Tag: Joseph Wolpe

What is Systematic Desensitisation?

Published on by Andrew Marshall2 Comments

Introduction

Systematic desensitisation, or graduated exposure therapy, is a behaviour therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioural therapy and applied behaviour analysis. When used in applied behaviour analysis, it is based on radical behaviourism as it incorporates counterconditioning principles. These include meditation (a private behaviour or covert conditioning) and breathing (a public behaviour or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behaviour, so it initially uses cognitive restructuring.

The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitisation occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.

Refer to Flooding.

Brief History

In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure. Wolpe studied Ivan Pavlov’s work on artificial neuroses and the research done on elimination of children’s fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms.

Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.

Three steps of desensitisation

There are three main steps that Wolpe identified to successfully desensitize an individual.

Establish anxiety stimulus hierarchy1. The individual should first identify the items that are causing the anxiety problems.
2. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety.
3. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately.
4. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking.
Learn the mechanism response1. Relaxation training, such as meditation, is one type of best coping strategies.
2. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time.
3. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity.
4. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels.
5. Only a few sessions are needed for a patient to learn appropriate coping mechanisms.
6.Additional coping strategies include anti-anxiety medicine and breathing exercises.
7. Another example of relaxation is cognitive reappraisal of imagined outcomes.
8. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes.
Connect stimulus to the incompatible response or coping method by counter conditioning1. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias.
2. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented.
3. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all.
4. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped.
5. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.


Example

A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitisation:

Establish anxiety stimulus hierarchy1. A therapist may begin by asking the patient to identify a fear hierarchy.
2. This fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake.
3. For example, seeing a picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter scenario becoming highest on the fear hierarchy.
Learn coping mechanisms or incompatible responses1. The therapist would work with the client to learn appropriate coping and relaxation techniques such as meditation and deep muscle relaxation responses.
Connect the stimulus to the incompatible response or coping method1. The client would be presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilising the deep relaxation techniques (i.e. progressive muscle relaxation) previously learned.
2. The imagined stimuli to help with a phobia of snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the snake, etc.
3. At each step in the imagined progression, the patient is desensitised to the phobia through exposure to the stimulus while in a state of relaxation.
4. As the fear hierarchy is unlearned, anxiety gradually becomes extinguished.


Uses

Specific Phobias

Specific phobias are one class of mental disorder often treated via systematic desensitisation. When persons experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of coping with it. In this regard, patients’ avoidance behaviours can become reinforced – a concept defined by the tenets of operant conditioning. Thus, the goal of systematic desensitisation is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated. Wolpe found that systematic desensitisation was successful 90% of the time when treating phobias.

Test Anxiety

Between 25 and 40 percent of students experience test anxiety. Children can suffer from low self-esteem and stress-induced symptoms as a result of test anxiety. The principles of systematic desensitisation can be used by children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and relaxing different muscle groups. With older children and college students, an explanation of desensitisation can help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions, finishing on time, marking the answers properly, spending too little time on tasks, or underperforming. Teachers, school counsellors or school psychologists could instruct children on the methods of systematic desensitisation.

Recent Use

Desensitisation is widely known as one of the most effective therapy techniques. In recent decades, systematic desensitisation has become less commonly used as a treatment of choice for anxiety disorders. Since 1970 academic research on systematic desensitisation has declined, and the current focus has been on other therapies. In addition, the number of clinicians using systematic desensitisation has also declined since 1980. Those clinicians that continue to regularly use systematic desensitisation were trained before 1986. It is believed that the decrease of systematic desensitisation by practicing psychologist is due to the increase in other techniques such as flooding, implosive therapy, and participant modelling.

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On This Day … 20 April [2022]

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1745 – Philippe Pinel, French physician and psychiatrist (d. 1826).
  • 1915 – Joseph Wolpe, South African psychotherapist and physician (d. 1997).
  • 1920 – Frances Ames, South African neurologist, psychiatrist, and human rights activist (d. 2002).

Philippe Pinel

Philippe Pinel (20 April 1745 to 25 October 1826) was a French physician, precursor of psychiatry and incidentally a zoologist. He was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy. He worked for the abolition of the shackling of mental patients by chains and, more generally, for the humanisation of their treatment. He also made notable contributions to the classification of mental disorders and has been described by some as “the father of modern psychiatry”.

