Three Flooding Procedures in the Treatment of Agoraphobics

Abstract

The experiment described was designed to test systematically the effects of in vivo flooding, combined with alprenolol, combined with a placebo, and used alone. The rationale for combining this drug with flooding is as follows:

• 1. Agoraphobics have been found to have markedly heightened unpleasant body sensations. This is a fact in the sense that it has not only been described repeatedly in the literature (ROBERTS, 1969; KLEIN, 1964; SNAITH, 1968; ROTH, 1959; MARKS, 1969), but has also been experimentally corroborated by means of specially developed questionnaires (ULLRICH and ULLRICH DE MUYNCK, 1972a). In comparision to patients having various other diagnoses, agoraphobics scored by far the highest on a Fear Survey Schedule (FSS) factor called ‘fear of bodily symptoms’. The same study used the Emotionality Inventory (EMI), which showed that this subjectively experienced heightened somatic anxiety was more prominent in the autonomous (EMI A₂) than in the psychomotor aspect (EMI A₁) of the scale.

• 2. The assumption was made that such unpleasant somatic sensations can be divided into two groups: a) stimulus-dependent conditioned emotional responses and b) somatic sensations, not dependent on external phobic stimuli.

• 3. MARKS and co-workers have shown that with flooding procedures stimulus-dependent ‘somatic’ anxiety (that is, physiological as well as emotional reactions) can be reduced in a relatively short period of time (MARKS et al., 1971; WATSON et al., 1971; 1972). In our own studies this occurred mainly within a one-week period involving 10 hours of flooding (ULLRICH and ULLRICH DE MUYNCK, 1972b, c). The removal of this stimulus-related somatic anxiety may not extend to the unpleasant stimulus-unrelated sensations. Sensations of this kind (e.g. severe panic attacks) may continue to appear during or after therapy, despite successful treatment; they may also produce new avoidance behaviour and thus give the appearance of a relapse.

• 4. Panic attacks induced by means of sympaticomimetics such as adrenalin can be neutralized by means of antagonists on the beta-adrenergic receptors (PITTS, 1971). This group of drugs, the beta-blocking agents, was shown to reduce anxiety symptoms better than a placebo (GRANVILLE-GROSSMANN and TURNER, 1966) and to the same degree as chlordiazepoxide (WHEATLEY, 1969). The most important aspect for our study is that this effect is probably due only to the peripheral, partial blocking of the autonomous stress reaction and that there is no central tranquillizing effect (CLEGHORN et al., 1970; BONN and TURNER, 1971; BONN et al., 1972; LADER and TYRER, 1972).