old, single woman who referred herself to the Psychological Clinic at Stony Brook complaining of anxiety and depression. Therapy principally involved instructing her in effective interpersonal behavior, providing her with accurate and unprejudiced information on sex, rational discussions directed towards eliminating unrealistie anxieties concerning sexual behavior, and relaxation training aimed at reducing her general anxiety level. The standard intake questionnaire had revealed that Miss H had a phobia of spiders. Since therapy was being directed towards the more serious area of her social/sexual problems, it was decided to "refer" her for "attribution therapy." Miss H was informed that a colleague (RK) was developing a new therapeutic technique for fear of insects, and it was suggested that her participation in his researeh program might prove therapeutie. She accepted enthusiastically. Thereafter, Miss H agreed to undergo a detailed "assessment" of her fear which was, in effect, the experimental procedure described above (but with spiders substituted for snakes). In the following therapy session, GTW questioned Miss H closely as to her experience in order to assess its effect. She reported that she had found the exposure to slides of spiders aversive and had declined to approach the spider on the behavioral avoidance test. She stated that she would prefer avoiding such "therapy" sessions in the future. She also stated that her fearful attitude toward spiders was in no wag altered or reduced. Of particular interest were her comments while under-
6
KENT~ \V1LSON, AND NELSON
going the Valins and Ray procedure. She accepted the false feedback as her own heart-rate, and spontaneously expressed surprise over the fact that her heart-rate did not increase when the spider slides were presented. However, she maintained that she "knew" she was "paralysed by fear" of them and discounted the [cedback. The whole nature of the "assessment" was then carefully explained to YJiss H, and she was assured that therapy would be continued to modify her fear if she so de.sired. However, she was discharged from therapy after significant progress in her presenting problems and after she stated flaat she did not consider additional treatment for her fear of spiders necessary since it did not interfere with her daily activities. While case histories are at best only suggestive, the foregoing does support Bandura's (1969) contention that more than "auspicious labelling" is required to reduce intense fear reactions. It is also consistent with the negative results obtained in the study reported above and by Sushinsky and Bootzin (1970). Further clinical trials of "attribution therapy," where appropriate, would be highly instructive. REFERENCES BANDURA, A. Principles oJ behavior modification. New York: Holt, 1969. BANDURA,A., BLANCHAim,E. B., & RITTER, B. The relative efficacy of desensitization and modeling approaches for inducing behavioral, affective, and attitudinal changes. Journal o[ Personality and Social Psychology, 1969, 13, 173-199. DAVlSON, G. C. Systematic desensitization as a counterconditioning process. Journal o~ Abnormal Psychology, 1968, 73, 91-99. ENDLER, N. S., HUNT, J. McV., & ROSENSTEIN, A. J. An S-R inventory of arLxiousness. Psychological monographs, 1962, 76, (17, Whole No. 536 ). JONES, E. E., KANOUSE, D. E., KELLEY, H. l-I., NISBETT, R. E., VALLN'S, S., & WEINER, B. (Eds.), Attribution: Perceiving the causes of behavior. New York: McCaleb-Seiler, in press. LANe, P. The meehanies of desensitization and the laboratory study of fear. In C. Franks (Ed.), Behavior therapy: appraisal and status. New York: McGraw-Hill, 1969. Pp. 160-191. MILLER, H. R., & NAWAS, M. Control of aversive stimulus termination in systematic desensitization. Behaviour Research and Therapy, 1970, 8, 57-62. MURRAY, E. J., & JACOBSON, L. I. The nature of learning in traditional and behavioral psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change. New York: Wiley, 1971. Pp. 709-747. NISBETT, R. E., & SCHACHTER, S. Cognitive manipulation of pain. Journal of Experimental Social Psychology, 1966, 2, 227-236. PAVL, G. L. Outcome of systematic desensitization II: Controlled investigations of individual treatment, technique variations, and current status. In Franks, C. M. (Ed.), Behavior Therapy: appraisal and status. New York: McGraw-Hill, 1969. Pp. 105-159. Ross, L., Roolx, J., & ZI~,IBAnDO,P. Toward an attribution therapy: the reduction of fear through indnced cognitive emotional nlisattribution. Journal of Personality and Social Psychology, 1969, 12, 279-288. SUSH1NSKY, L., & BOOTZlN, R. Cognitive desensitization as a model of systematic desensitization. Behaviour Research & Therapy, 1970, 8, 29-34. VALINS, S., & RAY, A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 345-350.
