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Exposure Therapy -9

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exposure therapy
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are used to treat anxiety, fear, and other intense m=negative emotional reactions such as anger by exposing the clients under-carefully controlled and safe conditions- to the situations or events that elicit the emotional reactions
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anxiety
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– it becomes problematic when its intensity is disproportionate to the actual situation and it inteferes with normal, everyday functioning – is frequently treated with systematic desensitization
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exposure therapy process
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– paradigm of exposure (brief/ graduated exposure therapy & prolonged/ intense exposure therapy) – mode of exposure (vivo exposure, imaginal exposure, virtual reality, imaginal end) – additional procedures (competing responses, response prevention, exaggeration scenes) – administration of exposure
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virtual reality
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allows clients to be exposed to anxiety provoking events through interactional computer stimulations that appear almost real
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exposure therapy additional procedures
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– competing responses – response prevention exaggeration scenes
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competing responses
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during exposure, the client engages in a bx that competes with anxiety such as relaxing muscles while visualizing an anxiety provoking event
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response prevention
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during treatment, the client is kept from engaging in the maladaptive avoidance or escape bx’s he or she typically uses to reduce anxiety such as washing hands
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exaggeration scenes
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to heighten the intensity or vividness of imaginal exposure, the depiction of the event may be exaggerated
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administration of exposure
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– exposure can be either therapist-administered in therapy sessions or self managed by the client outside of the therapy sessions – both methods can be used
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joseph wolpe
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developed systematic desensitization over 50 years ago
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systematic desensitization
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– was the first exposure therapy and the first major BT – the client imagines successively more anxiety arousing situations while engaging in a behaviour that competes with anxiety i.e. skeletal muscle relaxation – the client gradually (systematically) becomes less sensitive (desensitized) to the situations – is more effective than both no treatment and every psychotherapy variant and the treatment effects are durable
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elements to systematic desensitization
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– the therapist teaches the client a response that competes with anxiety – the specific events that cause anxiety are ordered in terms of the amount of anxiety the engender – the client repeatedly visualizes the anxiety evoking events, in order of increasing anxiety, while performing the competing response
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deep muscle relaxation
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– is the most frequently used competing response in systematic desensitization
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muscle relaxation
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– counters some of the physiological components of anxiety, including increased muscle tension, heart rate, blood pressure and respiration
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progressive relaxation
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– involves relaxing various skeletal groups: arms, face, neck, shoulders, chest abdomen, and legs – used in systematic desensitization – is an abbreviated version of edmund jacobson – clients first learn to differentiate relaxation from tension by tensing and then releasing each set of muscles – then they learn to induce relaxation without first tensing their muscles – also used to treat a host of psychological and phsycial problems
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anxiety hierarchy
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– is a list of specific events that elicit anxiety in the client, ordered in terms of increasing levels of anxiety – clients often with their therapist assistance, identify a number of specific, detailed scenes that would make them anxious and then order the scenes from highest to lowest anxiety evoked – generally consist of events that share a common theme
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desensitization anxiety evoking events
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begins as soon as the client has learned progressive relaxation (or competing response) and has constructed an anxiety hierarchy – the scenes are described in detail and are specific to the client
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aim of relaxation
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to replace the anxiety previously associated with the scene each scene in the hierarchy is presented repeatedly until the client reports little or no discomfort client uses SUDs to report the degree of anxiety they feel while visualizing
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features of systematic desensitization
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– before presenting scenes from the hierarchy, the therapist assessed if the client was deeply relaxed by presenting a neutral scene – the scenes from more than one hierarchy were visualized in the same session – the therapy was relatively brief
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two components of therapy
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– essential and facilitative component
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essential component
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– is a procedure that is necessary for the therapy to effective, the therapy will not work without it – isolated by systematically omitting components and then comparing the abbreviated treatment with the full treatment – if abbreviated treatment is shown to be effective as the complete one then the missing component is not essential
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facilitative component
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– is a procedure that is not always necessary but that may enhance the therapy’s effectiveness and efficiency – gradual exposure and engaging in a competing response
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major components of systematic desensitization
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– repeated safe exposure to anxiety evoking situations without experiencing negative consequence – in a gradual manner (gradual exposure) – while engaging in a competing response, are facilitative components
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deep muscle relaxation
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not always the most appropriate competing response
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emotive imagery
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-employs pleasant thoughts to counter anxiety and often is used with children
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systematic desensitization model treatment
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– is applicable to diverse problems, including anger, complicated grief, asthmatic attacks, insomnia, motion sickness, nightmares, problem drinking, sleep walking, speech d/o, and body disturbances
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group hierarchy
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– is constructed, which combines information from each client
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group desensitization
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– requires less therapist time, and sharing similar problems and solutions can be beneficial for clients
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standard desensitization
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anxiety associated with specific events is replaced with a competing response
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coping desensitization
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– a variation developed by Marvin Goldfried – the bodily sensations of anxiety are used to cue the client to engage in a coping response such as muscle relaxation – is a prime example of the self control approach that is inherent in many therapies – the anxiety hierarchy need not have a common theme, as it often does in standard desensitization
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coping response
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– muscle relaxation – visualizing themselves – praying
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active imaginal exposure
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– a hybrid form of coping desensitization – has clients physically perform coping responses while imagining the feared stimulus
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anxiety management training
