Behav. Res. & Therapy.

1977, Vol

IS. pp 435 438. Pergamon

CASE HISTORIES

Press. Printed m Great Bntain

AND SHORTER

COMMUNICATIONS

An investigation of the relation between reported fear and heart rate* (Recriued

14 March

1977)

For some time fear was regarded as an amalgam of apprehension, autonomic upset and avoidance behaviour (see Rachman, 1974). In response to the arguments and evidence proposed by Lang (1967, 1971), it is now agreed by many psychologists that these three components of fear show some degree of independence. Lang (1967) construes fear as comprising a group of loosely coupled components, and the concepts of concordance and desynchrony have been introduced to describe the relations between the three major components (Rachman and Hodgson, 1974). When subjective fear, avoidance and psychophysiological disturbance correlate closely, we have concordance between all measures, just as a high correlation between any two of the three components is evidence of (partial) concordance. When the components correlate poorly or not at all, we have discordance. The terms synchrony and desynchrony have a similar but not identical meaning to concordance and discordance. Synchrony refers to co-varying changes in the components and desynchrony refers to changes in the components that show independent or inverse variation. In elaborating the significance of these concepts, and their relevance to clinical topics, Hodgson and Rachman (1974) proposed five hypotheses and it is the first of these which is the prime subject of the present investigation. They stated that ‘(a) Concordance between response systems is likely to be high during strong emotional arousal; (b) discordance will be more evident when emotional responses are relatively mild,’ (p. 319). This hypothesis was deduced from their general analysis of Lang’s construction, and more directly from his observation that ‘. mild feeling states may involve no more than the verbal report’ with little accompanying behavioural or physiological changes, bearing in mind the far greater sensitivity of subjective experiences relative to the ‘crude autonomic system,’ (Lang, 1971). The subsidiary aims of the investigation were to replicate the work of Lang et al. (1970) on the relation between reported fear and heart rate (see also Marks et al., 1971) and to gather additional information on the habituation of the heart rate to fearful stimuli. METHOD

We aimed to expose our Ss to fear-eliciting situations of four different intensities. The intensities were assessed subjectively as 0, 50, 75 and 100, on a loo-point ‘fear-thermometer’ according to which 0 was a state of relaxation and 100 the maximum fear tolerable by Ss without having to escape from the situation. The stimuli consisted of real insects or animals, and subjective fear was manipulated by the E varying the distance between the seated S and the stimulus. The order of intensities was varied from one S to the next according to a Latin Square design in order to minimize order-effects. After completion of the first four stimulus-presentations, the same four were then repeated in the same order. We chose heart rate as the psychophysiological measure because of its demonstrated responsiveness in experiments on fear. As previous researchers have shown (e.g. Lang, 1971) heart rate increases show a useful on-off relationship with presence vs absence of the phobic stimulus, and this is of importance if one is concerned with phasic rather than tonic arousal. HR was recorded via an ear lobe photoplethysmograph and amplified by a Grass DC amplifier. The raw data were transformed by a Devices instantaneous rate meter which samples every two consecutive beats. Rate data were then stored on an analogue tape, together with a marker indicating onsets of trials on a different channel. PROCEDURE

The S was seated in a comfortable chair in a room adjacent to the equipment room, the door of which was open throughout the experiment. The equipment was calibrated before each experiment and the transducer attached to the S. During this time he was instructed as to the purpose of the experiment and the fearthermometer was explained to him. The experimenter then performed a practice trial without the stimulus, but asking the S to imagine it. This trial was administered to afford the S some practice in the use of the fear-thermometer and also to give the experimenter an idea of the distances between S and the stimulus that would produce the required fear intensities. The S was then asked to relax until his HR had settled down to a consistent level. At that stage, the S was told that the first trial was about to start and E assumed position at a distance likely to elicit fear at the required intensity (0, 50, 75 or 100). While assuming position, E held the animal in a closed container behind his back and as he presented it to S he operated a push button which provided a marker for the recording equipment signalling the onset of the trial. The stimulus was shown to the S for 15 set and then withdrawn. During presentation of the stimulus, Ss were reminded to keep looking at it, if they tried to look away. If they refused to look at it, the trial was repeated at a greater distance. If the subjective assessment of 100 units on the fear-thermometer was not achieved by close proximity, the lid of the container was removed. *This research was supported in part by a grant from the Medical Research Council. Reprint requests to the first author, c/o MRC Research Group, Institute of Psychiatry, 99 Denmark Hill, London SE.5 8AF, England. 435

