Imaginal Desensitization Research Articles

Comparison of Imaginal Desensitisation with other Behavioural Treatments of Pathological Gambling a Two- to Nine-Year Follow-up

Of 120 pathological gamblers randomly allocated to imaginal desensitisation (ID) or to other behavioural procedures (60 to each group, all procedures administered over one week) 63 subjects were contacted two to nine years later. Twenty-six of the 33 who received ID reported control or cessation of gambling compared with 16 of 30 who received other behavioural procedures. This difference was significant, indicating ID had a specific effect additional to that of the other behavioural procedures. It is suggested the other procedures could be regarded as placebos. As the response at a mean of over five years to one week of ID is comparable with that reported to more intensive therapies, after briefer follow-up, it is suggested ID is a cost-effective therapy for pathological gambling, and is worth considering when resources are limited.

A pathological or a compulsive gambler?

Development of the behavior completion model of compulsive behaviors and the imaginal desensitization therapy based on it is outlined. A case history is reported of a 65 year old woman who considered she was gambling out of control on slot machines and suffered from resultant guilt and depression. Following a week's treatment with imaginal desensitization she regained control. After an episode of heavy gambling following an unexpected inheritance she ceased slot-machine gambling entirely without further treatment. Her interest in her past activities increased and she developed additional ones. Her condition did not meet criteria for DSM-III-R diagnosis, yet she suffered from compulsive gambling which responded to treatment. Her response of controlled gambling appeared an acceptable outcome but proved unstable in her case. She was then able to cease gambling without therapy additional to the single mode employed.

Assessment and Treatment of Sex Offenders: The Prince of Wales Programme

The treatment programme for sex offenders at the Prince of Wales Hospital, Sydney, is described. Penile circumference assessment is not used as there is no evidence it provides a valid measure of individuals' paedophile or rapist tendencies. Sex offenders' self-reports remain the major source of information in their assessment. The development of the two major techniques used--imaginal desensitization and short-term medroxyprogesterone--is outlined. About 80% of subjects can be expected to show a good response to one or other of these therapies. Of those who do not, most respond to the alternative or aversive therapy. Adolescent offenders appear to require more intensive treatment. Results appear comparable with those of more intensive programmes in use overseas.

Behavior completion versus stimulus control in compulsive gambling. Implications for behavioral assessment.

Twenty subjects were randomly allocated to receive either imaginal relaxation (IR) or imaginal desensitization (ID) to reduce compulsive gambling. As predicted from a behavioral completion model, but not a stimulus control model, subjects' response to IR was comparable with that to ID. Also as predicted, response correlated with subjects' levels of tension following treatment. Detailed assessment of the situations in which subjects' gambling occurred was not necessary for effective IR therapy. The result established the treatment validity of the assessment used, this study being the first to compare the treatment validity of different behavioral assessments. The finding that manipulation of an organismic variable level of arousal is as effective as a manipulation of a stimulus variable in the treatment of compulsive gambling supports the trend among behavior therapists to place more emphasis on the importance of organismic variables as determinants of pathological behaviors.

Imaginal Desensitization: A cost-effective treatment in two shop-lifters and a binge-eater resistant to previous therapy

Case reports are given of three patients, two suffering from compulsive shop-lifting and one from binge-eating, who responded to a week's treatment with imaginal desensitization after having failed to respond to prolonged interpretative psychotherapy. Expectancy of improvement did not appear to play a major role in their response, but it appears impossible to disprove that expectancy determines the response to this or any form of psychotherapy. Whether or not imaginal desensitization acted specifically in the present study, in view of its cost-efficacy it is suggested it is worthy of trial in impulse disorders which have persisted despite treatment.

Systematic Desensitization and the Reduction of Anxiety

This article provides detailed information on systematic desensitization. The procedures of imaginal desensitization with individuals are described in detail, so that the reader can apply the most frequently used form of desensitization. Variants of group, in vivo, massed, and self-administered desensitization are briefly described to extend the reader's use of desensitization. Additionally, guidelines for the appropriate selection and use of desensitization are outlined, and a sampling of research findings with a diversity of anxiety and stress disorders is presented.

The Behavior Therapy of Erectile Dysfunction: The Nigeraian Experience

Abstract A case report is presented of erectile dysfunction. Triggered by the wife's hostility and maintained by the subsequent fear of failure, it responded well to imaginal systematic desensitization and a form of in vivo assertiveness training which aought to directly modify the stimulus rahter than the patient's response. Follow-up after twenty four months showed that the improvement has been maintained.

