Process Variables and the Prediction of Outcome in Behaviour Therapy

¹ Senior Research Psychologist, Department of Psychiatry, University of Oxford, The Warneford Hospital, Oxford, OX3 7JX
² Research Psychologist, Department of Psychiatry, University of Oxford, The Warneford Hospital, Oxford, OX3 7JX
³ Research Psychiatrist, Department of Psychiatry, University of Oxford, The Warneford Hospital, Oxford, OX3 7JX
⁴ W. A. Handley Professor of Psychiatry, Department of Psychiatry, University of Oxford, The Warneford Hospital, Oxford, OX3 7JX

Variables measured before and during behaviour therapy or non-specific treatment of 36 phobic patients were examined for their possible relevance to outcome and to the processes occurring during successful treatment. Measures obtained before treatment began did not provide a useful guide to outcome, with the possible exception of high extraversion scores, which were associated with a good response, irrespective of treatment given. There was no evidence that by using the measures examined, patients could be individually allocated in advance to the treatment most likely to help them.

Flooding treatment was associated with a greater initial increase in heart rate, which disappeared after eight treatment sessions but did not seem to influence outcome. Ratings of phobic anxiety made by patients who were improved after desensitization or flooding, declined systematically during treatment. Anxiety experienced when thinking about phobic situations showed a consistent decline after preparatory interviews were complete, but estimated anxiety in real life did not begin to decrease until immediately before the in vivo practice phase of treatment. The findings of significant differences between improved and unimproved groups in these measures suggests that response to the first few treatment sessions could be useful in predicting longer term changes.

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