1. Exposure Therapy & Aversive Therapy Lecture 18

2. Exposure Therapies n For fear/anxiety & other negative CERs l Intense, maladaptive, or inappropriate l Some strong fears adaptive n Based on Extinction l Fear-provoking events (CS+) l Safe environment (no US) ~

3. Exposure Therapies Models n Brief/graduated exposure therapy l Short exposure periods l Gadually increase intensity of CS n Prolonged/intense l Lengthy exposure periods l Immediate exposure to intense CS n Mode of exposure on continuum l Imaginal ---------------------- in vivo ~

4. Exposure Therapies:Techniques n Direction of therapy l Therapist directed l Self-managed n Additional procedures l Competing responses l Response prevention l Exaggerated scenes ~

5. Systematic Desensitization n Brief/Graduated Exposure Therapy l Fear & relaxation incompatible l Developed by Wolpe n 3 components l Relaxation Training l Fear Hierarchy l Graded Pairing ~

6. Systematic Desensitization n Relaxation Training l Identify & tense muscle groups l Relaxing the muscle groups n Fear Hierarchy l List of fear-provoking situations l Rank from least to most intense n Graded Pairing l CS for fear with muscle relaxation l Thru hierarchy: lowest  highest l In vivo vs. Covert desensitization ~

7. Systematic Desensitization: Other competing responses n Emotive imagery l Pleasant thoughts replace fear n Humor/laughter l No learning required l Coping with disease ~

8. Systematic Desensitization: Other Target Behaviors n Anger n Asthmatic attacks n Insomnia n Motion sickness n Nightmares n Problem drinking n Sleepwalking n Speech disorders n Body image disturbances n Racial Prejudice

9. Systematic Desensitization: Theoretical Explanations n Counterconditioning l Substitution of competing response n Reciprocal inhibition l Neurophysiological processes l Parasympathetic vs Sympathetic n Extinction l Cues present but no danger (US) n Cognitive factors ~

10. Flooding n Prolonged/Intense Exposure Therapy l Also called implosive therapy l In vivo or imaginal n Treatment for l Phobias l Obsessive-compulsive disorder l Post-traumatic stress disorder l Agoraphobia ~

11. Flooding n Aversive CS  escape/avoidance l Limits opportunity for extinction n Confront individual w/ fear- provoking situations/ images l No relaxation l Not graded l Extinction process n Potential for intensifying fear ~

12. Modeling n Vicarious learning l Observing therapists encounter with fear-provoking stimuli l e.g., Peter watching other child handle rabbit n Extinction of fear response l Observe absence of danger ~

13. Modeling n Participant modeling l Or Guided participation n Construct fear hierarchy l Start with least feared stimulus l Therapist experiences first l Then client ~

14. Aversive Therapy n Punishment of target behaviors l Instrumental conditioning l R  aversive stimulus l E.g., chronic vomiting  shock n Problems l Avoidance of therapy (drop out) l Disruptive CERs l  punishment of others l Ethics concerns ~

15. “More Acceptable” Punishers n Snap rubber band on wrist n Cigarette smoke n Bitter substance n Water mist sprayed in face n Loud noise n Mild mouthwash n Trichotillomania (Pulling out hair) n Compulsive eating n Nail biting n Face slapping n Bruxism n Biting other children Target Behavior Punisher

16. Aversive Therapy: Covert Sensitization n Classical & instrumental conditioning n Use of imaging l Therapist describes behavior l & aversive outcome n Advantages l Safe & more acceptable to clients l Clients can self-administer in vivo n Effectiveness equivocal ~