Systematic Desensitization Procedure Research Articles

Effect of systematic desensitization training on acceptable noise levels in adults with normal hearing sensitivity.

Context:The willingness of a person to accept noise while listening to speech can be measured using the acceptable noise level (ANL) test. Individuals with poor ANL are unlikely to become successful hearing aid users. Hence, it is important to enhance the individual’s ability to accept noise levels. The current study was an attempt to investigate whether systematic desensitization training can improve the ANL in individuals having high ANL.Aims:To investigate the effect of systematic desensitization training on ANLs in individuals with normal hearing sensitivity.Settings and Design:Observational study design.Materials and Methods:Thirty-eight normally hearing adults within the age range of 18–25 years participated in the study. Initially, baseline ANL was measured for all participants. Based on the baseline ANL, participants were categorized into three groups; low ANL, mid ANL, and high ANL. The participants with high ANL were trained using systematic desensitization procedure whereas, individuals with low and mid ANL did not undergo any training and served as the comparison groups. After the training period, ANL was measured again for all the participants.Statistical Analysis Used:Repeated measures of analysis of variance with follow up paired "t" test.Results:Analysis revealed a significant main effect of systematic desensitization training on ANL. There was a significant improvement in ANL in participants with high ANL. However, there was no significant difference in ANL between baseline and follow-up session in individuals with low and mid ANL.Conclusions:Systematic desensitization training can facilitate ANL, thereby enhancing the individual’s ability to accept the noise levels. This enhanced ANL can facilitate better hearing aid fitting and acceptance.

CBT for a Person With Schizophrenia: Systematic Desensitization for Phobias Led to Positive Symptom Improvement

Affective symptoms are often present and under-treated in schizophrenia. This case study reports the effect of treatment of a specific phobia and associated avoidance on the psychotic symptoms of a patient with medication resistant schizophrenia. The treatment of the specific phobia and agoraphobia followed a traditional systematic desensitization procedure. The successful treatment of the phobias led to improvements in psychotic symptoms. Previously, the client had only a limited response to a number of antipsychotic medications including clozapine but responded well to a traditional systematic desensitization program that produced positive consequences for the psychotic symptomatology. The clinical and theoretical aspects of this case are discussed.

Can contextual therapies save clinical behavior analysis?

Behavior therapy has become separated from its philosophical roots in radical behaviorism. In many respects, operant techniques have gradually been substituted first by cognitive-behavioral and later by interventions. The main reason for the diminishing influence of behavior analysis in the area of clinical psychology is that radical behaviorists have not paid close attention to the importance of verbal processes in psychotherapy. Through new developments in basic behavior analysis, specifically in the areas of rule-governed behavior and stimulus equivalence, contemporary clinical behavior analysts have begun to re-conceptualize behavioral interventions. They no longer assume that private events need not be taken into account as there is ample evidence that verbally constructed events introduce additional variables that interact with, and often alter, the effects of contingencies. This thinking has led to the development of new contextual psychotherapies. Research is needed to demonstrate whether these behavioral interventions present alternatives to empirically validated non-behavioral treatments. The contributions of the successful therapist to clinical outcomes also need to be clarified. ********** During the early 1980's, I was a doctoral student in clinical psychology at the University of North Carolina at Greensboro. From the beginning I was drawn to a group of graduate students and faculty with a decidedly behavioral bent, including Steve Hayes, Rick Shull, and the late Aaron Brownstein. Our group thrived on conceptual debates and we particularly wrestled with the implications of Skinner's philosophical position for our clinical work. However, despite creative case formulations and penetrating conceptual analyses, those of us who worked in the clinical trenches often felt a sense of disillusionment with behavior analysis because its methods were not as useful with adult outpatients as our behavior modification textbooks would have us believe. Operant techniques had proved most successful in relatively closed behavioral systems with institutionalized clients and children. They were far less effective with adult outpatients who possessed sophisticated verbal repertoires and came to us from complex environments to whom we had no access. Although we were well trained in a range of empirically supported behavioral techniques such as self-monitoring, skills training, systematic desensitization, and exposure-based procedures, they appeared of limited value. These techniques worked reasonably well with circumscribed complaints, especially anxiety related ones such as phobias and obsessive-compulsive behaviors. But they were much less effective for clients who presented with long-standing, diffuse maladjustments characterized by emotional lability, low self-esteem, chronic relationship problems, and other self-destructive behaviors. For some of these clients it was difficult even to specify target behaviors; other clients were plainly uncooperative with operant procedures or they complied and did not improve; and still others improved but relapsed soon after treatment was completed. I should note that negative outcomes were not indicative of incompetent student therapists or deficient clinical training in Greensboro; rather, treatment failures in behavior therapy are a well-established fact (see Mays & Franks, 1985). Behavior Therapy with a Cognitive Twist Many of us who faithfully applied operant principles in our clinical work struggled with an increasing sense of frustration and disillusionment because our field seemed to stagnate. At the same time, in behavior therapy at large a cognitive revolution was in full progress. A new breed of behavior therapists adopted a constructivist philosophy, advocating that maladaptive behavior was not caused by the external contingencies but by a dysfunctional belief system through which clients filter and interpret the events of their lives (e. …