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– developed by richard suinn and frank richardson – is a variant of coping desensitization in which clients learn to use feelings as cues t begin relaxing or to use emotive imagery – is highly structured and brief and does not employ an anxiety hierarchy – is used to treat anxiety d/o it has been applied to other negative emotions, including anger associated with road rage
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panic disorder
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– is characterized by repeated, unexpected and sudden attacks of intense apprehension and terror, which are accompanied by physical symptoms such as shortness of breath, dizziness, heart palpitation, and chest pain – are hypersensitive to bodily sensations that can trigger a panic attack
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interoceptive exposure
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– in which the bodily sensations associated with panic attacks are artificially induced while the client visualizes panic evoking events – clients cope with their anxiety by viewing the situation and sensations in a less threatening manner – is a treatment package that artificially induces the bodily sensations the client experiences while gradually visualizing panic inducing events – has been incorporated into treatment packages for post traumatic stress disorder and substance abuse – successfully modified to fit the cultural beliefs and culture-specific symptom interpretations of cambodian refugees
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interoceptors
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are specialized nerve receptors that respond to sensations in internal organs
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breathing retraining
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which involves diaphragmatic breathing that results in slow, steady inhalations and exhalations to combat hyperventilation that is often associated with panic attacks
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efficiency of systematic desensitization
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– exposure to problematic situations in one’s imagination is less time consuming than in vivo desensitization – compared with traditional psychotherapist that treat anxiety d/o, systematic desensitization requires relatively few sessions – the procedures can be adapted for groups of clients
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desensitization
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can be automated by using tape recorded instructions, written instructions, or computer programs
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self administered desensitization
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is used infrequently because of it’s limitations especially for clients who are extremely anxious or who have problems following the standard procedures such as difficulty visualizing scenes
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in vivo desensitization
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– is systematically desensitization except that the client is exposed to the actual feared event rather than imagining it – clients often employ muscle relaxation to compete with their anxiety as they progress through their anxiety hierarchy
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differential relaxation
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– clients to relax all their muscles that are not needed to engage in the actions they are performing and to tense the required muscles only as much as is needed
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in vivo desensitization competing response
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pleasant images, laughter, and sexual arousal and sometimes the presence of the therapist
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body dysmorphic disorder
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preoccupation with a perceived physical defect that is not noticeable to others
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self managed in vivo desensitization
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– is used more frequently and usually a part of a treatment package – involves having the client gradually apply less makeup and get physically closer t people at work when she talked to them – this is an example of ____
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telephone administered therapy
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beneficial for clients who are housebound or who live far from the therapist
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virtual reality
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– computer generated virtual reality technology – computer generated view of a virtual reality environment – clients experience is almost real as if they were in the actual situation
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virtual reality exposure therapy
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– is as effective or more effective than in vivo treatment -the scenes are equivalent to actual scenes – used to treat a variety of phobias including fear of flying, fear of heights, fear of spiders, claustrophobia (fear of enclosed spaces) and social phobia – being tested for post-traumatic stress disorder in military personal who have served in combat – the therapist add and subtracts various elements depending on the needs of the client
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exposure therapy through virtual iraq
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– for posttraumatic stress d/o – an advantage is that it will be a treatment for combat veterans and advertised as a post combat re-integration training rather than therapy
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benefits of virtual reality therapy
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– has the ability to expose clients to anxiety evoking situations that they could not be exposed to in vivo for practical and ethical reasons (such as combat) and the savings in time compared with in vivo desensitization
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elements of brief/graduated exposure reduce anxiety
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– counterconditioning (learning & maintained through classical conditioning ) – reciprocal inhibition (physiological responses) – extinction (learning & maintained through classical conditioning) – cognitive factors – nonspecific factors
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counterconditioning
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– part of wolpe’s original theory of counterconditioning process – an adaptive response (feeling relaxed) is substituted for a maladaptive response (anxiety) to a threatening stimulus – assumes that anxiety is developed by classical conditioning
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reciprocal inhibition
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– a neurological physiological explanation – involves the autonomic nervous system (sympathetic which are the physical symptoms and parasympathetic which are relaxation) – the clients anxiety (sympathetic) is inhibited by a opposite physiological response relaxation (parasympathetic)
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extinction
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– involves terminating reinforcement – biochemical changes occur during this process, which result in fear reduction
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cognitive factors
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– the safe exposure to anxiety arousing situations may result in clients thinking about the situations more realistically which renders the situations less threatening – exposure leads clients to expect that they will be less anxious than they had assumed they would be when exposed the anxiety evoking events – the exposure may strengthen clients beliefs that they are capable of coping with their anxiety
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non specific factors
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– elements common to all forms of therapy – this alone this not account for the effectiveness of the therapy
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brief and graduated
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– were the first exposure therapies to be developed – started with systematic desensitization and then vivo desensitization – the clients is gradually exposed t increasingly threatening events for short periods – employed by competing response for anxiety usually muscle relaxation; however, recently competing response have being omitted – results, the clients levels of distress is minimized
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prolonged/ intense exposure
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the client is exposed all at once to highly threatening events for a lengthy period
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steps to systematic desensitization
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– the client learns the competing response, most often muscle relaxation – the client and therapist construct an anxiety hierarchy, which is a list of events ordered in terms of increasing levels of anxiety they elicit – the clients visualizes the anxiety evoking events in hierarchy, beginning at the low end while performing the competing response. if the client experiences anxiety while visualizing a scene, the client stops the visualizing and relaxes
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variations of systematic desensitization
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include competing responses other than muscles relaxations, target behaviours other than anxiety (such as anger), group desensitization and coping desensitization in which the clients use bodily sensations of anxiety as cues to relax and cope with an anxiety evoking event