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Chapter 9: Brief/Graduated Exposure Therapy
PSYC D CBT Chapter 9
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About exposure therapies…
Used to treat fears and anxieties Other intense emotional reactions These reactions are maladaptive: extreme or inappropriate Goal is not necessarily to eliminate fears--rather, the aim is to make them adaptable PSYC D CBT Chapter 9
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About exposure therapies…
Two categories: Brief and graduated Short exposures (less than 5 min) Transition to situations that produce increasing levels of anxiety (tackle easiest problems first) PSYC D CBT Chapter 9
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About exposure therapies…
2. Prolonged and intense Longer exposures (15+ min) Situations that produce maximum fear and anxiety Little or no graduation Form of exposure may be in vivo (actual) or imaginal (visual/verbal) PSYC D CBT Chapter 9
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Systematic Desensitization (Wolpe, 1958)
Imagining anxiety producing situations while engaging in a competing behaviour Usually deep muscle relaxation Training in competing behaviour Constructing an Anxiety Heirarchy Visualization of anxiety producing behaviours while performing competing response PSYC D CBT Chapter 9
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Muscle Relaxation Frequently used as a competing response
Progressive: learning to relax various muscle groups Using a “tension-and-release” technique Eventually relaxing without tension Can be done in the office or at home Relaxation alone may be effective PSYC D CBT Chapter 9
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The Anxiety Hierarchy List of increasingly fear-inducing behaviors is generated using a fear survey schedule Subjective Units of Discomfort (SUDs): scaling Intra-individual usefulness only PSYC D CBT Chapter 9
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Desensitization Process
Shifting from relaxation to guided imagery of the anxious situation 10 to 15 seconds Client creates image and determines anxiety level, if any Reversion back to relaxation if there is excessive anxiety or discomfort Raising a finger PSYC D CBT Chapter 9
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Other particulars… Therapy is relatively brief
Exposure alone with no relaxation can also be effective (extinction) Graduated exposure may not be necessary Competing responses and other target behaviours may be used PSYC D CBT Chapter 9
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Generalized Anxiety Desensitization approaches can be used to cope with Generalized Anxiety or Panic Disorder Bodily sensations, not anxiety producing situations, are replaced Cognitive restructuring: Anxiety induces relaxation response PSYC D CBT Chapter 9
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Why does it work? (Classical) Counterconditioning
Reciprocal Inhibition Parasympathetic and sympathetic NS Extinction Cognitive Factors (Restructuring) Nonspecific Factors (Reactivity) PSYC D CBT Chapter 9
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The Power of Imagery We do not respond to situations themselves, but to the representation of those situations The more vivid the image, the more effective and efficient the therapy Combined in vivo, verbal and imagery based approaches PSYC D CBT Chapter 9
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