Decreasing Dental Resistance Among Individuals with Severe and Profound Mental Retardation

A significant number of individuals with mental retardation/developmental disabilities (MR/DD) are fearful of dental care resulting in a lack of cooperation or avoidance of dental treatment. Sedation and physical restraint are often used to help illicit cooperation among individuals with MR/DD. The following study examined the effect of a systematic desensitization procedure adapted to address the needs of individuals with severe and profound mental retardation. Participation levels of 35 individuals receiving dental desensitization were compared to a group of 28 individuals that had not received any intervention. Results indicated those receiving desensitization showed greater improvement in toleration of dental procedures than did those in the comparison group. Implications for future treatment avenues and investigations are discussed.

Cognitive-Behavioral and Systematic Desensitization Procedures in Reducing Stress and Anger in Caregivers for the Disabled

Twenty-six highly stressed family and community caregivers for people with a disability completed scales designed to assess perceived stress, state anger, and trait anger. They were randomly divided into three groups. Subjects in one group underwent stress-reduction training in a self-instructional procedure, subjects in the second group underwent stress-reduction training in systematic desensitization, and subjects in the third group were placed in a wait-list condition. Results showed that state anger and trait anger were correlated with perceived stress at pretreatment, and state anger was correlated with perceived stress at posttreatment and follow-up. Subjects in both the self-instructional and systematic desensitization groups showed a reduction in perceived stress. Subjects in the self-instructional training group also showed a decrease in trait anger. The wait-list group showed no significant change in perceived stress and anger.

Imagery, improvisation, and immunity

The use of music and mental imagery as therapeutic modalities has received much attention in the last two decades. Mechanisms explaining both techniques can be found within the language of cognitivebehaviorism. For example, music has been effectively demonstrated as a conditioned stimulus for both sympathetic and parasympathetic autonomic activity (Goldstein, 1980; Kibler & Rider, 1983; Slaughter, 1956; Spingte, 1988). Mental imagery, defined as perceptual activation in the absence of actual stimuli (Achterberg & Lawlis, 1980), has been extensively employed in mediating anxiety within systematic desensitization procedures (Wolpe, 1969) and in attenuating pain perception through cognitive strategies (Levine, Gordon, & Fields, 1978; Meichenbaum, 1977; Rider, 1985). The burgeoning discipline of psychoneuroimmunology has had an immense impact on the prolific amount of research on the relationship between stress and immunity (Glaser, Kiecolt-Glaser, Speicher, & Holliday, 1985; Kiecolt-GIaser, Stephens, Lipetz, Speicher, & Glaser, 1985; Locke, Kraus, Lesserman, Hurst, Heisel, & Williams, 1984; Pennebaker & O’Heeron, 1984). Although the utilization of cognitive-behavioral procedures employing imagery and music to affect immunological measures can currently be found in the clinical arena, research on these particular variables is lacking. Techniques related to imagery, such as hypnosis (Black, Humphrey, & Niven, 1963; Hall, 1982-1983)andbiofeedback(Peavey, Lawlis, & Goven, 1985) have been found to positively affect measures of immune functioning. Relaxation procedures, typically employing some imagery and/or music, have also been reported to elicit improved immune functioning in geriatrics (KiecoltGlaser, Glaser, Williger, Stout, Messick, Sheppard, Ricker, Romisher, Briner, Bonnell, & Donnerberg, 1985), improved clinical functioning in medical patients (Luthe, 1969) and cancer patients (Simonton, Mathews-Simonton, & Creighton, 1978), and reduced levels of adrenal corticosteroids in high-stress individuals (Rider, Floyd, & Kirkpatrick, 1985). A central question related to imagery is whether images merely facilitate relaxation, which in turn enhances immunological functioning, or whether specific imagery directed at biological mechanisms has more localized effects on the production, circulation, and activation of immune products. Initial research has been somewhat promising although not altogether conclusive. Features of biological imagery, such as “vividness” and perceived “effectiveness” of one’s immune system, have been found to be highly predictive of survival outcome of cancer patients (Achterberg & Lawlis, 1984). Several studies have been conducted on lymphocytes and neutrophils, the two most prolific subpopulations of white blood cells. White blood cells, or leukocytes, comprise the major portion of the immune system in protecting the body against disease. Neutrophil pooling and adherence has been shown to be affected by 6-7 weeks of cell-specific imaging (Smith, Schneider, Minning, & Whitcher, 1983). In another study, T-cell and natural killer cell counts have been significantly affected following one week of imagery procedures, although no long-term effects accrued (Crawford, 1985). Lymphocyte and neutrophil counts have been differentially affected by six weeks of ape-listening to specific imagery ins~uctions and

