Clin. Psychol. Psychother. - PDF document

Clin. Psychol. Psychother. Published online in Wiley InterScience (www.interscience.wiley.com).Copyright © 2006 John Wiley &Sons, Ltd.Department of Psychology, University of Arizona, USAeliminate anxiety, using fear of public speaking as a test case. Theand emotions. Arandom half of the subjects received treatmentfour weeks later. After having engaged in an actual public speakingexperience, subjectsself-reported ratings showed signi“cant reduc-tions in fearfulness, physical sensations and cognitive dif“cultiespropose that it holds promise as an intervention that might be effec-tive in treating many other disorders.Copyright © 2006 John Wiley Correspondence to: Morty Lefkoe, The Lefkoe Institute, 180Forrest Avenue, Fanfax, CA94930, USA.www.lefkoeinstitute.com Several surveys indicate that Americans rankspeaking in public as their number one fear(Bruskin Associates, 1973; Motley, 1988; Richmond& McCroskey, 1995). This fear can be socially debil-itating, and is often cited as a primary reason whysomeone is unable to advance in his or her career.Fear of public speaking may be related to a moregeneral social anxiety, but it is not coterminousotherwise normal social relationships. Differenttherapeutic approaches have been developed tohelp people overcome or deal with such fears aspublic speaking. One such approach is The LefkoeThe Lefkoe Method, developed by the secondauthor, aims to eliminate, quickly, long-held beliefsand de-condition the stimuli that produce fearing in public. Lefkoe has discovered that the fearci“c beliefs, such as Mistakes and failure are badand If I make a mistake, Ill be rejected and (b)conditioning, such as automatically experiencingfear whenever one is, or perceives oneself to be, ina position to be criticized or judged. Two processesin TLM, the Lefkoe Belief Process and the LefkoeStimulus Process, are used to address fear of publicMany, if not most, psychologists contend thatonly after extensive time, effort, and speci“cetraining. TLM challenges that assumption andcontends that even beliefs formed early in child-minutes. The basis for this claim is thousands ofas true is no longer experienced as true and thatthe behavior and emotions that result from thebelief are permanently eliminated. Moreover, TLMcontends that emotions that result from condi- Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. accomplished in a matter of minutes. Those areTLM, we have elected to test it in clinical settingsrather than a laboratory. This article reports on theesults of applying TLM to the reduction of fearTLM, despite its fairly lengthy history, is notbe shown to be effective in terms of scienti“c evi-be delivered even without face-to-face contact forAlthough the Lefkoe Belief Process (LBP) isapproaches (CT), there are many unique aspectsthat distinguish it from other such approaches.beliefs by challenging the validity of the evidencethat the client uses to support them. With LBPnoattempt is made to get clients to see that a currentbelief is wrong or not true, to see it as illogical, toaccept that it does not make sense, or to reject it asself-defeating. The LBPactually validates peoplethem to realize that most people probably wouldhave made a similar interpretation under similarcircumstances. It ensures that people realize thattheir belief actually is one valid meaning of theirearlier circumstances.The evidence that people offer for a beliefusually is not the actual reason they believe it. Theevidence offered usually consists of recent obser-eal source of ones beliefs, the LBPassumes, isinterpretations of circumstances earlier in life. Fundamental beliefs about ones self and life areusually formed in childhood. After a belief hasbeen formed, however, one acts consistently withit, thereby producing current evidence for thealready-existing belief. In other words, lifebecomes a self-ful“lling prophecy. Because the evi-dence one presents to validate ones beliefs usuallyis a consequence of the beliefs, not its source, chal-effective way to eliminate them.third element that distinguishes LBPfromclient to agree to act consistently with an alterna-tive belief to test its possible validity. Because thecurrent belief is totally eliminated by doing theLBP, one has no need to try to act differently changes naturally and effortlessly once the belief isStill another distinction between the LBPandmany cognitive approaches is that the latter fre-quently are a tool for the client, whereas the formeris a tool for the facilitator. Cognitive approachesassist clients to think more rationally in order to actmore rationally in the face of strong emotions suchas fear, anger, depression, hostility etc. The LBPising the beliefs that produce such emotions. Whenthese emotions stop after the beliefs that give riseto them are eliminated, there