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Emotional arousal as therapy: activation vs dissociation

Published online by Cambridge University Press:  16 April 2020

I Marks*
Affiliation:
Institute of Psychiatry, LondonSE5 8AF, UK
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Summary

Healing through emotional arousal is an ancient idea. Abreaction may yield lasting, brief, or no improvement, or alternatively sensitization. The predictors of outcome are unclear. The emotional experience of relevant exposure therapy yields more reliable improvement; forgotten traumas may surface, which ease as exposure proceeds. High arousal does not enhance the gains, but emotional engagement in exposure seems crucial for habituation to occur. Habituation is specific to the fear cues presented, marked generalization being unusual. Emotional experience irrelevant to a phobia can also improve the phobia, but the duration of such relief is unclear and different mechanisms may be involved. Fear-reduction is unreliable with non-exposure methods. Though counterproductive during exposure, dissociation and denial may have some uses. Optimal gains may come from being able to modulate activation or suppression to suit particular circumstances.

Type
Review
Copyright
Copyright © Elsevier, Paris 1991

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References

Al Kubaisy, TMarkes, IM, et al (1992) Therapist-accompanied vs self-exposure vs self-relaxation in phobias (in press)Google Scholar
Ascher, M (1979) Paradoxical intention in the treatment of urinary retention Behav Res Ther 17, 267270CrossRefGoogle ScholarPubMed
Asher, M (1981) Paradoxical intention for agoraphobia Behav Res Ther 19, 533542CrossRefGoogle Scholar
Bond, DD (1952) The Love and Fear of Flying International Universities Press, NYGoogle Scholar
Borkovec, T (1982) Functional CS exposure in the treatment of phobiasIn: Learning Theory Approaches to Psychiatry (Boulougouris, J, ed) Wiley, NY, 95102Google Scholar
Borkovec, T,Sides, J (1979) Relaxation and expectance in fear reduction via graded imaginal exposure to feared stimuli Behav Res Ther 17, 529540CrossRefGoogle Scholar
Brown, W (1920) Symposium on the revival of emotional memories and its therapeutic significance Br J Med Psychol 1, 30CrossRefGoogle Scholar
Cullington, AButler, GHibbert, GGelder, MG (1984) Problem solving: not a treatment for agoraphobia Behav Ther 15, 280286CrossRefGoogle Scholar
Edkins, JRP (1949) Further developments in abreactionIn: Modern Trends in Psychological Medicine (Harris, NG, ed) Hoeber, NY, 165288Google Scholar
Emmelkamp, PMGGiesselbach, P (1981) Relevant vs irrelevant exposure for obsessions Behav Psychother 9, 322329CrossRefGoogle Scholar
Emmelkamp, PMGHout A, Van derDe Vries, K (1983) Assertive training for agoraphobics Behav Res Ther 21, 6368CrossRefGoogle ScholarPubMed
Epstein, S (1970) Anxiety, reality and schizophrenia Schizophrenia 2, 1135Google Scholar
Foa, EBKozak, M (1986) Emotional processing of fear Psychol Bull 99, 2035CrossRefGoogle Scholar
Foa, EBBlau, JSProut, MLatimer, P (1977) Is horror a necessary component of flooding (implosion)? Behav Res Ther 15, 397402CrossRefGoogle Scholar
Frankl, V (1955) The Doctor and the Soul: From Psychotherapy to Logotherapy Knopf, NYGoogle Scholar
Garmany, G (1953) Discussion on abreaction ProcRSoc Med 43, 155157Google Scholar
Grayson, JBFoa, EBSteketee, G (1982). Distraction vs attention-focusing during exposure Behav Res Ther 20, 323328CrossRefGoogle ScholarPubMed
Greist, JMarks, IMBerlin, FNoshirvani, H (1980) Avoidance confrontation of fear Behar Ther 11, 114CrossRefGoogle Scholar
