&ha\
Res 8; Therap!.
1976. Vol
14. pp. 333-338. Perpamon PIAS. Prmed
UNPREPARED
I” Great Elnmn
PHOBIAS:
“BE PREPARED”*
S. RACHMAN Department
of Psychology.
Institute
of Psychiatry.
De Crespigny
Park.
London.
SE5 8AF. England,
and M. E. P. SELIGMAN Department
of Psychology.
University
of Pennsylvania, (Rrceited
3815 Walnut
7 Ocroher
Street.
Philadelphia
PA 19104. U.S.A.
1975)
Summary-The weaknesses of the equipotentiality premise are rehearsed and an alternative theory of preparedness. with particular reference to phobias. is outlined. Two climcal cases which appear to be contrary to prediction are described. Although their phobias were unprepared (lack of biological significance, rarity, and probably gradual acquisition) they showed features (high resistance and broad generalization) not predicted by the theory. It is suggested that these features may appear as a result oJ (i) overlearning. (ii) symboiic transform~~tion or (iii) considerable associated psychopathology.
In common with most learning theories, the conditioning theory of phobias rests on the equipotentiality premise. among others. The premise was described and analysed by Seligman and Hager (1972) who observed that ‘general-process learning theorists believe that what an organism learns about is a matter of relative indifference. In classical conditioning the choice of conditioned stimulus. unconditioned stimulus. and response matters little: that is. a11conditioned stimuli and unconditioned stimuli can be associated more or less equally well, and general laws exist which describe the acquisition, extinction, inhibition. delay of reinforcement, and spontaneous recovery of all conditioned and unconditioned stimuli.’ (p. 2). They proposed that the equipotentiality premise be replaced by the concept of preparedness and Seligman (1971) developed this alternative idea with particular reference to phobias. The major elements of the preparedness argument are summarized later in this paper and then followed by an examination of two clinical cases which appear to be exceptions to the rule. The conditioning theory of fear acquisition (see Eysenck and Rachman. 1965) carries the implicit assumption that any stimulus can be transformed into a fear signal. In addition the theory assumes that. given comparable exposures, all stimuli have roughly an equal chance of being transformed into fear signals. In some versions of the conditioning theory of fear. reservations were noted. For example, Eysenck and Rachman argued that “neutral stimuli which are of relevance in the fear-producing situation and/or make an impact on the person in the situation, are more likely to develop phobic qualities than weak or irrelevant stimuli,” (p. 81). Even when reservations of this sort were noted, little attempt was made to specify their nature or implications. With hindsight we can now see that difficulties with the equipotentiality premise began accumulating many years ago. For example, it has been pointed out that English (1929) was only partly successful in his attempt to replicate Watson’s demonstration of the acquisition of a fear of white rats in the experimental subject, little Albert. English found that fear reactions could be conditioned only to selected stimuli. Along similar lines, Bregman (1934) failed in her thorough attempts to condition a group of infants to fear a range of simple and biologically insigni~cant objects. The repeated presentation of geometrically shaped wooden objects and of cloth curtains in association with a disagreeably loud and startling sound of an electric bell, did not produce conditioned *We wish to thank Drs. B. Kulick. I. Marks and G. Sartory for their assistance, and the Boy Scouts for their motto. M. Sehgman also acknowledges the support of USPHS grant MH 19604 and a Guggenheim Foundation Fellowship. 333
3.33
S. RAC.HMA~
and M. Ir‘. P.
SI.LIGMA\
fear reactions to the (biologically insignificant) stimuli. She concluded that ‘changes in emotional behaviour.. . are not. as a general rule at least. readill brought about b! joint stimulation in early life’ and therefore conditioning cannot prov,idc a full explanation of the acquisition of emotional responses in infancy. An engaging account of some weaknesses of the equipotentialit! premise can be found in the writings of Valentine (1946). In his anal! sis of Watson’s demonstration. Valentine wondered w,hether the fear of the rat ‘was readily established partly because there was an existing innstc tendency. f~z~~ii~lzus j’et li~l~~~~,~~~~~~e~i~ to fear the rat’. (p. 216. italics added). He then went on to describe some of his own tests in which he tried to condition fear to an unlltmiliar object which ‘could not be supposed to have an> innate fear attached to it. namel!. an old pair of opera glasses’. Overcoming his resistance he performed some tests on his own child despite causing ‘momentar> discomfort to one’s little ones’. But the child was ‘an exceptionally health!. strong and jovial youngster. and I hardened m! heart su~cienti~ to try one or two simple tests with her‘. (p. 316). His de~~~~i~str~lt~on followed the same lines as that of Watson and when Valentine’s child. aged one, stretched out to touch the opera glasses, he loudly, blew a wooden whistle behind her. The child ‘quietly turned round as if to see where the noise came from’. This procedure \vas repeated several times without the child showing any fear of the opera glasses. Later in the same afternoon the experiment was repeated with a caterpillar. From the first association with the loud noise the child ‘gave a loud scream and turned avva~ from the caterpillar. This was repeated four times with precise11 the same elf‘ect’. These tests were continued for the next few days and the child showed signs of an unstable fear of the caterpillar. Although the fear showed signs of spontaneous fading. it was readily restored after only slight provocation. In summarizing the result. Valentine used a telling description: ‘Here we have again the rousing uffhe ll~r~ii~~~~~~r by the added disturbance of the whistle’, (p, 218) (italics added). On the analogy of ‘lock and key’, Valentine stressed that the noise itself only became aversive in connection with the caterpillar-not the opera glasses. Valentine’s case for the selective quality of fear acquisition was supported b! observations on other Joung children. He quoted for example, a two-lear-old child who readily acquired a fear of dogs ‘at slight provocation’ and this behaviour was contrasted ‘with the absence of fear even