Biofeedback and reinforcement to increase heterosexual arousal in homosexuals

Abstract Relatively few procedures exist for developing heterosexual arousal in the treatment of sexual deviation (Barlow, 1973) although several recent studies suggest this is a necessary component of treatment (Feldman and MacCulloch, 1971; Bancroft, 1970; Barlow, 1974). In recent years, biofeedback techniques have been applied to many types of disorders (Blanchard and Young, 1974). Basic to biofeedback technology is the notion that providing a person with feedback (or immediate information) of a bioelectric response enables him to learn (gain) self-control of that response. These responses traditionally have been considered involuntary and include heart rate (Scott et al. , 1973a). blood pressure (Benson et al. , 1971), stomach acid pH (Welgan. 1972), and electroencephalographic activity (Sterman, 1972), In the present experiments, biofeedback and its attendant technology was applied to the problem of generating heterosexual arousal in homosexual males. Frequently, in biofeedback research, reinforcement has been used in addition to feedback in attempting to teach self-control of a response. In fact, an alternate way of conceptualizing and describing the biofeedback research is in terms of operant conditioning (e.g., Weiss and Engel, 1971: Scott et al. , 1973b). In one sense, however, feedback and reinforcement are inextricably confounded: the delivery or non-delivery of a reinforcer provides the S with information about the rightness or wrongness of his response and hence, binary feedback about it. Likewise, if feedback or knowledge of whether the response has reached a criterion level or not is effective in leading to a change in the response, then feedback functions as a reinforcer. Reinforcement, however, may be viewed as providing both information about the response (feedback) plus an incentive to change it in the desired direction in addition to any incentive provided by successful performance of a task. Thus, if one provides S s with a separate, functionally defined reinforcer in such a way that no additional information about the response is conveyed, it becomes possible to detect additive effects of reinforcement over feedback effects. Such was the second purpose of this study. Several recent analogue experiments with volunteers have reported success in modifying erections through feedback and/or reinforcement. Price (1973) found that heterosexual volunteers who received analogue visual feedback as well as binary feedback, provided by a colored light once the needle had passed a pre-set criterion, showed a shorter latency to peak erection and maintained criterion erection longer than a control group receiving no feedback. Both groups were listening to erotic audio tapes. Rosen (1973) demonstrated significant suppression of tumescence in a group of heterosexual volunteers provided with response contingent signal lights. A group receiving non-contingent feedback did not show this effect. In a technical paper, Laws and Pawlowski (1973) have suggested audio feedback of tumescence as a treatment for deficits in sexual arousal. In the clinic, Harbison, Quinn and McAllister (1970), in an uncontrolled case study, reported increasing heterosexual responsiveness in homosexuals through reinforcement of erection. In one of their homosexual patients they were able, over a long series of trials, to increase erection to a heterosexual stimulus (female slide) through rewarding progressively larger responses with sips of iced lime after the patient was water deprived. In addition to the reinforcement, this S was given feedback, of sorts, in that a light was flashed for each successful trial. A second homosexual patient was similarly rewarded for maintaining progressively longer and clearer fantasies of heterosexual behavior. Since other treatments were also applied and no experimental analysis was performed, it is not possible to evaluate the effectiveness of the procedure. In the present experiment the separate effects of feedback and reinforcement to increase heterosexual arousal in homosexuals was experimentally evaluated using single case experimental design methodology (Barlow and Hersen, 1973). Since each experiment was somewhat different in design and purpose, each will be described separately.