Exposure txs

Question 1

Common elemnts of exposure

Answer 1

1. assessment
2. psychoed
3. prolonged exposure
4. processing

Question 2

2 basic paradigms of exposure tx

Answer 2

1. brief and graduated

2. prolonged and intense

Question 3

first 2 exposure txs (brief)

Answer 3

1. systematic desensitization

2. in vivo desensitization

Question 4

Examples of prolonged and intense exposure txs

Answer 4

• in vivo flooding
• imaginal flooding
• implosure therapy

Question 5

brief and graduated (description)

Answer 5

exposes clients to threatening events for short period of time and incrementally
- beginning w aspects of the events that produce minimal anxiety and progressing to more anxiety provoking aspects

Question 6

prolonged and intense (description)

Answer 6

exposes client to threatening events for a lengthy period of time at a high intensity from the outset

Question 7

Modes of exposure

Answer 7

1. In vivo - ACTUALLY exposed

2. Imaginal - vividly imagine scene

Question 8

Competing response

Answer 8

during exposure, client engages in a bx that competes w anxiety such as relaxing muscles while visualizing the anxiety-evoking event

Question 9

Response prevention

Answer 9

during tx, cl kept from engaging in the maladaptive avoidance or escape bxs typically used to reduce anxiety

Question 10

Exaggerated scenes

Answer 10

to heighten intensity or vividness or imaginal exposure

Question 11

Mechanisms of effect - systematic desensitization - Wolpe and counterconditioning

Answer 11

Brief/graduated exposure counters classical conditioned by associating the anxiety evoking event with relaxation or another anxiety competing response
- learn new assoc – anxiety event and competing response

Question 12

Limitation of counterconditioning

Answer 12

brief/grad works w/out competing response

Question 13

Mechanisms of effect - systematic desensitization - Wolpe and reciprocal inhibition

Answer 13

During brief/graduated exposure – cl’s anxiety (sympathetic) is inhibited by reciprocal or opposite physiological response ie relaxation (parasympathetic)
2 premises
1. first, anxiety increases and system is aroused
2. then relaxing stimulus starts to override it

Question 14

Mech of effect - systematic desensitization - extinction

Answer 14

pairing is broken in brief/graduated exposure when the cl is repeatedly exposed to the conditioned stimulus (speaking in class) in the absence of the unconditioned stimulus (being laughed at)

Question 15

Mech of effect - systematic desens - cog formulation

Answer 15

Self schema, shift in cognitive structure

• Thinking about situations more realistically
• Lead clients to expect that they will be less anxious
• Strengthen the clients’ beliefs that they are capable of coping with their anxiety

Question 16

Mech of effect - prolonged

Answer 16

• Operant extinction

- habituation process

Question 17

What is learned in systematic desensitization

Answer 17

CC does not entail acquisition of a new response

- but instead the connection of an existing response to a new stimulus

Question 18

Components of sys desens

Answer 18

1. Assessment
2. Relaxation training
3. Constructing an anxiety hierarchy
4. SUDS
5. Desensitization

Question 19

Factors affecting effectiveness of sys desens - facilitative

Answer 19

1. Repeated safe exposure to anxiety-evoking situations
2. In a gradual manner
3. While engaging in a competing response

Question 20

essential component for effectiveness for sys desens

Answer 20

= repeated exposure to anxiety evoking situations without the client experiencing any negative consequences (there are exceptions)

Question 21

desensitization can be effective when

Answer 21

• exposed to the highest items in the hierarchy first or only the highest items
• with or without relaxation

Question 22

Counterconditioning and aversive counterconditioning:

Answer 22

maladaptive bx paired with aversive stimulus to weaken the maladaptive bx response

Question 23

Coping desensitization

Answer 23

Goldfried

- Bodily sensations of anxiety are used to cue the cl to engage in coping response such as muscle relaxation

Question 24

Hybrid form of coping desensitization:

Answer 24

active-imaginal exposure –> physically perform coping response

Question 25

Coping desensitization differs from std in the following ways:

Answer 25

1. Cl stays w the scene 2. Instructed to use relaxation to cope - continues visualizing and thinking thoughts like "I am handling this" 3. Anx hierarchy does NOT need a common theme Rather than just terminate scene and relax, as in std desens

Question 26

Flooding

Answer 26

Generic name for prolonged/intense exposure bc cl is flooded w anxiety for prolonged period - NO feared consequences occur

Question 27

In vivo flooding

Answer 27

Prolonged/intense exposure to actual anxiety producing stimuli

Question 28

Essential component of in vivo flooding

Answer 28

exposure to highly anxiety-evoking situation long enough for client’s discomfort to peak then start to decline

Question 29

In vivo flooding can be used to treat

Answer 29

phobies, OCD, PTSD, AN, Body dysmorphic d/o

Question 30

Imaginal flooding

Answer 30

same basic principles and procedures w in vivo flooding except that exposure occurs in cl’s imagination - Adv = no restrictions on nature of situation

Question 31

Basic elements of imaginal flooding

Answer 31

- Clear, detailed visualization - Enhanced vividness by asking for multiple sensory modalities w as much detail as possible, using present tense, eyes closed

Question 32

characteristic of all exposure therapiest

Answer 32

cl experiences significant anxiety but feared consequences do NOT occur

Question 33

Emotional processing requirements of PE tx are..

