Thorndike’s first experiments were designed to prove that cats and dogs act by conditioned impulses, rather than by using memory or anticipation (1898; pp. 7-10 above). In his next monograph (1901), Thorndike went on to claim that this was also true of monkeys: ‘In their method of learning, the monkeys do not advance far beyond the generalized mammalian type.’ To Thorndike’s eye, there was no evidence of imitation, accurate discrimination, or memory in the behaviour of monkeys; they simply formed associations faster than other mammals. One might go on from this assumption to deduce that human learning must take an entirely different course. But already, in 1898, Thorndike was saying about his principle of stimulus-response connections that ‘this hitherto unsuspected law of animal mind may prevail in human mind to an extent hitherto unknown’ (Thorndike, 1898, p. 105). In fact, soon after doing his first work with animals, Thorndike became professor of educational psychology at the Teachers College of Columbia University and concerned himself mainly with human abilities. But this closer contact with research on
human beings did not make him change his mind—in 1931 he still felt that the stimulus-response principle could be applied to human activities, and in his book Human Learning (1931) he said ‘the situation-response formula is adequate to cover learning of any sort, whether it comes with ideas or without, conscious or unconscious, impulsive or deliberate, by Gestalten or even by a miracle’ (p. 132).
Many students are still familiar with one of Thorndike’s particular contributions to education, which may be used to illustrate both the virtues and vices of his general approach. Perhaps Thorndike’s most frequently read publication is The Teacher’s Word Book of 20,000 Words, expanded to include 30,000 words (Thorndike and Lorge, 1944). If language is composed of word habits, and habits are accumulations of practice, then it is useful to know exactly how often any given word is used. The first two chapters of Thorndike’s Human Learning are about the ‘frequency of a situation’ and the ‘frequency of a connection’ — frequency or how often something happens was the fundamental variable in Thorndike’s theory. Thus he developed the variable of word frequency how often we are likely to come across a particular word in a standard set of sources — and Thorndike actually counted up frequency values for the 20,000 most commonly used words.
There are surely virtues in measurement, or at least utilities in measurement, and that is why the Thorndike-Lorge word-frequency list is still consulted for experiments on words. But there may be vices too in measurement, or if not in measurement, in excessive quantification and systematization applied to human learning. Thorndike’s first educational recommendation was that mechanical repetition should be the primary tool of the teacher —‘the only way to teach fractions in algebra, for example, is to get the pupil to do, do, do’ (Thorndike, 1898, p. 105). This is quite the opposite of the stress on insight, understanding and personal discovery which characterizes more enlightened approaches to education. There are now perhaps some who feel that Thorndike was right all along, and that drilling pupils in the three R’s, with objective and quantitative tests to assess what pupils can actually do, would be preferable to enlightenment that produces no visible positive results. But those who are against too much ‘predigestion’ of material, especially in textbooks, and against too
many ‘paragraph headings, and cross-references, and examination questions’, would probably be against Thorndike. William James, whose massive two-volume The Principles of Psychology has just been reprinted, partly on the grounds of its literary merit, was very much against paragraph headings and numbered exercises, ‘and every other up-to-date device for frustrating the natural movement of the mind when reading’, because he believed that such interruptions would prevent ‘that irresponsible rumination of the material in one’s own way which is the soul of culture’. This quotation is from the introduction that James wrote to Thorndike’s The Elements of Psychology. Although, as Thorndike’s mentor and friend, James was recommending the book, it did itself contain many numbered exercises, paragraph headings, and questions and directions in small print, and James’s comments are rather back-handed. Could it be, he wondered, that Thorndike had become ‘a high-priest of the American text-book Moloch, in whose belly living children’s minds are turned to ashes’? Nevertheless, the eminent James gave Thorndike’s book a hearty recommendation, and although James’s own book has become a classic, it is a classic partly as the last in its line. In practice paragraph headings, and cross-references, with easily digested outlined boxes of material, form pan of the established religion of textbook writers, and Thorndike may be regarded as one of the founding fathers of this tradition.
