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Low Intensity Treatments > Exposure Therapy > Flashcards

Exposure Therapy Flashcards

1
Q

What is Exposure Therapy (ET)?

A

Part of Cognitive Behavior Therapy

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2
Q

Goals of Exposure Therapy

A

Exposing people to fear evoking stimuli

 Learn that anxiety will naturally go down (habituation

 Learn that the feared outcome does not occur

 Learn that even if this will occur, they can handle it

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3
Q

ET isBased on classical conditioning

A

Conditioned Stimulus -> Unconditioned stimulus -> Conditioned Response

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4
Q

Habituation

A

Conditioned Stimulus -> X Unconditioned Stimulus -> Conditioned Response

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5
Q

Emotional processing theory

A
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6
Q

Inhibitory learning theory

(Bouton, 1993; Craske et al., 2014; Craske , 2015)

A

Instead of unlearning conditioned response one “builds”a new pathway from conditioned stimulus directly to no unconditioned stimulus (dog = no harm)

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7
Q

Types of Exposure

A

 Exposure in vivo

 Imaginal exposure (“in vitro”)

 Introceptive exposure

 Virtual reality exposure

 Flooding

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8
Q

Inhibitory learing theory as opposed to emotional processing theory from ;

(Craske, M. (2015). Optimizing Exposure Therapy for Anxiety Disorders: An Inhibitory Learning and Inhibitory Regulation Approach. Verhaltenstherapie, 25(2), 134–143. doi:10.1159/000381574)

A

” Within a Pavlovian conditioning approach, the inhibitory learning models mean that the origi-nal CS-US (conditioned stimulus-unconditioned stimulus) associ-ation learned during threat conditioning is not erased during ex-tinction, but rather is left intact as a new, secondary inhibitory learning about the CS-US develops [e.g., Bouton and King, 1983; Bouton, 1993]. In other words, after extinction, the CS possesses 2 meanings; its original excitatory meaning (CS-US) as well as an ad-ditional inhibitory meaning (CS-noUS).”

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9
Q

Necessary conditions of TRADITIONAL Exposure Exercises

A
  • Graded
  • Prolonged
  • Repeated
  • Without distraction
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10
Q

Treatment components

A
  1. Fear Hierarchy (list)
  2. Exposure exercise
  3. Monitoring
  4. Evaluation
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11
Q
  1. Fear hierarchy (list)
A

from most difficult (e.g. to hold a spider in ones hand) to least difficult (watching a video of a spider moving)

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12
Q
  1. Pick an Exposure exercise
A
  1. Discuss THOROUGHLY with your patient: (where, how, why, when, who, what)
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13
Q
  1. Do the exposure exercise+ monitoring
A

a list of all the exposure sesssions with date, what they did, ratings of anxiety before, after and during etc.

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14
Q
  1. Evaluate
A

 What happened?

 Pick the next exposure exercise

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15
Q

Effectiveness

A

Exposure treatment efficacy:

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16
Q

Low Intensity Exposure

A

Well adaptable

Patient requirements:

  • Low to medium symptoms severity

Therapist requirements:

  • Knowledge of anxiety symptoms
  • Competent working with highly structured protocols

Client therapist time requirements:

  • unclear
17
Q

Low Intensity Treatment key components

A
  1. Psycho education
  2. Collecting information
  3. Guidance: set realistic goal for treatment
  4. Monitor and review progress
18
Q
  1. Psycho education
A
  1. Explain CBT model
  2. Explain Exposure Rationale

 Anxiety: fight flight

 Vicious cycle of fear and avoidance

 CS US CR relationship

19
Q
  1. Collecting information
A

Self monitoring

 Symptoms - frequency and intensity

 Behavior

 Cognitions

 Emotions

20
Q
  1. Setting realistic goals
A

 Don’t:

  • “not feeling anxious anymore”
  • “not getting a heart attack

Do:

  • Acquiring knowledge
  • Goals related to daily functioning
  • Learning to manage anxiety
21
Q
  1. Guidance + Monitor and review progress
A

no further infos on slides…

22
Q

Effectiveness of Low intensity exposure therapies

A

Low intensity exposure treatment efficacy

  • Self help compared with wait list and face to face (Haug et al., 2012)
  • Self help >wait list
  • Self help < face to face
23
Q

Relapse…

A

 19 62% of treatment responders show a return of fear (Craske and Mystkowski, 2006)

 …room for improvement!

24
Q

Strategies to improve Exposure

A

1) Expectancy violation
2) Deepened extinction
3) Removal of safety behaviour
4) Variability
5) Multiple contexts
6) Reconsolidation

25
Q

When picking an Exposure Exercise:

A

test it out first:

Analyze “If….then belief”:

  1. What do you fear most? What would happen?
  2. Under what circumstances is it most likely that this will actually happen?

Design:

  1. An experiment that will test your expectation the best
  2. Determine the duration and frequency needed to violate the expectancy .
  3. Check whether the experiment is doable.
26
Q

Expectancy violation

A

Determine

 What result/response/outcome will confirm fear expectation?

 What result/response/outcome will disconfirm fear expectation?

Important!!

 Reduction of fear is not required

 Do cognitive interventions afterwards, not before Exposure

27
Q

Deepened (compound) extinction

A

COMBINE IT

Combination of CS-s (internal/external)

28
Q

Removal of Safety Behavior

A

THROW IT OUT (distracting or numbing behaviours)

STAY WITH IT (Focus)

29
Q

Variability

A

MIX IT UP

Random order and length of exposures

•…but: has to be doable

30
Q

Multiple contexts

A

CHANGE IT UP

31
Q

Consolidation

A

BRING IT BACK bringing it from short term to long term memory (e.g. rehearsal)

More extensive evaluation

 What did you expect would happen? What actually happened? Were you surprised?

 What did you learn?

32
Q

Necessary conditions of non TRADITIONAL Exposure Exercises

A
33
Q

Take home message

A

 What is Exposure Therapy?

  • An effective behavioral intervention for Anxiety and Related Disorders

How does Exposure work?

  • Inhibitory learning (+habituation)
  • How effective is Exposure Therapy? Highly effective, also in LIT

How can efficacy be improved?

  • Test it out
  • Combine it
  • Throw it out
  • Stay with it
  • Change it up
  • Bring it back

Low Intensity Treatments (9 decks)

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