Interventions based on Classical Extinction

Question 1

**Two Factor Theory of Learning **

Mowrer

Answer 1

2 factor theory of learning:

• development of a phobic response is the result of both classical and operant conditioning.
  
  • anxiety reaction due to a neutral stimulus ‘dog’ (CS) paired with a stimulus (US) that naturally elicits anxiety or other aversive response (classical conditioning).
  • When you avoid the CS because doing so enables them to avoid anxiety (negative reinforcement).
• repeatedly expose client to the conditioned stimulus w/o the US while inhibiting their usual avoidance response in order to extinguish the client’s conditioned response.

Question 2

In Vivo Exposure with Response Prevention

Answer 2

In Vivo Exposure with Response Prevention

1. exposed to ‘real life’ ansitey-arounsing stimului for a prolonged period of time and prohibited from mamking usual avoidance or anxiety-reducing response.
2. OCD: obesssional cue (dirt on hands) but can’t wash 8 times.
3. FLOODING:
   
   1. exposure to the most anxiety or fear arousing stimuli for a prolonged time;
4. _Graduated (graded) Exposure: _
   
   1. exposure begins with situations that produce minimal anxiety and then gradually progresses that evoke more intense intense anxiety.
   2. helpful for reducing the fear and avoidance that may be caused by initial exposure to high-anxiety arousing situations.

EVALUATION OF TREATMENT

• exposure to the distressing stimulus and response prevention are both essential to treatment.
• prolonged continuous (massed) exposure to the anxiety-arousing stimulus is more effective than several brief exposures.
• high-anxiety provocation during exposure may not be necessary for successful treatment outcome. (use of tranquilizers during exposure may actually enhance the effectiveness of exposure)
• self-directed exposure (with training) is as effective as therapist-directed exposure.
• group exposure can be as effective as individual treatment.
• partner-assisted exposure is effective with agoraphobie and OCD
• Interoceptive exposure effective for panic attacks, PTSD.
  
  • use of strategies that are designed to evoke the feared bodily cues that are associated with fear and anxiety reactions (spinning in a chair, breathing into a bag).
  • By removing the fear of a panic attack happening whenever the person is exposed to a stimulus that has become a precursor to the attack, interoceptive exposure lessens the occurrences of attacks in patients who have received treatment. In short, interoceptive exposure seeks to remove the “fear of fear”, where the attacks happen because of the fear of actually having an attack.[1]Interoceptive exposure can be contrasted with in vivo exposure, which exposes the person directly to a feared situation.

Question 3

Implosive Therapy

Answer 3

**Implosive Therapy (Stamplf): **

• Like In Vivo w/Response Prevention, Implosive Therapy is based on the assumption that certain events (conditioned stimuli) are consistently avoided to reduce anxiety ant that prolonged exposure to those events w/o the unconditioned stimulus will produce extinction of the anxiety response.
• Imagined and presents the feared stimulus vividly enough so as to arouse high levels of anxiety (spider in mouth).
• images used during implosive therapy are embellished with psychodynamic themes, i.e. snake phobia imagined with a sex scene.
• implosion therapy anxiety is aroused by only imagining the simuli (without direct contact). Further, implosive therapy involves imagined scenes that are often exaggerated by a therapist and often relate to the client’s most feared fantasy. Finally, the anxiety that is provoked during implosive therapy is often addressed using psychodynamic approaches (e.g., addressing an oral fixation).
• Research on implosive therapy is mixed and the therapy may only temporarily reduce fears and anxiety.

Question 4

EMDR

eye movement desensitization and reprocessing

Answer 4

EMDR (Shapiro):

• exposure to a trauma can block a neurophysiological adaptive infomation-processing mechanism.
• combines rapid lateral eye movements with exposure and other techniques drawn from cognitive, behavioral, and psychodynamic approaches.
• effective for PTSD, but not the eye movement part.
  
  • eye movements are unnecessary and the EMDR may be viewed as an imaginal exposure technique