International Journal of Clinical and Experimental Hypnosis
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Experimental analysis of techniques for eliminating obsessions David F. Barone , Gerald S. Blum & Marcia L. Porter To cite this article: David F. Barone , Gerald S. Blum & Marcia L. Porter (1975) Experimental analysis of techniques for eliminating obsessions, International Journal of Clinical and Experimental Hypnosis, 23:4, 236-248, DOI: 10.1080/00207147508415949 To link to this article: http://dx.doi.org/10.1080/00207147508415949
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The In(etndional Journd of Clinic41 and &+pCrimm(ol avprapb 1976, Vol. XXIZI, No. 4, 238-248
EXPERIMENTAL ANALYSIS OF TECHNIQUES FOR ELIMINATING OBSESSIONS1
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
DAVID F. BARONE: GERALD S. BLUM, MARCIA L. PORTER8
AND
University of California, Santa Barbara
Abstract: Although psychoanalysis and learning theory have both dealt with obsessions, there is little pertinent empirical research. The present exploration, carried out with 2 female subjects thoroughly trained in hypnotic programming techniques, compared the effects of 4 types of interventions on an experimentally induced obeessional thought serving a defensive or non-defensive function. For the first 5 sec. of each trial, the subject was led to consciously experience obsessive concern over her mother’s well-being, accompanied by an unconscious violent or non-violent antecendent. Then one of these 5-sec. interventions followed: (1) a posthypnotic “blank mind” in which there were no thoughts, feelings or sensations; (2) a “substitute thoughts” condition; (3) an aversive white noise; and (4) a control procedure in which the subject was told simply to think about anything that came to mind. Each trial ended with a 2O-sec. free period for spontaneous thought. The blank mind intervention was found to be most consistently effective in immediately eliminating the obsession and in reducing its spontaneous recurrence in the free period. There were no differences associated with the violent vs. non-violent antecedent. The clinical and research implications of these findings are discussed.
There are various sources of hypotheses about obsessions, including psychoanalytic interpretations (see Fenichel, 1945) and derivations from learning theory (Taylor, 1963; Wolpe, 1958), but directly relevant research is scarce. Metzner (1963), basing his observations on animal learning experiments, has pointed out t h a t such analyses entail t h e admittedly tenuous assumption t h a t thought processes of humans are subject to t h e same laws as t h e behavior of animals. Mather (1970) reviewed relevant animal and human analogues of obsessions and compulsions, b u t the primary concern was with compulsions. Although there is a growing literature o n cognitive processes in humans, Bourne, EkManuscript submitted September 28, 1973; final revision received August 15, 1974.
This study was supported by National Institute of Mental Health Grant I16970-03 (G.S.Blum, Principal Investigator). Now at Division of Science, University of Wisconsin-Parkside. a Fieprint requests should be addressed to David F. Barone, Division of Science, University of Wisconsin-Parkside, Kenosha, Wisconsin 53140. 236
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strand, and Dominowski (1971) have noted that the focus is on directed and intentional rather than on uncontrolled thinking. This lack of pertinent research is unfortunate since the prognosi for treatment of obsessions is as poor today (Solyom, Zamanzadeh, Ledwidge, & Kenny, 1973) as when Fenichel wrote. According to the psychoanalytic view, an obsession is typically an intense idea serving as a defense against a strong impulse. It originates in Oedipal conflicts, along with regression to an anal-sadistic level. The idea acquires an obsessional form because it serves the defensive function of alleviating anxiety and also accommodates the unrelenting superego commands characteristic of anal-sadistic regression. For example, a girl’s continuing preoccupation with her mother’s health and safety can serve as a defense against more unacceptable violent impulses toward her mother, and can also mollify superego demands. In the learning tradition, Walton and Mather (1964) also recognize the avoidance function of obsessive-compulsive actions, but noted that in chronic cases they may become completely unrelated to the original impulse. It is even possible for persistent thoughts to exist that do not Serve an obvious defensive or avoidant function. Theoretically, such thoughta grow out of attempts to find a solution to an insoluble problem or they are repetitions of a partially successful solution (Dollard & Miller, 1950; Lazarus, 1971; Mather, 1970; Metzner, 1963). Although behavior therapists acknowledge the need for extended therapeutic intervention in cases of obsession, they have tried to deveIop a procedure for their short-term elimination. This direct attack on the symptomatology as one part of the therapeutic process is not without earlier support from psychodynamically-oriented therapists (Alexander & French, 1946; Wolberg, 1965). The procedure consists of the presentation of a “disruptive” stimulus, such as the word “Stop!” shouted by the therapist or the administration of electric shock, accompanied by the instruction that the client have pleasant thoughta or no thoughts at all (Garfield, McBrearty, & Dichter, 1969; Lazarus, 1971; Marks, Rachman, & Gelder, 1965; McGuire & Vallance, 1964; Solyom et al., 1973; Wolpe, 1958,1969; Wolpe & Lazarus, 1966). It may be noted that the choice of a disruptive stimulus need be limited only by the clinician’s ingenuity. For example, high levels of white noise have been found to be aversive for humans (Azrin, 1958). Although disruptions have typically been accompanied by instructed pleasant thoughts (Garfield et al., 1969), any strong, competing substitute thought might serve the same function. The production of “no thoughts” or a blank mind is more difficult. Bandura (1969) has pointed out that merely instructing the client to banish disturbing thoughts from his mind is insufficient, a fact noted earlier by
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Dollard and Miller (1950) when they assumed that there waa no direct mechanism for inducing a blank mind. More recently, however, techniques involving hspnosis have been used to accomplish this end (see Blum, Geiwitz, & Hauenstein, 1967; Graef, 1970).
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
METHOD Subjects TWO female undergraduates participated in the experiment. Both were highly susceptible to hypnosis, aa indicated by a maximumscore of 12 on the Stanford Hypnotic Susceptibility Scale, Form A of Weitzenhoffer and Hilgard (1959) and thoroughly trained in hypnotic techniques. Subject1 had served in experiments involving hypnosis for a 3-year period, and subjeck had taken part in these experiments for 1 year. Hypnotic Programming Obsessions. Prior t o the experiment, which was conducted in the waking state, the subjects were given hypnotic instructions for the creation of an obsessional thought, certain treatment interventions, and methods of reporting. The subjects were programmed (see Blum, 1972 for overview of hypnotic techniques) to have obsessive thoughts derived from the oral-sadistic Blacky picture, which shows Blacky chewing Mama’s collar (Blum, 1950). Each subject was told t o identify with Blacky so that Blacky’s feelings were her own. Two obsessional conditions were programmed prior t o the experiment. In the “non-violent” condition, the conscious concern over Mama’s well-being was assigned the following antecedent : Blacky is fond of Mama and Iikea to play with her, so she a h enjoys shaking Mama’s collar playfully. However, a sudden realization of Mama’s absence forces Blacky’s mind to be totally preoccupied with daughterly concerns over Mama’s health and the anxious wish that no harm might have befallen her.
In the “violent” condition, the same conscious obsession was given a pathogenic or codicted antecedent: Blacky has a deep-seated resentment against Mama snd secretly wishes
to attack her in the same violent way she is shaking Mama’s collar. Consciously, however, Blacky’s mind is totally preoccupied with daughterly concerns over Mama’s health and the anxious wish that no harm might have befallen her.
The antecedents (first sentence of each paragraph quoted above) though implicit in the violent and non-violent conditions, were not to be thought about consciously, however.
