Podcast
Questions and Answers
What characterizes the dissociative type of engagement in therapy?
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?
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?
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?
What are some associated disorders included in the new category of OCRDs?
Which of the following is a key feature of the emotionally overwhelmed type during therapy?
Which of the following is a key feature of the emotionally overwhelmed type during therapy?
What is the primary basis for Mowrer’s model in exposure therapy?
What is the primary basis for Mowrer’s model in exposure therapy?
What does emotional processing theory (EPT) emphasize in the context of exposure therapy?
What does emotional processing theory (EPT) emphasize in the context of exposure therapy?
What is crucial in exposure therapy for OCD alongside the exposure itself?
What is crucial in exposure therapy for OCD alongside the exposure itself?
What factor is highlighted by Craske et al. as essential for long-term fear extinction?
What factor is highlighted by Craske et al. as essential for long-term fear extinction?
How has the delivery of exposure and response prevention (ERP) for OCD typically changed since the 1960s?
How has the delivery of exposure and response prevention (ERP) for OCD typically changed since the 1960s?
What is noted about the use of a hierarchy of fears in exposure therapy?
What is noted about the use of a hierarchy of fears in exposure therapy?
Which cognitive theory is stated to better explain the development of obsessions than classical conditioning?
Which cognitive theory is stated to better explain the development of obsessions than classical conditioning?
What is one of the treatments used in OCD that involves both situational and imaginal exposure?
What is one of the treatments used in OCD that involves both situational and imaginal exposure?
What is the main purpose of exposure therapy?
What is the main purpose of exposure therapy?
Which statement is true regarding the therapist's role during exposure?
Which statement is true regarding the therapist's role during exposure?
What should be avoided when orienting clients to exposure therapy?
What should be avoided when orienting clients to exposure therapy?
How should the exposure hierarchy be constructed?
How should the exposure hierarchy be constructed?
What is a common misconception about experiencing anxiety during exposures?
What is a common misconception about experiencing anxiety during exposures?
What is the focus of debriefing an exposure task?
What is the focus of debriefing an exposure task?
Which of the following is a recommended practice when engaging in exposure therapy?
Which of the following is a recommended practice when engaging in exposure therapy?
Which action should a therapist avoid during exposure tasks?
Which action should a therapist avoid during exposure tasks?
When assigning homework for exposure tasks, it is important to:
When assigning homework for exposure tasks, it is important to:
What is the SUDs scale primarily used for in exposure therapy?
What is the SUDs scale primarily used for in exposure therapy?
How should a therapist address a client’s extreme anticipatory anxiety about exposure?
How should a therapist address a client’s extreme anticipatory anxiety about exposure?
What is a common misconception clients may have regarding past exposure experiences?
What is a common misconception clients may have regarding past exposure experiences?
Which concept is emphasized to help clients understand that exposure can be controlled?
Which concept is emphasized to help clients understand that exposure can be controlled?
What element is crucial to prevent overengagement during exposure treatment?
What element is crucial to prevent overengagement during exposure treatment?
What should a therapist communicate about risk during exposure?
What should a therapist communicate about risk during exposure?
What is an incorrect belief related to the normal people fallacy?
What is an incorrect belief related to the normal people fallacy?
What is the main purpose of exposure and response prevention in treating OCD?
What is the main purpose of exposure and response prevention in treating OCD?
What does Mowrer's two-stage learning theory suggest about the fear response?
What does Mowrer's two-stage learning theory suggest about the fear response?
Why is it problematic for compulsive rituals to provide immediate relief from anxiety?
Why is it problematic for compulsive rituals to provide immediate relief from anxiety?
What is an essential component when crafting a behavioral therapy plan for OCD?
What is an essential component when crafting a behavioral therapy plan for OCD?
Which of the following is a key technique used to treat OCD symptoms effectively?
Which of the following is a key technique used to treat OCD symptoms effectively?
What should not be the goal of exposure therapies when treating OCRDs?
