PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Chapter 10:Chapter 10:Prolonged/Intense Prolonged/Intense Exposure TherapyExposure Therapy

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Development and Development and Maintenance of FearMaintenance of FearTwo Factor TheoryTwo Factor Theory

1.1. Fears develop by Fears develop by classicalclassical conditioning: conditioning:

• A neutral event is associated with a A neutral event is associated with a fearful eventfearful event

• Fear elicited by neutral eventFear elicited by neutral event

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Development and Development and Maintenance of FearMaintenance of FearTwo Factor TheoryTwo Factor Theory2. Fear is maintained by 2. Fear is maintained by operantoperant

conditioningconditioning• Avoidance of fear inducing situation Avoidance of fear inducing situation

(negative reinforcement)(negative reinforcement)Flooding attempts to uncouple the Flooding attempts to uncouple the neutral situation from the fear by neutral situation from the fear by changing the operant contingencychanging the operant contingency

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

FloodingFlooding

• Exposure to stimuli that produce high Exposure to stimuli that produce high anxietyanxiety— No gradationNo gradation

• Exposure is long enough so that Exposure is long enough so that discomfort peaks and starts to declinediscomfort peaks and starts to decline

• Extremely uncomfortable but often very Extremely uncomfortable but often very brief therapybrief therapy

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

FloodingFlooding

• Can be in vivo or imaginalCan be in vivo or imaginal• No competing responseNo competing response• Usually includes Usually includes response preventionresponse prevention

of maladaptive coping strategiesof maladaptive coping strategies— Avoiding fight or flight responseAvoiding fight or flight response— Triggers the maintaining behaviourTriggers the maintaining behaviour

• More effective than drugs in some More effective than drugs in some casescases

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Implosive TherapyImplosive Therapy

• Extension of imaginal floodingExtension of imaginal flooding

1.1. Use of Use of hypothesizedhypothesized anxiety anxiety producing cues (the “why” factor)producing cues (the “why” factor)

2.2. Exaggerated scenesExaggerated scenes

3.3. Elaboration of scenes (visualizations Elaboration of scenes (visualizations may change)may change)

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Eye Movement Desensitization Eye Movement Desensitization and Reprocessing (EMDR)and Reprocessing (EMDR)1.1. Assessment and preparationAssessment and preparation

• Identifying the traumatic memoryIdentifying the traumatic memory

• Identifying body sensationsIdentifying body sensations

• Assessing level of anxiety (SUD)Assessing level of anxiety (SUD)

• Thinking of an adaptive beliefThinking of an adaptive belief

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Eye Movement Desensitization Eye Movement Desensitization and Reprocessing (EMDR)and Reprocessing (EMDR)2.2. Imaginal FloodingImaginal Flooding• Visualization of traumatic imageVisualization of traumatic image• Verbalization of maladaptive beliefVerbalization of maladaptive belief• Rapid visual tracking to simulate Rapid visual tracking to simulate

REMs associated with dreamingREMs associated with dreaming• Assessment of anxietyAssessment of anxiety• Move onto final step once anxiety has Move onto final step once anxiety has

been sufficiently reducedbeen sufficiently reduced

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Eye Movement Desensitization Eye Movement Desensitization and Reprocessing (EMDR)and Reprocessing (EMDR)3.3. Cognitive RestructuringCognitive Restructuring

• Imagine (formerly) traumatic image Imagine (formerly) traumatic image while verbalizing adaptive beliefwhile verbalizing adaptive belief

• Assessment of anxiety level Assessment of anxiety level

PSY4030 6.0DPSY4030 6.0D CBT Chapter 10CBT Chapter 10

Downside of FloodingDownside of Flooding

1.1. Higher dropout rates than more gradual Higher dropout rates than more gradual therapiestherapies

2.2. Potential danger of becoming even more Potential danger of becoming even more anxiousanxious

3.3. Given equal effectiveness, clients likely to Given equal effectiveness, clients likely to choose systematic desensitization over choose systematic desensitization over floodingflooding

• SD good for anxiety/avoidance behaviourSD good for anxiety/avoidance behaviour• Flooding is good for ritualistic acts/thoughtsFlooding is good for ritualistic acts/thoughts