Topic 24: Fear and Anxiety Reduction Procedures

Question 1

Fear

Answer 1

occurs when a stimulus situation elicits autonomic nervous system arousal and the individual engages in behavior to avoid or escape from the stimulus situation

Question 2

Anxiety

Answer 2

a term used to describe respondent behavior involving the activation of the autonomic arousal is an established operation that increases the probability of operant behavior involving escape or avoidance responses

typically, some event functions as a conditioned stimulus (CS) to elicit the autonomic arousal as a conditioned response (CR)

the operant behavior functions to escape from or avoid the CS

Question 3

Relaxation Training

Answer 3

a type of relaxation training in which one assumes a relaxed posture in all of the major muscle groups of the body to achieve relaxation

Question 4

Progressive Muscle Relaxation (PMR)

Answer 4

a relaxation procedure in which the client learns to tense and relax each of the major muscle groups of the body

by this means, the client decreases muscle tension and autonomic arousal in the body

Question 5

Diaphragmatic Breathing

Answer 5

a type of relaxation exercise in which one engages in slow, rhythmic breathing, using the diaphragm muscle to pull air deep into lungs

Question 6

Attention-Focusing Exercise

Answer 6

a type of anxiety-reduction strategy in which one focuses attention on a pleasant or natural stimulus to remove attention from the anxiety-producing stimulus

Question 7

Behavioral Relaxation Training

Answer 7

a type of relaxation training in which one assumes a relaxed posture in all of the major muscle groups of the body to achieve relaxation

Question 8

Systematic Desenitization

Answer 8

a procedure used to treat a fear of phobia

the person first learns relaxation

next, the person develops a hierarchy of fear-producing situations

finally, the person uses the relaxation procedure as he or she imagines each situation in the heirarching

starting with the least fear-producing situation and gradually working up to the most fear-producing situation

the goal is to replace the fear response with the relaxation responses as each situation is imagined

Question 9

Phobia

Answer 9

a fear in which the level anxiety or escape and avoidance behavior is severe enough to disrupt the person’s life

Question 10

Heirarchy

Answer 10

used in systematic desensitization or in vivo desensitization procedures

in the hierarchy (also called a fear hierarchy)

various fearful situations are listed in order from least to most fear-provoking

each new situation in the hierarchy is only slightly more fear-provoking than the previous situation

Question 11

In Vivo Densensitization

Answer 11

a procedure for treating a fear or phobia

the client first learns relaxation

next, the client develops a fear hierarchy in which fear-producing situation are ordered from least to most fear-producing

finally, the client makes actual contact with the fear-producing situation at each step in the hierarchy in turn while maintaining relaxation as a response that is incompatible with the fear response

Question 12

Contact Desensitization

Answer 12

a form of in vivo desensitization in which the therapist provides reassuring physical contacts, such as holding the client’s hand or placing a hand on the client’s back, as the client progresses through the heirarchy

Question 13

Flooding

Answer 13

a procedure in which the person is exposed to the feared stimulus at full intensity for a prolonged period until his or her anxiety subsides in the presence of the feared stimulus

Question 14

What is fear?

Answer 14

caused by a stimulus or situation that produces unpleasant physiological response (autonomic nervous system arousal, or anxiety) and cognitive appraisal

comprised of both respondent conditioning and operant behaviors

respondent conditioning: conditioned emotional response (CER)

operant conditioning: escape or avoidance (negative reinforcement)

Question 15

What is respondent extinction?

Answer 15

presenting a CS repeatedly without the US

part of procedure to reduce CERs

can help extinguish CRs associated with substance abuse

Question 16

What are different kinds of CSs?

Answer 16

in vivo: real-life events, objects, or people

imaginal: mental representations of events, objects, or people

symbolic: overt representation of events, objects, or people

Question 17

What is counterconditioning?

Answer 17

includes extinction: involves presenting the CS without the US

trains the person to substitute a competing or incompatible behavior or the CR when the CS is present

Question 18

What was Mary Cover Jones 1924 study on how conditioned fears can be removed?