Tolman’s purposive behaviourism in animals and men
Regrettably, Tolman’s purposive behaviourism is an example of the inverse plausibility rule for psychological theories. This states that, by and large, the practical effects of a psychological theory are in inverse proportion to its general soundness and plausibility. Thus a bizarre and astounding dogma, such as Freud’s contention that all human motivation and thought are dominated by sex, may come to be fervently accepted by thousands, and Watson’s behaviourism, which Tolman rightly derided for its inherently unsound dependence on muscle twitches as substitutes for thoughts, has had far more influence on clinical and educational psychology than Tolman’s more sensible and considered reflections on how rats negotiate mazes. Tolman liked the Gestalt field theories about human personality put forward by Lewin (e.g.
1935), and occasionally concerned himself with repression and unconscious motivation, but there was not very much direct application of his theory to human affairs in his lifetime.
One should mention, however, that Tolman attempted to contribute to the solution of what is now perhaps the single biggest human problem in his book Drives Towards War (I942). Brought up as a Quaker pacifist, Tolman was appalled by all war, but recognized and tried to analyse human motives which favoured war, even as a ‘glorious human adventure’. He used his learning theory in starting from biological drives, which he supposed supplied the first and most basic human needs. For Tolman the basics included curiosity, play and aesthetic experiences as well as hunger, thirst and sex. In order to satisfy these initial drives, individuals learn certain useful techniques, including ‘money-getting’ and social skills, and these techniques are either ‘self-assertive’ or ‘collective’. A child who develops self-assertive techniques tends to become ‘bumptious and demanding’ and eventually runs into resistance from a parental figure or from superiors in social or educational pecking orders. If the child then identifies with the parental figure this should generally lead to socially approved behaviours. Often, however, ‘self-abasive’ techniques are learned in order to conform to social pressures, with concomitant repressed hostility towards parental figures and other frustrating agents. It is this dammed-up hostility which interacts with the collective technique of identifying with the group, and becomes converted into hostile feelings towards outsiders — ‘This is the set-up in what I would call neurotically motivated war’ (Tolman, 1942, p. 86). Relatively benign loyalties to the group lead to equally powerful hostile feelings against any attacking enemies.
This is clearly an ad hoc and inconsistent analysis, but Tolman’s conclusion is still worthy of consideration: ‘A war in response to outside aggression does tend to preserve in some measure the communal life of a nation (if God and oil be on her side); but only in some measure. The accompanying losses are today obviously all too great’ (Tolman, 1942, p. 92). In order to save the world from its horrors Tolman proposes a ‘workable myth’ of psychological adjustment, composed of six principles, which boil down to three practical devices: (1) an economic order which minimizes biological frustrations in all individuals; this could be obtained by a compromise between self-assertive private initiative and collective
means — Tolman imagines ‘something like state socialism’ being necessary; (a) to avoid repression and neurosis, children will have to be helped to identify with and copy appropriate adults — Tolman believed that as much damage was done by children trying to be like their parents, as by their trying to be unlike their parents; and (3) to avoid wars, there should be a World Federation, with its own handsome and commanding buildings, its own flag and its own world anthem. Tolman says he will be more loyal to this than to the United States, and individuals all over the world should identify with this supranational group. This last did not commend Tolman to the authorities when explicit oaths of loyalty were demanded of university staff in California in the early 1950s, and, as he said himself, the whole idea is a utopian dream, with little chance of success. In some ways Tolman’s Utopia is repressive, since he wants photographs of the World Federation buildings in every home and, apart from fighting the common enemies represented by disease and earthquakes, he imagines that the youth of the future will unite to put down ‘rebellious subgroups which seek to break away’. But in general Tolman opposed discrimination against minorities. The argument from his theory was that cognitive maps represent reason, and that broad and comprehensive cognitive maps will represent the triumph of rationality over emotionally disordered hates and fears. By analogy with the intelligent performances of his rats in mazes, Tolman hopes that eventually people will be able to learn to
Practical techniques from Hullian postulates
It is, most unfortunately, a characteristic of appeals to reason that they utterly fail to overcome either emotional prejudices or neurotic habits. Even if it is not a question of high- level rationality, but just a matter of seeking obvious goals, then human goal-seeking mechanisms are fallible. Children do not stop wetting the
