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Is it really necessary to use mildly phobic analogue subjects?
I~EHAVIOR THERAPY 6, 6 8 - 7 1
(1975)
Is it Really Necessary to Use Mildly Phobic Analogue Subjects? GERALD M. ROSEN University of Oregon The current use of mildly phobic analogue subjects in desensitization research is largely unnecessary since highly fearful subjects are more easily recruited. An editorial policy aimed at discouraging unnecessary analogue studies is recommended.
During the past decade, behavioral journals have published an ever increasing number of analogue desensitization studies. These studies have been "analogues" in so far as they employed (a) treatment procedures and/or (b) mildly phobic subjects who were only "analogous" to the procedures and patients associated with "actual" clinic settings. Analogue procedures allow for control over specific method factors so that cause and effect relationships can be identified (Paul, 1969). In contrast to these methodological considerations, researchers study mildly fearful analogue subjects because access to highly anxious phobics is thought to be too restricted. Bernstein and Paul (1971) have detailed the many methodological pitfalls and problems associated with the use of "low fear" subjects. Putting these points aside, the present paper argues that the current flight to analogue subjects is unnecessary. Highly fearful subjects are often available and more easily recruited than mildly fearful undergraduates.
Recruiting Highly Fearful Subjects In Lang's early studies on systematic densensitization with snake phobics (Lang & Lazovik, 1963; Lang, Lazovik & Reynolds, 1965) highly fearful subjects were recruited from the top 1 or 2% of the available undergraduate population. Lang's time consuming screening process was unattractive to most researchers and totally unacceptable to pressured dissertation candidates. Accordingly, recent analogue studies Preparation of this paper was supported by Grant MH25657-01 from the National Institute of Mental Health, United States Public Health Service. Requests for reprints should be sent to the author, Department of Psychology, University of Oregon, Eugene, Oregon, 97403. 68 Copyright © 1975 by Academic Press, Inc. Printed in the United States. All rights of reproduction in any form reserved.
NOTES AND COMMENTS
69
have lowered their selection criteria and now draw from the top 10 to 30% of the undergraduate subject pool (Bernstein & Paul, 1971). An alternative to undergraduates and lowered selection criteria has been provided by Bandura, Blanchard, and Ritter (1969). T h e s e authors efficiently recruited substantial numbers of highly phobic subjects by simply placing an advertisement in a local newspaper. Recent research by this author further supports the use of newspaper announcements for subject recruitment. T h e local newspaper's reporter for campus news wrote an article which appeared for one day in conjunction with a small ad. 1 The article and advertisement explained that a study was being conducted to evaluate "treatment approaches to reduce people's fears of snakes." Readers were told that some fear was c o m m o n and that only people who were truly terrified of snakes should contact the local University's Psychology Clinic. During the next 10 days, over 100 individuals called for information about the study. Eighty-nine of the callers remained interested in participating although 14 were excluded on the basis of their initial self-reports. Eleven others reevaluated their interest in the study before subject selection was completed. O f the remaining 64 subjects, only nine had to be excluded from the final subject pool, four because of technical mistakes made during their pre-treatment assessments. All of the final subjects scored 19 or above on Lang's fear of snakes questionnaire (Lang, Melamed & Hart, 1971). On a behavior approach test, only nine of the subjects were willing to walk all the way up to the caged snake. T w e n t y - t h r e e subjects would not even allow the caged snake into their room despite the use of a moderately "high demand" instructional set. 2 In short, with only a single day of local advertising, 55 highly fearful subjects were successfully recruited. Contrast the success of the above with a typical selection program for the recruitment of undergraduate analogue phobics. In an earlier study (Rosen, 1974), 1744 fear o f snakes questionnaires were distributed to undergraduates at the University of Wisconsin! An attempt was then made to contact the 159 females who scored 15 or above on this questionnaire. Individuals w h o w e r e successfully contacted and interested in participating were then scheduled for a pre-treatment behavior approach test. Subjects who were willing to touch a caged snake during this test were eliminated from the study, resulting in a final N = 45. O f these 45 subjects, 32 were willing to at least walk all the way up to the caged snake, look at the snake, and touch the outside of the glass cage. In 1 Copies of the advertisement and article are available from the author upon request. 2 Copies of the instructions used during the behavioral assessments are available from the author upon request. Data demonstrating the effects of "demand characteristics" on pretreatment approach behavior have been reported by Bernstein (e.g., Behavior Therapy, 1974, 5, 183-192).
