Possible mechanisms for why desensitization and exposure therapy work
Section snippets
Possible mechanisms for why desensitization and exposure therapy work
Psychologists seem to agree, and our professional ethics require, that only reliable and valid psychological tests should be used. The new ethics code states that “Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested” (APA, 2002, p. 1071). Less agreement exists regarding psychotherapy. The extent to which interventions are to be based on and informed by scientific research is one of the primary professional
Explanatory bases and possible principles
We now understand that systematic desensitization depends upon exposure but the two therapies are treated separately here because that is how the explanatory literature is organized. Most literature citations regarding the explanatory basis of systematic desensitization are old because exposure therapy all but replaced it subsequent to Marks (1975) literature review and because research has focused almost exclusively on outcome research, hypothesis testing, and novel prediction since then. The
Empirically supported mechanisms
Parallel Distributed Processing Connectionist Neural Network (PDP-CNN) models are memory mechanisms that learn. Both learning and memory are driven by experience which makes both processes dependent upon sensation and perception. Hence, action mechanisms associated with the processes of learning, memory, sensation, and perception are pertinent to our understanding of how systematic desensitization and exposure therapy work. Some information regarding empirically supported PDP-CNN mechanisms is
Synaptic change
The network model presented above is empirically supported by evidence from neuroscience laboratories that has clearly demonstrated that learning and memory entail synaptic change; i.e., brain placticity. Connectionist models are memory systems that learn.
Neuroimaging studies
Kandel (1991) hypothesized that the biological changes produced by learning should be detectable with modern neuroimaging equipment. Baxter et al. (1992) reported PET results showing that nine OCD patients treated with CBT for 10 weeks
Weaknesses and limitations of connectionist explanations
The emerging field of PDP connectionism is not without its limitations and problems. O'Reilly and Munakata (2000) noted, “… the history of neural network modeling has been dominated by periods of either extreme hype or extreme skepticism” (p. 413). These authors summarized general and specific challenges to computational models (pp. 413–421): (a) PDP-CNN models have been criticized as being too simple thereby omitting potentially important details. Alternatively, simplification has been viewed
Conclusions
Reciprocal inhibition, counterconditioning, habituation, extinction, two-factor model, cognitive changes including expectation, self-efficacy, and cognitive restructuring, and emotional processing were considered as possible explanatory mechanisms for the effectiveness of systematic desensitization and exposure therapy. Various problems were identified that attenuate or undercut their explanatory force. A connectionist network cascade mechanism was presented that provides information beyond
Uncited references
Davis & Palladino, 2000
Noll, 1995
Tierney, 1995
References (171)
- et al.
Group preprogrammed systematic desensitization without the simultaneous presentation of aversive scenes with relaxation training
Behaviour Research and Therapy
(1971) - et al.
Overprediction of anxiety and disconfirmatory processes in anxiety disorders
Behaviour Research and Therapy
(1994) Effects of expectancy on the outcome of systematic desensitization and implosive treatments for analogue anxiety
Behavior Therapy
(1972)The role of expectancy and physiological feedback in fear research: A review with special reference to subject characteristics
Behavior Therapy
(1973)- et al.
A cognitive action theory of post-traumatic stress disorder
Journal of Anxiety Disorders
(1988) - et al.
Effects of systematic desensitization, programmed fantasy and bibliotherapy on a specific fear
Behaviour Research and Therapy
(1970) - et al.
Process of fear-reduction in systematic desensitization: Cognitive and social reinforcement factors in humans
Behavior Therapy
(1973) The necessity of neural networks
Learning and development in neural networks: The importance of starting small
Cognition
(1993)- et al.
The process of exposure in vivo: Cognitive and physiological changes during treatment of acrophobia
Behaviour Research and Therapy
(1985)
Behavioral/cognitive conceptualization of post-traumatic stress disorder
Behavior Therapy
Connectionism and the problem of systematicity (continued): Why Smolensky's solution still doesn't work
Cognition
Connectionism and the problem of systematicity: Why Smolensky's solution doesn't work
Cognition
Connectionism and cognitive architecture: A critical analysis
Cognition
The alleviation of test anxiety by systematic desensitization
Behaviour Research and Therapy
Computational models of the hippocampal region: Linking incremental learning and episodic memory
Trends in Cognitive Sciences
The etiology of post-traumatic stress disorder
Clinical Psychology Review
Drive level, incentive conditions and systematic desensitization
Behaviour Research and Therapy
Acquisition of blood, injury and needle fears and phobias
Behaviour Research and Therapy
A physiological model of phobic anxiety and desensitization
Behaviour Research and Therapy
Imagery in therapy: An information processing analysis of fear
Behavior Therapy
Implosive therapy
Can connectionism save constructivism?
Cognition
Rethinking eliminative connectionism
Cognitive Psychology
Connectionism: With or without rules?
Trends in Cognitive Sciences
Relaxation in systematic desensitization
Archives of General Psychiatry
Ethical principles of psychologists and code of conduct
American Psychologist
Principles of behavior modification
Self-efficacy: Toward a unifying theory of behavior change
Psychological Review
The self system in reciprocal determinism
American Psychologist
Self-efficacy mechanism in human agency
American Psychologist
Self-Efficacy: The exercise of control
The moderator-mediator variable distinctions in social psychological research: Conceptual, strategic, and statistical considerations
Journal of Personality and Social Psychology
Establishing specificity in psychotherapy: A meta-analysis of structural equivalence of placebo controls
Journal of Counseling and Clinical Psychology
Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive–compulsive disorder
Archives of General Psychiatry
Connectionism and the mind: Parallel processing, dynamics, and evolution in networks
Cognitive therapy and the emotional disorders
Cognitive therapy: Basics and beyond
Active muscular relaxation in desensitization of phobic patients
Psychological Medicine
Developmental plasticity in neural circuits for a learned behavior
Annual Review of Neuroscience
The eclipse of Darwinism: Anti-Darwinian evolution theories in the decades around 1900
A dual representation theory of Posttraumatic Stress Disorder
Psychological Review
Role of expectancy manipulation in systematic desensitization
Journal of Consulting and Clinical Psychology
Neural network models of conditioning and action
Evaluation of the efficacy of the components of reciprocal inhibition psychotherapy
Journal of Abnormal Psychology
The role of muscular relaxation in systematic desensitization
Reaction to trauma: A cognitive processing model
Journal of Abnormal Psychology
The origin of species: By means of natural selection or the preservation of favoured races in the struggle for life
Psychology
Cited by (127)
Self-perceived outcomes of informative and apologetic self-disclosure: A mixed methods study
2023, Journal of Communication DisordersFeasibility of Concussion Rehabilitation Approaches Tailored to Psychological Coping Styles: A Randomized Controlled Trial
2022, Archives of Physical Medicine and RehabilitationIdentifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures
2021, Journal of Affective Disorders ReportsBehavioral and neural processes in counterconditioning: Past and future directions
2020, Behaviour Research and TherapyCitation Excerpt :Positive mood induction increased CS valence ratings following extinction, relative to a control condition, and reduced reinstatement of fear-potentiated startle and self-reported fear at a one week test. The principles of counterconditioning have been effectively utilized through systematic desensitization therapy to treat disorders characterized by negative valence, such as Specific Phobias and Obsessive Compulsive Disorder (Tryon, 2005). Paunovic (2011) developed an exposure counterconditioning method to treat PTSD by asking patients to undergo imaginal reliving of a pleasurable emotional experience incompatible to the trauma.