bed just because they would prefer to have a dry bed; adult agoraphobics do not lose their fear of leaving the house just because they decide they would like a holiday; and desires for peace have never yet stopped wars. Hull’s theory of drives and habits undoubtedly had more initial influence on clinical psychology than Tolman’s cognitive theory (although, as we shall see, current ‘cognitive behaviour modification’ is getting very Tolmanian). This was partly because Hull put forward laws which he and others believed were even more fundamental than goal-seeking. Hull himself wanted to provide, not practical techniques, but an all-embracing set of theoretical principles:
This could be put up for the award of Most Grandiose Preface to any Book in Psychology, especially since the book is mainly about experiments on laboratory rats. It is true that the first professor of sociology in England, L.T. Hobhouse of the London School of Economics, started his career with a book about animal learning, called Mind in Evolution (1901), and went on from there; but by 1943 it was a bit much to expect the same book to serve as an introduction to all the social sciences, even theoretically. The remarkable thing was that not only was Hull’s theory popular with those conducting the laboratory experiments (in the 1940s 70 per cent of the papers in relevant journals referred to it), but it seemed to serve as a useful stimulus for fellow members of the Yale Institute of Human Relations, and for others interested in social and clinical problems. The emphasis on drives in Hull’s theory in fact allowed Hullians such as Neal Miller and O.H. Mowrer to take over many Freudian ideas about frustrations and conflicts and consequent displacements and repressions. But the most lasting memorials to Hull’s optimism may be two simple and practical techniques for dealing with superficial but troubling problems. In neither case can it be said that Hull’s equations are being applied, but the general ideas of applying fundamental laws by altering ‘conditions under which habits are set up and function’ are clearly at work.
In the first instance, the ‘bell and pad’ treatment of bedwetting, the incentive for a new method arose when O.H. Mowrer and his wife had responsibilities in one of the residential cottages for disturbed children run by the Yale Institute (Mowrer, 1980). About half the children were chronically enuretic — it is certainly true that anxiety, emotional disturbance or unhappiness is associated with this symptom, but how or why remains obscure. Punishments, even of the most vile kind, have little effect, perhaps partly because they increase anxiety. Benign exhortations and inducements are similarly almost worthless. Conditioning techniques designed directly to establish a habit of waking up in response to internal pressures have, by contrast, a well- established record of success. The very first attempts made by Mowrer, unpublished at the time, required a trick bed, which collapsed on one side, rolling out the unfortunate occupant, when wetness was electrically detected. It was then discovered that a loud electric bell, placed in a metal box, was equally effective as a wakening agent, and the moisture detecting pad, connected to a bell, is still in use. Any electrical apparatus is daunting to some, and the use of the bell and pad requires effort on the part of adult supervisors, who must wake up too, but children whose urinary habits are retrained by these means suffer no adverse side- effects, and indeed are often made happier by the release from the shame and ignominy of their complaint.
The theories and methods of Wolpe
Urinating in one’s sleep is a very specific behavioural problem, even if not unrelated to general emotional insecurities, and the bell and pad (more accurately, pad and bell) treatment could not, I think, be applied to any other syndrome. The only other behavioural trick which approaches the pad and bell method in the reliability of its effects is the method of ‘systematic desensitization’ developed by Wolpe (1958), which has a very much wider range of application. There is no doubt that Wolpe was deeply influenced by the Hullian school of thought, even though geographically distant, in South Africa, when he performed his first research and therapy. Wolpe’s credo is reminiscent of Hull’s preface in its lawfulness: ‘Everything in this book rests on the fundamental assumption that the behaviour of organisms, including human
beings, conforms to causal laws just as other phenomena do’ (Wolpe, 1976, p. 3). And this was more than lip-service, as experiments on cats preceded the first human patients. Wolpe’s theories were in a sense even more mechanistic than Hull’s, since they referred to principles of the nervous system: the name ‘reciprocal inhibition’ was taken by Wolpe from Sherrington’s work on the spinal cord. In essence, reciprocal inhibition is a more carefully worked-out version of Watson’s ‘direct conditioning’, and ‘systematic desensitization’ is a way of applying the Little Peter treatment (see pp. 88—91) to neurotic adults.
