Active muscular relaxation in desensitization of phobic patients

Behaviour Therapy for Neurotic Disorders

This article reviews evidence about the value of behaviour therapy for the treatment of patients who present with phobic disorders anxiety states, obsessional neuroses, and hysteria. Although progress has been made in developing effective behaviour therapy for the major neurotic syndromes, much remains to be done. Only in the phobic disorders is there a sufficient body of knowledge to give clear guidance to the clinician about the best methods of treatment. However, this work on phobias already has pointed to several lines of enquiry which are likely to be fruitful with the other syndromes in which the contribution of behavioural methods is promising, though less certainly established. In particular, more attention needs to be given to ways of ensuring that patient treatment by behavioural measures will be continued.

Deconditioning and ad hoc uses of relaxation: an overview

Muscle relaxation is one of the most effective means at our disposal for diminishing emotional stress. In the context of behavior therapy it has featured in systematic programs to overcome anxiety response habits. Its original usage by Jacobson was an ad hoc measure for meeting tensions as they arose, as well as for ongoing tensions. This usage also often results in diminution of anxiety response habits--inadvertently. It has been found of value in the treatment of migraine and tension headaches, insomnia and essential hypertension, and also in at least some cases of Type A personality. There is reason to think that in normal populations relaxation training may have a role in the prevention of neuroses.

Evaluation of standardized behavioural treatment for agoraphobic in-patients administered by untrained therapists

Using a standardized behavioural programme, nine in-patients with severe agoraphobia were treated by staff who had minimal training in the theory and practice of behaviour therapy. With one exception patients showed marked reduction in subjective fear and avoidance, both following treatment and at follow-up. The indications for such treatment are considered and compared with those for alternative behavioural approaches that have recently been advocated.

Cure and care of neurosis. I. Cure

Behavioural psychotherapy has long historical roots. Recently it has led to effective treatment for selected neuroses, including phobic, obsessive-compulsive and sexual disorders. Potent therapy has become a tool of experimental psychopathology which advances theory and practice. A pervasive principle is exposure of the patient to those stimuli which evoke his discomfort until this subsides. Level of arousal during exposure does not affect outcome. Theoretical issues are reviewed which decide when exposure will be sensitizing or habituating. Both psychoanalytical and conditioning models of neurosis are out of date, and models derived more directly from clinical experiment are becoming possible. The aetiology of phobias and rituals can be seen as failed extinction rather than enhanced acquisition. Relevant phylogenetic and biological factors are discussed. At the other extreme, well-documented faith-healing indicates huge gaps in our knowledge of psychotherapy.

Relaxation therapy, desensitization, and the treatment of anxiety-based disorders

Evaluated systematic desensitization and relaxation training for the treatment of snake phobia and test anxiety as representatives of two classes of anxiety-based disorders. Treatment outcomes were assessed by examining situational and dispositional components of anxiety as related to these disorders and by behavioral measures of performance in relevant anxiety-provoking situations. Analyses of variance revealed that more pervasive anxiety reductions occurred for the more focalized animal phobia and that there was little difference in the effectiveness of desensitization and relaxation training. The generalizability of research findings based on the treatment of animal phobias was questioned, and the possible role of nonspecific factors in determining success was considered.

Behaviour therapy: recent trends and current practice

To psychiatrists who entered clinical practice in the decade 1955–65, ‘behaviour therapy’ probably conjures up the names of Eysenck, Lazarus and Wolpe; the invocation of learned maladaptive anxiety as the basis of most neurotic illness; desensitization by graduated exposure in imagination and real life to anxiety evoking situations. Neurotic ‘symptoms' were maladaptive habits and the ‘symptoms' were the disease, not merely outward manifestations of underlying disorder. Eysenck (1959) described behaviour therapy as all methods of treatment which were based on ‘modern learning theory‘. The ‘bell and pad’ treatment for enuresis and aversion therapy for alcoholism were appropriated and refined. Operant conditioning crossed the Atlantic and the application of Skinnerian principles was illustrated by Krasner and Ullman (1965). In the early sixties, at the very least behaviour therapy offered a possible treatment for a small proportion of psychiatric patients, for example those with phobias, tics or alcoholism, a group for whom other treatments were of little value.

Nurse therapists in behavioural psychotherapy

Five registered mental nurses (R.M.N.s) were trained over two years to become behavioural psychotherapists for adult neurotic disorders. They achieved results comparable to those obtained with similar patients and methods by psychologists and psychiatrists. Similar results were maintained when over a third year the therapists were seconded to work in four hospitals and a general practice. Patients were satisfied at being treated by nurses. After initial teething difficulties nurse therapists became valuable members of treatment teams during both training and secondment, becoming accepted by most nurses, psychologists, and psychiatrists with whom they came into contact. The training of further nurse therapists would facilitate treatment of many disabled neurotics who would otherwise go without effective treatment. Training nurse therapists takes less time and money than training psychologists and psychiatrists because less of their education is redundant to the skills involved. The pool of R.M.N.s suitable for training is much larger than that of psychiatrists and psychologists. The nurse therapists can be integrated relatively easily into treatment teams. The present nursing structure imposes restrictions on the advancement of clinical nurse specialists and a clinical tree is badly needed parallel with present administrative and teaching hierarchies. An 18-month course in adult behavioural psychotherapy has been recognized by the Joint Board of Clinical Nursing Studies for England and Wales so that nurse therapists seem destined to be a lasting feature of future treatment teams.

Research in neurosis: a selective review. 2. Treatment

Treatment of neurosis is selectively surveyed, including physical methods. At least four differing aims of psychotherapeutic techniques can be distinguished—to produce a rewarding experience; to nurture self-knowledge; to allow confession or catharsis; and to effect a lasting change in behaviour. The report concentrates on the last two aims. Effects of psychological treatments are considered first by syndromes and then by procedures. Prognostic issues are defined and research strategies outlined. Further work is suggested, including the relief of acute neurotic distress before referral for specialist help, the combination of psychotropic drugs and psychological treatments, the application of specific psychotherapeutic techniques for defined ends, and elucidation of the active therapeutic ingredients in these methods.

Behaviour therapy. Reduction of fear: towards a unifying theory

In recent years many new methods which alleviate phobic disorders have been introduced. These include desensitization, operant shaping, flooding (implosion), prolonged exposure, paradoxical intention, modelling, cognitive rehearsal and intravenous short-acting sedatives. Different theories have been invoked to explain the action of these procedures, and these are often contradictory. Current evidence suggests that the same therapeutic principle is responsible for the efficacy of most of these methods, this being the continued exposure to the phobic situation until anxiety and avoidance responses are extinguished. This exposure is greatly facilitated when carried out in real life rather than in phantasy. The conditions for successful exposure are explored and other possible therapeutic elements are discussed.