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The conscious obsession (second sentence of each paragraph quoted above) in both conditions was instructed to be accompanied by a f&ly strong level of anxiety, 3 on a 5-point scale for which the subjects had already been trained and practiced extensively (see Blum, 1972). m e subject was also told that, az soon as the Blacky picture was e x p o d in full view at the start of each trial, she would immediately have the obseasive thought about Mama’s well-being and would sustain that thought for the 5-sec. duration of the picture. It was emphasked that, for the remainder of each trial, the subject should let her thought processes run freely. In other words, the obsession might either continue, recur later, or be totally absent after the first 5 secs. depending upon what happened in her mind spontaneously. Interventions. Four types of 5-sec. interventions or treatment techniques were employed (the first two were programmed hypnotically in advance of the experiment): (a) a “blank mind” intervention, cued by the visual exposure of the word NULL, in which the subject was instructed to experience no thoughts, feelings, or sensations at all for the duration of the cue exposure; (b) “substitute thoughts,” cued by visual exposure to the initials UCSB, in which the subject was programmed to have the thoughts, “My name is ; I amyears old; I .,, am taking the following courses this quarter at UCSB 1 the nonhypnotic interventions consisted of ( c ) an aversive 100 db white noise4 delivered through earphones, accompanied by visual exposure to the word ROAR; and (d) a control procedure in which the subject was told simply to think about anything that came to mind, cued by a plain white card. Reporting. The subject’s attention waa directed under hypnosis to a small metal box with a depressible button on the table where the subject waz seated. She waz told that later, whenever the thought about Mama’s health crossed her mind, she would press the button on the box, hold it down as long az the thought was present, and then release it when the thought ceased. This was to be done automatically, without conscious awareness. The experimenter pointed out the similarity of this reporting procedure to other hypnotic tasks involving dissociation which the subject had performed in the past, such as automatic writing. Unbeknownst to the subject pressing the button turned on a light adjacent to a timer located in front of the experimenter. The subject was also instructed to experience posthypnotic amnesia at the end of each trial of the subsequent experiment. Finally, practice in 4
The subjects listened to white noise prior to the experiment; they identified
100 db 88 unplessantly loud but not painful and agreed to have it presented in the
experiment.
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every aspect of the hypnotic programming was given, first under hypnosk and then in the waking state. Procedure The waking experiment utilized a 4 X 2 factorial design consiSting of the four interventions (blank mind, substitute thoughts, white nobe, and control) and the two implicit antecedents (violent and non-violent) of the conscious obsession. All combinations were assigned randomly to each subject with 16 triah in each of the 8 conditions, yielding a total of 128 trials sdministered over 3 separate days. The sequence of events on a given trial was as follows: the subject seated in front of a tachistoscope, first glanced aside to see whether the violent or non-violent cue was posted near the hood, and then placed her head in the viewing apparatus. The Blacky picture, which triggered the conscious obsession, appeared for 5-secs. The next 20-sec. segment was a “free period” in which the subject continued to keep her head in the hood. She had previously been told under hypnosis, and again in the waking state, that thia u)-sec. free period was one in which there were no restrictions on what she should think. However, she was to keep track of her spontaneous thoughts in order to report them as fully as poasible a t the conclusion of each trial. At the end of her report, she routinely said “That’s all,” which served as the cue for post-trial amnesia. The subject’s reports were tape-recorded. (Of course, without conscious awareness, the subject also kept her finger poised above the button which controlled the light in front of the experimenter and pressed it whenever the obsessional thought came to mind.)
RESULTS Occurrence of Obsession
The time of occurrence and duration of the obsessional thought was indicated by the light turning on in response to the subject’s button press. Incidence of the obsession for the eight conditions was recorded for the three successive phases of each trial: (a) 5-sec. exposure of the Blacky picture; ( b ) 5-sec. cue intervention period; and (c) 20-sec. free period. Both subjects always pressed the light button continuously in the first 5 secs., which naturally followed from the prior hypnotic programming of the obsession in response to viewing the picture. Table 1 gives the percent of time occupied by the obsession during the intervention period. The virtually complete absence of the obsession in the blank mind intervention accords with the assumption that the subjects’ minds were indeed blank at that time. The control condition showed a fairly high incidence
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24 1
TABLE 1 PERCENT OF TIMEO ~ ~ ~ P BY X EOBSESSION D DUIUNQINTEBVENTION PEUIOU
I I Type of Intervention
Obscasioeal Antecedent
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
%
Blank Mind Substitute Thoughts White Noise Control
I
Subject1
Noa-Violent
%
0.0 10.0 3.8
0.0 7.5 1.2 27.5
45.0
I
Subject;
I
I O h ~ d ~ i Antecedent o~l Violent %
Non-Violent
0.0 1.2 8.8 67.5
1.2 3.8 12.5 77.5
A~~~~~
%
0.3 5.6 6.6 54.4
of the obsession, with subject1 considerably lower than subjecb. The other two experimental interventions, substitute thoughts and white noise, fell between the two extremes, with white noise being the more effective in the elimination of the obsession for subject1 and substitute thoughts for subject+ Separate analyses of variance for each subject indicated these intervention period differences to be statistically significant (p < .Or), whereas the two types of antecedents did not differ from each other and the interactions were also nonsignificant. Pairwise comparisons of the interventions, combined acrom violent and nonviolent antecedents, revealed that for subject1 a blank mind and white noise were superior to the other interventions (p < .05) but no difierent from each other. For subjecb a blank mind and substitute thoughts were significantly more effective. Table 2 gives the comparable data for the 20-sec. free period where the subject had been instructed t o let her thoughts flow spontaneously. For both subjects the occurrence of the obsession increased somewhat over TABLE 2 PERCENT OF TIMEOCCUPIED BY OBSESSIONDURING FREEPERIOD
T,,,,~ of ti^^ ti^^
Subject1
Subjectt
Obsessional Antecedent
Obeasional Antecedent
%
Blank Mind Substitute Thoughts White Noise Control
8.5 14.8 9.5 12.2
I
Non-vent
8.2 15.2 4.6 7.6
%
7.6 10.5 24.3 31.3
I
A
~
Noo-Violent
%
17.1 14.5 16.1 41.5
10.4 13.8 13.6 23.7
~
~
.
~
~
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BARONE ET AL.
its intewention period level in the three intervention conditions, but decreased considerably in the control condition. Analy~esof variance for each subject once more yielded statistically signifcant differences for the interventions 0, < .Ol) but not for the antecedents or the interactions. Combining the violent and non-violent antecedents revealed a pattern of r e d t s very similar t o the intervention period, though the differences were not as large. For subjectl, a blank mind and white noise were again superior t o the others but no Werent from each other, for subject a blank mind and substitute thoughts were more effective.