Answer 18

was a student of J.B. Watson’s

pioneered the use of behavioral techniques in therapy, and was called “the first behavior therapist” and “the mother of behavior therapy”

Peter was a 3-year-old with average IQ (102)

target behavior: fear reaction (screamed or cried, and fell flat on his back) in response to a white rat, a rabbit, a fur coat, a feather, and cotton balls

initial behavioral treatment program: “un-conditioning” (respondent extinction), Peter observed behavior of other children who did not have a fear of rabbits, the other children played with the rabbit

due to circumstances, fear had regressed; tolerance dropped

subsequent behavioral treatment program: “direct conditioning”

Question 19

What was the subsequent behavioral treatment program used in Mary Cover Jones’s study?

Answer 19

a research assistant who Peter liked gave him a pleasant stimulus (food) which was associated with the rabbit

eating and remaining calm were the competing responses

Peter’s tolerance progressively increased over several weeks

in the final session, Peter showed no fear, even when another child was disturbed by the rabbit

Question 20

What are relaxation techniques?

Answer 20

gained widespread acceptance in the 1970s

setting should be comfortable, free of distraction and interruptions

person sits in a recliner or lies down in a comfortable position

person should be relaxed but alert at the end of the session; the goal is not for the person to fall asleep

person should record data on the intensity of the relaxation in each session on a data sheet

Question 21

What is relaxation?

Answer 21

a state of calmness with low physiological and psychological arousal and tension

Question 22

What is the duration of relaxation techniques?

Answer 22

sessions should last 10-30 minutes

initial sessions will typically take longer as the person is learning the technique

time should be set aside for regular sessions every day

Question 23

What is a rapid relaxation induction method?

Answer 23

after the person has mastered a techniques, they can develop a rapid relaxation induction method that allows them to calm themselves quickly with a set of words, images, and deep breathing

Question 24

What is progressive muscle relaxation (PMR)?

Answer 24

alternately tensing and relaxing different muscle groups while resting

this leaves the muscles more relaxed than they were before

follow-up assessments show that positive psychological and physiological results continue after treatment, and may even get stronger over time

can be used with children as young as 3 years of age to relieve fear and anxiety during dental treatment, for example

Question 25

What are controversial aspects of progressive muscle relaxation?

Answer 25

evidence shows the tensing the muscles may not be required, or may only be required while the person is being trained in the techniques; may aid in discrimination between tension and relaxation

audio recorded protocol or scripts that guide each step of the tensing-relaxing process may not be as effective as in-person training with a therapist

Question 26

What is diaphragmatic breathing?

Answer 26

using the muscles of the diaphragm to breathe deeply and slowly in a rhythmic pattern, characterized by expansion of the abdomen instead of just the chest

activates the parasympathetic nervous system

during breathing, the person focuses on the act of breathing and its sensations

this behavior is incompatible with the rapid, shallow breathing associated with high arousal and anxiety

can be used in conjunction with other relaxation procedures

Question 27

What is guided imagery?

Answer 27

person imagines pleasant and peaceful scenes and images

therapist guides the person through a script that descries what is experienced by each of the senses in the situation

attention is focused on the scene instead of anxiety-provoking thoughts and feelings

can be done in person with a therapist or while listening to an audio recording

Question 28

What is autogenic training?

Answer 28

person imagines being in a pleasant and peaceful scene and experiencing specific bodily sensations, such as their arms feeling warm or heavy

instructions specify which part of the body to focus on, what feeling to imagine; this is followed by a rest period, and is repeated three times

a full session involving all parts of the body takes 35 minutes

more suitable than progressive muscle relaxation for those people who have chronic pain or difficulty moving

meta-analysis found improvements vs. controls; it also improved quality of life

Question 29

What is meditation?