Effects of False Heart-Rate Feedback on Avoidance Behavior: An Investigation of "Cognitive Desensitization"1 RONALD N. KENT, G. TERENCE WILSON,-~ AND I~OSEMERY NELSON State University of New York at Stony Brook Valins and Ray (1967) report a procedure in which subjects, presented with bogus heart-rate recordings indicating an absence of fear arousal in the presence of the feared object (i.e., a snake), subsequently exhibited a reduction in behavioral avoidance of a snake. An attempt was made to replicate these findings employing a more conventional and stringent criterion of behavioral avoidance. Contrary to Valins and Ray, results showed no significant behavioral or attitudinal effect of the cognitive manipulation. A preliminary clinical application of this false feedback procedure was described. Although systematic desensitization (SD) has been shown to be a reliable technique for reducing unrealistic fear/avoidance in both experimental subjects and the clinical population (Paul, 1969), there is still debate as to the effective process mechanisms involved. Valins and Ray (1967) have challenged the customary conditioning explanations of SD (Davison, 1968) by suggesting that the modification of avoidance behavior by SD may be the result of the manipulation of key cognitions about one's internal reactions to the feared object. The belief that one is relaxed in the presence of a fear arousing stimulus, and the consequent relabeUing of that stimulus as non-threatening are held to be sufficient conditions for fear/avoidance reduction. This attributional process is predicted irrespective of whether or not the client is physiologically less aroused. Valins and Ray reported two experiments in which subjects were provided with false heart-rate feedback, indicating a lack of autonomic arousal, while they were viewing slides of snakes (experiment 1) or an actual snake (experiment 2). Exposure to this feared stimulus was alternated with the projection of the word "SHOCK," during which subThis research was supported in part by NIMH grant MH 14557 to Stuart Valins, to whom we are indebted for his impartial advice and generous assistance. Reprint requests should be sent to G. Terence Wilson, The Psychological Clinic, Rutgers University, New Brunswick, NJ 08903. 2Now at Rutgers University, New Brunswick, NJ. 1 © 1972 by Academic Press, h~c.
c2
KENT, *~VILSON, AND NELSON
jeets received a mildly painful shock and were led to believe that their heart-rate increased. These experhnental subjects showed a greater amount of approach behavior towards a snake after treatment than a control group which had heard the identical feedback but with the instructions that it w a s irrelevant background noise. Valins and l~ay argue that their false feedback acted in a manner analagous to the role of relaxation in SD, presumably inducing the belief that arousal had not occurred. This study has attracted considerable attention as an alternative explanation of SD. In a cavalier overgeneralization, Murray and Jaeobson (1971) state that this study strongly suggests "that the critical factor in desensitization therapy is a change in beliefs about the self--similar to that occurring in traditional therapy--rather than the mechanics of relaxation, hierarchies, images, and so on" (p. 739). Valins and Ray more properly point out that 'ht is not passible to conclude that successful desensitization therapy is based upon the induction of these cognitions," but they do conclude that "cognitions about internal reactions are important modifiers of behavior," and suggest that the same kind of cognitions might be responsible for successful desensitization. In view of the significance attributed to the Valins & Ray report, it is unfortunate that several factors preclude an unequivocal interpretation of the findings. In experiment l, Valins and Ray found it necessary to perh~rm an internal analysis on the data, discarding subjects who reported previously touching a snake, in order to demonstrate a significant experimental effect. This confounds the cognitive manipulation with self-selection factors. In experiment 2 significant treatment effects were observed, but on the basis of the amount of money required to induce subjects to touch the snake rather than the conventional behavioral avoidance test utilized in other studies of SD (Lang, 1969) and rejected by Valins and Ray because it might have been "too frightening." The Valins and Ray dependent measure represents a relatively weak behavioral requirement (Bandura, 1969), and makes it diffleult to compare these data to other studies on fear reduction methods. Sushinsky and Bootzin (1970) reported a "conceptual replication" of the Valins and Ray study in which they failed to demonstrate an attribution effect on avoidance behavior. These investigators eliminated the use of shock which was employed as a contrast stimulus bv Valins and Ray, and instead provided subjects with feedback that th~4r heart-rate was increasing when slides of rats were proieeted , but not when slides of snakes were shown. As Sushinsky and Bootzin note in their discussion, there are a number of procedural differences between their study and the Valins and Ray experiments, such as the use of a pretest, which could