Research in clinical process and outcome methodology: Psychophysiology, systematic desensitization and dental fear

Eleven dental phobics were treated with a modified systematic desensitization procedure which included EMG biofeedback and videotaped scene presentations. During treatment, multiple psychophysiological recordings as well as subjective and psychometric assessments of mood were made. Intraindividual correlations between process variables were, to a large extent, idiosyncratic. Variance in treatment outcome could be accounted for by change-over treatment sessions of psychometrically assessed mood ( R 2 = .76) alone or in combination with change-over treatment sessions of minimum heart rate ( R 2 = .84). The process variable correlation patterns indicate a need for much more multivariate methodological research.

Treatment by systematic desensitization of a recurring nightmare of a real life trauma

A modified systematic desensitization procedure was employed in the treatment of a Vietnam war veteran with a recurring nightmare of a gruesome mine explosion. The dream consisted of a vivid recreation of the traumatic events as they actually occured. After six sessions of desensitization with an additional self-control procedure, the dream ceased to occur and anxiety about sleeping diminished commensurately. Results were maintained at a seven month follow-up.

Desensitization without hierarchical presentation and concomitant relaxation

The consequences of eliminating both the procedures of training in deep muscle relaxation and hierarchical presentation of aversive imagery counterposed with muscle relaxation, were investigated in the experimental group desensitization of examination anxiety experienced by tertiary level students. It was found that the experimental condition of random presentation of aversive imaginal stimuli counterposed with a passage of time during which no specific activities were scheduled, resulted in a significant reduction of examination anxiety equal to that achieved by a standardized systematic desensitization (SD) procedure. Furthermore, this reduction of anxiety achieved by the experimental condition was maintained at an average four-week follow-up conducted at the completion of examinations. The extent to which these findings contradict current rationales of process underlying the efficacy of SD was discussed. An alternative rationale which accommodates the diversity of findings in the literature relating to SD and which also applies to other desensitization techniques, such as flooding and implosion, was proposed.

A laboratory comparison of systematic desensitization, flooding, and punishment procedures in the extinction of the human avoidance response

A button press avoidance response was conditioned in four groups of subjects using a photographic slide of a rat as CS and shock as UCS. Extinction was attempted by laboratory analogues of systematic desensitization (S.D.) and implosive therapy (Flooding) in two of the groups, by response contingent punishment (Punishment) in another group and by normal extinction (Extinction) in the fourth group. Both trials to extinction criterion, and Tear or anxiety felt by the subjects were measured. More subjects extinguished in the S.D. and Punishment groups than in the Flooding and Extinction groups and when the stringent extinction criterion in the S.D., condition was allowed for these two groups also required fewer trials to extinguish. The Punishment and Flooding groups experienced more fear during extinction than the S.D. and Extinction groups. Clinical evidence suggesting the efficacy of implosive therapy, when considered in the light of the present inferiority of Flooding to S.D., is thought to be due to the action of some variables extraneous to the learning theory basis of implosion. It is concluded that the application of the learning theory principles of S.D. provide the most effective extinction of avoidance and fear responses.