Grinker, RRSpiegel, JP (1945) Men Under Stress. Blakiston, PACrossRefGoogle Scholar
Hafner, J (1978) Catharsis during prolonged exposure for snake phobia Am J Psychatry 135, 247248Google ScholarPubMed
Hafner, RJMarks, IM (1976) Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation Psychol Med 6, 7188CrossRefGoogle ScholarPubMed
Hallam, RS (1985) Anxiety, Academic Press, NYGoogle Scholar
Hawkins, RDKandel, ER (1984) Is there a cell biological alphabet for learning? Psychol Rev 91, 375391CrossRefGoogle Scholar
Hodgson, RJRachman, S (1970) Experimental investigation of implosion Behav Res Ther 8, 2127CrossRefGoogle ScholarPubMed
Jacobi, W (1923) Grenzfr Nerv u Seelenled 114, 1; cited by Moody (1946)Google Scholar
James, W (1902) Varieties of Religious Experience. Colliers, NY, republished 1961Google Scholar
Jannoun, LMunby, MCatalan, JGelder, M (1980) Home-based treatment for agoraphobia, replication and controlled evaluation Behav Ther 11, 294305CrossRefGoogle Scholar
Kavanah, C (1983) Two psychological approaches for the severely burned child J Am Acad Child Psychiatry 22, 145156CrossRefGoogle Scholar
Kennedy, A (1960) Indications for psychological treatment Lancet i, 1257CrossRefGoogle Scholar
Lader, MSartorius, N (1968) Anxiety in patients with hysterical conversion symptoms J Neurol Neurosurg Psychiatry 31, 490495CrossRefGoogle ScholarPubMed
Lamontagne, YMarks, IM (1973) Psychogenic urinary retention: treatment by prolonged exposure Behav Ther 4, 581585CrossRefGoogle Scholar
Lang, P (1979) A bioinformational theory of emotional imagery Psychophysiology 16, 495512CrossRefGoogle Scholar
Lang, PMelamed, BHHart, J (1970) Psychophysiological analysis of fear modification with automated desensitization J Abnorm Psychol 76, 220234CrossRefGoogle ScholarPubMed
Lelliott, PTNorshirvani, HFMarks, IMet al (1987) Relationship of skin conductance activity to clinical features in obsessive-compulsive ritualizers Psychol Med 17, 904914CrossRefGoogle ScholarPubMed
Liddell, HS (1956) Emotional Hazards in Animals and Man. Thomas, Springfield, ILCrossRefGoogle Scholar
Lifshitz, KBlair, JH (1960) Polygraphic recording of repeated hypnotic abreaction J Nerv Ment Dis 130, 246252CrossRefGoogle ScholarPubMed
Marks, IM (1965) Patterns of Meaning in Psychiatric Patients Oxford University Press, LondonGoogle Scholar
Marks, IM (1969) Fears and Phobias Academic Press, NYGoogle Scholar
Marks, IM (1975) Behavioral treatments of phobic and obessive compulsive disorders: A critical appraisalIn: Progress in Behavior Modification (Hersen, Ret al, eds) Academic Press, NY, 65158Google Scholar
Marks, IM (1978) Exposure treatmentsIn: Behavior Modification (Agras, S, ed) Little, Brown and Co, NY, 2nd ed NY, ch 7, 8; 163242Google Scholar
Marks, IM (1987) Cure and Care of Neuroses, Wiley, NYGoogle Scholar
Marks, IM (1987) Fears, Phobias and Rituals Oxford University Press, NYGoogle Scholar
Marks, IMBasoglu, MLelliott, Pet al (1988) Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals Br J Psychiatry 152, 522534CrossRefGoogle ScholarPubMed
Marks, IMBoulougouris, JMarset, P (1971) Flooding vs desensitization for phobic patients: a crossover study Br J Psychiatry 119, 353375CrossRefGoogle Scholar
Marks, IMHodgson, RRachman, S (1975) Treatment of chronic OCD 2 years after in vivo exposure Br J Psychiatry 127, 349364CrossRefGoogle Scholar
Mathews, AMShaw, PM (1973) Continuous exposure and emotional arousal in flooding Behav Res Ther, 11, 587598CrossRefGoogle Scholar
Mawson, DMarks, IMRamm, EStern, RS (1981) Guided mourning for morbid grief: a controlled study Br J Psychiatry 138, 185193CrossRefGoogle ScholarPubMed