Wolpe’s substitute for both Little Peter and Little Albert was Septima, a short-haired tabby cat, with white throat and paws, who was the seventh cat tested among twelve that all showed roughly similar effects (Wolpe, 1952, 1976). It is possible to define neurotic behaviour in such a way that almost any cat given an electric shock in an experimental cage becomes neurotic. If a cat has been put in the special cage once or twice and given a series of shocks, then, reasonably enough, it will strongly resist being put back into that cage a week later. Once forced inside, its eyes will dilate with fear, it may mew, howl or scratch, and perhaps raise its fur. The ‘neurotic’ aspect of this is that (x) the fear tends not to diminish with time: even when put back several times without any shocks, or when put back months after being shocked, the animal may seem just as afraid; and (2) the cat refuses to eat in the cage, even when it has been without food for days, whether or not it has been used to eating in the cage before its trauma. (It should be said that this sort of experiment is rarely performed nowadays and is certainly not performed in the United Kingdom; and that since the experiments with these twelve cats, Wolpe has devoted himself to relieving the misery of large numbers of unacceptably anxious human beings.)
The refusal to eat is ‘maladaptive’ in the sense that the animals gain nothing by it, and their fears seem excessive. However, since such behaviour is characteristic of all cats (and dogs) tested in this way, and is common in wild animals when they are caught and confined, even if without any pain or discomfort, then we must presume that it is part of the animal’s ‘normal’ rather than abnormal psychology. Wild animals, greedy enough to start eating in circumstances even remotely dangerous, may pay for their relaxation with their lives. Natural selection thus puts a premium
on wariness and jumpiness rather than imperturbability, and this is probably the reason why ‘anxiety’ is the big problem in clinical psychology, and relatively few human individuals go to their doctor to complain that they are too relaxed. This evolutionary interpretation would add weight to analogies drawn between over-anxious cats and over-anxious people — what ways are there to cheat our personal and evolutionary histories, and lower anxiety levels to where we want them?
Wolpe found that the Little Peter treatment worked well with his cats. The cats would initially not eat even outside the cage in the room where they had been shocked. But if they were taken into another room, slightly different in appearance from the original, and were able to feed comfortably, then their anxiety seemed to be reduced even when they were taken back to the scene of their original trauma. This is the same idea, of gradual reconditioning, that was used in getting Little Peter to eat, first with his feared white rabbit a long distance away, and then with the rabbit progressively closer. It was not necessarily a very rapid or easy process though. Septima was made neurotic by being shocked on n and 23 August 1947, and, after almost daily therapeutic and testing sessions, did not begin to eat comfortably in the experimental room until 16 October: it took until 25 June 1948 for her to be declared cured, on the criteria that she had become indifferent to the hooter which had originally been sounded to signal the electric shocks, and purred and ate her food pellets even when the hooter was on.
The therapeutic process for Septima involved three different rooms, apart from the one she was originally shocked in, and a gradual change from eating in conditions remote from those which aroused fear to eating in the exact place where the experimental traumas had occurred. Other cats recovered more quickly — some simply when food was presented by a familiar human hand instead of being dropped down a shute, even in the shock cage. Wolpe noted that Septima was much calmer when accompanied by a friendly laboratory assistant, who had not been involved in the shocking procedure, than by himself, and of course it is usually the case that nervous cats respond well to being gently stroked.
In Wolpe’s theoretical scheme, anything which acts as an anti-anxiety agent can be useful, as long as this anti-anxiety state
can be conditioned to the same stimulus that causes the problem. In applying this principle (of reciprocal inhibition) to human patients, the most generally applicable antidote for anxiety is muscular relaxation. However Wolpe also often used a variety of alternatives under the heading of ‘assertion’, which included getting people to stand up for themselves against domineering relatives and colleagues, and also ‘outward expression of friendly, affectionate, and other non-anxious feelings’ (Wolpe, 1958, p.114).
When Wolpe received the 1979 Distinguished Scientific Award for the Application of Psychology at the American Psychological Association meeting in 1980, he reiterated his belief that the future of psychotherapy should lie with methods ‘founded on principles of learning established in the psychological laboratory’ (Wolpe, 1981, p. 159), if only we would give up leaving patients ‘interminably in chancery’ in futile psychoanalysis, and train more people with Wolpe’s methods instead of Freud’s methods. Expensive therapy lasting for many years, with no change at all in the patient’s initial complaint, is not at all unusual in psychoanalysis, and so it is hardly surprising that those who have a scientific belief in the method of learning from experience feel that there is room for improvement.