Answer 33

based on the fear structure

Question 34

Fear structure

Answer 34

``` = program for escaping danger includes info about: 1. feared stim 2. feared response 3. meaning of stimuli and responses ```

Question 35

Emotional processing requires

Answer 35

1. Accessing the fear structure - so can see it isn't scary anymore - psychoed 2. Availability of corrective info along the way - avoiding a memory

Question 36

Processing of traumatic memories requires..

Answer 36

- repeated activation of the trauma memory | - incorporation of corrective info about the world and self

Question 37

activation of the trauma memory occurs via

Answer 37

confronting trauma reminders

Question 38

two primary procedures in PE

Answer 38

1. In vivo - ALL h/w - start w SUDS of 50-60 2. Imaginal - repeated ask cl to recall memory - present tense - eyes closed - as much detail as possible - repeat

Question 39

conceptualization of panic d/o

Answer 39

acquired fear of bodily sensations, particularly sensations associated w autonomic arousal

Question 40

Triple vulnerability theory

Answer 40

1. Genetic contributions 2. psychological vulnerability to experience anxiety characterized by diminished sense of control arising from early developmental experiences, and 3. early learning experiences or learned associations

Question 41

In panic d/o – the experience of certain somatic sensations becomes associated w

Answer 41

heightened sense of threat and danger

Question 42

Factors perpetuating fear in panic d/o

Answer 42

1. Fear conditioning, 2. avoidant responding 3. info processing biases

Question 43

Fear of fear

Answer 43

AKA anxiety focused on somatic sensations - refers to anxiety about certain bodily sensations associated w panic - maintenance factor in panic

Question 44

fear of fear attributed to TWO factors

Answer 44

1. Interoceptive conditioning - conditioned fear of internal cues - low level somatic sensations = conditioned stimuli 2. Catastrophic misappraisals of bodily sensations

Question 45

Components of panic d/o tx

Answer 45

- Education - self-monitoring (ESSENTIAL) - breathing retraining (de-emphasized lately) - applied relaxation - cognitive restructuring - targets misappraisals of bodily sensations - exposure (CRITICAL PHASE) - disconform misappraisals and extinguish conditioned responses

Question 46

types of exposure in panic tx

Answer 46

- in vivo - imaginal - interoceptive

Question 47

Barlow's model of panic

Answer 47

Psychological and biological predispositions enhance vulnerability to acquire fear - Triple Vulnerability Theory

Question 48

Triple vulnerability theory

Answer 48

Organization of interacting etiologies - bio - psych - experience

Question 49

Biological vulnerability

Answer 49

Genetic contributions to the development of anxiety and negative affect - temperament = neuroticism or proneness to experience negative affect - negative affectivity

Question 50

negative affectivity

Answer 50

closely linked construct that is the tendency to experience a variety of negative emotions across a variety of situations even in the absence of objective stressors

Question 51

psychological vulnerability

Answer 51

experience anxiety and related negative affective states, characterized by a diminished sense of control arising from early developmental experiences - anxiety sensitivity - fear of fear

Question 52

Learning experiences

Answer 52

early learning experiences in some instances seem to focus anxiety on particular areas of concern - hx of medical illness and abuse - introceptive awareness

Question 53

length of exposure - what is best?

Answer 53

longer = better

Question 54

Studies suggest that a single massed exposure is ____ effective than a series of short exposures of the same total duration

Answer 54

MORE

Question 55

most effective forms of exposure

Answer 55

tasks designed to violate expectancies for negative outcomes

Question 56

physiological habituation and/or the amount of fear reduction in an exposure trial is predictive of the overall outcome - True or false?

Answer 56

FALSE - tolerating fear/anxiety = more critical learning experience - focus = staying in situation until fear/anx subsides

Question 57

length of exposure trial = based on

Answer 57

conditions necessary for new learning | - NOT fear reduction

Question 58

learning is best measured by

Answer 58

the level of anxiety experienced the next time the cl encounters the phobic situation or at a some later time

Question 59

schedule of exposure practices - superior outcomes assoc w

Answer 59

schedule of progressively increasing duration b/w exposure trials in circumscribed phobias - begin wkly

Question 60

level of arousal assoc w superior outcomes

Answer 60

want cl to reach a peak then decline - this is when learning occurs

Question 61

associative model (for safety signals)

Answer 61

assumes that the negative associative strength of the inhibitory stimulus cancels out the positive associative strength of the excitatory stimulus - neg assoc of inhib > pos assoc of excitatory stim

Question 62

attributional model (for safety signals)

Answer 62

if subjects attribute the absence of an expected outcome to the inhibitory stimulus, then there is no reason to change the causal status of the excitatory stimulus - attribute absence of bad outcome to safety signal - eg meds

Question 63

exposure optimizes learning thru

Answer 63

extinction

Question 64

T or F - multiple contexts minimize context renewal effects

Answer 64

TRUE

Question 65

T of F - reminding cls of experiences in tx may offset return of fear

Answer 65

TRUE

Question 66

natural environ is helpful for

Answer 66

cog restructuring

Question 67

OCD tx w empirical support is referred to as

Answer 67

exposure/response prevention

Question 68

EX/RP txs incl both

Answer 68

1. prolonged exposures to obsessional cues AND 2. Procedures aimed at blocking rituals