Desensitization and Psychotherapy in the Treatment of Phobic States: A Controlled Inquiry

¹ Senior Lecturer, Institute of Psychiatry and The Maudsley Hospital, London, S.E.5
² Research Worker and Honorary Senior Registrar, Institute of Psychiatry and The Maudsley Hospital, London, S.E.5
³ Consultant Psychotherapist, Institute of Psychiatry and The Maudsley Hospital, London, S.E.5

1. A prospective trial is described of desensitization and two forms of psychotherapy in phobic outpatients. Sixteen received desensitization in imagination, 16 group psychotherapy and 10 individual psychotherapy. Groups were well matched on clinical and other variables.

2. Desensitization lasted, on the average, nine months. Individual psychotherapy was limited to a year, and group psychotherapy to eighteen months. All treatments were carried out once a week. Results were compared over two years throughout treatment and follow-up.

3. Symptoms were rated every six weeks, and social adjustment every six months. The patient, the therapist and another doctor completed ratings, and a psychiatric social worker followed up all patients.

4. Four patients dropped out early from desensitization, none out of psychotherapy. These were described and followed up.

5. All raters agreed that, of the three treatments, desensitization produced more patients whose symptoms improved at the end of treatment and follow-up.

6. Symptoms, especially the presenting phobias, improved faster with desensitization than with psychotherapy. After six months, desensitization patients had changed significantly more than others, but this difference diminished later, as the patients in psychotherapy went on improving slowly. Only two patients lost their symptoms completely, both with desensitization. At follow-up the degree of improvement still tended to be greater in those who had been treated with desensitization, but at this stage the difference was no longer statistically significant.

7. Ratings of social adjustment were less sensitive and reliable than symptom ratings; however, greater and more rapid improvement occurred in work and leisure adjustment with desensitization. Desensitization and group therapy produced equal changes in relationships with other people, but with desensitization this occurred only after symptoms had changed, with group psychotherapy it took place also in the absence of symptom change.

8. There was no evidence for "symptom substitution".

9. Patients from this and a previous investigation were grouped according to the amount their phobias had improved at the end of treatment. When treatment started, 26 variables were recorded about them. Patients who improved were compared with the rest, and data from the 16 out-patients who had desensitization were studied separately.

10. Patients who did badly with either treatment tended to be agoraphobic, to be older at treatment, and to have more severe obsessional symptoms and more neurotic symptoms. Patients who did badly with desensitization resembled the larger sample, but agoraphobia and high initial anxiety were relatively more important and age at treatment unimportant.

11. A 14-item questionnaire was constructed which helped to identify patients who did badly with desensitization.

12. Desensitization and psychotherapy can each contribute in different ways to the treatment of phobic patients; neither can be relied on for all patients, and some patients may need both.

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