is no longer a needfor a tool for clients to deal with them more effectively.Finally, the Lefkoe Stimulus Process facilitateswhich has nothing to do with beliefs. In order toextinguish the conditioned stimuli that havebecome associated with fear, such as facing criti-ejected. The point of this process is to assist theperson to realize that initially the current stimulusnever produced the emotion. The current stimulusgot conditioned to produce the negative emotioneal original cause in some way.Potential effectiveness of the Lefkoe MethodThe Lefkoe Method has not previously been sub-jected to rigorous investigation, although there iseason to believe that it might well be effective intreating a wide range of problems. In 1994 TheLefkoe Institute, in collaboration with Sechrest,conducted a study involving 16 incarceratedThe study indicated fairly strongly that using TLM,speci“cally the Lefkoe Belief Process, to eliminatesuch beliefs as Im bad, Theres something wrongwith me, I dont matter and What makes meokay is the power that comes from a gunimproved the self-esteem and reduced the hostilitybecause of the small sample, the study, although”ecting statistically signi“cant effects, was neverpublished; the effect was actually fairly large. Thestudy did, however, provide impetus for Lefkoe to Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. vention. He and his associates have by now treatedover 2000 people with a wide range of problems,and results as he has seen them have been consis-number of other clinicians in the use of his method,and they, too, have, in aggregate, treated, success-fully, a very large number of persons. The experi-ences of these clinicians constitute a strong basisfor more systematic testing of the effectiveness ofthe Lefkoe approach.An increasing number of case studies and anecdotal reports provide evidence that TLM hasbeen effective in resolving a wide variety of seriouspsychological issues, including anxiety, drug andalcohol addition, ADD, bulimia, phobias, theinability to leave abusive relationships, anger, hos-does is ever good enough, procrastination and theinability to express feelings. Whether the anecdo-tal reports of the effectiveness of TLM with theabove-mentioned psychological issues can beeplicated in controlled scienti“c studies remainsThe signi“cant results obtained in the 1994 study,coupled with the plentiful observational evidencesupporting the proposition that TLM might well beboth ef“cient and effective in treating a range of at least mild to moderately severe disorders,prompted us to conduct the present study. Insearching about for a test bed for TLM, we hit uponing. This problem is, apparently, not uncommon, itis often at least moderately severe, and manypeople who experience it are highly motivated toget rid of it. Moreover, Toastmasters clubs andsimilar groups provide a good entry to the recruit-ment of persons interested in treatment.number of studies designed to determine the reli-Forty volunteers were recruited primarily throughoastmaster groups located near a large metropol-itan Western city and were assigned randomly toeither the immediate or wait-list comparison con-dition. Three persons dropped out of the immedi-ate treatment group and one from the wait-listgroup before beginning treatment or after onesession, so that the “nal sample size was 36. To beeligible for the study, participants had to report atby a self-rating of 5 or greater on a 10-point Likertscale ranging from 1 (extremely fearfulacknowledge that their fear related only to cir-broader areas of their life, have access to a tele-ticipate in the study, and be ”uent in English.men comprised 53% of the sample. The meaning in public.Eligible participants were randomly assigned toTLM or a yoked wait-list control group (WL); i.e.,subjects were paired at time of assignment. Figuretionnaire administration.ait-list control design was chosen because thethe reduction in fear associated with speaking inpublic. This endpoint entailed waiting until afterTLM subjects completed treatment and had anlowing their public speaking experience, TLM subjects completed posttest questionnaires andyoked WLsubject could be instructed to completeposttest measures. WLsubjects received treatmentset of the same posttest questionnaires immedi-ately following their “rst public speaking experi- GroupTimeline of activities TLMPretest Treatment 1st public speaking Posttest — — — WLPretest — — Posttest Treatment 1st public speaking Posttest Figure 1.Study design and timeline of activities Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. ence. Both TLM and WLsubjects attended theirgroups had the opportunity to speak there duringthe course of the study.ProcedureSubjects were recruited primarily throughvia emails sent to club members. After the studycoordinator received a signed consent form