Journal of Abnormal and Social Psychology
1901, Vol. 63, No. 3, 504-510
GROUP THERAPY OF PHOBIC DISORDERS BY SYSTEMATIC
DESENSITIZATION1
ARNOLD A. LAZARUS
Psychiatric Unit, Witwaterstand University Medical School
T HF, increasing demands for psychological
and psychiatric services dictate the
need for effective short-term therapeutic
techniques and the extension of the existing
services. Consequently, group techniques have
grown in clinical stature, and the past decade
has witnessed the development of numerous
divergent procedures. A most promising
variety of short-term therapy is Wolpe's (1958)
system of "reciprocal inhibition," by which he
achieved the recovery of 188 out of 210
neurotic cases in an average of 34.8 sessions.
A double economy can be achieved by
combining the advantages of Wolpe's (19S8)
expedient clinical procedures with the addi-
tional time- and effort-saving properties of
group therapy. This paper describes the
adaptation of Wolpe's most important thera-
peutic procedure—the technique of systematic
descnsitization based on relaxation—to the
group treatment of phobic disorders. In
addition, the therapeutic effects of group
desensitizatiou were compared with more
conventional forms of interpretive group
psychotherapy on matched pairs of phobic
subjects.
MKTHOD
General Procedure
The sample consisted of 35 middle-class urban
white South Africans who were handicapped by
phobic disorders.2 Social class membership was denned
in terms of education, vocation, and income. There
were 7 university graduates, 16 matriculants, and 12
patients with at least 3 years of secondary schooling.
Apart from 3 professional women, the majority of
1
This paper is an outline of the experimental section
of a thesis entitled "New Group Techniques in the
Treatment of Phobic Conditions," which was accepted
by the University of the Witwatersrand in December
1960, for the degree of Doctor of Philosophy.
2
The sample was not drawn from psychiatric
hospitals or institutions as it was felt that extraneous
variables would be introduced. Since the rules of the
South African Psychological Association forbid regis-
tered psychologists to advertise in the press, the
patients were obtained with the generous aid of friends
and colleagues who made announcements at lectures
and contacted their own associates.
504
female patients were housewives whose husbands'
average earnings were the equivalent of $550 a month.
The mean income for the rest of the group was approxi-
mately $600 a month. In all, there were 12 men and 23
women, the mean age being 33.2 years with a standard
deviation of 9.87.
The entire group included It acrophobics, 15
claustrophobics, 5 impotent men (treated as suffering
from sexual phobia), and a mixed group of 4 phobic
patients. The latter comprised a girl with a fear of
sharp objects, a man with a fear of physical violence,
a woman who was afraid to be a passenger in a moving
vehicle, and a woman with a phobia for dogs.
The basic experimental design was to compare
group desensitization therapy with more conventional
methods of group treatment (or therapy based on
"group dynamics"). The group desensitization tech-
nique consisted of systematically counterposing by
relaxation graded lists of anxiety evoking stimuli
which the separate groups of patients were asked to
imagine.
The efficacy of group desensitization was first
compared with group interpretation. The same therapist
(the investigator) conducted all the therapeutic groups.
The initial comparison was made on a group of five
acrophobic patients, two of whom received desensitiza-
tion therapy, and three who were treated by interpretive
group procedures,
Throughout the experiment, pairs of phobic patients
were matched in terms of sex, age (within a 4-year
range), and the nature and objective severity of the
phobic disorders. A coin was tossed to decide whether
a given member of each matched pair would be treated
by desensitization therapy or by group interpretation.
Extra (unmatched) individuals were always placed in
the interpretive groups because it is generally agreed
that these groups require a minimum of three members
(Corsini, 1957).
When, after six sessions, treatment with the acro-
phobic groups was well underway, the next group (five
impotent men) was selected and similarly subdivided
into two additional groups, treated by desensitization
and interpretation, respectively.
Three months later, the group of six claustrophobic
patients was selected and equally subdivided to form a
third separate desensitization-interpretation com-
parison.
Thus, at the end of 6 months, a total of seven patients
had received group desensitization and nine had been
treated by group interpretation.