Postexperimental Inquiry Comments Immediately following the experiment, the subjects were queried in detail under hypnosis concerning their responses to the various phases of the procedure. The initial glance at the violent or non-violent cue produced no discernible effect on subjectl, who stated merely that she felt she was responding but no consciow thoughts ever entered her mind. However, subjeck had feelings of violence toward her mother when she saw the violent cue and was happily disposed toward her for the other, but she “didn’t think about it.” The obsessional thought in response to viewing the Blacky picture was described by subject1 as very “distressing” and consisted of “worrying about mother, wondering where she was, and hoping that she was okay.” Subjecb said that she thought “something was going to happen to mother” that she did not want to happen, and that ‘(she should be very careful and not get sick or something dangerous like that.” She described her own state as very anxious, with “adrenalin in my body, stomach churning and coming up to my throat.” It was thus apparently eaay for the subjects to introject the feelings ascribed to Blacky, especially since they had had intensive prior familiarity with all the Blacky pictures, including narration under hypnosis of their own personal experiences suggested by each one. The 5-sec. interventions after the Blacky picture produced the following reactions. For a blank mind, subject1 felt that everything was ‘‘shut out, nothing in my mind, didn’t hear or see anything except the uord NULL, which I didn’t really think about.’’ Subjectz experienced everything going blank, like being in black, with nothing there except a vague impression of the word NULL. Both subjects stated that the 5-sec. period of substitute thoughts was filled only with the thoughts about their own name, age, and current list of classes. The white noise intervention was “terrible” and made subjectl very anxious, usually wiped out any thoughts, and she just sat there waiting for it to end. The noise startled subjectz every time, made her jump, and caused everything to go out of her mind. For the control condition, both subjects reported that
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
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thoughts about mother often continued; a t other times, miscellmmus thoughts took over. The subjects ah0 offered some comments as to how the intenrentions atrected thought processes in the free period. After a blank mind subject, felt as if she waa “waking up from a dreamless sleep, 88 if starting with nothing, just letting things come in.” Both stated that the substitute thoughts cue resulted in more school-related thoughts in the free period. Subjeck characterized the white noise period as a ‘long interruption, after which the earlier thoughts often came back.” Both asserted that, during the experiment, they were unaware of pressing the button and that the instructed posthypnotic amnesia after each trial was always experienced. When asked to give their impression of how the interventiom had actually affected their obsessive thoughts, subjectl correctly ranked a blank mind first. Subjectz, however, felt that the substitute thoughts had reduced the obsession most, whereas in reality a blank mind had been generally more effective.The latter observation opposes possible explanation of her data in terms of the operation of demand characteristics.
DISCUSSION The use of hypnotic programming to experimentally induce obsessional though& was successful. Throughout the exposure of the Blacky picture used to cue the obsession, both subjects signaled the occurrence of the obsession almost continuously. Later they reported the contents of the obsession to be a concern with mother’s well-being accompanied by quite a bit of anxiety. Their honesty in reporting had been established on numerous past occasions in the course of their extensive laboratory experience, when independent checks were more available than in the present case.s Success in programming the violent and non-violent antecedents of the o b s e o n is of course more elusive t o pin down since the accompanying cognitions were instructed to occur without conscious awareness; however, one of the two subjects did report feelings appropriate to the antecedents. No statistically significant dif€erenceswere found in the occurrence of the violent or non-violent obsession during the obsession cue period, the intervention period, or the free period. Also, interventions did not differentially affect the two antecedents, shown statistically by the lack of an interaction effect. Thus, although defensive and nondefensive obsessions are conceptually distinguishable, they were not 6 See a detailed discussion of the issues of honest reporting and operation of demand characteristics, based partly on participation of these same two subjects in an experiment on selective loss of concentration, in Blum and Porter, 1973.
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empirically distinguishable in this study. If this finding is replicated in other studies, it will have important implications for the theory and treatment of obsession. Especially valuable would be replications with naturally-occurring obsessions judged to be defensive or nondefensive, obsessions experimentally induced by methods other than the one used in this study, and obsessions with themes other than health and safety. The antecedents used in this study also need to be clarified and a better method devised for verifying their occurrence as programmed. The ditrerential success of the four interventions in eliminating the obsession during the intervention period was in agreement with the instructed efEects: the blank mind eliminated the obsession and the control condition favored its continuation, with the substitute thoughts and white noise falling in between (in a different order for each subject). The same differential succm was maintained during the free period which followed the termination of the intervention cue. The blank mind had the lowest recurrence, the control the highest, and substitute thoughts and white noise in between. The findings suggest that the blank-mind manipulation is most consistently effective for immediately eliminating an obsession and for reducing its recurrence. Depending on the person, substitute thoughts and white noise can also be effective in reducing the occurrence of an obsession. However, there are problems associated with these interventions. Substitute thoughts may turn out to be associated with the obsession, as was the case for subjectl, whose thoughts about school led to thoughts of a visit by her mother. For her, the obsession recurred more frequently in the substitute thoughts condition than in the control condition. White noise, and perhaps other loud auditory stimuli (e.g., a therapist shouting “Stop!”), can produce emotional and behaviord 5 e c t s typical of aversive stimuli, as was evidenced by both subjects in this study. Mather (1970) presented evidence that compulsions can be caused by aversive stimuli but cannot consistently be cured by aversive stimuli.Besides, such stimuli require a therapist to administer them and an honest patient to report his obsession when it occurs. Of course, the aversive stimulus could be self-administered; however, such a prmtice would be suspect with a syndrome involving a large amount of guilt and strong self-punitive tendencies (cf. Fenichel, 1945; Mather, 1970). A therapist should therefore be cautious in wing substitute thoughts or external stimuli t o disrupt an obsession since they may be drawn into the syndrome and become a part of it. A blank mind, on the other hand, is the very opposite of the feverish mental and behavioral activity characteristic of the obsessive syndrome. Although the mechanisms which underlie mind-emptying v8. mind-
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distracting interventions are only beginning to be explored (we Blum and Porter, 1973 for a theory of inhibition and competition), the pursuit of the blanl-mind experience is already well under way in Western society. This study provides evidence for the value of this experience in the case of experimentally induced health and safety obsessions. Of course, this evidence should be replicated as discussed above. Of particular interest would be the potential training and application of the blank-mind manipulation under general conditions of relaxation without the specific use of hypnosis. Other possible intervention strategies also merit consideration. The blank-mind intervention could be programmed to occur automatically with every occurrence of the obsession, in contrast to the single intervention period in this study. With the obsession being persistently eliminated, it is then possible t o consider combining the blank-mind intervention with a subsequent substitute thought. In her inquiry subjectz actually endorsed this suggestion when she stated that a blank mind is more effectivein eliminating the obsession but there is a chance for it to recur after the void. With an already salient and available substitute thought to fill the gap, the likelihood of recurrence would be further minimized. In conclusion, this pilot study attests generally to the potential of hypnotic programming techniques for laboratory exploration of clinical phenomena, and specifically to the utility of the blank-mind intervention for reducing obsessional thought.
REFERENCES ALEXANDER, F., & FRENCH, T. M. Psychoanalytic therapy. New York: Ronald Press, 1946. AZRIN,N. H. Some effects of noise on human behavior. J . e z p . Anal. Behav., 1958, 1,183-200. BANDURA, A. Principles o f behavior modijkation. New York: Holt, Rinehart & Winston, 1 x 9 . BLUM,G. S. The Blacty pictures: A technique for the ezploration of personality dynamics. Ann Arbor, Mich. : Psychodynamic Instruments, 1950. BLUM,G. S. Hypnotic programming techniques in psychological experiments. In E. F r o m , & R. E. Shor (Eds.), Hypnosis: Research developments and perspectives. Chicago: Aldine-Atherton, 1972. Pp. 359-385. BLDM,G. S., GEIWITZ, P. J., & HAUENSTEIN, L. S. Principles of cognitive reverberation. Behav. Sci., 1967, 13, 275-288. BLUM,G. S., & PORTER,M. L. The capacity for selective concentration on color versus form of consonants. Cog. Psychol., 1973, 6 , 47-70. BOURNE, L. E., JR., EKSTFCAND, B. R., & DOMINOWEKI, R. L. The psychology of thinking. Englewood Cliffs, N. 3. : Prentice-Hall, 1971. DOLLARD, J., & MILLER,N . E . Personality and psychotherapy: A n analysis i n terms of learning, thinking and culture. New York: McGraw-Hill, 1950. FSNICHEL, 0. The psychoanalytic theory of neurosis. New York: Norton, 1945.
