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Psychological Interventions > Exposure Therapy > Flashcards

Exposure Therapy Flashcards

1
Q

What is desensitisation?

A

Process where the subject is made to confront (exposed to) the feared stimulus or situation (i.e., exposure therapy)

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2
Q

What are types of desensitisation (exposure therapy)

A
  • In-vitro (imaginal) e.g., systematic desensitisation, impolosion
  • in-vivo - e.g., flooding
  • interoceptive
  • eye-movement desensitisation (EMDR)
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3
Q

What is the rationale for exposure therapy?

A
  • well-documented phenomenon
  • most validated technique in psychotherapy
  • achieve habituation
  • designed to tackle avoidance so they have an opportunity to learn the feared outcome will not happen
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4
Q

What are the mechanisms of desensitisation?

A
  • reciprocal inhibition hypothesis (REPLACE)
  • extinction hypothesis - (REMOVAL)
  • habituation (DECREASE in response)
  • Neural toughening hypothesis
  • cognitive hypothesis (learned self-efficacy)
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5
Q

what early work supports desensitisation

A
  • Case of Albert (Watson) - white rat
  • classical conditioning
  • but did not desensitise him - very unethical these days
  • 12 years later, systematic desensitisation was established (counter-conditioning)
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6
Q

(Common) Protocols for exposure

A

Habituation - cannot stay anxious forever
- more we enter a situation, less anxious we get :)
Extinction

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7
Q

(Other) protocols for exposure therapy

A
  • Cognitive-therapy paradigm - use of BE, to generate changes to threat appraisal
  • EMDR
  • ACT
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8
Q

Steps for exposure therapy

A
  1. Preparation
    a) Psychoed
    b) Motivational enhancement
    c) Hierarchy construction
  2. Conducting exposure therapy
  3. Consolidation and generalisation
  4. Termination
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9
Q

How do you prepare clients for exposure?

A
  • explain rationale (use psycho-ed)
  • examine client attitudes (will feel anxiety)
  • examine past experiences
  • be persuasive without bullying (more psycho-ed)
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10
Q

How do you be persuasive without bullying?

A
  • point out differences between programs that do and don’t work
  • use info from past experiences
  • principles of attitude change
  • discuss habituation w/ examples
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11
Q

What is hierarchy construction?

A
  • graded items
  • items are concrete, specific, real
  • collaborative
  • discomfort can be varied
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12
Q

How can you vary discomfort within an exposure hierarchy?

A
  • time before and distance from the event
  • multiple sensory modalities
  • use fearful cognitions/sensations
  • time projection (now vs past)
  • vary control
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13
Q

How should you conduct exposure therapies?

A
  • use scientific principles of desensitisation
  • manage compliance and maintain/enhance motivation
  • supervise if necessary
  • address problems in exposure
  • set as homework
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14
Q

What are the scientific principles of desensitisation?

A
  • prolonged exposure is better than brief
  • if brief, repeat several times (preferably within the same session)
  • more regular = better outcome
  • in-vivo better than imaginal
  • graduated better than flooding
  • terminate when anxiety is low
  • identify and phase out safety behaviours
  • combo of imaginal and in-vivo sometimes required
  • may be paired with response prevention
  • tailored to motivational status and expectations
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15
Q

how do you manage exposure compliance?

A
  • monitoring charts
  • supportive others if applicable
  • supervise sessions from time to time
  • good therapeutic alliance will allow discussion of more problems
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16
Q

How do you enhance motivation during exposure?

A
  • express empathy
  • use motivational interviewing
  • develop discrepancies
  • support self-efficacy
  • ensure they are in touch with WHY they are completing the task
17
Q

How should you use positive feedback during exposure?

A
  • be generous with pos. feedback
  • examine how feedback is received
  • use social supports
18
Q

When is supervision necessary for exposure?

A
  • when the interview gives us inadequate or inconsistent data
  • identify reasons for lack of progress
  • observe directly = more information
19
Q

Is exposure supervision therapeutic?

A

yes!!
- often reduces distress levels
- increases compliance
- provides support
- motivates
- enforces

20
Q

what are some problems or challenges with exposure?

A
  • worsening of symptoms
  • not progressing at the expected rate
  • drop outs
  • therapist as the problem
21
Q

why might the client progress at the expected rate for exposure?

A
  • principles of scientific exposure not followed
  • anxieties of the therapist
  • comorbidity
  • unrealistic ‘expectations’
  • over-reaction to bad days
  • problems with compliance or understanding instructions
  • medication
22
Q

Solutions to help exposure regression

A
  • set realistic and achievable goals
  • supervise
  • monitor
  • set milestones and celebrations
23
Q

How may the therapist be the problem in exposure?

A
  • therapist anxiety and discomfort = client doubt
  • knowledge factors (principles not followed)
  • the therapist’s skills
24
Q

How can you effectively use exposure tasks as homework?

A

SMART!
(specific, measurable, attainable, realistic, timely)

25
Q

Can the client use distraction strategies and safety cues

A

apparently “silly question”
- can be good to achieve some control over distress but this needs to be phased out

26
Q

What do you do if a panic attack happens during exposure?

A

therapist response is important!
- don’t panic,
- acknowledge distress
- examine attributions (what caused this)
- examine coping (de-catastrophise)
- effect of panic on future sessions (supervise if necessary, organise celebration when they return)
- challenge negative attitute

27
Q

Can you use benzodiazepines and SSRI’s during exposure therapy?

A

benzos = no!!! - they reduce anxiety
SSRI = sure
note that habituation will become dependent on the medication

28
Q

Exposure therapy ethical issues

A
  • is it forced on the client?
  • confidentiality
  • duty of care for client (is personal distress factored in? would you be happy to refer the client on if necessary?)
29
Q

what are the contradictions for exposure

A
  • psychotic conditions
  • severe personality disorders
  • conditions where control over aggressive impulses might be hard to predict
  • where anxiety is not the predominant problem
  • where distress might not be indicated
30
Q

Steps for imaginal desensitisation

A
  1. Explain the rationale
  2. Hierarchy construction
  3. Selection of coping response to exposure
  4. Scene presentation
  5. Debriefing and cognitive appraisal
  6. Homework and follow-up
31
Q

How do you construct a hierarchy?

A
  • identify a few scenarios (triggers) that can raise anxiety levels (e.g., SUDS 20, 40, 60)
  • identify 2 positive imagery scenes
  • may want to vary discomfort
32
Q

Possible coping responses

A
  • slow breathing, instructions to ‘relax’ during exhalation
  • diaphragmatic breathing
  • brief muscle relaxation
  • body scan and relaxation exercise
    switch from anxiety to relaxation imagery

Psychological Interventions (3 decks)

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