Western Michigan University ScholarWorks at WMU Dissertations Graduate College 12-1991 The Effects of Relaxation Plus Imaginal Flooding Versus Relaxation Only on Panic Attacks in Veterans with Post-Traumatic Stress Disorder Jan E . Bachman Western Michigan University Follow this and additional works at: https://scholarworks.wmich.edu/dissertations Part of the Applied Behavior Analysis Commons, and the Military and Veterans Studies Commons Recommended Citation Bachman, Jan E ., "The Effects of Relaxation Plus Imaginal Flooding Versus Relaxation Only on Panic Attacks in Veterans with Post-Traumatic Stress Disorder" (1991). Dissertations. 2032. https://scholarworks.wmich.edu/dissertations/2032 This Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact [email protected]. THE EFFECTS OF RELAXATION PLUS IMAGINAL FLOODING VERSUS RELAXATION ONLY ON PANIC ATTACKS IN VETERANS WITH POST-TRAUMATIC STRESS DISORDER by Jan E . Bachman A Dissertation Submitted to the Faculty of The Graduate College in partial fulfillment of the requirements for the Degree of Doctor of Philosophy Department of Psychology Western Michigan University Kalamazoo, Michigan December 1991 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. THE EFFECTS OF RELAXATION PLUS IMAGINAL FLOODING VERSUS RELAXATION ONLY ON PANIC ATTACKS IN VETERANS WITH POST-TRAUMATIC STRESS DISORDER Jan E. Bachman, Ph.D. Western Michigan University, 1991 Many Vietnam veterans experience intrusive recollec­ tions of combat-related events in the form of nightmares and flashbacks, a primary symptom of Post-traumatic Stress Disorder (PTSD). Imaginai flooding has shown some promise in reducing the frequency and intensity of these. Cogni­ tive-behavioral therapies have also been used, but their effectiveness has not been studied. Experiment 1 attempted to determine whether a self-imposed version of imaginai flooding (called Self-Imaginai Flooding) could be used rather than the usual therapist-led procedure, and whether treatment effects could generalize from the treated to un­ treated intrusive memories. In a between groups design, with six Vietnam veteran subjects in each group, the ef­ fects of Self-Imaginai Flooding were compared with Relax­ ation Only. Following relaxation training for both groups, three intrusive memories were presented for treatment to the Flooding Group in a multiple baseline fashion. The Re­ laxation Group received extended relaxation training. Probes, in which subjective and physiological measures were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. obtained, were conducted prior to treatment, after relax­ ation training, and following treatment of each of the three intrusive memories. Results indicated that Self- Imaginal Flooding was more effective than Relaxation Only in reducing the frequency and intensity of intrusive memo­ ries outside of treatment, neither anxiety nor depression were decreased, generalization of treatment effects did not occur, and EDG was the only physiological measure which changed significantly as a result of the Self-Imaginai Flooding treatment. In Experiment 2, six subjects were taught the Self-Imaginai Flooding technique and four cogni­ tive-behavioral coping strategies. Subjects received training for each of these techniques and selected one strategy for extended practice. Probes, similar to those in Experiment 1, were conducted before and after training. The results showed that strategy preferences were related to the amount of discomfort reduction. In addition, there were significant within-group decreases in the frequency of intrusive memories and measures of anxiety and depression. As measured in the probes, self-selected coping strategies were more effective than previously used coping methods in reducing subjective discomfort and heart rates. The impli­ cations of the results of both experiments are discussed. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. 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Contact UMI directly to order. UMI University Microfilms International A Bell & Howell Information Company 300 Nortfi Zeeb RoaO. Ann Arbor. Ml 48106-1346 USA 313/761-4700 800/521-0600 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Order Number 9211592 The effects of relaxation plus imaginai flooding versus relaxation only on panic attacks in veterans with post-traumatic stress disorder Bachman, Jan E., Ph.D. Western Michigan University, 1991 UMI 300 N. ZeebRd. Ann Arbor, MI 48106 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENTS I wish to express a special acknowledgement and sin­ cere appreciation to the individuals who were instrumental in supporting this work in a variety of ways. They include my committee, R. Wayne Fuqua, Ph.D., Michele Burnette, Ph.D., Malcolm Robertson, Ph.D., and David Sluyter, Ed.D., who provided valuable guidance and comments during the course of the research and/or development of this document; the staff at the Battle Creek Veterans Administration Medi­ cal Center, particularly Dharm Bains, Ph.D., Pat Munley, Ph.D., Gordon Hare, Ph.D., Larry Schwartz, Ph.D., Lynn Becker, Ph.D., and Jim Frazee, who provided access to the subjects, the equipment, and the environment in which to conduct the research; my wife, Cheryl Bachman, who sacri­ ficed much, tolerated my extended involvement in higher ed­ ucation, and gave me the strength to complete it; and our children, Andrea and Aaron, who have been most forgiving about my spending more time with the Macintosh than with Hungry Hippos. Jan E . Bachman 11 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS ACKNOWLEDGEMENTS .................................... ii LIST OF TABLES ..................................... vii LIST OF FIGURES ......................................viii CHAPTER I. INTRODUCTION .................................... 1 Statement of the Problem.................... 1 Review of Related Literature ................ 4 Purposes of Experiment 1 ..................... 10 II. EXPERIMENT 1 .................................... 13 Method ................................. 13 Sub] ects.................................. 13 Approval of Study......................... 14 Setting................................... 16 Equipment................................. 16 Treatment Conditions...................... 17 Stress Recovery Treatment Program 17 Experimental Treatments............... 17 Procedure................................. 18 General Procedure .................. 18 Baseline............................ 18 Relaxation Training................... 19 Self - Imaginai Flooding Training....... 20 Probes.................................... 21 iii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents--Continued CHAPTER Dependent Measures........................ 22 Subjective Units of Discomfort (SUDS) Levels................................. 22 Physiological Measures................ 22 Self-Report Data....................... 24 Design and Data Analysis................. 24 Results of Experiment 1 ...................... 26 Symptom Reduction......................... 26 STAI................................... 26 BDI .................................... 26 Intrusive Recollections............. 28 Probe D a t a ................................ 29 SUDS Levels............................ 29 Physiological Measures................ 30 Generalization Across CEs ............. 35 Discussion of Experiment 1 ................... 36 III. EXPERIMENT 2 .................................... 43 Introduction