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GABFIELD, Z. H., MCBBEABTY, J. F., & DICHTEE,M.A C a S e Of impotence S U C -fully treated with desensitization combined with i n vim operant training and thought substitution. In R. D. Rubin & C. M. Franks (Eds.),Advances in behavior therapy, 1968. New York: Academic Press, 1969. Pp. 97-103. GRAEF,J. R. The iduence of cognitive states on time estimation and subjective time rate. Unpublished doctoral dissertation, Univer. of Michigan, 1969. LAZARUS, A. A. Behavior therapy and beyond. New York: McGraw-Hill, 1971. ~ K S I. M., , RACEMAN, S., & GELDEB,M. G. Methods for assessment of aversion treatment in fetishism with masochism. Behav. Res. Ther., 1965,S,253-258. MATHER, M. D. Obsessions and compulsions. I n C. G. Costello (Ed.), Symptoms of psychopathology: A handbook. New York: John Wiley UZ Sons, 1970. Pp. 302319.
MCGUIRE,R. J., & VALLANCE, M. Aversion therapy by electric shock: A simple technique. Brit. med.J . , 1964,1,151-153. METZNEB, R. Some experimental analogues of obsession. Behav. Res. Ther., 1963, f ,
231-236. SOLYOM, L., ZAHANZADEH, D., LEDWIDQE, B.. & KENNY, F. Aversion relief treatment of obsessive neurosis. In R. D. Rubin, EL Fensterheim, A. A. Lazarus, & C. Franks (Ede.),Aduances i n behavior therapy. New York: Academic Press, 1973. Pp. 93-109. TAYLOR, J. G. A behavioural interpretation of obsessive-compulsive neurosis. Behav. Res. Ther. 1963, I , 237-244. WALTON, D., & MATHER, M. D. The application of learning principles to the treatment of obsessive-compulsive states in the acute and chronic phases of illness. I n H. J. Eysenck (Ed.), E z p e r i m d s in behwiour therapy: Readings in modern methods of treatment of mental disorders derived from learning theory. New York: MacMillan, 1964. Pp. 117-151. WEITZENHOFFEB, A. M., C HILQARD, E. R. Stanford Hypnotic Susceptibility Scale, Forms A and B . Palo Alto, Calif.: Consulting Psychologista Press, 1959. WOLBERQ, L. R. The technique of short-term psychotherapy. In L. R. Wolberg (Ed.), d b t - t e m r psychotherapy. New York: Grune & Stratton, 1965. Pp. 121-200.
WOLPE,J. Psychotherapy by reciprocal inhibition, Stanford, Calif. : Stanford Univer. Press, 1958. WOLPE,J. The practice of behavior therapy. New York: Pergamon Press, 1969. WOLPE,J., & LAZARUS, A. A. Behavior therapy techniques: A guide to (he treatment of neuroses. London : Pergamon PI&, 1966. Expe3mentelle Analyse der Techniken zur Eliminierung des Besessenseins David F. Barone. Gerald S. Blum und Marcia L. Porter Abstrakt : Obgleich Psychoanalyse und Lernenstheorie sich h i d e mit dem Besessenseinbeschaftigt haben, besteht doch kaum eine einschlagige. empirische Forschung auf diesem Gebiet. Die hier vorliegende Forschung. die an 2 weiblichen Subjekten durchgef6hrt wurde. die beide griindlich i n hypnotischen Programmtechniken geschult waren, verglich die Effekte .der 4 Interventionstypen hi einem experimentell induzierten. besessenden Gedanken mit defensiver oder nicht-defensiver Funktion. In den ers t e n 5 Sek. eines jeden Versuchs brachte man das Subjekt dazu, bewusst eine zwanghafte Besorgnie urn das Wohlbefinden seiner Mutter zu erleben.
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Dieser Zustand war von einem unbewussten, heftigen oder nicht-heftigen Vorleben begleitet. Danach folgten dann eine dieser 5 Sek. langen Interventionen: (1) eine posthypnotische “Geistesleere” ohne irgendwelche Gedanken, Gefiihle oder Sensationen; (2) ein Zustand mit “Substitutionsgedanken”; (3) ein unertriiglicher, weisser Ton. und (4) ein Kontrollverfahren, bei dem man dem Subjekt befahl, einfach iiber das n a c b u d e n ken, was ihm in den Kopf kiime. Jeder Versuch endete mit einer freien, 20 Sek. langen Periode fiir spontanes Denken. Man fand. dass die Intervention, die Geistesleere bewirkte, a m bestiindigsten in ihrem Effekt war, die Besessenheit sofort zu eliminieren und ihre spontane Wiederkehr in der freien Periode zu reduzieren. Man fand keine Unterschiede, die mit dem heftigen und nicht-heftigen Vorleben assoziiert waren. Die klinischen und forschungsbezogenen Implikationen dieser Befunde werden bier eriirtert. Analyse exptrimentale de techniques d’tlimination des obsessions David F. Barone, Gerald S. Blum et Marcia
L. Porter
R t s u m b : Bien que la psychanalyse et la thkorie de l’apprentissage se soient toutes deux prtoccuptes des obsessions, il existe peu de recherche8 empiriques pertinentes. Une dtude exploratoire, mente avec 2 Ss de sexe ftminin parfaitement entrain& dans les techniques de prograxnmation hypnotique, compare les effets de 4 types d’intervention sur des p e n s k s obsessionnelles induites expkrimentalement e t servant une fonction d6fensive ou non dtfensive. Pendant les premiares 5 secondes de chaque essai, on a m h e le sujet faire l’exphrience consciente d’une prtoccupation obsessive concernant le bien-&tre de sa mCre, experience accompagnke d’un anttctdant inconscient violent ou non violent. Le s est alors s o d s P l’une des interventions de 5 secondes qui suivent: (1) la cr6ation posthypnotique d’un “vide intbrieur”, dans lequel il n’y a aucune pensie, aucun sentiment et aucune sensation; (2) une condition de “penstes substitutives”; (3) un bruit de fond aversif; e t (4) une procMure de contrble dans laquelle on demande simplement au sujet de penser P quoi que ce soit qui lui vienne 31 l’esprit. Chaque essai se termine par une phriode fibre de 2.0 sec., resewbe P la pens6e spontanke. La crdation d’un vide interieur est la technique la plus const-ent efficace pour tliminer i-aiatement l’obsession et pour raduire sa rtcurrence dans la ptriode libre. Aucune d s t r e n c e n’est associte aux antecedents violent ou non violent. Suit une discussion des implications cliniques e t exptrimentales de ces rtsultats. Andlisis experimental de las ttcnicas empleadas para eliminar obsesiones David F. Barone, Gerald S. Blum y Marcia
L. Porter
Resumen: Aunque el psicoanilisis y la teoria del aprendizaje se han ocupado de las obsesiones, se dispone de poca investigaci6n empirica adecuada. La presente exploracibn, llevada a cab0 con 2 sujetos femeninos perfectamente ejercitados en las tdcnicas de programaci6n hipnbtica, compara 10s efectos de 4 tipos de intervenciones sobre una idea obsesiva inducida experimentahente, y que desempeaa una funci6n defensiva o no defensiva. Durante 10s primcros 5 seg. de cada ensayo, el sujeto es Ile-
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vado a expcrimentar conscientemente una preocupaci6n obsesiva por el bienestar de eu madre. acompaiiada por un antecedente inconsciente violento o no violento. Tiene lugar, a continuaci6n. una de estas intervenciones de 5 eeg.: 0)sugeeti6n posthipn6tica de “mente en blanco”, que implica la ausencia de ideas, eentimientoa o sensaciones: (2) condici6n de “ideas substitutivas”: (S) ruido blanco aversivo: (4) procedimiento de control. en el que ee dice a1 sujeto que piense en cualqnier cosa que se le ocurra. Cadn ensayo termina con un period0 libre de 20 see. de p e n s d e n t o espontAneo. Ss encuentra que la intervenci6n “mente en blanco” es la m4s mnsistantemente eficaz en la eliminaci6n inmediata de la obsesi6n y en la reducci6n de su reaparicidn esponthea durante el perfodo libre. No hay diferenciaa asociadas a la distinci6n antecedente violento-antecedente no violento. Se discuten lae implicaciones cllnicas y relativas a la investigaci6n. de estos hallazgos.
