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The role of imagination in semantic desensitization
BEHAVIORTHERAPY (1972) 3, 223-231
The Role of Imagination in Semantic Desensitization 1 HAMID HEKMAT Universily o~ Wisconsin Thirty phobic subjects matched on the basis of their subjective fear of spiders and behavioral avoidance were randomly assigned to one of the following treatments: Group I received semantic desensitization by a semantic visualization method in which subjects were asked to imagine positive evaluative responses to the word "spider"; Group II received semantic desensitization by verbal emission whereby subjects verbalized aloud the same positive evaluative responses to the word "spider"; Group III, the control group, received a pseudosensitization on a buffer task. The semantically desensitized subjects showed a significant reduction in the negative value of the word "spider"; significant decrement in their subjective fears of spiders, and a significant behavioral approach toward a huntsman spider. Verbal emission and senlantic visualization procedures unequivocally produced positive results in the modification of phobic behavior. The implications of semantic desensitization methods for the practice of behavior therapy were discussed. Among behavior therapy procedures, counterconditioning principles have b e e n successfidly implemented to extinguish a countless n u m b e r of incapacitating phobias (Bandura, 1969; Kanfer & Phillips, 1970; Wolpe, 1958, 1961, 1969; Wolpe & Lazarus, 1966; Yates, 1970). The principle of counterconditioning essentially consists of sequencing an incompatible response contingent upon some threatening anxiety provoking cues. T h e competing events in this process must be sufficiently strong to neutralize an array of emotional arousing stimuli. The most widely used and prominent implementation of counterconditioning principles appears in systematic desensitization where muscular relaxation is induced in the patient in an effort to counteract anxiety (Wolpe, 1958, 1961, 1969; W o l p e & Lazarus, 1966). Active muscular relaxation training has b e e n recently shown to reduce substantially subjective tension, distress and physiological arousal (Paul, 1969). In practice, phobic patients are guided to imagine a hierarchy of 1The writer is indebted to Dan Vanian and members of the psychology staff at Pasadena City College for their assistance and cooperation in this experiment. Requests for reprints may be submitted to Hamid Hekmat, Department of Psychology, University of Wisconsin, Stevens Point, WI 54481. 223 © 1972 by Academic Press, Inc.
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anxiety generating scenes which are crucially tailored to the individual's frame of experience, in each instance efforts are made by the therapist to neutralize progressively the anxiety engendered by emotionarousing cues. In addition to muscular relaxation, appetizing foods (Jones, 1924), positive imagery (Lazarus & Abramovitz, 1962), pharmacological agents (Brady, 1966, 1969; Friedman, 1968; Lader & Mathews, 1970), and hypnotic suggestion (Paul, 1969) have also been used successfully to counteract fear responses. The antagonistic responses which have been used in the past have been predominantly nonverbal in nature. The heuristic potential of semantic eounterconditioning principles have not yet been systematically explored. Phobic behaviors can be learned through a semantic conditioning process whereby a previously neutral sign (word "spider," "snake," etc.) by being associated with other highly unpleasant words (i.e., poison, dangerous, disgusting, etc.) would come to elicit negative emotional responses leading to avoidance behavior. Staats and his associates have already demonstrated that when nonsense syllables and national names are paired with words elieiting negative attitudinal responses (ugly, failure, vomit, etc. ), they would acquire the negative value of these words and thus would be rated as unpleasant (Staats & Staats, 1957, 1958). Further studies have indicated that the intensi W of conditioned emotional responses were related to the intensity of negative attitudes and that the semantic rating of the phobic object could be used as an index of emotional behavior (Staats, Staats, & Crawford, 1962; Maltzman, Raskin, Gould, & Johnson, 1965; Hekmat & Vanian, 1971). It is proposed that phobic subjects have at hand a repertoire of words depicting positive evaluative experiences (vacation, gift, joy, ere.) that can be effectively utilized in a programmed therapeutic intervention timed at counteracting anxiety. What will happen if these symbols of positive connotation were made to occur in the presence of anxietyprovoking cues? Can they alter the anxiety induced by threatening situations? In an attempt to explore the above questions, two basic techniques of semantie desensitization were developed by the author and then subjected to empirical verification. These techniques, labeled as semantie desensitization, are based upon eounterconditioning of meaning principles. This consists basically of a therapist's presentation of a series of crucially seleeted words which have a meaning antagonistic to anxiety. It is expected that high evaluative responses engendered by pleasant eonnotating words would sueeessfully modify the phobie behavior of many individuals. In an attempt to implement semantie desensitization in a laboratory
SEMANTIC DESENSITIZATION
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m o d i f i c a t i o n of p h o b i c b e h a v i o r , t w o b a s i c t e c h n i q u e s w e r e c o n s i d e r e d : s e m a n t i c v i s u a l i z a t i o n a n d v e r b a l emission. S e m a n t i c v i s u a l i z a t i o n is a c o v e r t s e m a n t i c d e s e n s i t i z a t i o n t e c h n i q u e in w h i c h i n d i v i d u a l s a r e a s k e d to c o n j u r e u p a series of c o n t r o l l e d visual i m a g e s in r e s p o n s e to p h o b i c signs (i.e., the w o r d " s p i d e r " ) . I n t h e v e r b a l emission m e t h o d , on t h e o t h e r h a n d , c o u n t e r c o n d i t i o n i n g of m e a n i n g is a c h i e v e d b y asking t h e i n d i v i d u a l to e v o k e o v e r t l y a series of e v a l u a t i v e r e s p o n s e s a l o u d a n d c o n t i n g e n t u p o n t h e t h e r a p i s t ' s p r e s e n t a t i o n of t h e p h o b i c sign. T h e d e t a i l s of t h e c o u n t e r c o n d i t i o n i n g p r o c e d u r e s are d e s c r i b e d in t h e Proc e d u r e s s e c t i o n of this p a p e r . C a n s e m a n t i c v i s u a l i z a t i o n a n d v e r b a l emission m e t h o d s b e u t i l i z e d in a p r o g r a m m e d i n t e r v e n t i o n a i m e d at s u c c e s s f u l l y d i m i n i s h i n g p h o b i c b e h a v i o r ? I f so, w h i c h m e t h o d is m o r e efficacious in s e m a n t i c a l l y desensitizing fear? METHOD
Subiects Two hundred and five subjects attending the introductory psychology classes at Pasadena City College were administered the Fear Survey Schedule (FSS III, Wolpe & Lang, 1964 ) and semantic differential scales. Only subjects responding with "much" or "very much" to fear of spiders on the Fear Survey Schedule were selected. These subjects had no prior participation in any behavior modification experiment. Sixty-two subjects selected hy the above criterion were given a subsequent behavior avoidance test. Twenty-seven subjects were rejected for failing to display sufficient avoidance behavior in the presence of a huntsman spider (Heteropoda venatoria), three failed to show for desensitization sessions and two were randomly eliminated to reduce the size of group to 30 subjects. This group consisted of 21 females and 9 males ranging in age from 17 to 39 with a mean age of 19.9 years.
