THE CONTRIBUTION OF RELAXATION AND EXPECTANCY TO FEAR REDUCTION VIA GRADED, IMAGINAL EXPOSURE TO FEARED STIMULI T. D. BORKOVEC* and J. KROCH SIDES University (Rrcuirud
of Iowa
6 frhruar,v
1979)
Summary-Speech phobic subjects received five treatment sessions under either positive or neutral expectancy set. Therapy conditions included hierarchy exposure with contiguous relaxation (desensitization), exposure with noncontiguous relaxation. exposure only. and no-treatment. Expectancy had virtually no outcome effects. Desensitization was superior to the other conditions on subjective outcome measures. In contrast to the two exposure conditions without contiguous relaxation, desensitization resulted in increased imagery vividness, greater cardiovascular response to the first visualization of the initial hierarchy scene. and greater dechnrs in cardiovascular response within repetitious visualizations of scenes and across initial visualizations of increasingly anxiety-provoking scenes. Expectancy significantly influenced both fear ratings and cardiovascular response to scenes during the first session. the latter effect disappearing after the first session. The results are discussed in terms of recent theorizing regarding the role of relaxation and expectancy in desensitization.
The underlying mechanism(s) of systematic desensitization and the contribution of relaxation to that process have remained contested issues for nearly 20 yr. Wolpe’s (1958) original conception of desensitization emphasized the counterconditioning of anxiety during imaginal presentations of graded, feared stimuli and the essential role of relaxation as a reciprocal inhibitor of anxiety in that process. The research literature attempting to test these assumptions has been diverse, ranging from human analogue studies involving desensitization component designs to human psychophysiological and animal fear reduction studies. Yet, the issue has not been resolved. Given these circumstances, it is understandable that recent authors (e.g. Kazdin Bnd Wilcoxon, 1976) have concluded that no data exist to support the specific effects of desensitization. A partial basis for the latter conclusion stems from the inadequacies commonly plaguing analogue outcome research. Over 20 component studies have compared exposure to phobic hierarchies with vs without contiguous relaxation. Due to the frequent use of small animal phobias so susceptible to demand effects, the general absence of physiological measures required to test fundamental desensitization assumptions, and frequent absence of a control condition receiving hierarchy exposure followed by noncontinuous relaxation, few conclusions regarding the contribution of relaxation to the fear reduction process can be drawn from these efforts (cf. Borkovec and O’Brien, 1976). More valuable information has been .gleaned from animal and psychophysiological fear investigations. Wilson and Davison’s (1971) review of animal fear studies suggested that relaxation and other anxiety-incompatible responses facilitate exposure to the feared stimuli by motivating directed attention or by reducing distractions inherent in the rapid occurrence of anxious behavior in response to the stimuli. A conceptually similar position concluded Mathews’ (1971) review of the psychophysiological evidence for desensitization. He suggested that a state of low arousal induced by relaxation may produce three effects of importance for the rapid fear extinction: increased vividness of the imaginal stimuli, augmentation of the autonomic effects of imagery, and maximization of response decrements to repeated exposures to the fear stimuli. This conclusion was partially based on Lang, Melamed and Hart’s (1970) finding that subjects with l Present address: Department of Psychology, University Park. PA 16802. U.S.A.
Pennsylvania
State University,
417 Bruce V. Moore
Building,
520
T. D.
BORKOVEC
and
I.