ISSN: 0020-7144 (Print) 1744-5183 (Online) Journal homepage: http://www.tandfonline.com/loi/nhyp20
Experimental analysis of techniques for eliminating obsessions David F. Barone , Gerald S. Blum & Marcia L. Porter To cite this article: David F. Barone , Gerald S. Blum & Marcia L. Porter (1975) Experimental analysis of techniques for eliminating obsessions, International Journal of Clinical and Experimental Hypnosis, 23:4, 236-248, DOI: 10.1080/00207147508415949 To link to this article: http://dx.doi.org/10.1080/00207147508415949
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The In(etndional Journd of Clinic41 and &+pCrimm(ol avprapb 1976, Vol. XXIZI, No. 4, 238-248
EXPERIMENTAL ANALYSIS OF TECHNIQUES FOR ELIMINATING OBSESSIONS1
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
DAVID F. BARONE: GERALD S. BLUM, MARCIA L. PORTER8
AND
University of California, Santa Barbara
Abstract: Although psychoanalysis and learning theory have both dealt with obsessions, there is little pertinent empirical research. The present exploration, carried out with 2 female subjects thoroughly trained in hypnotic programming techniques, compared the effects of 4 types of interventions on an experimentally induced obeessional thought serving a defensive or non-defensive function. For the first 5 sec. of each trial, the subject was led to consciously experience obsessive concern over her mother’s well-being, accompanied by an unconscious violent or non-violent antecendent. Then one of these 5-sec. interventions followed: (1) a posthypnotic “blank mind” in which there were no thoughts, feelings or sensations; (2) a “substitute thoughts” condition; (3) an aversive white noise; and (4) a control procedure in which the subject was told simply to think about anything that came to mind. Each trial ended with a 2O-sec. free period for spontaneous thought. The blank mind intervention was found to be most consistently effective in immediately eliminating the obsession and in reducing its spontaneous recurrence in the free period. There were no differences associated with the violent vs. non-violent antecedent. The clinical and research implications of these findings are discussed.
There are various sources of hypotheses about obsessions, including psychoanalytic interpretations (see Fenichel, 1945) and derivations from learning theory (Taylor, 1963; Wolpe, 1958), but directly relevant research is scarce. Metzner (1963), basing his observations on animal learning experiments, has pointed out t h a t such analyses entail t h e admittedly tenuous assumption t h a t thought processes of humans are subject to t h e same laws as t h e behavior of animals. Mather (1970) reviewed relevant animal and human analogues of obsessions and compulsions, b u t the primary concern was with compulsions. Although there is a growing literature o n cognitive processes in humans, Bourne, EkManuscript submitted September 28, 1973; final revision received August 15, 1974.
This study was supported by National Institute of Mental Health Grant I16970-03 (G.S.Blum, Principal Investigator). Now at Division of Science, University of Wisconsin-Parkside. a Fieprint requests should be addressed to David F. Barone, Division of Science, University of Wisconsin-Parkside, Kenosha, Wisconsin 53140. 236
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strand, and Dominowski (1971) have noted that the focus is on directed and intentional rather than on uncontrolled thinking. This lack of pertinent research is unfortunate since the prognosi for treatment of obsessions is as poor today (Solyom, Zamanzadeh, Ledwidge, & Kenny, 1973) as when Fenichel wrote. According to the psychoanalytic view, an obsession is typically an intense idea serving as a defense against a strong impulse. It originates in Oedipal conflicts, along with regression to an anal-sadistic level. The idea acquires an obsessional form because it serves the defensive function of alleviating anxiety and also accommodates the unrelenting superego commands characteristic of anal-sadistic regression. For example, a girl’s continuing preoccupation with her mother’s health and safety can serve as a defense against more unacceptable violent impulses toward her mother, and can also mollify superego demands. In the learning tradition, Walton and Mather (1964) also recognize the avoidance function of obsessive-compulsive actions, but noted that in chronic cases they may become completely unrelated to the original impulse. It is even possible for persistent thoughts to exist that do not Serve an obvious defensive or avoidant function. Theoretically, such thoughta grow out of attempts to find a solution to an insoluble problem or they are repetitions of a partially successful solution (Dollard & Miller, 1950; Lazarus, 1971; Mather, 1970; Metzner, 1963). Although behavior therapists acknowledge the need for extended therapeutic intervention in cases of obsession, they have tried to deveIop a procedure for their short-term elimination. This direct attack on the symptomatology as one part of the therapeutic process is not without earlier support from psychodynamically-oriented therapists (Alexander & French, 1946; Wolberg, 1965). The procedure consists of the presentation of a “disruptive” stimulus, such as the word “Stop!” shouted by the therapist or the administration of electric shock, accompanied by the instruction that the client have pleasant thoughta or no thoughts at all (Garfield, McBrearty, & Dichter, 1969; Lazarus, 1971; Marks, Rachman, & Gelder, 1965; McGuire & Vallance, 1964; Solyom et al., 1973; Wolpe, 1958,1969; Wolpe & Lazarus, 1966). It may be noted that the choice of a disruptive stimulus need be limited only by the clinician’s ingenuity. For example, high levels of white noise have been found to be aversive for humans (Azrin, 1958). Although disruptions have typically been accompanied by instructed pleasant thoughts (Garfield et al., 1969), any strong, competing substitute thought might serve the same function. The production of “no thoughts” or a blank mind is more difficult. Bandura (1969) has pointed out that merely instructing the client to banish disturbing thoughts from his mind is insufficient, a fact noted earlier by
BARONE ET AL.
238
Dollard and Miller (1950) when they assumed that there waa no direct mechanism for inducing a blank mind. More recently, however, techniques involving hspnosis have been used to accomplish this end (see Blum, Geiwitz, & Hauenstein, 1967; Graef, 1970).
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
METHOD Subjects TWO female undergraduates participated in the experiment. Both were highly susceptible to hypnosis, aa indicated by a maximumscore of 12 on the Stanford Hypnotic Susceptibility Scale, Form A of Weitzenhoffer and Hilgard (1959) and thoroughly trained in hypnotic techniques. Subject1 had served in experiments involving hypnosis for a 3-year period, and subjeck had taken part in these experiments for 1 year. Hypnotic Programming Obsessions. Prior t o the experiment, which was conducted in the waking state, the subjects were given hypnotic instructions for the creation of an obsessional thought, certain treatment interventions, and methods of reporting. The subjects were programmed (see Blum, 1972 for overview of hypnotic techniques) to have obsessive thoughts derived from the oral-sadistic Blacky picture, which shows Blacky chewing Mama’s collar (Blum, 1950). Each subject was told t o identify with Blacky so that Blacky’s feelings were her own. Two obsessional conditions were programmed prior t o the experiment. In the “non-violent” condition, the conscious concern over Mama’s well-being was assigned the following antecedent : Blacky is fond of Mama and Iikea to play with her, so she a h enjoys shaking Mama’s collar playfully. However, a sudden realization of Mama’s absence forces Blacky’s mind to be totally preoccupied with daughterly concerns over Mama’s health and the anxious wish that no harm might have befallen her.