Detail and Elaboration in Phobic Imagery

It is hypothesized that phobics have cognitive representations of phobic stimuli that are relatively lacking in detail and elaboration, and that this is reflected in imagery relating to them. In a study of verbal imagery for coping with a spider, the accounts of phobics were found to be briefer and to include fewer stages. In a study of stimulus imagery, vividness was separated into its two components of (a) awareness of the image and (b) degree of detail, following a similar distinction proposed by Klinger. Awareness, but not detail, was found to be greater in phobics, though the hypothesis of less detail in phobics was not confirmed. It is suggested that a lack of elaboration of phobic imagery is likely to impede anxiety reduction in imaginal desensitization, and to reduce the effectiveness of imaginal representations of coping behaviour.

The relative efficacy of imaginal and in vivo desensitization in the treatment of agoraphobia

Claims have often been made that in vivo procedures are generally superior to imaginal approaches in the clinical management of anxiety and avoidance behavior. Such claims seem unwarranted in that the relevant clinical research appears only to have involved either flooding or rapid exposure techniques. The aim of the present study was specifically to examine the relative efficacy of imaginal and in vivo desensitization in the clinical management of debilitating phobia. Six agoraphobic women participated in the study which employed a multiple-baseline single-subject methodology. Severity of phobia was repeatedly assessed on measures of avoidance behavior and subjective distress, and subjects self-monitored pulse rate. Significant reductions in phobic behavior were observed during both imaginal and in vivo desensitization, but neither treatment was found to be more effective than the other. Moreover, the same pattern of results was observed for both treatment and generalization settings. As such, the results do not support previous suggestions that in vivo exposure is necessarily superior to imaginal desensitization in the treatment of agoraphobia. Encouraging follow-up results provided some confirmation of previous findings indicating the effectiveness of self-management procedures in the long-term control of agoraphobia.

Differential treatment of phobias: Use of imipramine for panic attacks

The core disorder in agoraphobia and mixed phobia typically is the “spontaneous” panic attack, which may be due to various psychologic and physiologic triggering mechanisms. The panics tend to lead to anticipatory anxiety and, consequently, avoidance behavior. Tricyclics and MAO inhibitors suppress the spontaneous panics. Once this is accomplished, psychotherapeutic intervention helps patients overcome their phobias. Supportive psychotherapy, imaginal desensitization and in vivo exposure appear to be equally effective. Phobics who do not experience spontaneous panics are unaffected by these drugs but improve with psychotherapeutic techniques.

Progress in the treatment of female sexual dysfunction

Over a decade of research since the publication of Human Sexual Inadequacy by Masters and Johnson has confirmed the effectiveness of psychological treatment for sexual problems, but has not advanced our understanding of aetiology very much. It is generally assumed that anxiety blocks normal function in sexual disorders such as impotence or frigidity, although hormonal changes have also been suggested. Evidence for either proposition is lacking. Our own attempts to understand mechanisms have included the use of a dismantling strategy to investigate the effective components of psychological treatment, and latterly the role of exogenous androgens. In our first study, brief treatment modelled on that of Masters and Johnson proved superior to another version of graded practice in sexual contact which lacked the counselling component. Similarly, the fuller version had more effect than did imaginal desensitization, suggesting that sexual dysfunctions cannot be treated like phobic anxiety. A second study focused on women complaining of little sexual interest or enjoyment. The use of a minor tranquillizer was compared with that of androgen (testoral) in the hope that different treatments would be shown to be best for different types of disorder. Unexpectedly, the androgen proved best overall while another variable, monthly vs weekly sessions, did not produce any differences in effect. In the most recent study, a further 48 women were given androgens or placebo, and were seen weekly or monthly for four months by either one or two therapists. There were few significant differences, the most consistent being greater subjective improvement by the women being seen at weekly intervals. The failure to find a positive hormone effect in comparison with placebo raises the possibility that the anxiolytic used earlier may have been counter-productive. If so, it seems unlikely that either excessive anxiety or simple androgen deficiency is an adequate aetiological explanation for female sexual dysfunction.

Desensitization for a Severe Phobia of a Fourteen-Year Old Male

After an intense panic attack at school this 14-year-old male became virtually housebound and did not attend school for five months prior to therapy. Treatment, consisting of self-monitoring, relaxation, thought stopping imaginal desensitization, and vivo exposure, ended after 10 weakly sessions when the boy returned to school. At 18 months follow up, school records showed nearly perfect attendance and improved grades to a B+ from a pretherapy C average. MMPI changes from pretherapy to 12 months post-therapy andan interview at 12 months follow-up showed additional improvements in overall personality adjustment and social behavior. Results illustrate hypotheses about choice of treatment methods proposed in a recent review of densensitization with children.

An inexpensive automated desensitization procedure for clinical application

A fully automated imaginal desensitization procedure which has been used successfully for five years in a clinical behaviour therapy practice is described. The procedure is discussed in terms of its high degree of clinical flexibility, low cost and simplicity of operation. Two case histories exemplify its use in the treatment of both simple and complex anxiety related problems.

