A FEAR SURVEY SCHEDULE FOR USE IN BEHAVIOUR THERAPY

A FEAR SURVEY SCHEDULE FOR BEHAVIOUR THERAPY USE IN JOSEPH WOLPE* and PETER J. LANG? (Received 8 Junuury 1964) BEHAVIOUR therapy (or conditioning therapy) is the use of techniques based on experimentally tested principles of learning to overcome persistent unadaptive habits. It has been mainly applied to the treatment of neuroses (Wolpe, 1958; Eysenck, 1960; Rachman, 1963), which, there is now good reason to believe, are persistent, unadaptive habits-most often autonomic habits of an anxiety response pattern. In all cases, it is a necessary preliminary to have a full picture of the stimulus antecedents of the neurotic reactions. While many such antecedents are easily discernible, and indeed may be brought forward by the patient among his presenting complaints, others may be quite obscure, recognized only after a great deal of questioning and observing the patient-and sometimes not even then. The idea of determining anxiety stimuli through an inventory was, it seems first put forward several years ago by Dixon, De Monchaux and Sandler (1957). The present instrument was directly suggested and partly derived from a Fear Survey Schedule (FSS-I).$ This FSS was developed to assess change in phobic behaviour and generalized anxiety in experimental studies of desensitization psychotherapy (Lang and Lazovik, 1963). A second experimental form (FSS-II) has since been constructed from the responses of a college population, and a factor analysis, as well as a study of the schedule’s relationship to several personality scales has been completed (Geer, 1963). The revised and extended schedule presented here has been designed for clinical use. It includes the most frequent neurotic anxiety stimuli that have been encountered in patients in the course of fifteen years of practice of behaviour therapy. It provides a clinical means of surveying a wide range of reasonably common sources of disturbed reactions in a very short time. It will be noted that, without exception, the stimulus situations forming the content of the inventory are situations to which it is unadaptive for a person to have anything more than mild anxiety (except perhaps under very special circumstances): and a persistent habit of responding with considerable anxiety in any such situation is by definition neurotic (Wolpe, 1954, 1958). After each item in the schedule shown here there is a letter in parenthesis which refers to a subclassification of the item-A for animal; T for tissue damage illness, death or associated stimuli; C for other classical phobias; S for social stimuli; N for noises; and M for miscellaneous. (These letters are not included in the forms given to patients.) Table 1 shows how the items are distributed into these subclasses. A few items really fit into more * Professor of Psychiatry, University of Virginia School of Medicine, Charlottesville, Virginia. t Associate Professor of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania. : Although scored differently, the original FSS instructions and items are part of an inventory constructed by Akutagawa (1956). 27 28 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA J. WOLPE and P. J.LANG than one subclass and arbitrary decisions about their placement have been made. However, the classification is given mainly to facilitate clinical use and is in no sense definitive. A formal, statistical analysis of the scale is planned. TABLE1. DISTRIBUTION OF CLASSESOF ANXIETY-EVOKING STIMULI IN THE INVENTORY Animal Social or interpersonal Tissue damage, illness and death, and their associations Noises Other classical phobias Miscellaneous Strange places, falling, failure, imaginary creatures, strange shapes, feeling angry, dull weather, making mistakes. 9 17 18 4 16 8 Though the schedule is of general use in behaviour therapy, irrespective of which of the many available techniques are employed, it is likely to be found most often relevant to systematic desensitization (the piecemeal deconditioning of thematically related neurotic habits, using imagined stimuli against a background of deep muscle relaxation (Wolpe, 1958, 1961)). It must again be stated (cf. Wolpe, 1963) that it is unsatisfactory for any therapy to be administered by persons untutored in its principles and untrained in its methods. Nevertheless, in the present lack of training facilities some therapists may feel justified in trying out the methods in some of their cases on the principle that half a loaf is better than no bread. But inventories and other aids are no substitute for the skill of the therapist. FEAR SURVEY SCHEDULE(FSS-III) The items in this questionnaire refer to things and experiences that may cause fear or other unpleasant feelings. Write the number of each item in the column that describes how much you are disturbed by it nowadays. Not at alJ 1. A little A fair amount Much Very much Noise of vacuum cleaners (N) 2. open wounds 0 3. 4. 5. 6. 7. 8. 9. 10. Beiig alone (C) Being in a strange place (M) Loud voices (N) Dead people 0 Speaking in public (S) crossing streets (C) People who seem insane (T) Falling zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA (M) Automobiles Q 12. Being teased (S) 11. 13. Dentists(T) 14. Thunder (C) 15. Sirens (N) 16. Failure (M) 17. Entering a room where other people are already seated (S) 18. High places on land (C) 19. People with deformities (T) 20. Worms (A) 21. Imaginary creatures (M) 22. Receiving injections (T) A FEAR SURVEY SCHEDULE FOR USE IN BEHAVIOUR THERAPY 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 5 I. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. Strangers (S) Bats (A) Journeys (C) u-Train h-Bus c--Car Feeling angry (M) People in authority (S) Flying insects (A) Seeing other people injected (T? Sudden noises (N) Dull weather (M) Crowds (S) Large open spaces (C) Cats (A) One person bullying another (T) Tough looking people (S) Birds (A) Sight of deep water (C) Being watched working (S) Dead animals Q Weapons (M) Dirt (C) Crawling insects (A) Sight of fighting (f) Ugly people (S) Fire (C) Sick people Q Dogs (A) Being criticized (S) Strange shapes (M) Being in an elevator (C) Witnessing surgical operations (T) Angry people W Mice (A) Blood Q u-Human b-Animal Parting from friends (S) Enclosed places (c) Prospect of a surgical operation (T) Feeling rejected by others (S) Airplanes (C) Medical odors Q Feeling disapproved of(S) Harmless snakes (A) Cemeteries (T) Being ignored (S) Darkness (C) Premature heart beats (missing a beal 0 0 (a) Nude men (S) (b) Nude women Lightning (C) Doctors (T) Making mistakes (M) Looking foolish (S) 29 30 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA J. W OLPE and P. J. LANG REFERENCES AKUTAGAWAD. (1956) A Study in Construct Validity of the Psychoanalytic Concept of Latent Anxiety and a Unpublished Ph. D. thesis, University of Pittsburgh. DIXON J. J., DE MONCHAUXC. and zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCB SANDLER J. (1957) Patterns of anxiety: the phobias Brit. J. med. Test of a Projection Psycho/. Distance Hypothesis. 30, 3440. EYSENCKH. J. (Ed.) (1960) Behavioar Therapy and the Neuroses. New York, Pergamon Press. GEER J. H. (1963) Personal communication. LANG P. J. and LAZOVIKA.D (1963) Experimental desensitization of a phobia. J. abnorm. (sot.) Psycho/. 66, 519-525. RACHMANS. (1963) An introduction to behaviour therapy. Behav. Res. Ther. 1, 3-15. WOLPEJ. (1954) Reciprocal inhibition as the main basis of psychotherapeuticeffects. Arch. Neural. Psychiat. 72.205-226. WOLPEJ. (1958) Psychotherapy by Reciprocal Inhibition. Stanford University Press, Stanford. WOLPE J. (1961) The systematic desensitization treatment of neurosis. J. nerv. ment. Dis. 132, 189-203. WOLPEJ. (1964) Behavior therapy in complex neurotic states. Brit. J. Psychiat. 110,28-34.