1. B&w. The-r. & Erp. Psychmr. Vol. 8. pp. 423425. Pcrgamon Press. 1977. Printed an Great Bnlain.

SYSTEMATIC DESENSITIZATION AND NEGATIVE PRACTICE TO ALTER THE AFTEREFFECTS OF A RAPE ATTEMPT

RICHARD WOLFF

Community Psychiatric Clinic, Wheaton, Maryland

Summary-Seven years after a rape attempt a ZO-year-old female feared staying alone at night and compulsively checked her apartment when she arrived home. Systematic desensitization was applied to the fear and negative practice to the checking.

While reports of success in treating compulsive behaviors has long been in the tradition of the psychotherapeutic literature, the last few years have witnessed an increase in both the variety and efficiency of behavioral treatments. Hackman and McLean (1975) have successfully applied thought stopping, while success has also been demonstrated for response prevention (Meyer, Robertson and Tatlow, 1975); flooding plus modeling (Rachman and Marks, 1973); systematic desensitization (Rackensperger and Feinberg, 1972); and a method of having the subject complete the checks in the presence of the therapist (Roper and Rachman, 1976). Melamed and Siegel (1975) have recentiy repor- ted the successful treatment of a checking ritual using a multiple treatment program, which in- corporated operant conditioning, response prevention, systematic desensitization, and programmed disruption of a ritualistic behavioral chain.

her, threatening her well-being and that of the children under her care. Rape did not technically occur, for the man ejaculated before intromission and left the home. She was then able to free herself and called her parents, who notified the police. Unfortunately, the validity of her story was questioned, and when the semen was discovered she was accused of making up the entire episode and of having a boyfriend stay with her, which served to in- crease her elevated state of anxiety. Within two weeks her story was accepted and a con- sultation with a psychiatrist was arranged. The subject stated that she was far too upset to discuss any topic with a therapist and could not begin to discuss the rape attempt. No further consultations were sought.

The present program describes a treatment program utilizing systematic desensitization and negative practice in tandem aimed at two separate, but related problem behaviors resulting from a rape attempt.

CASE HISTORY

The subject was an attractive female, almost 20 years of age, who described the problem as the result of a rape attempt. At age 13, she had fallen asleep on a couch while babysitting to be awakened by a man who bound and gagged

For years she “hated men,” but gradually began dating, especially policemen. No dif- ficulties with males in dating or sexual situations were reported. However, since that incident, she had not spent a night alone and had moved to an apartment with her sister (a policewoman) and another girlfriend. Treat- ment was sought because the friend was moving and the sister would be working the evening and early morning hours. The chief complaint was a fear of being alone, especially after dark.

METHOD Systematic desensitization

The entire course occurred on a once a week basis. The patient was trained in deep muscle relaxation and asked to record the number of hours that she slept each evening.

Requests for reprints should be addressed to Richard Wolff, North, Wheaton, Maryland. 20902.

Community Psychiatric Clinic, Suite 500. Wheaton Plaza,

423

424 RICHARD WOLFF

Although she was taking an “over the counter” sleeping medication, the high anxiety state kept her awake most of the night. Thus. hours slept per evening was the dependent variable. Routine desensitization proceeded with a hierar- chy of being alone in an apartment w!th increasing degrees of darkness, and hearing strange noises near and within her home. The final item was being awakened in a totally darkened room by an obscene telephone caller who stated that he would rape her.

At the end of the fourth week insomnia was no longer a problem. She reported feeling only slightly frightened when home alone, and she independently discontinued the medication. The hierarchy was completed at the end of the seventh session.

Negariveprucfice Following the program of systematic desensitization she

was not fearful when alone in the apartment. However, she reported that when entering the empty apartment alone. she felt compelled to continue to check for the presence of an intruder. The checking ritual, which included thirteen separate steps ranging from looking into the kitchen to opening closets and looking under beds, had been in existence since the attack and was not affected by the time of day. It occurred only when she entered the empty apar- tment alone.