KROCH
SIDES
successful desensitization displayed higher heart rate responsss to scenes reported to be fear-inducing and greater decline in heart rate to repetitions of the scene than did unsuccessful subjects. Due to both the methodological inadequacies of the otherwise powerful and analytic component designs of the past and the compellin g hypotheses emerging from animal and psychophysiological studies, it seemed that a study which would combine psychophysiological measurement during treatment with sound component analysis of desensitization would provide clarity to the issue. The primary purpose of the present study was to conduct a complete component study on speech anxious subjects far less susceptible to demand effects (Borkovec and O’Brien, 1976) and to obtain continuous heart rate recordings during the process of imaginal treatment. We predicted that exposure with contiguous relaxation would have the greatest outcome effects and that, in accord with Mathew’s (1971) conclusions. this condition would produce evidence of greater autonomic reactivity and its habituation. The secondary purpose of the investigation was to evaluate the effects of positive and neutral expectancy on process and outcome. There were two related reasons for including this variable. First, expectancy effects may represent nothing more than demand characteristic effects on mild fear behavior, i.e. positive instructions place greater demand on the subject to display less fear behavior than neutral instructions (Borkovec, 1973). Since demand has been found to exert little influence on fear targets characterized by strong physiological components and since speech anxiety involves such components (Borkovec and O’Brien, 1976) expectancy was predicted to have no effect on the outcome of the present study. Second, expectancy, independent of demand, may still have an influence on fear process during treatment. A one-session study on speech phobics (Grayson and Borkovec, 1978) crossed expectancy with three methods of repeated exposure to imaginal phobic stimuli, all under non-relaxed conditions. On both self-report and heart rate responses to the phobic imagery, positive expectancy subjects showed greater reaction to the initial presentation of each image and greater reduction of reaction over repeated exposures to the same image than neutral expectancy subjects. The fact that this process paralleled that of Lang er al.‘s (1970) successful subjects suggested that expectancy may have an effect of fundamental importance to fear reduction. The present study afforded an opportunity to replicate this effect and to assess whether that effect would find expression in outcome measures if treatment was extended to four sessions. METHOD Subjects
Twenty-five male and 35 female undergraduates from the introductory psychology courses completed the study. During the second week of the semester students were asked to respond to Geer’s Fear Survey Schedule (1965) as part of a group testing procedure. This item has been found in our lab to correlate highly (r = 0.75, N = 700) with Paul’s (1966) more extensive public speaking questionnaire. Of the 750 students tested, 150 indicated ‘very much fear’ or ‘terror’ on the public speaking item. Sixty-five of these subjects agreed to participate; five terminated during the pre-test. Each subject received research credit and 82 per session for prompt attendance of the scheduled sessions. Procedure
Five female psychology majors, following detailed procedural manuals and ‘blind’ to the condition of the subjects, served as experimenters during the pre- and post-tests. Two female students served as raters. The pre- and post-test speeches were video-taped and scored for overt signs of anxiety on a modified form of Paul’s Timed Behavioral Checklist (1966). Each speech was rated by two independent and ‘blind’ observers (interrater correlations: 0.72 and 0.72, respectively). Unfortunately, problems with the video-
Rchat~on
and rxpectmcy
53 I
tape system allowed ratings on only 637; of the subjects. Not surprisingly. then, no effects emerged from analysis of these ssores: cnnsequentfy, they wiii not bt: discussed further. The second author and another female psychology major. trained in the use of systematic desensitization and following detailed procedural manuals, served as therapists, One therapist had f yr of experience and the other had 1; yr of experience in progressive relaxation training. Each therapist treated half of the subjects in each condition. Pre-rrsr. Each participant was seen ~nd~vid~a~~y for the pre-test. After completing a pre-task Anxiety DiRerential (Husek and Alexander, 19633 and a pre-task Autonomic Perception Questionnaire (Mandler, Mandler & Uvilier, 1958) to serve as measures of anticipatory. subjective anxiety, they were escorted to the experimental room and seated. The experimenter returned to the polygraph room and played the initial instruction tape explaining the pre-test. AI1 subjects were told that they were to spend five minutes preparing a speech and then present the speech for three minutes to the videotape camera. The presumed purpose of the task was to determine the relationship among behavioral, physiological. and self-report measures of anxiety. If they agreed to participate, the experimenter attached silver-silver chloride electrodes to the right and left lower portions of the rib cage to measure heart rate and to the base of the index finger and hypothenar surface of the nondominant hand to record