when real pain was suffered under circumstances in which no object stimulating an innate tendency to fear is present’. (p. 214). Demonstrations of this type carried out with young children and the impressive experimental information assembled by Seligman and Hager (1971) are a serious challenge to the equipotentialitx premise. The corollary for phobias. that all stimuli have an equal chance of being tr~lnsformed into fear signals, is not borne out b! surveys of the distribution of fears. either in a general population or in psychiatric samples (see Rachman, 1974). Subject onl! to their prominence in the environment many objects and situations should hate an equal probability of becoming fear-provoking. What we find instead, however. is that some fears are exceedingly common-far too common for the conditioning theor\. Other fears are far too rare. Fear of the dark is commonly seen among children. but not pvjama phobias. In the case of animal phobias. one might expect that within a tit\ population the prevalence of fear of lambs should approximate that of the fear of snakes. In practice, however. the fear of snakes is common and the fear of lambs is rare. Moreover. a genuine fear of snakes often is reported b! people who ha\,e had no contact with the reptiles. Consequently one is forced to conclude that a fear of snakes can be acquired in the absence of direct contact-and this opens three possibilities. Either the fear of snakes is innate or it can be tr~~nsn?itted indirectly. or the fear of snakes is ‘lurking’ and will appear with only slight provocation. The last two of these three possibilities are of course compatible. In their account of the concept of preparedness, Seligman and Hager concentrated on acquisition as the defining criterion for preparedness. For most of their argument. the terms p~~pcc&. ~~~?~~~~pu~~~~ and ~~/lf~up~~~~~zr~~~l are used rclativel> and are based on ease of ~~~qliisition. An association which is readily acquired is dciined as ‘prepared’
and one which is acquired with considerable difficult!, is ‘unprepared’. In addition. it is hypothesized that ‘phobias are highly prepared to be learned b> humans. and. like other highly prepared relationships the\, are selective and resistant to extinction. and probably are non-cognitive’, (Seligman, 1973. p. 4551. It is also suggested that most phobias are of biological significance. Seligman (p. 460) argued that ‘the great majorit> of phobias are about objects of natural importance to the survival of the species. It does not deny that other phobias are possible. it onl! claims that the! should be less frequent. since they are less prepared’. He goes on to sa\ that human phobias ‘are largely restricted to objects that have threatened survival. potential predators. unfamiliar places. and the dark’, (Seligman and Hager, 1972. p. 465). It is argued b!, Seligman and Hager that the laws of learning are influenced b! the preparedness of the association. So for example. extinction of prepared learning should proceed slowly. By contrast. unprepared connections should be subject to easier extinction (and of course, slower acquisition). The introduction of the concept of prcparedness into the study of fear has led to some new questions. For example. what is the relationship between preparedness and avoidance behaviour? When unprepared stimuli are turned to fear signals. is the consequent avoidance behaiiour weah and or transient’? In addition to learning theoretic interest. the concept of preparedness is of potential value for clinicians. For example, can clinicians predict outcome of therapy or make decisions about therapy of choice by knowing how prepared a given phobia is? Do prepared and unprepared phobias respond to different treatments: or hale different prognoses without treatment? As a first step in asking clinical questions related to preparedness. we present two unusual cases of unprepared or perhaps even contraprepared phobias. The first patient. Mrs. V. was admitted to hospital with a chronic and severe neurotic disorder in which the main features were compulsive rituals centred on a powerful fear of chocolate. She complained of and demonstrated extreme fear when confronted with chocolate or any object or place associated with chocolate. She avoided most brown objects; so for example, she would never agree to sit on any furniture that had brown in it. On one occasion she walked up eight flights of stairs rather than push the lift button because of the presence of a brown stain close to the button. She took great care to avoid any shops which might stock chocolate or any public places where chocolate might be eaten. As the fear grew over the years. she was forced to cease working and became increasingly confined. Before admission to hospital she was practically housebound. There was no denying the authenticity of her distress when presented with chocolate or the associated stimuli, and there was no doubt about the vigour of the avoidance behaviour evoked by such confrontation. Before going into the full history of the fear and possible significance, it is worth emphasizing the rarity of this complaint-neither the two authors nor any of their colleagues had ever reported encountering a chocolate phobic. It cannot be argued plausibly that this peculiar fear is of survival value or that it is common. According to the patient and the independent account given b! her husband. her psychiatric complaints began shortly after the death of her mother. to whom she was inordinatel! attached. After the death she was depressed for a prolonged period and also became aware of a strong aversion towards and probably fear of. cemeteries and funeral parlours. She first became aware of a slight distaste for chocolate several months after the death of her mother but it was nearly four years after this event that it became clear to her and her husband that she was actively avoiding chocolate and indeed had become extremel!, frightened of it. Prior to her mother’s death she had eaten chocolate with erljobment but this pleasure seemingly waned gradually in the period after her mother’s death. In passing we can mention that during the course of her otherwise largei] unsuccessful treatment. the patient regained the ability to touch and even to eat small pieces of chocolate. hzrt the pleasurable taste did not return. She continued to feel indifference or even slight dislike. This recalls the observation made b> Hallam and Rachman (1972) that some alcoholics reported a change in the taste of their drinks