What should not be the goal of exposure therapies when treating OCRDs?
What misunderstanding does the article object to regarding anti-obsessional behavioral therapies?
What misunderstanding does the article object to regarding anti-obsessional behavioral therapies?
What does the negative reinforcement of compulsive rituals result in?
What does the negative reinforcement of compulsive rituals result in?
What is a key consideration when constructing a hierarchy for exposure therapy?
What is a key consideration when constructing a hierarchy for exposure therapy?
Which of the following is important to include in exposure tasks?
Which of the following is important to include in exposure tasks?
When should the clinician plan to stop an exposure task?
When should the clinician plan to stop an exposure task?
How should clinicians approach the review of exposure homework?
How should clinicians approach the review of exposure homework?
What should a clinician avoid during an exposure task?
What should a clinician avoid during an exposure task?
What strategy can clinicians use to help clients who are skeptical of alternatives to their beliefs?
What strategy can clinicians use to help clients who are skeptical of alternatives to their beliefs?
What is a sign that an exposure task is successful?
What is a sign that an exposure task is successful?
Which of the following approaches should be taken when starting an exposure task?
Which of the following approaches should be taken when starting an exposure task?
What is the most effective approach to deal with client fears during exposure?
What is the most effective approach to deal with client fears during exposure?
Which statement best describes the role of habituation in corrective learning during exposure therapy?
Which statement best describes the role of habituation in corrective learning during exposure therapy?
Flashcards
Dissociative PTSD
Dissociative PTSD
A subtype of PTSD characterized by dissociative episodes and frequent, prolonged flashbacks.
Emotionally Overwhelmed PTSD
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
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)
Obsessive-Compulsive and Related Disorders (OCRDs)
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OCD Reclassification
OCD Reclassification
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Fear Tolerance
Fear Tolerance
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Debriefing Exposure Tasks
Debriefing Exposure Tasks
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Exposure Therapy
Exposure Therapy
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Extreme Anticipatory Anxiety
Extreme Anticipatory Anxiety
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Normal People Fallacy
Normal People Fallacy
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Overengagement
Overengagement
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Arguments About Risk
Arguments About Risk
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Previous Unsuccessful Exposure
Previous Unsuccessful Exposure
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Avoidance
Avoidance
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Avoidance Prevents Learning
Avoidance Prevents Learning
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Exposure Hierarchy
Exposure Hierarchy
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Subjective Units of Distress (SUDS)
Subjective Units of Distress (SUDS)
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Therapist's Role in Exposure
Therapist's Role in Exposure
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In Vivo Exposures
In Vivo Exposures
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Imaginal Exposure
Imaginal Exposure
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Devil's Advocate Role
Devil's Advocate Role
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SUD Graded Hierarchy
SUD Graded Hierarchy
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Habituation
Habituation
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Overestimated Probability of Feared Outcome
Overestimated Probability of Feared Outcome
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Fear of Embarrassment in Panic Patients
Fear of Embarrassment in Panic Patients
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Safety Signals
Safety Signals
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Corrective Learning
Corrective Learning
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Exposure Task
Exposure Task
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Tailored Exposure
Tailored Exposure
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Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP)
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Inhibitory Learning
Inhibitory Learning
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Emotional Processing
Emotional Processing
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Cognitive model of OCD
Cognitive model of OCD
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Response Prevention
Response Prevention
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Fear Hierarchy
Fear Hierarchy
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Random Exposure
Random Exposure
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What is OCD?
What is OCD?
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What is ERP therapy?
What is ERP therapy?
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How do compulsions reinforce OCD?
How do compulsions reinforce OCD?
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What is Mowrer's two-factor theory?
What is Mowrer's two-factor theory?
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How does ERP work?
How does ERP work?
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Why is prevention of compulsions essential in ERP?
Why is prevention of compulsions essential in ERP?
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What is exposure therapy in ERP?
What is exposure therapy in ERP?
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What is response prevention in ERP?
What is response prevention in ERP?
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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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