andcompleted baseline measures, subjects were ran-domly assigned to either the TLM or WLgroup.Subjects in the TLM group then scheduled a seriesof phone calls to receive as many individual treat-the fear. The range was from two to “ve sessions,with a mean of 3.3. About half of the 2000 clientswho have been treated with TLM receive help overthe telephone, and the reported results are alwaysas effective as the in-person sessions (M. Lefkoe,personal communication, 25 March 2004). Theusing TLM to assist clients to get rid of a wideincluding the fear of speaking in public. The treat-ment consists of one-hour sessions and is deliveredaccording to structured treatment protocols devel-oped by Mr. Lefkoe.TLM consists of a number of processes, two ofwhich were used in this study: the Lefkoe BeliefProcess, which is used to eliminate beliefs, and theLefkoe Stimulus Process, which is used to de-Description of the Lefkoe Belief ProcessThe LBPbegins with the client describing an unde-sirable or dysfunctional pattern of behavior or feel-ings that she has been trying unsuccessfully tochange. Feeling patterns could include fear, hostil-ity, shyness, anxiety, depression or worrying aboutcould include phobias, relationships that neverseem to work, violence, procrastination, unwill-ingness to confront people, an inability to expressfeelings, sexual dysfunction or anti-social behavior.Once the client has identi“ed her undesirablewith a multitude of reasons. Aclients story,interpretations, and analysis are not at all relevantin the LBP. This step is designed to elicit one ormore beliefs (that she probably was not consciousof before the LBPbegan) that logically would man-ifest as her undesirable pattern.even thinks about having to give a presentation infront of a group, probably has the following beliefs:mistakes and failure are bad; if I make a mistakeIll be rejected; people arent interested in what Iof me; change is dif“cult; public speaking is inher-ently scary. In other words, the theory is that thebeliefs (and sometimes additional conditioning)Once a belief is identi“ed, the client is asked tosay the words of the belief out loud to con“rm thatated with the statement or a sense that the wordsthemselves are true.circumstances or events that led her to form theare usually formed before the age of six (Briggs,1970). For the most part they are based on interac-tions with ones parents and other primary care-takers, if any. Beliefs in other areas of life, such aswork and society, are formed at the time thoseareas of life are encountered. Undesirable Behavioralor Emotional Pattern Identify SupportingBeliefs* Process If pattern is a result of conditioning *Belief: The meaning given to a pattern of meaningless events, which then becomes a description of reality one thinks is ‘the’ truth. Figure 2.When the LBPand LBPare used Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. Although the client can usually identify the rele-she spends as much as half an hour recallingvarious events from her childhood. At some pointwith over 2000 clients indicates that beliefs rarelyare formed based on only one or two events.Usually a great many similar events are required,unless a really traumatic event occurred.example, the source might be a childhood in whichgood enough for him. She never received anyThe next step is to have the client realize that thecurrent belief was, in fact, a reasonable interpreta-tion of her childhood circumstances and that mostchildren probably would have reached a similarconclusion, given their experience and knowledgeat that time in their life. Ones beliefs are almostalways a reasonable explanation for the events oneclient is never told that her beliefs are irrational orwrong.This is one of the differences between LBPandCT, where a client is told that her beliefs are irra-tional and wrong, and shown why.interpretations of, or meanings for, the sameearlier circumstances, which she had not thought ofat the time. In other words, the client as a childclient is asked to do is make upadditionalmean-ings or interpretations of her fathers behavior.(In CT clients are often asked to create or areshown other ways to interpret events in the presentthat they currently feel bad about. This is taught asthey happen and to calm fears and anxieties beforestressful events. In the LBPthis technique is usedas part of a process to eliminate a belief, so that theclient leaves the therapists of“ce.)continue the illustration weve been using,other reasonable interpretations of her fathersbehavior and comments could include the he was wrong.when I grow up.was not good enough by my fathers stan-dards, but I might be by the standards of others.that way with everyone, whether they wereMy fathers behavior with me had nothing to doa function of my fathers beliefs from his child-My fathers behavior with me had nothing