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False heart-rate feedback and reciprocal inhibition by aversion relief in the treatment of snake avoidance behavior
BEHAVIOR TItEItAPY
( 1972 ) 3, 7-20
False Heart-Rate Feedback and Reciprocal Inhibition by Aversion Relief in the Treatment of Snake Avoidance Behavior1 LARRY A. GAUPP, ROBERT M. STERN, AND GARY G. GALBI~ArI:Iff The Pennsylvania State University The purpose of this study was to examine physiological and behavioral data collected uisng cognitive desensitization technique of treating snake avoidance behavior (Valins & Ray, 1967). The reciprocal inhibition by aversion-relief model was utilized to reinterpret the cognitive desensitization~ treatment paradigm. The roles of both false and veridieal heart-rate feedback were also investigated. Forty subjects who were unable to pick up a snake on a specially designed test of snake intimacy were randomly assigned to one of three experimental treatment procedures and one control group. GSR and EKG responding were measured throughout the experimental treatment procedures. Immediately following the treatment session, subjects were again tested on the snake intimacy test. Subjective fear ratings were also obtained both before and after treatment. Support for the aversion-relief model was found in various aspects of the data. The results indicated that if the cognition, "That stimulus has not affected me internally," is operating for the snake slides, as suggested by Valins and Ray, it is veridieal in nature and based on actual reduced physiological responding. It was also found that false heart rate feedback facilitated the overall aversion-relief treatment process.
T h e p u r p o s e of this s t u d y w a s to e x a m i n e f u r t h e r a r e c e n t l y r e p o r t e d c o g n i t i v e d e s e n s i t i z a t i o n p r o c e d u r e for t r e a t m e n t of a v o i d a n c e b e h a v i o r ( V a l i n s & Ray, 1967). Valins c o n s i d e r s his t e c h n i q u e to b e p r o c e s s a n a l o g u e to W o l p e ' s (1958) s y s t e m a t i c desensitizat:.on. T h e p r e s e n t a u thors q u e s t i o n w h e t h e r Valins' s t u d y p e r m i t s t h e f o r m u l a t i o n of v a l i d conclusions c o n c e r n i n g " c o g n i t i v e " versus " s y s t e m a t i c " d e s e n s i t i z a t i o n since h e d i d n o t r e c o r d a n y p h y s i o l o g i c a l m e a s u r e . F u r t h e r , it is s u g g e s t e d t h a t Valins a n d Ray's results are a f u n c t i o n of d i f f e r e n t i a l classical cond i t i o n i n g , r a t h e r t h a n t h e c o g n i t i v e e v a l u a t i o n of p r e s u m e d p h y s i o l o g i c a l 1This paper is based in part on a thesis submitted by the senior author in partial fulfillment of the M.S. degree at The Pennsylvania State University. Support for the senior author was provided by a Public Health Service Fellowship. Requests for reprints should be addressed to Larry A. Gaupp, Department of Psychology, The Pennsylvania State University, 417 Psychology Building, University Park, Pennsylvania 16802. 7 Q 1972 by Academic Press, Inc.
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GAUPP, STERN, AND GALBRAITH
reactivity, and that, in this respect, their procedure is a form of aversionrelief therapy (Thorpe, Schmidt, Brown & Castell, 1964; Solyom & Miller,
1967). Valins and Ray (1967) used false heart rate feedback procedures in an attempt to assess the role of induced cognitions concerning autonomic responsivity, as opposed to autonomic responsivity per se, in the elimination of phobic behavior associated with snakes. Using students who reported fear of snakes on a questionnaire, their experimental procedures consisted of projecting 10 pictures of snakes and 10 pictures containing the work "SHOCK" before each subject. The experimental subjects (Heart Rate Feedback Group), told that they were listening to their own heart beats, heard their "heart beats" accelerate in response to slides containing the word "SHOCK" and remain constant in response to projected pictures of snakes. In addition, the subjects received a mild electric shock seven seconds after the onset of each shock slide. Subjects in the control group (Extraneous Sounds Group) were told that they were listening to meaningless sounds but otherwise heard the same pattern of accelerated and constant sounds, and received the same electric shocks, as subjects in the experimental group. Using an in situ, behavior measure of snake intimacy, Valins and Ray found less snake avoidance among experimental subjects than among control subjects. Subjects in the experimental group were presumably led to believe that they were relaxed, or physiologically unresponsive, in the presence of snakes, thereby shifting their attitudes and behavior in the direction of greater approach. Alternatively, the attention-demand factor operating in the Heart Rate Feedback Group (i.e., the heightened attention to the stimulus-bound sound changes), which is generated by the atypical presence of one's audible "heart sound," may have produced the obtained group behavioral results (see Botto & Stern, 1968). Despite this contaminating attention-demand factor and the fact that no measure of physiological responding was obtained, Valins and Ray concluded that reciprocal inhibition via muscular relaxation, accorded a central role in Wolpe's theory, is not a necessary component of desensitization, and that cognitive desensitization, i.e., the belief that one is relaxed, is a sufficient condition for the elimination, or reduction, of avoidance behavior. No measure of actual physiological responding was obtained in the study, however. The experimental paradigm used by Valins and Ray closely parallels the paradigm (differential class,-'cal conditioning) used in the aversionrelief therapies of Thorpe et al. (1964) and Solyom and Miller (1967) which embodies the principle of reciprocal inhibition as a necessary component. The procedure of randomly presenting two different stimuli,
FALSE FEEDBACK AND AVERSIONRELIEF
9
one of which is followed by or paired with aversive stimulation (i.e., electric shock) while the other (i.e., snake pictures) is not, would be expected to establish the respective stimuli as danger and safety signals. Aversion-relief therapy, which is theoretically identical to Wolpe's reciprocal inhibition by progressive relaxation, presumably produces physiological incompatibility to anxiety by pairing anxiety-evoking stimuli with a state of relief. The similarity between reciprocal inhibition by aversion-relief therapy and Valins and Ray's cognitive desensitization paradigm is apparent. The aversive stimulus, the shock slide and accompanying electric shock, were randomly followed by the relief stimulus-a snake slide. The anxiety-evoking snake stimulus, then, became the CS for the relief response resulting in possible physiological changes incompatible with the previous anxiety response. When Valins and Ray's cognitive desensitization paradigm is analyzed in terms of the aversion-relief model, a question arises which their study did not adequately acknowledge. Did physiological responses incompatible with anxiety become associated with the snake stimulus and inhibit the anxiety which was previously evoked by the snake? The purpose of the present research was to replicate the study by Valins and Ray and to extend it by (a) recording actual heart rate activity and skin resistance measures that accompany the presentation of snake and shock stimuli, (b) adding additional experimental and control groups not present in the Valins and Ray study, and (c) utilizing an improved method of measuring the degree of pre-experimental fear associated with snakes. In the present study, it was hypothesized that at the physiological level, all three experimental groups, i.e., a group similar to Valin and Ray's experimental group, and a second group similar to their control group and a group that received veridical feedback, would show a gradual decrease in responding to snake slides and an increase in responding to shock slides. It was also predicted that the three experimental groups would show a corresponding reduction in fear of snakes. Because of the above mentioned heightened attention, which was predicted for the group similar to Valins and Ray's experimental group, it was hypothesized that this group would show the greatest differential physiological responding and, accordingly, the greatest reduction in fear of snakes. METHOD
Subiects. The subjects were seven male and 33 female undergraduate volunteers from introductory psychology classes at The Pennsylvania State University. All subjects expressed relatively intense fears of snakes, the stated prerequisite for participation in the present experiment, and exhibited no cardiac abnormality as
10
GAUPP, STERN~ AND GALBI/AITII
