11. exposure therapy for anxiety disorders

Question 1

who developed exposure therapy?

Answer 1

joseph wolpe

Question 2

what prompted the creation of exposure therapy?

Answer 2

wolpe wasn’t satisfied with current tx of PTSD, developed systematic desensitization

Question 3

2 main contributions of wolpe

Answer 3

1. reciprocal inhibition
2. SUDS scale

Question 4

what is reciprocal inhibition?

Answer 4

can’t have competing responses at same time

Question 5

what is the SUDS, what is it used for?

Answer 5

subjective units of distress scale
0-100 scale of distress during exposure

Question 6

how a fear develops?

2 things

Answer 6

neural stimulus paired w fear response
trauma/bad experience

Question 7

what’s an indirect way that fear can be modeled?

Answer 7

through parental exposure

ex: parent is scared of dogs, child internalizes that dogs are dangerous

Question 8

examples of benign events that can evoke fear responses

Answer 8

ex: after car accident
* cars
* location where accident happened
* people who were present
* etc

Question 9

what is exposure therapy?

Answer 9

• therapy techniques used to teach clients to approach feared stimuli
• can be paired with relaxation techniques
• can be paired with preventions of compulsions/safety behaviours

Question 10

what’s a safety behaviour?

Answer 10

behaviour used to cope from fear of initial stimulus

Question 11

why should we prevent performance of safety behaviours?

Answer 11

client might attribute safety to the behaviour rather than reality

Question 12

what are the two main goals of exposure therapy?

Answer 12

1. teach client that anxiety leaves on its own
2. help client learn corrective information about feared stimulus

Question 13

exposure therapy

what are the 4 mechanisms of change?

Answer 13

1. habituation
2. extinction
3. inhibitory learning
4. increased self-efficacy

Question 14

mechanisms of change

what’s a con of habituation?

Answer 14

not sustainable over time

Question 15

mechanisms of change

explain extinction

Answer 15

• feared stimulus no longer paired with escape/avoidance behaviour
• stimulus may be paired with relaxation so that new association is learned

Question 16

mechanisms of change

what is inhibitory learning?

Answer 16

client learns that feared outcomes don’t happen/v unlikely over repeated trials

Question 17

mechanisms of change

how does increased self-efficacy work?

Answer 17

even if fear response isn’t completely gone, client learns that they can handle their own feelings

Question 18

5 types of exposure GO!!!

Answer 18

1. graded exposure
2. systematic desensitization
3. prolonged exposure
4. flooding
5. one-session

Question 19

types of exposure

difference between graded exposure and systematic desensitization?

what’s an issue with systematic desensitization?

Answer 19

systematic desensitization is graded expoure but with relaxation techniques (deep breathing, etc)
* can’t be anxious + relaxed at the same time
* not everyone likes relaxing (ex: people with anxiety – it makes them hyperaware)

Question 20

types of exposure

explain what prolonged exposure is and everything that comes with it

Answer 20

• PTSD – after 3 months
• repeatedly going through event in detail
• exposure to situations, objects, people that are reminders of event, but don’t pose a threat
• facilitate emotional processing of event (emotions)

Question 21

types of exposure

flooding, talk about it – explain, rationale, cons

Answer 21

• starting at worst of the hierarchy
• why? can’t sustain intense fear for extended period of time, they’ll evnetually have to relax
• can backfire and traumatize again

Question 22

types of exposure

one-session: what is it, what does it consist of, who’s the demographic?

Answer 22

• extended session (3hrs)
• teaching client, modelling, exposure, cognitive challenge (it’s kind of like an exposure therapy “class” - test their hypoethesis, challenging their cognition)
• works with adults (working with specific phobias)
• might not work as well for kids/teens

Question 23

explain the paper on evidence for one-session tx for specific phobias in youth

Answer 23

• OST and education support tx (EST) superior to waitlist in terms of clinician rating and % of pts who were dx-free following tx but not behaviour approach tests BAT or self/parent-reports
• OST superior to EST for clinician ratings, % of dx-free pts, child rating of pre-BAT anx + tx satisf
• 6 month follow up: only superior on clinician ratings + % of dx-free pts

samples were US + Sweden lol

Question 24

modes of delivery of exposure therapy

Answer 24

1. in vivo
2. imaginal
3. VR
4. interoceptive
5. modelling

Question 25

# modes of delivery of exposure therapy what's in vivo exposure?

Answer 25

exposure to actual feared stimulus, or some approximation | can require field trips!

Question 26

what's a mode of delivery thats frequently used for PTSD, GAG, and phobias of uncommon stimuli?

Answer 26

imaginal

Question 27

# modes of delivery of exposure therapy what's interoceptive exposure? what is it most often used for?

Answer 27

exposure to physical sensations used mostly for panic disorder learning that sx aren't dangerous

Question 28

# modes of delivery of exposure therapy what is modelling? characteristics, etc

Answer 28

* you do the action * used mostly as adjunt rather than primary mode of delivery * show client that feared outcome is unlikely * not always suitable (GAD, OCD -- "you can do it and nothing bad will happen but if I do, something will go bad")

Question 29

# typical course of exposure therapy steps of early sessions (7)

Answer 29

1. assessment of sx + interferences in daily life 2. psychoeducation 3. provide rationale for exposure 4. introduce sx monitoring + SUDS 5. build fear hierarchy 6. plan exposure exercises, prevention rituals 7. build rapport

Question 30

# typical course of exposure therapy middle sessions (5)

Answer 30

1. in session exposure 2. homework 3. SMART 4. modify as needed 5. periodically assess overall sx

Question 31

# typical course of exposure therapy: middle sessions what does in-session exposure consist of? how can pt move up pyramid?

Answer 31

* therapist guided * prevention of compulsions "let's try" * ask client SUDS * can't move up hierarchy until client can complete iten with little effort **AND** without engaging in compulsions | can jump up and down ladder as needed

Question 32

# typical course of exposure therapy: middle sessions benefits of asking client to do homework

Answer 32

helps with generalizability to different stimuli + self efficacy (avoid associating therapist to safety)

Question 33

# typical course of exposure therapy pros and cons of cognitive restructuring

Answer 33

* can help clients engage in therapy more readily * some might use cog restr to neutralize anxiety during exposure

Question 34

# typical course of exposure therapy late sessions

Answer 34

* generalization/maintenance * relapse prevention

Question 35

pros of exposure therapy

Answer 35

* high efficacy * relatively brief (under 15 sessions)

Question 36

cons of exposure therapy

Answer 36

* high dropout rate * some therapists don't like it * several barriers to tx

Question 37

# cons of exp ther what are some of the potential barriers to tx?

Answer 37

1. noncompliance 2. subtle avoidance 3. family involvement 4. comorbidities