galvanic skin response. All recording was obtained from a Beckman Type Rdl f dynograph Iocated in an adjacent equipment room. Chart speed was set at 10 mmjsec. After electrode attachment, the experimenter returned to the polygraph room for a 10-min baseline recording period. The instruction tape then provided the topic of the speech (grading policies at the University) and informed the subject to begin the 5-min preparation period. At the end of the preparation period, the tape asked the subject to face the camera and begin the speech. When the 3-min speaking period ended, the experimenter returned to the experimental room and administered the post-task Anxiety Differential, Autonomic Perception Questionnaire, and a self-report scale consisting of eight 5-point ratings of the degree of fear experienced during the speech. Post-test. Six to seven weeks after the pre-test, each subject returned for a post-test identical in procedure to the pre-test except for the topic of the speech (over-population problem). Treatment conditions. After the pre-test, subjects ‘were randomly assigned to one of eight conditions (no-treatment (NT) and three therapy conditions under positive or neutral expectancy). Sex of subject was evenly distributed across conditions. The three therapy conditions were desensitization (hierarchy exposure plus relaxation, E + R), hierarchy exposure fotfowed later by relaxation (E/R), and hierarchy exposure only (Ef. Seven subjects were assigned to each of the six therapy x expectancy cells and nine subjects to each of the two no-treatment conditions. All therapy conditions were equated for amount of time spent in each session. Subjects were seen in groups of 2 or 3; each subject was placed in a separate ‘room during the therapy sessions. Standard as welt as individualized instructions were presented via intercom by the therapist who was located in the equipment room. Therapy c~~~ir~u~s. Except where otherwise noted, alf treated subjects received identical procedures. During the first session, 1Omin were spent in presented taped rationales for the procedures, 40 min in progressive relaxation training (Bernstein and Borkovec, 1973) for conditions involving relaxation, 5 min in pleasant imagery practice, and 15 min in discussing a standard 16item speech hierarchy. Subjects in the E condition practiced pleasant scenes to substitute for the relaxation training. Content of the pleasant scenes was ~ndividua~iy determined by each subject. The only requirement was that the subject create images that were pieasant and involved active participation in the SCXXE. Each 1 image was presented twice for 60 set, followed by discussion of image quality. This procedure continued for 40 min. The 16 hierarchy scenes were constructed by the experimenter but were individuafty rank-ordered by every subject; average rank by each therapy session group was
employed to determine that group’s hierarchy ordrr. The scenes all referred to the specific environmental conditions of the pre-test situation. Subjects in positive expectancy completed credibility (Borkovec and Nau. 19721 and e\uyectancy of improvement questionnaires at the end of the first session. Subjects receiving relaxation were administered the training via subject-controlled. automated tapes described elsewhere (cf. Borkovet, Grayson and Cooper, 1975), and were instructed to practice relaxation twice daily for the duration of the study. Twice-a-day practice of pleasant scenes was assigned to the E group. At the beginning of the remaining four sessions. electrodes \vere attached to the forearms ofeach subject (forehead to ground) for heart rate recording. Subjects were located in separate rooms (always the same room for each subject throughout the sessions) and reclined in beds during relaxation training. Subjects in E + R received automated relaxation training prior to commencement of hierarchy exposure. Subjects in E;R underwent hierarchy presentations during the first half of the session and relaxation training during the last half. Pleasant imagery practice identical in procedure to the first session preceded hierarchy exposure for subjects in the E condition. Amount of time was yoked to the average duration of relaxation training in the other two groups. Hierarchy exposure for all three therapy conditions followed Paul’s (1966) criteria, i.e. description of the hierarchy scene, iO-set visualization period. 60sec rest between scene descriptions. If no anxiety was signalled after two presentations, the next item was presented. If anxiety was signalled by any subject (who simply called out his/her name to the intercom), visualization was terminated for 60 sec. Three, 5. IO- and 20-set visualizations then followed before proceeding to the next scene. If anxiety was once again signalled during these exposures, visualization again proceeded with 3. 