determiued by a university physician. Tile subjects received experimental credit which enhanced their academic grade. Apparatus. The GSR was continuously measured with a model 22A Eels Dermolnnmeter; subject current was 70 #amps. A permanent record of responses was recorded on a Brush Mark II recorder. A 3~ in. diameter zinc electrode was attached to the subject's left pahn and a 1Ji in. by 2ll in. zinc electrode to the ventral surface of the subject's left forearm. The electrodes were coated with zinc sulfate paste. EKG was continumlsly recorded with a model 121 Unipak Bioamplifier and a model 170C Biotach (Biocom). A permanent record of responses was reeorded on the second channel of the Brush recorder. Stainless steel electrodes coated with Sanborn Redux electrode paste were attached to the right arm and right (ground) and left leg. A microphone placed adjacent to the Biotaeh was utilized to transmit veridical heart sounds to certain subjects. A model HAR-2 Hargrave Pulse-Meter was employed with an EKS 70 Telemetrics Heart Beat Simulator to tape record non-verdical heart sounds. The shock supply was A.C. and constant-current. Two 1-in. diameter silver shock electrodes coated with Sanborn Bedux electrode paste were attached to subject's right ankle approximately 1-in. apart. Shock and snake stimuli. Shock stimuli consisted of 10 slides of the word "SHOCK" accompanied by an electric shock. All shocks were delivered 7 sec after the ~tinmlns word appeared. All shocks were delivered for 0.1 sec. Shock intensity ranged from 1.0 ma for the first two shock stimuli, increasing 0.5 ma per two shock stimuli, to a maximum of 3.0 ma for the last two shock stimuli. The increase in shock intensity was designed to prevent subjective adaptation to the shock stinmli (Stern, Ganpp and Leonard, 1970) and to heighten the anxiety-relief response pattern. Snake stimuli consisted of 10 black and white slides depicting various kinds of snakes. The 10 slides were previously rank-ordered by 30 judges according to the degree of fear provoked. The stimuli were presented in increasing order of intensity. The shock stimuli (slides 1, 3, 6, 8, 9, 11, 13, 16, 18, 19), and the snake stimuli (slides 2, 4, 5, 7, 10, 12, 14, 15, 17, 20), were presented at 45 sec intervals for a dnration of 15 sec. Snake intimacy test (S/T). Subjects who had previously indicated a fear of snakes reported individually to the observation room of the Psychological Clinic, where they were asked to rate their fear of snakes on a five point Subjective Fear Rating (SFR 1) scale ranging from 1 (very low) to 5 (very high). In the presence of the experimenter, the subjects then viewed the snake, a three foot boa constrictor contained in a glass cage, through a one-way nrirror. Answers to subjects about the snake were limited to informing subjects that the snake was nonpoisonous; no other information was given about the snake or the nature of the experiment. Subjects attempted to perform the following behavioral tasks: (1) enter the room and look over at the snake; (2) go over to the table on which the caged snake is sitting; (3) sit down in the chair next to the table; (4) put his hand on the outside portion of the cage next to the snake; (5) stand up, take the lid off the cage and look down at the snake; (6) put his hand over to level with the top of the cage; (7) put his hand into the cage; (8) touch the snake; (9) pick the snake up a few inches within the cage; (10) pick the snake up and out of the cage and hold it. Each subject's snake intimacy, as measured by the last behavioral task successfully completed, was recorded. The subjects who suecessftdly completed all 10 behavioral tasks listed, that is,
FALSE FEEDBACK AND AVERSION RELIEF
11
who demonstrated a high degree of snake intimacy were given experimental credit and excluded from the study. The remaining subjects were again asked to rate their fears of snakes on the five point rating scale and rescheduled for the second session. Postsnake intimacy test (PIT). The PIT immediately followed the second session (described below) and was identical to the SIT. SFR 2 and SFR 3 preceded and followed the PIT, respectively. Procedure. Seven to nine days following the SIT, subjects reported individually for the second session. While the electrodes were being attached, subjects were told that they would receive several electric shocks on their right ankles throughout the course of the session. The subjects were randomly assigned to the following four groups: Non-Veridical informed group (N-VIG). The subjects in this group heard false sounds during the presentation of both the shock and snake stimuli. There was no increase in the sounds during the presentation of the snake stimuli throughout the treatment session but a marked increase in the sounds to the shock stimuli. The sounds were pre-recorded. After the electrodes were attached, subjects were told that the experimenter was going to record several physiological measures during this part of the experiment and that he was interested in their physiological responses to both the shock and snake stimuli. Further, subjects were told that, because of a faulty piece of equipment, they would hear their heart beat throughout the course of the session, but that these sounds should be ignored. This group was similar to Valins and Ray's Heart-Beat Feedback group. Non-Veridical extraneous sounds group (N-VEG). The subjects in this group heard the same false sounds as the N-VIG group. However, these subjects were told that the audible sounds were meaningless and that the experimenter was interested in the effects these sounds would have on their physiological reactions to the shock and snake stimuli. The subjects were told to ignore these sounds. This group designed as a control for the N-VIG, was similar to Valins and Ray's Extraneous Sounds group. Veridical group (VG). The subjects in this group heard their actual heart beats during the presentation of both the shock and snake stimuli. After the electrodes were attached, they were given the same information as the N-VIG subjects; however, they were not told to ignore their heart beat. This group was designed to determine the importance of veridical feedback. Control group (CG). With the exception of the actual experimental manipulations, i.e., the presentation of the shock and snake stimuli with the concomitant sound feedback, subjects in this group performed all those tasks performed by the experimental groups, i.e., the SIT and PIT. This group was designed to determine the effects of exposure to the actual fear stimulus, with no intervening therapeutic process, on snake intimacy and on the subjective fear ratings. After subjects in each group were given the appropriate information, they were told that there would be a 5 rain rest period followed by the stimulus slides and then another I min rest period marking the end of the session. During the 5 rain rest period, subjects heard either their own heart sounds, non-veridical heart sounds, or extraneous sounds, depending on the experimental group. During this period, the non-veridical heart sounds and extraneous sounds varied in rate from 66 to 72 bpm. For all groups, beginning with the sixth minute, the 20 stimulus slides were projected into the slide-cubical. A marked increase in the sound consisted of an increase from the resting level of 66 to 72 bpm, to a maximum of 110 bpm. This increase in rate
12
GAUPP, STERN, AND GALBRAITH
continued throughout the duration of the slide (15 see) and then gradually subsided to the resting level during the 45 see slide presentation interval. Immediately following this session, subjects were again taken to tile clinic observation room and put through the PIT.
RESULTS Snake Intimacy as a Function of Treatments
The snake intimacy data are presented in Fig. 1. Analysis of the SIT data shows that the N-VIG demonstrate a significantly greater increase in snake intimacy than the CG; no difference between experimental groups was found. Following completion of the experimental procedures, an analysis of variance of SIT revealed no significant difference in snake intimacy between groups [F(3,36)=0.48, p > .05]. An analysis of variance of PIT scores revealed no difference [F(3,36) = 0.82, p > .05]. Treatment effects were examined by comparing the difference scores-PIT minus SIT---for the various groups [F(3,36 = 2.94, p < .05]. The Tukey (a) method of multiple comparisons based on total scores was 1
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Flc. i. Mean pretest (SIT) and posttest (PIT) snake intimacy seores and mean subjective fear rating scores for subjective fear ratings one, three and four for all groups.
F A L S E FEEDBACK AND AVERSION R E L I E F
conducted to determine if specific hypothesized between-group sons were significant These statistical comparisons indicate N-VIG demonstrate a significantly greater increase in snake from the SIT to the PIT [Tukey (a) critical value----11.65, than the increase exhibited by the CG.
13 comparithat the intimacy p > .05]
Subjective Fear Rating as a Function of Treatments Subjective fear rating (SFR) data are also presented in Fig. 1. Analysis of the SFR data shows that N-VIG demonstrate a significantly greater decrease in subjective fear than the CG; again no difference between experimental groups was found. Treatment effects were again examined by using a single factor analysis of variance based on difference scores--SFR 1 minus SFR, and SFR 1 minus SFR. The result in both cases is significant [F(3,36) = 3.67, F(3,36) = 3.19, respectively, p < .05]. Multiple comparisons of SFR total difference scores (1-2) between groups indicate that the N-VIG differ from the CG [Tukey (a) critical value = 8.00, p < .05]. Multiple comparisons of SFR total difference scores (1-3) between groups indicate that the N-VIG differ from the CG [Tukey (a) critical value = 9.05, p < .05].
