February 1983

Treatment of PhobiasII. Behavior Therapy and Supportive Psychotherapy: Are There Any Specific Ingredients?

Author Affiliations

From the Department of Psychiatry, Long Island Jewish-Hillside Medical Center, Glen Oaks, NY. Drs Klein and Ross are now with the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York.

Arch Gen Psychiatry. 1983;40(2):139-145. doi:10.1001/archpsyc.1983.01790020033003

• Systematic hierarchical desensitization (behavior therapy [BT]) was compared with supportive psychotherapy (ST) during a 26-week treatment trial of patients with agoraphobia, mixed phobia, or simple phobia. We found essentially no difference in effectiveness, not because patients treated with BT had done badly, but because patients receiving ST had done well. A detailed methodologic review concludes that this finding is entirely compatible with the major critical reviews of the psychotherapy literature. Is the active ingredient in psychotherapy simply the generation of hopeful expectancies? This is necessary but not sufficient. For phobics, the psychotherapy session serves primarily as an instigator. The specific corrective activity occurs outside of the formal session in the form of maintained exposure in vivo. Supposed differences between therapies may be entirely due to the rapidity with which the instigational function becomes effective.