336
S. RACHMAK and M. E. P.
SLLIGMAX
after undergoing a course of electrical aversion therapy. Most often they reported that their favourite drink had become somewhat insipid: some even claimed that the therapists were deliberately watering down the drinks. For present purposes. the most relevant characteristics of Mrs. V’s chocolate phobia were: its rarity, its gradual onset, the intensity of the fear and associated avoidance behaviour. the widespread generalization from chocolate to a large variety of brown objects. and as we shall see. its resistance to modification. The rarity. gradual acquisition and biological significance of this fear entitle us to describe it as being different from the common. recognised prepared phobias-as u~tprc~pcr~tl. If we allow that this fear of chocolate was different from the prepared type. we are in a position to answer the question about the ease of treatment (extinction’?) of an unprepared phobia and whether it is associated with weak or transient avoidance behaviour. In fact. Mrs. V responded only slightly to an intensive course of behavioural treatment that normally achieves a success rate of between 70 and 80”,,. She was given thirty treatment sessions of participant modelling. involving repeated exposures to the fear-provoking stimuli. and at the same time her ritualistic behaviour was subjected to response prevention. So in this case at least. the unprepared phobia was resistant to treatment. The avoidance behaviour associated with the phobia was enduring. estensive and pronounced-in the year prior to admission she had been able to leave her home only twice. Before we draw conclusions about the quantities of unprepared phobias on the basis of a single case, two reservations should be mentioned. In the first place Mrs. V ws comparatively inarticulate and provided a spotty history of the development of her phobia. This problem was mitigated by obtaining an independent account from her husband. Secondly, the therapist was able to construct or re-construct a possible relationship between her fear of chocolate and an earlier but persistent and strong fear of scenes connected with death. It is barely possible that the fear of chocolate had as its origin a strong emotional reaction to the death of her mother during which time she had been obliged to observe the coffin containing the body. The patient believes that this coffin was dark brown in colour and that it may have contributed to the association which she had between death and chocolate. Even more telling. she feels sure that she saw a bar of chocolate in the room containing the coffin. This sy,mbolic connection between death. the colour brown and chocolate might be based on too fanciful an interpretation but we did obtain confirmatory evidence of her fear of death scenes. During a behavioural avoidance test she displayed an inability to approach funeral parlours and considerable fear was aroused during the attempt. The second case of an unusual phobia was a young woman who was virtually blind from early infancy and complained of an excessive fear of vegetables and plants. particularly their leaves. The phobia had its origin in early childhood. Like the first patient. she expressed and displayed intense fear of the objects and engaged in extensiv,e and active avoidance. She attributed the genesis of the fear to a series of extremely unpleasant experiences which she had undergone as a child when attending a boarding school for children with defective vision. She claims that numbers of the other children taunted and teased her by rubbing vegetables and plants on her face in order to irritate her. In her view this gave rise to an intense dislike of vegetables and plants that later turned into fear. Her phobia handicapped her in a number of ways and prevented her from engaging in ordinary social activities. For example. she was unable to eat in public places or in unfamiliar homes in which vegetables or salads might be served. She took great care to avoid walking past certain areas where she knew she might encounter shops that stocked vegetables or plants, and so on. It should be remarked that this patient had two or more vivid and terrifying dreams each week in which vegetables or plants featured prominently. These dreams seemed to increase the severity of the phobia. Like the earlier patient. she made little progress in therapy despite concentrated and intensive efforts to help her. In all she received forty-eight hours of treatment time.