Measures Osgood's semantic differential scales were administered during the initial selection phase of the experiment. On the semantic differential scales, subjects were requested to rate several randomly presented words, such as "rats," "snakes," "spiders," "crawling insects," "homosexuals," "father," "mother," "nude men," and "being alone" on pleasant-unpleasant, strong-weak, and active-passive bipolars. Only the evaluative dimension measuring the intensity of word meaning on the pleasantunpleasant bipolar of the semantic differential was scored. The behavior avoidance test was similar to that used in previous desensitization studies with animal phobic subjects (Lang, Lazowik & Reynolds, 1965; Krapfl & Nawas, 1969). The test was designed to measure the intensity of an individual's response to a fear object. It consisted of a check list of a graded series for steps ranging from standing outside the testing room to approaching the spider, putting a hand in the cage, and finally contact with the spider. Subjects were instructed to stop at any point if they felt too anxious to attempt the next step. The test was conducted in a 9 × 16 foot room containing a table at the end corner of the room where the glass spider cage was located. Each subject was given individual measures in terms of proximity to the spider.
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HEK~IAT
Procedures
Subjects were compared on the basis of their performance on the hehaviora] avoidance test and assigned randomly to one of the following treatments: semantic desensitization by semantic visualization (Group I), semantic desensitization by verbal emission (Group 1I), and the control group (Groin9 III). Semantic desensitization via semantic visualization. Sul jects were requested to evoke a positive evaluative imaginatory response to the stimulus word "spider." This counterconditioning of meaning is based upon the modification of Staats and Staats' (1957) conditioning of meaning techniques. The word "spider" was paired with 18 words having high factor loadings on positive evaluative dimensions of the semantic differential. The response words employed here are identical to those reported by Staats and Staats" (1957) list. Subjects were given the following instrnctions: I am studying the effects of imagination on emotit, ml transfer. I will present pairs of words together. Each time, I woul& ~ike you to imagine the second word as vividly and clearly as you can to follow the first one. For example, I would say room-dark. I will stay silent for 15 seconds during which I would like you to imagine darkness when I say the word room. Remember, that it is important to imagine the second word as rapidly as you can. I will not repeat these instructions again as the experiment progresses further. If there are any questions about the task, I will be happy to answer them now. The experimenter responded to questions raiseJ by clarifying the task. The stimulus word was always the word "spider" given by the experimenter. The response consisted of the imagination of pleasant connotating words (vacation, gift, etc.). Semantic desensitization via verbal emission. The procedures involved in verhal emission method were similar to that of the semantic visualization group, except the subjects were requested to omit a positive evaluative verbal response to the stimulus word "spider." Briefly, subjects were instructed that the purpose of the experiment was to study the effect of loud verbalization in enmtional transfer. The experimenter presented the pairs of words and requested the subjects to say aloud the positiveevahmtive word (gift, vacation, etc.) innnediately after the stimulus word (spider) was presented. The verbal emission employed here to countercondition phobic behavior is similar to the conditioning of meaning procedures described by Staats and Staats (1957). For both experimental groups the word "spider" was randomly paired with 18 pleasant words, each occurring six times, making a total pairing of 108 trials. Control group. Subjects in the control group were instructed that the study aimed to discover the effects of loud verbalization on emotional transfer. The control-group subjects then received a pseudodesensitization buffer task itl which the word "apple" was paired 108 times with the same evaluative meaning words as those employed in the experimental groups. It should be noted that a verbal emission method was used with the control group in an effort to alter the meaning of the word "apple." Behavioral avoidance test, Fear Survey, and semantic differential scales were readministered immediately after the completion of the conditioning sessions. RESULTS
J
Table 1 summarizes the data. A description of the,:r statistical treatment follows.
