CBTexposure interventions
MSW: SOW 6931Lecture
START
1. Introduction
2. Evidence-Based Practice
INDEX
3. Emotional Processing Theory
4. Steps
5. Conclusion
01
INTRODUCTION
Exposure is the process where one confronts a feared stimulus or situation in a controlled and systematic way. Often, the response to feared stimuli or situations is to simply avoid them. While providing temporary relief, avoidance can actually cause the fear to become more intense over time, which is often the case for many clients who come in to therapy for phobias.
Example
SOLUTION
- Prolonged contact with a feared situation (e.g. Jan spending a few hours a day at the job site) can aid in helping clients understand that anxiety doesn’t have to be enduring.
- Over time people find that their reactions to feared stimuli or situations decrease (i.e., habituation) or the association between feared stimuli or situations and distress subside (i.e., extinction) after prolonged exposure.
02
EVIDENCE-BASED PRACTICE
Exposure therapy has been known to help with:
- Phobias
- Panic Disorder
- Social Anxiety Disorder
- Obsessive-Compulsive Disorder
- Postraumatic Stress Disorder
- Generalized Anixety Disorder
03
EMOTIONAL PROCESSING THEORY
The cognitive structure contains information of the feared stimuli, the fear responses, and the meaning attached to both the feared stimuli and the response to those stimuli.
Exposure therapy is based on Emotional Processing Theory (EPT; Foa and Kozack, 1986), and goes beyond classical and operant conditioning to explain that fear is acquired, maintained, and modified through exposure.According to EPT, the fear is represented in memory as a cognitive structure.
Info
There are several steps in exposure therapy:
STEP 1: Conduct a functional analysis of the behavior. Share your conceptualization with the client. View a list of questions you can ask about the antecedents:
04
+ INFO
STEPS TO EXPOSURE THERAPY
View a list of questions you can ask about the episode:
+ INFO
STEP 2: Orient the client to exposure therapy. Educate your client about exposure therapy. Provide a rationale for using exposure therapy.
STEP 3: Select Appropriate Intervention. There are a number of different exposure interventions. The most common are:
IN VIVO EXPOSURE
Involves actual or real-life contact with a feared stimulus or situation.
INTEROCEPTIVE EXPOSURE
Involves deliberately bringing on physical sensations that are harmless, but part of a feared stimulus or situation.
Involves vividly imagining the feared stimulus or situation.
IMAGINAL EXPOSURE
Do you remember when we discussed Jan and the rebar at the beginning of this lecture? Let’s look at Jan using these different types of exposure.
Imaginal Exposure
You would guide Jan through various cognitions involving her directly confronting her fear (i.e., using her imagination and describing the event); so that she may imagine being at the construction site when the accident happened.
You would continue by having Jan encounter the fear in a real life situation, such as actually traveling to a construction site with rebar.
In Vivo Exposure
Ask Jan to experience the physical sensation she feels when she is at the job site. You may ask her to jog in place to increase her heart rate.
Interoceptive Exposure
Watch this video to learn more about exposure therapy.
STEP 4: Consider pace, schedule, and duration for Exposure. Exposures can be paced in a number of ways:
Systematic Desensitization
Graded Exposure
+ INFO
+ INFO
Flooding
+ INFO
05
CONCLUSION
You should now have a better understanding of Exposure Therapy and how to use exposure with your clients.Practice incorporating the steps into your sessions.
Other important issues to consider:
Before and during
+ info
Before,during, and after
Exposures
Provide
+ info
+ info
Allow
+ info
Example Scenario:
Following an accident where Jan was impaled by a piece of rebar, she experienced anxiety whenever she went back to the construction site where she worked as one of the project managers.Although she was no longer in danger, she still overestimated the degree of the threat while underestimating her ability to cope with the anxiety. As a result, she avoided going to the job site where she is responsible for overseeing the work of others.
Does CBT Facilitate Emotional Processing? Figure 1. The Emotional Processing Model. The eight factors of the EPS-38 are mapped onto their respective components of the model. “F” denotes the factor number for each subscale on the EPS (adapted from Baker et al., Reference Baker, Thomas, Thomas and Owens2007).
Desensitization (Joseph Wolpe) involves pairing an anxiety-provoking stimulus or situation with an incompatible response (e.g. progressive muscle relaxation) to make the exposure more manageable. When using systematic desensitization with your client, for example, you would establish a fear hierarchy, teach them progressive muscle relaxation, and then connect the feared stimulus to progressive muscle relaxation.
Graded exposure establishes a fear hierarchy, in which the feared stimuli or situations are ranked according to difficulty.
SOURCE
Flooding involves rapid or abrupt exposure to the feared stimuli or situation.
