Download Convert

Exposure Therapy
&
Aversive Therapy
Lecture 18
Exposure Therapies
For fear/anxiety & other negative CERs
 Intense, maladaptive, or
inappropriate
 Some strong fears adaptive
 Based on Extinction
 Fear-provoking events (CS+)
 Safe environment (no US) ~

Exposure Therapies Models
Brief/graduated exposure therapy
 Short exposure periods
 Gadually increase intensity of CS
 Prolonged/intense
 Lengthy exposure periods
 Immediate exposure to intense CS
 Mode of exposure on continuum
 Imaginal ---------------------- in vivo ~

Exposure Therapies:Techniques
Direction of therapy
 Therapist directed
 Self-managed
 Additional procedures
 Competing responses
 Response prevention
 Exaggerated scenes ~

Systematic Desensitization
Brief/Graduated Exposure Therapy
 Fear & relaxation incompatible
 Developed by Wolpe
 3 components
 Relaxation Training
 Fear Hierarchy
 Graded Pairing ~

Systematic Desensitization
Relaxation Training
 Identify & tense muscle groups
 Relaxing the muscle groups
 Fear Hierarchy
 List of fear-provoking situations
 Rank from least to most intense
 Graded Pairing
 CS for fear with muscle relaxation
 Thru hierarchy: lowest highest
 In vivo vs. Covert desensitization ~

Systematic Desensitization:
Other competing responses
Emotive imagery
 Pleasant thoughts replace fear
 Humor/laughter
 No learning required
 Coping with disease ~

Systematic Desensitization:
Other Target Behaviors






Anger
Asthmatic attacks
Insomnia
Motion sickness
Nightmares
Problem drinking




Sleepwalking
Speech disorders
Body image
disturbances
Racial Prejudice
Systematic Desensitization:
Theoretical Explanations
Counterconditioning
 Substitution of competing response
 Reciprocal inhibition
 Neurophysiological processes
 Parasympathetic vs Sympathetic
 Extinction
 Cues present but no danger (US)
 Cognitive factors ~

Flooding
Prolonged/Intense Exposure Therapy
 Also called implosive therapy
 In vivo or imaginal
 Treatment for
 Phobias
 Obsessive-compulsive disorder
 Post-traumatic stress disorder
 Agoraphobia ~

Flooding
Aversive CS  escape/avoidance
 Limits opportunity for extinction
 Confront individual w/ fearprovoking situations/ images
 No relaxation
 Not graded
 Extinction process
 Potential for intensifying fear ~

Modeling
Vicarious learning
 Observing therapists encounter
with fear-provoking stimuli
 e.g., Peter watching other child
handle rabbit
 Extinction of fear response
 Observe absence of danger ~

Modeling
Participant modeling
 Or Guided participation
 Construct fear hierarchy
 Start with least feared stimulus
 Therapist experiences first
 Then client ~

Aversive Therapy
Punishment of target behaviors
 Instrumental conditioning
 Raversive stimulus
 E.g., chronic vomiting  shock
 Problems
 Avoidance of therapy (drop out)
 Disruptive CERs
  punishment of others
 Ethics concerns ~

“More Acceptable” Punishers
Punisher
Target Behavior






Trichotillomania
(Pulling out hair)
Compulsive eating
Nail biting
Face slapping

Bruxism
Biting other children





Snap rubber band
on wrist
Cigarette smoke
Bitter substance
Water mist
sprayed in face
Loud noise
Mild mouthwash
Aversive Therapy:
Covert Sensitization
Classical & instrumental conditioning
 Use of imaging
 Therapist describes behavior
 & aversive outcome
 Advantages
 Safe & more acceptable to clients
 Clients can self-administer in vivo
 Effectiveness equivocal ~