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227
TABLE 1 Means and Standard Deviations of the Various Assessment Measures in the Three Groups Before and After Treatment •.,
Predesensitization scores
Postdesensitization scores
Measure"
N
fi5
SD
N
)IT
SD
SI)-E Group I b SD-E Group II SD-E Group III FSS Group I c FSS Group II FSS Group III BAT Group I ~ BAT Group 1I BAT Group III
10 10 10 10 10 ~'10 l0 l0 10
6.80 6.90 6.60 4.70 4.60 4.50 13.79 13.39 13.60
0.40 0.30 0.49 0.64 0.49 0.50 1.60 1.68 1.28
10 10 10 10 10 10 10 l0 10
4.60 3.80 6.70 2.70 2.90 4.10 0.45 0.12 13.11
1.01 1.24 0.46 0.90 0.70 0.70 0.62 0.51 1.79
SD-E Semahtic Differential-evaluative, FSS Fear Survey Schedule, BAT Behavior Avoidance Test. b The pleasant pole scored 1, the unpleasant 7. c The maximum phobia score is 5 which indicates "very much" and minimum is 1 which indicates "no fear." The scores range from 0 (actual contact with spider) to 15 (refusal to enter the room). a
Modification o[ Semantic Differential Ratings I n order to find w h e t h e r a significant alteration in m e a n i n g took place as a result of semantic desensitization treatment, p r e - p o s t d i f f e r e n c e scores w e r e o b t a i n e d for the semantic visualization, verbal emission, and control g r o u p on the semantic differential ratings. H o m o g e n e i t y of variance assumption was tested b y means of Hartley's test (Myers, 1966). Results indicate that the assumption of h o m o g e n e i t y a m o n g groups entering the analysis was not tenable ( F ( 3 / 9 ) = 14.11, p < .01). Since the variance of groups entering the analysis was heterogeneous, Kruskel-Wallis' o n e - w a y analysis of variance b y ranks was c o m p u t e d (Siegel, 1956, p. 189). Results indicate that a significant difference exists a m o n g groups (H(2)= 21.67, p < .01). Individual post comparisons b e t w e e n two treatments following an overall H test were m a d e b y means of M a n n - W h i t n e y U tests (Siegel, 1956, pp. 111-116). Results indicate t h a t in the Semantic visualization g r o u p there was a significant difference from the control g r o u p ( U = 0, p < .01). Also, the verbal emission g r o u p s h o w e d significant d e c r e m e n t i n negative m e a n i n g as c o m p a r e d to the control g r o u p ( U = 0, p < .01). M a n n - W h i t n e y U test also indicate that the semantic visualization m e t h o d of desensitization did not differ significantly f r o m the verbal emission m e t h o d in altering the m e a n i n g of the p h o b i a ( U = 27.5, p > .1).
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Fear Survey Ratings Pre-postdifference scores were computed for each group on the spider item of the Fear Survey Schedule. Hartley's test indicated that the variance of different scores on Fear Survey Schedule were quite homogeneous (F(3/9)max. = 1.48, p > .1). Further analysis of variance on pre-post difference scores indicated that significant differences exist among the treatment groups (F(2/27) = 12.55, p < .01). Postcomparison among treatment means was done by means of Newman-Keul's method (Winer, 1962, p. 82). The results indicate that the experimental groups differed significantly from the control group (p < .01). However, the semantic visualization method of desensitization did not differ significantly from the verbal emission method (p > .1) in subjective alteration of fear.
Behavior Avoidance Test Pre-post difference scores were calculated for treatment groups and the homogeneity of variance was checked. Hartley's test indicated that the assumption of homogeneity of group entering the analysis of variance was tenable (F(3/9)max. = 1.76, p > .1). One-way analysis of variance on behavior avoidance difference scores indicated that treatment groups differed significantly from each other (F(2/27)= 226.93, p < .01), Further, Newman-Keul's postcomparison among treatment means yielded that the experimental groups differed significantly from the control group (p < .01). However, the semantic visualization group did not differ to any significant degree from the verbal emission group ( p > .1). DISCUSSION To alleviate the chagrin of some behavior therapists who do not find anxiety decrement by systematic desensitization, Wolpe (1969, p. 139) attributes their basic failure to three main sources: 1. Difficulties of relaxation 2. Use of misleading or irrelevant hierarchies 3. The inadequacies of patient's imagination The ability to conjure up reasonably vivid images is considered an essential and almost universal ingredient for effective use of systematic desensitization. However, studies linking visual imagery with desensitization outcome are scarcely reported. The results of this study suggest that, although behavior modifica-
SEMANTIC DESENSITIZATION
229
tion occurs significantly via imagining of positive evaluative responses to a negatively connotating phobic sign (i.e., spider), imagination p e r se is not a genuinely important factor in desensitization therapies. Behavior modification occurred in this study regardless of whether semantic visualization or verbal emission method were used. Thus, loud verbalization of positive evaluative responses to phobic sign can practically accomplish the same purpose as imagining positive consequences to a sign. Both methods unequivocally appear to produce results when the modification of phobic behavior is concerned. It is suggested that verbal emission methods can be of special value to behavior therapists working with phobic patients who are unable to conjure up auditory or visual images. In implementing these techniques in the practice of behavior therapy, the therapists can procure from the patients a list of highly positive rated relevant words, present the phobic scenes and request their patient to verbalize aloud the semantic antagonistic responses. Using these procedures, significant reduction in subjective fear, significant approach to phobic object and significant reduction in the negative connotation of the phobic sign are expected to occur. It is speculated that verbalized or imagined signs of negative connotation (i.e., death, cancer, poison) can likewise produce negative evaluative responses that interfere with persistent approach behavior seen in many forms of compulsive acts. The latter needs to be explored empirically and clinically with patients showing a wide variety of compulsive behaviors (i.e., chronic smoking, nail biting, etc.). It is suggested that phobias can be produced by a higher order conditioning process whereby a previously neutral sign (the word "spider") acquires the aversive properties of other symbols with negative connotation (i.e., poison, dangerous, etc.). This conditioning of meaning can be amplified further by symbolic self reinforcement procedures which strengthen avoidance behavior toward the fear object. This interpretation is especially pertinent in a majority of cases in which phobic behavior occurs in the absence of any known eliciting events. Many individuals demonstrating substantial fear of animals do not report specific instances where they have been bitten, injured, or harmed by the phobic animal but nevertheless persists in displaying avid avoidance behavior toward them (Bandura, 1968). The peripheral classical conditioning model cannot adequately explain the development of fear in such instances without incorporating a semantic intermediate stage. In a large majority of phobias, the phobic individuals would rate the object of their fear and its verbal symbolic representation (i.e., the word snake or spider) as significantly intense in negative meaning. When
