Systematic desensitization and nonspecific treatment effects: A methodological evaluation.

Abstract

This paper evaluates the extent to which the therapeutic effects of systematic desensitization may be attributed to a specific therapy ingredient beyond nonspecific treatment effects. The vast majority of studies have not determined empirically whether desensitization and nonspecific treatment control conditions are equal in credibility and expectancy for improvement generated in the clients. Recent research suggests that control conditions commonly employed in desensitization research are less credible than desensitization and generate less expectancy for improvement on the part of the clients, and that desensitization is not superior to control groups that unambiguously rule out as a rival hypothesis differential expectancies across treatment and control conditions. A review of the research that has controlled for expectancies for improvement does not support the proposition that desensitization has a specific therapeutic ingredient. This review does not impugn the efficacy of desensitization. However, on purely methodological grounds, it appears that nonspecific treatment effects, at least at present, cannot be ruled out in accounting for the effects of desensitization. Strategies to control for differential credibility and expectancies for therapeutic change generated by treatment and comparison groups are presented.Numerous articles on systematic desensi-cific therapeutic ingredients beyond nonspetization have appeared, including extremely cific treatment factors account for behavior valuable reviews of the empirical literature as change. We examine from a purely methodowell as theoretical and conceptual treatises logical standpoint whether this assumption is (

Placebo psychotherapy: Synonym or oxymoron?

“…Empirically derived controls (Kazdin & Wilcoxon, 1976) are specific procedures that are as credible and compelling as the investigational treatment, but are in other respects very different from it (see, for example, Kirsch et al, 1983). If the effects of these control procedures are found to be comparable to those of the investigational treatment, the hypothesis that the effects of both may be due to expectancies for improvement is supported.…”

Nonveridical heart rate feedback and emotional attribution

“…Presumably , transient changes in heart rate may exert a direct interoceptive influence on inhibitory and excitatory central nervous system pathways (Lacey & Lacey, 1978). It also is possible that the amplified heart rate signal could be used exteroceptively to appraise affective state (Hirschman, Young, & Nelson, 1979) or could be used to appraise expectancies about the effects of the feedback manipulation (Kazdin & Wilcoxin, 1976). …”

Clinical Dysfunction and Psychosocial Interventions: The Interplay of Research, Methods, and Conceptualization of Challenges

“…In the context of null hypothesis statistical testing, I have written on artifact and bias in measurement; unobtrusive measures; evaluation of treatment integrity; diverse control group options and what they can and cannot accomplish; moderators, mediators, and mechanisms of change and how they might be better studied; how and why comparative treatment outcome studies are likely to find no differences; statistical power; and meta-analysis (e.g., Kazdin 1986bKazdin , 2001bKazdin & Bass 1989;Perepletchikova et al 2007). I have given special emphasis to expectancy and nonspecific (common) factors as an explanation of therapeutic change (e.g., Kazdin 1979cKazdin , 2005bKazdin & Wilcoxon 1976) and have used this as a base for urging work on mechanisms (not just mediators) of change (e.g., Kazdin 2007Kazdin , 2014b; Kazdin & Nock 2003).…”

“…This began early in my career with two associate editorships (Behavior Therapy, 1975-1978Journal of Applied Behavior Analysis, 1975-1976 and moved to editorships. By now I have been fortunate to have served as editor of six journals (Behavior Therapy, 1979Journal of Consulting andClinical Psychology, 1985-1990;Psychological Assessment, 1989-1991Clinical Psychology: Science andPractice, 1994-1998;Current Directions in Psychological Science, 1999-2004and Clinical Psychological Science, 2012-present).…”