In the “violent” condition, the same conscious obsession was given a pathogenic or codicted antecedent: Blacky has a deep-seated resentment against Mama snd secretly wishes
to attack her in the same violent way she is shaking Mama’s collar. Consciously, however, Blacky’s mind is totally preoccupied with daughterly concerns over Mama’s health and the anxious wish that no harm might have befallen her.
The antecedents (first sentence of each paragraph quoted above) though implicit in the violent and non-violent conditions, were not to be thought about consciously, however.
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The conscious obsession (second sentence of each paragraph quoted above) in both conditions was instructed to be accompanied by a f&ly strong level of anxiety, 3 on a 5-point scale for which the subjects had already been trained and practiced extensively (see Blum, 1972). m e subject was also told that, az soon as the Blacky picture was e x p o d in full view at the start of each trial, she would immediately have the obseasive thought about Mama’s well-being and would sustain that thought for the 5-sec. duration of the picture. It was emphasked that, for the remainder of each trial, the subject should let her thought processes run freely. In other words, the obsession might either continue, recur later, or be totally absent after the first 5 secs. depending upon what happened in her mind spontaneously. Interventions. Four types of 5-sec. interventions or treatment techniques were employed (the first two were programmed hypnotically in advance of the experiment): (a) a “blank mind” intervention, cued by the visual exposure of the word NULL, in which the subject was instructed to experience no thoughts, feelings, or sensations at all for the duration of the cue exposure; (b) “substitute thoughts,” cued by visual exposure to the initials UCSB, in which the subject was programmed to have the thoughts, “My name is ; I amyears old; I .,, am taking the following courses this quarter at UCSB 1 the nonhypnotic interventions consisted of ( c ) an aversive 100 db white noise4 delivered through earphones, accompanied by visual exposure to the word ROAR; and (d) a control procedure in which the subject was told simply to think about anything that came to mind, cued by a plain white card. Reporting. The subject’s attention waa directed under hypnosis to a small metal box with a depressible button on the table where the subject waz seated. She waz told that later, whenever the thought about Mama’s health crossed her mind, she would press the button on the box, hold it down as long az the thought was present, and then release it when the thought ceased. This was to be done automatically, without conscious awareness. The experimenter pointed out the similarity of this reporting procedure to other hypnotic tasks involving dissociation which the subject had performed in the past, such as automatic writing. Unbeknownst to the subject pressing the button turned on a light adjacent to a timer located in front of the experimenter. The subject was also instructed to experience posthypnotic amnesia at the end of each trial of the subsequent experiment. Finally, practice in 4
The subjects listened to white noise prior to the experiment; they identified
100 db 88 unplessantly loud but not painful and agreed to have it presented in the
experiment.
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every aspect of the hypnotic programming was given, first under hypnosk and then in the waking state. Procedure The waking experiment utilized a 4 X 2 factorial design consiSting of the four interventions (blank mind, substitute thoughts, white nobe, and control) and the two implicit antecedents (violent and non-violent) of the conscious obsession. All combinations were assigned randomly to each subject with 16 triah in each of the 8 conditions, yielding a total of 128 trials sdministered over 3 separate days. The sequence of events on a given trial was as follows: the subject seated in front of a tachistoscope, first glanced aside to see whether the violent or non-violent cue was posted near the hood, and then placed her head in the viewing apparatus. The Blacky picture, which triggered the conscious obsession, appeared for 5-secs. The next 20-sec. segment was a “free period” in which the subject continued to keep her head in the hood. She had previously been told under hypnosis, and again in the waking state, that thia u)-sec. free period was one in which there were no restrictions on what she should think. However, she was to keep track of her spontaneous thoughts in order to report them as fully as poasible a t the conclusion of each trial. At the end of her report, she routinely said “That’s all,” which served as the cue for post-trial amnesia. The subject’s reports were tape-recorded. (Of course, without conscious awareness, the subject also kept her finger poised above the button which controlled the light in front of the experimenter and pressed it whenever the obsessional thought came to mind.)
RESULTS Occurrence of Obsession
The time of occurrence and duration of the obsessional thought was indicated by the light turning on in response to the subject’s button press. Incidence of the obsession for the eight conditions was recorded for the three successive phases of each trial: (a) 5-sec. exposure of the Blacky picture; ( b ) 5-sec. cue intervention period; and (c) 20-sec. free period. Both subjects always pressed the light button continuously in the first 5 secs., which naturally followed from the prior hypnotic programming of the obsession in response to viewing the picture. Table 1 gives the percent of time occupied by the obsession during the intervention period. The virtually complete absence of the obsession in the blank mind intervention accords with the assumption that the subjects’ minds were indeed blank at that time. The control condition showed a fairly high incidence
TECHNIQUES FOR ELIMINATING OBSESSIONS
24 1
TABLE 1 PERCENT OF TIMEO ~ ~ ~ P BY X EOBSESSION D DUIUNQINTEBVENTION PEUIOU
I I Type of Intervention
Obscasioeal Antecedent
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
%
Blank Mind Substitute Thoughts White Noise Control
I
Subject1
Noa-Violent
%
0.0 10.0 3.8
0.0 7.5 1.2 27.5
45.0
I
Subject;
I
I O h ~ d ~ i Antecedent o~l Violent %
Non-Violent
0.0 1.2 8.8 67.5
1.2 3.8 12.5 77.5
A~~~~~
%
0.3 5.6 6.6 54.4
of the obsession, with subject1 considerably lower than subjecb. The other two experimental interventions, substitute thoughts and white noise, fell between the two extremes, with white noise being the more effective in the elimination of the obsession for subject1 and substitute thoughts for subject+ Separate analyses of variance for each subject indicated these intervention period differences to be statistically significant (p < .Or), whereas the two types of antecedents did not differ from each other and the interactions were also nonsignificant. Pairwise comparisons of the interventions, combined acrom violent and nonviolent antecedents, revealed that for subject1 a blank mind and white noise were superior to the other interventions (p < .05) but no difierent from each other. For subjecb a blank mind and substitute thoughts were significantly more effective. Table 2 gives the comparable data for the 20-sec. free period where the subject had been instructed t o let her thoughts flow spontaneously. For both subjects the occurrence of the obsession increased somewhat over TABLE 2 PERCENT OF TIMEOCCUPIED BY OBSESSIONDURING FREEPERIOD
T,,,,~ of ti^^ ti^^
Subject1
Subjectt
Obsessional Antecedent
Obeasional Antecedent
%
Blank Mind Substitute Thoughts White Noise Control
8.5 14.8 9.5 12.2
I
Non-vent
8.2 15.2 4.6 7.6
%
7.6 10.5 24.3 31.3
I
A
~
Noo-Violent
%
17.1 14.5 16.1 41.5
10.4 13.8 13.6 23.7
~
~
.
~
~
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BARONE ET AL.
its intewention period level in the three intervention conditions, but decreased considerably in the control condition. Analy~esof variance for each subject once more yielded statistically signifcant differences for the interventions 0, < .Ol) but not for the antecedents or the interactions. Combining the violent and non-violent antecedents revealed a pattern of r e d t s very similar t o the intervention period, though the differences were not as large. For subjectl, a blank mind and white noise were again superior t o the others but no Werent from each other, for subject a blank mind and substitute thoughts were more effective.