FALSE FEEDBACK AND AVOIDANCE
3
h a v e a c c o u n t e d for t h e differences in results. T h e p r e t e s t , for e x a m p l e , m a y h a v e r e s u l t e d n o t o n l y in m o r e f e a r f u l subjects t h a n t h e Valins a n d R a y s t u d y , b u t m i g h t also h a v e m a d e t h e l r s u b s e q u e n t r e l a b e l l i n g p r o c e s s m o r e difficult b y e m p h a s i z i n g t h e i r f e a r f u l r e a c t i o n t o w a r d s snakes. G i v e n t h e difficulties in i n t e r p r e t i n g this c o n c e p t u a l r e p l i c a t i o n of t h e Valins a n d R a y findings, it was felt t h a t t h e first step in s y s t e m a t i c a l l y i n v e s t i g a t i n g t h e v a l i d i t y a n d g e n e r a l i t y of such findings w o u l d b e to r e p l i c a t e t h e Valins a n d R a y p r o c e d u r e per se. T h e o n l y d i f f e r e n c e w o u l d b e in s u b s t i t u t i n g a c o n v e n t i o n a l p o s t - t r e a t m e n t b e h a v i o r a l a v o i d a n c e test for t h e i n c e n t i v e c o n d i t i o n u s e d b y Valins a n d Ray, so as to a l l o w m o r e m e a n i n g f u l c o m p a r i s o n s w i t h p r e v i o u s l y r e p o r t e d m e t h o d s of f e a r reduction. METHOD Subjects. 26 students in an introductory psychology course at Stony Brook served as subjects. They were selected on the basis of their self-rating of fear of snakes as 4 or 5 on a five point scale ranging from "no fear at all" to "very nmch fear." Subjects were randomly assigned to feedback or non-feedback conditions using a withinsample matching procedure to equalize level of fear and sex of subjects in the two matching groups. Procedure. The Valins and Ray procedure (1967, experiment 1 ) was followed as closely as possible. The experiment was described to all subjects as an experimental investigation of fear behavior in which physiological measures would be recorded. All subjects heard a prerecorded tape recording closely resembling heart-beat sounds which was synchronized with a slide projector. To 10 slides of snakes (the ones used by Valins and Ray) the "heart beat" was constant; to the other 10 slides of the word "'SHOCK," which were accompanied by a mild electric shock to the first and third fingers of the right hand, the "heart-rate" increased noticeably. Instructions to the feedback subjects led them to believe that they were listening to their own heartrate; instructions to the control subjects indicated that the sounds were irrelevant background noise. Instead of taping a dummy microphone to the subject's chest, feedback subjects were told that their heart-rate was being monitored by pulse changes recorded via photoelectric cell in an ear clip and then recorded on a tape recorder. Nonfeedback subjects were told that their GSR was being measured. A more detailed description of the procedure is to be found in Valins and Ray (1967). The post-treatment avoidance test was conducted immediately following the experimental session. Subjects were instructed to approach a 3 ft common boa contained in a glass cage as closely as possible. The scale on this test was adapted directly from that used by Nawas and his colleagues (Miller & Nawas, 1970), and consisted of 20 items. Following the completion of the behavioral test subjects filled out a questionnaire consisting of the S-R Inventory of Anxiety (Endler, Hunt, & Rosenstein, 1962), the Semantic Differential as used by Bandura, Blanehard, & Ritter (1969), and a series of questions designed to cheek on the cognitive manipulation employed. These were as follows: (a) "Did you notice any differences in the heartrate (sounds)?"; (b) "Can you describe these changes?"; (e) "What did these changes mean to you?" Subjects were also given a forced choice between the following alternatives to the question "what did this experiment tell you about your fear of snakes. " ~"
4
KENT, WILSON~ AND NELSON
