Ralph M. Turner

Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long-term effects

The present experiment was designed to examine the separate and combined effects of exposure and blocking of ritualistic behavior on obsessive-compulsive symptoms. Thirty-two patients with a primary diagnosis of obsessive-compulsive disorder were assigned to one of three treatment groups: exposure in vivo only, response prevention only and the combination of these two procedures. Assessments were conducted before treatment, three days after completion of treatment, and at follow-ups 3, 6, and 12 months later. All three groups were significantly improved on most measures of symptomatology, with some tendency for partial loss of gains at follow-up, particularly for the single-component treatments. Overall, combined treatment produced greater changes in anxiety and rituals than did the single component treatments. There was some evidence for the specificity of the treatment effects: exposure affected anxiety to contaminants significantly more than did response prevention; a tendency for the latter procedure to impact more on ritualistic behavior was also observed. Possible mechanisms which may be operative during these procedures are discussed in light of conceptualizations of processing of fear-associated information.

Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers ☆

The combined effects of imaginal exposure to feared catastrophes and in vivo exposure to external stimuli were compared with the effects of in vivo exposure alone in 15 obsessive-compulsives with checking rituals. The first group received 90 min of uninterrupted exposure in imagination, which concentrated mainly on disastrous consequences, followed by 30 min of exposure in vivo to stimuli-situations which triggered rituals. The second group was given 2 hr of exposure in vivo only. Both groups were prevented from performing rituals. Treatment consisted of 10 daily sessions within a 2 week period. Assessments were conducted before and after treatment and at follow-up ranging from 3 months to 2.5 yr with a mean of 11 months. At post-treatment both groups improved considerably and did not differ. But at follow-up those who received imaginal and in vivo exposure maintained their gains, whereas the group who were treated by exposure in vivo alone evidenced partial relapse on four of the six dependent measures. The results tend to indicate that a closer match between a patients internal fear model and the content of exposure enhances long term treatment efficacy.

Paradoxical intention and insomnia: an experimental investigation

Abstract A study by Turner and Ascher (1978) compared the efficacy of progressive relaxation, stimulus control, and paradoxical intention in ameliorating sleep onset insomnia. Results indicated that the three were equally effective. The present study is a partial replication of Turner and Ascher (1978) and focuses on the use of paradoxical intention in reducing sleep difficulties. Twenty-five individuals complaining of sleep discomfort were randomly assigned to three groups: paradoxical intention, placebo control, no treatment control. Clients in the paradoxical intention group were instructed to remain awake while lying in bed in a darkened room. The complete rationale for such a prescription was provided. Those in the placebo group received a pseudo systematic desensitization program. Results indicated that subjects exposed to the paradoxical intention procedure reported significant improvement on several measures of sleep behavior when compared with reports of subjects in either placebo or no-treatment control groups.

Massed vs. spaced exposure sessions in the treatment of agoraphobia

The differential effects of massed and spaced sessions of exposure in vivo were investigated with 11 agoraphobics in a crossover design. Clients were randomly assigned to one of the following two groups: (a) 10 daily sessions followed by 10 weekly sessions, or (b) 10 once-weekly sessions followed by 10 daily sessions. The results indicated that both massed and spaced sessions of exposure in vivo effected changes in avoidance behavior and subjective anxiety of agoraphobics, massed practice being superior especially with respect to avoidance. It was suggested that the superiority of massed practice is due to the lack of opportunity to engage in avoidance or escape during short inter-session intervals. The relationship between subjective anxiety and avoidance were considered and the differences between clinical and statistical significance were discussed.

Therapist factor in the treatment of insomnia.

Abstract This quasi-experiment attempted to replicate the finding of Turner and Ascher (1979) in contrasting progressive relaxation, stimulus control and paradoxical intention therapies for the treatment of insomnia using clinicians-in-training as therapists. Progressive relaxation and stimulus control were again shown to be effective, paradoxical intention instructions were not. A significant therapist effect was found which is discrepant with previous findings in the field.

Case study evaluations of a bio cognitive behavioral approach for the treatment of borderline personality disorder

This case study report evaluated the efficacy of a cognitive-behavioral treatment programcombined with alprazolam in the treatment of symptoms associated with Borderline Personality Disorder with four patients. The results suggested that the treatment was correlated with reductions in target symptoms, depression, anxiety and global psychopathology. Suggestions for further research are made.

Fear of criticism in washers, checkers and phobics

Abstract Fear of criticism in patients who manifested specific phobias, washing rituals and checking rituals was investigated. Six items from the Fear Survey Schedule measuring degree of anxiety to criticism were selected for this purpose. Results indicated that both washers and checkers showed more sensitivity to criticism than did phobics, while washers and checkers did not differ significantly. The implications of these findings for treatment are discussed.

Psychometric analysis of the Willoughby Personality Schedule

Abstract The Willoughby Personality Schedule (WPS) was subjected to Item Analysis, Coefficient Alpha Reliability Analysis, Factor Analysis and parametric tests for sex and age differences to assess its psychometric qualities. A set of norms for adult neurotics was also developed. The WPS items were all shown to be significantly related to total WPS score and to converge into a unitary construct: hypersensitivity to interpersonal situations. The potential clinical and research uses for the WPS in assertion and social skills training are discussed.

Dynamic Cognitive-Behavior Therapy

Cognitive-behavior therapy is at a critical juncture in its development. It is in the midst of a second cognitive revolution (Mahoney, 1991). Cognitive psychology no longer views the mind as a collection of static self-statements and passive schemata. The mind is a dynamic, constructive process. Cognitive processing affects how information is stored and retrieved. Cognitive processing also influences what information is perceived and attended to in the first place. Cognitive psychology’s tenets of tacit, or unconscious, mental processing and a feed-forward mechanism have opened the portal for dynamic theorizing in cognitive-behavior therapy (Turner, 1989; 1993a, b).

Assessment of social anxiety: a controlled comparison among social phobics, obsessive-compulsives, agoraphobics, sexual disorders and simple phobies

Abstract The construct validity of the Willoughby Personality Schedule (WPS) as an index of social anxiety was established in the present study. The WPS correctly identifies social phobics from controls in 88% of the cases.