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signs depicting phobic objects are judged to be so negatively evaluated, a higher-order classical conditioning of meaning seems to be a reasonably important and valid interpretation to account for the symbolic acquisition of fear. Staats has recently extended his integrated learning principle to explain many facets of current behavior therapy procedures (Staats, 1968, 1970). He has specifically suggested that behavior therapy can be viewed in a broader theoretical context in terms of attitude modification toward stimuli. Phobic behavior within such context occurs when a stimulus inappropriately elicits persistent attitudinal response. For the spider phobics, then the "spider" inappropriately elicits a negative attitudinal response which provides a discriminative cue guiding avoidance instrumental behavior toward live spiders. Staats' (1968, 1970) principles governing the formation and modification of attitude-reinforcer-discrimination (ARD) system have strong implications for the theory and practice of behavior therapy. The present results provide additional support for Staats' social behavioristic theory. Examination of the pre--rating of the word "spider" on the semantic differential scales indicated that the phobics possess a strongly negative attitude toward the "spider." Also, our earlier research indicated that snake phobics displayed a significantly more negative attitude rating of the "snake" than nonphobics (Hekmat & Vanian, 1971), a finding which is consistent with Staats' theory. These intense negative attitudes produce discriminative cues guiding instrumental avoidance behavior toward the phobic object. When the negative values of these attitudinal responses are reduced by semantic counterconditioning procedures, instrumental approach behavior and modification of subjective fear will occur. Since phobias involve a semantic intermediate stage, semantic desensitization techniques offer heuristic potential as a new behavior therapy method for clinical application and research. REFERENCES A. A social learning interpretation of psychological dysfunctions. In P. London and D. Rosenhan (Eds.), Foundations of abnormal psychology. New York: Holt, Rinehart & Winston, 1968. Pp. 293-344. BANDURA, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969. Bm~DY, J. P. Brevital-relaxation treatment of frigidity. Behaviour Research and Therapy, 1966, 4, 71-77. BRADY, J. P. Brevital-aided systematic desensitization. In R. D. Rubin, H. Fensterheim, A. A. Lazarus and C. M. Franks (Eds.), Advances in behavior therapy. New York: Academic Press, 1971. Pp. 77-83.
BANDURA,
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FRIEDMAN, D. The treatment of impotence by brevital relaxation therapy. Behaviour Research and Therapy, 1968, 6, 257-261. HEKMAT, H., & VANXAN, D. Behavior modification through covert semantic desensitization. Journal of Counseling and Clinical Psychology, 1971, 36, 248-251. JoNEs, M. C. A laboratory study of fear. The case of Peter, Journal of Genetic Psychology, 1924, 31, 308. KANFEn, F. H., & PHmLIrS, J. S. Learning foundations of behavior therapy. New York: Wiley, 1970. KaAPFL, J. E., & NAwas, M. N. Client-therapy relationship factor in systematic desensitization. Journal of Consulting and Clinical Psychology, 1969, 33, 435439. LADEn, M. H., & MATHEWS, A. M. Comparison of methods of relaxation using physiological measures. Behaviour Research and Therapy, 1970, 8, 331-337. LANG, P., LAZOWIK, A. D., & REYNOLDS, D. J. Desensitization, suggestibility and pseudo-therapy. Journal of Abnormal and Social Psychology, 1965, 70, 395-402. MALTZMAN,I., RASKIN,P. C., GOULD, J,, & JOHNSON, O. Individual differences in the orienting reflex and semantic conditioning and generalization under different UCS intensities. Paper delivered at the Western Psychological Association meetings in Honolulu, 1965. MYERS, J. L. Fundamentals of experimental design. Boston: Allyn & Bacon, 1966. PAUL, G. L. Physiological effects of relaxation training and hypnotic suggestion. Journal of Abnormal Psychology, 1969, 74, 425-437. SIEGEL, S. Non-parametric statistics for the behavioral science~. New York: McGrawHill, 1956. STAATS, A. W. Social behaviorism and human motivation: Principles of the A-R-D System. In A. G. Greenwald, T. C. Brock and T. M. Ostrom (Eds.), Psychological foundations o/attitudes. New York: Academic Press, 1968. Pp. 33-65. STAIrs, A. W. Social behaviorism, human motivation and the conditioning therapies. In B. A. Maher (Ed.), Progress in experimental personality research, Vol. 5. New York: Academic Press, 1970. Pp. 1-32. STAATS, C. K., & STAATS, A. W. Meaning established by classical conditioning. Journal of Experimental Psychology, 1957, 54, 74-80. STAATS, A. W., & STAATS, C. K. Attitude established by classical conditioning. Journal of Abnormal and Social Psychology, 1958, 57, 37-40. STAATS, A. W., STAATS, C. K., & CRAWFOPd),H. L. First-order conditioning of meaning and the parallel conditioning of a GSR. Journal of Genetic Psychology, 1962, 67, 159-167. WINER, B. J. Statistical principles in experimental de.ign. New York: McGraw-Hill, 1962. WOLPE, J. Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press, 1958. WOLPE, J. The systematic desensitization treatment of neuroses. Journal of Nervous and Mental Disorders, 1961, 132, 189-203. WOLPE, J. The practice of behavior therapy. New York: Pergamon Press, 1969. WOLPE, J., & LANG, P. J. A fear survey schedule for use in behavior therapy. Behaviour Research and Therapy, 1964, 2, 27-30. WOLPE, J., & LAZARUS, A. A. Behavior therapy techniques. New York: Pergamon Press, 1966. YATES, A. J. Behavior therapy. New York: Wiley, 1970.
