Key study : Chapman and DeLapp Flashcards
(15 cards)
what is the aim in the study by Delapp and Chapman
To investigate whether BII phobia could be successful treated using CBT and applied muscle tension
what is the sample in the study by Delapp and Chapman
-A 42 year old non-hispanic white male referred to as T.
-T was self referred after hearing about CBT on the internet for his intense fear of medical procedures e.g blood pressure cuffs and waiting rooms and he suffered vasovagal syncope during blood tests.
-T’s child had autism spectrum disorder and he felt a sense of guilt due to being unable to attend regular medical appointments with his child.
what is the research method in the study by Delapp and Chapman
it is a case study
Describe the events preceding T’s phobia in the study by Delapp and Chapman
As a child, T’s mother “jokingly” suggested on a number of occasions that he was susceptible to heart problems.
For example, T noted that his grandmother was
extremely anxious and that she continuously listened to an ambulance dispatch scanner that reported local emergencies throughout the day,
At the age of 10, he was the only individual physically present when his grandfather died of cancer
He witnessed his uncle die of cancer and his
aunt die of lupus on separate occasions
Describe the procedure
Several questionnaires were administered to T The Beck Anxiety Inventory (BAI) , The Beck Depression Inventory (BDI) etc and he successfully completed 9 sessions of manualized, cognitive behavioral therapy.
What questionnaires and interviews did T do
The Beck Anxiety Inventory (BAI
The Beck Depression Inventory (BDI)
Quality of Life Satisfaction Questionnaire (Q-LES-Q)
The Fear Survey Schedule II (FSS-II)
The Blood-Injection Symptom Scale (BISS)
what happened in session 1-3
Psychoeducation covering phobias, vasovagal syncope, the importance of self-monitoring using the PER,
cognitive restructuring, thinking errors and the graduated exposure, i.e. remaining in the feared situation until
new learning has taken place. T prioritised objects and situations for treatment from doctors/hospital (greatest
priority) through to airplanes (lowest priority).
Progress: Reading helped T to understand anxiety at the hairdressers earlier in the week. He had felt ‘panicky’
but remained in the situation and reflected on his thoughts until he felt calm.
what happened in session 4
Creating a ten-item fear hierarchy, each item rated from 0 to 100. The therapist explained that T would be asked
to rate his level of distress on the Subjective Units of Discomfort Scale (SUDS) (0-100) to monitor changes in
his anxiety.
Progress: T felt optimistic and had bought a blood pressure cuff and a heart rate monitor to prepare him for
phobic encounters.
What happened in session 5
T was asked to do item 1 from the fear hierarchy at home. The therapist explained and modelled applied tension
(AT) to reduce the risk of fainting while applying the tourniquet and looking at his vein.
Progress: T reported no phobic encounters yet but felt he was more aware of cues relating to potential fainting,
anxiety and fear.
What happened in session 6
T watched YouTube videos of people having blood tests (item 2 on hierarchy). SUDS increased from 30 to 35
minutes into the first video. He used AT as the blood was seen going into the tube. SUDS stayed at 35 and he
said it was ‘not bad’. SUDS dropped to 20 at the end of the first video. He said he felt ‘slight nausea but not a
big deal’. Further videos were shown with closer camera angles. T reported similar SUDS.
Progress: T experienced ‘immense success’ on item 1; SUDS was 40, but said, ‘it was fine’.
What happened in session 7
T pricked his finger to check for blood sugar and looked at his own blood. SUDS were 45 before the test,
dropping to 20, even without AT. T pricked two more fingers (SUDS=20) and said he was ‘about there’.
Progress: T’s wife checked his blood sugar three times using the finger-prick test. SUDS was 45; he used AT
twice but managed the third test without. He looked at his blood for five minutes.
What happened in session 8
T and his therapist observed people giving blood at a ‘blood bank’ (a centre where people donate blood)
(SUDS=65 before the procedure, dropping to 45 within five minutes and 30 within ten minutes). He did not use
AT and did not feel faint. He watched a second person give blood and said his SUDS score was 0. He agreed to
go for his own blood test in the coming week.
Progress: T said he would make an appointment for his own blood test.
What happened in session 9
T took his own blood pressure (SUDS=55, dropping to 20). When he took it again, his SUDS remained at 20. He
said he would make an appointment for a blood pressure test in the week and telephone the therapist if he
needed an additional session.
Progress: T’s blood test went well; he only used AT at the start. SUDS=40, quickly dropping to 0. SUDS peaked
at 25 in a second test on his other arm.
what are the results
Following his ninth session, T took his own blood pressure
at a drug store (pharmacy). He had his blood pressure
taken by a nurse and was examined by a doctor. He did not
need to use AT and described his SUDS as ‘rather low’. He
said he had ‘never felt better in my life’ and did not need
any more treatment sessions.
Follow-up
Four months later, T thanked the therapist and had several
doctor’s appointments booked. Ten months later, he was
still doing well and 12 months post-treatment he completed
follow-up questionnaires, to allow comparisons to be made
between his baseline and follow-up scores
conclusion
Psychoeducation, objective recording, cognitive restructuring and graduated exposure were highly effective when
combined with applied tension in the treatment of a man with a severe BII phobia.
