Exposure to feared situations has been found to result in decrement in subjective anxiety and heart rate (HR) for anxiety-disordered patients. In a preliminary study using a crossover design, obsessive-compulsives experienced less return of fear during in vivo exposure when attention was focused on their feared obsessional stimuli than when it was distracted from them. Thus, attention seemed to facilitate between-session but not within-session habituation. The present study was conducted to replicate and extend the previous investigation using a between-groups design. Seventeen obsessive-compulsives with washing rituals were exposed to their most feared contaminant for two consecutive 90-min sessions under either distracting (playing a video game) or attention-focusing (observing and discussing the contaminant) conditions. Consistent with our earlier findings, HR response reduced substantially during attention-focusing but remained elevated during distraction. However, on subjective anxiety greater reduction was observed in the distraction condition, particularly during the first exposure session. Results are discussed in light of findings by other investigators regarding procedural manipulations during exposure.

In the present study, several hypotheses were examined regarding differences between subtypes of obsessive-compulsive ritualizers with respect to the types of cues for fears, the degree of fear and avoidance exhibited and parental characteristics. The sample consisted of 36 washers and 23 checkers. No differences on demographic variables were observed. Washers' fears were triggered more by environmental stimuli than checkers', whose fears tended to focus more on concern with preventing future harm. More fears and greater passive avoidance was exhibited by washers than by checkers. Checkers more often perceived their mothers as meticulous and demanding than did washers. The possible implications of these findings for the application of exposure treatment methods are discussed.

The efficacy of imaginal and in vivo exposure was compared in 19 obsessive-compulsives who manifested checking rituals. Response prevention was not instituted in either group. No difference between the two procedures was detected either at posttreatment or at follow-up; both were moderately effective in ameliorating obsessive-compulsive symptoms. There appears to be a tendency for patients treated with in vivo exposure to improve further at follow-up, whereas those treated with imaginal exposure maintained the level of gains achieved at posttreatment. In comparison with a treatment regimen which includes both exposure and response prevention, the exposure procedures in vestigated here yielded inferior outcomes. The finding of no difference between in vivo and imaginal exposure modalities is incongruent with studies on phobics. Possible explanations for this discrepancy are discussed.

The present experiment was designed to examine the separate and combined effects of exposure and blocking of ritualistic behavior on obsessive-compulsive symptoms. Thirty-two patients with a primary diagnosis of obsessive-compulsive disorder were assigned to one of three treatment groups: exposure in vivo only, response prevention only and the combination of these two procedures. Assessments were conducted before treatment, three days after completion of treatment, and at follow-ups 3, 6, and 12 months later. All three groups were significantly improved on most measures of symptomatology, with some tendency for partial loss of gains at follow-up, particularly for the single-component treatments. Overall, combined treatment produced greater changes in anxiety and rituals than did the single component treatments. There was some evidence for the specificity of the treatment effects: exposure affected anxiety to contaminants significantly more than did response prevention; a tendency for the latter procedure to impact more on ritualistic behavior was also observed. Possible mechanisms which may be operative during these procedures are discussed in light of conceptualizations of processing of fear-associated information.

The last decade has witnessed remarkable progress in the treatment of obsessive-compulsives, with the introduction of response prevention and deliberate exposure to feared situations in vivo and in imagination. In a series of studies, the effects of the single components of this program were investigated. The results suggest that the optimal treatment includes a combination of all three procedures. It appears that in vivo exposure mainly affects anxiety/discomfort associated with cues for ritualizing; response prevention affects primarily compulsive behavior; and imaginal exposure assists in maintenance of treatment gains, perhaps through its impact on fears of future catastrophes associated with obsessions.

ABSTRACTUsing imaginal stimuli, the present investigation examined psychophysiological responses to imagery and the roles of Groves and Thompson's (1970) dual process theory and Sokolov's (1963) model of the defensive response(DR) in mediating the incremental stimulus intensity effect (ISIE). Experiment I was undertaken to determine whether phobic and neutral imagery could be discriminated by DRs and orienting responses (ORs). In a within groups design. 19 analogue speech phobics were exposed to 4 neutral and 4 phobic scenes. Dependent measures were skin conductance measures and second‐by‐second heart rate (HR). The results showed that DRs occurred only in response to phobic scenes. In a between groups design. Experiment II compared an incremental series (IS) of 16 phobic imaginal stimulus presentations to a constant series. Subjects were analogue speech phobics with 14 subjects per condition. For both conditions the last 4 scene presentations were the same. Dependent measures were second‐by‐second HR, second‐by‐second cephalic pulse amplitude, and skin conductance measures. The results showed greater habituation in the IS condition, but were inconclusive with regard to the roles played by dual process theory and the DR model in the ISIE.

To investigate the effects of distraction and attention-focusing during in-vivo exposure to feared stimuli, the responses of 16 obsessive-compulsives with washing rituals were studied. A cross-over design was employed in which 6 of the subjects underwent exposure with attention focusing on the first day followed by exposure with distraction on the second day. The remaining subjects received the reverse order. Habituation of both heart rate and subjective anxiety was observed under both conditions, the rate of habituation tending to remain constant throughout the 90-min exposure. Greater between-session habituation and greater synchrony between the psychophysiological and the subjective measures of anxiety was observed when attention-focusing preceded distraction. Since habituation and synchrony have previously been found to be positively related to treatment outcome, the present results suggest that treatment by exposure to feared stimuli may be more effective if attention-focusing is promoted.

Twenty-nine insomniacs underwent four consecutive sleep laboratory evaluations before and after receiving tension-release relaxation training, no-tension-release relaxation training, or no-treatment. On the basis of the discrepancy between subjective and EEG-defined measures of latency to sleep onset, subjects were classified as pseudoinsomniacs or idiopathic insomniacs. As predicted, tension-release relaxation was significancy more effective than the other two conditions on subjective sleep measures, regardless of insomnia subtype and on objective sleep measures only for idiopathic insomniacs. Subjective improvement was maintained at 12-month followup. Numerous differences between the two subtypes emerged on pretherapy and during-therapy measures distinct from the latency measures, but changes on those variables were unrelated to outcome improvement.

Speech phobic subjects prepared and presented two speeches with an interpolated phobic imagery task. During the imagery task subjects imagined a phobic stimulus scene followed by scene elaboration describing the subjects' responses to the situation. Phobic stimulus scenes were identical for all subjects, with only the response elaboration varying. For one-third of the subjects depicted response elaboration involved behaving in a relaxed and competent fashion; one-third imagined being anxious and performing incompetently; one-third visualized avoiding the phobic situation. Three stimulusresponse pairs were each presented three consecutive times. Half of the subjects in each imagery condition were given positive expectations regarding the likely effect of the imagery procedure on their speech fear, while half were given neutral expectations. Response imagery was significantly related to rate of subjective fear reduction within and across phobic image presentations, while expectancy influenced fear reduction on both subjective and heart rate measures during the imagery task.