70
NOTES AND COMMENTS
short, the analogue subjects recruited by these laborious and inefficient methods were only mildly fearful and few in number.
Are Analogue Subjects Necessary? Considering the relative efficacy of different methods for recruiting phobic individuals, researchers' current reliance on mildly fearful analogue subjects is both unnecessary and unjustified. In many cases, highly fearful subjects can be easily recruited through the planned use of newspaper advertisements. Naturally, the use of advertisements does not automatically guarantee that only highly fearful subjects will respond and "high" demand screening assessments (Bernstein & Paul, 1971) should always be employed. Nevertheless, the use of advertisements appears to be an extremely efficient method by which researchers can gain access to large numbers of clinically relevant phobics. Researchers may be concerned that public advertising will lead to numerous phone calls from individuals whose interests in treatment are really motivated by "other problems". Although one caller did take up the author's time talking about haunted houses, there were no other such difficulties from any of the respondents. Of course, clinical decisions must be made responsibly and highly phobic subjects need to be closely monitored. For example, placebo controls should be offered a viable treatment program at the end of any study and subjects who drop out should always have their reasons carefully clarified. However, these are small responsibilities to assume when one considers the increased clinical relevance of research employing highly fearful subjects. A pertinent question at this point is how researchers can be prompted to abandon their use of analogue subjects. Arguments concerning critical methodological problems associated with the use of mildly fearful subjects (Bernstein & Paul, 1971) have failed to slow the pace of these studies. Fortunately, since highly fearful subjects are readily available for study, behavioral journals are justified in adopting an editorial policy that specifically discourages publication of unnecessary analogue studies. This approach would certainly place control over important contingencies affecting researchers' behavior. Specifically, it is recommended that journals accept studies employing mildly fearful analogue subjects only when authors of these studies document that they first attempted to recruit phobics whose relevance to clinical questions is clear. Thus, researchers who cannot gain access to highly anxious phobics can still use typical analogue subjects for initial tests of their hypotheses. At the same time, uncritical use of analogue subjects would be effectively discouraged. This would place analogue studies in their proper perspective. After all, researchers are supposedly using mildly fearful analogue subjects for reasons of necessity rather than choice. That being the case,
NOTES AND COMMENTS
71
why report findings on subjects of questionable relevance when the phenomena of real interest are more readily accessible? REFERENCES BANDURA, A., BLANCHARD, E. B., & RITTER, B. J. The relative efficacy of desensitization and modeling therapeutic approaches for inducing behavioral, affective, and attitudinal changes. Journal of Personality and Social Psychology, 1969, 13, 173-199. BERNSTEIN, D. A., & PAUL, G, L. Some comments on therapy analogue research with small animal "Phobias". Journal of Behavior Therapy and Experimental Psychiatry, 1971, 2, 225-237. LANG, P. J., & LAZOVIK, A. D. Experimental desensitization of a phobia. Journal of Abnormal and Social Psychology, 1963, 66, 519-525. LANG, P. J., LAZOVIK, A. O., & REYNOLDS, O. J. Desensitization, suggestibility, and pseudotherapy. Journal of Abnormal Psychology, 1965, 70, 395-402. LANG, P. J., MELAMED, B. G., & HART, J. A psychophysiological analysis of fear modification using an automated desensitization procedure. Journal ofA bnormal Psychology, 1970, 76, 220-234. PAUL, G. L. Behavior modification research: Design and tactics. In C. M. Franks (Ed.) Behavior Therapy: Appraisal and Status. New York: McGraw-Hill, 1969, pp. 29-62. ROSEN, G. M. Therapy set: Its effects on subjects' involvement in systematic desensitization and treatment outcome. Journal of Abnormal Psychology, 1974, 83, 291-300.