5. IOand 20-set presentations. If anxiety was indicated for the third time. two IO-set visualizations of the previous item were presented. Subjects were instructed to imagine the scene as soon as the verbal description of the scene was completed. Progression through the hierarchy for the session group was determined by the rate of the slowest subject. Hierarchy exposure was administered to E + R subjects while reclined in bed, whereas subjects in the other two conditions were seated upright in chairs during the exposure periods. During the 60-see inter-scene interval, each subject u’as asked via intercom to rate on scales from &6 how vivid the image was and how much fear they esperienced during the visualization. The 60-second inter-scene interval \vas filled by instructions to focus on the relaxation sensations for E +- R subjects. whereas the other two groups counted backwards from 100 in order to prevent perseveration of phobic images. After completion of four scenes, the therapy session was terminated. Each session thus involved completion of 4 of the 16 scenes. Subjects assigned to NT were phoned the week after the pretest and informed that treatment would not begin for 4 weeks and would be preceded by a second speech task. All NT subjects were offered desensitization treatment after the post-test. Exprctanty cunditions. Haff of the subjects in each therapy condition received therapeutic instructions during the rationale presentation of Session 1. These subjects were told that the therapy they would be receiving was designed to eliminate their speech anxiety. The same instructions were repeated at the beginning of each session. The nine subjects in the positive expectancy NT group, when contacted by telephone, were told that past research had indicated that subjects who attend the second laboratory speech test routinely find themselves reacting with much less fear to the speech task. Subjects assigned to the neutral expectancy therapy groups were told that the speech and imagery procedures represented a method for investigating the complex relationships among self-report, physiological and behavioral measures of anxiety. The purpose of the study was to investigate these indices under various conditions. The words ‘therapy’. ‘therapist’ or ‘treatment’ were not used. This purpose \vas restated at the beginning of each session. The NT subjects in neutral expectancy. \vhen contacted by phone, were simply asked to return for a second speech.
Relaxation
and rxpectanc?
533
Physiologicul data reduction. Nine 30-set heart rate samples (converted to bpm) were obtained from the speech tasks: last minute of adaptation. the beginning of each of the 5 min of the preparation period, and the beginning of each of the 3 min of the speech presentation. Basal skin conductance scores were derived from those same moments by selecting the highest level obtained during each 30-set sample. Spontaneous fluctuations from the same periods were counted for each deflection greater than 0.2 micromhos. During therapy, lo-see heart rate samples were obtained during a silent period just prior to each hierarchy scene description. during scene description, and during the first IOsec of scene visualization. Derived measures involving subtraction of the pre-scene value from the description sample and from the visualization sample were calculated to reflect heart rate reaction to description and visualization of the scene. RESULTS Pre-test
nrralyses
The group as a whole displayed typically high heart rate reactions to the onset of the pre-test speech (mean = 105 bpm). Therapy x Expectancy analyses of variance were performed on all pre-test measures to assess condition equivalence prior to treatment. The only significant results indicated a chance main effect of Expectancy on heart rate on both the end of adaptation and on the overall speech period. Positive expectancy subjects had higher rates than neutral expectancy subjects during adaptation, F (1, 51) = 6.22, P < 0.02, and during the speech, F (1, 51) = 5.29, P < 0.025. Analyses of the four credibility questions asked at the end of the first session, their total, and the percentage of improvement expected by the positive expectancy subjects revealed no effects due to therapy condition. Mean improvement expected was 55.0%. Outcome measures
All pre-post-test scores were submitted to repeated measures analysis of variance involving Therapy, Expectancy, and Time factors. Analyses of physiological measures also included a Phase factor representing the 8 samples obtained during speech preparation and presentation periods. In summary of the results to be detailed below, we found E + R to produce the greatest reductions in subjective fear but no clear effect on physiological measures. Subjective measures. Significant Therapy x Time interactions emerged from analysis of the self-report scale, F (3, 49) = 5.23, P < 0.005, the pre-task Anxiety Differential, F (3, 49) = 3.73, P -C 0.02, and the post-task Anxiety Differential, F (3, 49) = 5.04. P
of Iowa
6 frhruar,v
1979)
Summary-Speech phobic subjects received five treatment sessions under either positive or neutral expectancy set. Therapy conditions included hierarchy exposure with contiguous relaxation (desensitization), exposure with noncontiguous relaxation. exposure only. and no-treatment. Expectancy had virtually no outcome effects. Desensitization was superior to the other conditions on subjective outcome measures. In contrast to the two exposure conditions without contiguous relaxation, desensitization resulted in increased imagery vividness, greater cardiovascular response to the first visualization of the initial hierarchy scene. and greater dechnrs in cardiovascular response within repetitious visualizations of scenes and across initial visualizations of increasingly anxiety-provoking scenes. Expectancy significantly influenced both fear ratings and cardiovascular response to scenes during the first session. the latter effect disappearing after the first session. The results are discussed in terms of recent theorizing regarding the role of relaxation and expectancy in desensitization.
