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/ fear-provoking 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

Snap rubber band on wrist

Cigarette smoke Bitter substance Water mist sprayed

in face Loud noise Mild mouthwash

Trichotillomania (Pulling out hair)

Compulsive eating Nail biting Face slapping

Bruxism Biting other children

Target Behavior Punisher

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 ~