to doa function of his parenting style.Each of these statements is as reasonable ameaning for her fathers behavior as the one shecame up with as a child. The point here is not toconvince the client that her belief is unreasonableor that any of the other interpretations are moreaccurate; it is for her to realize that there are manydifferentconsistent with the events she experienced.Further, notice that not all of these interpreta-tions are positive. They are not designed to makethe client feel better. Their only purpose is to helpthe client realize that her interpretations are atruth, one of many possible interpretations, andnot the truth, the only interpretation. This isanother difference between the LBPand CBT.Next the client is asked if, when she formed thebelief as a child, it seemed as if she could see in theif we discovered or viewed our beliefs in theclient that every time her father criticized her orfailed to praise something she was proud of, sheusually are so certain that their belief was out inthe world to be seen that they frequently say, Ifyou were there in my house, you would have seenhas given the events seem to be inherent in thein the events.The client is then asked Is it clear, right now, thatsaw the belief in the world?.In other words, you want the client to realize thatshe never did see that . All sheeally saw was her fathers statements and behav-was only one interpreta- Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. After the client realizes that she never really didsee her belief in the world, she is asked If youin the world, whereIn my mind.The client then realizes that the events of herthe time, had no inherent meaning. The events hadmany possible meanings, but no real meaningbefore the client assigned the events a meaning.When a client recognizes that something she hasheld as a belief (truth) is, in fact, only one ofoccurred (truth), and when she realizes that shenever saw the belief in the world, it ceases to existas a belief. It literally disappears. Abelief is a state-ment about reality that we think is truth. Whenit is transformed into truth, it is no longer a beliefpatterns in a clients life.The LBPmakes the following assumptions: Anmeaningless events, after which one seems to seeevents. It usually is dif“cult to eliminate a beliefbecause the individual thinks she has seen it in theIn other words, if you can point to it, it is true. It isvery dif“cult to use logic or any other technique toit in the world. On the other hand, if an individualis able to revisit the events and realize that sheher mind, that had she come up with a differentcurrent belief„the belief will be eliminated.The difference between TLM and Insight Thera-pies should be clear from this description of TLM.Insight Therapies assume that a persons behavior,thoughts and emotions become disordered as aesult of the individuals lack of understanding asto what motivates him or her. The LBPpostulatesthat merely understanding that beliefs cause acause a given pattern, will not affect the pattern.The client needs to eliminate all of the beliefs thatMoreover, mere understanding of the source of abelief is not suf“cient to eliminate it. The client alsomust recognize that she never saw it in the worldbelief have no inherent meaning.Finally, with the LBPit is not necessary to see theconnection between the undesirable behavioral orbeliefs that cause it. In other words, insight into the appropriate beliefs are eliminated.Description of the Lefkoe Stimulus Processtheir lives on a recurring basis, such as fear, anger,sadness, guilt and anxiety. People experience thesefeelings every time speci“c events or circum-stances occur, such as fear whenever they make amistake or someone rejects them, or anger when-ever they are asked to do something. In many casesthe events that stimulate the feeling in some peopledo not produce the same feeling in others, and viceversa. Why does an event that is not inherentlyfearful produce fear in some people and not inproduce emotions in the present.Consider a client who experiences fear wheneverhe is judged or evaluated. This is not inherentlyfearful. When did he “rst experience fear associ-ated with being judged or evaluated? Assume theoriginal source of the fear was a father who wasnever satis“ed with what the client did as a childand who showed his displeasure by yelling andthreatening. No matter what the child did, theWhen the client reviews the cause of the fear, hediscovers that what really caused the fear was thehe unconsciously attributed to how hisfather judged and evaluated him, namely, withlove, no care; no care, no survivalthe fear. The fear was never caused merely byThe client realizes that had he had been judgedstanding and supportive way there would havebeen no fear. It was meaning he gave his fathers behaviorfear; namely, the yelling