Behavioral Analysis Quiz #5 Review

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Questions and Answers

What characterizes the dissociative type of engagement in therapy?

  • Sobbing for short sessions
  • Feeling intensely overwhelmed during sessions
  • Having extreme anxiety before exposure
  • Experiencing prolonged flashbacks (correct)

Which of the following strategies helps manage overengagement during therapy sessions?

  • Starting with tasks that are less than 20 SUDs
  • Allowing unlimited time for exposure without breaks
  • Modifying exposure tasks to include safety signals (correct)
  • Completely avoiding feared situations altogether

What change has been made regarding the classification of OCD?

  • Considered a cognitive disorder
  • Grouped with mood disorders
  • Reclassified as an obsessive compulsive and related disorder (correct)
  • Reclassified as a anxiety disorder

What are some associated disorders included in the new category of OCRDs?

<p>Body dysmorphic disorder and hoarding disorder (C)</p> Signup and view all the answers

Which of the following is a key feature of the emotionally overwhelmed type during therapy?

<p>Extreme anxiety before and during exposure (C)</p> Signup and view all the answers

What is the primary basis for Mowrer’s model in exposure therapy?

<p>Operant conditioning (C)</p> Signup and view all the answers

What does emotional processing theory (EPT) emphasize in the context of exposure therapy?

<p>Modification of threat associations through corrective information (C)</p> Signup and view all the answers

What is crucial in exposure therapy for OCD alongside the exposure itself?

<p>Response prevention (A)</p> Signup and view all the answers

What factor is highlighted by Craske et al. as essential for long-term fear extinction?

<p>Inhibitory learning (B)</p> Signup and view all the answers

How has the delivery of exposure and response prevention (ERP) for OCD typically changed since the 1960s?

<p>Increased effectiveness of treatment (D)</p> Signup and view all the answers

What is noted about the use of a hierarchy of fears in exposure therapy?

<p>Random exposure may enhance extinction. (B)</p> Signup and view all the answers

Which cognitive theory is stated to better explain the development of obsessions than classical conditioning?

<p>Cognitive theories (B)</p> Signup and view all the answers

What is one of the treatments used in OCD that involves both situational and imaginal exposure?

<p>Exposure therapy (A)</p> Signup and view all the answers

What is the main purpose of exposure therapy?

<p>To correct unhelpful beliefs by blocking avoidance (B)</p> Signup and view all the answers

Which statement is true regarding the therapist's role during exposure?

<p>The therapist acts as a supportive coach without providing excessive reassurance (D)</p> Signup and view all the answers

What should be avoided when orienting clients to exposure therapy?

<p>Minimizing the difficulty of the exposure tasks (C)</p> Signup and view all the answers

How should the exposure hierarchy be constructed?

<p>With items that the client is willing to confront and rated using the SUDs scale (D)</p> Signup and view all the answers

What is a common misconception about experiencing anxiety during exposures?

<p>Experiencing anxiety is a natural part of the exposure process (D)</p> Signup and view all the answers

What is the focus of debriefing an exposure task?

<p>To emphasize mastery and gather client experiences (D)</p> Signup and view all the answers

Which of the following is a recommended practice when engaging in exposure therapy?

<p>Validating and normalizing the client's experience (A)</p> Signup and view all the answers

Which action should a therapist avoid during exposure tasks?

<p>Showing excessive emotional responses (A)</p> Signup and view all the answers

When assigning homework for exposure tasks, it is important to:

<p>Minimize distractions and allow for privacy (B)</p> Signup and view all the answers

What is the SUDs scale primarily used for in exposure therapy?

<p>To rate the level of distress associated with different anxiety-provoking items (B)</p> Signup and view all the answers

How should a therapist address a client’s extreme anticipatory anxiety about exposure?

<p>Validate their fears but explain that anxiety is temporary and manageable (D)</p> Signup and view all the answers

What is a common misconception clients may have regarding past exposure experiences?

<p>Previous exposure attempts will always result in failure (C)</p> Signup and view all the answers

Which concept is emphasized to help clients understand that exposure can be controlled?

<p>Gradual exposure can help manage anxiety levels (D)</p> Signup and view all the answers

What element is crucial to prevent overengagement during exposure treatment?

<p>Ensuring that distress does not interfere with learning (A)</p> Signup and view all the answers

What should a therapist communicate about risk during exposure?

<p>They should acknowledge minimal risks and encourage testing perceptions (D)</p> Signup and view all the answers

What is an incorrect belief related to the normal people fallacy?

<p>Acting according to societal norms is the ultimate goal (C)</p> Signup and view all the answers

What is the main purpose of exposure and response prevention in treating OCD?

<p>To weaken the association between anxiety and compulsive behaviors (B)</p> Signup and view all the answers

What does Mowrer's two-stage learning theory suggest about the fear response?