Analysis of Physiological Data Analysis of the GSR data shows that significantly greater responses were made to the shock slides despite a significant decrease in responding to both snake and shock s/ides. No difference was found between groups. A 3 X 2 X3 factorial analysis of variance with repeated measures on the last two factors (all statistical analyses are based on models in Winer, 1962) was utilized to analyze the GSR response data. The purpose of this analysis was to determine the effect of the three different treatment conditions (factor A) upon GSR responding to two different types of stimulus slides (factor B) randomly presented 10 times each (factor C). Because of the experimental novelty of the treatment procedures, the GSR response data to the first shock slide and the first snake slide were excluded from the analysis. The remaining nine shock slides and nine snake slides were divided into three blocks of three slides each and analyzed as three levels of factor C. The GSR response measure was defined as the maximum percentage change in skin resistance occurring within 5 see after slide onset. No significant main effect was obtained for factor A. A significant main effect was obtained for factor B [F(1,27) = 32.90, p < .01]; greater responses were made to the shock slides. A significant main effect for factor C was also obtained IF (2,54 --~ 8.00, p < .01]; the general trend being decrease in responding to both snake and shock slides. The EKG response data for the N-VIG, N-VEG, and VG for the first
14
GAUPP~ STEHX~ AND GALBRAITFI
five and the second five heart beats after slide onset are presented ill Fig. 2. Analysis of the EKG response data shows a significant deerease and concomitant increase in responding across blocks of slides to the snake and shock slides respectively. The N-VIG show a greater increase in EKG responding across blocks of shock slides for the first five heart heats than the N-VEG. The N-VIG also show a greater decrease in EKG responding across blocks of snake slides for the second five heart beats than the N-VIG. The form of the analysis of variance of the EKG response data is identical to the overall GSR response analysis. The EKG response measure for the analysis of the first and second five I
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BLOCKS OF STIMULUS SLIDES FIG. 2. M e a n p e r c e n t a g e of E K G r e s p o n d i n g for t h e first five h e a r t beats a n d second five heart b e a t s after s t i m u l u s o n s e t to t h e shock a n d snake s t i m u l u s slides for t h e N-VIG, N - V E G a n d VG.
FALSE FEFDBACK AND AVERSION RELIEF
15
heart beats after slide onset was defined as a percentage of the prestimulus level in inter-heart beat interval (mean five heart beat intervals prior to stimulus slide onset). No significant main effect is obtained for factor A. A significant main effect is obtained with the first five heart beats for factor B [F(1,27) --4.95, p < .05]; overall greater responses were made to the shock slides. For the second five heart beats, the A )K B interaction approaches significance [F(2,27) = 2.41, p < .10], indicating that the treatment groups showed a different pattern of response to the two types of slides. The A X C interaction approaehes significance [ F ( 4 , 5 4 ) = 2.30, p < .10], indieating that the treatment groups did not respond uniformly differently across the three sequential bloeks of slides. To determine whether the mean in EKG responding for the first and second five heart beats after stimulus slide onset differed as a function of type of slide, 4 X 2 difference score analyses of variance were conducted. Faetor A was the three treatment group and factor B the two types of stimulus slides. The difference score was calculated by subtraeting the third block of slides from the first block of slides. Significant main effects were obtained for factor B [ F ( 1 , 2 7 ) = 4 . 7 7 , F ( 1 , 2 7 ) = 6.37, respectively, p < .05], indicating that the ehanges in EKG responding for the first to the third block of slides differed as a function of the type of stimulus slide. Multiple comparisons of EKG difference scores between groups to the shock slides for the first five heart beats indicate that the N-VIG differ from the N-VEG [Tukey (a) eritieal value = 1.42, p < .05]. Examination of Fig. 2 suggests that this difference is largely a function of the N-VIG's increase in mean pereentage ehange in EKG responding across blocks of shock slides. Multiple comparisons between groups on shoek slides difference scores for the second five heart beats yield no significant differenee. Multiple comparisons between groups on snake slide difference seores for the second five heart beats indicate that the N-VIG mean percentage in EKG responding differs from the N-VEG [Tukey (a) critical value = 1.30, p < .05]. Examination of Fig. 2 suggests that this difference is largely a function of the decrease in mean pereentage in EKG responding by the N-VIG to the snake slides. Multiple comparisons of EKG difference scores between groups to slides for the first five heart beats yield no significant difference; however, the greatest decrease in mean percentage change in EKC responding aeross blocks of snake slides is exhibited by the N-VIG. To determine whether change in snake intimacy was a function of ehange in physiologieal responding from the first to the third block of
16
GAUPP, STERN, AND GALBRAITH
snake slides, the subjects were divided into two groups. One group consisted of those subjects who showed either no change or an increase in physiological responding. The other group consisted solely of those subjects who showed a decrease in physiological responding. No significant effect was obtained for change in snake intimacy as a function of GSR or of the first five heart beat EKG response data. A significant effect was obtained for change in snake intimacy as a fnnction of changes in the second five heart beat EKG response data [F(1,38) = 4.42, p < .05], indicating that subjects who demonstrated a decrease, across slides, in EKG responding during the second five heart beats demonstrated a significant increase in snake intimacy. DISCUSSION The purpose of this research was to replicate and extend the research on cognitive desensitization conducted by Valins and Ray (1967). More specifically, the data obtained by Valins and Ray, and the paradigm which they used, seem equally accountable for on the basis of two competing theoretical models: a cognitive desensitization model or an aversion-relief model (i.e., differential classical conditioning). The present study was designed to test the applicability of the latter model to cognitive desensitization procedures, Methodologically, the study by Valins and Ray was extended by (a) the recording of veridical physiological responses, i.e., GSR and EKG, associated with the presentation of the snake and shock slides, (b) the use of pretest-posttest design involving the same in situ behavioral measure of snake intimacy, and (c) the addition of two groups (VG & CG) not included in the Valins and Ray design. Steps were also taken in the selection of subjects to insure that the experimental subjects were characterized by relatively intense fears of snakes. It is interesting to note that the addition of the pretest measure of snake intimacy eliminated 65.7~ of all subjects indicating a "relatively intense fear" of snakes. Focusing first upon changes in snake intimacy as a fnnction of the various treatment groups, the data are more consistent with an aversionrelief position. Unlike the data of Valins and Ray, there is no significant difference between groups on the posttest measure of snake intimacy. More importantly, and unlike the data of Valins and Ray, there is no signi~cant difference between the pretest-post-test changes in snake intimacy shown by the various treatment groups; all treatment groups exhibited greater snake intimacy on the posttest measure than on the pretest measure. The fact that there is no significant difference between the snake intimacy increments shown by the N-VIG, N-VEG, and VG is entirely consistent with predictions from an aversion-
FALSE FEEDBACK AND AVERSION RELIEF
17
relief model, and seemingly inconsistent with the cognitive model advanced by Valins and Ray. Similarly, there is no significant difference between the pretest-posttest changes in subjective fear shown by the various treatment groups. Turning to an examination of the physiological data collected, it seems desirable to restate the aversion-relief interpretation of the experimental design. Stated simply, the procedure of randomly presenting two different stimuli, one of which (i.e., the word "SHOCK") is followed by an electric shock while the other (i.e., picture of snake) is followed by no aversive stimulation, constitutes a differential classical conditioning paradigm. One important hypothesis of this experiment, that irrespective of treatment group, physiological incompatibility in the form of a relief response for the snake stimuli would result in a reduced physiological responding to the snake stimuli, was supported. The results of the major GSR response data analysis support the expected non-significant difference in physiological responding between the treatment groups, the expected difference in physiological responding between the snake slides and shock stimulus slides, and the reduction in physiological responding to the snake slides across the sequential blocks of slides. The EKG response data provide more support for the aversion-relief model. The results of the major EKG response data analyses support not only the expected non-significant difference in physiological responding between the treatment groups, but the consistent significant main effect for factor B indicates that the EKG responses to the snake and shock slides differ. Examination of Fig. 2 indicates that this difference is not uniformly different across the three sequential blocks of slides as expected. Further, subjects who demonstrated a decrease in EKG responding during the second five heart beats demonstrated a significant increase in snake intimacy. Examination of Fig. 2 further indicates that this is largely a function of the N-VIG and the VG; the reasons for this will be dealt with later. The marked decrement in EKG responding to the snake slides accompanied by the marked increment in EKG responding to the shock slides across the sequential blocks of slides follows directly from the aversionrelief model and would not, so far as the present authors can determine, be predicted by the cognitive desensitization model as outlined by Valins and Ray. The EKG response data are strongly suggestive of the possibility that, in treatment procedures which intermix both aversive stimuli and phobic stimuli, the aversive stimuli become CS signifying unpleasant stimulation whereas the phobic stimuli become CS signifying relief and "safety."