Antecedent Questions
1. What was going on before you got anxious? 2. What was going on in your environement? 3. What were you doing?
4. What were you thinking?
5. What were you feeling?
6. Did you notice any physical sensation?
Episode Questions
1. How long did it last?
2. What physical sensations did you have?
3. How intense did it get?
4. How did the episode end?
5. How did you feel?
6. What did you do afterwards?
CBT EXPOSURE THERAPY PRESENTATION
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Transcript
CBTexposure interventions
MSW: SOW 6931Lecture
START
1. Introduction
2. Evidence-Based Practice
INDEX
3. Emotional Processing Theory
4. Steps
5. Conclusion
01
INTRODUCTION
Exposure is the process where one confronts a feared stimulus or situation in a controlled and systematic way. Often, the response to feared stimuli or situations is to simply avoid them. While providing temporary relief, avoidance can actually cause the fear to become more intense over time, which is often the case for many clients who come in to therapy for phobias.
Example
SOLUTION
02
EVIDENCE-BASED PRACTICE
Exposure therapy has been known to help with:
03
EMOTIONAL PROCESSING THEORY
The cognitive structure contains information of the feared stimuli, the fear responses, and the meaning attached to both the feared stimuli and the response to those stimuli.
Exposure therapy is based on Emotional Processing Theory (EPT; Foa and Kozack, 1986), and goes beyond classical and operant conditioning to explain that fear is acquired, maintained, and modified through exposure.According to EPT, the fear is represented in memory as a cognitive structure.
Info
There are several steps in exposure therapy:
STEP 1: Conduct a functional analysis of the behavior. Share your conceptualization with the client. View a list of questions you can ask about the antecedents:
04
+ INFO
STEPS TO EXPOSURE THERAPY
View a list of questions you can ask about the episode:
+ INFO
STEP 2: Orient the client to exposure therapy. Educate your client about exposure therapy. Provide a rationale for using exposure therapy.
STEP 3: Select Appropriate Intervention. There are a number of different exposure interventions. The most common are:
IN VIVO EXPOSURE
Involves actual or real-life contact with a feared stimulus or situation.
INTEROCEPTIVE EXPOSURE
Involves deliberately bringing on physical sensations that are harmless, but part of a feared stimulus or situation.
Involves vividly imagining the feared stimulus or situation.
IMAGINAL EXPOSURE
Do you remember when we discussed Jan and the rebar at the beginning of this lecture? Let’s look at Jan using these different types of exposure.
Imaginal Exposure
You would guide Jan through various cognitions involving her directly confronting her fear (i.e., using her imagination and describing the event); so that she may imagine being at the construction site when the accident happened.
You would continue by having Jan encounter the fear in a real life situation, such as actually traveling to a construction site with rebar.
In Vivo Exposure
Ask Jan to experience the physical sensation she feels when she is at the job site. You may ask her to jog in place to increase her heart rate.
Interoceptive Exposure
Watch this video to learn more about exposure therapy.
STEP 4: Consider pace, schedule, and duration for Exposure. Exposures can be paced in a number of ways:
Systematic Desensitization
Graded Exposure
+ INFO
+ INFO
Flooding
+ INFO
05
CONCLUSION
You should now have a better understanding of Exposure Therapy and how to use exposure with your clients.Practice incorporating the steps into your sessions.
Other important issues to consider:
Before and during
+ info
Before,during, and after
Exposures
Provide
+ info
+ info
Allow
+ info
Example Scenario:
Following an accident where Jan was impaled by a piece of rebar, she experienced anxiety whenever she went back to the construction site where she worked as one of the project managers.Although she was no longer in danger, she still overestimated the degree of the threat while underestimating her ability to cope with the anxiety. As a result, she avoided going to the job site where she is responsible for overseeing the work of others.
Does CBT Facilitate Emotional Processing? Figure 1. The Emotional Processing Model. The eight factors of the EPS-38 are mapped onto their respective components of the model. “F” denotes the factor number for each subscale on the EPS (adapted from Baker et al., Reference Baker, Thomas, Thomas and Owens2007).
Desensitization (Joseph Wolpe) involves pairing an anxiety-provoking stimulus or situation with an incompatible response (e.g. progressive muscle relaxation) to make the exposure more manageable. When using systematic desensitization with your client, for example, you would establish a fear hierarchy, teach them progressive muscle relaxation, and then connect the feared stimulus to progressive muscle relaxation.
Graded exposure establishes a fear hierarchy, in which the feared stimuli or situations are ranked according to difficulty.
SOURCE
Flooding involves rapid or abrupt exposure to the feared stimuli or situation.
Antecedent Questions
1. What was going on before you got anxious? 2. What was going on in your environement? 3. What were you doing? 4. What were you thinking? 5. What were you feeling? 6. Did you notice any physical sensation?
Episode Questions
1. How long did it last? 2. What physical sensations did you have? 3. How intense did it get? 4. How did the episode end? 5. How did you feel? 6. What did you do afterwards?