<p>Fear is acquired through classical conditioning and maintained via operant conditioning (C)</p> Signup and view all the answers

Why is it problematic for compulsive rituals to provide immediate relief from anxiety?

<p>It prevents the natural extinction of the anxiety response. (C)</p> Signup and view all the answers

What is an essential component when crafting a behavioral therapy plan for OCD?

<p>Examining antecedents and consequences (B)</p> Signup and view all the answers

Which of the following is a key technique used to treat OCD symptoms effectively?

<p>Exposure and response prevention (D)</p> Signup and view all the answers

What should not be the goal of exposure therapies when treating OCRDs?

<p>To maintain the compulsive behaviors (C)</p> Signup and view all the answers

What misunderstanding does the article object to regarding anti-obsessional behavioral therapies?

<p>They are misapplied in treating OCD uniquely. (D)</p> Signup and view all the answers

What does the negative reinforcement of compulsive rituals result in?

<p>Continued use of rituals to alleviate anxiety (B)</p> Signup and view all the answers

What is a key consideration when constructing a hierarchy for exposure therapy?

<p>Ensure every item has a clear rationale. (B)</p> Signup and view all the answers

Which of the following is important to include in exposure tasks?

<p>Incorporate the client's worst fear to challenge their beliefs. (B)</p> Signup and view all the answers

When should the clinician plan to stop an exposure task?

<p>When maximum learning has occurred and behavioral goals are met. (A)</p> Signup and view all the answers

How should clinicians approach the review of exposure homework?

<p>Reinforce homework completion and assess the client’s experience. (B)</p> Signup and view all the answers

What should a clinician avoid during an exposure task?

<p>Providing excessive reassurance to the client. (B)</p> Signup and view all the answers

What strategy can clinicians use to help clients who are skeptical of alternatives to their beliefs?

<p>Act as a devil's advocate to explore different viewpoints. (A)</p> Signup and view all the answers

What is a sign that an exposure task is successful?

<p>The client achieves observable behavioral goals. (D)</p> Signup and view all the answers

Which of the following approaches should be taken when starting an exposure task?

<p>Discuss procedures and provide clear instructions. (A)</p> Signup and view all the answers

What is the most effective approach to deal with client fears during exposure?

<p>Encourage discussion of specific feared outcomes and beliefs. (D)</p> Signup and view all the answers

Which statement best describes the role of habituation in corrective learning during exposure therapy?

<p>Habituation is not necessary for corrective learning to occur. (C)</p> Signup and view all the answers

Flashcards

Dissociative PTSD

A subtype of PTSD characterized by dissociative episodes and frequent, prolonged flashbacks.

Emotionally Overwhelmed PTSD

A subtype of PTSD marked by intense anxiety before and during exposure to trauma-related stimuli, excessive crying, and strong physical reactions.

Managing Overengagement

Strategies used when someone is overly engaged in a feared situation during exposure therapy. Aim to reduce distress and promote progress.

Obsessive-Compulsive and Related Disorders (OCRDs)

A newly formed diagnostic category that includes OCD and related disorders, based on shared etiological factors.

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OCD Reclassification

The reclassification of OCD from an anxiety disorder to a new category, OCRDs, due to shared origins and characteristics.

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Fear Tolerance

Focuses on increasing tolerance and mastery of fear instead of solely seeking to reduce fear.

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Debriefing Exposure Tasks

Provides positive feedback and encourages reflection on the experience during an exposure task.

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Exposure Therapy

The process of gradually confronting fearful situations to decrease anxiety and challenge negative beliefs.

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Extreme Anticipatory Anxiety

A systematic approach to addressing anticipated anxiety before a planned exposure.

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Normal People Fallacy

A common misconception that normal people wouldn't engage in exposure tasks.

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Overengagement

Overwhelming distress during exposure that hinders learning and reduces the effectiveness of treatment.

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Arguments About Risk

A challenge faced in exposure therapy where clients resist engaging in tasks due to perceived risk.

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Previous Unsuccessful Exposure

A common concern raised by clients who have tried exposure before without success.

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Avoidance

The process of avoiding situations or thoughts that trigger anxiety, preventing the opportunity to challenge and correct unhelpful beliefs.

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Avoidance Prevents Learning

A key principle of exposure therapy: Avoiding feared situations prevents the correction of negative beliefs about the situation. By facing your fear, you learn that it's not as bad as you thought.

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Exposure Hierarchy

A list of situations or stimuli that trigger anxiety, ranked from least to most distressing, used to guide exposure therapy.

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Subjective Units of Distress (SUDS)

A scale used in exposure therapy to measure the subjective intensity of anxiety on a scale from 0 to 100.

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Therapist's Role in Exposure

A therapist's role in exposure therapy: Providing support and guidance, planning and selecting exposures, and encouraging clients during and after exposure tasks.

