Treatment

Question 1

• Empirically Supported Treatments

Answer 1

• Empirically Supported Treatments
• Therapies that have been shown to be effective through
  scientific clinical trials
• BT or CBTs

Question 2

Anxiety Disorders

Answer 2

• Normal adaptations to a
  dangerous world
• Emotions experienced in a
  maladaptive way
• Patients are fully aware of the
  irrationality associated with
  their behavior
• Key: The threat does not merit
  the response

Question 3

Phobias

Answer 3

• Involve animals that
  can be dangerous
• Involve situations (e.g.,
  heights) that can be
  dangerous
• Overgeneralization

Question 4

Systematic Desensitization

Answer 4

• A CS that elicits one type of response (e.g., fear)
  paired with another stimulus that elicits the
  opposite response (e.g., relaxation)
• Counter-conditioning; Reciprocal inhibition
• Positive response (relaxation) inhibits negative one
  (anxiety)
• Works well with specific phobias

Procedure
* Relaxation training (deep muscle relaxation;
hypnosis)
* Create of hierarchy of fears
* e.g., start with image of spider 20 meters away
progressively get closer and finally to touching the
spider
* Pair each item in the hierarchy with relaxation
* e.g., start with imagining least fearful situation (15 s)
then engage in relaxation; when fear is extinguished
move to next most fearful situation
* Imaginal or in vivo (visualizing vs actual experience)

Question 5

Flooding

Answer 5

• Prolonged exposure to feared stimulus allowing fear to
  extinguish (must be about 30-45 min or more)
• Because avoidance is prevented fear can extinguish
• Mainly in vivo but also imaginal
• Must be extremely careful due to potential for stress

Procedure
* Snake phobic individual
presents to clinic.
Treatment involves
prolonged, inescapable
exposure to the snake.
The person will initially
show considerable
distress but with time
the distress disappears
when nothing bad
happens in presence of
snake.

Question 6

Hybrid approaches (exposure
therapy)

Answer 6

• Most commonly used for treatment of
  phobias
• Öst (1989) In vivo exposure
• Ps asked to approach spider as close as possible
• Remain until anxiety dissipates by 50%
• Approach again etc.
• Each stage proceeds when fear reduced by 50%
• Of 20 Ps who underwent procedure 19 reported
  considerably less fear following 2.1 hours of
  treatment
• 18 reported complete recovery at 4 year follow up
  Participant Modeling
• Both client and therapist are participating together
  in feared situation
• Therapist models approaches to feared stimuli

Question 7

Panic Disorder and Agoraphobia

Answer 7

• Panic attacks
• Require at least 4 of following: (a) heart-rate abnormalities,
  (b) sweating; (c) trembling; (d) shortness of breath or feeling
  of being smothered; (e) feelings of choking; (f) chest pain or
  discomfort; (g) nausea or extreme abdominal discomfort; (h)
  dizziness or feeling light-headed or faint; (i) feeling of
  unreality; (j) numbness or tingling sensation; (k) chills or hot
  flushes; (l) fear of going crazy or losing control; and (m) fear
  of dying.
• Cognitive Behavioral Treatment
• Behavioral component – exposure (in vivo)
• Cognitive component – changing client’s misconception about
  panic attacks

Question 8

Generalized Anxiety Disorder

Answer 8

• Most effective treatments combine cognitive and
  behavioral strategies
• Exposure an efficient form of behavioral treatment:
• Teach client relaxation techniques
• Client uses start of worrying as signal to relax
• Cognitive techniques can be used to challenge and
  change client’s beliefs and thoughts

Question 9

Posttraumatic Stress Disorder

Answer 9

• Symptoms include:
• Re-experiencing the intense fear that occurred during the
  trauma
• Exhibiting other intense psychological reactions like:
  heightened arousal, depression, difficulty sleeping, lack of
  concentration, and impaired daily functioning
• Impaired functioning may be due to attempts to avoid
  thinking about the trauma and to avoid stimuli that are
  reminders of the event.
• Prolonged exposure treatment
• Imagination
• Talking about event
• Writing about event
• Combination of cognitive restructuring and exposure

Question 10

Obsessive-Compulsive Disorder
(OCD)

Answer 10

• Persistent thoughts, impulses (obsessions)
• Repetitive behaviors (compulsions)
• Compulsive behaviors performed the alleviate obsessions
• Cleaning & checking = 2 most common forms of OCD
• Obsessions & compulsions – opposite effects on anxiety
• Obsessions increase anxiety
• Compulsions decrease anxiety
• Role of avoidance in OCD similar to phobias
• OCD – active avoidance (e.g., showering to reduce anxiety)
• Phobia – passive avoidance response (e.g., avoid going near dogs)

Question 11

• People with OCD often can’t recall conditioning
  event that led to response
• Often believe they should be in complete control of
  thoughts
• Feel personally responsible for improbable events

Answer 11

• People with OCD often can’t recall conditioning
  event that led to response
• Often believe they should be in complete control of
  thoughts
• Feel personally responsible for improbable events

Question 12

OCD treatment

Answer 12

• Compulsions (e.g., hand washing) maintained by
  avoidance of anxiety evoking event (e.g., contact with
  germs)
• Exposure & response prevention (ERP therapy)
• Prevention of avoidance response should extinguish
  behavior
• ERP – prolonged exposure to anxiety provoking stimulus;
  prevention of compulsive behavior
• Gradual exposure of systematic desensitization
• Prolonged flooding
• Cognitive Therapy
• Used to change self statements clients makes that help
  maintain the obsession
• Example:
• Person begins by touching objects associated with
  moderate anxiety (e.g., door handles) and
  progresses to objects associated with more intense
  anxiety (e.g., toilet bowl). Client not permitted to
  engage in compulsive acts (e.g., hand washing).
  After prolonged session (e.g., 90 mins) anxiety
  begins to extinguish.