CASE HISTORIES

436

AND

SHORTER

TO.MMI:NI(‘ATlONS

Immediately after the presentation of the stimulus, the S was asked to experienced during that trial. Whenever the subjective assessment differed level aimed at, the presentation was repeated at an adjusted distance. The half and three-quarters of an hour, depending on how many presentations between trials depended on recovery of the heart rate from the previous minute.

assess the subjccttve fear level + or - 10 points from the fear total procedure lasted between had to be repeated. Intervals trial, and were usually under a

SIJBJECTS

The Ss were 17 solicited Ss and three patients who all complained of an excessive and circumscribed fear, with distinctive avoidance behaviour. Thirteen of the Ss were afraid of spiders, two of pigeons, two of worms. another two of mice and one was afraid of dead animals. Three ~Idditional volunteers were rejected because they experienced no fear even at close proximity to a spider- a fact which they had not realised prior to the experiment, having always avoided spiders (see Rachman. lY76). One additional patient had to be rejected because, in addition to fearing spiders, he was socially phobic and the testing situation had a more distressing effect on him than the presence of the spider. The Ss’ ages ranged from 22 to 42 years. RESVLTS

The HR data were analysed on a PDP 12 computer with Law’s (1975) SARA programme for nnaiogue data. Two measures were extracted for each of the eight stimulus presentations (four in each run): one was the absolute peak in HR during stimulation. and the other the mean HR for the duration of each stimulus presentation, To assess a possible LIV effect, peak and mean rate data of the no-fear condition were correlated with the difference in rate between the highest fear condition and the no-fear condition. Product-moment correlations were higher during the first run (peak rate: I’ = -0.56: mean rate: I’ = -0.55; df’= 19. p < 0.01) than during the second run (peak rate non-significant: mean rate: I’ = -0.51, p ‘ressmcnt of fear and changes in heart rate, can be described as positively accelerating.

:\s fur ah the main hypothesis is concerned, the results are in part inconclusive. They clearly support the tir\t part of the hypothesis in showing that ‘concordance between response systems is likely to he high during strong emotional arousal’. but provide only slender support for the second part. It was postulated that ‘discordance will he more evident when emotional responses are relatively mild’ and this is what wc find hut the discordance is not as evident or as marked as might have been expected. 100

.

99 98

(Run I)

97

96 95 94 93 92

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91 I

I’

90

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a 89

m aa a7 i a6

;

/

/ I/

84 a3 a2 81

d/

__cr

aou

50

0

Sublectlve 3. Mean

HR in beats

d

/I

a5

Fig.

,6 Run 2) I

i

per minute

75

100

assessment

for the four levels of subjective

fear assessment

438

CASE

HISTORIESAND

SHORTER

COMMUNICATIONS

Part one of the hypothesis is supported by the high concordance observed between mean heart rate and subjective fear report. The third component of fear, avoidance behaviour, was held constant and the extent to which this component changes synchronously during high levels of fear. remains to be demonstrated. As noted above, the discordance (between HR and subjective fear) observed at the intermediate levels of reported fear (i.e. 50 and 75) was slighter than might have been expected-rather than predicted. The original statement of the hypothesis is understandably but irritatingly non-specific-‘will be more evident.’ The accumulation of evidence will, we trust, eventually enable us to make more specific predictions. In addition to providing a test of the main hypothesis, the present experiment is a useful replication of Lang’s (1970) report of a linear relationship between subjective fear and HR, partially confirmed by Marks et al. (1971). From a practical point of view this means that. under specifiable conditions. HR is a useful monitor of subjective fear. It is likely that under most fear-provoking circumstances a steep increase in HR will be indicative of a high level of subjective fear-for some possible exceptions see Hodgson and Rachman (1974). The replication of Lang’s findings is also of interest in showing that the relation between HR and report remains constant, regardless of whether one uses real or imagined fear stimuli. Finally, the experiment is another demonstration of HR habituation to fearful stimuli, and moreover, of fairly rapid change even to those stimuli that provoke intense fear. G. SARTORY S. RACKMAX S. GKEY