The Role of Imagination in Semantic Desensitization 1 HAMID HEKMAT Universily o~ Wisconsin Thirty phobic subjects matched on the basis of their subjective fear of spiders and behavioral avoidance were randomly assigned to one of the following treatments: Group I received semantic desensitization by a semantic visualization method in which subjects were asked to imagine positive evaluative responses to the word "spider"; Group II received semantic desensitization by verbal emission whereby subjects verbalized aloud the same positive evaluative responses to the word "spider"; Group III, the control group, received a pseudosensitization on a buffer task. The semantically desensitized subjects showed a significant reduction in the negative value of the word "spider"; significant decrement in their subjective fears of spiders, and a significant behavioral approach toward a huntsman spider. Verbal emission and senlantic visualization procedures unequivocally produced positive results in the modification of phobic behavior. The implications of semantic desensitization methods for the practice of behavior therapy were discussed. Among behavior therapy procedures, counterconditioning principles have b e e n successfidly implemented to extinguish a countless n u m b e r of incapacitating phobias (Bandura, 1969; Kanfer & Phillips, 1970; Wolpe, 1958, 1961, 1969; Wolpe & Lazarus, 1966; Yates, 1970). The principle of counterconditioning essentially consists of sequencing an incompatible response contingent upon some threatening anxiety provoking cues. T h e competing events in this process must be sufficiently strong to neutralize an array of emotional arousing stimuli. The most widely used and prominent implementation of counterconditioning principles appears in systematic desensitization where muscular relaxation is induced in the patient in an effort to counteract anxiety (Wolpe, 1958, 1961, 1969; W o l p e & Lazarus, 1966). Active muscular relaxation training has b e e n recently shown to reduce substantially subjective tension, distress and physiological arousal (Paul, 1969). In practice, phobic patients are guided to imagine a hierarchy of 1The writer is indebted to Dan Vanian and members of the psychology staff at Pasadena City College for their assistance and cooperation in this experiment. Requests for reprints may be submitted to Hamid Hekmat, Department of Psychology, University of Wisconsin, Stevens Point, WI 54481. 223 © 1972 by Academic Press, Inc.
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HAMm HEK3IAT
anxiety generating scenes which are crucially tailored to the individual's frame of experience, in each instance efforts are made by the therapist to neutralize progressively the anxiety engendered by emotionarousing cues. In addition to muscular relaxation, appetizing foods (Jones, 1924), positive imagery (Lazarus & Abramovitz, 1962), pharmacological agents (Brady, 1966, 1969; Friedman, 1968; Lader & Mathews, 1970), and hypnotic suggestion (Paul, 1969) have also been used successfully to counteract fear responses. The antagonistic responses which have been used in the past have been predominantly nonverbal in nature. The heuristic potential of semantic eounterconditioning principles have not yet been systematically explored. Phobic behaviors can be learned through a semantic conditioning process whereby a previously neutral sign (word "spider," "snake," etc.) by being associated with other highly unpleasant words (i.e., poison, dangerous, disgusting, etc.) would come to elicit negative emotional responses leading to avoidance behavior. Staats and his associates have already demonstrated that when nonsense syllables and national names are paired with words elieiting negative attitudinal responses (ugly, failure, vomit, etc. ), they would acquire the negative value of these words and thus would be rated as unpleasant (Staats & Staats, 1957, 1958). Further studies have indicated that the intensi W of conditioned emotional responses were related to the intensity of negative attitudes and that the semantic rating of the phobic object could be used as an index of emotional behavior (Staats, Staats, & Crawford, 1962; Maltzman, Raskin, Gould, & Johnson, 1965; Hekmat & Vanian, 1971). It is proposed that phobic subjects have at hand a repertoire of words depicting positive evaluative experiences (vacation, gift, joy, ere.) that can be effectively utilized in a programmed therapeutic intervention timed at counteracting anxiety. What will happen if these symbols of positive connotation were made to occur in the presence of anxietyprovoking cues? Can they alter the anxiety induced by threatening situations? In an attempt to explore the above questions, two basic techniques of semantie desensitization were developed by the author and then subjected to empirical verification. These techniques, labeled as semantie desensitization, are based upon eounterconditioning of meaning principles. This consists basically of a therapist's presentation of a series of crucially seleeted words which have a meaning antagonistic to anxiety. It is expected that high evaluative responses engendered by pleasant eonnotating words would sueeessfully modify the phobie behavior of many individuals. In an attempt to implement semantie desensitization in a laboratory
SEMANTIC DESENSITIZATION
225
m o d i f i c a t i o n of p h o b i c b e h a v i o r , t w o b a s i c t e c h n i q u e s w e r e c o n s i d e r e d : s e m a n t i c v i s u a l i z a t i o n a n d v e r b a l emission. S e m a n t i c v i s u a l i z a t i o n is a c o v e r t s e m a n t i c d e s e n s i t i z a t i o n t e c h n i q u e in w h i c h i n d i v i d u a l s a r e a s k e d to c o n j u r e u p a series of c o n t r o l l e d visual i m a g e s in r e s p o n s e to p h o b i c signs (i.e., the w o r d " s p i d e r " ) . I n t h e v e r b a l emission m e t h o d , on t h e o t h e r h a n d , c o u n t e r c o n d i t i o n i n g of m e a n i n g is a c h i e v e d b y asking t h e i n d i v i d u a l to e v o k e o v e r t l y a series of e v a l u a t i v e r e s p o n s e s a l o u d a n d c o n t i n g e n t u p o n t h e t h e r a p i s t ' s p r e s e n t a t i o n of t h e p h o b i c sign. T h e d e t a i l s of t h e c o u n t e r c o n d i t i o n i n g p r o c e d u r e s are d e s c r i b e d in t h e Proc e d u r e s s e c t i o n of this p a p e r . C a n s e m a n t i c v i s u a l i z a t i o n a n d v e r b a l emission m e t h o d s b e u t i l i z e d in a p r o g r a m m e d i n t e r v e n t i o n a i m e d at s u c c e s s f u l l y d i m i n i s h i n g p h o b i c b e h a v i o r ? I f so, w h i c h m e t h o d is m o r e efficacious in s e m a n t i c a l l y desensitizing fear? METHOD
Subiects Two hundred and five subjects attending the introductory psychology classes at Pasadena City College were administered the Fear Survey Schedule (FSS III, Wolpe & Lang, 1964 ) and semantic differential scales. Only subjects responding with "much" or "very much" to fear of spiders on the Fear Survey Schedule were selected. These subjects had no prior participation in any behavior modification experiment. Sixty-two subjects selected hy the above criterion were given a subsequent behavior avoidance test. Twenty-seven subjects were rejected for failing to display sufficient avoidance behavior in the presence of a huntsman spider (Heteropoda venatoria), three failed to show for desensitization sessions and two were randomly eliminated to reduce the size of group to 30 subjects. This group consisted of 21 females and 9 males ranging in age from 17 to 39 with a mean age of 19.9 years.