Effectiveness of structured psychodrama and systematic desensitization in reducing test anxiety.

Thirty-six students with examination anxiety volunteered to take part in a study of the effectiveness of two kinds of treatment, the structured psychodrama method and the systematic desensitization procedure, in reducing test anxiety. They were randomly assigned to one of three groups: structured psychodrama, systematic desensitization, and a no-treatment control. All the subjects were tested before and after the treatments on two tests, the Suinn Test Anxiety Behavior Scale (STABS), which measures test anxiety, and the Neuroticism scale of the Eysenck Personality Inventory (EPI-N scale), which measures level of neurotic behavior. The results showed that subjects in both treatment groups significantly reduced their test-anxiety scores compared with the controls. This was also congruent with gains as tested in vivo. A comparison between the two treatments, however, showed no significant differences. Also, there were no statistical differences among the three groups on the measure of neuroticism either before or after the treatments. It is concluded that the structured psychodrama method is as effective a mode of counseling as systematic desensization in treating test anxiety.

Imaging vividness and the outcome of in vivo and imagined scene desensitization.

This study reexamined the role of imaging vividness in desensitizati on success. Scores on the Betts Questionnaire on Mental Imagery were used to divide 48 snake-phobic subjects into high, medium, and low vivid groups, who were assigned to imagined scene or in vivo desensitization treatments. Imaging vividness was assessed at scheduled points during therapy. Significant decreases in behavioral and self-reported fear were observed after both treatments, though in vivo desensitization produced significantly greater fear reduction. Intherapy imaging vividness scores were significantly correlated with therapeutic success and were superior to pretherapy ratings as predictors of outcome. Imagination of fear-relevant scenes is central to most systematic desensitization procedures. However, previous investigators have failed to find a positive relation between imaging vividness and desensitization success. To examine this apparent paradox, we refined the method of previous studies and conducted the following experiment. Forty-eight snake phobics were pretested to establish initial fear level. A behavioral avoidance test, self-ratings of fear during this test, a questionnaire on attitudes toward snakes were used to assess fear of snakes, and the Fear Survey Schedule (Wolpe & Lang, 1964) was used to measure general fearfulness. Subjects were then separated into high, medium, and low imaging ability groups on the basis of scores on the Betts Questionnaire on imagery vividness, and were assigned to one of two standardized, individually administered desensitization procedures: imagined scene (conventional) or in vivo desensitization. Subjects in in vivo treatment were asked to enact, rather than imagine, each hierarchy scene. Imaging vividness during therapy was assessed by subject self-ratings at 19 scheduled points. Posttesting was scheduled between 1 and 3 days after completion of the treatment, and the behavioral and self-report measures were repeated. Analyses of variance of Treatment X Pretherapy Imaging Vividness Condition indicated no Requests for reprints and for an extended report of this study should be sent to John M. Dyckman, who is now at the Psychiatry Clinic, Kaiser Medical Center, 975 Sereno Drive, Vallejo, California 94590.

A comparison between group systematic desensitization and cue-controlled relaxation in the treatment of test anxiety

Thirty-one subjects were assigned to one of three experimental conditions: cuecontrolled relaxation, systematic desensitization, or no-treatment control. Self-report anxiety and academic performance data were collected before and after the treatment program. Both cue-controlled and systematic desensitization procedures produced significant reductions in reported anxiety on the two dependent variables directly related to test anxiety. No significant difference was found between experimental conditions on the measure of academic performance. In addition, no significant difference was observed between the cue-controlled and systematic desensitization procedures on any of the dependent variables.

Videotaped desensitization of frigidity

The effects of a new systematic desensitization procedure were evaluated in a case of sexual frigidity. Videotaped cassettes of heterosexual behavior were arranged in a hierarchy and shown to a 24-yr-old female by her husband who acted as therapist. Following seven sessions of this, significant improvement in the couple's heterosexual behavior was reported. Therapeutic gains were maintained at a 9-month follow-up.