18
GAUPP, STEltN, AND GALBIqAITH
While the behavioral and physiological data lend more, though not unequivocal-as the data represent only one treatulent session-support for the aversion-relief model than the cognitive desensitization model, the difference score and multiple comparison analyses also indicate that the N-VIG treatment procedure facilitated the effect of this general tre:ltment paradigm, i.e., the N-VIG treatment procedure was more effective in increasing snake intimacy, decreasing subjective fear and in producing a greater reduction in actual physiological responding to the snake slides. While subjects in the N-VIG were told to ignore what they believed to be their actual heart sounds, the results obtained by Botto and Stern (1968) suggest that these subjeets do closely attend to the sounds. It is suggested that the presence of one's audible heart sound, an unusual occurrence for most individuals, might generate an "empathic listening" which would result in actual physiological changes and thereby produee the behavioral results as well. That non-veridieal phys!ological feedbaek has the effect of altering actual physiologieal responding in a manner consistent with the nature of the nonviridieal feedback has been demonstrated (e.g., Jones, 1958; Koenig & Del Castillo, 1969). The nature of the feedback may have also contributed, i.e., the N-VIG attended to the most differentially distinct and marked stimulusbound "heart rate" changes whieh served to verify and reinforce the pleasantness or "safety" aspect of the snake stinmli and the anxietyprovoking properties of the "SHOCK" stimuli. It is interesting to note that Stern and Tyler (1968) found that heart rate feedback during a stress period (eleetrie shock) produced a faster heart rate than during a rest period (no shock) and a significantly faster heart rate than a no-feedbaek group. This analysis would also explain the VG response data since those subjects' actual heart rate ehanges were similar to, though not as marked as, the non-veridieal heart rate changes heard by the N-VIG. From a theoretieal viewpoint, the cognitive desensitization model advanced by Valins and Ray would not require the actual use of an eleetrie shock. Theoretically, the cognition, "that stimulus has not affected me internally," and subsequent behavioral change should be induced merely by the presentation of the appropriate stimulus contingent nonveridieal "heart sound" changes sueh as heard by the N-VIG. It was the employment of the electric shock in the cognitive desensitization treatment paradigm whieh led the present authors to question its hypothesized similarity to reciprocal inhibition by systematic desensitization. More recently, Sushinsky and Bootzin (1970) also questioned Valins and t/ay's use of cognitive desensitization as a process-analogue of systematic desensitization for the same reason. In their replication of Valins and
FALSE FEEDBACK AND AVERSION RELIEF
19
Ray's study, Sushinsky and Bootzin led rat-snake phobic subjects to believe that their heart rate remained unchanged during rat-slide presentations, but increased markedly during snake-slide presentations. Theoretically, subjects were expected to believe that they were physiologically unresponsive in the presence of rats, thereby shifting their attitudes and behavior in the direction of greater approach. In the presence of snakes, however, subjects were led to believe that their fear was justified, i.e., snakes affected them physiologically, thereby reinforcing their present cognitions and snake avoidance behavior. The results obtained by Sushinsky and Bootzin failed completely to replicate the findings of Valins and Ray. The findings of Sushinsky and Bootzin suggest that the successful application of cognitive desensitization requires the utilization of an averslve stimulus as a contrast stimulus. These findings, when taken in conjunction with those of the present study, further suggest an aversion-relief interpretation of the "cognitive desensitization" treatment paradigm. The results of the present study have direct relevance to the recent interchange between Davison and Valins (1968, 1970) and Wolpe (1969, 1970) concerning the role of cognitive processes in systematic desensitzation. Based on Valins and Ray's (1967) results, Davison and Valins suggested "that subjects undergoing systematic desensitization are motivated to re-evaluate their phobic attitudes and behavior because they realize that a previously arousing stimulus is now having no physiological effects . and subsequently act in accordance with this new cognition" (p. 401). While not diminishing the importance of altered cognitive states (e.g., see London, 1964; Brown, 1967; Weitzman, 1967; Nawas, Fishman & Pucel, 1970) in behavior change, the present authors suggest that cognitions such as, "That stimulus has not affected me internally," may in fact be veridical in nature and based on the actual reduction of the relevant physiological reactivity (e.g., see Moore, 1965; Paul, 1969; Lang, 1969; Van Egeren, Feather & Hein, 1970). REFERENCES ]~OTTO, R. W., & STERN, R. M. False heart-rate feedback: the relationship of choice behavior to true EKG and GSR. Paper presented at the annual meeting of the Society for psychophysiological Research, Washington, D. C., 1968. BROWN, B. M. Cognitive aspects of Wolpe's behavior therapy. American Journal of Psychiatry, 1967, 124, 162-167. DAVISON, G. C., & VALINS, S. On self-produced and drug-produced relaxation. Behaviour Research & Therapy, 1968, 6, 401-402. DAVlSON, G. C. & VALIXS, S. A replay to Wolpe's critique regarding self-produced and drug-produced relaxation. Behaviour Research & Therapy, 1970, 8, 107-108. JONES, H. G. The application of conditioning and learning techniques to the treat-
~0
GAUPP~ STERN, AND GALBRAITH
ment of a psychiatric patient. Journal of Ab~wrmal and Social Psychology, 1956, 52, 414-420. KOENm, K. P., & DEL CASTmLO, D. False feedback and longevity of the conditioned GSR during extinction: some implications for aversion therapy. Journal of Abnormal and Social Psychology, 1969, 4, 505-510. LANe, P. J. The mechanics of desensitization and the laboratory study of human fear. In C. M. Franks (Ed.), Behavior therapy: Appraisal and starers. New York: McGraw-Hill, 1969, pp. 160-191. LONDON, P. The modes and morals of psychotherapy. New York: Holt, 1964. MoonE, N. Behaviour therapy in bronchial asthma: a controlled study. Journal of Psychosomatic Research, 1965, 9, 257-276. NawAs, M. M., FISrIMaN, S. T., & PUCEL, J. C. A standardized desensitization prograin applicable to group and individual treatments. Behaviour Research & Therapy, 1970, 8, 49-56. PAUL, G. I. Inhibition of physiological response to stressful imagery by relaxation training and hypnotically suggested relaxation. Behavior Research & Therapy, 1969, 7, 249-256. SOLYOM, L., & MmLEn, S. B. Reciprocal inhibition by aversion relief in the treatment of phobias. Behaviour Research & Therapy, 1967, 5, 313-324. STEnN, R. M., & TYLEn, R. W. Augmented heart rate feedback: Differential effects during rest and stress. Paper presented at the annual meeting of the Society for Psychophysiological Research, Washington, D. C., 1968. STERN, R. M., GavPP, L. A., & LEONARD,W. C. A comparison of GSR and subjective adaptation to stressful stimuli. Psychophysiology, 1970, 7, 3-9. SUSHINSKY,L. W., & Boo'vzlN, R. R. Cognitive desensitization as a model of systematic desensitization. Behaviour Research & Therapy, 1970, 8, 29-33. THOaPE, J. G., SCHMIDT, E., BROWN, P. T., & CaSTELL, D. Aversion-relief therapy: a new method for general application. Behaviour Research & Therapy, 1964, 2, 71-82. VamNs, S., & Ray, A. A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 345--350. VaN EGEV,EN, L. F., FEATI-mR, B. W., & HEIN, P. L. Desensitization of phobias: Some psychophysiological propositions. Unpublished manuscript, Department of Psychiatry, Duke University Medical Center, 1970. WEITZMAN, B. Behavior therapy and psychotherapy. Psychological Review, 1962, 79, 300-317. WINER, B. J. Statistical principles in experimental design. New York: McGraw-Hill, 1962. WOLPE, J. How can "cognitions" influence desensitization? Behaviour Research & Therapy, 1969, 7, 219. WOLPE, J. Emotional conditioning and cognitions: A rejoinder to Davison and Valins. Behaviour Research & Therapy, 1970, 8, 107-108.