Measures Osgood's semantic differential scales were administered during the initial selection phase of the experiment. On the semantic differential scales, subjects were requested to rate several randomly presented words, such as "rats," "snakes," "spiders," "crawling insects," "homosexuals," "father," "mother," "nude men," and "being alone" on pleasant-unpleasant, strong-weak, and active-passive bipolars. Only the evaluative dimension measuring the intensity of word meaning on the pleasantunpleasant bipolar of the semantic differential was scored. The behavior avoidance test was similar to that used in previous desensitization studies with animal phobic subjects (Lang, Lazowik & Reynolds, 1965; Krapfl & Nawas, 1969). The test was designed to measure the intensity of an individual's response to a fear object. It consisted of a check list of a graded series for steps ranging from standing outside the testing room to approaching the spider, putting a hand in the cage, and finally contact with the spider. Subjects were instructed to stop at any point if they felt too anxious to attempt the next step. The test was conducted in a 9 × 16 foot room containing a table at the end corner of the room where the glass spider cage was located. Each subject was given individual measures in terms of proximity to the spider.
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HEK~IAT
Procedures
Subjects were compared on the basis of their performance on the hehaviora] avoidance test and assigned randomly to one of the following treatments: semantic desensitization by semantic visualization (Group I), semantic desensitization by verbal emission (Group 1I), and the control group (Groin9 III). Semantic desensitization via semantic visualization. Sul jects were requested to evoke a positive evaluative imaginatory response to the stimulus word "spider." This counterconditioning of meaning is based upon the modification of Staats and Staats' (1957) conditioning of meaning techniques. The word "spider" was paired with 18 words having high factor loadings on positive evaluative dimensions of the semantic differential. The response words employed here are identical to those reported by Staats and Staats" (1957) list. Subjects were given the following instrnctions: I am studying the effects of imagination on emotit, ml transfer. I will present pairs of words together. Each time, I woul& ~ike you to imagine the second word as vividly and clearly as you can to follow the first one. For example, I would say room-dark. I will stay silent for 15 seconds during which I would like you to imagine darkness when I say the word room. Remember, that it is important to imagine the second word as rapidly as you can. I will not repeat these instructions again as the experiment progresses further. If there are any questions about the task, I will be happy to answer them now. The experimenter responded to questions raiseJ by clarifying the task. The stimulus word was always the word "spider" given by the experimenter. The response consisted of the imagination of pleasant connotating words (vacation, gift, etc.). Semantic desensitization via verbal emission. The procedures involved in verhal emission method were similar to that of the semantic visualization group, except the subjects were requested to omit a positive evaluative verbal response to the stimulus word "spider." Briefly, subjects were instructed that the purpose of the experiment was to study the effect of loud verbalization in enmtional transfer. The experimenter presented the pairs of words and requested the subjects to say aloud the positiveevahmtive word (gift, vacation, etc.) innnediately after the stimulus word (spider) was presented. The verbal emission employed here to countercondition phobic behavior is similar to the conditioning of meaning procedures described by Staats and Staats (1957). For both experimental groups the word "spider" was randomly paired with 18 pleasant words, each occurring six times, making a total pairing of 108 trials. Control group. Subjects in the control group were instructed that the study aimed to discover the effects of loud verbalization on emotional transfer. The control-group subjects then received a pseudodesensitization buffer task itl which the word "apple" was paired 108 times with the same evaluative meaning words as those employed in the experimental groups. It should be noted that a verbal emission method was used with the control group in an effort to alter the meaning of the word "apple." Behavioral avoidance test, Fear Survey, and semantic differential scales were readministered immediately after the completion of the conditioning sessions. RESULTS
J
Table 1 summarizes the data. A description of the,:r statistical treatment follows.