Seven months later, additional acrophobic and
claustrophobic patients were obtained in order to
investigate the effects of relaxation per se. It was
hypothesized that individuals who received training in
relaxation at the end of each interpretive session would
show a greater diminution of phobic reactions than
those patients who had been treated solely by group
 GKOUP THERAPY BY SYSTEMATIC DESENSITIZATION
interpretation. The suggestion that interpretation-plus-
relaxation might be more effective than desensilization
was also tested.
Accordingly, an additional six acrophobic patients
were equally divided into two matched groups, the one
receiving desensitization therapy and the other receiv-
ing interpretation-plus-relaxation. The latter group
was trained in an accelerated version of Jacobson's
(1938) progressive relaxation for about 15 minutes at
the end of each interpretive therapeutic discussion.
A few weeks later, an additional nine claustrophobic
patients were similarly subdivided. Group desensitiza-
tion was administered to four patients and group
interpretation-plus-relaxation was applied to five.
Finally, the mixed phobic group was treated by
desensitization in order to determine whether desensi-
tization could be successfully applied to a heterogeneous
phobic group.
Thus, group desensitization was applied to 18
patients; group interpretation was applied to 9 patients,
and 8 patients were treated by group interpretation-
plus-relaxation.
Selection of Phobic Patients
Although there were numerous volunteers for
inclusion in the investigation, only those people whose
phobias imposed a severe limitation on their social
mobility, jeopardized their interpersonal relationships,
or hindered their constructive abilities were admitted
to the therapeutic groups.
Several people who were greatly handicapped by
phobic disorders were excluded because they had
received previous psychiatric treatment, ranging from
psychoanalysis to electroconvulsive therapy. These
people were given individual treatment in order to
avoid ambiguity concerning the effects of the thera-
peutic groups.
The character and severity of the phobias were
assessed in the following manner: Patients reporting
acrophobic symptoms were privately and individually
required to climb a metal fire escape. The experimenter
climbed the stairs directly behind the patients and
urged them to see how high they could climb. Few of
the patients were able to proceed higher than the first
landing (approximately 15-20 feet from ground level).
The patients who were admitted to the acrophobic
groups were all able to achieve a pretherapeutic height
of between 15 and 25 feet.
Similarly, patients with claustrophobic traits were
admitted individually into a well-ventilated cubicle
with large French windows which opened onto a
balcony. The patient sat facing the open windows. To
the left of the patient was a movable screen which
could be pushed as far as the centre of the cubicle,
thus, creating a sensation of space constriction. The
patients were told that the experimenter would first
shut the French windows and then proceed to push the
screen towards the centre of the room. They were
urged to remain in the cubicle for as long as possible
and to reopen the windows only when they felt that the
need for air had become unbearable. Most of the
patients showed visible signs of discomfort as soon as
the windows were shut, and no one was able to tolerate
the screen at a distance of less than 20 inches.
505
Detailed information regarding the purpose of the
investigation was withheld from the patients to avoid
possible prejudice to the results. They were merely
informed that the experimenter was conducting research
into the alleviation of phobic disorders by group
methods.
Apart from the initial screening procedures, in-
dividual contact with the patients was avoided in
order to exclude the influence of any additional thera-
peutic factors. It is thought, for instance, that history
taking and psychometric investigations may in them-
selves be therapeutic. In order to determine the value
of group therapy per se, it was considered necessary to
eliminate as many of these extraneous variables as
possible. Attention was deliberately focused, therefore,
on the specific techniques under investigation, avoiding
the use of any supplementary measures which might
facilitate therapeutic progress. For instance, in clinical
practice it is customary to precede the application of
systematic desensitization by a brief outline of the
theoretical rationale behind the technique. Since it
could be argued that this practice has a direct bearing
on the results, the patients were directly desensitized
without any preliminary explanation.
Group Desensitization
Anxiety hierarchies (graded lists of stimuli to which
the patients reacted with unadaptive anxiety) were
constructed (Wolpe, 1958). In preparing these hier-
archies, the experimenter extracted common elements
from remarks which individual patients wrote on the
questionnaires they filled out, and a group hierarchy
was constructed. It must be emphasized that the
hierarchical situations were imaginary ones, listed on
paper and presented only symbolically to the patients.