The contribution of relaxation to symbolic modeling in the modification of dental fear

Studies of symbolic modeling suggest that it is a technique which is at least as effective and more efficient (faster) than imaginal desensitization in the treatment of fears (Bandura el al., 1969; Woody and Schaible, 1969). Bandura et al. (1969) assessed the contributions of relaxation to the procedure and found less subjective anxiety and greater positive attitude change with relaxation but no significant differences in oven behavior nor in generalized anxiety reduction. In this study the ‘symbolic modeling only’ subjects received their treatment after they and the other subjects had received the original post-testing assessment. The present experiment was an attempt to assess the contributions of deep muscle relaxation to symbolic modeling without such confounding and with a more nearly clinical population. Dental fear represents a ‘near clinical’ phobia which satisfies Bernstein and Paul's (1971) criteria for analogue desensitization research. That is. dental phobics exhibit a strong, costly and distressing avoidance response which increases in strength as a function of exposure despite high demand.

Self-report of anxiety in imaginal desensitization.

Self-report of anxiety in imaginal desensitization.

Gone with the wind: Role-reversed desensitization for a wind phobic client

A wind phobia was eliminated by a series of behavioral interventions. After the application of imaginal and in-vivo desensitization techniques, the therapist changed roles with the client so that the client presented scenes and devised strategies for lessening anxiety. A21/2 yr follow-up revealed no anxiety reaction to moderate winds.

Guided behavior rehearsal

Guided behavior rehearsal is a method for training individuals with a general lack of interpersonal skills. Central to the program is the peer model (a non-professional trained guide) who has facility in the area in which the patient has the most difficulty. The guide models appropriate behavior of the patient in the relevant troublesome social situations. The entire program centers on the desensitization paradigm, utilizing in vivo desensitization and imaginal desensitization, together with modeling, positive reinforcement, behavior rehearsal and assertive training. Office sessions with the therapist are interspersed among those with the model.

Treatment of a spider phobia by in vivo and imaginal desensitization

The use of in vivo and imaginal desensitization procedures in the treatment of a spider phobia is described. A diversity of in vivo programs, following a thematic hierarchy paradigm, are discussed in detail to encourage more frequent attention to and utilization of easily arranged, controlled exposures.

The control of spontaneous recovery of anxiety in imaginal desensitization

One of the practical difficulties encountered in imaginal desensitization is that an item that has been completely desensitized in one session can show some spontaneous recovery of anxiety by the next (Agras, 1965; Rachman, 1966). No doubt the extent to which this occurs is largely related to the subject's phobic experiences between sessions. But it is also probably affected by the way desensitization is carried out. For example the amount of anxiety decrement that survives spontaneous recovery is greater if 30 rather than 5-sec item presentations are used. In contrast it does not seem to be affected by interstimulus inverval length (Watts, 1973). it also seems possible that the subject's arousal level during desensitization may affect the amount of spontaneous recovery. Teasdale (1971) found that relaxation produced more spontaneous recovery in auditory habituation, and the same may apply in desensitization. It is obviously of considerable importance to understand fully the factors that control such spontaneous recovery. The present research reveals another relevant procedural variable. The starting point was the previous finding (Watts, 1971) that item presentation lengths is important in this connection. One possible explanation of this is that longer presentations provide greater opportunity for stimulus learning or familiarization of some kind. The extent to which desensitization is accompanied by such familiarization may influence how much spontaneous recovery of anxiety occurs subsequently. A parallel can be found in the effects of stimulus differentiation on verbal learning (Saltz, 1971). In Saltz's revision of stimulus differentiation theory, a well differentiated stimulus is less likely to attract an irrelevant response that will interfere with the correct one after learning. In the same way a well differentiated desensitization item may be less likely to re-attract anxiety after the treatment session. One way of investigating this hypothesis is to employ a procedural variable that directly affects the opportunity for stimulus differentiation in desensitization. This can probably be done through the way an item is presented. If it fully described each time the subject has to imagine it, stimulus differentiation should be greater than if he is merely told to imagine ‘the same’ items again. Spontaneous recovery of anxiety should be reduced as a consequence. Watts (1971) also found that longer item presentations resulted in faster desensitization of ‘high’ items. This may also be due to better stimulus learning, though the rationale for this is less clear. The effects of item re-description were therefore examined both on the speed at which high items desensitized and on the amount of anxiety reduction that survived spontaneous recovery. It seemed possible that the benefit of item redescription might be greater with longer presentations. To examine this and also to replicate the original findings, stimulus length was used as a second independent variable. Different values (45 and 15 sec) were used from those used previously (30 and 5 sec). The two independent variables were combined in a (2 × 2) factorial design and the resulting conditions rotated across desensitization sessions in a series of five individual-centred experiments.

Determinants of expectation in imaginal desensitization.

Determinants of expectation in imaginal desensitization.