Wolpe’s own line of treatment is based on a series of interviews between himself and individual patients. Having been a convinced Freudian before being converted to Hullian enlightenment, it is arguable that Wolpe’s own success may be due to his combining the catharsis of emotional confession with active emotional retraining, with Wolpe himself playing the parts of both confessor and coach. It is a subjective problem which usually drives the neurotic to seek treatment, and for Wolpe ‘the patient’s story is the primary data’ (1981, p. 162). Patients first describe in detail this history, in so far as they know it, of their complaints and also give the background history of their childhood memories, educational record and sexual relations, whether it is immediately relevant or not. In mild cases, of course, just talking over one’s troubles with a reassuring expert can be a considerable relief (and ‘inadvertent deconditioning of unadaptive anxiety responses may take place’: Wolpe, 1978, p. 442; 1958, p. 193). But not all neuroses are so mild. Some idea of the severity of a patient’s neurosis (but by no means an exact measure) can be obtained by questionnaires. The one Wolpe used originally had questions such as ‘Are you afraid of falling when you are on a high place?’ ‘Are your feelings easily
hurt?’ ‘Do you keep in the background on social occasions?’ and so on, with answers to be given on a 5-point scale, varying from ‘never’, to ‘practically always’. Someone who gives the ‘always’ answer to a range of questions like this must be pretty miserable, and a downward shift in the total score can be used as a measure of the patient’s progress in therapy. The sorts of human problems that Wolpe felt he was able to solve were given as case histories (1958, passim).
Mr W: insecurity countered by assertion
Mr W was a commercial traveller with an unhappy childhood and an unfaithful wife. He had a guilty habit of staring at buxom women and pervasive social anxieties and feelings of insecurity. He had very strong feelings about the iniquities of racial discrimination, which for a commercial traveller in South Africa was unusual as well as unsettling. By the fourth interview, when all these things had been discussed, Wolpe ‘attempted to give Mr W a perspective’ by noting that he had always been a rather anxious person, and was no doubt suffering further from the feeling that his wife had never loved him. However, he needed in the first place to get over his deficiencies in the social sphere by expressing his views as clearly and as forcefully as possible no matter how critical his colleagues and friends might seem to be of him. In a nutshell, the therapist’s advice was ‘Stop being on the defensive and stop apologizing for yourself’ (Wolpe, 1958, p. 124). At the fifth interview Mr W reported that he still felt tense in company, but had been buoyed up by the experience of asserting himself among fellow commercial travellers in the bar lounge of a hotel. Wolpe then suggested that now was the time for Mr W to go home and express his true feelings to his wife, whose infidelities he had previously condoned. Mr W immediately went home and told his wife that her extramarital relationship had got to stop, to which she replied, ‘It’s about time. You’re jealous at last.’ Mr W was thus feeling much improved by the sixth interview but was still troubled by insomnia. Wolpe hypnotized him into a deep trance and suggested that he would feel much more relaxed in future. By the ninth interview, which was just over a year since the treatment had begun, Mr W reported that he was socially in demand and getting
a kick out of life, having started to tell jokes at parties, joined a lodge and taken up public speaking. His fantasies about very buxom women continued, but with much less guilt. At a follow-up session two years later (without any intervening pep talks) Mr W regarded himself as a happy man. People continued to remark on how much he had changed, and his wife, who had not previously taken part in the therapy, announced to Wolpe that her husband had become a pleasure to live with.
This case indicates the directive nature of Wolpe’s method; his piecemeal treatment of individual symptoms, and his initial inclination towards hypnosis (also the subject of a book by Hull, 1933).
