Exposure Therapy Flashcards
What is desensitisation?
Process where the subject is made to confront (exposed to) the feared stimulus or situation (i.e., exposure therapy)
What are types of desensitisation (exposure therapy)
- In-vitro (imaginal) e.g., systematic desensitisation, impolosion
- in-vivo - e.g., flooding
- interoceptive
- eye-movement desensitisation (EMDR)
What is the rationale for exposure therapy?
- 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
What are the mechanisms of desensitisation?
- reciprocal inhibition hypothesis (REPLACE)
- extinction hypothesis - (REMOVAL)
- habituation (DECREASE in response)
- Neural toughening hypothesis
- cognitive hypothesis (learned self-efficacy)
what early work supports desensitisation
- 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)
(Common) Protocols for exposure
Habituation - cannot stay anxious forever
- more we enter a situation, less anxious we get :)
Extinction
(Other) protocols for exposure therapy
- Cognitive-therapy paradigm - use of BE, to generate changes to threat appraisal
- EMDR
- ACT
Steps for exposure therapy
- Preparation
a) Psychoed
b) Motivational enhancement
c) Hierarchy construction - Conducting exposure therapy
- Consolidation and generalisation
- Termination
How do you prepare clients for exposure?
- explain rationale (use psycho-ed)
- examine client attitudes (will feel anxiety)
- examine past experiences
- be persuasive without bullying (more psycho-ed)
How do you be persuasive without bullying?
- point out differences between programs that do and don’t work
- use info from past experiences
- principles of attitude change
- discuss habituation w/ examples
What is hierarchy construction?
- graded items
- items are concrete, specific, real
- collaborative
- discomfort can be varied
How can you vary discomfort within an exposure hierarchy?
- time before and distance from the event
- multiple sensory modalities
- use fearful cognitions/sensations
- time projection (now vs past)
- vary control
How should you conduct exposure therapies?
- use scientific principles of desensitisation
- manage compliance and maintain/enhance motivation
- supervise if necessary
- address problems in exposure
- set as homework
What are the scientific principles of desensitisation?
- 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
how do you manage exposure compliance?
- monitoring charts
- supportive others if applicable
- supervise sessions from time to time
- good therapeutic alliance will allow discussion of more problems
How do you enhance motivation during exposure?
- express empathy
- use motivational interviewing
- develop discrepancies
- support self-efficacy
- ensure they are in touch with WHY they are completing the task
How should you use positive feedback during exposure?
- be generous with pos. feedback
- examine how feedback is received
- use social supports
When is supervision necessary for exposure?
- when the interview gives us inadequate or inconsistent data
- identify reasons for lack of progress
- observe directly = more information
Is exposure supervision therapeutic?
yes!!
- often reduces distress levels
- increases compliance
- provides support
- motivates
- enforces
what are some problems or challenges with exposure?
- worsening of symptoms
- not progressing at the expected rate
- drop outs
- therapist as the problem
why might the client progress at the expected rate for exposure?
- 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
Solutions to help exposure regression
- set realistic and achievable goals
- supervise
- monitor
- set milestones and celebrations
How may the therapist be the problem in exposure?
- therapist anxiety and discomfort = client doubt
- knowledge factors (principles not followed)
- the therapist’s skills
How can you effectively use exposure tasks as homework?
SMART!
(specific, measurable, attainable, realistic, timely)
