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Comment on the Status of Systematic Desensitization

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Articles about systematic desensitization that appeared in mainstream behavior therapy journals between the years 1970 and 2002 were counted. Graphic displays of the data point to a sudden and lasting decline of interest in systematic desensitization among academics and researchers. A questionnaire concerning clinical use of orthodox systematic desensitization was mailed to 310 selected providers. Returns from 171 of those providers show that use of systematic desensitization has declined but continues to be fairly widespread. The decline of interest in systematic desensitization is explained: arguments are offered that revitalized interest would be beneficial but is not likely to occur.
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Behavior Modification
DOI: 10.1177/0145445503259414
2004; 28; 194 Behav Modif
F. Dudley McGlynn, Todd A. Smitherman and Kelly D. Gothard
Comment on the Status of Systematic Desensitization
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10.1177/0145445503259414BEHAVIOR MODIFICATION / March 2004McGlynn et al. / SYSTEMATIC DESENSITIZATION
Comment on the
Status of Systematic Desensitization
F. DUDLEY MCGLYNN
TODD A. SMITHERMAN
KELLY D. GOTHARD
Auburn University
Articles about systematic desensitization that appeared in mainstream behavior therapy journals
between the years 1970 and 2002 were counted. Graphic displays of the data point to a sudden
and lasting decline of interest in systematic desensitization among academics and researchers. A
questionnaire concerning clinical use of orthodox systematic desensitization was mailed to 310
selected providers. Returns from 171 of those providers show that use of systematic desensitiza-
tion has declined but continues to be fairly widespread. The decline of interest in systematic
desensitization is explained; arguments are offered that revitalized interest would be beneficial
but is not likely to occur.
Keywords: systematic desensitization
Wolpes (1958) technique known as systematic desensitization
based on relaxation played a very prominent role in the evolution of
behavior therapy during the 1960s and 1970s. The orthodox use of
systematic desensitization involved three sets of activities. The thera-
pist and patient constructed one or more increasingly fearsome series
of narrative scene descriptions in which the patient encountered
feared circumstances. The therapist trained the patient to relax the
skeletal muscles using some variant of Jacobsons (1938) progressive
relaxation exercises. The patient visualized the increasingly fearsome
scenes in order while taking care to remain relaxed. Painstakingly
careful and thorough reviews of the literature (Paul, 1969a, 1969b)
documented early on that systematic desensitization was reliably
effective when used to treat phobias and some other anxiety-related
194
BEHAVIOR MODIFICATION, Vol. 28 No. 2, March 2004 194-205
DOI: 10.1177/0145445503259414
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disorders. Nonetheless, interest in systematic desensitization declined
during the three decades that followed; seemingly systematic desensi-
tization receives scan attention within the contemporary behavior
therapy movement.
Has the time come to write the epitaph of systematic desensitiza-
tion; will the orthodox method be consigned to the history books?
This article examines that question in the following ways. We first
report results from an archival study that documents the decline of
academic-research interest in systematic desensitization as judged
from behavior therapy’s mainstream literature. We then report results
from a questionnaire study that sought to determine the extent to
which clinicians’use of systematic desensitization has declined. Next,
we attempt to explain the decline of interest in systematic desensiti-
zation, especially the decline within the academic arm of the behav-
ior therapy movement. Finally, we argue that revitalized academic-
research interest in systematic desensitization would be beneficial but
is unlikely to occur.
STUDY 1
To what extent has research on systematic desensitization de-
clined? Perusal of the mainstream behavior therapy journals leaves
the impression that researchers lost interest in systematic desensitiza-
tion during the early 1970s and that little work has been devoted to the
technique since that time. Our first undertaking here was to document
the accuracy of that impression.
METHOD
Three mainstream behavior therapy journals were chosen to repre-
sent the behavior therapy literature for the 32-year period between
1970 and the middle of 2002: Behaviour Research and Therapy,
Behavior Therapy, and The Journal of Behavior Therapy and Experi-
mental Psychiatry. Two independent raters used the volume for each
even-numbered year and tallied the total number of articles published
per annual volume and the number of articles per annual volume
McGlynn et al. / SYSTEMATIC DESENSITIZATION 195
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devoted to systematic desensitization (excluding book reviews, edi-
torials, letters to the editor, articles about eye-movement desensiti-
zation, etc.). From among 2,919 articles that appeared in 150 journals
the two raters disagreed only five times; these disagreements were
easily reconciled.
