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                                                       SYSTEMATIC DESENSITIZATION OF PHOBIAS

 

NORRIS H. WEINBERG AND MARSHALL ZASLOVE

University of California at Los Angeles Medical Center

 

PROBLEM

Systematic desensitization to phobic stimuli through the use of relaxation has

been described in detail by Wolpe.  In this procedure the phobic patient begins by

helping the therapist construct a hierarchical list of anxiety-provoking stimuli. He

is then taught the principles of progressive relaxation (^\ after which he is presented,

while in a relaxed state, with increasing doses of the phobic stimuli. Usually these

stimuh are in the form of images suggested to the patient while under light hypnosis.

It is expected that eventually the patient will be able to generalize the calm, relaxed

state induced in the desensitization session to previously threatening life situations.

Under the impetus of Wolpe's successful application of this method, a number of

clinicians have employed these procedures and some attempts to objectify these

findings have begun difficulties inherent in the method have been indicated, there has been little discussion

of potential "resistance" which might interfere with conducting such a

program. The term "resistance" is employed here, much as it is in the literature of

psychotherapy, to describe certain difficulties which block progress when the patient

is faced with anxiety-provoking material. This topic has been largely ignored by

practitioners of desensitization and it was felt that a description of the problems

encountered by the writers might be of service to researchers and therapists trying to

utilize these procedures.

The following observations were made while conducting a study of the course of

GSR during desensitization. Subjects of the experiment were selected to meet the

following criteria: (a) relatively "normal'' adjustment as determined by several

interviews, history, and MMPI; (b) having at least one fairly circumscribed phobia;

and (c) willing to meet the requirements of the study in terms of time investment and

procedure demands. Two *Ss were afraid of dogs and one was disturbed by stepping

on "squashy" bugs.

All three Ss were treated by the desensitization method of Wolpe, involving

hierarchy construction, relaxation training, and gradual presentation of increasingly

"threatening" material under light hypnosis. The number of sessions per *S varied,

depending on scheduling problems; they had a total of 12, 16 and 19 sessions, respectively.

The only apparent departures from Wolpe's method involved (a) the

use of GSR finger electrodes and recording equipment (behind a screen), to which

the

atmosphere, i.e., the summer session time limit was established, the experimental

nature of the technique was explained, and no assurance of success was

given. Efforts were thus made to reduce the possible effects of suggestion, and to

limit anxiety-reduction effects to the desensitization procedures

these conditions a number of problems or "resistances", heretofore not discussed in

the literature, became apparent. These forms of resistance may be conveniently

classified under three headings: Direct (treatment-bound) Resistance; Indirect

(treatment-related) Resistance; and Resistance Related to the Research Setting.

1. Direct Resistance:

This refers to problems arising during the desensitization process

involving (a) fluctuations of the hypnotic state, and (b) manipulation of the

imaginal process.

(a) All three

This included increased sleepiness at times (all three

blurring the images; variations in level of concentration, reflected in occasional reports

of restlessness, boredom, and inattention (all

^\ While some failures have been reported, and certainSs quickly became accustomed; and (b) a somewhat more academic and impersonalper se^*- ^K Underper se, problemsSs revealed signs of qualitative variation of the hypnotic state.Ss) which had the effect ofSs at times); and fluctuations in

180 NORRIS H. WEINBERG AND MARSHALL ZASLOVE

ease and depth of hypnotic induction (one

vicissitudes of alertness and cooperation under hypnosis seemed related to particular

stresses in the desensitization process. One

association of ''being attacked by a crowd of urchins" to the image of a "playful

police dog jumping upon a woman", and another

of interest in the procedure at a time when she was having anxiety dreams which

appeared to symbolize the deconditioning session.

(b) All <Ss at one time or another reported "involuntary" manipulations of the

imaginal process. Two of the three stated that the image had occasionaUy been

diluted^ by changing the context to a more secure setting (i.e., having a protective

person at the scene), and all the

the image which seemed to reflect its relative threat. (It was apparent that in spite

of careful hierarchy construction, and monitoring of anxiety level, both by GSR

and hand signal ^'^ a certain amount of disturbance could not be avoided.) One

S). In some instances, at least, theseS, for example, had the interpolatedS reported distractibility and lossSs noted variations in the clarity and intensity ofS

also managed to separate her reaction to the image from her response to the real

situation, "If that had really happened it would bother me, but the image is okay".

A similar separation occurred in the one failure reported by Lazovik and Lang^<\

2. Indirect Resistance:

All <Ss presented difficulties related to the treatment regimen, but not directly

manifested under hypnosis and stimulus confrontation. All Ss failed to follow rules

at times; important instances were "forgetting" or finding it "too noisy at home" to

practice relaxation, and failure to test their reactions to real life stimuli. Two of the

4Ss tended to lateness, and two <Ss revealed interesting examples of flight into health.

While still having considerable difficulty with dogs, one

she "liked dogs and was not afraid any more", and another stated that she was

"cured—I saw a dog and liked it and I wasn't afraid—I guess I'm finished now".

The similarity between these types of indirect resistance and the "avoidance maneuvers"

of traditional psychotherapy is noteworthy.