( 1972 ) 3, 7-20
False Heart-Rate Feedback and Reciprocal Inhibition by Aversion Relief in the Treatment of Snake Avoidance Behavior1 LARRY A. GAUPP, ROBERT M. STERN, AND GARY G. GALBI~ArI:Iff The Pennsylvania State University The purpose of this study was to examine physiological and behavioral data collected uisng cognitive desensitization technique of treating snake avoidance behavior (Valins & Ray, 1967). The reciprocal inhibition by aversion-relief model was utilized to reinterpret the cognitive desensitization~ treatment paradigm. The roles of both false and veridieal heart-rate feedback were also investigated. Forty subjects who were unable to pick up a snake on a specially designed test of snake intimacy were randomly assigned to one of three experimental treatment procedures and one control group. GSR and EKG responding were measured throughout the experimental treatment procedures. Immediately following the treatment session, subjects were again tested on the snake intimacy test. Subjective fear ratings were also obtained both before and after treatment. Support for the aversion-relief model was found in various aspects of the data. The results indicated that if the cognition, "That stimulus has not affected me internally," is operating for the snake slides, as suggested by Valins and Ray, it is veridieal in nature and based on actual reduced physiological responding. It was also found that false heart rate feedback facilitated the overall aversion-relief treatment process.
T h e p u r p o s e of this s t u d y w a s to e x a m i n e f u r t h e r a r e c e n t l y r e p o r t e d c o g n i t i v e d e s e n s i t i z a t i o n p r o c e d u r e for t r e a t m e n t of a v o i d a n c e b e h a v i o r ( V a l i n s & Ray, 1967). Valins c o n s i d e r s his t e c h n i q u e to b e p r o c e s s a n a l o g u e to W o l p e ' s (1958) s y s t e m a t i c desensitizat:.on. T h e p r e s e n t a u thors q u e s t i o n w h e t h e r Valins' s t u d y p e r m i t s t h e f o r m u l a t i o n of v a l i d conclusions c o n c e r n i n g " c o g n i t i v e " versus " s y s t e m a t i c " d e s e n s i t i z a t i o n since h e d i d n o t r e c o r d a n y p h y s i o l o g i c a l m e a s u r e . F u r t h e r , it is s u g g e s t e d t h a t Valins a n d Ray's results are a f u n c t i o n of d i f f e r e n t i a l classical cond i t i o n i n g , r a t h e r t h a n t h e c o g n i t i v e e v a l u a t i o n of p r e s u m e d p h y s i o l o g i c a l 1This paper is based in part on a thesis submitted by the senior author in partial fulfillment of the M.S. degree at The Pennsylvania State University. Support for the senior author was provided by a Public Health Service Fellowship. Requests for reprints should be addressed to Larry A. Gaupp, Department of Psychology, The Pennsylvania State University, 417 Psychology Building, University Park, Pennsylvania 16802. 7 Q 1972 by Academic Press, Inc.
/~
GAUPP, STERN, AND GALBRAITH
reactivity, and that, in this respect, their procedure is a form of aversionrelief therapy (Thorpe, Schmidt, Brown & Castell, 1964; Solyom & Miller,
1967). Valins and Ray (1967) used false heart rate feedback procedures in an attempt to assess the role of induced cognitions concerning autonomic responsivity, as opposed to autonomic responsivity per se, in the elimination of phobic behavior associated with snakes. Using students who reported fear of snakes on a questionnaire, their experimental procedures consisted of projecting 10 pictures of snakes and 10 pictures containing the work "SHOCK" before each subject. The experimental subjects (Heart Rate Feedback Group), told that they were listening to their own heart beats, heard their "heart beats" accelerate in response to slides containing the word "SHOCK" and remain constant in response to projected pictures of snakes. In addition, the subjects received a mild electric shock seven seconds after the onset of each shock slide. Subjects in the control group (Extraneous Sounds Group) were told that they were listening to meaningless sounds but otherwise heard the same pattern of accelerated and constant sounds, and received the same electric shocks, as subjects in the experimental group. Using an in situ, behavior measure of snake intimacy, Valins and Ray found less snake avoidance among experimental subjects than among control subjects. Subjects in the experimental group were presumably led to believe that they were relaxed, or physiologically unresponsive, in the presence of snakes, thereby shifting their attitudes and behavior in the direction of greater approach. Alternatively, the attention-demand factor operating in the Heart Rate Feedback Group (i.e., the heightened attention to the stimulus-bound sound changes), which is generated by the atypical presence of one's audible "heart sound," may have produced the obtained group behavioral results (see Botto & Stern, 1968). Despite this contaminating attention-demand factor and the fact that no measure of physiological responding was obtained, Valins and Ray concluded that reciprocal inhibition via muscular relaxation, accorded a central role in Wolpe's theory, is not a necessary component of desensitization, and that cognitive desensitization, i.e., the belief that one is relaxed, is a sufficient condition for the elimination, or reduction, of avoidance behavior. No measure of actual physiological responding was obtained in the study, however. The experimental paradigm used by Valins and Ray closely parallels the paradigm (differential class,-'cal conditioning) used in the aversionrelief therapies of Thorpe et al. (1964) and Solyom and Miller (1967) which embodies the principle of reciprocal inhibition as a necessary component. The procedure of randomly presenting two different stimuli,
FALSE FEEDBACK AND AVERSIONRELIEF
9
one of which is followed by or paired with aversive stimulation (i.e., electric shock) while the other (i.e., snake pictures) is not, would be expected to establish the respective stimuli as danger and safety signals. Aversion-relief therapy, which is theoretically identical to Wolpe's reciprocal inhibition by progressive relaxation, presumably produces physiological incompatibility to anxiety by pairing anxiety-evoking stimuli with a state of relief. The similarity between reciprocal inhibition by aversion-relief therapy and Valins and Ray's cognitive desensitization paradigm is apparent. The aversive stimulus, the shock slide and accompanying electric shock, were randomly followed by the relief stimulus-a snake slide. The anxiety-evoking snake stimulus, then, became the CS for the relief response resulting in possible physiological changes incompatible with the previous anxiety response. When Valins and Ray's cognitive desensitization paradigm is analyzed in terms of the aversion-relief model, a question arises which their study did not adequately acknowledge. Did physiological responses incompatible with anxiety become associated with the snake stimulus and inhibit the anxiety which was previously evoked by the snake? The purpose of the present research was to replicate the study by Valins and Ray and to extend it by (a) recording actual heart rate activity and skin resistance measures that accompany the presentation of snake and shock stimuli, (b) adding additional experimental and control groups not present in the Valins and Ray study, and (c) utilizing an improved method of measuring the degree of pre-experimental fear associated with snakes. In the present study, it was hypothesized that at the physiological level, all three experimental groups, i.e., a group similar to Valin and Ray's experimental group, and a second group similar to their control group and a group that received veridical feedback, would show a gradual decrease in responding to snake slides and an increase in responding to shock slides. It was also predicted that the three experimental groups would show a corresponding reduction in fear of snakes. Because of the above mentioned heightened attention, which was predicted for the group similar to Valins and Ray's experimental group, it was hypothesized that this group would show the greatest differential physiological responding and, accordingly, the greatest reduction in fear of snakes. METHOD
Subiects. The subjects were seven male and 33 female undergraduate volunteers from introductory psychology classes at The Pennsylvania State University. All subjects expressed relatively intense fears of snakes, the stated prerequisite for participation in the present experiment, and exhibited no cardiac abnormality as
10
GAUPP, STERN~ AND GALBI/AITII
