What You Can Change _. And What You Can't - Martin E. Seligman [142]
The combination of exposure and antidepressants looks like the least controversial treatment of choice. Improvement rate may be as high as 90 percent with the combination (see J. Ballenger, “Pharmacotherapy of the Panic Disorders,” Journal of Clinical Psychiatry 47 [1986]: 27–32). In a particularly well executed study, only the combination group improved, with the agoraphobes who had either tricyclics alone or exposure alone not improving significantly (see M. Telch, S. Agras, C. Taylor, et al., “Combined Pharmacological and Behavioural Treatment for Agoraphobia,” Behaviour Research and Therapy 23 [1985]: 325–35). For other well-executed combined drug-and-exposure studies, see M. Mavissakalian and L. Michelson, “Two-Year Follow-up of Exposure and Imipramine Treatment of Agoraphobia,” American Journal of Psychiatry 143 (1986): 1106–12.
For a quantitative review of the drug and psychotherapy literatures in agoraphobia, see R. Mattick, G. Andrews, D. Hadzi-Pavlovic, and H. Christensen, “Treatment of Panic and Agoraphobia: An Integrative Review,” Journal of Nervous and Mental Disease 178 (1990): 567–76.
12. This case history comes from Isaac Marks, the leading contemporary British investigator of phobias.
13. See M. Seligman, “Preparedness and Phobias,” Behavior Therapy 2 (1971): 307–20; and S. J. Rachman and M. Seligman, “Unprepared Phobias: Be Prepared,” Behaviour Research and Therapy 14 (1976): 333–38.
14. A. Ohman, M. Fredrikson, K. Hugdahl, and P. Rimmo, “The Premise of Equipotentiality in Classical Conditioning: Conditioned Electrodermal Responses to Potentially Phobic Stimuli,” Journal of Experimental Psychology: General 105 (1976): 313–37. For an articulate dissenter from the Ohman experiments and from the preparedness theory of phobias, see R. McNally, “Preparedness and Phobias: A Review,” Psychological Bulletin 101 (1987): 283–303.
15. L. Ost and K. Hugdahl, “Acquisition of Phobias and Anxiety Response Patterns in Clinical Patients,” Behaviour Research and Therapy 21 (1981): 623–31
16. S. Hygge and A. Ohman, “Modelling Processes in Acquisition of Fear: Vicarious Electrodermal Conditioning to Fear-Relevant Stimuli,” Journal of Personality and Social Psychology 36 (1978): 271–79. For a beautifully done parallel experiment in nonhuman primates, see S. Mineka, M. Davidson, M. Cook, and R. Keir, “Observational Conditioning of Snake Fear in Rhesus Monkeys,” Journal of Abnormal Psychology 93 (1984): 355–72.
17. Snakes and spiders make for stronger CSs than guns and knives, although the latter are more dangerous in cultural—but not evolutionary—fact than the former. See E. Cook, P. Hodes, and P. Lang, “Preparedness and Phobias: Effects of Stimulus Content on Human Visceral Conditioning,” Journal of Abnormal Psychology 95 (1986): 195–207.
CHAPTER 7 Obsessions
1. As remembered from “What Do We Plant?,” by Henry Abbey (i 842–1911).
2. So catchy is this ditty that I read it once in fifth grade (some forty years ago) and it has stayed with me—intact—ever since, making monthly appearances on my jingle channel. Mark Twain, “Punch, Brothers, Punch” (1876), in The Complete Humorous Sketches and Tales of Mark Twain, ed. Charles Neider (Garden City, N.Y.: Doubleday, 1961), 303.
Ethical considerations forbid my telling you the lyrics of the even catchier jingles.
3. D. Barlett and J. Steele, Empire: The Life, Legend, and Madness of Howard Hughes (New York: Norton, 1979), 233.
4. S. J. Rachman and R. Hodgson’s classic book Obsessions and Compulsions (New York: Appleton-Century-Crofts, 1980) remains the definitive