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Treatment of phobias by a self-administered desensitization technique
J. Behav. Ther. & Exp. Psychiat. Vol. 4, pp. 397-399. Pergamon Press, 1973. Printed in Great Britain.
TREATMENT
OF PHOBIAS BY A SELF-ADMINISTERED DESENSITIZATION TECHNIQUE LARRY W. MORRIS Middle Tennessee State University and
CARROLL R. THOMAS* Multi-County Comprehensive Mental Health Center, Tullahoma, Tennessee Summary--Self-administered desensitization was applied to eight patients in their home environment. In 3-10 weeks, all subjects reported successful completion of each hierarchy. The Willoughby Personality Schedule and the S-P. Inventory of Anxiousness showed significant reductions in anxiety reactions. SELF-ADMINISTERED desensitization
was first reported to be clinically effective in overcoming one client's fear of public speaking with the help of a tape recorder (Migler and Wolpe, 1967). Direct self-administered desensitization was subsequently shown to be useful in dealing with a variety of "subclinical" phobias in college students (Kahn and Baker, 1968; Phillips, Johnson and Geyer, 1972). The purpose of the present study was to explore the effectiveness of this method for various clinical phobias.
METHOD
Subjects. The subjects voluntarily came to the mental health center because of incapacitating phobic reactions. They were four males and four females ranging from 21 to 50 yr of age and having from a third grade to a college level education. Table 1 presents the specific fears of each subject. Procedure. Following an interview with each subject aimed at obtaining data to justify the use of systematic desensitization, the therapist explained how phobias are learned and extinguished and described the method to be used
in detail. The subjects were then given a deep muscle relaxation tape similar to that used by Wolpe (1969, p. 124) and instructed to practice the relaxation technique twice daily for 1 week. Following that week, the subjects met with the experimenter for the purpose of constructing anxiety hierarchies. The experimenter made a list of reported fears, grouped them by common themes, and asked the subjects to make an anxiety hierarchy for the themes they wished to begin work on by numbering the lowest to the highest anxiety-evoking stimuli, writing the hierarchy in their own words. Next, the subjects were given instructions in the procedure of systematic desensitization. Beginning by relaxing as deeply as possible, they were to imagine each item on the memorized hierarchy in turn, separated by moments of concentrated relaxation; scenes producing anxiety were to be repeated until they could be visualized with tranquility. Subjects were instructed never to end a session with an unsuccessful trial. If unsuccessful after several trials on a particular item, they were to revise the hierarchy by inserting an additional item. After these instructions for self-administered desensitization
* This research was done in partial fulfilment of the requirements of the degree Master of Arts at Middle Tennessee State University. Requests for reprints should be sent to Carroll Thomas, Multi-County ComprehensiveMental Health Center, P.O. Box 299, Tullahoma, Tennessee 37388. 397
LARRY W. MORRIS and CARROLL R. THOMAS
398
TABt~ 1. ANXIETYSCORESFORALLSUBJECTS Measure
Willoughby
Hierarchies
Pre
Post
Subject A Automobiles Jealousy Death Insanity
68
29
Subject B Speaking Performing Flashbacks Insanity
55
Subject C Irritations Public Places
61
Subject D Insects
31
25
Subject E Death
85
74
Subject F Being Alone
77
67
Subject G Automobiles
66
Subject H People
48
S-R Inventory (Weekly) 1
2
3
4
5
6
7
8
9
54
36 53
35 32
34 28 56
30 29 57 44
34 35 50 38
32 30 47 40
31 30 40 34
29 32 38 36
53
51 47
46 42
32 38
36 37
37 37 68
37 36 60 61
35 35 57 60
32 32 53 47
45
39 40
37 40
29 33
57
50
39
48
39
33
66
22
52
28
49
38
44
51
60 34
were given, the subjects were given a form to keep a record of (a) the number of sessions completed each day, (b) time spent at each session, (c) self-evaluation, and (d) specific situations worked on. At the first session with the experimenter and again at the end of treatment, the subjects completed the Willoughby Personality Schedule (Willoughby, 1934), and items of the S-R Inventory of Anxiousness (Endler, Hunt and Rosenstein, 1962) were administered during weekly meetings with the experimenter (using the situations feared by the subject instead of those normally used with this questionnaire). It assesses three anxiety response modes--disruption and distress, autonomic reactions, and exhilaration--for each of the situations presented. It was hypothesized that scores on both of these instruments would decrease from preto post-treatment.
RESULTS A N D D I S C U S S I O N Over periods ranging from 3 to 10 weeks (see Table 1), each subject reported that he had successfully completed all of his hierarchies and that the treatment was effective. Five subjects received no further treatment after desensitization; the remaining three felt no need for further treatment of phobias but requested vocational or marital counseling. Statistically, difference t tests (presented in Table 2) were computed for (a) subjects' pre- and post-treatment scores on both the Willoughby and the S-R Inventory, and for (b) S-R Inventory subscale scores for each of the hierarchies (i.e. specific fears) utilized, without reference to individual subjects. Significant changes occurred between pre- and posttreatment on all indices of anxiety, using either subjects of hierarchies as the units for observation. The disruption mode of the SRI yielded the
PHOBIA TREATMENT BY A SELF-ADMINISTERED DESENSITIZATION TECHNIQUE TABLE2.
