Anxiety Management Training with Competence Imagery to Reduce Phobic Behavior: Radical Cognitive Behavior Therapy

1. 1 Anxiety Management Training with Competence Imagery to Reduce Phobic Behavior: Radical Cognitive Behavior Therapy

2. 2 Beginnings of Behavior Therapy Exposure Based Treatments of Anxiety Systematic Desensitization through Reciprocal Inhibition

3. 3 Disadvantages Therapist Administered Hierarchy Based (Unnecessary) Lengthy Relaxation Procedure Limited to a Specific Fear

4. 4 Anxiety Management Training (Suinn & Richardson, 1971) Also Exposure and Reciprocal Inhibition based Subjects taught to imaginally rehearse encountering the feared stimulus while using the inhibitor to prevent anxiety. BUT Learn General Skill to Inhibit Any Anxiety No Hierarchy Once Learned: Can be Self-Administered to Any New Fear.

5. 5 Suinn and Richardson initially suggested that either relaxation or competence imagery could be used to inhibit anxiety in Anxiety Management Training (AMT). Suinn (1990) later abandoned competence imagery because his patients could not produce images of themselves performing competently. The Patients had no Competent Performances on which to build the imagery. They didn’t succeed very often in real life. Relaxation was taught to these subjects but Suinn expected them to bring competency images with them based on their past experience. Goldman and O’Brien (2004) hypothesized that it should be possible to provide subjects with success experiences on which to build competence imagery.

6. 6 Relaxation has Disadvantages Cumbersome. Some patients have trouble achieving it. Some patients habituate to it. High Energy Patients (Adolescents) resistant. Boring.

7. 7 Reemergence of Competence Imagery I began to use competence imagery to inhibit anxiety in clinical practice. Clinical Examples 1. 16 year old male Roller Hockey Player Anxious around Girls. 2. 30 Year old female Performance Anxiety

8. 8 Controlled Studies 3. Roban and O’Brien (2000) demonstrated a decrease in self-reports of test anxiety with a one session, competence based AMT. 4. Nichols and O’Brien (2004) showed decreases in anxiety and depression in a geriatric population using competence imagery.

9. 9 5. Subject with a fear of Encountering Vomit (Moran & O’Brien, 2004). Desensitization after failure using relaxation. Obsessions gone. Patient returned to school and social activities

10. 10 Failure: Like Suinn, I had a patient with no success experiences, who could produce no competent imagery. (High School girl; fear of driving) Reaffirmed Suinn’s point: Anxiety Neurotics may not have a lot of competent images. Does that justify abandoning competence imagery?

11. 11 NO! Scott Goldman and I (Goldman & O’Brien, 2004a; 2004b) hypothesized that it should be possible to provide subjects with success experiences on which to build competence imagery. Instead of relying on the thoughts and memories that the client brought with them as the controlling variables for competence imagery, we used rock climbing to provide success experiences to build the competence imagery.

12. 12 Rock Climbing: Guaranteed Success

13. 13 Scott is a certified rock climbing instructor. The subjects climbed a rock wall while he served as the belayer anchoring their climb. For the novice, the first time that one climbs a wall is a challenging experience. Conquering it elicits very strong feelings of having overcome a difficult task.

14. 14 Rock Climbing: Guaranteed Success

15. 15 Sling Shot Belay Climb

16. 16 Their success on the wall was the basis for developing competence imagery. That imagery was used to inhibit anxiety in an AMT treatment that involved alternating anxiety induction images of the snake and competence inducing images from their successful climbs of the rock wall.

17. 17 Augmented Anxiety Management Training: Competency Imagery Program Provide subjects with a direct competence experience; Convert this experience into a competence imagery program. Administer the competency imagery program to generate physiological response produced stimuli that would serve as a competing response to anxiety in the same way that relaxation, eating, and sexuality is taught to reciprocally inhibit anxiety in Wolpe’s Reciprocal Inhibition and Suinn’s Anxiety Management Training (AMT). Reduce phobic responses using the Competence Imagery Based Anxiety Management Training

18. 18 Method Subjects: Ten volunteers (6 females and 4 males) who could get no closer than ten feet to a snake on a behavioral avoidance test. Randomly assigned to an early treatment or a late treatment group in a multiple baseline across subjects design. The subjects had no rock climbing experience. All subjects were interviewed prior to treatment to develop specific snake anxiety scenes.

19. 19 Procedure: The Early Group has one Behavioral Avoidance Test (BAT) with the snake using a 30’ runway and then experienced 6 guaranteed successful rock climbs. (See Table 1) After each climb of the wall they were given an approximately 7 minute session of AMT which involved two anxiety scenes and three competence imagery scenes developed from their successful rock climbing experience. They, then completed another BAT. The Late Treatment Group completed a BAT during the first four trials but made no climbs and had no AMT. They made their first successful climb and had their first AMT session prior to the BAT on Trial 5.

20. 20 Although all subjects had all the rock climbing trials on one day, the early treatment group experienced 6 climbs and AMT sessions but the late group experienced only 3. Both groups were brought in weekly for the next four weeks for a once a week AMT and measurement session but no rock climbing was included. One month and four month follow-up measurements were taken.

21. 21 Administration of Treatment

22. 22

23. 23 Visual Analog Scale

24. 24

25. 25 Snake Anxiety Questionnaire

26. 26

27. 27 Individual Data Individual data generally parallel the group data however subjects showed so little fear as treatment progressed that some new tasks had to be added to the measurement system such as “Had the snake crawl up her arm”, “Brought the snake up to his face”, and “Had the snake curled around her neck”. It is clear that the subjects are showing little fear on either the performance measures or the pictures of them handling the snake.

28. 28 Subject 8

29. 29 Subject 5

30. 30 Subject 10

31. 31 Subject 3

32. 32 Subject 7

33. 33 Follow-up So AMT with competence imagery instilled in this way can be used to decrease snake phobia, it is still necessary to demonstrate that these effects endure as long as those produced using other exposure based approaches. Follow-up measures of 9 of the 10 subjects revealed maintained gains on the behavioral avoidance test and the visual analog scale. The Snake Anxiety Questionnaire showed some deterioration in the early group at the four month follow-up but the subjects’ behavior revealed little fear.

34. 34 Conclusions These results suggest that competency imagery can be an effective tool in treating fear within the AMT paradigm if the therapist can provide bone fide competence inducing experiences. In the present study, competence imagery was employed to inhibit anxiety in an AMT program that virtually eliminated fears of snakes as measured by a Behavioral Avoidance Test. These effects were generally supported by the indirect, self-report measures: the Visual Analog measure of anxiety and the Snake Anxiety Questionnaire.

35. 35 Unlike traditional CBT, the source for the imagery was neither ignored nor assumed to lie in the unknown history of the subject. Without their knowledge, subjects were given realistic but artificially controlled success experiences to serve as the source for the competence images. The inhibition of their anxiety is attributed to the experiences that we provided not to their inventive ideation.

36. 36 The response produced stimuli elicited by the competence imagery program were expected to act as the incompatible response to anxiety in AMT. Under those conditions, the antecedent controlling variables are not thoughts or memories that lie beyond further analysis but the experiences that we provided.

37. 37 In Radical Behaviorism (Skinner, 1953) thoughts are not dismissed or ignored. It is assumed that thoughts follow the same laws of learning as any other behavior. You must account for the controlling variables on the thought. You can’t end an explanatory chain with a thought. You must be able to document what produced that thought. Otherwise it is whimsy not science.

38. 38 In this Radical Behavioral Approach to an Imagery Intervention, we account for the source of the imagery.