The acrophobic group hierarchy, for example,
consisted of the following situations: looking down
from a very high building, seeing films taken from an
airplane, looking down from a height of 80-100 feet,
looking down a well, sitting high up on a grandstand
during a football game, looking down from a 60-foot
balcony, sitting on a narrow ledge at a height of 60 feet
with a safety net a few feet away, looking down from a
height of about 55 feet, seeing someone jump from a
50-foot diving board, sitting on a wide ledge about 35
feet from the ground, looking down from a height of
approximately 20 feet, looking down from a height of
about 10 feet.
The claustrophobic group hierarchy consisted of 16
situations ranging from "sitting in a large and airy
room with all the windows open," to "sitting in front
of an open fire in a small room with the doors and
windows shut." The group hierarchy applied to the
impotent men contained 10 items referring progressively
intimate sexual situations requiring increasing amounts
of initiative.
The first therapeutic session was devoted entirely
to training the patients in intensive muscular relaxation.
At the end of the session, the patients were instructed
to practise specific relaxation exercises for about 15
minutes morning and night.
The second session was held 3 days later, when
further training in relaxation was provided. Towards
the end of this session, desensitization commenced
506 ARNOLD A. LAZARUS
with the presentation (in imagination) of the two
weakest items of the relevant anxiety hierarchy. The
acrophobic patients, for example, were first told to
picture themselves looking out of a window about 10
feet from the level of the street. It was impressed upon
them that if any scene proved upsetting or disturbing,
they were to indicate this by raising their left hand.
When any patient signaled in this manner, the scene
was "withdrawn" immediately.
When the two least disturbing items in the relevant
anxiety hierarchy had been presented, each of the
patients was asked to report on the clarity of the
imagined scenes and their accompanying levels of
disturbance. The second session ended after the patients
had been told to practise relaxation twice daily for
periods of about 10 minutes.
The subsequent desensitization sessions followed a
set pattern. The therapist named the various muscle
groups to be relaxed. When a deep level of relaxation
was reached, the patients were presented with succes-
sive items from the hierarchical series. The desensitiza-
tion procedure was conducted at the pace of the "slow-
est" (i.e., most anxious) subject.
The third session was terminated only when all the
patients were able to tolerate an exposure of about 10
seconds to the first three items on the hierarchy without
signaling anxiety. Thereafter, new items were intro-
duced only when a 10-second tolerance to the preceding
item had been achieved. It took several sessions before
the entire group was able to visualize a given item for
as long as 10 seconds without one or another member's
signaling some disturbance.
Apart from occasional restlessness in those who were
ready for more "difficult" anxiety items but who were
constantly re-exposed to stimuli which they had long
since mastered, no harm seemed to ensue from proceed-
ing at a pace that was obviously too slow for part of
the group. On the other hand, experience has shown
that too rapid a pace can prove extremely antithera-
peutic and lead to increased levels of anxiety.
Therapy in the desensitization groups was termi-
nated when the final item on the hierarchy was tolerated
by the patients for 10 seconds without signaling.
Patients often reported a marked amelioration of their
phobic responses when the anxiety hierarchies were
only half completed. It was insisted that each member
would nevertheless have to undergo desensitization
of the entire hierarchy in order to consolidate and
reinforce their therapeutic gains.
The treatment of the claustrophobic groups was
conducted out of doors. The patients in the mixed
phobic group were handed the items of their relevant
anxiety hierarchies on slips of paper. Here, the relaxa-
tion procedure adopted was as previously outlined,
but instead of describing the items, the therapist handed
a typewritten anxiety scene to each group member and
instructed him to read the description of the scene, to
close his eyes and to try to imagine the situation with
tranquility. The patients were instructed to signal in
the usual manner when a given situation became
disturbing, and then immediately to stop imagining the
scene and to continue relaxing. After about 10 seconds,
all the patients were told to stop picturing the scene
and remain relaxed. Those who had successfully
imagined their item without undue disturbance were
then handed a new anxiety situation. In this manner,
each group member was able to proceed at his own
pace. No more than two successive items were presented
at any one session.