Answer 29

the process of contemplating or focusing one’s attention on an object, event, or idea to help the person become detached or dissociated from their physical states, thoughts, and feelings

derives from Eastern philosophy and religion; produces relaxation and mindful awareness of current experience

focus can be on a meditation stimulus, like a visual object (e.g. a flower), a mantra (word-like sound), or person’s own breathing

successfully applied to chronic pain by focusing on and separating physical sensations from the cognitive and emotional reactions to pain

alleviates anxiety and depression to a similar degree as antidepressant drug therapy

but low/no evidence of any affect on positive mood, substance use, eating habits, sleep and weight

Question 29

What are the essential components of meditation?

Answer 29

1. quiet, distraction-free location
2. specific, comfortable posture
3. open attitude
4. focus of attention

Question 30

What is behavioral relaxation training?

Answer 30

involves relaxing different muscle groups, and adopting certain relaxed body postures

similar to PMR, but does not include the muscle tensing component

typically incorporates other relaxation procedures such as breathing exercises and focused attention

Question 31

What is systematic desensitization?

Answer 31

developed by Joseph Wolpe (1958) based on Mary Cover Jones’ counter-conditioning

applied to reverse a person’s learned fear response (phobia or CER)

Question 32

What are the steps of systematic desensitization?

Answer 32

1. person first learns a person’s learned fear response (phobia or CER)
2. person then develops stimulus hierarchy (or fear hierarchy) of CSs, CSs are arranged in a hierarchy, from least fear-inducing to most fear-inducing
3. therapist describes a CS while the person maintains a state of relaxation, starts with the least fear-inducing CS, if the person can remain calm and relaxed, therapist moves on to the next most fear-inducing CS in the hierarchy

Question 33

What is the Subjective Units of Discomfort Scale (SUDS)?

Answer 33

0-100 scale that is used to rate the amount of fear produced by a given CS

Question 34

What is reciprocal inhibition?

Answer 34

relaxation response decreases the fear response

Question 35

What is the evaluation of systematic desensitization?

Answer 35

highly effective in helping overcome fears

effectiveness is maintained over time: follow-ups 2 years later reveal few recurrences in fears

often improves other areas of emotional functioning

also effective for other anxiety-related problems and compulsive behaviors

Question 36

What are the controversies of systematic desensitization?

Answer 36

not all research finds that relaxation enhances desensitization

some studies using only the strongest CSs had as much success as those using the full hierarchy

Question 37

What is in vivo desensitization?

Answer 37

person is gradually exposed to the actual stimulus that is producing fear/anxiety

similar to systematic desensitization; typically includes relaxation

may be supplemented with cognitive procedures, in which the person practices self-statements to cope with the situation and avoids statements that will make the anxiety worse

Question 38

What situations does the research show in vivo desensitization is effective for?

Answer 38

anxiety disorders

obsessions and compulsions

Question 39

What is flooding?

Answer 39

aka response prevention

person is exposed to a highly feared object or situation for a prolonged period of time

therapist prevents person from escaping or avoiding the sitution

relaxation is not included

can often be completed in a single session for specific fears

some clients are not able to tolerate extremely intense exposures

flooding should be carried out only be a professional behavior analyst

Question 40

What is modeling?

Answer 40

phobic person watches someone else performing a feared behavior

can desensitize fears vicariously

Question 41

What is participant modeling?

Answer 41

person first observes someone else cope with increasingly feared situation

the person is encouraged to join in

is guided to increase contact with the feared object or event using verbal and physical guidance prompts

Question 42

What is videotaped modeling?

Answer 42

person watches a video of someone else dealing with feared situation

found to be effective in reducing patients’ anxieties about medical treatments such as surgery or invasive dental work

however, watching a filmed model has been found to be less effective than participant modeling

Question 43

What is a computer-aided vicarious exposure?

Answer 43

participants wear a head-mounted stereoscopic virtual reality (VR) display that presents a three-dimensional, immersive experience that may include directional audio, haptic feedback/vibration, and scents

presents a controlled, stimulated experience as part of exposure therapy

highly effective in fear of heights (acrophobia)

has been applied to fears and scpeific phobias including flying, storms, brdiges, public speaking, needles, claustrophobia, driving, insects, and snakes

VR is as effective as traditional exposure-based therapy in treating PTSD

may be more useful in treating clients who are resistant to traditional therapies