After you read the following case study you will be asked a series of questions about it based on the Systematic Desensitization: Theory section of this tutorial. It is assumed that you have a basic understanding of classical conditioning. If not, then you are encouraged to first complete the classical conditioning tutorial.
Following the birth of her son, Jill suffered from prolonged diarrhea as a consequence of post-partum enemas. Her control improved before she left the hospital, but worsened when she returned home. She shared the restroom with 12 others persons in her apartment building, and as a result of prolonged waiting, experienced many accidents. Worse yet, she had several distressing accidents in public places such as grocery stores and dining rooms. People looked at her in disgust, and she felt extremely embarrassed and anxious. Consequently, the slightest sensation of having to go to the restroom resulted in severe anticipatory attacks. Over a 22 year period she consulted various medical and mental health professionals, with little to no relief. She had to restrict herself to situations in which she could be within 15 seconds of an available restroom, and had resigned herself to living this way for the rest of her life.
Jill had recently heard about a new form of therapy and figured she had nothing to lose by giving it a try. As part of Jill's new therapy, she was taught deep muscle relaxation for several sessions. Her therapist also encouraged Jill to practice this procedure daily at home. In addition, Jill and her therapist constructed several "hierarchies" related to her fears. Each hierarchy contained a list of situations that Jill dreaded, centered on a specific theme. One theme was proximity to the restroom (see the Table below). The situations were "hierarchical" in the sense that they were rank ordered in accordance with a score (between 0 and 100) assigned by Jill to each one based on its fear-provoking potential for her.
|1. Restroom not visible; 30 miles away||100|
|2. Restroom not visible; 20 miles away||90|
|3. Restroom not visible; 10 miles away||80|
|4. Restroom not visible; 1 mile away||70|
|5. Restroom not visible; 1000 feet away||60|
|6. Restroom not visible; 500 feet away||50|
|7. Restroom not visible; 100 feet away||40|
|8. Restroom visible; 100 feet away||30|
|9. Restroom not visible; 30 feet away||20|
|10. Restroom visible; 30 feet away||10|
While relaxed, Jill's therapist asked her to imagine one of the situations on the hierarchy, after which he repeated the instructions to relax. They started with the bottommost item (i.e., the one that elicited the least fear) and gradually worked their way upwards. Jill was asked to imagine the next situation on the hierarchy only after she was able to remain calm while imagining the current one (which typically required several presentations). Eventually Jill could imagine being 30 miles away from the closest restroom and feel no anxiety whatsoever.
By the 8th session Jill had achieved complete bowel control and her family life improved. She became increasingly involved in community affairs. At a 2-year follow-up she had regular once a day bowel movements and could hold off going for hours if a restroom was not accessible. Jill reported: "I feel like a bird that has been let out of a cage."
Related Source: Hedberg (1973)