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TABLE 1 Means and Standard Deviations of the Various Assessment Measures in the Three Groups Before and After Treatment •.,
Predesensitization scores
Postdesensitization scores
Measure"
N
fi5
SD
N
)IT
SD
SI)-E Group I b SD-E Group II SD-E Group III FSS Group I c FSS Group II FSS Group III BAT Group I ~ BAT Group 1I BAT Group III
10 10 10 10 10 ~'10 l0 l0 10
6.80 6.90 6.60 4.70 4.60 4.50 13.79 13.39 13.60
0.40 0.30 0.49 0.64 0.49 0.50 1.60 1.68 1.28
10 10 10 10 10 10 10 l0 10
4.60 3.80 6.70 2.70 2.90 4.10 0.45 0.12 13.11
1.01 1.24 0.46 0.90 0.70 0.70 0.62 0.51 1.79
SD-E Semahtic Differential-evaluative, FSS Fear Survey Schedule, BAT Behavior Avoidance Test. b The pleasant pole scored 1, the unpleasant 7. c The maximum phobia score is 5 which indicates "very much" and minimum is 1 which indicates "no fear." The scores range from 0 (actual contact with spider) to 15 (refusal to enter the room). a
Modification o[ Semantic Differential Ratings I n order to find w h e t h e r a significant alteration in m e a n i n g took place as a result of semantic desensitization treatment, p r e - p o s t d i f f e r e n c e scores w e r e o b t a i n e d for the semantic visualization, verbal emission, and control g r o u p on the semantic differential ratings. H o m o g e n e i t y of variance assumption was tested b y means of Hartley's test (Myers, 1966). Results indicate that the assumption of h o m o g e n e i t y a m o n g groups entering the analysis was not tenable ( F ( 3 / 9 ) = 14.11, p < .01). Since the variance of groups entering the analysis was heterogeneous, Kruskel-Wallis' o n e - w a y analysis of variance b y ranks was c o m p u t e d (Siegel, 1956, p. 189). Results indicate that a significant difference exists a m o n g groups (H(2)= 21.67, p < .01). Individual post comparisons b e t w e e n two treatments following an overall H test were m a d e b y means of M a n n - W h i t n e y U tests (Siegel, 1956, pp. 111-116). Results indicate t h a t in the Semantic visualization g r o u p there was a significant difference from the control g r o u p ( U = 0, p < .01). Also, the verbal emission g r o u p s h o w e d significant d e c r e m e n t i n negative m e a n i n g as c o m p a r e d to the control g r o u p ( U = 0, p < .01). M a n n - W h i t n e y U test also indicate that the semantic visualization m e t h o d of desensitization did not differ significantly f r o m the verbal emission m e t h o d in altering the m e a n i n g of the p h o b i a ( U = 27.5, p > .1).
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Fear Survey Ratings Pre-postdifference scores were computed for each group on the spider item of the Fear Survey Schedule. Hartley's test indicated that the variance of different scores on Fear Survey Schedule were quite homogeneous (F(3/9)max. = 1.48, p > .1). Further analysis of variance on pre-post difference scores indicated that significant differences exist among the treatment groups (F(2/27) = 12.55, p < .01). Postcomparison among treatment means was done by means of Newman-Keul's method (Winer, 1962, p. 82). The results indicate that the experimental groups differed significantly from the control group (p < .01). However, the semantic visualization method of desensitization did not differ significantly from the verbal emission method (p > .1) in subjective alteration of fear.
Behavior Avoidance Test Pre-post difference scores were calculated for treatment groups and the homogeneity of variance was checked. Hartley's test indicated that the assumption of homogeneity of group entering the analysis of variance was tenable (F(3/9)max. = 1.76, p > .1). One-way analysis of variance on behavior avoidance difference scores indicated that treatment groups differed significantly from each other (F(2/27)= 226.93, p < .01), Further, Newman-Keul's postcomparison among treatment means yielded that the experimental groups differed significantly from the control group (p < .01). However, the semantic visualization group did not differ to any significant degree from the verbal emission group ( p > .1). DISCUSSION To alleviate the chagrin of some behavior therapists who do not find anxiety decrement by systematic desensitization, Wolpe (1969, p. 139) attributes their basic failure to three main sources: 1. Difficulties of relaxation 2. Use of misleading or irrelevant hierarchies 3. The inadequacies of patient's imagination The ability to conjure up reasonably vivid images is considered an essential and almost universal ingredient for effective use of systematic desensitization. However, studies linking visual imagery with desensitization outcome are scarcely reported. The results of this study suggest that, although behavior modifica-
SEMANTIC DESENSITIZATION
229
tion occurs significantly via imagining of positive evaluative responses to a negatively connotating phobic sign (i.e., spider), imagination p e r se is not a genuinely important factor in desensitization therapies. Behavior modification occurred in this study regardless of whether semantic visualization or verbal emission method were used. Thus, loud verbalization of positive evaluative responses to phobic sign can practically accomplish the same purpose as imagining positive consequences to a sign. Both methods unequivocally appear to produce results when the modification of phobic behavior is concerned. It is suggested that verbal emission methods can be of special value to behavior therapists working with phobic patients who are unable to conjure up auditory or visual images. In implementing these techniques in the practice of behavior therapy, the therapists can procure from the patients a list of highly positive rated relevant words, present the phobic scenes and request their patient to verbalize aloud the semantic antagonistic responses. Using these procedures, significant reduction in subjective fear, significant approach to phobic object and significant reduction in the negative connotation of the phobic sign are expected to occur. It is speculated that verbalized or imagined signs of negative connotation (i.e., death, cancer, poison) can likewise produce negative evaluative responses that interfere with persistent approach behavior seen in many forms of compulsive acts. The latter needs to be explored empirically and clinically with patients showing a wide variety of compulsive behaviors (i.e., chronic smoking, nail biting, etc.). It is suggested that phobias can be produced by a higher order conditioning process whereby a previously neutral sign (the word "spider") acquires the aversive properties of other symbols with negative connotation (i.e., poison, dangerous, etc.). This conditioning of meaning can be amplified further by symbolic self reinforcement procedures which strengthen avoidance behavior toward the fear object. This interpretation is especially pertinent in a majority of cases in which phobic behavior occurs in the absence of any known eliciting events. Many individuals demonstrating substantial fear of animals do not report specific instances where they have been bitten, injured, or harmed by the phobic animal but nevertheless persists in displaying avid avoidance behavior toward them (Bandura, 1968). The peripheral classical conditioning model cannot adequately explain the development of fear in such instances without incorporating a semantic intermediate stage. In a large majority of phobias, the phobic individuals would rate the object of their fear and its verbal symbolic representation (i.e., the word snake or spider) as significantly intense in negative meaning. When