determiued by a university physician. Tile subjects received experimental credit which enhanced their academic grade. Apparatus. The GSR was continuously measured with a model 22A Eels Dermolnnmeter; subject current was 70 #amps. A permanent record of responses was recorded on a Brush Mark II recorder. A 3~ in. diameter zinc electrode was attached to the subject's left pahn and a 1Ji in. by 2ll in. zinc electrode to the ventral surface of the subject's left forearm. The electrodes were coated with zinc sulfate paste. EKG was continumlsly recorded with a model 121 Unipak Bioamplifier and a model 170C Biotach (Biocom). A permanent record of responses was reeorded on the second channel of the Brush recorder. Stainless steel electrodes coated with Sanborn Redux electrode paste were attached to the right arm and right (ground) and left leg. A microphone placed adjacent to the Biotaeh was utilized to transmit veridical heart sounds to certain subjects. A model HAR-2 Hargrave Pulse-Meter was employed with an EKS 70 Telemetrics Heart Beat Simulator to tape record non-verdical heart sounds. The shock supply was A.C. and constant-current. Two 1-in. diameter silver shock electrodes coated with Sanborn Bedux electrode paste were attached to subject's right ankle approximately 1-in. apart. Shock and snake stimuli. Shock stimuli consisted of 10 slides of the word "SHOCK" accompanied by an electric shock. All shocks were delivered 7 sec after the ~tinmlns word appeared. All shocks were delivered for 0.1 sec. Shock intensity ranged from 1.0 ma for the first two shock stimuli, increasing 0.5 ma per two shock stimuli, to a maximum of 3.0 ma for the last two shock stimuli. The increase in shock intensity was designed to prevent subjective adaptation to the shock stinmli (Stern, Ganpp and Leonard, 1970) and to heighten the anxiety-relief response pattern. Snake stimuli consisted of 10 black and white slides depicting various kinds of snakes. The 10 slides were previously rank-ordered by 30 judges according to the degree of fear provoked. The stimuli were presented in increasing order of intensity. The shock stimuli (slides 1, 3, 6, 8, 9, 11, 13, 16, 18, 19), and the snake stimuli (slides 2, 4, 5, 7, 10, 12, 14, 15, 17, 20), were presented at 45 sec intervals for a dnration of 15 sec. Snake intimacy test (S/T). Subjects who had previously indicated a fear of snakes reported individually to the observation room of the Psychological Clinic, where they were asked to rate their fear of snakes on a five point Subjective Fear Rating (SFR 1) scale ranging from 1 (very low) to 5 (very high). In the presence of the experimenter, the subjects then viewed the snake, a three foot boa constrictor contained in a glass cage, through a one-way nrirror. Answers to subjects about the snake were limited to informing subjects that the snake was nonpoisonous; no other information was given about the snake or the nature of the experiment. Subjects attempted to perform the following behavioral tasks: (1) enter the room and look over at the snake; (2) go over to the table on which the caged snake is sitting; (3) sit down in the chair next to the table; (4) put his hand on the outside portion of the cage next to the snake; (5) stand up, take the lid off the cage and look down at the snake; (6) put his hand over to level with the top of the cage; (7) put his hand into the cage; (8) touch the snake; (9) pick the snake up a few inches within the cage; (10) pick the snake up and out of the cage and hold it. Each subject's snake intimacy, as measured by the last behavioral task successfully completed, was recorded. The subjects who suecessftdly completed all 10 behavioral tasks listed, that is,
FALSE FEEDBACK AND AVERSION RELIEF
11
who demonstrated a high degree of snake intimacy were given experimental credit and excluded from the study. The remaining subjects were again asked to rate their fears of snakes on the five point rating scale and rescheduled for the second session. Postsnake intimacy test (PIT). The PIT immediately followed the second session (described below) and was identical to the SIT. SFR 2 and SFR 3 preceded and followed the PIT, respectively. Procedure. Seven to nine days following the SIT, subjects reported individually for the second session. While the electrodes were being attached, subjects were told that they would receive several electric shocks on their right ankles throughout the course of the session. The subjects were randomly assigned to the following four groups: Non-Veridical informed group (N-VIG). The subjects in this group heard false sounds during the presentation of both the shock and snake stimuli. There was no increase in the sounds during the presentation of the snake stimuli throughout the treatment session but a marked increase in the sounds to the shock stimuli. The sounds were pre-recorded. After the electrodes were attached, subjects were told that the experimenter was going to record several physiological measures during this part of the experiment and that he was interested in their physiological responses to both the shock and snake stimuli. Further, subjects were told that, because of a faulty piece of equipment, they would hear their heart beat throughout the course of the session, but that these sounds should be ignored. This group was similar to Valins and Ray's Heart-Beat Feedback group. Non-Veridical extraneous sounds group (N-VEG). The subjects in this group heard the same false sounds as the N-VIG group. However, these subjects were told that the audible sounds were meaningless and that the experimenter was interested in the effects these sounds would have on their physiological reactions to the shock and snake stimuli. The subjects were told to ignore these sounds. This group designed as a control for the N-VIG, was similar to Valins and Ray's Extraneous Sounds group. Veridical group (VG). The subjects in this group heard their actual heart beats during the presentation of both the shock and snake stimuli. After the electrodes were attached, they were given the same information as the N-VIG subjects; however, they were not told to ignore their heart beat. This group was designed to determine the importance of veridical feedback. Control group (CG). With the exception of the actual experimental manipulations, i.e., the presentation of the shock and snake stimuli with the concomitant sound feedback, subjects in this group performed all those tasks performed by the experimental groups, i.e., the SIT and PIT. This group was designed to determine the effects of exposure to the actual fear stimulus, with no intervening therapeutic process, on snake intimacy and on the subjective fear ratings. After subjects in each group were given the appropriate information, they were told that there would be a 5 rain rest period followed by the stimulus slides and then another I min rest period marking the end of the session. During the 5 rain rest period, subjects heard either their own heart sounds, non-veridical heart sounds, or extraneous sounds, depending on the experimental group. During this period, the non-veridical heart sounds and extraneous sounds varied in rate from 66 to 72 bpm. For all groups, beginning with the sixth minute, the 20 stimulus slides were projected into the slide-cubical. A marked increase in the sound consisted of an increase from the resting level of 66 to 72 bpm, to a maximum of 110 bpm. This increase in rate
12
GAUPP, STERN, AND GALBRAITH
continued throughout the duration of the slide (15 see) and then gradually subsided to the resting level during the 45 see slide presentation interval. Immediately following this session, subjects were again taken to tile clinic observation room and put through the PIT.
RESULTS Snake Intimacy as a Function of Treatments
The snake intimacy data are presented in Fig. 1. Analysis of the SIT data shows that the N-VIG demonstrate a significantly greater increase in snake intimacy than the CG; no difference between experimental groups was found. Following completion of the experimental procedures, an analysis of variance of SIT revealed no significant difference in snake intimacy between groups [F(3,36)=0.48, p > .05]. An analysis of variance of PIT scores revealed no difference [F(3,36) = 0.82, p > .05]. Treatment effects were examined by comparing the difference scores-PIT minus SIT---for the various groups [F(3,36 = 2.94, p < .05]. The Tukey (a) method of multiple comparisons based on total scores was 1
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F A L S E FEEDBACK AND AVERSION R E L I E F
conducted to determine if specific hypothesized between-group sons were significant These statistical comparisons indicate N-VIG demonstrate a significantly greater increase in snake from the SIT to the PIT [Tukey (a) critical value----11.65, than the increase exhibited by the CG.
13 comparithat the intimacy p > .05]
Subjective Fear Rating as a Function of Treatments Subjective fear rating (SFR) data are also presented in Fig. 1. Analysis of the SFR data shows that N-VIG demonstrate a significantly greater decrease in subjective fear than the CG; again no difference between experimental groups was found. Treatment effects were again examined by using a single factor analysis of variance based on difference scores--SFR 1 minus SFR, and SFR 1 minus SFR. The result in both cases is significant [F(3,36) = 3.67, F(3,36) = 3.19, respectively, p < .05]. Multiple comparisons of SFR total difference scores (1-2) between groups indicate that the N-VIG differ from the CG [Tukey (a) critical value = 8.00, p < .05]. Multiple comparisons of SFR total difference scores (1-3) between groups indicate that the N-VIG differ from the CG [Tukey (a) critical value = 9.05, p < .05].