Unprepared
phobias
337
The main form of treatment used was systematic desensitization in riro. supplemented by modelling during which the therapist made approach movements to vegetables and plants while keeping her eyes tightly shut. The patient was also given counter-conditioning treatment in fantasy in the hope of reducing her fears and also teaching her coping mechanisms. While it was hoped that the imaginary counter-conditioning exercises might serve to reduce the fears, the patient was also given the specific suggestion that she should attempt to incorporate the coping fantasies into her terrifying nightmares. When. after a great deal of treatment. comparatively modest progress had been made. the patient complained about her slow progress. A switch to flooding treatment was contemplated but never implemented because of the intolerable anxiety provoked in a preliminary attempt. Both patients complained of excessive anxiety during in riro treatment sessions and both claimed that they were unable to comply with anything more than minimal therapeutic demands. Although both of them made some slight progress. when it became necessary for them to get closer to the phobic object. their compliance withered and then disappeared. In neither case was it possible to complete the planned treatment programme. If we restrict ourselves to a clinical interpretation of their respective failures to respond to treatment. it might be that the blind patient experienced intense fear precisely because of her visual handicap and the way in which it precluded her from gaining control over distressing stimulation. Her visual field was extremely limited and she relied largely on differentiations between light and shade. One of the consequences of this reliance was that she tended to interpret sudden changes in the pattern of light and shade as the occurrence of movement and indeed often expressed the idea that plants could move. If there is any substance in this interpretation, based mainly on her visual handicap, one might expect fears to be more common among blind people but we are unaware of any data on this subject. The chocolate phobic patient might have been unresponsive to treatment because of the putative symbolic significance of chocolate: there seemed to be a close connection for her between chocolate and the death of significant people in her life. Our reasons for suspecting that there was such a close connection between chocolate and death are four-fold. In the first place the patient gave inarticulate expression to this belief. Secondly, both the patient and her husband independently reported that there had been a bar of chocolate present in the room where the brown coffin had been placed. Thirdly, when subjected to direct behavioural tests she displayed an intense fear of funeral parlours. She firmly resisted any attempt to include these fears in the treatment programme on the grounds that they were far too upsetting for her to tolerate. Fourthly, she claimed that the unpleasant physical sensations produced by the introduction of the chocolate were identical to those she experienced during the behavioural avoidance test in which she was asked to approach funeral parlours. What we are left with then is a seeming conflict of evidence. On the one hand the two phobias can be regarded as unprepared. They are of a rare type, of no apparent biological significance and are unrelated to natural dangers. (Rarity of occurrence is here used as an index of unpreparedness on the grounds that rarity indicates low susceptibility to fear acquisition). On the other hand, Seligman hypothesizes that prepared learning-not unprepared learning-is very resistant to extinction, is non-cognitive and generalizes widely. So these two phobias have the defining features of unpreparedness (lack of biological significance. rarity, and probably gradual acquisition), but the empirical properties that are hypothesized to cohere with preparedness (resistance to extinction. irrationality and wide generalization), We can see three possible resolutions to the apparent conflict: (a) As we have already suggested, Mrs. V’s fear of chocolate might have become mixed with or even symbolic of death. Such symbolic transformation might well be a hallmark of unprepared phobias. The vegetable phobia does not lend itself to this sort of interpretation but instead we can point to the patient’s handicaps and the fact
338
S. RACHVAX and
M. E. P.
SELIGMAI
that she had been exposed to repeated and prolonged aversive stimulation--perhaps of a kind sufficient to turn an unprepared stimulus into a phobic one. (b) These cases ma> reflect a peculiar sampling problem. Unprepared fears are sureI> acquired in nature, but then. b! hypothesis the! should extinguish rapidl!. Verb few will be sufficiently se\‘ere or longlasting to turn up at a clinic. Those few people whose unprepared phobias last long enough and are severe enough to be seen in the clinic may be severe& disturbed people or ma\ ha\.e abnormal personalities. Individual differences in associated psychopathology might not be spread e\cnl> o\er the range of phobias: rather. those people who present unprepared phobias ma! bc unusually disturbed (with the judgement made on grounds independent from the phobia). Both of the patients described here had an unusuall! wide range of other problems: the Legetable phobic was suicidal. had pronounced sleep disturbances. a histor! of enuresis. somnambulism. and night terrors-occasionall\ displayed disordered thinking-and had problems of aggression and sexualit! in addition to the phobia. The chocolate phobic was hypochondriacal. abnormalI> dependent on her mother. sexuall! inadequate and chronicall! depressed. (cl While ease of acquisition and biological significance are inherent in the r/qfinirion of preparedness. extinction, generalization and irrationality are rarpirical h~~porhes~s proposed to covary with the defining features. The evidence for coherence between the defining features and the empirical characteristics of prepared learning come largely from the taste-aversion conditioning literature (see Seligman and Hager. 1973). So. Seligman’s analysis of preparedness and phobias may retain its value, but some of the hypothesized consequences of having an unprepared phobia ma>’ need reiision. In particular. it need not follow that comparativel!. unprepared phobias will necessaril> show eas! extinction and narrow generalization. With further evidence it ma> be possible to specif! the conditions in which unprepared phobias manifest broad generalization and,or high resistance to extinction. On the modest and sparse basis of the two cases described here. these conditions ma! include: (a) exceptionally strong or frequentI!-repeated learning experiences. (b) symbolic transformation of the content of a prepared phobia into that of an unusual and unprepared phobia. and (c) considerably disturbed personality. In conclusion. diGding phobic and obsessive cases into prepared and unprep~~red ma! produce a surprising clinical dividend. Even though not predicted b! theor?. unprepared phobias that reach the clinic may prove to be high11 intractable to the gamut of behaviour therap!. lvhereas behaviour therapy may well be the treatment of choice for prepared phobias. Patients with unprepared phobias ma> need broader rehabilitation programmes and a significantI> greater amount of therapeutic eltbrt. REFERENCES RKIc;\I.&xE.
(19341 An attempt to modif) the emotional attitudes of infants b! the conditioned response technique. J. gyner. Ps~d~;~/. 45, 169-iY6. ENGLISI~ H. B. (19291 Three cases of the ‘conditioned fear resuonse’. .I. ~~hrrowt. SOC. P\\~c~/tol. 24, ‘21 115.