Covert Reinforcement and Self-Control Procedures in Systematic Desensitization of Gagging Behavior

A case of chronic gagging associated with numerous topographically dissimilar CSs was successfully treated in 11 sessions of behavioral therapy. A flexible, multifaceted approach was applied utilizing systematic desensitization, covert reinforcement, and self-control procedures.

The Effects of Choice in Systematic Desensitization

It was hypothesized that implicit choice in a traditional systematic desensitization procedure produces dissonance, the reduction of which is partially responsible for anxiety reduction. To test this, 24 female snake-phobic 5s were divided into 3 treatments, which varied in the degree of perceived choice in progressing through the hierarchy. Desensitization with Choice decreased fear as measured by self-report (n.s.) and a behavioral test more than Traditional Desensitization, which in turn decreased fear more than Forced Desensitization. The principle of reciprocal inhibition could not account for the results, while both dissonance theory and attribution theory could.

Operant conditioning procedures with systematic desensitization in a hyperkinetic asthmatic boy

Panic during asthma attacks interfered with medical treatment of an asthmatic boy. His hyperkinesis and youth (6 yr) prevented the use of ordinary systematic desensitization procedures in treating his panic, therefore an operant conditioning procedure was used. First, it was used to shape relaxed sitting. Then the boy was able to earn tokens by remaining relaxed while the therapist described to him his having progressively worsening asthma. After working through descriptions ranging from mild asthma to death from status asthmaticus, the nurses and physicians attending the boy reported no further difficulties in treating his asthma. Moreover, the hyperkinesis also showed considerable improvement in the first few months following therapy.

Group desensitization of test anxiety in elementary school.

Summary Fifth and sixth grade students (N = 87) were divided into High Test Anxious and Low Test Anxious groups on the basis of galvanic skin responses (GSR). Ss identified as High Anxious responded positively to group systematic desensitization procedures, exhibiting significantly (p < .05) lower autonomic indices of test anxiety and significantly (p < .001) improved criterion test scores. Low Anxious Ss exposed to the systematic desensitization program demonstrated no significant change in criterion test scores.

Psychophysiological responses during analogue systematic desensitization and non-relaxation control procedures

This investigation tested the hypotheses than an analogue systematic desensitization procedure (SD) would be both more effective and more efficient than a comparable non-relaxation control procedure (NRC) with respect to subjective report, behavioral and psychophysiological variables. Phobic subjects responded to slides depicting a feared aversive stimulus. The SD procedure resulted in significantly less reported fear, fewer trials to a criterion level of decrease in subjective fear, and significantly greater decreases in ANS baseline measures. However, measures of behavioral avoidance and measures of decrease in psychophysiological responsivity to the aversive stimuli revealed significant changes within both SD and NRC groups, and no significant differences between the groups, whether or not the groups were equated for number of stimulus presentations. The results, indicating equivalent efficacy and efficiency for the SD and NRC procedures, suggested a limited role for relaxation in systematic desensitization. An extinction or habituation hypothesis was supported at the expense of a counterconditioning hypothesis.

A comparison of reciprocal inhibition and operant conditioning in the systematic desensitization of a fear of snakes

There is considerable evidence for the effectiveness of Wolpe's technique for the alleviation of fear by systematic desensitization with relaxation; however, the basic learning principles involved continue to be questioned. Wolpe (1958) argues that counterconditioning by reciprocal inhibition is the principal process wherein aversive stimuli are paired with the relaxation response rather than the noxious response of anxiety. An alternate theoretical approach to this process considers that integral to the systematic desensitization procedure is the relationship between the therapist (E) and his client (S). In the first treatment phase, E teaches S to relax and be relatively tension (anxiety) free. The contiguity relaxation response of the S to the presence of E can have the effect of creating a positively reinforcing situation. In the next stage, E encourages and generally uses his value as a positively reinforcing stimulus to have S relax in the presence of increasingly anxiety-provoking stimuli. Each step along the way should increase E's power as a source of social reinforcement. This might be the necessary and sufficient condition for change, with the change explained by the simpler, more straightforward theory of operant conditioning. This study compares the effectiveness of reciprocal inhibition by relaxation with a positive social reinforcement procedure in the systematic desensitization of a fear of snakes. The systematic desensitization procedure was modified to use progressive distance from a live snake instead of visual images of items on a fear hierarchy.