The underlying mechanism(s) of systematic desensitization and the contribution of relaxation to that process have remained contested issues for nearly 20 yr. Wolpe’s (1958) original conception of desensitization emphasized the counterconditioning of anxiety during imaginal presentations of graded, feared stimuli and the essential role of relaxation as a reciprocal inhibitor of anxiety in that process. The research literature attempting to test these assumptions has been diverse, ranging from human analogue studies involving desensitization component designs to human psychophysiological and animal fear reduction studies. Yet, the issue has not been resolved. Given these circumstances, it is understandable that recent authors (e.g. Kazdin Bnd Wilcoxon, 1976) have concluded that no data exist to support the specific effects of desensitization. A partial basis for the latter conclusion stems from the inadequacies commonly plaguing analogue outcome research. Over 20 component studies have compared exposure to phobic hierarchies with vs without contiguous relaxation. Due to the frequent use of small animal phobias so susceptible to demand effects, the general absence of physiological measures required to test fundamental desensitization assumptions, and frequent absence of a control condition receiving hierarchy exposure followed by noncontinuous relaxation, few conclusions regarding the contribution of relaxation to the fear reduction process can be drawn from these efforts (cf. Borkovec and O’Brien, 1976). More valuable information has been .gleaned from animal and psychophysiological fear investigations. Wilson and Davison’s (1971) review of animal fear studies suggested that relaxation and other anxiety-incompatible responses facilitate exposure to the feared stimuli by motivating directed attention or by reducing distractions inherent in the rapid occurrence of anxious behavior in response to the stimuli. A conceptually similar position concluded Mathews’ (1971) review of the psychophysiological evidence for desensitization. He suggested that a state of low arousal induced by relaxation may produce three effects of importance for the rapid fear extinction: increased vividness of the imaginal stimuli, augmentation of the autonomic effects of imagery, and maximization of response decrements to repeated exposures to the fear stimuli. This conclusion was partially based on Lang, Melamed and Hart’s (1970) finding that subjects with l Present address: Department of Psychology, University Park. PA 16802. U.S.A.
Pennsylvania
State University,
417 Bruce V. Moore
Building,
520
T. D.
BORKOVEC
and
I.
