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PSYC 408 > 11. exposure therapy for anxiety disorders > Flashcards

11. exposure therapy for anxiety disorders Flashcards

history of expo ther, overview of expo ther, typical course of ther, pros/cons

1
Q

who developed exposure therapy?

A

joseph wolpe

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2
Q

what prompted the creation of exposure therapy?

A

wolpe wasn’t satisfied with current tx of PTSD, developed systematic desensitization

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3
Q

2 main contributions of wolpe

A
  1. reciprocal inhibition
  2. SUDS scale
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4
Q

what is reciprocal inhibition?

A

can’t have competing responses at same time

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5
Q

what is the SUDS, what is it used for?

A

subjective units of distress scale
0-100 scale of distress during exposure

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6
Q

how a fear develops?

2 things

A

neural stimulus paired w fear response
trauma/bad experience

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7
Q

what’s an indirect way that fear can be modeled?

A

through parental exposure

ex: parent is scared of dogs, child internalizes that dogs are dangerous

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8
Q

examples of benign events that can evoke fear responses

A

ex: after car accident
* cars
* location where accident happened
* people who were present
* etc

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9
Q

what is exposure therapy?

A
  • therapy techniques used to teach clients to approach feared stimuli
  • can be paired with relaxation techniques
  • can be paired with preventions of compulsions/safety behaviours
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10
Q

what’s a safety behaviour?

A

behaviour used to cope from fear of initial stimulus

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11
Q

why should we prevent performance of safety behaviours?

A

client might attribute safety to the behaviour rather than reality

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12
Q

what are the two main goals of exposure therapy?

A
  1. teach client that anxiety leaves on its own
  2. help client learn corrective information about feared stimulus
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13
Q

exposure therapy

what are the 4 mechanisms of change?

A
  1. habituation
  2. extinction
  3. inhibitory learning
  4. increased self-efficacy
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14
Q

mechanisms of change

what’s a con of habituation?

A

not sustainable over time

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15
Q

mechanisms of change

explain extinction

A
  • feared stimulus no longer paired with escape/avoidance behaviour
  • stimulus may be paired with relaxation so that new association is learned
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16
Q

mechanisms of change

what is inhibitory learning?

A

client learns that feared outcomes don’t happen/v unlikely over repeated trials

17
Q

mechanisms of change

how does increased self-efficacy work?

A

even if fear response isn’t completely gone, client learns that they can handle their own feelings

18
Q

5 types of exposure GO!!!

A
  1. graded exposure
  2. systematic desensitization
  3. prolonged exposure
  4. flooding
  5. one-session
19
Q

types of exposure

difference between graded exposure and systematic desensitization?

what’s an issue with systematic desensitization?

A

systematic desensitization is graded expoure but with relaxation techniques (deep breathing, etc)
* can’t be anxious + relaxed at the same time
* not everyone likes relaxing (ex: people with anxiety – it makes them hyperaware)

20
Q

types of exposure

explain what prolonged exposure is and everything that comes with it

A
  • PTSD – after 3 months
  • repeatedly going through event in detail
  • exposure to situations, objects, people that are reminders of event, but don’t pose a threat
  • facilitate emotional processing of event (emotions)
21
Q

types of exposure

flooding, talk about it – explain, rationale, cons

A
  • starting at worst of the hierarchy
  • why? can’t sustain intense fear for extended period of time, they’ll evnetually have to relax
  • can backfire and traumatize again
22
Q

types of exposure

one-session: what is it, what does it consist of, who’s the demographic?

A
  • extended session (3hrs)
  • teaching client, modelling, exposure, cognitive challenge (it’s kind of like an exposure therapy “class” - test their hypoethesis, challenging their cognition)
  • works with adults (working with specific phobias)
  • might not work as well for kids/teens
23
Q

explain the paper on evidence for one-session tx for specific phobias in youth

A
  • OST and education support tx (EST) superior to waitlist in terms of clinician rating and % of pts who were dx-free following tx but not behaviour approach tests BAT or self/parent-reports
  • OST superior to EST for clinician ratings, % of dx-free pts, child rating of pre-BAT anx + tx satisf
  • 6 month follow up: only superior on clinician ratings + % of dx-free pts

samples were US + Sweden lol

24
Q

modes of delivery of exposure therapy

A
  1. in vivo
  2. imaginal
  3. VR
  4. interoceptive
  5. modelling
25
Q

modes of delivery of exposure therapy

what’s in vivo exposure?

A

exposure to actual feared stimulus, or some approximation

can require field trips!

26
Q

what’s a mode of delivery thats frequently used for PTSD, GAG, and phobias of uncommon stimuli?

A

imaginal

27
Q

modes of delivery of exposure therapy

what’s interoceptive exposure?
what is it most often used for?

A

exposure to physical sensations
used mostly for panic disorder
learning that sx aren’t dangerous

28
Q

modes of delivery of exposure therapy

what is modelling?
characteristics, etc

A
  • you do the action
  • used mostly as adjunt rather than primary mode of delivery
  • show client that feared outcome is unlikely
  • not always suitable (GAD, OCD – “you can do it and nothing bad will happen but if I do, something will go bad”)
29
Q

typical course of exposure therapy

steps of early sessions (7)

A
  1. assessment of sx + interferences in daily life
  2. psychoeducation
  3. provide rationale for exposure
  4. introduce sx monitoring + SUDS
  5. build fear hierarchy
  6. plan exposure exercises, prevention rituals
  7. build rapport
30
Q

typical course of exposure therapy

middle sessions (5)

A
  1. in session exposure
  2. homework
  3. SMART
  4. modify as needed
  5. periodically assess overall sx
31
Q

typical course of exposure therapy: middle sessions

what does in-session exposure consist of? how can pt move up pyramid?

A
  • therapist guided
  • prevention of compulsions “let’s try”
  • ask client SUDS
  • can’t move up hierarchy until client can complete iten with little effort AND without engaging in compulsions

can jump up and down ladder as needed

32
Q

typical course of exposure therapy: middle sessions

benefits of asking client to do homework

A

helps with generalizability to different stimuli + self efficacy (avoid associating therapist to safety)

33
Q

typical course of exposure therapy

pros and cons of cognitive restructuring

A
  • can help clients engage in therapy more readily
  • some might use cog restr to neutralize anxiety during exposure
34
Q

typical course of exposure therapy

late sessions

A
  • generalization/maintenance
  • relapse prevention
35
Q

pros of exposure therapy

A
  • high efficacy
  • relatively brief (under 15 sessions)
36
Q

cons of exposure therapy

A
  • high dropout rate
  • some therapists don’t like it
  • several barriers to tx
37
Q

cons of exp ther

what are some of the potential barriers to tx?

A
  1. noncompliance
  2. subtle avoidance
  3. family involvement
  4. comorbidities

PSYC 408 (20 decks)

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