3. Resistance Related to the Research Setting:

Because they were experimental subjects rather than disturbed patients focusing

on their symptoms, certain additional problems arose which may be classified as

(a) life-situation influences, and (b) frustration of "volunteer" motives.

(a) All three <Ss were deeply concerned at times with outside events which seemed

unrelated to the deconditioning. These events (i.e., a quarrel with the parents;

concern with grades; boy friend troubles) almost always took precedence in their

daily lives and frequently invaded the desensitization process. Experiences with

fearful stimuli outside the sessions—useful in evaluating progress—were sparse, and

did not seem to play a significant role in their current affairs.

(b) The research setting tended to frustrate some of the motives which prompted

the Ss to volunteer. One

wish to win out over her friends in being selected, grew dissatisfied as the noncompetitive

character of the research became clear. Another

the program as an opportunity to discuss family problems with the j^s, became mildly

frustrated as this was gently discouraged. In general, the goal of pleasing the

more important to them than the wish to be free of their symptom.

In spite of varied "resistances" and the time limitations of the study, some

shght improvements may have taken place. All Ss reported at the conclusion, and

on at least one follow-up, that there was some change for the better. They stated

that they felt more detached and relaxed in the presence of mild phobic stimuli, and

at times were even amused by their fears. The "dog phobics" reported positive feel-

S reported a dream in whichS, for example, who had in part been motivated by aS, apparently viewingEs was

^It should be noted that changes in the image in the direction of greater threats were also

i.e.,

her and chasing her", and a "German Shepherd" was transformed into "a wolf". These unscheduled

shifts make the gradual "dosing" of anxiety more difficult.

seen,an image of a "playful dog jumping up on a woman" suddenly changed into "a dog jumping on

"RESISTANCE" TO SYSTEMATIC DESENSITIZATION OF PHOBIAS 181

ings for small dogs, and two

8tomach" indicated a reduced frequency and intensity of these reactions. Finally,

the GSR patterns of the two

reduced skin conductance under presentation of the phobic stimuli.

It was felt, however, that the gains were quite modest, while the degree and

variety of resistance was most impressive. The reasons for this are not clear. It

happened by chance that all three /Ss were relatively "extraverted" according to the

Maudsley Personality Inventory (scores of 30, 36 and 40, as compared with the

norm of 28.5 ^^^ for American students), and extraverts are reportedly resistant to

conditioning, and to this type of procedure ^*\ In addition, the relative inexperience

of

given sufficient emphasis to relaxation training. Finally, it is possible that these

relatively circumscribed phobias were in some way linked with important, repressed

threats. There was some evidence, from dreams and associations, that dogs were

linked by one

sexual threat; the girl who experienced extreme revulsion to "squashed bugs" seemed

to be particularly disturbed by her own aggressive feelings. Whatever the cause, it

seems likely that a variety of resistances to desensitization, heretofore undescribed,

may have to be considered. Perhaps these problems should be handled by supplementing

desensitization procedures with more traditional therapuetic techniques

such as mild interpretation and support. It is also possible, as is suggested by

Wolpe's management of his patients, that a broader, more flexible use of learning

theory methods is generally required for successful outcome.

Sa who had been troubled by "upset feelings in theSs on whom there was complete data revealed graduallyE with this technique may have been a handicap; in particular, he may not haveS to a. more generalized fear of painful attack, and by the other *S to

SUMMARY

Three volunteer "phobic" subjects were subjected to the relaxation-desensitization

regimen described by Wolpe. A number of resistances to this procedure were

observed and classified into three types. Direct resistances included fluctuations of

the hypnotic state (sleepiness, poor concentration, changes in hypnotic induction)

and variation in the imaginal process (dilution of the image, reduced clarity, separation

from the real life situation). Indirect resistances included failure to follow rules,

lateness, and "flight into health". Resistances related to the research setting included

interferences through life situation influences, and frustration of the motives

prompting the volunteer. Some modest gains were noted in the reduction of the

phobic symptoms, but the resistances were felt to be a serious drawback, requiring

either supplementary use of traditional therapeutic techniques or broader and more

flexible use of learning theory methods.

REFERENCES

1.

ETSENCK, H. J. Manual of the Maudsley Personality Inventory. London: University of London

Press, 1959.

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Psychotherapy.

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Systematic Desensitization.

6.

ETSBNCK, H, J. (Ed.). Behavior Therapy and the Neuroses. New York: Pergamon Press, 1960.JACOBSON, E . Progressive Relaxation. Chicago: University of Chicago Press, 1938.LAZOVIK, A. D. and LANG, P. J. A Laboratory Demonstration of Systematic DesensitizationJ. Psychol Studies, I960,11, 238-247.LAZOVIK, A. D. and LANG. P. J. A Study of Fear Reduction in Phobic Subjects Treated byAm^r. Psychologist, 1961,16, 367. (abstract).METER, V. The Treatment of Two Phobic Patients on the Basis of Learning Principles. / .

abn. soc. Psychol,

1957, 55, 261-266.

7.

WOLPE, J. Psychotherapy by Reciprocal Inhibition. Stanford: Stanford University Press, 1958.

 

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