Question 13

Depression

Answer 13

• 2 major theories
• Cognitive theory: results from core beliefs (schemas)
  that lead to negative interpretations of life events
• Behavioral activation: imbalance of punishment to
  positive reinforcement
• Most support for
• BT
• CT
• Prob-solving Treatment

Question 13

Depression

Answer 13

• 2 major theories
• Cognitive theory: results from core beliefs (schemas)
  that lead to negative interpretations of life events
• Behavioral activation: imbalance of punishment to
  positive reinforcement
• Most support for
• BT
• CT
• Prob-solving Treatment

Question 14

Depression treatments

Answer 14

• Behavioral interventions:
• Increasing contingency reinforcers in individuals’ lives
• Encourage clients to seek out reinforcers through
  hobbies and various social activities
• Involve significant others in reinforcement
• Cognitive Interventions – Beck’s Cognitive Therapy
• Negative cognitive schemas lead to negative
  interpretation of life events, which lead to depressed
  behavior
• Cognitive restructuring a key component
• Homework includes behavioral activities
• Behavioral activation – behavioral homework
  assignments that are aimed at increasing
  contingency reinforcers
• ACT also works effectively

Question 15

Alcohol & Substance Abuse

Answer 15

• Over 9% of the US population 12 years and above
  are addicted to substances other than nicotine
• Of these, less than 10% receive any treatment for their
  addictions
• Very few receive EST
• Behavioral Couple Therapy
• Teach partner without substance abuse issue to prompt
  and reinforce nondrinking behavior
• Behavioral contracts earning reinforcers to staying sober
• Moderate drinking for alcohol-use disorders
• Modest research support
• Learn to drink in moderate
• Control triggers (SDs)
• Learn problem-solving skills to avoid high risk
  siutaitons
• Engage in self-monitoring to detect triggers and
  maintain consequences
• Contingency management
• Measure abstinence (e.g., Breathalyzers)
• Provide reinforcers strong enough to compete
  with the substance
• Money, vouchers, etc.

Question 16

Behavioral programs have utilized

Answer 16

• Motivational interview
• Therapist asks client questions, the answers for which
  act as motivational establishing operations for change
• Functional analysis
• Identify antecedents and consequences
• Coping-skills training
• Teach clients to deal with stressors that may lead to
  excessive alcohol consumption
• Contingency contracting – provide reinforcers
• Relapse prevention strategies using self-control

Question 17

Eating disorders

Answer 17

• Bulimia, anorexia, binge eating disorder, and
  obesity
• Family-based treatments (anorexia)
• CBT as having strong research support for bulimia
• CBT and interpersonal psychotherapy as having
  strong research support for binge eating disorder
• Behavioral weight-loss treatment as having strong
  research support for the treatment of obesity

Question 18

Couple Distress

Answer 18

• At least one person in a relationship is experiencing
  dissatisfaction with the relationship
• Underlying assumption: more negative than positive
  interactions or communications in the relationship
• Behavioral couple therapy includes:
• Instigation of positive exchanges – increasing behaviors that
  are pleasant to partner
• Communication training – teaching how to express thoughts
  and feelings; teaching to be an effective listener
• Problem-solving training – learn to use communication skills
  to identify and solve problems
• Program generality – look for signs of relapse and use skills
  learned
• May include acceptance skills

Question 19

Sexual Dysfunction

Answer 19

• Several types:
• Inability to have an erection
• Premature ejaculation
• Vaginismus
• Dyspareunia (genital pain)
• Inhibited orgasm
• Low sex drive
• Hypothesis that anxiety is a factor in sexual
  dysfunction

Question 20

Sexual dysfunction

Answer 20

• Exposure programs appear most effective
• Masters and Johnson (1970)
• Couple engage in pleasurable stimulation
• Relaxation, no pressure for orgasm
• Sensate focuw – focus on sensations of contact with
  other rather than orgasm
• Goal is pleasure not performance
• Need to be cautious about being overly simplistic view
  of the problem because there ar emany potential causes
• Therapists should use range of assessments first before
  treatment

Question 21

Habit Disorders

Answer 21

• Repetitive behaviors that are inconvenient and
  annoying
• Nail biting, lip biting, etc.
• Habit reversal – Three step program:
  1.Client learns to describe and identify problem behavior
  2. Client leans and practices a behavior that is
  incompatible with or competes with problem behavior
• Client practices competing behavior daily in front of mirror and
  engages in it immediately after the occurrence of the problem
  behavior
  3. For motivation, the client reviews the inconvenience
  caused by disorder, records and graphs the behavior, and
  has a family member provide reinforcement for engaging
  in treatment