Stimulus Conditioned Autonomic Response Training (SCARS): Biofeedback-Assisted Automated Desensitization

In 1958, a psychiatrist by the name of Joseph Wolpe published a book entitled Psychotherapy by Reciprocal Inhibition – RIT, or Systematic Desensitization as it generally known – in which he described a learning-based, behaviourally-oriented deconditioning procedure, in contrast to Freud’s more established cognitively-oriented psychoanalytic psychotherapy. In essence, it involves teaching the client to relax and then, while relaxed, to approach the trigger stimulus (an event to which the subject responds with some negative emotion such as anxiety) in imagination at a rate slow enough for the client to be able to maintain the relaxation. Assuming that the event is not currently harmful, this results in the eventual pairing of relaxation with the event, which teaches the body/mind that its proper response to that kind of trigger stimulus is relaxation rather than arousal. That is, the client learns at a gut level that there is no need to get “all cranked up” about that kind of event. Hence, no more distress!

In 1962, Quirk visited the Green Valley School and Hospital in Florida for the first time and began a mutual consultative role with its superintendent, George von Hilsheimer, which lasted until Quirk’s death in 1997. Regarding RIT, Von Hilsheimer suggested to Quirk that he use galvanic skin response (GSR), a measure of physiological activity, to monitor the patient’s anxiety level which, in RIT, is measured in reported subjective units of distress; and Quirk found the GSR to be a reliable and valid method for monitoring the client’s level of distress.

Von Hilsheimer also suggested to Quirk that he replace the usual verbal hierarchy of stressors used in Wolpe’s RIT with picture slides of the stressor stimuli to be presented to his patients. Finally, he suggested that immobility be substituted for the relaxation instructions in RIT, and designed a light sensor that caused a signal to go off if the subject moved during a session.

In response to von Hilsheimer’s suggestions, Quirk created a library of slides ranging from innocuous to distressing in thirty or so potentially stressful categories, including those stressors which might be expected to be found in the schizophrenic patients that he was treating: lessened perceptual acuity, body image disturbances, disturbances of conceptual clarity, and ambiguity and uncertainty.

Slide change was contingent upon measured relaxation. That is, a new slide was presented to the patient/subject each time he/she showed a measured increase in relaxation as indicated by a change in skin resistance, essentially “rewarding” the patient for relaxing by being presented with a new stressor stimulus.

Outcome data following treatment with SCARS suggests that it may be a useful procedure to use with patients who do not do well with other forms of psychotherapy, including systematic desensitization. In addition, since it is an automated procedure, it is amenable to supervised use by those with relatively little psychotherapy training.