Res 8; Therap!.
1976. Vol
14. pp. 333-338. Perpamon PIAS. Prmed
UNPREPARED
I” Great Elnmn
PHOBIAS:
“BE PREPARED”*
S. RACHMAN Department
of Psychology.
Institute
of Psychiatry.
De Crespigny
Park.
London.
SE5 8AF. England,
and M. E. P. SELIGMAN Department
of Psychology.
University
of Pennsylvania, (Rrceited
3815 Walnut
7 Ocroher
Street.
Philadelphia
PA 19104. U.S.A.
1975)
Summary-The weaknesses of the equipotentiality premise are rehearsed and an alternative theory of preparedness. with particular reference to phobias. is outlined. Two climcal cases which appear to be contrary to prediction are described. Although their phobias were unprepared (lack of biological significance, rarity, and probably gradual acquisition) they showed features (high resistance and broad generalization) not predicted by the theory. It is suggested that these features may appear as a result oJ (i) overlearning. (ii) symboiic transform~~tion or (iii) considerable associated psychopathology.
In common with most learning theories, the conditioning theory of phobias rests on the equipotentiality premise. among others. The premise was described and analysed by Seligman and Hager (1972) who observed that ‘general-process learning theorists believe that what an organism learns about is a matter of relative indifference. In classical conditioning the choice of conditioned stimulus. unconditioned stimulus. and response matters little: that is. a11conditioned stimuli and unconditioned stimuli can be associated more or less equally well, and general laws exist which describe the acquisition, extinction, inhibition. delay of reinforcement, and spontaneous recovery of all conditioned and unconditioned stimuli.’ (p. 2). They proposed that the equipotentiality premise be replaced by the concept of preparedness and Seligman (1971) developed this alternative idea with particular reference to phobias. The major elements of the preparedness argument are summarized later in this paper and then followed by an examination of two clinical cases which appear to be exceptions to the rule. The conditioning theory of fear acquisition (see Eysenck and Rachman. 1965) carries the implicit assumption that any stimulus can be transformed into a fear signal. In addition the theory assumes that. given comparable exposures, all stimuli have roughly an equal chance of being transformed into fear signals. In some versions of the conditioning theory of fear. reservations were noted. For example, Eysenck and Rachman argued that “neutral stimuli which are of relevance in the fear-producing situation and/or make an impact on the person in the situation, are more likely to develop phobic qualities than weak or irrelevant stimuli,” (p. 81). Even when reservations of this sort were noted, little attempt was made to specify their nature or implications. With hindsight we can now see that difficulties with the equipotentiality premise began accumulating many years ago. For example, it has been pointed out that English (1929) was only partly successful in his attempt to replicate Watson’s demonstration of the acquisition of a fear of white rats in the experimental subject, little Albert. English found that fear reactions could be conditioned only to selected stimuli. Along similar lines, Bregman (1934) failed in her thorough attempts to condition a group of infants to fear a range of simple and biologically insigni~cant objects. The repeated presentation of geometrically shaped wooden objects and of cloth curtains in association with a disagreeably loud and startling sound of an electric bell, did not produce conditioned *We wish to thank Drs. B. Kulick. I. Marks and G. Sartory for their assistance, and the Boy Scouts for their motto. M. Sehgman also acknowledges the support of USPHS grant MH 19604 and a Guggenheim Foundation Fellowship. 333
3.33
S. RAC.HMA~
and M. Ir‘. P.
SI.LIGMA\
fear reactions to the (biologically insignificant) stimuli. She concluded that ‘changes in emotional behaviour.. . are not. as a general rule at least. readill brought about b! joint stimulation in early life’ and therefore conditioning cannot prov,idc a full explanation of the acquisition of emotional responses in infancy. An engaging account of some weaknesses of the equipotentialit! premise can be found in the writings of Valentine (1946). In his anal! sis of Watson’s demonstration. Valentine wondered w,hether the fear of the rat ‘was readily established partly because there was an existing innstc tendency. f~z~~ii~lzus j’et li~l~~~~,~~~~~~e~i~ to fear the rat’. (p. 216. italics added). He then went on to describe some of his own tests in which he tried to condition fear to an unlltmiliar object which ‘could not be supposed to have an> innate fear attached to it. namel!. an old pair of opera glasses’. Overcoming his resistance he performed some tests on his own child despite causing ‘momentar> discomfort to one’s little ones’. But the child was ‘an exceptionally health!. strong and jovial youngster. and I hardened m! heart su~cienti~ to try one or two simple tests with her‘. (p. 316). His de~~~~i~str~lt~on followed the same lines as that of Watson and when Valentine’s child. aged one, stretched out to touch the opera glasses, he loudly, blew a wooden whistle behind her. The child ‘quietly turned round as if to see where the noise came from’. This procedure \vas repeated several times without the child showing any fear of the opera glasses. Later in the same afternoon the experiment was repeated with a caterpillar. From the first association with the loud noise the child ‘gave a loud scream and turned avva~ from the caterpillar. This was repeated four times with precise11 the same elf‘ect’. These tests were continued for the next few days and the child showed signs of an unstable fear of the caterpillar. Although the fear showed signs of spontaneous fading. it was readily restored after only slight provocation. In summarizing the result. Valentine used a telling description: ‘Here we have again the rousing uffhe ll~r~ii~~~~~~r by the added disturbance of the whistle’, (p, 218) (italics added). On the analogy of ‘lock and key’, Valentine stressed that the noise itself only became aversive in connection with the caterpillar-not the opera glasses. Valentine’s case for the selective quality of fear acquisition was supported b! observations on other Joung children. He quoted for example, a two-lear-old child who readily acquired a fear of dogs ‘at slight provocation’ and this behaviour was contrasted ‘with the absence of fear even when