Analysis of Physiological Data Analysis of the GSR data shows that significantly greater responses were made to the shock slides despite a significant decrease in responding to both snake and shock s/ides. No difference was found between groups. A 3 X 2 X3 factorial analysis of variance with repeated measures on the last two factors (all statistical analyses are based on models in Winer, 1962) was utilized to analyze the GSR response data. The purpose of this analysis was to determine the effect of the three different treatment conditions (factor A) upon GSR responding to two different types of stimulus slides (factor B) randomly presented 10 times each (factor C). Because of the experimental novelty of the treatment procedures, the GSR response data to the first shock slide and the first snake slide were excluded from the analysis. The remaining nine shock slides and nine snake slides were divided into three blocks of three slides each and analyzed as three levels of factor C. The GSR response measure was defined as the maximum percentage change in skin resistance occurring within 5 see after slide onset. No significant main effect was obtained for factor A. A significant main effect was obtained for factor B [F(1,27) = 32.90, p < .01]; greater responses were made to the shock slides. A significant main effect for factor C was also obtained IF (2,54 --~ 8.00, p < .01]; the general trend being decrease in responding to both snake and shock slides. The EKG response data for the N-VIG, N-VEG, and VG for the first
14
GAUPP~ STEHX~ AND GALBRAITFI
five and the second five heart beats after slide onset are presented ill Fig. 2. Analysis of the EKG response data shows a significant deerease and concomitant increase in responding across blocks of slides to the snake and shock slides respectively. The N-VIG show a greater increase in EKG responding across blocks of shock slides for the first five heart heats than the N-VEG. The N-VIG also show a greater decrease in EKG responding across blocks of snake slides for the second five heart beats than the N-VIG. The form of the analysis of variance of the EKG response data is identical to the overall GSR response analysis. The EKG response measure for the analysis of the first and second five I
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BLOCKS OF STIMULUS SLIDES FIG. 2. M e a n p e r c e n t a g e of E K G r e s p o n d i n g for t h e first five h e a r t beats a n d second five heart b e a t s after s t i m u l u s o n s e t to t h e shock a n d snake s t i m u l u s slides for t h e N-VIG, N - V E G a n d VG.
FALSE FEFDBACK AND AVERSION RELIEF
15
heart beats after slide onset was defined as a percentage of the prestimulus level in inter-heart beat interval (mean five heart beat intervals prior to stimulus slide onset). No significant main effect is obtained for factor A. A significant main effect is obtained with the first five heart beats for factor B [F(1,27) --4.95, p < .05]; overall greater responses were made to the shock slides. For the second five heart beats, the A )K B interaction approaches significance [F(2,27) = 2.41, p < .10], indicating that the treatment groups showed a different pattern of response to the two types of slides. The A X C interaction approaehes significance [ F ( 4 , 5 4 ) = 2.30, p < .10], indieating that the treatment groups did not respond uniformly differently across the three sequential bloeks of slides. To determine whether the mean in EKG responding for the first and second five heart beats after stimulus slide onset differed as a function of type of slide, 4 X 2 difference score analyses of variance were conducted. Faetor A was the three treatment group and factor B the two types of stimulus slides. The difference score was calculated by subtraeting the third block of slides from the first block of slides. Significant main effects were obtained for factor B [ F ( 1 , 2 7 ) = 4 . 7 7 , F ( 1 , 2 7 ) = 6.37, respectively, p < .05], indicating that the ehanges in EKG responding for the first to the third block of slides differed as a function of the type of stimulus slide. Multiple comparisons of EKG difference scores between groups to the shock slides for the first five heart beats indicate that the N-VIG differ from the N-VEG [Tukey (a) eritieal value = 1.42, p < .05]. Examination of Fig. 2 suggests that this difference is largely a function of the N-VIG's increase in mean pereentage ehange in EKG responding across blocks of shock slides. Multiple comparisons between groups on shoek slides difference scores for the second five heart beats yield no significant differenee. Multiple comparisons between groups on snake slide difference seores for the second five heart beats indicate that the N-VIG mean percentage in EKG responding differs from the N-VEG [Tukey (a) critical value = 1.30, p < .05]. Examination of Fig. 2 suggests that this difference is largely a function of the decrease in mean pereentage in EKG responding by the N-VIG to the snake slides. Multiple comparisons of EKG difference scores between groups to slides for the first five heart beats yield no significant difference; however, the greatest decrease in mean percentage change in EKC responding aeross blocks of snake slides is exhibited by the N-VIG. To determine whether change in snake intimacy was a function of ehange in physiologieal responding from the first to the third block of
16
GAUPP, STERN, AND GALBRAITH
snake slides, the subjects were divided into two groups. One group consisted of those subjects who showed either no change or an increase in physiological responding. The other group consisted solely of those subjects who showed a decrease in physiological responding. No significant effect was obtained for change in snake intimacy as a function of GSR or of the first five heart beat EKG response data. A significant effect was obtained for change in snake intimacy as a fnnction of changes in the second five heart beat EKG response data [F(1,38) = 4.42, p < .05], indicating that subjects who demonstrated a decrease, across slides, in EKG responding during the second five heart beats demonstrated a significant increase in snake intimacy. DISCUSSION The purpose of this research was to replicate and extend the research on cognitive desensitization conducted by Valins and Ray (1967). More specifically, the data obtained by Valins and Ray, and the paradigm which they used, seem equally accountable for on the basis of two competing theoretical models: a cognitive desensitization model or an aversion-relief model (i.e., differential classical conditioning). The present study was designed to test the applicability of the latter model to cognitive desensitization procedures, Methodologically, the study by Valins and Ray was extended by (a) the recording of veridical physiological responses, i.e., GSR and EKG, associated with the presentation of the snake and shock slides, (b) the use of pretest-posttest design involving the same in situ behavioral measure of snake intimacy, and (c) the addition of two groups (VG & CG) not included in the Valins and Ray design. Steps were also taken in the selection of subjects to insure that the experimental subjects were characterized by relatively intense fears of snakes. It is interesting to note that the addition of the pretest measure of snake intimacy eliminated 65.7~ of all subjects indicating a "relatively intense fear" of snakes. Focusing first upon changes in snake intimacy as a fnnction of the various treatment groups, the data are more consistent with an aversionrelief position. Unlike the data of Valins and Ray, there is no significant difference between groups on the posttest measure of snake intimacy. More importantly, and unlike the data of Valins and Ray, there is no signi~cant difference between the pretest-post-test changes in snake intimacy shown by the various treatment groups; all treatment groups exhibited greater snake intimacy on the posttest measure than on the pretest measure. The fact that there is no significant difference between the snake intimacy increments shown by the N-VIG, N-VEG, and VG is entirely consistent with predictions from an aversion-
FALSE FEEDBACK AND AVERSION RELIEF
17
relief model, and seemingly inconsistent with the cognitive model advanced by Valins and Ray. Similarly, there is no significant difference between the pretest-posttest changes in subjective fear shown by the various treatment groups. Turning to an examination of the physiological data collected, it seems desirable to restate the aversion-relief interpretation of the experimental design. Stated simply, the procedure of randomly presenting two different stimuli, one of which (i.e., the word "SHOCK") is followed by an electric shock while the other (i.e., picture of snake) is followed by no aversive stimulation, constitutes a differential classical conditioning paradigm. One important hypothesis of this experiment, that irrespective of treatment group, physiological incompatibility in the form of a relief response for the snake stimuli would result in a reduced physiological responding to the snake stimuli, was supported. The results of the major GSR response data analysis support the expected non-significant difference in physiological responding between the treatment groups, the expected difference in physiological responding between the snake slides and shock stimulus slides, and the reduction in physiological responding to the snake slides across the sequential blocks of slides. The EKG response data provide more support for the aversion-relief model. The results of the major EKG response data analyses support not only the expected non-significant difference in physiological responding between the treatment groups, but the consistent significant main effect for factor B indicates that the EKG responses to the snake and shock slides differ. Examination of Fig. 2 indicates that this difference is not uniformly different across the three sequential blocks of slides as expected. Further, subjects who demonstrated a decrease in EKG responding during the second five heart beats demonstrated a significant increase in snake intimacy. Examination of Fig. 2 further indicates that this is largely a function of the N-VIG and the VG; the reasons for this will be dealt with later. The marked decrement in EKG responding to the snake slides accompanied by the marked increment in EKG responding to the shock slides across the sequential blocks of slides follows directly from the aversionrelief model and would not, so far as the present authors can determine, be predicted by the cognitive desensitization model as outlined by Valins and Ray. The EKG response data are strongly suggestive of the possibility that, in treatment procedures which intermix both aversive stimuli and phobic stimuli, the aversive stimuli become CS signifying unpleasant stimulation whereas the phobic stimuli become CS signifying relief and "safety."
