Processes of fear-reduction in systematic desensitization: Cognitive and social reinforcement factors in humans

Systematic desensitization (SD) is a technique which usually takes place in a social context and involves the use of imagery and possibly other symbolic/cognitive processes as well. Research and theory bearing on these two sets of uniquely human variables are critically reviewed. The main conclusions are as follows: (a) a conceptualization of SD as a procedure which is effective via the induction of counterphobic cognitions has failed to find replicable support and is, furthermore, questionable on a priori grounds because of the doubtful relevance of attribution theory to the alteration of severe, long-standing phobias; (b) expectation of gain can produce increments in beneficial effects arising from SD but does not appear to account for all improvement; (c) deliberately induced self-instructions may increase the efficacy of SD and may, furthermore, be operating in uncontrolled but important ways in the procedure as currently practiced; (d) the word "cognitive" is used in both a descriptive and an explanatory sense in the literature, threatening even more obfuscation than already exists; (e) experiments designed to determine the role of the desensitizer as a social reinforcer for increased (imaginal) approach behavior are either inappropriate in conception, confounded in design, or productive of inconclusive results; and (f) stimulus-response formulations are proposed not to be ipso facto incapable of usefully conceptualizing and manipulating covert processes, including imagery.