Willoughby SRI Disruption Autonomic Exhilaration P <0'05 " P <0.01 b p <0'001
399
MEAN ANXIETY SCORES
Pre
Hierarchies Post
t
52"88 20"87 18'00 13-33
34-73 13-53 10"27 10.93
7"94b 6-52b 5"70b 2"49c
greatest change o f the three response modes, indicating t h a t the m a i n p u r p o s e o f therapy, to enable the client to function in a m o r e a d a p t i v e m a n n e r , was accomplished. The significant decrease in W i l l o u g h b y scores indicates that, in a d d i t i o n to reduced anxiety concerning p h o b i c objects, subjects experienced a decrease in general anxiety level, i.e. the t r e a t m e n t effects generalized to o t h e r situations. In fact, fears which were n o t actually w o r k e d on in t h e r a p y were extinguished in at least two subjects. Use o f the r e l a x a t i o n t a p e was discontinued after 2-3 weeks for m o s t subjects. The subjects' success in the use o f the r e l a x a t i o n response was m o s t encouraging, a l t h o u g h some o f the subjects did occasionally r e p o r t p r o c e d u r a l p r o b -
Pre 61.38 52.93
Subjects Post 48.00 33"22
3.54a 5"24a
lems, especially with respect to hierarchy construction, calling for experimenter assistance. REFERENCES ENDLER N. S., HUNT J. and ROSENSTErNA. J. (1962) An S-R inventory of anxiousness, Psychol. Monogr. 76, 1-33. KAHN M. and BAKER B. (1968) Desensitization with minimal therapist contact, J. abnorm. PsychoL 73, 198-200. MIGLER B. and Wota'E J. (1967) Automated self-desensitization: A case report, Behav. Res. & Therapy 5, 133-135. PHILLIPSR. E., JOHNSONG. D. and GEYERA. (1972) Selfadministered systematic desensitization, Behav. Res. & Therapy 10, 93-96. WILLOUCHBYR. R. (1934) Norms for the Clark-Thurston inventory, J. abnorm. Soc. PsychoL 5, 91--97. WOLPE J. (1969) The Practice of Behavior Therapy, Pergamon Press, New York.
(First received 19 July 1973; in revisedform 11 September 1973)
TREATMENT
OF PHOBIAS BY A SELF-ADMINISTERED DESENSITIZATION TECHNIQUE LARRY W. MORRIS Middle Tennessee State University and
CARROLL R. THOMAS* Multi-County Comprehensive Mental Health Center, Tullahoma, Tennessee Summary--Self-administered desensitization was applied to eight patients in their home environment. In 3-10 weeks, all subjects reported successful completion of each hierarchy. The Willoughby Personality Schedule and the S-P. Inventory of Anxiousness showed significant reductions in anxiety reactions. SELF-ADMINISTERED desensitization
was first reported to be clinically effective in overcoming one client's fear of public speaking with the help of a tape recorder (Migler and Wolpe, 1967). Direct self-administered desensitization was subsequently shown to be useful in dealing with a variety of "subclinical" phobias in college students (Kahn and Baker, 1968; Phillips, Johnson and Geyer, 1972). The purpose of the present study was to explore the effectiveness of this method for various clinical phobias.