Instilute 0fPsyrhiatrJ Unirersity qf_!.ondon

REFERENCES

S. (1974) Desynchrony in measures of fear. B&I:. Res. and Therapy 12, 319-326. LAX P. (1967) Fear reduction and fear behavior. In Research in P.sychotherapq (Ed. J. SHLEIN). American Psychological Association, Washington, D.C. LANG P. (1971) The application of psychophysiological methods to the study of psychotherapy and behavior modification. In Handbook of Psychotherapy and Behaoior Change (Eds. A. BERGIN and S. GARFIELD). Wiley, New York. LANG P., MELAMED B. and HART J. (1970) A psychophysiological analysis of fear modification using an automated desensitization procedure. J. abnorm. Psychol. 72, 22&234. LAW L. (1975) SARA-Stimulus and response analysis programs. (Unpublished). MARKS I., MARSET P., BOULOUGOURIS J. and HUDSON J. (1971) Physiological accompaniments of neutral and phobic imagery. Psychol. Med. 1, 2999307. RACHMAN S. (1974) The Meanings of Fear. Penguin Books, Middlesex. RACHMAN S. (1976) The passing of the 2-stage theory of fear and avoidance. Brhar. Rrs. and Therapy 14, 125-132. RACHMAN S. and HODGSON R. (1974) Synchrony and desynchrony in fear and avoidance. Behav. Rrs. und Therapy 12, 311-318. HODGSONR. and RACHMAN

Behav. Rcs. & Therapy,

1977. Vol. 15, pp. 438441

Perwmon

Press. Printed m Great Brltam

Contingency contracting as a therapeutic tool with methadone maintenance clients : Six single subject studies* (Receiwd

10 Drcember

1976)

In the United States methadone maintenance attracts greater numbers of heroin addicts than any other treatment modality. It has become clear that provision of methadone per se does not change the addict lifestyle; that is, a primary use of methadone must be to attract and hold clients so that they come in contact with effective behavior change procedures. The studies reported illustrate the use of one such procedure, contingency contracting. A contingency contract is an agreement, usually written, that specifies behaviors to be performed and reinforcers to be provided. While there are a few reports of contracting with addicts. for the most part these have been implemented in drug-free facilities (Boudin and Valentine, 1973; Boudin, Regan and Ruiz, 1976) which, though theoretically appealing to the behaviorist, attract relatively few clients. No published studies assess contracting in methadone maintenance clinics, These facilities are often understaffed, chaotic and lacking in professional personnel, and represent a difficult and challenging site in which to implement behavior change procedures. MFTHOD

Therupists The therapists were two female staff counselors counselled and dispensed methadone to 40 clients.

(a nurse

and

a paraprofessional

health

worker).

Each

* Requests for reprints and a more detailed report of these studies can be obtained from the senior author whose address is: 1490 Fifth Avenue, University of California, San Francisco. California 94143. U.S.A. The research was supported by NIDA Program Project Grant DA No. 4RG012. The authors wish to thank Dr. William Hargreaves, Dr. David Levine and Robin Hammerman, R.N. for their support and interest.

An investigation of the relation between reported fear and heart rate.

Behav. Res. & Therapy. 1977, Vol IS. pp 435 438. Pergamon CASE HISTORIES Press. Printed m Great Bntain AND SHORTER COMMUNICATIONS An investigat...
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