Quiz 3 Flashcards

Question

Habit reversal training Components

Answer 1

1. awareness training - recognizing when they're ticking 2. Development of a competing response - less noticeable, can be carried out for more than a few minutes 3. Building motivation - make a list of the problems caused by tics, all the bad things it brings 4. Generalization of new skills - practice the skills in new contexts and locations

Answer 2

Have the client explain the purpose of the experiment and then challenge safety behavior by having them do something different (instead of pulling pillow away from face, move it closer to face) periodically ask her to notice how she's feeling

Answer 3

Appears to be the primary, active ingredient in CBT for anxiety disorders. --> just as effective as more complex CBTs; particularly true for PTSD, OCD, Social anxiety, cognitive therapy alone is not as effective as combined CBT treatments Exposure is effective for ALL anxiety disorders --> cognitive therapy has only been shown to work for some anxiety disorders and not specific phobias or OCD.

Answer 4

Strong effect sizes for CBT and BT with little difference adding the cognitive component to the behavioral component for specific disorders (i.e. PTSD)

Answer 5

Examination concluded that adding relaxation and anxiety management strategies prior to exposures did not improve outcomes for exposure-based treatment. More gold-standard clinician based outcomes measures need to be implemented to assess efficacy of adding anxiety management strategies to exposure therapy in order to increase efficacy of CBT for CADS to that of ERP for OCD.

Answer 6

60-85% of anxiety disorder clients who receive exposure therapy show clinically significant improvement. --> 68% remit from PTSD; 77% of panic disorder no longer experience panic attacks; 83% of OCD show significant improvement

Answer 7

Brief - 12-16 sessions total and efficient. Can be effectively implemented by clinicians with little prior CBT training or experience.

Answer 8

Treatment refusal - 30% Attrition - 15-30% Limited response rates - 40-50% Fear returns - 19-62%

Answer 9

No. Dropout rate is less than that or the same as other treatments. Exposure - 20% CBT or SIT - 22% Combined exposure and other CBT - 27% EMDR - 19%

Answer 10

Symptom exacerbation due to exposure therapy is extremely rare. <5% of clients show increase in PTSD symptoms. Among severe BPD clients receiving DBT + an exposure-based PTSD protocol: 0% showed an increase in PTSD symptoms. <10% had increase in suicide risk or urge to self-harm following exposure. suicide risk and self-harm may be lower than in standard DBT.

Answer 11

If exposure is too easy, it's less potent. less experienced, anxious clinicians less likely to do more difficult exposures

Answer 12

Perception of real threat and disappears when the danger is removed.

Answer 13

it is disruptively intense (excessive response) Responses are resistant to modification. it occurs when there is minimal risk of actual threat or danger.

Answer 14

A negative event is paired with a previously neutral object or situation

Answer 15

Observing another person be hurt or afraid in a specific situation.

Answer 16

being told that specific objects or situations are dangerous (by others or media)

Answer 17

Avoidance of things that elicit anxiety: internal cues - thoughts, memories, physical sensations, emotions external cues - people, places, objects, smells, situations

Answer 18

Anything that decreases anxiety, increases sense of safety, or alleviates uncomfortable physical sensations.

Answer 19

Problematic or unhelpful beliefs. Overestimation of the likelihood of negative outcomes. Overestimation of the severity of negative outcomes - they're going to laugh at me Negative beliefs about anxiety - It's dangerous to feel this anxious Negative beliefs about oneself - I can't handle feeling this way.

Answer 20

exposure --> reduction in fear of spiders --> reduction in fear of heights.

Answer 21

Avoidance --> unhelpful beliefs --> continued avoidance

Answer 22

Corrective learning: 1. Feared outcomes are unlikely to happen. 2. Negative outcomes are unlikely to be catastrophic. 3. Anxiety can be tolerated and decreases over time. 4. Able to cope effectively with stressful situations.

Answer 23

Goal = corrective learning Between-session habituation - lower anxiety at start point of each session. Within-session habituation - lower from beginning to end of session (does not correlate with out of session improvement)

Answer 24

Fear can't be destroyed, just suppressing it. Non-threat blocks threat expectancy --> if dog barks or snaps at you the fear might return Goal to help client automatically retrieve neutral meaning of stimulus *increase the accessibility of the non-threat meaning (practice in as many contexts as possible)

Answer 25

Focus on removing anxiety rather than being able to tolerate it

Answer 26

Have the client describe in present-tense, real time exactly what happened. "I woke up to the smell of smoke...etc." Questions to ask - How anxious are you? What's the chance the feared outcome will happen? How do you think you will be able to handle the feared outcome?

Answer 27

*De-emphasizing habituation as goal and moving toward inhibitory new structure.* Use it as a reverse compass --> when the urge tells us to pull away, pull the feared object closer. "Are we going to listen to the dictator all the time or take our life back?" Thank the "alarm" for being there and then ignore it.

Answer 28

1. Violate negative expectancies of harm. 2. de-contextualize inhibitory associations. - eliminate the rules around exposure (i.e. I can't do it because I'm not feeling well) 3. Promote distress tolerance. - increase ability to tolerate distress. 4. Promote self-efficacy.