real pain was suffered under circumstances in which no object stimulating an innate tendency to fear is present’. (p. 214). Demonstrations of this type carried out with young children and the impressive experimental information assembled by Seligman and Hager (1971) are a serious challenge to the equipotentialitx premise. The corollary for phobias. that all stimuli have an equal chance of being tr~lnsformed into fear signals, is not borne out b! surveys of the distribution of fears. either in a general population or in psychiatric samples (see Rachman, 1974). Subject onl! to their prominence in the environment many objects and situations should hate an equal probability of becoming fear-provoking. What we find instead, however. is that some fears are exceedingly common-far too common for the conditioning theor\. Other fears are far too rare. Fear of the dark is commonly seen among children. but not pvjama phobias. In the case of animal phobias. one might expect that within a tit\ population the prevalence of fear of lambs should approximate that of the fear of snakes. In practice, however. the fear of snakes is common and the fear of lambs is rare. Moreover. a genuine fear of snakes often is reported b! people who ha\,e had no contact with the reptiles. Consequently one is forced to conclude that a fear of snakes can be acquired in the absence of direct contact-and this opens three possibilities. Either the fear of snakes is innate or it can be tr~~nsn?itted indirectly. or the fear of snakes is ‘lurking’ and will appear with only slight provocation. The last two of these three possibilities are of course compatible. In their account of the concept of preparedness, Seligman and Hager concentrated on acquisition as the defining criterion for preparedness. For most of their argument. the terms p~~pcc&. ~~~?~~~~pu~~~~ and ~~/lf~up~~~~~zr~~~l are used rclativel> and are based on ease of ~~~qliisition. An association which is readily acquired is dciined as ‘prepared’
and one which is acquired with considerable difficult!, is ‘unprepared’. In addition. it is hypothesized that ‘phobias are highly prepared to be learned b> humans. and. like other highly prepared relationships the\, are selective and resistant to extinction. and probably are non-cognitive’, (Seligman, 1973. p. 4551. It is also suggested that most phobias are of biological significance. Seligman (p. 460) argued that ‘the great majorit> of phobias are about objects of natural importance to the survival of the species. It does not deny that other phobias are possible. it onl! claims that the! should be less frequent. since they are less prepared’. He goes on to sa\ that human phobias ‘are largely restricted to objects that have threatened survival. potential predators. unfamiliar places. and the dark’, (Seligman and Hager, 1972. p. 465). It is argued b!, Seligman and Hager that the laws of learning are influenced b! the preparedness of the association. So for example. extinction of prepared learning should proceed slowly. By contrast. unprepared connections should be subject to easier extinction (and of course, slower acquisition). The introduction of the concept of prcparedness into the study of fear has led to some new questions. For example. what is the relationship between preparedness and avoidance behaviour? When unprepared stimuli are turned to fear signals. is the consequent avoidance behaiiour weah and or transient’? In addition to learning theoretic interest. the concept of preparedness is of potential value for clinicians. For example, can clinicians predict outcome of therapy or make decisions about therapy of choice by knowing how prepared a given phobia is? Do prepared and unprepared phobias respond to different treatments: or hale different prognoses without treatment? As a first step in asking clinical questions related to preparedness. we present two unusual cases of unprepared or perhaps even contraprepared phobias. The first patient. Mrs. V. was admitted to hospital with a chronic and severe neurotic disorder in which the main features were compulsive rituals centred on a powerful fear of chocolate. She complained of and demonstrated extreme fear when confronted with chocolate or any object or place associated with chocolate. She avoided most brown objects; so for example, she would never agree to sit on any furniture that had brown in it. On one occasion she walked up eight flights of stairs rather than push the lift button because of the presence of a brown stain close to the button. She took great care to avoid any shops which might stock chocolate or any public places where chocolate might be eaten. As the fear grew over the years. she was forced to cease working and became increasingly confined. Before admission to hospital she was practically housebound. There was no denying the authenticity of her distress when presented with chocolate or the associated stimuli, and there was no doubt about the vigour of the avoidance behaviour evoked by such confrontation. Before going into the full history of the fear and possible significance, it is worth emphasizing the rarity of this complaint-neither the two authors nor any of their colleagues had ever reported encountering a chocolate phobic. It cannot be argued plausibly that this peculiar fear is of survival value or that it is common. According to the patient and the independent account given b! her husband. her psychiatric complaints began shortly after the death of her mother. to whom she was inordinatel! attached. After the death she was depressed for a prolonged period and also became aware of a strong aversion towards and probably fear of. cemeteries and funeral parlours. She first became aware of a slight distaste for chocolate several months after the death of her mother but it was nearly four years after this event that it became clear to her and her husband that she was actively avoiding chocolate and indeed had become extremel!, frightened of it. Prior to her mother’s death she had eaten chocolate with erljobment but this pleasure seemingly waned gradually in the period after her mother’s death. In passing we can mention that during the course of her otherwise largei] unsuccessful treatment. the patient regained the ability to touch and even to eat small pieces of chocolate. hzrt the pleasurable taste did not return. She continued to feel indifference or even slight dislike. This recalls the observation made b> Hallam and Rachman (1972) that some alcoholics reported a change in the taste of their drinks