Group Interpretation
The approach used in the interpretive groups was a
form of insight therapy with re-educative goals (Wol-
berg. 1954). Leadership was basically democratic, and
the therapist's primary role was that of a participant
observer. The groups passed through two phases:
First, there was an introductory period during which
the group situation was structured with the emphasis
on a free and permissive emotional atmosphere. Feelings
of initial tension and reticence were dealt with by
open discussion, emphasizing group tolerance and
acceptance and clarifying numerous misconceptions.
Second, descriptions of phobic symptoms preceded
intensive discussions which focused attention on
emotions and on current interpersonal relationships.
The emphasis shifted from a situational to a personal
exploration. A considerable amount of historical data
emerged and frequently provided abrcactive and
cathartic responses. The recall of forgotten memories
was often accompanied by violent emotional reactions.
The group of impotent men displayed a high degree
of empathy for one another, and frequently expressed
feelings of hostility and resentment towards the thera-
pist. These feelings were accepted by him and clarified
for the patients; they were followed by discussions of
the effects of frustration.
At the end of each session, the therapist provided a
summary of the proceedings. He attempted not only to
recapitulate the remarks of the subjects and to reflect
back to the group the emotional significance of their
statements, but also to suggest possible connections
between their symptoms and their feelings. Interpretive
remarks dealt mainly with possible motives behind the
facade of manifest behavior. Premature interpretations
were vigilantly avoided. Obvious rationalizations, as
well as statements of overprotestation, were challenged
by the therapist only when he sensed a readiness on
the part of the group.
Both the interpretive groups and the desensitization
sessions were usually conducted three times a week.
The desensitization groups were disbanded when all
the patients were able to tolerate the most severe
anxiety producing stimulus in the hierarchy without
undue disturbance.
Members of the interpretive groups were given the
same number of sessions as the corresponding desensi-
tization groups. Since very few patients recovered
from their phobias by means of the interpretive
procedures, the ones whose phobic symptoms persisted
were provided with an opportunity of undergoing group
desensitizatiou. (There were too few desensitization
failures to satisfy the minimum numerical requirements
for comparable interpretive groups.) Although the
main response was an immediate willingness to intro-
duce the "different group technique," the group of
impotent men decided to continue employing interpre-
tive procedures a while longer. Group desensitization
was then administered to those patients who were not
rendered symptom-free by the interpretive methods.
 GROUP THERAPY BY SYSTEMATIC DESENSITIZATION
RESULTS
Assessment of Recovery
One month after therapy had terminated,
the acrophobia and claustrophobic patients
who claimed to have recovered from their
phobias were required to undergo additional
stress tolerance tests.
The acrophobic subjects were required to
climb to the third landing of a fire escape
(a height of about 50 feet). From the third
story, they were required to go by elevator
with the experimenter to the roof garden,
eight stories above street level, and then to
count the number of passing cars for 2 minutes.
The claustrophobic subjects were required
to remain in the cubicle with the French
windows shut and the movable screen a few
inches away. Those who were able to endure
the situation with no apparent distress for 5
minutes were regarded as recoveries, provided
that they were also able to present satisfactory
evidence that they were no longer handicapped
in their life situations. The tests were con-
ducted individually in the presence of a
witness.
With two exceptions, all the patients who
stated that they had recovered from their
phobias were able to face the tolerance tests
with outward tranquility, although some of
the acrophobic patients later admitted that
they had felt "a trifle anxious" when looking
down from the edge of the roof garden.
I Neither the impotent men nor the members
of the mixed phobic group were objectively
tested.
The most rigorous criteria were used in
assessing therapeutic results. For instance,
only those patients who displayed an unam-
biguous posttherapeutic freedom from their
respective phobic disorders were classified as
recoveries. These criteria were, of course,
essentially symptomatic. If a claustrophobic
patient for instance, was still unable after
therapy to visit the cinema for fear of suffoca-
tion, his treatment was considered a failure,
regardless of any ex parte testimony to the
contrary. Merely to enable a patient to
"accept his neurosis" or to achieve a so-called
"personality reintegration" without sympto-
matic relief was considered not good enough.