RESULTS
Figure 1 shows the percentage of articles devoted to systematic
desensitization for each even-numbered year as aggregated for all
three journals. Figure 2 shows the numbers of articles for each of the
three journals. There are no surprises. The decline of interest in sys-
tematic desensitization began after 1970 and was well under way by
the middle of the decade. The decline occurred more or less uniformly
in each of the mainstream journals. Contemporary behavior therapy
researchers show little interest in systematic desensitization.
196 BEHAVIOR MODIFICATION / March 2004
Year
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
Percentage of Systematic Desensitization Articles
30
20
10
0
Figure 1. Percentage of systematic desensitization articles combined among three behav-
ior therapy journals.
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STUDY 2
To what extent have behaviorally oriented clinicians stopped using
systematic desensitization based on relaxation? Obviously this is a
much more difficult question to answer confidently than was the ques-
tion above. We resorted to a survey method.
METHOD
A brief survey instrument was mailed (along with instructions, a
consent form, and a stamped, self-addressed envelope) to 310 people
listed in the 1999-2000 AABT Membership Directory. The instru-
ment, reproduced in Table 1, was intended to determine when, how
often, and in what way the respondent had used orthodox systematic
desensitization. The potential respondents were selected from the
directory because they were members of AABT Division 39, they
McGlynn et al. / SYSTEMATIC DESENSITIZATION 197
Year
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
Number of Systematic Desensitization Articles
16
14
12
10
8
6
4
2
0
BT
BTEP
BRAT
Figure 2: Number of systematic desensitization articles by journal.
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were listed as engaged in clinical practice, and they had received the
terminal degree before 1986. (The year 1986 was chosen arbitrarily to
produce a pool of respondents who probably had been trained to use
systematic desensitization or who had at least been familiarized with
systematic desensitization during the graduate school years.)
RESULTS
Of 310 survey instruments that were mailed, 28 were undeliver-
able for one reason or another. Of the remaining 282 instruments,
198 BEHAVIOR MODIFICATION / March 2004
TABLE 1
Systematic Desensitization Survey
As used for questionnaire purposes, the term systematic desensitization means Wolpes
approach: muscle relaxation training accompanied by guided visualization of hierarchically
arranged aversive scenes.
Have you ever used systematic desensitization? (Circle one)
No** (6/171, 3.51%)
Rarely (77/171, 45.03%)
Routinely (88/171, 51.46%)
Do you still use systematic desensitization? (Circle one)
No (32/165, 19.39%)
Rarely (94/165, 56.97%)
Routinely (39/165, 23.64%)
Do you use it alone, with actual exposure, or both? (Circle one)
Alone (15/133, 11.28%)
With actual exposure (49/133, 36.84%)
Both (68/133, 51.13%) Note: 1/133 was not decipherable on this question
If you did but no longer use systematic desensitization, about when did you quit using it?
(Circle one)
Early 1970s (2/32, 6.25%)
Late 1970s (4/32, 12.50%)
1980s (16/32, 50.00%)
1990s (9/32, 28.13%) Note: 1/32 left this question blank
**If you circle no in the first question, do not answer the remaining questions, but please fold
up the survey and return it anyway.
Thank you for your participation.
NOTE Corresponding percentages reflect the proportion of respondents endorsing each survey
option. Those answering Noto the first question did not respond to the remaining questions.
The third question is applicable only to those who reported continuing to use systematic desensi-
tization in clinical practice.
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171 (60.4%) were completed and returned. The percentages of re-
spondents who answered in various ways are shown in parentheses in
Table 1.
Our arbitrary cut-off date of 1986 turned out to be a good one;
nearly all of the respondents reported having used systematic desensi-
tization at least rarely. Of those respondents who reported having used
systematic desensitization 80% reported continuing to do so; 24%
routinely.
The question about using systematic desensitization alone, with
actual exposure, or both was somewhat vague (as was lamented by
several respondents). Seemingly, however, 88% of the 133 respon-
dents who reported continuing to use systematic desensitization re-
ported also using in vivo exposure treatments with the same patients
and/or with different patients. Of the 33 respondents who reported
having stopped using systematic desensitization half did so during the
1980s.