METHOD
Subjects. The subjects voluntarily came to the mental health center because of incapacitating phobic reactions. They were four males and four females ranging from 21 to 50 yr of age and having from a third grade to a college level education. Table 1 presents the specific fears of each subject. Procedure. Following an interview with each subject aimed at obtaining data to justify the use of systematic desensitization, the therapist explained how phobias are learned and extinguished and described the method to be used
in detail. The subjects were then given a deep muscle relaxation tape similar to that used by Wolpe (1969, p. 124) and instructed to practice the relaxation technique twice daily for 1 week. Following that week, the subjects met with the experimenter for the purpose of constructing anxiety hierarchies. The experimenter made a list of reported fears, grouped them by common themes, and asked the subjects to make an anxiety hierarchy for the themes they wished to begin work on by numbering the lowest to the highest anxiety-evoking stimuli, writing the hierarchy in their own words. Next, the subjects were given instructions in the procedure of systematic desensitization. Beginning by relaxing as deeply as possible, they were to imagine each item on the memorized hierarchy in turn, separated by moments of concentrated relaxation; scenes producing anxiety were to be repeated until they could be visualized with tranquility. Subjects were instructed never to end a session with an unsuccessful trial. If unsuccessful after several trials on a particular item, they were to revise the hierarchy by inserting an additional item. After these instructions for self-administered desensitization
* This research was done in partial fulfilment of the requirements of the degree Master of Arts at Middle Tennessee State University. Requests for reprints should be sent to Carroll Thomas, Multi-County ComprehensiveMental Health Center, P.O. Box 299, Tullahoma, Tennessee 37388. 397
LARRY W. MORRIS and CARROLL R. THOMAS
398
TABt~ 1. ANXIETYSCORESFORALLSUBJECTS Measure
Willoughby
Hierarchies
Pre
Post
Subject A Automobiles Jealousy Death Insanity
68
29
Subject B Speaking Performing Flashbacks Insanity
55
Subject C Irritations Public Places
61
Subject D Insects
31
25
Subject E Death
85
74
Subject F Being Alone
77
67
Subject G Automobiles
66
Subject H People
48
S-R Inventory (Weekly) 1
2
3
4
5
6
7
8
9
54
36 53
35 32
34 28 56
30 29 57 44
34 35 50 38
32 30 47 40
31 30 40 34
29 32 38 36
53
51 47
46 42
32 38
36 37
37 37 68
37 36 60 61
35 35 57 60
32 32 53 47
45
39 40
37 40
29 33
57
50
39
48
39
33
66
22
52
28
49
38
44
51
60 34
were given, the subjects were given a form to keep a record of (a) the number of sessions completed each day, (b) time spent at each session, (c) self-evaluation, and (d) specific situations worked on. At the first session with the experimenter and again at the end of treatment, the subjects completed the Willoughby Personality Schedule (Willoughby, 1934), and items of the S-R Inventory of Anxiousness (Endler, Hunt and Rosenstein, 1962) were administered during weekly meetings with the experimenter (using the situations feared by the subject instead of those normally used with this questionnaire). It assesses three anxiety response modes--disruption and distress, autonomic reactions, and exhilaration--for each of the situations presented. It was hypothesized that scores on both of these instruments would decrease from preto post-treatment.
RESULTS A N D D I S C U S S I O N Over periods ranging from 3 to 10 weeks (see Table 1), each subject reported that he had successfully completed all of his hierarchies and that the treatment was effective. Five subjects received no further treatment after desensitization; the remaining three felt no need for further treatment of phobias but requested vocational or marital counseling. Statistically, difference t tests (presented in Table 2) were computed for (a) subjects' pre- and post-treatment scores on both the Willoughby and the S-R Inventory, and for (b) S-R Inventory subscale scores for each of the hierarchies (i.e. specific fears) utilized, without reference to individual subjects. Significant changes occurred between pre- and posttreatment on all indices of anxiety, using either subjects of hierarchies as the units for observation. The disruption mode of the SRI yielded the
PHOBIA TREATMENT BY A SELF-ADMINISTERED DESENSITIZATION TECHNIQUE TABLE2.
Willoughby SRI Disruption Autonomic Exhilaration P <0'05 " P <0.01 b p <0'001
399
MEAN ANXIETY SCORES
Pre
Hierarchies Post
t
52"88 20"87 18'00 13-33
34-73 13-53 10"27 10.93
7"94b 6-52b 5"70b 2"49c
greatest change o f the three response modes, indicating t h a t the m a i n p u r p o s e o f therapy, to enable the client to function in a m o r e a d a p t i v e m a n n e r , was accomplished. The significant decrease in W i l l o u g h b y scores indicates that, in a d d i t i o n to reduced anxiety concerning p h o b i c objects, subjects experienced a decrease in general anxiety level, i.e. the t r e a t m e n t effects generalized to o t h e r situations. In fact, fears which were n o t actually w o r k e d on in t h e r a p y were extinguished in at least two subjects. Use o f the r e l a x a t i o n t a p e was discontinued after 2-3 weeks for m o s t subjects. The subjects' success in the use o f the r e l a x a t i o n response was m o s t encouraging, a l t h o u g h some o f the subjects did occasionally r e p o r t p r o c e d u r a l p r o b -
Pre 61.38 52.93
Subjects Post 48.00 33"22
3.54a 5"24a
lems, especially with respect to hierarchy construction, calling for experimenter assistance. REFERENCES ENDLER N. S., HUNT J. and ROSENSTErNA. J. (1962) An S-R inventory of anxiousness, Psychol. Monogr. 76, 1-33. KAHN M. and BAKER B. (1968) Desensitization with minimal therapist contact, J. abnorm. PsychoL 73, 198-200. MIGLER B. and Wota'E J. (1967) Automated self-desensitization: A case report, Behav. Res. & Therapy 5, 133-135. PHILLIPSR. E., JOHNSONG. D. and GEYERA. (1972) Selfadministered systematic desensitization, Behav. Res. & Therapy 10, 93-96. WILLOUCHBYR. R. (1934) Norms for the Clark-Thurston inventory, J. abnorm. Soc. PsychoL 5, 91--97. WOLPE J. (1969) The Practice of Behavior Therapy, Pergamon Press, New York.
(First received 19 July 1973; in revisedform 11 September 1973)