Chapter 4 - Exposure Flashcards
3 main types of exposure:
- In vivo (real life), flooding
- Imaginal, systematic desensitization
- Interoceptive
Mowrer’s two factor model
therapy must not only promote extinction through confrontation with erroneously feared objects, but also eliminate avoidances that would prohibit extinction from occurring.
Emotional processing theory (EPT) - Fear structure becomes pathological when…
-the associations among stimulus, response, and meaning representations do not accurately reflect reality
-and the fear structure becomes activated by harmless stimuli or responses that are erroneously viewed as dangerous.
- Emotional processing
process by which accurate information is incorporated into the fear structure and modifies the pathological elements in the structure.
Panic disorders (with and without agoraphobia) and exposure therapy:
- fear structure is characterized by erroneous beliefs regarding bodily sensations: Physical sensations are considered dangerous because they are erroneously perceived as indicators of catastrophes, such as having a heart attack or going crazy.
-Avoidance of situations that give rise to these sensations (that is, agoraphobia). - Goal of exposure therapy:
-have individuals directly confront feared bodily sensations through interoceptive exposure and situations that generate these sensations through in vivo exposure. -> exposure therapy alone is best
Specific phobias and exposure therapy
- In specific phobias, the fear structure contains erroneous information regarding the feared object or situation
- exposure procedures involve confrontation with the feared stimulus
-to activate the fear structure and disconfirm negative expectations of harm
Specific phobias and exposure therapy - effectiveness of treatment
-in vivo exposure works best (more rapid symptom improvement).
-Evidence suggests that 1-session protocols are as effective as five-session programs (for children and adults).
-Group treatments show promise as a way of increasing the cost-effectiveness of exposure therapy for specific phobias.
-VR is also effective.
Social anxiety disorder and exposure therapy
Individual treatment works better, In vivo exposure and role-play is used.
Generalized anxiety disorder and exposure therapy
-Characterized by exaggerations in a sense of harm.
-Worry is an avoidance strategy:
* Imaginal and in vivo exposure are commonly used to counteract these avoidances and promote emotional processing
-teaching individuals that they can tolerate mental images that generate distress as well as situations that provoke feelings of uncertainty
-Exposure is not as used as much for GAD as for other anxiety disorders because there is no clear target.
- GAD remains ‘‘the least successfully treated of the anxiety disorders’’
Obsessive compulsive disorder and exposure therapy
- Effective exposure treatment must involve:
-confrontation with anxiety-provoking stimuli
-abstinence from rituals that are believed to prevent harm > disconfirmation of the expected harm and thus promote emotional processing.
-Exposure and ritual prevention (EX/RP),
-training family members as cotherapists may lead to greater symptom reduction
Prolonged exposure (PE) for PTSD:
-chronic PTSD as a failure to adequately process the trauma memory because of extensive avoidance of thoughts and situations that are trauma reminders.
Goal of PE:
-promote emotional processing through deliberate, systematic confrontation with trauma-related stimuli.
-In vivo and imaginal exposure are used concurrently to disconfirm the erroneous beliefs that are common in PTSD.
in vivo exposure for PTSD
-target erroneous negative beliefs about people, places, and situations that PTSD sufferers avoid because:
-they perceive realistically safe situations associated with the trauma as dangerous
-believe that their anxiety will last forever if they remain in trauma-related situations rather than escape them
-and believe that they are incapable of coping with stress and distress
imaginal exposure - PTSD
= to help patients distinguish between thinking about the trauma and reexperiencing the trauma, generate habituation to the trauma memory so that:
the trauma can be remembered without causing undue anxiety
foster the realization that engaging in the trauma memory does not result in harm
and organize the trauma memory to promote differentiation between the traumatic event and similar events (describing the trauma with eyes closed, or writing about itetc.)
research prolonged exposure - PTSD
Prolonged exposure was found to reduce not only PTSD symptoms, but also depression, anger, guilt, and general anxiety
