Individual response patterns, treatment matching, and the effects of behavioural and cognitive interventions for acrophobia

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Abstract
The relationship of individual response patterns to cognitive-behavioural treatment outcome with acrophobics was investigated. Sixty acrophobic subjects were initially tested with a battery of measures including a Height Avoidance Test that allowed direct physiological (heart rate, systolic and diastolic blood pressure), verbal-cognitive (subjective anxiety, danger expectancies), and behavioural (avoidance) assessment. Subjects were then randomly allocated to a physiologically-focussed (progressive muscle relaxation), cognitively-focussed (cognitive restructuring), or behaviourally-focussed (in vivo exposure) treatment. All subjects were treated individually in eight, one-hour sessions. All pre-treatment measures were readministered at post-treatment and at a nine-month follow-up. After follow-up assessment subjects were divided into physiological, cognitive, and behavioural responders on the basis of their standardized pre-treatment Height Avoidance Test scores. Subjects who had been treated consonantly (i.e., with the procedure designed to target their primary response), had not experienced any greater improvement, on any of the eleven outcome measures, than subjects who had been treated non-consonantly. That is, at post-treatment and follow-up no support for the treatment matching hypothesis could be found. Supplementary analyses showed that in vivo exposure produced significantly greater treatment benefits than relaxation or cognitive restructuring which were equally, but less, effective. Differences between the present results and previous positive findings with treatment matching are discussed in terms of the many methodological differences across studies.