and punishment meant hisThe point of the Lefkoe Stimulus Process is toassist the client to realize that initially the currentstimulus never produced the emotion. It was only Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. produced by the meaning he gave to the originalcause; the current stimuli just happened to be asso-The Lefkoe Stimulus Process works by helpingclients to realize that initially being judged or eval-uated never produced fear. The original cause ofthat accompanied the request), by someone whosesurvival he depended on (his father). He associatedwhich ultimately he experienced as a threat to hissurvival. When the association is broken, whenthe client realizes that he made this arbitrary asso-judged or evaluated) no longer cause fear.Joseph LeDoux (1996), a professor at the Centerfor Neural Science at New York University, pointsout Extinction [of a conditioned stimulus] appearsto involve the cortical [our thinking brain] regula-egula-]....This is precisely what the Lefkoe Stimulus ProcessNotice the parallel between how the Lefkoe Stim-ulus Process works and how the Lefkoe BeliefProcess works: When a client makes a distinctionbetween the events that were the source of a beliefassociated elements, the emotion will no longer beproduced by those elements.Outcome MeasuresQuestionnaires were emailed to research subjects.All data were collected by email or fax. Because themajor problem being reported by the subjects wasthe experience of anxiety, that construct was thefocus of our attempts to determine the effective-ness of the treatment. Other aspects of theproblem include uncomfortable and unpleasantphysical sensation, which we also measured. Wealso included one measure from an establishedesearch tradition as a way of anchoring our “nd-ings to show that they are congruent with those ofSubjects rated their last public speaking experi-ence with “ve single-item measures including howfelt. Items were scored on a 10-point scale fromranging from1 (not at allextremelysensations commonly reported as intrusive whilespeaking in public. Items were rated on a four-point scale ranging from 0 (severely bothersome). Subjects were instructed tofer to their last public speaking experience whencompleting the items. Ratings are summed to gen-erate a total score with a potential range from 0 to36. Cronbachs alpha for the pretest on this studyCon“dence as a speaker was measured using thePaul, 1966). The PRCS is a 30-item self-reportmeasure that assesses affective and behavioral reac-tions to public speaking situations. The items areanswered in true…false format; half are keyed trueand half are keyed false to control for acquiescentsponding. Respondents were instructed to con-sider each item as it related to their most recentpublic speaking experience. Scores have a possiblerange from a low of 0 to a high of 30: the higher thescore, the greater the degree of anxiety. Cronbachsalpha was 0.80 for the pretest on the study sample.assess differences for between- and within-group treatment effects, we used a series of one-waymeasures. The primary outcome measure was thepublic speaking experience. Secondary outcomemeasures included ratings of how satis“ed, relaxed,anxious, and con“dent the subject felt during his orher last public speaking experience, level of con“-dence as a speaker measured by the PRCS, andbothersome sensations measured by the SUBSS.Three TLM and one WLsubject terminated thestudy after the “rst session. Obviously, the numberof cases was very small, but attrition from thedescriptive variables or pretest data. Reasons givenfor terminating were insuf“cient time and disap-anxiety.RESULTSMeans and standard deviations for all measures ateach assessment period are presented in Table 1. Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. Because of the somewhat exploratory nature of thisstudy, we report data separately for each measure,The data reported in Table 1 are remarkably con-sistent across measures, including the PRCS, ameasure well established in the literature. Particu-group did not change at all on any measure untiltreatment, after which their scores were closelyequivalent to those of persons in the initial treat-ment group. Thus, the change cannot be attributedto effects of retesting. First, there were no signi“-cant differences between groups on any measure atpretest. Second, scores in the TLM group at posttestwere dramatically different from WLposttestscores. Third, after they received treatment, sub-jects in the WLgroup had scores that were not dif-ferent from those at posttest for the TLM group.Figure 3 is a graphic display of average results forall outcome measures. The “gure shows quite wellthe change occurring in each group when treat-ment takes place and the apparent magnitude ofthe treatment effect, which seems quite large. Justto illustrate, across