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GAUPP, STEltN, AND GALBIqAITH
While the behavioral and physiological data lend more, though not unequivocal-as the data represent only one treatulent session-support for the aversion-relief model than the cognitive desensitization model, the difference score and multiple comparison analyses also indicate that the N-VIG treatment procedure facilitated the effect of this general tre:ltment paradigm, i.e., the N-VIG treatment procedure was more effective in increasing snake intimacy, decreasing subjective fear and in producing a greater reduction in actual physiological responding to the snake slides. While subjects in the N-VIG were told to ignore what they believed to be their actual heart sounds, the results obtained by Botto and Stern (1968) suggest that these subjeets do closely attend to the sounds. It is suggested that the presence of one's audible heart sound, an unusual occurrence for most individuals, might generate an "empathic listening" which would result in actual physiological changes and thereby produee the behavioral results as well. That non-veridieal phys!ological feedbaek has the effect of altering actual physiologieal responding in a manner consistent with the nature of the nonviridieal feedback has been demonstrated (e.g., Jones, 1958; Koenig & Del Castillo, 1969). The nature of the feedback may have also contributed, i.e., the N-VIG attended to the most differentially distinct and marked stimulusbound "heart rate" changes whieh served to verify and reinforce the pleasantness or "safety" aspect of the snake stinmli and the anxietyprovoking properties of the "SHOCK" stimuli. It is interesting to note that Stern and Tyler (1968) found that heart rate feedback during a stress period (eleetrie shock) produced a faster heart rate than during a rest period (no shock) and a significantly faster heart rate than a no-feedbaek group. This analysis would also explain the VG response data since those subjects' actual heart rate ehanges were similar to, though not as marked as, the non-veridieal heart rate changes heard by the N-VIG. From a theoretieal viewpoint, the cognitive desensitization model advanced by Valins and Ray would not require the actual use of an eleetrie shock. Theoretically, the cognition, "that stimulus has not affected me internally," and subsequent behavioral change should be induced merely by the presentation of the appropriate stimulus contingent nonveridieal "heart sound" changes sueh as heard by the N-VIG. It was the employment of the electric shock in the cognitive desensitization treatment paradigm whieh led the present authors to question its hypothesized similarity to reciprocal inhibition by systematic desensitization. More recently, Sushinsky and Bootzin (1970) also questioned Valins and t/ay's use of cognitive desensitization as a process-analogue of systematic desensitization for the same reason. In their replication of Valins and
FALSE FEEDBACK AND AVERSION RELIEF
19
Ray's study, Sushinsky and Bootzin led rat-snake phobic subjects to believe that their heart rate remained unchanged during rat-slide presentations, but increased markedly during snake-slide presentations. Theoretically, subjects were expected to believe that they were physiologically unresponsive in the presence of rats, thereby shifting their attitudes and behavior in the direction of greater approach. In the presence of snakes, however, subjects were led to believe that their fear was justified, i.e., snakes affected them physiologically, thereby reinforcing their present cognitions and snake avoidance behavior. The results obtained by Sushinsky and Bootzin failed completely to replicate the findings of Valins and Ray. The findings of Sushinsky and Bootzin suggest that the successful application of cognitive desensitization requires the utilization of an averslve stimulus as a contrast stimulus. These findings, when taken in conjunction with those of the present study, further suggest an aversion-relief interpretation of the "cognitive desensitization" treatment paradigm. The results of the present study have direct relevance to the recent interchange between Davison and Valins (1968, 1970) and Wolpe (1969, 1970) concerning the role of cognitive processes in systematic desensitzation. Based on Valins and Ray's (1967) results, Davison and Valins suggested "that subjects undergoing systematic desensitization are motivated to re-evaluate their phobic attitudes and behavior because they realize that a previously arousing stimulus is now having no physiological effects . and subsequently act in accordance with this new cognition" (p. 401). While not diminishing the importance of altered cognitive states (e.g., see London, 1964; Brown, 1967; Weitzman, 1967; Nawas, Fishman & Pucel, 1970) in behavior change, the present authors suggest that cognitions such as, "That stimulus has not affected me internally," may in fact be veridical in nature and based on the actual reduction of the relevant physiological reactivity (e.g., see Moore, 1965; Paul, 1969; Lang, 1969; Van Egeren, Feather & Hein, 1970). REFERENCES ]~OTTO, R. W., & STERN, R. M. False heart-rate feedback: the relationship of choice behavior to true EKG and GSR. Paper presented at the annual meeting of the Society for psychophysiological Research, Washington, D. C., 1968. BROWN, B. M. Cognitive aspects of Wolpe's behavior therapy. American Journal of Psychiatry, 1967, 124, 162-167. DAVISON, G. C., & VALINS, S. On self-produced and drug-produced relaxation. Behaviour Research & Therapy, 1968, 6, 401-402. DAVlSON, G. C. & VALIXS, S. A replay to Wolpe's critique regarding self-produced and drug-produced relaxation. Behaviour Research & Therapy, 1970, 8, 107-108. JONES, H. G. The application of conditioning and learning techniques to the treat-
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ment of a psychiatric patient. Journal of Ab~wrmal and Social Psychology, 1956, 52, 414-420. KOENm, K. P., & DEL CASTmLO, D. False feedback and longevity of the conditioned GSR during extinction: some implications for aversion therapy. Journal of Abnormal and Social Psychology, 1969, 4, 505-510. LANe, P. J. The mechanics of desensitization and the laboratory study of human fear. In C. M. Franks (Ed.), Behavior therapy: Appraisal and starers. New York: McGraw-Hill, 1969, pp. 160-191. LONDON, P. The modes and morals of psychotherapy. New York: Holt, 1964. MoonE, N. Behaviour therapy in bronchial asthma: a controlled study. Journal of Psychosomatic Research, 1965, 9, 257-276. NawAs, M. M., FISrIMaN, S. T., & PUCEL, J. C. A standardized desensitization prograin applicable to group and individual treatments. Behaviour Research & Therapy, 1970, 8, 49-56. PAUL, G. I. Inhibition of physiological response to stressful imagery by relaxation training and hypnotically suggested relaxation. Behavior Research & Therapy, 1969, 7, 249-256. SOLYOM, L., & MmLEn, S. B. Reciprocal inhibition by aversion relief in the treatment of phobias. Behaviour Research & Therapy, 1967, 5, 313-324. STEnN, R. M., & TYLEn, R. W. Augmented heart rate feedback: Differential effects during rest and stress. Paper presented at the annual meeting of the Society for Psychophysiological Research, Washington, D. C., 1968. STERN, R. M., GavPP, L. A., & LEONARD,W. C. A comparison of GSR and subjective adaptation to stressful stimuli. Psychophysiology, 1970, 7, 3-9. SUSHINSKY,L. W., & Boo'vzlN, R. R. Cognitive desensitization as a model of systematic desensitization. Behaviour Research & Therapy, 1970, 8, 29-33. THOaPE, J. G., SCHMIDT, E., BROWN, P. T., & CaSTELL, D. Aversion-relief therapy: a new method for general application. Behaviour Research & Therapy, 1964, 2, 71-82. VamNs, S., & Ray, A. A. Effects of cognitive desensitization on avoidance behavior. Journal of Personality and Social Psychology, 1967, 7, 345--350. VaN EGEV,EN, L. F., FEATI-mR, B. W., & HEIN, P. L. Desensitization of phobias: Some psychophysiological propositions. Unpublished manuscript, Department of Psychiatry, Duke University Medical Center, 1970. WEITZMAN, B. Behavior therapy and psychotherapy. Psychological Review, 1962, 79, 300-317. WINER, B. J. Statistical principles in experimental design. New York: McGraw-Hill, 1962. WOLPE, J. How can "cognitions" influence desensitization? Behaviour Research & Therapy, 1969, 7, 219. WOLPE, J. Emotional conditioning and cognitions: A rejoinder to Davison and Valins. Behaviour Research & Therapy, 1970, 8, 107-108.