(1) nothing (2) that you were less frightened than you thought you were (3) that you were as frightened of snakes as you thought you were (4) that you were more frightened of snakes than you thought you were (5) that you were maybe less frightened of snakes than you thought you were (6) that you were maybe more frightened of snakes than you thought you were A parallel question asked "'what did this experiment tell you about your fear of shocks?". RESULTS All feedback subjects who participated in the study accepted the heart-rate feedback as veridical and noticed that the heart-rate increased during shock slides but not during slides of snakes. Under these circumstances, attribution theory would predict that feedback subjects would view themselves as less fearful of snakes and more fearfid of shocks than control subjects. As a check on the manipulation, these predictions were compared with the subiect's ratings of what the experimental session had told them about their fear of snakes and shocks. As predicted, significantly more feedback (n = 10) than control (n = 4) subjects indicated that they were "less frightened" or "maybe less frightened" of snakes (Fisher's Exact Probability = .021), as opposed to alternative interpretations of the experimental session. Also as predicted, more feedback (n = 8) than control (n = 2) subjects indicated they were "more frightened" or "maybe more frightened" of shocks (Fisher's Exact Probability = .019). An analysis of variance failed to reveal significant effects of the experimental treatment on any dependent measure ( F < 1). In view of these strikingly negative findings, an internal analysis was performed on the data, employing a more stringent criterion for including subjects in the analysis. Only those feedback subjects who indicated that they were less frightened, or maybe less frightened of snakes (n = 10) were included. Non-feedback subjects who indicated these possibilities (n = 4) were excluded from the data analysis. Despite biasing the results towards a demonstration of group differences, negative results were obtained on the behavioral approach test ( F = 3.59, p = .07), on the Semantic Differential ( F < 1), and the S-R Inventory (F =-- 2.29, p = .14). DISCUSSION In marked contrast to the findings of Valins and Ray (1967), the results from the present experiment show no effect of false heart-rate feedback on behavioral or questionnaire measures of fear. These consistently negative results are all the more remarkable given the fact that the cognitive manipulation during the experimental session was apparently successful and in the direction predicted by Valins and Ray. Thus subjects,
FALSE FEEDBACK AND AVOIDANCE
5
during the experimental feedback session, did believe that their own heart-rate was being monitored, that it did not increase during exposure to a feared object, and that they were apparently not as frightened of snakes as they had thought they were. Yet this cognition h a d no effect on their overt behavior or on their anxiety and attitudes towards snakes as measured b y the S-R Inventory and the Semantic Differential. It seems plausible to attribute the discrepancy between the two studies to the obvious procedural difference, viz., the use of a more stringent behavioral criterion of change in the present study. This would be consistent with the notion that attribution effects are relatively weak and do not hold up where initial level of fear is very high or where the external reality with which subjects are confronted is particularly compelling (cf. Nisbett & Schachter, 1966). Valins and Ray's findings are part of attribution theory, which is currently very fashionable and which is being mined for clinical implications (Ross, Rodin, & Zimbardo, 1969; Jones, Kanouse, Kelley, Nisbett, Valins, & Weiner, in press). Given the lack of definitive research in this area, it would seem p r e m a t u r e to speculate about "attribution therapies" as Ross, Rodin, and Zimbardo (1969) have done. As they themselves point out, misattribution or relabelling would p r o b a b l y b e ineffective in cases of extreme fear more characteristic of the clinical population than mildly fearful college students. A CLINICAL ADDENDUM To further investigate the utility of the Valins and Ray findings, an attempt was made to reduce an extreme fear of spiders by employing their procedure with a client being seen in therapy by GTW. Miss H was a 24 year old, single woman who referred herself to the Psychological Clinic at Stony Brook complaining of anxiety and depression. Therapy principally involved instructing her in effective interpersonal behavior, providing