DISCUSSION
In general, the two sets of data lead to three conclusions. First, aca-
demic-research interest in systematic desensitization declined
abruptly during the 1970s. Second, clinical use of systematic desensi-
tization declined during the 1980s. Third, many clinicians who were
trained before 1986 continued to use systematic desensitization.
Why did academic-research interest in systematic desensitiza-
tion decline abruptly? The direct cause of the decline of academic-
research interest in systematic desensitization was an abrupt shift in
the editorial climate of behavior therapys mainstream journals. The
history is straightforward. In a series of experiments reported early on
by Peter J. Lang and his colleagues (Lang & Lazovik, 1963; Lang,
Lazovik, & Reynolds, 1965; Lazovik & Lang, 1960) changes in self-
reported fear of snakes and in avoidance of a nonpoisonous snake dur-
ing a behavioral walkway test were used to study the fear-reducing
effects of systematic desensitization administered to college students.
These experiments became benchmarks because they were reported at
the beginning of the behavior therapy movement and, along with the
McGlynn et al. / SYSTEMATIC DESENSITIZATION 199
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200 BEHAVIOR MODIFICATION / March 2004
innovative research of Paul (1966), they offered the prospect of a truly
experimental study of clinical behavior-change tactics.
Langs early reports spawned scores of analogue desensitization
experiments in which changes from pretreatment to posttreatment
measures of college students fear and avoidance of nonpoisonous
snakes were used to evaluate effects from experimental versions of
systematic desensitization. Problematically, the typical experiments
that followed Langs early reports were flawed in multiple ways, for
example, subjects were insufficiently fearful and experimental
demand effects were uncontrolled (cf. Kazdin & Wilcoxon, 1976;
McGlynn, Mealiea, & Landau, 1981). The widespread methodologi-
cal flaws occasioned criticism, especially an in-depth critique of ana-
logue research methods (Bernstein & Paul, 1971) that appeared by
invitation in Wolpes Journal of Behavior Therapy and Experimental
Psychiatry. Major contributors to the early analogue research litera-
ture on systematic desensitization began receiving editorial rejections
soon after the criticisms appeared. Experimental research on systema-
tic desensitization all but disappeared from the mainstream literature.
Why did clinical interest in systematic desensitization decline? The
major reason for declining interest in systematic desensitization
among clinicians was the emergence of competing treatments. The
first competitors were flooding (Malleson, 1959), implosive therapy
(Stampfl & Levis, 1976), and participant modeling (Bandura, 1971).
These treatments seemingly offered equivalent or even better out-
comes by contrast with systematic desensitization. In due course
came competition in the form of exposure technology. Marks (1973,
1975) argued persuasively that exposure to fear signals was the com-
mon element of treatments such as systematic desensitization, flood-
ing, and modeling; therefore, exposure to fear signals was the vehicle
of their successes. Marks argument eventuated in exposure technol-
ogyin one way or another arranging for continuous exposure to fear
signals beyond the point at which fear inevitably subsides.
Figure 3 shows the percentage of articles devoted to exposure tech-
nology for each even-numbered year between 1970 and the middle of
2002 as aggregated for the three mainstream journals used earlier.
The figure shows that exposure technology has been of continuing
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interest during the three decades of declining interest in systematic
desensitization.
A less direct but nonetheless important factor in the decline of
interest in systematic desensitization was the shift toward cognitive
behavior therapy (cf. Wolpe, 1976, 1989). From the very beginning of
the behavior therapy movement there was criticism of stimulus-
response psychology as providing adequate organizing principles
for psychological therapy as well as argument that cognitive factors
deserved a prominent theoretical role (see especially Breger &
McGaugh, 1965). Early on, the approaches to therapy that were devel-
oped by people such as Ellis (1962) and Meichenbaum (1975) became
popular competitors to behavior therapy in some arenas. Partially cog-
nitive explanations of the outcomes of systematic desensitization
were made available (Wilkins, 1971), but they failed to garner appre-
McGlynn et al. / SYSTEMATIC DESENSITIZATION 201
Year
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
Percentage of Exposure Articles
8
7
6
5
4
3
2
1
0
Figure 3. Percentage of articles devoted to exposure combined among three behavior
therapy journals.
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ciable attention. Seemingly, the neobehavioristic lineage and lan-
guage of systematic desensitization (e.g., reciprocal inhibition,
counterconditioning, extinction) placed it outside of the growing
cognitive behavior therapy movement.