336
S. RACHMAK and M. E. P.
SLLIGMAX
after undergoing a course of electrical aversion therapy. Most often they reported that their favourite drink had become somewhat insipid: some even claimed that the therapists were deliberately watering down the drinks. For present purposes. the most relevant characteristics of Mrs. V’s chocolate phobia were: its rarity, its gradual onset, the intensity of the fear and associated avoidance behaviour. the widespread generalization from chocolate to a large variety of brown objects. and as we shall see. its resistance to modification. The rarity. gradual acquisition and biological significance of this fear entitle us to describe it as being different from the common. recognised prepared phobias-as u~tprc~pcr~tl. If we allow that this fear of chocolate was different from the prepared type. we are in a position to answer the question about the ease of treatment (extinction’?) of an unprepared phobia and whether it is associated with weak or transient avoidance behaviour. In fact. Mrs. V responded only slightly to an intensive course of behavioural treatment that normally achieves a success rate of between 70 and 80”,,. She was given thirty treatment sessions of participant modelling. involving repeated exposures to the fear-provoking stimuli. and at the same time her ritualistic behaviour was subjected to response prevention. So in this case at least. the unprepared phobia was resistant to treatment. The avoidance behaviour associated with the phobia was enduring. estensive and pronounced-in the year prior to admission she had been able to leave her home only twice. Before we draw conclusions about the quantities of unprepared phobias on the basis of a single case, two reservations should be mentioned. In the first place Mrs. V ws comparatively inarticulate and provided a spotty history of the development of her phobia. This problem was mitigated by obtaining an independent account from her husband. Secondly, the therapist was able to construct or re-construct a possible relationship between her fear of chocolate and an earlier but persistent and strong fear of scenes connected with death. It is barely possible that the fear of chocolate had as its origin a strong emotional reaction to the death of her mother during which time she had been obliged to observe the coffin containing the body. The patient believes that this coffin was dark brown in colour and that it may have contributed to the association which she had between death and chocolate. Even more telling. she feels sure that she saw a bar of chocolate in the room containing the coffin. This sy,mbolic connection between death. the colour brown and chocolate might be based on too fanciful an interpretation but we did obtain confirmatory evidence of her fear of death scenes. During a behavioural avoidance test she displayed an inability to approach funeral parlours and considerable fear was aroused during the attempt. The second case of an unusual phobia was a young woman who was virtually blind from early infancy and complained of an excessive fear of vegetables and plants. particularly their leaves. The phobia had its origin in early childhood. Like the first patient. she expressed and displayed intense fear of the objects and engaged in extensiv,e and active avoidance. She attributed the genesis of the fear to a series of extremely unpleasant experiences which she had undergone as a child when attending a boarding school for children with defective vision. She claims that numbers of the other children taunted and teased her by rubbing vegetables and plants on her face in order to irritate her. In her view this gave rise to an intense dislike of vegetables and plants that later turned into fear. Her phobia handicapped her in a number of ways and prevented her from engaging in ordinary social activities. For example. she was unable to eat in public places or in unfamiliar homes in which vegetables or salads might be served. She took great care to avoid walking past certain areas where she knew she might encounter shops that stocked vegetables or plants, and so on. It should be remarked that this patient had two or more vivid and terrifying dreams each week in which vegetables or plants featured prominently. These dreams seemed to increase the severity of the phobia. Like the earlier patient. she made little progress in therapy despite concentrated and intensive efforts to help her. In all she received forty-eight hours of treatment time.
