This is the 2007 version. Click here for the 2017 chapter 13 table of contents.

Wolpe and Desensitization Therapy

Desensitization was the first therapy to be called a behavior therapy. It was self-consciously designed to use insights from laboratory work on conditioning, and it focused directly on problem behavior rather than trying to treat an underlying mental illness. Desensitization was proposed by Joseph Wolpe (pronounced VOLE-py). Because desensitization was the first widely-adopted therapy based on a behavioral principles, Wolpe is often called the father of behavior therapy.

How did Masserman produce neurotic cats? What did Wolpe do, to reduce anxiety in cats?

Wolpe's inspiration came from experiments by a researcher named Masserman . Masserman made cats "neurotic" by giving them electric shocks in a certain box. Soon the cats acted anxious whenever they were put in the box. Masserman observed that the cats lost their "neurosis" if they were fed in the box. He interpreted this in psychodynamic terms, as "breaking through the motivational conflict." Wolpe saw the same events in terms of conditioning. Wolpe replicated Masserman's work and showed that cats could be induced to show gradually less and less fear, by being fed first at a distance, then closer to the box where previously they were shocked.

Wolpe called this counter-conditioning, literally using one association (between the box and feeding) to run counter to another association (between the box and shocks). Wolpe also termed the process reciprocal inhibition because he felt the responses of anxiety and eating inhibited or prevented each other. By encouraging animals to have a response incompatible with anxiety, while exposing them to the stimulus that previously caused anxiety, he found that he could weaken and eliminate the conditional response of anxiety caused by being put in the box.

How was desensitization therapy conducted, in Wolpe's original procedure?

Wolpe devised a procedure for counter-conditioning in humans. First, he taught the patient to relax deeply, using a technique called Jacobsonian progressive relaxation which may itself take a few weeks to master. Then he encouraged patients to visualize or imagine the anxiety-arousing stimulus while remaining relaxed. To gradually eliminate the anxiety-arousing characteristics of the feared stimulus, Wolpe had his patients make a fear hierarchy from least-fearsome to most-fearsome imagery. For example, if the patient was snake-phobic (terribly afraid of snakes) he or she might produce this list:

1. A tiny snake 50 feet away (the least fearsome image)

2. A larger snake 30 feet away

3. A large snake 10 feet away

4. A large snake on the ground right in front of me

5. A snake bumping against my foot then slithering away

6. A snake being placed in my hands

7. A snake wrapping itself around my arm

8. A snake slithering up my arm toward my neck

9. A snake taking a big bite out of my cheek

10. Falling into a pit of poisonous snakes (the most fearsome image)

The patient started with the least anxiety-arousing image (#1) and moved on to the next only when able to imagine the first image while staying fully relaxed. Given enough time, and enough practice with relaxation techniques, a snake-phobic individual could work through the hierarchy. Eventually he or she would be able to imagine the worst, most horrible scene while staying fully relaxed. At this point, the conditioned emotional response (CER) was fully undone or extinguished. To use the terminology from the Conditioning chapter, the conditional stimulus (sight of the snake) no longer elicited a conditional response of anxiety.

Desensitization works, and it is simple to administer, although the classic Wolpe procedure often took months. As noted in Chapter 8, certain types of phobias seem to be "prepared" by evolution and are more difficult to treat. These include snake, spider, and small animal phobias. However, even these instinctive fears usually yield to desensitization in the long run. Less biologically-based phobias such as test anxiety and fear of flying often can be eliminated quickly.

Wolpe (1958) described a three-part systematic desensitization procedure:

1. The client is trained in deep relaxation.

2. The client and therapist construct a list of anxiety-eliciting stimuli, the so-called fear hierarchy, ordered from least to most distressing.

3. Starting with the least anxiety-arousing image, the feared stimuli are paired with relaxation, until eventually the most feared stimulus is tolerated calmly.

In the years after Wolpe publicized his original procedure, researchers tried out dozens of variations, looking for more efficient procedures. For example, researchers found that drugs or carbon dioxide/oxygen mixtures could provide rapid relaxation, making time-consuming relaxation training unnecessary.

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