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signs depicting phobic objects are judged to be so negatively evaluated, a higher-order classical conditioning of meaning seems to be a reasonably important and valid interpretation to account for the symbolic acquisition of fear. Staats has recently extended his integrated learning principle to explain many facets of current behavior therapy procedures (Staats, 1968, 1970). He has specifically suggested that behavior therapy can be viewed in a broader theoretical context in terms of attitude modification toward stimuli. Phobic behavior within such context occurs when a stimulus inappropriately elicits persistent attitudinal response. For the spider phobics, then the "spider" inappropriately elicits a negative attitudinal response which provides a discriminative cue guiding avoidance instrumental behavior toward live spiders. Staats' (1968, 1970) principles governing the formation and modification of attitude-reinforcer-discrimination (ARD) system have strong implications for the theory and practice of behavior therapy. The present results provide additional support for Staats' social behavioristic theory. Examination of the pre--rating of the word "spider" on the semantic differential scales indicated that the phobics possess a strongly negative attitude toward the "spider." Also, our earlier research indicated that snake phobics displayed a significantly more negative attitude rating of the "snake" than nonphobics (Hekmat & Vanian, 1971), a finding which is consistent with Staats' theory. These intense negative attitudes produce discriminative cues guiding instrumental avoidance behavior toward the phobic object. When the negative values of these attitudinal responses are reduced by semantic counterconditioning procedures, instrumental approach behavior and modification of subjective fear will occur. Since phobias involve a semantic intermediate stage, semantic desensitization techniques offer heuristic potential as a new behavior therapy method for clinical application and research. REFERENCES A. A social learning interpretation of psychological dysfunctions. In P. London and D. Rosenhan (Eds.), Foundations of abnormal psychology. New York: Holt, Rinehart & Winston, 1968. Pp. 293-344. BANDURA, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969. Bm~DY, J. P. Brevital-relaxation treatment of frigidity. Behaviour Research and Therapy, 1966, 4, 71-77. BRADY, J. P. Brevital-aided systematic desensitization. In R. D. Rubin, H. Fensterheim, A. A. Lazarus and C. M. Franks (Eds.), Advances in behavior therapy. New York: Academic Press, 1971. Pp. 77-83.
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FRIEDMAN, D. The treatment of impotence by brevital relaxation therapy. Behaviour Research and Therapy, 1968, 6, 257-261. HEKMAT, H., & VANXAN, D. Behavior modification through covert semantic desensitization. Journal of Counseling and Clinical Psychology, 1971, 36, 248-251. JoNEs, M. C. A laboratory study of fear. The case of Peter, Journal of Genetic Psychology, 1924, 31, 308. KANFEn, F. H., & PHmLIrS, J. S. Learning foundations of behavior therapy. New York: Wiley, 1970. KaAPFL, J. E., & NAwas, M. N. Client-therapy relationship factor in systematic desensitization. Journal of Consulting and Clinical Psychology, 1969, 33, 435439. LADEn, M. H., & MATHEWS, A. M. Comparison of methods of relaxation using physiological measures. Behaviour Research and Therapy, 1970, 8, 331-337. LANG, P., LAZOWIK, A. D., & REYNOLDS, D. J. Desensitization, suggestibility and pseudo-therapy. Journal of Abnormal and Social Psychology, 1965, 70, 395-402. MALTZMAN,I., RASKIN,P. C., GOULD, J,, & JOHNSON, O. Individual differences in the orienting reflex and semantic conditioning and generalization under different UCS intensities. Paper delivered at the Western Psychological Association meetings in Honolulu, 1965. MYERS, J. L. Fundamentals of experimental design. Boston: Allyn & Bacon, 1966. PAUL, G. L. Physiological effects of relaxation training and hypnotic suggestion. Journal of Abnormal Psychology, 1969, 74, 425-437. SIEGEL, S. Non-parametric statistics for the behavioral science~. New York: McGrawHill, 1956. STAATS, A. W. Social behaviorism and human motivation: Principles of the A-R-D System. In A. G. Greenwald, T. C. Brock and T. M. Ostrom (Eds.), Psychological foundations o/attitudes. New York: Academic Press, 1968. Pp. 33-65. STAIrs, A. W. Social behaviorism, human motivation and the conditioning therapies. In B. A. Maher (Ed.), Progress in experimental personality research, Vol. 5. New York: Academic Press, 1970. Pp. 1-32. STAATS, C. K., & STAATS, A. W. Meaning established by classical conditioning. Journal of Experimental Psychology, 1957, 54, 74-80. STAATS, A. W., & STAATS, C. K. Attitude established by classical conditioning. Journal of Abnormal and Social Psychology, 1958, 57, 37-40. STAATS, A. W., STAATS, C. K., & CRAWFOPd),H. L. First-order conditioning of meaning and the parallel conditioning of a GSR. Journal of Genetic Psychology, 1962, 67, 159-167. WINER, B. J. Statistical principles in experimental de.ign. New York: McGraw-Hill, 1962. WOLPE, J. Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press, 1958. WOLPE, J. The systematic desensitization treatment of neuroses. Journal of Nervous and Mental Disorders, 1961, 132, 189-203. WOLPE, J. The practice of behavior therapy. New York: Pergamon Press, 1969. WOLPE, J., & LANG, P. J. A fear survey schedule for use in behavior therapy. Behaviour Research and Therapy, 1964, 2, 27-30. WOLPE, J., & LAZARUS, A. A. Behavior therapy techniques. New York: Pergamon Press, 1966. YATES, A. J. Behavior therapy. New York: Wiley, 1970.