Unprepared
phobias
337
The main form of treatment used was systematic desensitization in riro. supplemented by modelling during which the therapist made approach movements to vegetables and plants while keeping her eyes tightly shut. The patient was also given counter-conditioning treatment in fantasy in the hope of reducing her fears and also teaching her coping mechanisms. While it was hoped that the imaginary counter-conditioning exercises might serve to reduce the fears, the patient was also given the specific suggestion that she should attempt to incorporate the coping fantasies into her terrifying nightmares. When. after a great deal of treatment. comparatively modest progress had been made. the patient complained about her slow progress. A switch to flooding treatment was contemplated but never implemented because of the intolerable anxiety provoked in a preliminary attempt. Both patients complained of excessive anxiety during in riro treatment sessions and both claimed that they were unable to comply with anything more than minimal therapeutic demands. Although both of them made some slight progress. when it became necessary for them to get closer to the phobic object. their compliance withered and then disappeared. In neither case was it possible to complete the planned treatment programme. If we restrict ourselves to a clinical interpretation of their respective failures to respond to treatment. it might be that the blind patient experienced intense fear precisely because of her visual handicap and the way in which it precluded her from gaining control over distressing stimulation. Her visual field was extremely limited and she relied largely on differentiations between light and shade. One of the consequences of this reliance was that she tended to interpret sudden changes in the pattern of light and shade as the occurrence of movement and indeed often expressed the idea that plants could move. If there is any substance in this interpretation, based mainly on her visual handicap, one might expect fears to be more common among blind people but we are unaware of any data on this subject. The chocolate phobic patient might have been unresponsive to treatment because of the putative symbolic significance of chocolate: there seemed to be a close connection for her between chocolate and the death of significant people in her life. Our reasons for suspecting that there was such a close connection between chocolate and death are four-fold. In the first place the patient gave inarticulate expression to this belief. Secondly, both the patient and her husband independently reported that there had been a bar of chocolate present in the room where the brown coffin had been placed. Thirdly, when subjected to direct behavioural tests she displayed an intense fear of funeral parlours. She firmly resisted any attempt to include these fears in the treatment programme on the grounds that they were far too upsetting for her to tolerate. Fourthly, she claimed that the unpleasant physical sensations produced by the introduction of the chocolate were identical to those she experienced during the behavioural avoidance test in which she was asked to approach funeral parlours. What we are left with then is a seeming conflict of evidence. On the one hand the two phobias can be regarded as unprepared. They are of a rare type, of no apparent biological significance and are unrelated to natural dangers. (Rarity of occurrence is here used as an index of unpreparedness on the grounds that rarity indicates low susceptibility to fear acquisition). On the other hand, Seligman hypothesizes that prepared learning-not unprepared learning-is very resistant to extinction, is non-cognitive and generalizes widely. So these two phobias have the defining features of unpreparedness (lack of biological significance. rarity, and probably gradual acquisition), but the empirical properties that are hypothesized to cohere with preparedness (resistance to extinction. irrationality and wide generalization), We can see three possible resolutions to the apparent conflict: (a) As we have already suggested, Mrs. V’s fear of chocolate might have become mixed with or even symbolic of death. Such symbolic transformation might well be a hallmark of unprepared phobias. The vegetable phobia does not lend itself to this sort of interpretation but instead we can point to the patient’s handicaps and the fact
338
S. RACHVAX and
M. E. P.
SELIGMAI
that she had been exposed to repeated and prolonged aversive stimulation--perhaps of a kind sufficient to turn an unprepared stimulus into a phobic one. (b) These cases ma> reflect a peculiar sampling problem. Unprepared fears are sureI> acquired in nature, but then. b! hypothesis the! should extinguish rapidl!. Verb few will be sufficiently se\‘ere or longlasting to turn up at a clinic. Those few people whose unprepared phobias last long enough and are severe enough to be seen in the clinic may be severe& disturbed people or ma\ ha\.e abnormal personalities. Individual differences in associated psychopathology might not be spread e\cnl> o\er the range of phobias: rather. those people who present unprepared phobias ma! bc unusually disturbed (with the judgement made on grounds independent from the phobia). Both of the patients described here had an unusuall! wide range of other problems: the Legetable phobic was suicidal. had pronounced sleep disturbances. a histor! of enuresis. somnambulism. and night terrors-occasionall\ displayed disordered thinking-and had problems of aggression and sexualit! in addition to the phobia. The chocolate phobic was hypochondriacal. abnormalI> dependent on her mother. sexuall! inadequate and chronicall! depressed. (cl While ease of acquisition and biological significance are inherent in the r/qfinirion of preparedness. extinction, generalization and irrationality are rarpirical h~~porhes~s proposed to covary with the defining features. The evidence for coherence between the defining features and the empirical characteristics of prepared learning come largely from the taste-aversion conditioning literature (see Seligman and Hager. 1973). So. Seligman’s analysis of preparedness and phobias may retain its value, but some of the hypothesized consequences of having an unprepared phobia ma>’ need reiision. In particular. it need not follow that comparativel!. unprepared phobias will necessaril> show eas! extinction and narrow generalization. With further evidence it ma> be possible to specif! the conditions in which unprepared phobias manifest broad generalization and,or high resistance to extinction. On the modest and sparse basis of the two cases described here. these conditions ma! include: (a) exceptionally strong or frequentI!-repeated learning experiences. (b) symbolic transformation of the content of a prepared phobia into that of an unusual and unprepared phobia. and (c) considerably disturbed personality. In conclusion. diGding phobic and obsessive cases into prepared and unprep~~red ma! produce a surprising clinical dividend. Even though not predicted b! theor?. unprepared phobias that reach the clinic may prove to be high11 intractable to the gamut of behaviour therap!. lvhereas behaviour therapy may well be the treatment of choice for prepared phobias. Patients with unprepared phobias ma> need broader rehabilitation programmes and a significantI> greater amount of therapeutic eltbrt. REFERENCES RKIc;\I.&xE.
(19341 An attempt to modif) the emotional attitudes of infants b! the conditioned response technique. J. gyner. Ps~d~;~/. 45, 169-iY6. ENGLISI~ H. B. (19291 Three cases of the ‘conditioned fear resuonse’. .I. ~~hrrowt. SOC. P\\~c~/tol. 24, ‘21 115.
