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

Exposure Therapies

Desensitization was such a successful therapy that it became very important to behavior therapists. It established the credibility of their approach, because it worked, and it seemed to deliver on the promise of moving psychology from the conditioning laboratory to the clinic, basing treatment on procedures derived from experimental evidence. However, researchers were not sure about which elements of Wolpe's procedure were necessary. Was the relaxation training really necessary? Apparently not; clients did just as well if they did not learn to relax. Was the fear hierarchy used by Wolpe necessary? Controlled comparisons showed that it was not. People seemed to lose their fear just as quickly if they simply placed themselves into the feared situation and let their fear burn out.

What is exposure therapy?

A quick, extreme version of desensitization was tested in the 1970s. It was initially called flooding or immersion therapy. Now it is simply called exposure therapy. In comparison after comparison, it worked as well or better than the Wolpe approach, and it took much less time. Clients no longer had to learn progressive relaxation or work through a hierarchy. In exposure therapy, a client is exposed to a safe version of the fearsome stimulus at maximum intensity. The anxiety reaction burns out, and extinction occurs after that.

Eysenck, like many other investigators, found that time of exposure was critically important in this type of therapy.

Patients with a great fear of spiders, who were exposed to spiders for two minutes in a laboratory setting, did not overcome their fear of spiders. In fact, their fear became worse because the exposure time was not long enough. If the exposure was longer, however, extinction occurred. (Cunningham, 1984)

Exposure therapy was the only therapy that worked for obsessive hand-washing, in Eysenck's experience. Some people washed their hands hundreds of times a day, until their hands were red and sore. A deeply rooted anxiety about contamination seemed to be involved. Eysenck tried an extinction procedure. He had compulsive hand-washers immerse their hands in a barrel of rubbish, then just stand there with contaminated hands for several hours, without being allowed to wash them.

How did Eysenck claim to cure 90% of compulsive hand-washers?

"Immediately there is a welling-up of anxiety and fear," said Eysenck. "The patient is forced to remain there for an hour or two. Eventually the emotion is gone.... Even doing it once produced such a change in the attitude and emotions of the subject." The treatment worked for 90 percent of the patients, he added. (Cunningham, 1984)

What is in vivo desensitization?

Exposing a spider-phobic person to spiders, or a compulsive hand-washer to dirty hands, is an example of in vivo (in VEE-vo) desensitization. In vivo is a Latin phrase meaning in life. The client is exposed to the real thing, the actual feared stimulus, rather than just imagining fearful scenes. Professionals find that this type of therapy must be approached carefully, because clients may have panic reactions during flooding procedures. However, that is not discouraged; in fact, clients may be fed a water-and-caffeine mixture to induce a panic reaction. The reaction will run its course in 20-30 minutes, then extinction occurs.

How is drug-induced relaxation used to treat fear of flying?

In vivo desensitization is much faster than Wolpe's original procedure. Dramatic improvements can be achieved in a few treatment sessions, instead of many months. In vivo desensitization is easily combined with drug-facilitated relaxation. For example, Meldmand and Hatch (1969) treated an airplane phobia by administering an anxiety-reducing drug (methoxyflorone) to clients who were then taken aloft in a plane. This effectively eliminated their fear of flying. In vivo desensitization of airplane phobias, aided if necessary by anxiety-reducing tranquilizers, is still the treatment of choice for that disorder.

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