KROCH
SIDES
successful desensitization displayed higher heart rate responsss to scenes reported to be fear-inducing and greater decline in heart rate to repetitions of the scene than did unsuccessful subjects. Due to both the methodological inadequacies of the otherwise powerful and analytic component designs of the past and the compellin g hypotheses emerging from animal and psychophysiological studies, it seemed that a study which would combine psychophysiological measurement during treatment with sound component analysis of desensitization would provide clarity to the issue. The primary purpose of the present study was to conduct a complete component study on speech anxious subjects far less susceptible to demand effects (Borkovec and O’Brien, 1976) and to obtain continuous heart rate recordings during the process of imaginal treatment. We predicted that exposure with contiguous relaxation would have the greatest outcome effects and that, in accord with Mathew’s (1971) conclusions. this condition would produce evidence of greater autonomic reactivity and its habituation. The secondary purpose of the investigation was to evaluate the effects of positive and neutral expectancy on process and outcome. There were two related reasons for including this variable. First, expectancy effects may represent nothing more than demand characteristic effects on mild fear behavior, i.e. positive instructions place greater demand on the subject to display less fear behavior than neutral instructions (Borkovec, 1973). Since demand has been found to exert little influence on fear targets characterized by strong physiological components and since speech anxiety involves such components (Borkovec and O’Brien, 1976) expectancy was predicted to have no effect on the outcome of the present study. Second, expectancy, independent of demand, may still have an influence on fear process during treatment. A one-session study on speech phobics (Grayson and Borkovec, 1978) crossed expectancy with three methods of repeated exposure to imaginal phobic stimuli, all under non-relaxed conditions. On both self-report and heart rate responses to the phobic imagery, positive expectancy subjects showed greater reaction to the initial presentation of each image and greater reduction of reaction over repeated exposures to the same image than neutral expectancy subjects. The fact that this process paralleled that of Lang er al.‘s (1970) successful subjects suggested that expectancy may have an effect of fundamental importance to fear reduction. The present study afforded an opportunity to replicate this effect and to assess whether that effect would find expression in outcome measures if treatment was extended to four sessions. METHOD Subjects
Twenty-five male and 35 female undergraduates from the introductory psychology courses completed the study. During the second week of the semester students were asked to respond to Geer’s Fear Survey Schedule (1965) as part of a group testing procedure. This item has been found in our lab to correlate highly (r = 0.75, N = 700) with Paul’s (1966) more extensive public speaking questionnaire. Of the 750 students tested, 150 indicated ‘very much fear’ or ‘terror’ on the public speaking item. Sixty-five of these subjects agreed to participate; five terminated during the pre-test. Each subject received research credit and 82 per session for prompt attendance of the scheduled sessions. Procedure
Five female psychology majors, following detailed procedural manuals and ‘blind’ to the condition of the subjects, served as experimenters during the pre- and post-tests. Two female students served as raters. The pre- and post-test speeches were video-taped and scored for overt signs of anxiety on a modified form of Paul’s Timed Behavioral Checklist (1966). Each speech was rated by two independent and ‘blind’ observers (interrater correlations: 0.72 and 0.72, respectively). Unfortunately, problems with the video-
Rchat~on
and rxpectmcy
53 I
tape system allowed ratings on only 637; of the subjects. Not surprisingly. then, no effects emerged from analysis of these ssores: cnnsequentfy, they wiii not bt: discussed further. The second author and another female psychology major. trained in the use of systematic desensitization and following detailed procedural manuals, served as therapists, One therapist had f yr of experience and the other had 1; yr of experience in progressive relaxation training. Each therapist treated half of the subjects in each condition. Pre-rrsr. Each participant was seen ~nd~vid~a~~y for the pre-test. After completing a pre-task Anxiety DiRerential (Husek and Alexander, 19633 and a pre-task Autonomic Perception Questionnaire (Mandler, Mandler & Uvilier, 1958) to serve as measures of anticipatory. subjective anxiety, they were escorted to the experimental room and seated. The experimenter returned to the polygraph room and played the initial instruction tape explaining the pre-test. AI1 subjects were told that they were to spend five minutes preparing a speech and then present the speech for three minutes to the videotape camera. The presumed purpose