The decline of interest in systematic desensitization did not occur
because the answers to important questions were found. The decline
did not occur because the therapeutically optimal nuances of proce-
dure were effectively worked out. It did not occur because a con-
sensually endorsed explanation of the effects of systematic desensiti-
zation was made available. The diverse methodological shortcomings
lamented by Bernstein and Paul (1971) forestalled both procedural
fine-tuning and empirical arbitration among a dozen or so would-be
explanatory theories that appeared.
The decline of interest in systematic desensitization did not occur
because the competing treatments that emerged were uniformly suc-
cessful. Marks (1971) reported early on that only 3 of 65 phobic
patients treated with exposure techniques were symptom-free at fol-
low-up. Jansson and Öst (1982) reported a 12% median drop-out rate
among patients treated with exposure-based methods. Barlow (1988)
noted that the literature on exposure treatments contained many
examples of failure, relapse, and limited clinical improvement.
In light of the various factors that were and were not involved in the
decline of interest in systematic desensitization, a case can be made
that the decline was premature and that a period of renewed interest
might be beneficial. A detailed argument is beyond the present scope.
It is worth noting, however, that most of the methodological problems
lamented by Bernstein and Paul (1971) were solved within a decade
after their critique appeared (see McGlynn et al., 1981). It is notewor-
thy also that entirely new opportunities for research on fear reduction
via systematic desensitization are afforded by a number of recent
developments in the anxiety-disorders arena. Among these develop-
ments are alterations in our conceptualization of autonomic regula-
tion (see Berntson, Cacioppo, & Quigley, 1991), improvements in the
assessment of vagal function (e.g., Friedman & Thayer, 1998), re-
search on attentional and memory processes in anxiety disorders (see
McNally, 1990), and efforts to link anxiety disorders with the broader
202 BEHAVIOR MODIFICATION / March 2004
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field of emotion (e.g., Barlow, 1988) and with the particular emotion
of disgust (e.g., deJong, Peters, & Vanderhallen, 2002).
Notwithstanding such opportunities, however, the early history of
American psychology affords little reason to anticipate a resurgence
of interest in systematic desensitization. According to that history, sci-
entific questions in psychology do not lose their appeal because they
are answered. Rather, they lose their appeal because they are super-
seded or bypassed; pushed off the stage by newer, more interesting
questions (cf. Dallenbach, 1953). The history of systematic desensiti-
zation is a textbook example; the important questions were left unan-
swered as the field of behavior therapy moved on.
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F. Dudley McGlynn received the Ph.D. degree in clinical psychology from the University
of Missouri in 1968. Before affiliating with Auburn University, he held faculty posts at
Mississippi State University, the University of Florida, and the University of Mis-
souri–Kansas City. He contributes research about behavior therapy for anxiety
disorders.
204 BEHAVIOR MODIFICATION / March 2004
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by Todd Smitherman on November 22, 2007 http://bmo.sagepub.comDownloaded from
Todd A. Smitherman received the B.S. degree in psychology from Samford University in
2000. He is currently a graduate student in clinical psychology at Auburn University. His
current interests include anxiety disorders, especially claustrophobia, and empirically
supported treatments.
Kelly D. Gothard received the B.A. degree in psychology from Auburn University in 2001.
She is currently a graduate student in clinical psychology at Auburn University. Her
interests revolve around anxiety disorders, particularly panic attacks and related events
during childhood and adolescence.
McGlynn et al. / SYSTEMATIC DESENSITIZATION 205
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by Todd Smitherman on November 22, 2007 http://bmo.sagepub.comDownloaded from
... Indeed, there are instances when stimuli are no longer seemingly aversive. For example, systematic desensitization is a process by which individuals are exposed to increasingly aversive stimuli while being prompted to engage in an incompatible physiological response to fear to decrease distress to the target stimulus (McGlynn, Smitherman, & Gothard, 2004). This process seems to render these stimuli neutral; but demonstrations of stimuli becoming reinforcing via this process are warranted. ...