Answer 29

1. Cue 2. Corrective learning 3. Response prevention - preventing hand washing after putting hand in toilet

Answer 30

Deliberate and planned exposure to a stimulus that elicits fear. Exposure to the feared stimulus is typically repeated across sessions as homework, prolonged (30-45 minutes)

Answer 31

Goal is "non-reinforced" exposure - as in no relief from anxiety Important to notice pre-avoidance behaviors (i.e. body tensing, slouching) Should occur in absence of actual threat. Safety can't be guaranteed but must ensure exposure tasks are minimal to low risk.

Answer 32

Must block avoidance and escape responses for new learning to occur Involves preventing overt and covert strategies of avoidance: cognitive (dissociation, distraction) emotional (numbing, secondary emotions) behavioral (not looking at the cue, leaving the exposure situation, compulsions and rituals) Block action urges and expression associated with problematic emotions (i.e. avoiding eye contact)

Answer 33

Clients are active collaborators in selecting exposure tasks. They are never forced into doing exposure tasks. They can choose not do do an exposure task. They can choose to stop in the middle of an exposure task --> use principle of "controlled escape" - encouraging clients to take a break and remain present in the exposure (i.e. briefly looking at the wall when they should be looking at a spider)

Answer 34

Exposure to the feared stimulus in real life Typically used for: People - strangers, people who resemble abusers. Places - crowded stores, hospitals, schools Things - animals, doorknobs, smell of beer, certain songs Activities - public speaking, being hugged, driving

Answer 35

Exposure to the feared stimulus in imagination Designed to counteract avoidance of thoughts, memories, and images that elicit fear. Clients typically describe the imagined situation out loud and record it Typically used for: post-traumatic events feared outcomes that can't be simulated in real life (i.e. burning in hell, contracting HIV) Distressing mental images (i.e. sexual abuse of children) As an early step in a fear hierarchy (i.e. imagining flying before getting on an airplane)

Answer 36

Exposure to feared physical sensations Designed to counteract avoidance of specific bodily cues that elicit fear. Most often used to treat panic disorder. Typically done via exercises that induce panic-type sensations: difficulty breathing (i.e. breathe through a straw) Increased heart rate (i.e. run in place) Dizziness (i.e. spin in a chair)

Answer 37

What will happen if _____? How will it be if _____? How likely is it that you will be able to handle it?

Answer 38

AI or virtual reality exposure

Answer 39

If I have the thought I will actually jump off the balcony.

Answer 40

1. Orienting clients to exposure treatment. 2. Assessment and hierarchy construction.

Answer 41

For the client to understand how and why their anxiety is not going away and is likely getting worse over time --> discuss the tradeoff, block the escape from discomfort so you can get the long-term benefits Key points: Anxiety is maintained by avoidance and unhelpful beliefs Unhelpful beliefs --> anxiety about situations that are not actually dangerous Avoidance only decreases anxiety in short-term

Answer 42

Because it prevents corrective learning

Answer 43

"Can we view anxiety as a sign we're moving in the right direction?" Things may get harder before they get easier It is normal to feel anxious during an exposure Anxiety during exposure is a sign that it is being done correctly Try not to resist or fight the anxiety, just allow the emotions to be there Anxiety is temporary!

Answer 44

Role as a coach or cheerleader DO's: help select and plan effective exposures provide instruction and encouragement as needed during exposures process exposures once they're done DON'Ts: Say much during exposure Show intense emotional responses during exposures Provide excessive reassurance and soothing

Answer 45

Provide clear/detailed description of treatment rationale. Spend sufficient time orienting. Avoid using jargon. Engage the client in a collaborative discussion. Validate and normalize the client's experience Assess the client's understanding. For exposure - have them do easiest one in session and assign for homework. If they only feel safe doing it in session with the therapist have them practice in different places at different times

Answer 46

Lecture or be overly didactic Minimize the difficulty of the exposure Suggest their behaviors are "bad" Overemphasize fear reduction (habituation) as the goal of exposure tasks. Guarantee safety or promise that feared outcomes will not occur during exposure task.

Answer 47

What are the specific stimuli that trigger anxiety?: feared situations intrusive thoughts, images, memories feared physical sensations What are the feared consequences of exposure to these triggers? What avoidance or safety behaviors are used to reduce anxiety?

Answer 48

A list of internal or external stimuli that are avoided because they cause anxiety. - typically 10-20 items that client must be willing to confront. Each item is rated using the SUDs scale (0-100) Can include in vivo, imaginal, and/or interoceptive exposure tasks Clients may have more than one hierarchy - 1 for fear of contamination via bodily fluids and 1 for fear of contamination via environmental toxins

Answer 49

consider varying: distance to stimulus (looking at vs. touching) stimulus intensity (vividness, number of stimuli present) Length of time in contact with the stimulus use of safety signals (presence of others) Contexts (time of day, location)

Answer 50

Be collaborative - involve client in identifying and selecting tasks. Be specific - "throw away clutter" vs. "sort and throw away mail on the dining room table" Each item on the hierarchy should have a clear rationale Be creative - don't limit yourself to what can be done in the office