of the task was to determine the relationship among behavioral, physiological. and self-report measures of anxiety. If they agreed to participate, the experimenter attached silver-silver chloride electrodes to the right and left lower portions of the rib cage to measure heart rate and to the base of the index finger and hypothenar surface of the nondominant hand to record galvanic skin response. All recording was obtained from a Beckman Type Rdl f dynograph Iocated in an adjacent equipment room. Chart speed was set at 10 mmjsec. After electrode attachment, the experimenter returned to the polygraph room for a 10-min baseline recording period. The instruction tape then provided the topic of the speech (grading policies at the University) and informed the subject to begin the 5-min preparation period. At the end of the preparation period, the tape asked the subject to face the camera and begin the speech. When the 3-min speaking period ended, the experimenter returned to the experimental room and administered the post-task Anxiety Differential, Autonomic Perception Questionnaire, and a self-report scale consisting of eight 5-point ratings of the degree of fear experienced during the speech. Post-test. Six to seven weeks after the pre-test, each subject returned for a post-test identical in procedure to the pre-test except for the topic of the speech (over-population problem). Treatment conditions. After the pre-test, subjects ‘were randomly assigned to one of eight conditions (no-treatment (NT) and three therapy conditions under positive or neutral expectancy). Sex of subject was evenly distributed across conditions. The three therapy conditions were desensitization (hierarchy exposure plus relaxation, E + R), hierarchy exposure fotfowed later by relaxation (E/R), and hierarchy exposure only (Ef. Seven subjects were assigned to each of the six therapy x expectancy cells and nine subjects to each of the two no-treatment conditions. All therapy conditions were equated for amount of time spent in each session. Subjects were seen in groups of 2 or 3; each subject was placed in a separate ‘room during the therapy sessions. Standard as welt as individualized instructions were presented via intercom by the therapist who was located in the equipment room. Therapy c~~~ir~u~s. Except where otherwise noted, alf treated subjects received identical procedures. During the first session, 1Omin were spent in presented taped rationales for the procedures, 40 min in progressive relaxation training (Bernstein and Borkovec, 1973) for conditions involving relaxation, 5 min in pleasant imagery practice, and 15 min in discussing a standard 16item speech hierarchy. Subjects in the E condition practiced pleasant scenes to substitute for the relaxation training. Content of the pleasant scenes was ~ndividua~iy determined by each subject. The only requirement was that the subject create images that were pieasant and involved active participation in the SCXXE. Each 1 image was presented twice for 60 set, followed by discussion of image quality. This procedure continued for 40 min. The 16 hierarchy scenes were constructed by the experimenter but were individuafty rank-ordered by every subject; average rank by each therapy session group was
employed to determine that group’s hierarchy ordrr. The scenes all referred to the specific environmental conditions of the pre-test situation. Subjects in positive expectancy completed credibility (Borkovec and Nau. 19721 and e\uyectancy of improvement questionnaires at the end of the first session. Subjects receiving relaxation were administered the training via subject-controlled. automated tapes described elsewhere (cf. Borkovet, Grayson and Cooper, 1975), and were instructed to practice relaxation twice daily for the duration of the study. Twice-a-day practice of pleasant scenes was assigned to the E group. At the beginning of the remaining four sessions. electrodes \vere attached to the forearms ofeach subject (forehead to ground) for heart rate recording. Subjects were located in separate rooms (always the same room for each subject throughout the sessions) and reclined in beds during relaxation training. Subjects in E + R received automated relaxation training prior to commencement of hierarchy exposure. Subjects in E;R underwent hierarchy presentations during the first half of the session and relaxation training during the last half. Pleasant imagery practice identical in procedure to the first session preceded hierarchy exposure for subjects in the E condition. Amount of time was yoked to the average duration of relaxation training in the other two groups. Hierarchy exposure for all three therapy conditions followed Paul’s (1966) criteria, i.e. description of the hierarchy scene, iO-set visualization period. 60sec rest between scene descriptions. If no anxiety was signalled after two presentations, the next item was presented. If anxiety was signalled by any subject (who simply called out his/her name to the intercom), visualization was terminated for 60 sec. Three, 5. IO- and 20-set visualizations then followed before proceeding to the next scene. If anxiety was once again signalled during these exposures, visualization again proceeded with 3. 