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RESUMEN Este artículo es un trabajo de investigación teórica que da cuenta de la prevalencia de los trastornos de ansiedad a nivel mundial y específicamente en el ámbito colombiano. Se realiza un desglose teórico que tiene como punto de partida las emociones básicas, haciéndose énfasis en la emoción del miedo, que cuando se mantiene en el tiempo sin causa aparente se traduce en un trastorno de ansiedad como la fobia específica, siendo esta el objeto de estudio del proyecto investigativo "Eficacia del uso de dispositivos de inmersión virtual en él tratamiento psicológico de fobias específicas" adelantado por el programa de Psicología de la Universidad de Manizales. Dicho estudio busca comprobar la efectividad del tratamiento tradicional versus el tratamiento por medio de la inmersión a un ambiente de realidad virtual, por lo que se exponen los tres tratamientos más utilizados para su intervención como son la desensibilización sistemática, la terapia de exposición y la realidad virtual. Encontrando que los tres procedimientos tienen evidencia contradictoria sobre su eficacia siendo necesario realizar investigaciones que amplíen las muestras de trabajo y evalúen la eficacia de la misma a lo largo del tiempo.
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Traumatic memories are the critical factors in maintaining the symptoms of chronic post-traumatic stress disorder (PTSD), treatment resistant depression (TRD), and traumatic psychosis but current treatment strategies don’t address them adequately. Current trauma therapies are based on memory extinction mechanisms which have important limitations in their methodologies, client engagement, and effectiveness. Recent work on memory shows that extinction should be paired with reconsolidation in order to build resilience and skills necessary to deal with the pathologically ingrained traumatic memories (TMs). A mindful state that is alert, calm, and nonreactive is ideal not only for extinction of the traumatic memories but also for reconsolidation of the calming memories created by the meditation practice so that detached reformulation of TMs becomes possible to ameliorate the symptoms of chronic PTSD, TRD, and traumatic psychosis.
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Dieses Verfahren ist gewissermaßen eine Vorläufermethode heutiger verhaltenstherapeutischer Spezialtechniken zur Angstreduktion für verschiedene Störungsbilder und Problemkonstellationen. In seiner ursprünglichen Form wird es weiterhin für spezifische Phobien (z. B. Höhen, enge Räume, Hunde, Schnecken) und für Prüfungsängste eingesetzt. Modifikationen und Weiterentwicklungen der Ursprungsform sind die Angstbewältigungsprogramme, die wiederum auch für Prüfungs- und Leistungsängste eingesetzt werden sowie das Selbstinstruktionstraining nach Meichenbaum, das z. B. für spezifische soziale Phobien (z. B. Redeangst) angewandt wird. Eine wichtige Rolle für die In-sensu-Durchführung der systematischen Desensibilisierung spielt die Fähigkeit zur imaginativen Vorstellung der gefürchteten Situation, für deren Beurteilung es gut ausgearbeitete Skalen gibt.
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Die systematische Desensibilisierung ist ein Verfahren, das Angstreaktionen, die auf einen klar bestimmbaren Reiz folgen, löschen soll. Durch mehrfache, gestufte Konfrontation mit dem angstauslösenden Reiz soll eine Habituierung der Angstreaktion erreicht werden. Die Konfrontation erfolgt durch gedankliche Vorstellung. Die Habituierung kann durch eine gleichzeitige Entspannung erleichtert werden. Zugleich spielen aber auch kognitive Prozesse wie Erwartungen oder Attributionen eine Rolle. Zur Durchführung der systematischen Desensibilisierung können auch computerbasierte Expositionen genutzt werden.
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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.
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Increasing evidence suggests that disgust and fear of contamination is involved in spider phobia. Yet, because the evidence exclusively relies on self-report data it can not be ruled out these findings are produced by mechanisms such as a negative attribution bias, or imprecise emotional labeling. Therefore, the present study sought to complement these previous studies by including physiological measures (i.e., facial EMG). Highly spider fearful (n=24) and explicitly nonfearful women (n=24) were exposed to general disgust-eliciting and spider relevant material using guided imagery (general disgust, spider) and video-exposure (general disgust only). Sustaining the idea that spider fearful individuals are characterized by a heightened disgust sensitivity, exposure to general (oral) disgust elicitors resulted in relatively strong disgust responses (self-report and EMG) in spider fearful women. In support of the idea that disgust is implicated in phobics’ emotional responding, spider-relevant imagery elicited disgust responses (self-report and EMG) in addition to fear. Accentuating the importance of contamination ideation in spider phobia, participants’ sensitivity to contagion (as indexed by the Magic Subscale of the Disgust Scale [Personality and Individual Differences 16 (1994) 701.]) was the single best predictor of elicited fear during spider imagery. Together, the available evidence converges to the conclusion that fear of contamination plays a pivotal role in the development of spider phobia.