Lecture 6 - PE Flashcards
Prolonged Exposure therapy - founder and principle
- Founder: Dr. Edna Foa, University of Pennsylvania
- Evidence Based Treatment for PTSD
- Foundation in Behavior Theory for Treatment of Anxiety Disorders (Habituation, Associative Learning and Extinction).
PE - difference between phobias and PTSD
the haunting memory of an event. It was the memory
that needed to be processed and treated.
Components of PE
- In vivo exposure
- Imaginal exposure/processing
- Psychoeducation
- Breathing retraining
In vivo exposure
In vivo exposure involves the gradual confrontation of anxiety provoking but objectively safe trauma-reminders, including people, places, objects and situations. In vivo exposure promotes: (a) reduction in negative trauma-related cognitions; (b) learning that the feared situation is not dangerous; (c) learning that fear and arousal do not last indefinitely; and (d) learning about the ability to tolerate anxiety.
Imaginal exposure/processing
Imaginal exposure and processing involve the revisiting of the trauma memory aloud coupled with discussing core cognitions and beliefs about the self, others and the world related to the trauma. By repeatedly confronting the memory of the trauma, patients can learn that: (a) the memory itself is not dangerous; (b) the distress associated with thinking about what happened declines over time; and (c) some of the faulty perceptions they may hold about their own and other’s behavior are not accurate.
Psychoeducation
Psychoeducation involves the provision of didactic information about PTSD, common reactions to trauma, and the role of avoidance in maintaining PTSD. Educating individuals about trauma. Info.
Breathing retraining
breathing retraining, patients learn to slow their breathing to regulate distressing emotions.
Emotional Processing Theory (EPT) and PTSD
In EPT, PTSD is believed to emerge due to the development of a fear network in memory that elicits escape and avoidance behavior. Mental fear structures include stimuli, responses, and meaning elements.
Anything associated with the trauma may elicit the fear structure or schema and subsequent avoidance behavior.
The fear network in people with PTSD is thought to be stable and broadly generalized so that it is easily accessed. When the fear network is activated by reminders of the trauma, the information in the network enters consciousness (intrusive symptoms).
According to emotional processing theory, repetitive exposure to the traumatic memory in a safe environment will result in habituation of the fear and subsequent change in the fear structure.
As emotion decreases, patients with PTSD will begin to modify their meaning elements spontaneously and will change their self-statements and reduce their generalization.
Repeated exposures to the traumatic memory are thought to result in habituation or a change in the information about the event, and subsequently, the fear structure.
EPT and PTSD - summary
Experience a traumatic event ==> formation of fear network; eliciting escape and avoidance. Need to peel back layers of fear network.
challenge though ==> activate emotion.
Mechanism of change in PE
Behaviourism.
- Emotional Activation and Habituation
- Both in vivo exposure and imaginal exposure exercises involve emotional activation. This emotional activation allows for the incorporation of new information into the emotion structure.
- Additionally, within-session habituation is encouraged in PE. Patients are commonly encouraged to continue in vivo exposures until their fear reduces by 50%. Similarly, patients engage in extended imaginal exposure exercises, often about 40 min in length, in part to promote within-session habituation.
- Finally, between session habituation, or the reduction of anxiety from one session to the next, is promoted in PE through exposure homework assignments.
Risks of PE
Revisiting trauma, so
Exacerbation of Symptoms
Retraumatization?