(1975)
Is it Really Necessary to Use Mildly Phobic Analogue Subjects? GERALD M. ROSEN University of Oregon The current use of mildly phobic analogue subjects in desensitization research is largely unnecessary since highly fearful subjects are more easily recruited. An editorial policy aimed at discouraging unnecessary analogue studies is recommended.
During the past decade, behavioral journals have published an ever increasing number of analogue desensitization studies. These studies have been "analogues" in so far as they employed (a) treatment procedures and/or (b) mildly phobic subjects who were only "analogous" to the procedures and patients associated with "actual" clinic settings. Analogue procedures allow for control over specific method factors so that cause and effect relationships can be identified (Paul, 1969). In contrast to these methodological considerations, researchers study mildly fearful analogue subjects because access to highly anxious phobics is thought to be too restricted. Bernstein and Paul (1971) have detailed the many methodological pitfalls and problems associated with the use of "low fear" subjects. Putting these points aside, the present paper argues that the current flight to analogue subjects is unnecessary. Highly fearful subjects are often available and more easily recruited than mildly fearful undergraduates.
Recruiting Highly Fearful Subjects In Lang's early studies on systematic densensitization with snake phobics (Lang & Lazovik, 1963; Lang, Lazovik & Reynolds, 1965) highly fearful subjects were recruited from the top 1 or 2% of the available undergraduate population. Lang's time consuming screening process was unattractive to most researchers and totally unacceptable to pressured dissertation candidates. Accordingly, recent analogue studies Preparation of this paper was supported by Grant MH25657-01 from the National Institute of Mental Health, United States Public Health Service. Requests for reprints should be sent to the author, Department of Psychology, University of Oregon, Eugene, Oregon, 97403. 68 Copyright © 1975 by Academic Press, Inc. Printed in the United States. All rights of reproduction in any form reserved.
NOTES AND COMMENTS
69
have lowered their selection criteria and now draw from the top 10 to 30% of the undergraduate subject pool (Bernstein & Paul, 1971). An alternative to undergraduates and lowered selection criteria has been provided by Bandura, Blanchard, and Ritter (1969). T h e s e authors efficiently recruited substantial numbers of highly phobic subjects by simply placing an advertisement in a local newspaper. Recent research by this author further supports the use of newspaper announcements for subject recruitment. T h e local newspaper's reporter for campus news wrote an article which appeared for one day in conjunction with a small ad. 1 The article and advertisement explained that a study was being conducted to evaluate "treatment approaches to reduce people's fears of snakes." Readers were told that some fear was c o m m o n and that only people who were truly terrified of snakes should contact the local University's Psychology Clinic. During the next 10 days, over 100 individuals called for information about the study. Eighty-nine of the callers remained interested in participating although 14 were excluded on the basis of their initial self-reports. Eleven others reevaluated their interest in the study before subject selection was completed. O f the remaining 64 subjects, only nine had to be excluded from the final subject pool, four because of technical mistakes made during their pre-treatment assessments. All of the final subjects scored 19 or above on Lang's fear of snakes questionnaire (Lang, Melamed & Hart, 1971). On a behavior approach test, only nine of the subjects were willing to walk all the way up to the caged snake. T w e n t y - t h r e e subjects would not even allow the caged snake into their room despite the use of a moderately "high demand" instructional set. 2 In short, with only a single day of local advertising, 55 highly fearful subjects were successfully recruited. Contrast the success of the above with a typical selection program for the recruitment of undergraduate analogue phobics. In an earlier study (Rosen, 1974), 1744 fear o f snakes questionnaires were distributed to undergraduates at the University of Wisconsin! An attempt was then made to contact the 159 females who scored 15 or above on this questionnaire. Individuals w h o w e r e successfully contacted and interested in participating were then scheduled for a pre-treatment behavior approach test. Subjects who were willing to touch a caged snake during this test were eliminated from the study, resulting in a final N = 45. O f these 45 subjects, 32 were willing to at least walk all the way up to the caged snake, look at the snake, and touch the outside of the glass cage. In 1 Copies of the advertisement and article are available from the author upon request. 2 Copies of the instructions used during the behavioral assessments are available from the author upon request. Data demonstrating the effects of "demand characteristics" on pretreatment approach behavior have been reported by Bernstein (e.g., Behavior Therapy, 1974, 5, 183-192).