Postexperimental Inquiry Comments Immediately following the experiment, the subjects were queried in detail under hypnosis concerning their responses to the various phases of the procedure. The initial glance at the violent or non-violent cue produced no discernible effect on subjectl, who stated merely that she felt she was responding but no consciow thoughts ever entered her mind. However, subjeck had feelings of violence toward her mother when she saw the violent cue and was happily disposed toward her for the other, but she “didn’t think about it.” The obsessional thought in response to viewing the Blacky picture was described by subject1 as very “distressing” and consisted of “worrying about mother, wondering where she was, and hoping that she was okay.” Subjecb said that she thought “something was going to happen to mother” that she did not want to happen, and that ‘(she should be very careful and not get sick or something dangerous like that.” She described her own state as very anxious, with “adrenalin in my body, stomach churning and coming up to my throat.” It was thus apparently eaay for the subjects to introject the feelings ascribed to Blacky, especially since they had had intensive prior familiarity with all the Blacky pictures, including narration under hypnosis of their own personal experiences suggested by each one. The 5-sec. interventions after the Blacky picture produced the following reactions. For a blank mind, subject1 felt that everything was ‘‘shut out, nothing in my mind, didn’t hear or see anything except the uord NULL, which I didn’t really think about.’’ Subjectz experienced everything going blank, like being in black, with nothing there except a vague impression of the word NULL. Both subjects stated that the 5-sec. period of substitute thoughts was filled only with the thoughts about their own name, age, and current list of classes. The white noise intervention was “terrible” and made subjectl very anxious, usually wiped out any thoughts, and she just sat there waiting for it to end. The noise startled subjectz every time, made her jump, and caused everything to go out of her mind. For the control condition, both subjects reported that
International Journal of Clinical and Experimental Hypnosis 1975.23:236-248.
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thoughts about mother often continued; a t other times, miscellmmus thoughts took over. The subjects ah0 offered some comments as to how the intenrentions atrected thought processes in the free period. After a blank mind subject, felt as if she waa “waking up from a dreamless sleep, 88 if starting with nothing, just letting things come in.” Both stated that the substitute thoughts cue resulted in more school-related thoughts in the free period. Subjeck characterized the white noise period as a ‘long interruption, after which the earlier thoughts often came back.” Both asserted that, during the experiment, they were unaware of pressing the button and that the instructed posthypnotic amnesia after each trial was always experienced. When asked to give their impression of how the interventiom had actually affected their obsessive thoughts, subjectl correctly ranked a blank mind first. Subjectz, however, felt that the substitute thoughts had reduced the obsession most, whereas in reality a blank mind had been generally more effective.The latter observation opposes possible explanation of her data in terms of the operation of demand characteristics.
DISCUSSION The use of hypnotic programming to experimentally induce obsessional though& was successful. Throughout the exposure of the Blacky picture used to cue the obsession, both subjects signaled the occurrence of the obsession almost continuously. Later they reported the contents of the obsession to be a concern with mother’s well-being accompanied by quite a bit of anxiety. Their honesty in reporting had been established on numerous past occasions in the course of their extensive laboratory experience, when independent checks were more available than in the present case.s Success in programming the violent and non-violent antecedents of the o b s e o n is of course more elusive t o pin down since the accompanying cognitions were instructed to occur without conscious awareness; however, one of the two subjects did report feelings appropriate to the antecedents. No statistically significant dif€erenceswere found in the occurrence of the violent or non-violent obsession during the obsession cue period, the intervention period, or the free period. Also, interventions did not differentially affect the two antecedents, shown statistically by the lack of an interaction effect. Thus, although defensive and nondefensive obsessions are conceptually distinguishable, they were not 6 See a detailed discussion of the issues of honest reporting and operation of demand characteristics, based partly on participation of these same two subjects in an experiment on selective loss of concentration, in Blum and Porter, 1973.
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empirically distinguishable in this study. If this finding is replicated in other studies, it will have important implications for the theory and treatment of obsession. Especially valuable would be replications with naturally-occurring obsessions judged to be defensive or nondefensive, obsessions experimentally induced by methods other than the one used in this study, and obsessions with themes other than health and safety. The antecedents used in this study also need to be clarified and a better method devised for verifying their occurrence as programmed. The ditrerential success of the four interventions in eliminating the obsession during the intervention period was in agreement with the instructed efEects: the blank mind eliminated the obsession and the control condition favored its continuation, with the substitute thoughts and white noise falling in between (in a different order for each subject). The same differential succm was maintained during the free period which followed the termination of the intervention cue. The blank mind had the lowest recurrence, the control the highest, and substitute thoughts and white noise in between. The findings suggest that the blank-mind manipulation is most consistently effective for immediately eliminating an obsession and for reducing its recurrence. Depending on the person, substitute thoughts and white noise can also be effective in reducing the occurrence of an obsession. However, there are problems associated with these interventions. Substitute thoughts may turn out to be associated with the obsession, as was the case for subjectl, whose thoughts about school led to thoughts of a visit by her mother. For her, the obsession recurred more frequently in the substitute thoughts condition than in the control condition. White noise, and perhaps other loud auditory stimuli (e.g., a therapist shouting “Stop!”), can produce emotional and behaviord 5 e c t s typical of aversive stimuli, as was evidenced by both subjects in this study. Mather (1970) presented evidence that compulsions can be caused by aversive stimuli but cannot consistently be cured by aversive stimuli.Besides, such stimuli require a therapist to administer them and an honest patient to report his obsession when it occurs. Of course, the aversive stimulus could be self-administered; however, such a prmtice would be suspect with a syndrome involving a large amount of guilt and strong self-punitive tendencies (cf. Fenichel, 1945; Mather, 1970). A therapist should therefore be cautious in wing substitute thoughts or external stimuli t o disrupt an obsession since they may be drawn into the syndrome and become a part of it. A blank mind, on the other hand, is the very opposite of the feverish mental and behavioral activity characteristic of the obsessive syndrome. Although the mechanisms which underlie mind-emptying v8. mind-
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distracting interventions are only beginning to be explored (we Blum and Porter, 1973 for a theory of inhibition and competition), the pursuit of the blanl-mind experience is already well under way in Western society. This study provides evidence for the value of this experience in the case of experimentally induced health and safety obsessions. Of course, this evidence should be replicated as discussed above. Of particular interest would be the potential training and application of the blank-mind manipulation under general conditions of relaxation without the specific use of hypnosis. Other possible intervention strategies also merit consideration. The blank-mind intervention could be programmed to occur automatically with every occurrence of the obsession, in contrast to the single intervention period in this study. With the obsession being persistently eliminated, it is then possible t o consider combining the blank-mind intervention with a subsequent substitute thought. In her inquiry subjectz actually endorsed this suggestion when she stated that a blank mind is more effectivein eliminating the obsession but there is a chance for it to recur after the void. With an already salient and available substitute thought to fill the gap, the likelihood of recurrence would be further minimized. In conclusion, this pilot study attests generally to the potential of hypnotic programming techniques for laboratory exploration of clinical phenomena, and specifically to the utility of the blank-mind intervention for reducing obsessional thought.
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GABFIELD, Z. H., MCBBEABTY, J. F., & DICHTEE,M.A C a S e Of impotence S U C -fully treated with desensitization combined with i n vim operant training and thought substitution. In R. D. Rubin & C. M. Franks (Eds.),Advances in behavior therapy, 1968. New York: Academic Press, 1969. Pp. 97-103. GRAEF,J. R. The iduence of cognitive states on time estimation and subjective time rate. Unpublished doctoral dissertation, Univer. of Michigan, 1969. LAZARUS, A. A. Behavior therapy and beyond. New York: McGraw-Hill, 1971. ~ K S I. M., , RACEMAN, S., & GELDEB,M. G. Methods for assessment of aversion treatment in fetishism with masochism. Behav. Res. Ther., 1965,S,253-258. MATHER, M. D. Obsessions and compulsions. I n C. G. Costello (Ed.), Symptoms of psychopathology: A handbook. New York: John Wiley UZ Sons, 1970. Pp. 302319.