A one week baseline indicated that the checks were per- formed O-2 times per day with the variability dependent upon the presence or absence of another person when she arrived home. Every time the apartment was empty, she would perform the checks.

The patient was informed that the behavior would be treated by negative practice and that each time she entered the apartment she would have to perform the checking five times in succession. Specifically. she was to check in the customary manner, but was then to put her coat back on and leave the apartment, locking the door behind her. She would then again unlock the door, hang up her coat, check the thirteen items, put on her coat. leave the apartment, lock the door, etc. Upon completion of the fifth chain, she would resume her normal activities. This procedure was in

effect for one week and it occurred when no one else would be staying with her. On days 4. 5 and 6, someone was present when the subject returned home and the checking ritual was not performed.

After one week she was told that if she wished to make the checks she could do so. but that she would then have to do it for a total of five times in succession. That is, if she wished to check she had to complete the entire chain five times in succession or not at all.

RESULTS

Table 1 presents the hours of sleep during the course of treatment by desensitization.

Table I

Average Week hours of

sleep

Base 5.50

1 1.57

2 8.36

3 7.21

4 6.54

5 7.21

6 6.36

The variability toward the end of treatment seems within normal limits.

The number of times that she checked the apartment are illustrated in Fig. 1. Forced represents the time when the treatment program dictated that she must perform the checks five

Days

I.i!q. I

Follow-UD

j month! 12 months

SYSTEMATIC DESENSITIZATION AND NEGATIVE PRACTICE 42s

times in succession. Choice represents the con- dition under which she could choose to check or not to check, but if she chose to check she was required to check five times in succession.

Six, twelve, and twenty-four month follow- ups indicated no relapse. Between the ter- mination of weekly therapy and the six-month follow-up period the checking had occurred only once, because unusual lights had been left burning, and an interior door inadvertently left open by her sister. The checking did not occur on subsequent days. No checking had occurred prior to the twelve and twenty-four month follow-up periods. At twenty-four months the subject reported that she had been dating without difficulty, and had attempted to secure an apartment by herself, though she was unable to afford it.

DISCUSSION

The efficacy of systematic desensitization is hardly surprising in this day and age. Negative practice as a procedure operating un- der many labels has gone through periods of popularity and disuse since Dunlap’s 1932 Text*. Its employment here illustrates that it can be successfully applied quickly to eliminate compulsive behaviors.

It should be noted that the goal of therapy was not to feel relaxed while wandering through dark alleys in high crime districts or to maintain a low anxiety level in response to sexual attack. Rather, the goal was to alter specifically high frequency behaviors which were preventing her from living her life in the manner of her choosing.

REFERENCES

Dunlap K. (1932) Habits: Their Muking und f_/nmaking, Liverwright, New York.

Hackman A. and McLean C. (1975) A comparison of flooding and thought stopping in the treatment of obsessional neurosis, Behav. Res. & Therupy 13. 263-369.

Melamed B. G. and Seigel L. J. (1975) Self-directed in vivo treatment of an obsessive-compulsive checking ritual, 1. Behuv. Ther. & Erp. Psychiuf. 6,31-35.

Meyer V., Robertson J. and Tatiow A. (1975) Home treatment of an obsessive-compulsive disorder by response prevention, J. Eehuv. Ther. & Exp. Psych&. 6.37-38.

Rachman S.. Marks 1. M. and Hodgson R. (1973) The tratment of obsessive-compulsive neurotics by modeling and flooding in viva. Behuv. Res. t Therupy lL463-472.

Rackensperger W. and Feinberg A. (1972) Treatment of severe handwashing compulsion by systematic desensiti- ration: A case report. 1. Behuv. Ther. & Exp. Psychiur. 3, 123-128.

Roper G. and Rachman S. (1976) Obsessional-compulsive checking: experimental replication and development, Behuv. Res. & Therupy 14.25-32.

*Although Dunlap’s 1932 text (Hubits: Their hfuking und Unmuking) is usually cited as the first reference to negative practice, it was first presented in a 1928 article (Dunlap. K. A Revision of the Fundamental Law of Habit Formation. Science. 1928, 360-362).