After the French Revolution, Dr. Pinel changed the way we look at the crazy (or “aliénés”, “alienated” in English) by claiming that they can be understood and cured. An 1809 description of a case that Pinel recorded in the second edition of his textbook on insanity is regarded by some as the earliest evidence for the existence of the form of mental disorder later known as dementia praecox or schizophrenia, although Emil Kraepelin is generally accredited with its first conceptualisation.

“Father of modern psychiatry”, he was credited with the first classification of mental illnesses. He had a great influence on psychiatry and the treatment of the alienated in Europe and the United States.

Joseph Wolpe

Joseph Wolpe (20 April 1915 to 04 December 1997) was a South African psychiatrist and one of the most influential figures in behaviour therapy.

Wolpe grew up in South Africa, attending Parktown Boys’ High School and obtaining his MD from the University of the Witwatersrand.

In 1956, Wolpe was awarded a Ford Fellowship and spent a year at Stanford University in the Centre for Behavioral Sciences, subsequently returning to South Africa but permanently moving to the United States in 1960 when he accepted a position at the University of Virginia.

In 1965, Wolpe accepted a position at Temple University.

One of the most influential experiences in Wolpe’s life was when he enlisted in the South African army as a medical officer. Wolpe was entrusted to treat soldiers who were diagnosed with what was then called “war neurosis” but today is known as post traumatic stress disorder. The mainstream treatment of the time for soldiers was based on psychoanalytic theory, and involved exploring the trauma while taking a hypnotic agent – so-called narcotherapy. It was believed that having the soldiers talk about their repressed experiences openly would effectively cure their neurosis. However, this was not the case. It was this lack of successful treatment outcomes that forced Wolpe, once a dedicated follower of Freud, to question psychoanalytic therapy and search for more effective treatment options. Wolpe is most well known for his reciprocal inhibition techniques, particularly systematic desensitisation, which revolutionised behavioural therapy. A Review of General Psychology survey, published in 2002, ranked Wolpe as the 53rd most cited psychologist of the 20th century, an impressive accomplishment accentuated by the fact that Wolpe was a psychiatrist.

Frances Ames

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody. When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalization for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.

On This Day … 20 April

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1745 – Philippe Pinel, French physician and psychiatrist (d. 1826).
  • 1915 – Joseph Wolpe, South African psychotherapist and physician (d. 1997).
  • 1920 – Frances Ames, South African neurologist, psychiatrist, and human rights activist (d. 2002).

Philippe Pinel

Philippe Pinel (20 April 1745 to 25 October 1826) was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy. He also made notable contributions to the classification of mental disorders and has been described by some as “the father of modern psychiatry”.

An 1809 description of a case that Pinel recorded in the second edition of his textbook on insanity is regarded by some as the earliest evidence for the existence of the form of mental disorder later known as dementia praecox or schizophrenia, although Emil Kraepelin is generally accredited with its first conceptualisation.

Joseph Wolpe

Joseph Wolpe (20 April 1915 to 04 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behaviour therapy.

Wolpe grew up in South Africa, attending Parktown Boys’ High School and obtaining his MD from the University of the Witwatersrand.

In 1956 Wolpe was awarded a Ford Fellowship and spent a year at Stanford University in the Center for Behavioral Sciences, subsequently returning to South Africa but permanently moving to the United States in 1960 when he accepted a position at the University of Virginia.

In 1965 Wolpe accepted a position at Temple University.

One of the most influential experiences in Wolpe’s life was when he enlisted in the South African army as a medical officer. Wolpe was entrusted to treat soldiers who were diagnosed with what was then called “war neurosis” but today is known as post traumatic stress disorder. The mainstream treatment of the time for soldiers was based on psychoanalytic theory, and involved exploring the trauma while taking a hypnotic agent – so-called narcotherapy. It was believed that having the soldiers talk about their repressed experiences openly would effectively cure their neurosis. However, this was not the case. It was this lack of successful treatment outcomes that forced Wolpe, once a dedicated follower of Freud, to question psychoanalytic therapy and search for more effective treatment options. Wolpe is most well known for his reciprocal inhibition techniques, particularly systematic desensitisation, which revolutionised behavioural therapy.

A Review of General Psychology survey, published in 2002, ranked Wolpe as the 53rd most cited psychologist of the 20th century, an impressive accomplishment accentuated by the fact that Wolpe was a psychiatrist.

Frances Ames

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody. When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalisation for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.