MCGUIRE,R. J., & VALLANCE, M. Aversion therapy by electric shock: A simple technique. Brit. med.J . , 1964,1,151-153. METZNEB, R. Some experimental analogues of obsession. Behav. Res. Ther., 1963, f ,
231-236. SOLYOM, L., ZAHANZADEH, D., LEDWIDQE, B.. & KENNY, F. Aversion relief treatment of obsessive neurosis. In R. D. Rubin, EL Fensterheim, A. A. Lazarus, & C. Franks (Ede.),Aduances i n behavior therapy. New York: Academic Press, 1973. Pp. 93-109. TAYLOR, J. G. A behavioural interpretation of obsessive-compulsive neurosis. Behav. Res. Ther. 1963, I , 237-244. WALTON, D., & MATHER, M. D. The application of learning principles to the treatment of obsessive-compulsive states in the acute and chronic phases of illness. I n H. J. Eysenck (Ed.), E z p e r i m d s in behwiour therapy: Readings in modern methods of treatment of mental disorders derived from learning theory. New York: MacMillan, 1964. Pp. 117-151. WEITZENHOFFEB, A. M., C HILQARD, E. R. Stanford Hypnotic Susceptibility Scale, Forms A and B . Palo Alto, Calif.: Consulting Psychologista Press, 1959. WOLBERQ, L. R. The technique of short-term psychotherapy. In L. R. Wolberg (Ed.), d b t - t e m r psychotherapy. New York: Grune & Stratton, 1965. Pp. 121-200.
WOLPE,J. Psychotherapy by reciprocal inhibition, Stanford, Calif. : Stanford Univer. Press, 1958. WOLPE,J. The practice of behavior therapy. New York: Pergamon Press, 1969. WOLPE,J., & LAZARUS, A. A. Behavior therapy techniques: A guide to (he treatment of neuroses. London : Pergamon PI&, 1966. Expe3mentelle Analyse der Techniken zur Eliminierung des Besessenseins David F. Barone. Gerald S. Blum und Marcia L. Porter Abstrakt : Obgleich Psychoanalyse und Lernenstheorie sich h i d e mit dem Besessenseinbeschaftigt haben, besteht doch kaum eine einschlagige. empirische Forschung auf diesem Gebiet. Die hier vorliegende Forschung. die an 2 weiblichen Subjekten durchgef6hrt wurde. die beide griindlich i n hypnotischen Programmtechniken geschult waren, verglich die Effekte .der 4 Interventionstypen hi einem experimentell induzierten. besessenden Gedanken mit defensiver oder nicht-defensiver Funktion. In den ers t e n 5 Sek. eines jeden Versuchs brachte man das Subjekt dazu, bewusst eine zwanghafte Besorgnie urn das Wohlbefinden seiner Mutter zu erleben.
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Dieser Zustand war von einem unbewussten, heftigen oder nicht-heftigen Vorleben begleitet. Danach folgten dann eine dieser 5 Sek. langen Interventionen: (1) eine posthypnotische “Geistesleere” ohne irgendwelche Gedanken, Gefiihle oder Sensationen; (2) ein Zustand mit “Substitutionsgedanken”; (3) ein unertriiglicher, weisser Ton. und (4) ein Kontrollverfahren, bei dem man dem Subjekt befahl, einfach iiber das n a c b u d e n ken, was ihm in den Kopf kiime. Jeder Versuch endete mit einer freien, 20 Sek. langen Periode fiir spontanes Denken. Man fand. dass die Intervention, die Geistesleere bewirkte, a m bestiindigsten in ihrem Effekt war, die Besessenheit sofort zu eliminieren und ihre spontane Wiederkehr in der freien Periode zu reduzieren. Man fand keine Unterschiede, die mit dem heftigen und nicht-heftigen Vorleben assoziiert waren. Die klinischen und forschungsbezogenen Implikationen dieser Befunde werden bier eriirtert. Analyse exptrimentale de techniques d’tlimination des obsessions David F. Barone, Gerald S. Blum et Marcia
L. Porter
R t s u m b : Bien que la psychanalyse et la thkorie de l’apprentissage se soient toutes deux prtoccuptes des obsessions, il existe peu de recherche8 empiriques pertinentes. Une dtude exploratoire, mente avec 2 Ss de sexe ftminin parfaitement entrain& dans les techniques de prograxnmation hypnotique, compare les effets de 4 types d’intervention sur des p e n s k s obsessionnelles induites expkrimentalement e t servant une fonction d6fensive ou non dtfensive. Pendant les premiares 5 secondes de chaque essai, on a m h e le sujet faire l’exphrience consciente d’une prtoccupation obsessive concernant le bien-&tre de sa mCre, experience accompagnke d’un anttctdant inconscient violent ou non violent. Le s est alors s o d s P l’une des interventions de 5 secondes qui suivent: (1) la cr6ation posthypnotique d’un “vide intbrieur”, dans lequel il n’y a aucune pensie, aucun sentiment et aucune sensation; (2) une condition de “penstes substitutives”; (3) un bruit de fond aversif; e t (4) une procMure de contrble dans laquelle on demande simplement au sujet de penser P quoi que ce soit qui lui vienne 31 l’esprit. Chaque essai se termine par une phriode fibre de 2.0 sec., resewbe P la pens6e spontanke. La crdation d’un vide interieur est la technique la plus const-ent efficace pour tliminer i-aiatement l’obsession et pour raduire sa rtcurrence dans la ptriode libre. Aucune d s t r e n c e n’est associte aux antecedents violent ou non violent. Suit une discussion des implications cliniques e t exptrimentales de ces rtsultats. Andlisis experimental de las ttcnicas empleadas para eliminar obsesiones David F. Barone, Gerald S. Blum y Marcia
L. Porter
Resumen: Aunque el psicoanilisis y la teoria del aprendizaje se han ocupado de las obsesiones, se dispone de poca investigaci6n empirica adecuada. La presente exploracibn, llevada a cab0 con 2 sujetos femeninos perfectamente ejercitados en las tdcnicas de programaci6n hipnbtica, compara 10s efectos de 4 tipos de intervenciones sobre una idea obsesiva inducida experimentahente, y que desempeaa una funci6n defensiva o no defensiva. Durante 10s primcros 5 seg. de cada ensayo, el sujeto es Ile-
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vado a expcrimentar conscientemente una preocupaci6n obsesiva por el bienestar de eu madre. acompaiiada por un antecedente inconsciente violento o no violento. Tiene lugar, a continuaci6n. una de estas intervenciones de 5 eeg.: 0)sugeeti6n posthipn6tica de “mente en blanco”, que implica la ausencia de ideas, eentimientoa o sensaciones: (2) condici6n de “ideas substitutivas”: (S) ruido blanco aversivo: (4) procedimiento de control. en el que ee dice a1 sujeto que piense en cualqnier cosa que se le ocurra. Cadn ensayo termina con un period0 libre de 20 see. de p e n s d e n t o espontAneo. Ss encuentra que la intervenci6n “mente en blanco” es la m4s mnsistantemente eficaz en la eliminaci6n inmediata de la obsesi6n y en la reducci6n de su reaparicidn esponthea durante el perfodo libre. No hay diferenciaa asociadas a la distinci6n antecedente violento-antecedente no violento. Se discuten lae implicaciones cllnicas y relativas a la investigaci6n. de estos hallazgos.