Mr V: countering sexual anxieties
Mr V was a 40-year-old architect who was good at his work, and without general anxieties, but who complained of premature ejaculations. Having had only intermittent and casual sexual relationships in his twenties, he had developed severe sexual difficulties in his thirties after a period of long abstinence. He had now met a woman he wanted to marry and had sought professional help before attempting intercourse with her. After three exploratory interviews, Wolpe explained his theory (which was not exactly original) that anxiety provoked by the occasion of sexual intercourse could interfere with male physiology to the extent of eliciting premature ejaculation, and that anxiety could be countered by relaxation as a first step, and by increasing familiarity with the circumstances of intercourse in the absence of the stresses and excitements of the act itself. For six interviews over four weeks Wolpe trained Mr V in muscular relaxation, at the same time as building up his confidence by telling him of success in similar cases and preparing him for difficulties by arguing that even complete failure at the first two or three attempts at intercourse is no reason why a couple should not eventually find sexual happiness: Then Wolpe sent Mr V away; he was not to come back until he had explained his problems to Anne, his intended: Mr V came back in a month, but with only failure to report. He had persuaded Anne to attempt intercourse, but had been too nervous at the first attempt, and after that had lost all sexual feeling and did not even get an erection.
Wolpe’s advice was that it was far too early for sexual intercourse, and over the next few weeks Mr V was instructed on no account to attempt it, but to try to enjoy other physical intimacies for their own sake. Under instructions Mr V first lay naked in bed with Anne with no other activities to follow and found that erections returned; the next step was the handling of his erect penis by Anne without any ejaculation; only after several nights of this was intercourse attempted. There were some setbacks, but even after the first ninety-second insertion Mr V understandably began to feel much happier about his chances, and a seaside holiday with Anne appeared to have a very liberating effect. Eight months later Mr V reported that he and Anne were happily married and that all his sexual problems had disappeared.
Here there was an overt sexual problem — apparently unrelated to any other difficulties. In contrast to the Freudian tradition, in which nothing is ever what it seems, Wolpe treats the superficial problem directly. The relation of anxiety to many sexual problems is very direct — it either causes them in the first place or else makes them worse. And the importance that may be attached to sexual performance, as well as its arousing and exciting nature, can itself start off anxiety, so it is possible for vicious circles of fear to change mild apprehension into sexual nullity. Direct therapy for these sorts of problems is now (and perhaps always has been) almost a profession in itself, but Wolpe deserves some of the credit for the ‘go slow’ technique of the intercourse ban as well as the direct attack on anxiety by muscular relaxation and friendly reassurance. It is a strange irony that direct non-Freudian methods of therapy seem to have their greatest appeal as treatments for the most fundamentally Freudian conditions — those which frustrate the great sexual drive of the id.
Miss T: desensitization to social stimuli
The procedure for which Wolpe is best known is ‘systematic desensitization’. This involves deconditioning anxiety by a little- by-little method, when the anxiety is irrationally evoked by a set of specific problems or outside stimuli. Wolpe was particularly keen on the method of using deep muscular relaxation to antagonize anxiety. Anxiety usually involves being tense — in peripheral musculature as well as inner feeling. Thus not many anxious
patients are capable of learning to relax completely in the face of their real-life fears. But many can produce very relaxed muscles during the therapeutic interview, especially with the aid of drugs or hypnosis, at the same time as imagining some moderately difficult situations. In learning the relaxation technique over a number of weeks, patients first grip the arm of their chair, then completely relax their hands, to notice the difference. Then particular muscles — arm, forehead, jaw, neck, shoulder and so on — are deliberately relaxed in turn. With practice, patients could then keep fairly relaxed when Wolpe told them to.
Miss T was a 46-year-old dressmaker with peptic ulcers. Almost any social interaction made her nervous, and almost any nervousness made her nauseous. She had been happy at home but slow at school, and she left school at 14 to help her mother at home. There she attracted little attention from young men, and she came to feel inferior and nervous in male company: When, eventually, at 33, she had her first and only affair, she became fond of her lover, and was deeply hurt as after four years of their association he went away on business and came back engaged to someone else. It is hardly surprising that she was unable to respond to Wolpe’s first instructions to assert herself more and stand up to other people. Since this did not work, Wolpe began to train Miss T in the techniques of muscular relaxation, and at the same time constructed with her a ‘Hierarchy on the theme of her sensitivity to people’ (Wolpe, 1958, p. 149). This was a list of circumstances the contemplation of which made Miss T increasingly nervous as she went up the list. At the bottom was ‘Being at a party with other girls who work with her’; in the middle was ‘Going up to receive a prize at the end-of-the-year party’; and at the top was ‘Having an interview with any doctor or lawyer’ (there were thirteen items altogether, not all needed at the same time).