Recovery from a phobic condition implies total
neutrality or indifference to the formerly
507
TABLE 1
NUMBER OF PATIENTS ASSIGNED TO EACH CONDITION
AND ME THERAPEUTIC OUTCOME
Treated Re- Treated Re- by Treated
inter- Re-
by de- cov- by in- cov- pretation
Patients cov-
sensi- ered terpre- ered and relax- ered
tization tation
Acrophobics 5 4 3 0 3 1
Claustropho- 7 4 3 0 5 1
bics
Impotence 2 2 3 0 — —
Mixed group 4 3 —• —
— —
Total 18 13 9 0 8 2
anxiety generating stimulus constellation.
The present study made no provision for
moderate or slight improvements. The latter
were all classified as failures.
Statistical Analysis of the Results
Results are summarized in Table 1. As
shown, there were 13 recoveries and 5 failures
for desensitization, 2 recoveries and 15 failures
for other forms of treatment. The resulting chi
square is 10.69, which is highly significant
(p < .01).
Additional statistical comparisons were
computed for the matched pairs of acrophobic
and claustrophobic patients who received
group desensitization or group interpretation,
respectively. There was a total of five matched
pairs in these groups. Both members remained
unimproved in one pair; in four, the desensiti-
zation patients recovered but the interpreta-
tion cases failed. There were no pairs in which
both recovered or in which only interpretive
methods succeeded. By applying the null
hypothesis that the two methods are equally
effective, the probability of obtaining this
result is .0625.
In the case of the impotent men, no matching
was carried out. Fisher's (1946, p. 97) exact
test, which gave a probability of .1, was
employed for testing significance. When the
two probabilities, .0625 and .1, were combined
(Fisher's 1946, p. 99), the resulting level of
significance was .03, favoring desensitization.
It is interesting to note that when com-
parisons were made between the matched
pairs of acrophobic and claustrophobic patients
who received group desensitization as opposed
to group interpretation-plus-relaxation, the
level of significance in favor of desensitization
508 ARNOLD A. LAZARUS
was only 12.5%. There were three matched
pairs in which desensitization proved success-
ful and interprctation-plus-relaxation failed.
There were no cases where group interpretation
plus-relaxation succeeded while group desensi-
tization failed. Both methods failed with
three matched pairs and both methods
succeeded with one matched pair.
Since a significance level of 12.5% falls
outside the conventional limits, the obvious
conclusion is that there is no evidence of
differences between the desensitization and
interpretation-plus-relaxation conditions. Of
course, seven matched pairs provides one
with little leverage and the statistical analysis
of such a small number cannot be conclusive.
It is worth noting, however, that of the six
individuals who were initially unsuccessfully
treated by interpretation-plus-rclaxation, four
later recovered from their phobias after a mean
of 9.8 group desensitization sessions.
Of the total of 15 patients who had derived
no apparent benefit from the interpretive
procedures, 10 recovered from their phobias
after a mean of 10.1 group desensitization
sessions, as compared with the mean of 20.4
sessions which were necessary for effective
group desensitization when only this pro-
cedure was employed.
Follow-Up Studies
Follow-up studies were conducted by means
of the following questionnaire:
1. Has your original phobic disorder returned?
2. If you have had a relapse, is it slight, moderate,
or severe?
3. Since receiving treatment have you developed
any new symptoms? (If so, please elaborate.)
4. Please underline all the following complaints
which apply to you:
Tension Depression Anxiety Palpitations
Dizziness Insomnia Nightmares Headaches
Tremors Sexual problems Fatigue Stomach
trouble Other symptoms (specify)
5. Please indicate whether any of the above com-
plaints commenced after your participation in the
therapeutic groups.
6. Are you still handicapped in any area of your
daily living? (Specify.)
7. Have you consulted another therapist?
The duration of after-study history varied
from group to group, and ranged from 15
months to 1.5 months with a mean of 9.05
months. All those subjects whose follow-up
reports revealed even slight phobic recurrences
were considered to have relapsed. Particular
attention was devoted to the question of
possible symptom substitution, but no evi-
dence of this phenomenon was encountered.
