5b) Imaginal desensitisation Flashcards
Describe imaginal desensitisation (3)
- expose to feared images and memories
- expose in a gradual manner
- prolonged exposure is better than brief exposure
BUT prolonged imaginal exposure does not work
Identify the main steps for imaginal desensitisation (11)
- 1) Explain rationale and re-assure
- 2) Construct hierarchy: initial stage
- 3) Selection of coping response to exposure
- 4) Scene presentation i.e., do the imaginal desensitisation
- 5) Debriefing and cognitive appraisal
- 6) Final hierarchy construction
- 7) HW and follow-up
- 8) If outcomes are expected and desensitisation progress well, then:
- 9a) Additional assessment to finalise hierarchy
- 9b) Selection and training of coping response during exposure if appropriate
- 10) If outcomes are not expected, reassess and trouble-shoot
What is involved in the first step of imaginal desensitisation? (3)
- Explain rationale briefly in lay terms
- Examine expectations of client; some anxiety is expected
- Reassure client that client can terminate exposure if it becomes excessive
What is involved in the 2nd step of imaginal desensitisation? (4)
- Dividing the hierarchy construction into initial and later stages is efficient because it prevents wasted time and effort in cases where imaginal desensitisation does not work well.
- The objective in this stage is to to identify a few scenarios (triggers) that can raise anxiety levels (e.g., Items to increases SUDs to 20, 40, 60 by interview or by homework task.
- Identify 2 positive imagery scenes as coping responses
- Discomfort can be varied by manipulation of a variety of parameters
o time before & distance from event
o use of multiple sensory modalities
o use of fearful cognitions or fearful sensations
o time projection (now vs. in the past)
o varying measures of control/assistance available to the subject
Why is it efficient to divide the hierarchy construction into initial and later stages?
it prevents wasted time and effort in cases where imaginal desensitisation does not work well.
What are common coping responses for the 3rd step of imaginal desensitisaation? (4)
Describe them
- Slow breathing and instructions to “relax” during exhalation. Use diaphragmatic breathing if client is trained in this procedure.
- Brief muscle relaxation (e.g., tense to 50%, then relax)
- Body scan and relax exercise: Here client is asked to scan the body from head to toe, identify pockets of tensions before relaxing these by gentle touch and imagery
- Switch from anxiety to relaxation imagery
Describe how scene presentation 1 works. (4)
- Commence with items low on hierarchy
- Client signals to indicate levels of distress (e.g., raise fingers: 1 for 20%, 2 for 40%…etc)
- Scene is held in imagination for a brief period (30 seconds to minutes). Duration may vary depending on level of anxiety experienced.
o Remember sustaining imagery is a controlled attentional process, so prolonged imagery is fatiguing.
o No point in getting people to imagine for a long period of time - Coping response is held for a couple of minutes or until effective.
Describe how scene presentation 2 works. (4)
- Scene is repeated until SUDS rating drops to low levels (e.g., 20 SUDs or below, or drops by 50% of original level).
- Next item presented
- Entire session may take 30-60 minutes or more. Session terminates with a neutral item or item that does not evoke anxiety.
- New session begins with last item that subject coped with
When does an imaginal desensitisation session terminate and how?
Entire session may take 30-60 minutes or more. Session terminates with a neutral item or item that does not evoke anxiety.
How does the new session begin?
New session begins with last item that subject coped with
Provide guidelines for scene presentation. (6)
- Keep SUDS within manageable limits at all times
- Most clients happily tolerate SUDs in the 40-60 window (exposure cues) and 40 or below (when no cues/relaxing)
- Initial sessions: you may use lower SUDs to gain engagement
- You can raise SUDS to 80 or higher for brief periods if you are confident you can down-regulate anxiety
- Coping thresholds vary across/within individuals and therapy stages. Be collaborative.
- High levels of distress can lead to panic => negative consequences on motivation, confidence
What are some general guidelines for systematic desensitisation? (1;2)
- Recorded audio tapes of desensitisation session is a good home task
- Supervision of one or more sessions has advantages
o To prevent unexpected adverse consequences.
o To understand individual patterns of anxiety experience, appraisal and coping (including safety behaviours)
What is involved in debriefing and reappraisal? (3)
- Examine client’s appraisal of events
- Enhance awareness of how anxiety is triggered and maintained. Excellent opportunity for psychoeducation.
- Excellent opportunity to target key beliefs that underlie client’s anxiety and avoidance.
What is involved in the final hierarchy construction? (4)
- This hierarchy is more elaborate and covers key tasks for the entire exposure program
- Situations are graduated from low to high ratings of subjective units of distress (SUDs).
- Items numbers range from 8-20
- Items are concrete, specific, real.
What should you do if imagery fails to provoke anxiety? (1;2;2)
- Check for mental blocking of anxiety which may be deliberate or automatic.
- Use escalation strategies
o Move up the hierarchy
o Switch/push additional anxiety buttons (add negative cognitions, physiological sensations) - You might be pressing the wrong anxiety buttons
o Switch modalities; use multisensory modalities.