70
NOTES AND COMMENTS
short, the analogue subjects recruited by these laborious and inefficient methods were only mildly fearful and few in number.
Are Analogue Subjects Necessary? Considering the relative efficacy of different methods for recruiting phobic individuals, researchers' current reliance on mildly fearful analogue subjects is both unnecessary and unjustified. In many cases, highly fearful subjects can be easily recruited through the planned use of newspaper advertisements. Naturally, the use of advertisements does not automatically guarantee that only highly fearful subjects will respond and "high" demand screening assessments (Bernstein & Paul, 1971) should always be employed. Nevertheless, the use of advertisements appears to be an extremely efficient method by which researchers can gain access to large numbers of clinically relevant phobics. Researchers may be concerned that public advertising will lead to numerous phone calls from individuals whose interests in treatment are really motivated by "other problems". Although one caller did take up the author's time talking about haunted houses, there were no other such difficulties from any of the respondents. Of course, clinical decisions must be made responsibly and highly phobic subjects need to be closely monitored. For example, placebo controls should be offered a viable treatment program at the end of any study and subjects who drop out should always have their reasons carefully clarified. However, these are small responsibilities to assume when one considers the increased clinical relevance of research employing highly fearful subjects. A pertinent question at this point is how researchers can be prompted to abandon their use of analogue subjects. Arguments concerning critical methodological problems associated with the use of mildly fearful subjects (Bernstein & Paul, 1971) have failed to slow the pace of these studies. Fortunately, since highly fearful subjects are readily available for study, behavioral journals are justified in adopting an editorial policy that specifically discourages publication of unnecessary analogue studies. This approach would certainly place control over important contingencies affecting researchers' behavior. Specifically, it is recommended that journals accept studies employing mildly fearful analogue subjects only when authors of these studies document that they first attempted to recruit phobics whose relevance to clinical questions is clear. Thus, researchers who cannot gain access to highly anxious phobics can still use typical analogue subjects for initial tests of their hypotheses. At the same time, uncritical use of analogue subjects would be effectively discouraged. This would place analogue studies in their proper perspective. After all, researchers are supposedly using mildly fearful analogue subjects for reasons of necessity rather than choice. That being the case,
NOTES AND COMMENTS
71
why report findings on subjects of questionable relevance when the phenomena of real interest are more readily accessible? REFERENCES BANDURA, A., BLANCHARD, E. B., & RITTER, B. J. The relative efficacy of desensitization and modeling therapeutic approaches for inducing behavioral, affective, and attitudinal changes. Journal of Personality and Social Psychology, 1969, 13, 173-199. BERNSTEIN, D. A., & PAUL, G, L. Some comments on therapy analogue research with small animal "Phobias". Journal of Behavior Therapy and Experimental Psychiatry, 1971, 2, 225-237. LANG, P. J., & LAZOVIK, A. D. Experimental desensitization of a phobia. Journal of Abnormal and Social Psychology, 1963, 66, 519-525. LANG, P. J., LAZOVIK, A. O., & REYNOLDS, O. J. Desensitization, suggestibility, and pseudotherapy. Journal of Abnormal Psychology, 1965, 70, 395-402. LANG, P. J., MELAMED, B. G., & HART, J. A psychophysiological analysis of fear modification using an automated desensitization procedure. Journal ofA bnormal Psychology, 1970, 76, 220-234. PAUL, G. L. Behavior modification research: Design and tactics. In C. M. Franks (Ed.) Behavior Therapy: Appraisal and Status. New York: McGraw-Hill, 1969, pp. 29-62. ROSEN, G. M. Therapy set: Its effects on subjects' involvement in systematic desensitization and treatment outcome. Journal of Abnormal Psychology, 1974, 83, 291-300.