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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 Raversive 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 ~