When the hierarchy of circumstances had been agreed on, and Miss T had been trained to relax, 6 sessions took place in the following month, with 2 or 3 sessions per month for the next three months. Miss T was both hypnotized and relaxed while Wolpe narrated to her one or more scenes from the hierarchy, moving up through the list as the sessions progressed, the patient being supposed to visualize to herself the occasion being described while remaining as relaxed as possible. A party with other girls from work was imagined without undue disturbance at the first
session. Telling her employer she had done incorrect stitching because of someone else’s wrong instructions went off (in fantasy) during hypnosis at the third session with only slight associations of anxiety reported by Miss T on waking from her trance. Items higher up the list were usually disturbing when first presented under these conditions, but repetitions of the items succeeded in producing diminished reactions during the therapeutic sessions. And by the eighth session even the first presentation of the third most difficult scene, ‘Being phoned by a man to whom recently introduced’, produced hardly any anxiety. However, the first presentation of scene 2, ‘Unexpectedly finding a strange man when visiting her brother’s house’, created a stir at the eleventh session, and was still disturbing after five imaginary repetitions during this session. Following this there was also an external setback when Miss T was shouted at by a supervisor at work. In any event she was now feeling continuously nervous, with a characteristic sick feeling in her stomach.
Continuous and pervasive feelings of anxiety are difficult to treat except by drugs, but Wolpe found that occasionally dramatic and immediate relief occurred after patients inhaled a gas mixture (70 per cent carbon dioxide arid 30 per cent oxygen) which briefly produces a stupor, with lights flashing before the eyes, tingling sensations and sometimes loss of consciousness. Perhaps this interrupts a vicious circle of symptoms connected with respiration, since an initial anxiety attack may produce hyperventilation (too much breathing), which in turn leads to light-headedness, dizziness and feelings of unreality, as well as numbness and tremors, pains in muscles, and in particular pain in the heart. Any or some of these secondary symptoms might themselves cause anxiety, or according to Wolpe’s theory might be very suitable stimuli for conditioned associations with the original anxiety-provoking event.
Miss T was given the carbon dioxide and oxygen treatment, and immediately said she felt better. Then the desensitization sessions continued, but with the addition of scenes involving shouting. After another five sessions Miss T was able to visualize without any nervousness even her worst fears (which now included men punching each other with Miss T as the only witness, as well as the ‘strange man in brother’s house’ scene and the doctor’s interviews). The crucial point of course is whether this made any
difference when she was not being hypnotized in Wolpe’s office. In fact Miss T appears to have become emotionally imperturbable to a slightly worrying degree. Her questionnaire scores now indicated little social anxiety, and she found herself happily talking to other guests when she went away on holiday to a hotel by herself. On returning home she had to deal with her mother having a heart attack in the middle of the night, but this did not upset her in the least. Whether this sort of impassivity is a good thing or not is debatable, but at least Miss T’s ulcers cleared up, and her physician reported a year after Wolpe’s therapy that she had remained in good condition medically.
Wolpe’s methods of behaviour therapy — conclusions
Although in 1981 Wolpe bemoaned the lack of impact of his kind of ‘behaviour analysis’ in North America, all the psychological methods of anxiety-reduction which he put forward in 1958 have received a certain amount of attention, from clinical psychologists if not from psychiatrists. In particular, the three methods used in the case histories I have just repeated — of encouraging patients to assert themselves and to stand up to people who make them anxious in their everyday life; of step-by-step, matter-of-fact progress in sexual activities, under the guidance of a therapist, as a means of overcoming sexual anxieties; and of systematic desensitization during a series of interviews, by getting the patient to work through a list of scenes which are particular sources of anxiety, while at the same time remaining relaxed — all of these individual methods have been widely adopted by others, even if those others do not always adopt Wolpe’s more general background technique of analysing the personal history of each individual patient. Wolpe was also able to claim, in 1978, that in his early work he had anticipated the later trend of emphasizing the alteration of a patient’s thought processes during therapy.
Although it would be unwise to accept Wolpe’s work as a complete theory without flaws, or as the last word on therapeutic techniques, he deserves credit as a humane and creative pioneer in the search for psychological techniques of combating irrational anxieties. To quote from his citation in the American Psychologist (American Psychological Association, 1980, p. 44):