5. IOand 20-set presentations. If anxiety was indicated for the third time. two IO-set visualizations of the previous item were presented. Subjects were instructed to imagine the scene as soon as the verbal description of the scene was completed. Progression through the hierarchy for the session group was determined by the rate of the slowest subject. Hierarchy exposure was administered to E + R subjects while reclined in bed, whereas subjects in the other two conditions were seated upright in chairs during the exposure periods. During the 60-see inter-scene interval, each subject u’as asked via intercom to rate on scales from &6 how vivid the image was and how much fear they esperienced during the visualization. The 60-second inter-scene interval \vas filled by instructions to focus on the relaxation sensations for E +- R subjects. whereas the other two groups counted backwards from 100 in order to prevent perseveration of phobic images. After completion of four scenes, the therapy session was terminated. Each session thus involved completion of 4 of the 16 scenes. Subjects assigned to NT were phoned the week after the pretest and informed that treatment would not begin for 4 weeks and would be preceded by a second speech task. All NT subjects were offered desensitization treatment after the post-test. Exprctanty cunditions. Haff of the subjects in each therapy condition received therapeutic instructions during the rationale presentation of Session 1. These subjects were told that the therapy they would be receiving was designed to eliminate their speech anxiety. The same instructions were repeated at the beginning of each session. The nine subjects in the positive expectancy NT group, when contacted by telephone, were told that past research had indicated that subjects who attend the second laboratory speech test routinely find themselves reacting with much less fear to the speech task. Subjects assigned to the neutral expectancy therapy groups were told that the speech and imagery procedures represented a method for investigating the complex relationships among self-report, physiological and behavioral measures of anxiety. The purpose of the study was to investigate these indices under various conditions. The words ‘therapy’. ‘therapist’ or ‘treatment’ were not used. This purpose \vas restated at the beginning of each session. The NT subjects in neutral expectancy. \vhen contacted by phone, were simply asked to return for a second speech.
Relaxation
and rxpectanc?
533
Physiologicul data reduction. Nine 30-set heart rate samples (converted to bpm) were obtained from the speech tasks: last minute of adaptation. the beginning of each of the 5 min of the preparation period, and the beginning of each of the 3 min of the speech presentation. Basal skin conductance scores were derived from those same moments by selecting the highest level obtained during each 30-set sample. Spontaneous fluctuations from the same periods were counted for each deflection greater than 0.2 micromhos. During therapy, lo-see heart rate samples were obtained during a silent period just prior to each hierarchy scene description. during scene description, and during the first IOsec of scene visualization. Derived measures involving subtraction of the pre-scene value from the description sample and from the visualization sample were calculated to reflect heart rate reaction to description and visualization of the scene. RESULTS Pre-test
nrralyses
The group as a whole displayed typically high heart rate reactions to the onset of the pre-test speech (mean = 105 bpm). Therapy x Expectancy analyses of variance were performed on all pre-test measures to assess condition equivalence prior to treatment. The only significant results indicated a chance main effect of Expectancy on heart rate on both the end of adaptation and on the overall speech period. Positive expectancy subjects had higher rates than neutral expectancy subjects during adaptation, F (1, 51) = 6.22, P < 0.02, and during the speech, F (1, 51) = 5.29, P < 0.025. Analyses of the four credibility questions asked at the end of the first session, their total, and the percentage of improvement expected by the positive expectancy subjects revealed no effects due to therapy condition. Mean improvement expected was 55.0%. Outcome measures
All pre-post-test scores were submitted to repeated measures analysis of variance involving Therapy, Expectancy, and Time factors. Analyses of physiological measures also included a Phase factor representing the 8 samples obtained during speech preparation and presentation periods. In summary of the results to be detailed below, we found E + R to produce the greatest reductions in subjective fear but no clear effect on physiological measures. Subjective measures. Significant Therapy x Time interactions emerged from analysis of the self-report scale, F (3, 49) = 5.23, P < 0.005, the pre-task Anxiety Differential, F (3, 49) = 3.73, P -C 0.02, and the post-task Anxiety Differential, F (3, 49) = 5.04. P