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In Vivo Exposures

Examples of exposure methods that involve engaging with real-life situations.

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Imaginal Exposure

A type of exposure therapy where clients imagine the feared situation rather than engaging in it physically.

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Devil's Advocate Role

Involves a therapist actively challenging a clients exaggerated beliefs and fears by acting as the 'devil's advocate'. This is particularly useful when a client is resistant to change and relies heavily on their distorted beliefs.

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SUD Graded Hierarchy

A hierarchy graded based on the level of anxiety or distress (SUDs) that each item triggers. It's essential to choose items with a wide range of SUDs to create a challenging yet achievable gradient.

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Habituation

The process of repeating a feared exposure multiple times in order to reduce the intensity of the anxiety response. This goal is not necessary for successful exposure therapy.

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Overestimated Probability of Feared Outcome

The belief that the feared event or outcome is more likely to occur than it actually is. Exposure therapy aims to challenge and correct these misbeliefs.

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Fear of Embarrassment in Panic Patients

A common feared outcome among panic patients, where individuals worry about potentially embarrassing themselves in public, even if they don't have a panic attack.

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Safety Signals

Actions or statements made by the therapist that unintentionally reinforce the client's fears and avoidance behaviors. This can hinder the effectiveness of exposure therapy.

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Corrective Learning

The process of helping the client make specific changes to their beliefs and expectations about the feared situation, leading to a reduction in anxiety and avoidance behaviors.

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Exposure Task

The period during an exposure session where the therapist actively manages the client's anxiety and helps them to remain engaged with the feared situation.

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Tailored Exposure

The process of actively monitoring and adjusting the exposure procedure based on the client's individual needs and responses. This includes adapting the duration, repetitions, or behaviors during the exposure task.

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Exposure and Response Prevention (ERP)

A therapy technique for OCD that involves confronting feared stimuli and thoughts while deliberately preventing ritualistic behaviors, aiming to break the association between intrusive thoughts and compulsive actions.

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Inhibitory Learning

The theory that exposure therapy works by creating new, non-threatening associations that compete with existing fear associations.

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Emotional Processing

The process by which fear structures are modified through exposure to feared stimuli, leading to a reduction in anxiety and fear responses.

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Cognitive model of OCD

A model proposing that obsessions develop due to cognitive processes like misinterpretations of intrusive thoughts and appraisals of perceived threats.

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Response Prevention

A crucial aspect of exposure therapy for OCD, where individuals are encouraged to engage directly with their feared situations and thoughts without engaging in compulsive behaviors.

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Fear Hierarchy

In exposure therapy, the gradual introduction of feared stimuli, starting with less fear-provoking situations and progressing to more challenging ones.

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Random Exposure

The idea that the order of exposure to feared situations doesn't necessarily influence the outcome of therapy, possibly leading to faster extinction of fears.

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What is OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that a person feels driven to perform in order to reduce anxiety.

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What is ERP therapy?

Exposure and response prevention (ERP) is a behavioral therapy specifically designed to treat OCD. It involves gradually exposing the individual to their feared situations or triggers and preventing them from engaging in their usual compulsions.

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How do compulsions reinforce OCD?

In OCD, the act of performing compulsions, like hand washing, provides temporary relief from anxiety. This reinforcement strengthens the connection between the obsessional stimulus and the compulsive behavior, making it harder to break the cycle.

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What is Mowrer's two-factor theory?

Mowrer's two-factor theory explains how OCD develops. First, fear is learned through classical conditioning (association of a neutral stimulus with anxiety). Then, the fear is maintained through operant conditioning (compulsions are reinforced by anxiety reduction).

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How does ERP work?

ERP aims to break the connection between obsessional stimuli and compulsive rituals. By exposing individuals to their feared triggers without allowing them to perform compulsions, the conditioned fear response eventually weakens.

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Why is prevention of compulsions essential in ERP?

A key principle of ERP is to prevent the individual from engaging in their usual compulsions. This allows the anxiety to naturally subside, promoting extinction learning, which is the process of the conditioned fear response gradually fading away.

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What is exposure therapy in ERP?

Exposure therapy involves systematically introducing the individual to their feared situations or triggers, starting with less intense ones and gradually progressing to more intense ones. This gradual approach helps the individual gradually habituate to their fears.

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What is response prevention in ERP?

Response prevention is the aspect of ERP that involves preventing the individual from engaging in their compulsions. It can be challenging, as it often involves intense discomfort and anxiety. However, it is crucial for disrupting the negative reinforcement cycle that perpetuates OCD.

