Fear reduction by psychotherapies: A response

Dr Snaith (2000) misquotes us (Marks & Dar, 2000) on an important point. We do not conclude that “all elements… have therapeutic potential and that any assertion of superiority of one approach over another is unwarranted”. We specifically state that non-applied relaxation, avoidance (anti-exposure instructions), diary keeping, treatment set, giving a rationale, and regular homework assignments are not particularly therapeutic per se. Several approaches are less helpful than others.

We are grateful to Dr Snaith for reminding us of his results with anxiety control training (ACT). His paper (Snaith, 1974) noted that several ACT patients did imaginal or live exposure, which is covered by our discussion on exposure. He described his 1982 trial (Constantopoulos et al, 1982) of ACT briefly in a non-peer-reviewed chapter. Just 12 patients were randomised to either experience anxiety scenes or just cope with anxiety without exposure. His papers (Constantopoulos et al, 1982; Snaith, 1998) give too little detail to judge how much each treatment used imaginal exposure (implosion) or irrelevant fear exposure (stress immunisation). The reports give no mean ratings and standard deviations before and after treatment, preventing judgement of how much each group improved. Though both groups improved with no significant differences between them, the study lacked power - a very big difference would be needed to yield significance when comparing two cells containing just six patients each. Dr Snaith's results with “ just coping with anxiety” may echo those with irrelevant fear exposure and support our idea that stress immunisation (irrelevant fear exposure) may reduce anxiety. Snaith et al's (1992) paper did not describe randomisation to ACT or a contrasting procedure.

Our call for psychotherapists to work towards a common psychotherapy language that defines each procedure in a standard accepted terminology is bolstered by examining Dr Snaith's terms. What he calls “ meditation” has relatively little in common with Kabat-Zinn's (1996) mindfulness meditation, and his ACT, for example, includes components which are not specified regarding relevant v. irrelevant exposure. If psychotherapists agreed to call the same procedures by the same names, that would be a huge step forward. European and American associations in the field (the European Association for Behavioural and Cognitive Therapy (EABCT) and the Association for Advancement of Behavioural Therapy (AABT)) have appointed a joint task force to develop a common psychotherapy language.