When the follow-up evaluations were taken
into account, 10 of the 13 patients who had
recovered by means of group desensitization
still maintained their freedom from phobic
symptoms. Thus, 3 patients were regarded as
having relapsed.
Of the 2 patients who had recovered after
undergoing group interpretation-plus-relaxa-
tion, 1 maintained his recovery.
Eight of the 10 patients who recovered after
undergoing postinterpretive group desensitiza-
tion maintained recovery.
Summary of Findings
Group desensitization was applied to 18
patients of whom 13 initially recovered and
3 subsequently relapsed.
Group interpretation was applied to 9
patients. There were no recoveries in this
group.
Group interpretation-plus-relaxation was
applied to 8 patients of whom 2 recovered and
1 subsequently relapsed.
The 15 patients who had not benefited from
the interpretive procedures were then treated
by group desensitization. There were 10
recoveries of whom 2 subsequently relapsed.
DISCUSSION
Wolpe (1958) has expressed the basis of his
"reciprocal inhibition" therapy as follows:
If a response incompatible with anxiety can be made
to occur in the presence of anxiety-evoking stimuli so
that it is accompanied by a complete or partial sup-
pression of the anxiety-responses, the bond between
these stimuli and the anxiety-responses will be
weakened.
His method of systematic desensitization
based on relaxation incorporates Jacobson's
(1938) finding that muscular relaxation
inhibits anxiety and that their concurrent
expression is physiologically impossible.
The deliberate use of the parasympathetic
accompaniments of skeletal muscular relaxa-
tion to inhibit neurotic anxieties reciprocally
may be termed "specific reciprocal inhibition."
There is, however, a broad range of stimuli
which have nonspecific properties for inhibiting
neurotic responses reciprocally. The more
 GROUP THERAPY BY SYSTEMATIC DESENSITIZATION
usual clinical medium of verbal interchange,
for instance, may in itself bring about the
incidental or nonspecific reciprocal inhibition
of neurotic responses. In other words, it is
postulated that interview situations can some-
times evoke autonomic responses similar to
those of deep muscle relaxation.
The fact that far fewer sessions were re-
quired to desensitize those subjects in the
present sample who had previously received
interpretive therapy may be explicable by the
notion that interpretive group situations
evoked appropriate emotional responses in
most of the subjects to inhibit some of their
anxieties. In other words, it is probable that
some of the anxiety responses evoked by the
group discussions underwent a measure of
nonspecific reciprocal inhibition. Furthermore,
those patients who received postintcrpretive
group desensitization had the advantage of
having established a therapeutic relationship
with the experimenter. It is postulated that
"the therapeutic atmosphere of empathy and
acceptance may in itself reciprocally inhibit
neurotic anxieties" (Lazarus, 1959).
It should be mentioned that the interpretive
groups apparently enabled many of the
patients to achieve a constructive modification
of their self-evaluation, often clarified their
evaluation of others, and enhanced their
potentialities of interpersonal integration.
These gains, however, appeared to have little
bearing on their phobic symptoms, which
usually persisted until desensitization pro-
cedures were administered.
The comparatively high relapse rate in the
present series is probably related to the fact
that the treatment was rather narrowly con-
fined to a single range of stimuli which could
in some cases have been a small part of a
broad constellation, other elements of which
may have afforded additional and possibly
more useful bases for desensitization. In a
proper clinical setting, the group desensitiza-
tion procedures would have been preceded by
individual history taking and the compilation
of detailed clinical information for use either
individually or in the group situations.
Consequently, the conditions for the applica-
tion of desensitization therapy were far less
than optimum, a point which suggests that
the experimental outcomes are only minimally
indicative of the utility of this therapeutic
approach to phobic symptoms.
509
The concept of "experimenter bias" is a
relevant consideration in any study of this
kind. It is difficult to determine the extent to
which the present results were influenced by
the therapist's theoretical affiliations. In terms
of subjective interest, however, it should be
noted that the experimenter's preferences were
decidedly in favor of the interpretive methods.