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Study Notes

Behavioral Analysis Quiz #5 Review

  • Exposure Therapy Questions: How anxious are you? How well can you tolerate anxiety? What is the feared outcome of the exposure? These are asked before and during exposure.
  • Exposure Stoppage: Exposure stops when the belief in the feared outcome decreases to 5-10%. Can stop earlier if the reduction plateaus.
  • Exposure Technique: First step—orienting clients to exposure therapy explaining the purpose, components, and reasoning. Discuss why the client must engage in aversive behavior, emphasizing the client's control.
  • Fear Maintenance: Explain how fear is maintained, highlighting aspects like avoidance perpetuating anxiety. While avoidance reduces immediate anxiety, it increases long-term anxiety as it prevents corrective learning. Unhelpful avoidance prevents the client from learning the feared situations are not dangerous.
  • Rationalizing Exposure: Describe why avoidance prevents useful belief correction. Explain how exposure blocks avoidance.
  • Anticipating Anxiety: Prepare the client for anxious feelings. Acknowledge it’s normal during exposure and not something to fight.
  • Therapist's Role: Supportive yet not overly reassuring during exposure. Help select exposure tasks, provide instruction/encouragement, and process at the end. Avoid excessive responses that could distract from exposure.
  • Orienting Client Do's: Provide a clear rationale, engage client in a collaborative discussion, validate experience and normalize anxiety, assess client understanding of exposure.
  • Orienting Client Don'ts: Excessive, lecturing, minimizing difficulty, overemphasizing fear.
  • Exposure Hierarchy: Create a ranked list of feared internal/external stimuli (10-20 items). Each item is rated with Subjective Units of Distress (SUDs). Items should be confrontational, in vivo, imaginal, or interoceptive.

Exposure Hierarchy Construction and Guidelines

  • Hierarchy Construction: Create a collaborative hierarchy with the client, focusing on specifics vs. broad descriptions.
  • Evaluation: Define a rationale for each item in the hierarchy. Ask “What belief is this item designed to test?”
  • Hierarchy Considerations: Include tasks that will increase the likelihood of relapse and situations that are more difficult than everyday tasks.
  • Exposure Sessions Structure: Review homework (5-10 minutes), conduct exposure (30 minutes), debrief exposure (15-20 minutes), and plan next session (5 minutes).
  • Exposure Homework Review: Assess the client's experience, validate learning through questions and assessing belief change, and reinforce coping. Addressing skepticism with questioning as in a devil's advocate role may help.

Exposure Session Dynamics

  • Exposure Session Structure: Review homework (5-10 minutes), conduct exposure (30 minutes), debrief (15-20 minutes), and plan next session (5 minutes).
  • Session Guidance (Do's): Assess the client’s anxiety level and SUDs (Subjective Units of Distress), every 5 minutes. Appear calm, and confirm that the goal is reducing anxiety. Avoid safety signals, and reinforce learning.
  • Session Guidance (Don'ts): Show emotional distress, offer excessive reassurance, express disgust, or shock, or be directive to avoid or make the exposure easier (unless strategically done).
  • Exposure Stoppage Rules: Stop when maximum learning has occurred. Set achievable goals (time, specific behavior, reps), emphasizing mastery and tolerance rather than reduction.
  • Client Concerns: Address anticipatory anxiety ("won't be able to tolerate it") through validation, gradual approach, and normalization of temporary anxiety. Encourage client control and ability to manage anxiety. Confirming prior successes and/or providing a rationale for the exposure. Ensure client does not feel the exposure is risk for harm.

Debriefing and Guidelines

  • Debriefing Process: Provide positive feedback, discuss client's experiences using open-ended questions, and review observations. Highlight meaningful elements of the exposure. Assess corrective learning.
  • Homework Guidelines: Set appropriately challenging assignments considering aspects like number, type, frequency, minimize distractions, and use clear instructions.
  • Addressing Previous Unsuccessful Exposures: Assess previous experiences, understand why the previous exposure attempts did not succeed, and then revise future strategies based on the analysis.

OCD and Exposure Therapy

  • OCD Symptoms: Obsessional stimuli (e.g., contact with the floor), anxiety increases. Compulsive rituals like washing reduce anxiety.
  • Operant Conditioning and Rituals: Rituals create escape from anxiety and negatively reinforce their use.
  • Cognitive Processes in OCD: Fear responses and ritual avoidance keep the anxiety from decreasing.
  • Exposure and Response Prevention (ERP): Effective behavioral therapy to weaken links between obsessional stimuli and rituals/avoidance. Improves fear extinction of these associations and diminishes response patterns. ERP is valuable for decreasing OCD symptoms because it stops compulsive behaviors and allows the client to experience fear without avoidance. OCD is often resistant to treatment, until ERP is implemented.
  • Response Prevention: A key component to ERP for OCD. Clients are encouraged to face feared situations or sensations without engaging in the usual avoidance or compulsive behaviors. The goal is to teach the client to tolerate anxiety without resorting to harmful or ineffective rituals.

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