CHAPTER 4: exposure therapy - promoting emotional processing of pathological anxiety

Question 1

Contiguous pairing (conditioning)

Answer 1

When things are learned by pairing a stimulus (dog) with an action (bite). This creates a conditioned response (fear).

(Black box model)

Question 2

Avoidance learning

Answer 2

Avoiding the now conditioned stimulus (dog) maintains fear.

Question 3

History of exposure in CBT

Answer 3

1. Systemic desensitization (relaxation techniques)
2. Exposure without relaxation
3. Implosive therapy (highly anxiety provoking)
4. Flooding (effective but kut)
5. Now: gradual exposure beginning with moderately arousing stimuli

Question 4

Retrieval competition

Answer 4

Competition of retrieval between the old fear structure and the new non-fear structure.

Question 5

3 types of exposure

Answer 5

• In vivo = real life
• Imaginal = imaginary
• Interoceptive = exposure to a physical state.

Question 6

Habituation in emotional processing therapy

Answer 6

Based on the idea than when anxiety is going down during exposure, this means that the fear-structure is getting updated. Only then you stop the exposure.
BUT: habituation is NOT predictive of long-term therapy outcome.

Question 7

Strategies for enhancing inhibitory learning (to make new non-fear structure as strong as possible)

Answer 7

1. Expectancy violation - Test it out!
2. Remove safety behaviours - Throw it out!
3. Variability - Vary it up!
4. Deepened extinction - Combine it!
5. Reinforced extinction - Face your fears!
6. Attentional focus - Stay with it!
7. Mental reinstatement / retrieval cues - Bring it back!

Question 8

Exposure of choice for different anxiety disorders

Answer 8

1. Specific phobia: brief therapist-guided in vivo exposure.
2. Panic disorders: in vivo interoceptive exposure.
3. Social anxiety: individual CBT focus on subtle avoidances.
4. GAD: in vivo and imaginary (tolerating distress).
5. OCD: confrontation with discomfort and abstinence from rituals (EX/RP).
6. PTSD: prolonged exposure (in vivo or imagined) without safety behaviours.