her with accurate and unprejudiced information on sex, rational discussions directed towards eliminating unrealistie anxieties concerning sexual behavior, and relaxation training aimed at reducing her general anxiety level. The standard intake questionnaire had revealed that Miss H had a phobia of spiders. Since therapy was being directed towards the more serious area of her social/sexual problems, it was decided to "refer" her for "attribution therapy." Miss H was informed that a colleague (RK) was developing a new therapeutic technique for fear of insects, and it was suggested that her participation in his researeh program might prove therapeutie. She accepted enthusiastically. Thereafter, Miss H agreed to undergo a detailed "assessment" of her fear which was, in effect, the experimental procedure described above (but with spiders substituted for snakes). In the following therapy session, GTW questioned Miss H closely as to her experience in order to assess its effect. She reported that she had found the exposure to slides of spiders aversive and had declined to approach the spider on the behavioral avoidance test. She stated that she would prefer avoiding such "therapy" sessions in the future. She also stated that her fearful attitude toward spiders was in no wag altered or reduced. Of particular interest were her comments while under-
6
KENT~ \V1LSON, AND NELSON
going the Valins and Ray procedure. She accepted the false feedback as her own heart-rate, and spontaneously expressed surprise over the fact that her heart-rate did not increase when the spider slides were presented. However, she maintained that she "knew" she was "paralysed by fear" of them and discounted the [cedback. The whole nature of the "assessment" was then carefully explained to YJiss H, and she was assured that therapy would be continued to modify her fear if she so de.sired. However, she was discharged from therapy after significant progress in her presenting problems and after she stated flaat she did not consider additional treatment for her fear of spiders necessary since it did not interfere with her daily activities. While case histories are at best only suggestive, the foregoing does support Bandura's (1969) contention that more than "auspicious labelling" is required to reduce intense fear reactions. It is also consistent with the negative results obtained in the study reported above and by Sushinsky and Bootzin (1970). Further clinical trials of "attribution therapy," where appropriate, would be highly instructive. REFERENCES BANDURA, A. Principles oJ behavior modification. New York: Holt, 1969. BANDURA,A., BLANCHAim,E. B., & RITTER, B. The relative efficacy of desensitization and modeling approaches for inducing behavioral, affective, and attitudinal changes. Journal o[ Personality and Social Psychology, 1969, 13, 173-199. DAVlSON, G. C. Systematic desensitization as a counterconditioning process. Journal o~ Abnormal Psychology, 1968, 73, 91-99. ENDLER, N. S., HUNT, J. McV., & ROSENSTEIN, A. J. An S-R inventory of arLxiousness. Psychological monographs, 1962, 76, (17, Whole No. 536 ). JONES, E. E., KANOUSE, D. E., KELLEY, H. l-I., NISBETT, R. E., VALLN'S, S., & WEINER, B. (Eds.), Attribution: Perceiving the causes of behavior. New York: McCaleb-Seiler, in press. LANe, P. The meehanies of desensitization and the laboratory study of fear. In C. Franks (Ed.), Behavior therapy: appraisal and status. New York: McGraw-Hill, 1969. Pp. 160-191. MILLER, H. R., & NAWAS, M. Control of aversive stimulus termination in systematic desensitization. Behaviour Research and Therapy, 1970, 8, 57-62. MURRAY, E. J., & JACOBSON, L. I. The nature of learning in traditional and behavioral psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change. New York: Wiley, 1971. Pp. 709-747. NISBETT, R. E., & SCHACHTER, S. Cognitive manipulation of pain. Journal of Experimental Social Psychology, 1966, 2, 227-236. PAVL, G. L. Outcome of systematic desensitization II: Controlled investigations of individual treatment, technique variations, and current status. In Franks, C. M. (Ed.), Behavior Therapy: appraisal and status. New York: McGraw-Hill, 1969. Pp. 105-159. Ross, L., Roolx, J., & ZI~,IBAnDO,P. Toward an attribution therapy: the reduction of fear through indnced cognitive emotional nlisattribution. Journal of Personality and Social Psychology, 1969, 12, 279-288. SUSH1NSKY, L., & BOOTZlN, R. Cognitive desensitization as a model of systematic desensitization. Behaviour Research & Therapy, 1970, 8, 29-34. VALINS, S., & RAY, A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 345-350.