Fortunately, the ennui which is generated
while applying desensitization procedures is
adequately offset by the gratifying results.
If another therapist had treated the inter-
pretive groups, a significant difference in the
results might merely have reflected the
superiority of the individual therapist rather
than the methods employed. The treatment of
phobias by interpretive methods, however, is
well known to be difficult. Curran andPartridge
(1955), for instance, state that "phobic
symptoms are notoriously resistant to treat-
ment, and their complete removal is rarely
achieved." Similar views are expressed by
Maslow and Mittelmann (1951), Henderson
and Gillespie (1955), and Mayer-Gross,
Slater, and Roth (1955). By contrast, phobias
respond to desensitization exceedingly well
(Eysenck, 1960; Lazarus & Rachman, 1957;
Wolpe, 1958). It is contended, therefore, that
the superior results achieved by group desensi-
tization are not a function of the therapist's
disproportionate skills (or unconscious preju-
dices) but a reflection of the intrinsic value of
desensitization per se in the treatment of
phobic disorders.
The point may legitimately be raised as to
whether desensitization achieves any result
other than the elimination of the phobic
symptom. Comments on the general reper-
cussions of desensitization are not possible in
the context of the present study. No attempt
was made to study changes in personality or
general adaptation. Many patients, however,
made remarks which suggested that the elimi-
nation of a phobic symptom is not an isolated
process, but has many diverse and positive
implications. As Eysenck (1959) states:
The disappearance of the very annoying symptom
promotes peace in the home, allays anxiety, and leads
to an all-round improvement in character and behavior.
The extent to which desensitization is a
method of general applicability (i.e., whether
this method would benefit any neurotic
patients other than those suffering from
510 ARNOLD A. LAZARUS
phobic disorders) is also worthy of mention.
The value of desensitization is limited to those
conditions wherein appropriate hierarchies
can be constructed and where specific rather
than pervasive anxiety is present. In other
words, it is only where reasonably well-defined
stimulus configurations can be identified that
desensitization techniques should be applied.
For example, patients whose interpersonal
relationships are clouded by specific fears of
rejection, hypersensitivity to criticism, clear-
cut areas of self-consciousness, or similar
specific anxiety evoking stimuli often derive
benefit from desensitization procedures. By
contrast, desensitization cannot readily be
applied in such cases as character neuroses,
hysterical disorders, and chronic inadequacy.
A further prerequisite for the effective appli-
cation of desensitization is the ability to
conjure up reasonably vivid visual images
which elicit emotional reactions comparable
to the feelings evoked in the real situation.
While dealing with the limitations of
desensitization procedures, one should not
lose sight of the fact that systematic desensiti-
zation appears to be a most valuable technique
in the alleviation of phobic disorders. The fact
that this method can be effectively adminis-
tered in groups suggests greater availability
with little loss in economy or effectiveness for
phobic sufferers.
SUMMARY
Wolpe's (1958) technique of systematic
desensitization based on relaxation was
adapted to the treatment of phobic disorders in
groups. Of the 18 subjects who were treated
by direct group desensitization, 13 recovered
in a mean of 20.4 sessions. Follow-up inquiries
after an average of 9.05 months revealed that
3 of the subjects had relapsed. With a more
traditional form of interpretive group psycho-
therapy applied to 17 subjects, after a mean
of 22 therapeutic meetings, it was found that
only 2 patients were symptom-free. Both these
patients had attended groups in which relaxa-
tion was employed as an adjunct to the inter-
pretive procedures. The 15 subjects who were
not symptom-free after interpretive group
therapy were then treated by group desensiti-
zation. After a mean of 10.1 sessions, 10 of
them recovered. The very much shorter time
required to effect a recovery by desensitization
in those patients who had previously received
interpretive therapy suggests that the thera-
peutic relationship and additional nonspecific
factors may have facilitated the reciprocal
inhibition of neurotic anxieties motivating the
phobic symptoms. There is some basis for the
idea that therapists of every persuasion could
helpfully employ systematic desensitization
as an adjunct to their traditional techniques
in the management of phobic disorders.
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(Received September 22, 1960)