McCutcheon, BAAdams, HE (1975) The physiological basis of implosive therapy Behav Res Ther 13, 93100CrossRefGoogle ScholarPubMed
McDougall, W (1920) The revival of emotional memories and its therapeuutic value Br J Med Psychol 1, 2333CrossRefGoogle Scholar
Michelson, LAscher, LM (1984) Paradoxical intention for agoraphobia and other anxiety disorders J Behav Ther Exp Psychiatry 15, 215220CrossRefGoogle ScholarPubMed
Moody, RL (1946) Bodily changes during abreaction Lancet ii, 934935CrossRefGoogle Scholar
Nemiah, JFreyberger, HSifneos, P (1976) Alexithymia: a view of the psychosomatic processIn: Modern Trends in Psychosomatic Medicine (Hill, O, ed) Butterworths, London, 3, 430439Google Scholar
Nichols, MPZax, M (1977) Catharsis in Psychotherapy Gardner Press, NYGoogle Scholar
Newsweek (1981) Quote from Breakthrough (by Moshe, Dayan) Oct 26, p 59Google Scholar
Olasov, BFoa, EB (1988) World Assoc Behav Ther, Edinburgh, SeptemberGoogle Scholar
Post, RM (1980) Intermittent vscontinuous stimulation: effect of time interval on sensitization or tolerance Life Sci 26, 12751282CrossRefGoogle ScholarPubMed
Racharan, S (1984) Fear and Courage, Freeman, San FranciscoGoogle Scholar
Rosen, HMyers, HJ (1947) Abreaction in the military setting Arch Neurol Psychiatry 54, 161172CrossRefGoogle Scholar
Roth, Tet al (1986) High heart rate response to exposure predicts better outcome to exposure and imipramine. Psychiatr Res □ , □ - □Google Scholar
Sargant, W (1948) Abreaction with drugs Dig Neurol Psychiatry, 16, 193206Google Scholar
Sargant, W (1957) Battle for the Mind Pan, London, UKGoogle Scholar
Sartory, GRachman, SGrey, S (1982) Return of fear: the role of rehearsal Behav Res Ther 20, 123133CrossRefGoogle ScholarPubMed
Schwartz, LA (1945) Group psychotherapy in the war neuroses Am J Psychiatry, 101, 498500CrossRefGoogle Scholar
Segraves, RTSmith, RC (1975) Treatment of neurotic outpatients by concurrent psychotherapy and behavior Anrval therapy. APA, Meeting Anaheim, MayCrossRefGoogle Scholar
Shorvon, HG (1953) Discussion on abreaction Proc R Soc Med 43, 158161Google Scholar
Sireling, LCohen, DMarks, IM (1987) Guided mourning for morbid grief: a controlled replication Behav Ther 19, 121132CrossRefGoogle Scholar
Strong, SR (1984) Experimental studies in paradoxical interventions Behav Ther Exp Psychiatry 15, 189194CrossRefGoogle ScholarPubMed
Telch, MAgras, WSTaylor, CBet al (1985) Imipramine and behavioral treatment for agoraphobia Behav Res Ther 23, 325335CrossRefGoogle ScholarPubMed
Thorpe, GLFreedman, EGLazar, JD (1985) Assertiveness training and exposure in vivo for agoraphobics Behav Psychother 13, 132141CrossRefGoogle Scholar
Vermilyea, JABoice, RBarlow, DH (1984) How do desynchronous response systems relate to the treatment of agoraphobia? Behav Res Ther 22, 615621CrossRefGoogle ScholarPubMed
Watson, JPMarks, IM (1972) Relevant and irrelevant fear in flooding - a crossover study of phobic patients Behav Ther 2, 276293Google Scholar
Wegman, C (1985) Psychoanalysis and Cognitive Psychology: A Formalization of Freud’s Earliest Theory Academic Press, NYGoogle Scholar
Wilde, JF (1942) Narco-analysis for war neuroses Br Med J 2, 4CrossRefGoogle ScholarPubMed
Williams, SLKleifield, E (1985) Transfer of behavioral change across phobias in multiply phobic clients Behav Modif 9, 2231CrossRefGoogle ScholarPubMed
Zahn, TPInsel, TRMurphy, DL (1984) Psychophysiologic changes during pharmacological treatment of OCD Br J Psychiatry 145, 3944CrossRefGoogle Scholar
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