the 12 items in the SUBBS, atpretest subjects would have been reporting pat-terns of response something likesix moretwo moreAfter treatment, the patterns would have beenmore likeratings of 1 on three itemsBetween-Group Effects at Posttestable 2 presents between-group effects. Resultswere large differences on all outcome variableswhen comparing TLM and WLposttest scores. Bycontrast, comparisons of TLM posttest scores withscores for the WLgroup after having received treat-) were very small and associatedwith uniformly small and non-signi“cant able 1.Means and standard deviations for pretest and posttest measures MeasureTLM group (17)WLgroup (PretestPosttestPretestPosttestPosttest Fear6.65 (1.32)1.38 (0.50)6.53 (1.71)6.95 (1.61)1.53 (0.51)Anxiety7.24 (1.75)1.69 (0.48)6.89 (1.63)7.32 (0.67)1.89 (0.87)Satisfaction4.81 (2.31)8.63 (1.09)4.42 (1.98)4.11 (2.23)7.89 (2.16)Con“dence4.18 (1.51)8.81 (0.75)4.26 (1.76)4.37 (1.86)8.16 (1.89)Relaxed3.65 (1.80)8.88 (0.81)3.42 (1.54)3.74 (1.63)8.05 (2.27)PRCS19.88 (4.59)4.50 (3.10)18.79 (5.09)20.11 (4.16)5.32 (4.78)SUBSS17.18 (4.54)2.65 (1.66)16.68 (5.95)15.16 (6.82)2.11 (2.47) The Lefkoe Method group; WLwait-list control group; PosttestWLscores after receiving treatment; PRCS pretest Outcome Variable TLM WLposttest Figure 3.Mean ratings before (pretest) and after(posttest) treatment Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. On average, subjects in both groups receivedthree sessions (0.62). Only threesubjects in the WLgroup required a “fth session.ithin-Group Effects from Pretest to PosttestAnalysis of within-group changes from pretest tothe “rst posttest showed signi“cant treatmenteffects for all outcome measures in the TLM groupand no such changes in the WLgroup (see Table 3).Across all outcome measures, after WLsubjectseceived treatment, their scores were negligiblydifferent from those in the TLM group.assess the magnitude of the treatment effect,we calculated Cohens we calculated Cohens (postŠMprepre(1988). Because the pretest and posttreatmentvalues in the TLM and WLgroups were not sig-ni“cantly different from one another, we pooledtheir data. All effect size estimates were substantial2.97, SUBSS Subjects were asked to rate how helpful the ses-sions were for them in reducing or eliminatingextremely helpful. Ninety-four percent of thesample rated the treatment as 7 or higher.The large, positive changes on all outcome mea-sures subsequent to treatment give strong supportto the claim of ef“cacy of the TLM for reducing fearwait-listed subjects adds to the robustness of theevidence of TLMs ef“cacy. The TLM resulted insubstantial decreases or complete eliminations offear, accompanied by positive changes in con“-dence and reduced negative sensations felt duringspeaking in public, in both groups. Overall, theTLM appears to have potential as an effective,quick, and convenient procedure to eliminate thefear of speaking in public.It is true that the measures we used all involveself-report, but, as noted earlier, the complaint withwhich people began was self-report. Moreover, wedo not think that measures such as observationshave been dif“cult to arrange in a way that wouldproduce reliable “ndings. Some people with highlevels of anxiety are able to cover it up very well,”ustered if they have not prepared well. Thus, forintervention is effective in eliminating a subjectsexperience of anxiety, asking the subject to rate hislevel of fear (and his related physical symptoms)both before and after the intervention is the bestoption to reliably determine whether or not theBecause the treatment group was tested aftergiving a speech and the control group was not, itmight be argued that the active treatment ingredi-ent is the exposure to public speaking, rather thanTLM, given the substantial evidence of the effec-tiveness of exposure methods for social anxiety.There are two answers to this argument. First, sub-able 2.Between-group effects (-values) for posttest measuresMeasureTLM vs. WLTLM vs. WL PosttestPosttest FpFpFear175.550.0010.770.39Anxiety786.620.0010.710.40Satisfaction54.450.0011.500.23Con“dence79.890.0011.690.56Relaxed131.750.0011.890.18PRCS153.140.0010.340.56SUBSS54.230.0010.580.45 The Lefkoe Method group; WLwait-list control group;WLscores after receiving treatment; PRCS subjective units ofknow that results could have been summarized by a singlescore and a single test, but we present the results in this way,with a series of univariate tests, to show the remarkable consis- able 3.Within-group effects (-values) for pretest to posttreatment in TLM and WLgroupsMeasureTLMWLWLPretest vs. Pretest vs.Pretest vs. posttestposttestposttest Fear224.510.6134.19Anxiety149.811.08138.85Satisfaction35.530.2126.72Con“dence122.290.0343.16Relaxed113.310.3854.11PRCS125.490.7670.61SUBSS153.380.5497.19 -values are non-signi“cant.WLscores after receiving treatment. Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. jects from both groups had spoken many timesprior to the study without any signi“cant reduc-tion in the fear. In fact, Toastmaster membershipequires regular speaking. Second, to the extentdesensitization works, it requires repeated expo-sure, not one. It would make little sense to claimthat subjects who spoke regularly at Toastmastermeetings who reported a fear level with a mean ofalmost 7 reduced the fear to a mean of 1.5 merely want to argue at this point that TLM is a pro-method, a direct applicationof psychological constructs and principles to theeffecting of behavioral change (Sechrest & Smith,1994). The method is centered on the concept ofgeneral, and, we think, to a very great extent,be true as a result of their prior experiences andmental processing of them. If people believe thatanother person is liable to harm them, they willwant to stay away from that person. If peopleegard some situation as fearsome and they believethemselves to be incapable of mastering their fear,helping people recognize and eliminate beliefsare no longer relevant to the problems that facethem today.TLM has a good bit in common with CBT, RETpeutic intervention, but it is not simply a reformu-eliminating beliefs, rather than learning to copeits claim that the problems resulting from thosebeliefs can be eliminated entirely, not just reducedby some degree. The appropriate outcome test forTLM is a category change (from having a problemto not having any problem) rather than a reductionin the mean value of the problem. This is a boldclaim, and it remains to be seen whether it can be upheld for a wide range of problems. Thepresent results are certainly suggestive of the pos-of convenience in completing an initial test of TLM,not out of any particular interest in providing atreatment for public speaking problems . Webelieve that the results of this study should beinterpreted as demonstrating that TLM may be auseful intervention for dealing with mental andbehavioral disorders that are to some extent Our plans for the immediate future are topossible to recruit a number of therapists trainedin TLM who will agree to participate in random-ized trials to assess the usefulness of TLM in treating a range of problems common in clinicalsettings. The aim is to make TLM generally avail-charging their professional responsibilities.do need, obviously, to determine how longthe effects of TLM are sustained. Six-month follow-up questionnaires available currently for 23 of the37 subjects indicate that the TLM approach has along-sustained effect for our primary variable ofinterest, the experience of fear while speaking inpublic. Ratings based on 23 returned question-naires range from 1 to 4 with a mean of 1.9 1.0), values that are not different from thoseThe impressions of clinicians who have usedTLM are that the effects are quite durable.that the intervention reported on here was conducted entirely by telephone; the facilitator,Although participants were all residents of westcoast communities, mostly in the Bay area, thatwas solely because they were recruited from publicspeaking clubs identi“ed by Lefkoe. In principle,the intervention could have been delivered any-where in the English-speaking world. It is alsobrief. These characteristics of TLM, for the kinds ofproblems exempli“ed by fear of public speaking,indicate that the intervention should be highly cost effective and that it could be made widelydependency on self-report data. However, we “ndthe consistent response patterns of subjects in both groups to be compelling enough to rule outdemand characteristics often associated with self-eport data. At the very least, we think these resultsprovide a strong basis for recommending furtherrigorous testing of TLM.Beck, M.D., & Aaron, T. (1976). . New York: Penguin.Briggs, D. (1970). Your childs self-esteem. Garden City,NY: Doubleday. Copyright © 2006 John Wiley &Sons, Ltd.Clin. Psychol. Psychother. Bruskin Associates. (1973). What are Americans afraidCampbell, D.T. (1963). Social attitudes and otheracquired behavioral dispositions. In S. Koch (Ed.), chology: Vol. 6, AStudy of a ScienceLeDoux, J. (1996). The emotional brain. New York: Simonand Schuster.Re-create your life: Transforming yourselfand your world with the DecisionMakerprocessCity, KS: Andrews and McMeel.dif“cult. inate fundamental beliefs quickly and permanently.Are you sure? , May, 54…60.Motley, M.T. (1988). Taking the terror out of talk: Think-ing in terms of communication rather than perfor-mance helps us calm our biggest fear. Psychology Today. Stanford, CA: Stanford University Press.Richmond, V.P., & McCroskey, J.C. (1995). tion: Apprehension, avoidance, and effectivenessScottsdale, AZ: Gorsuch Scarisbrick.Sechrest, L., & Smith, B.H. (1994). Psychotherapy is thepractice of psychology.