Transcript Chapter 8 - People Server at UNCW

Systems of Psychotherapy:
A Transtheoretical Analysis
Chapter 8.
Exposure
Therapies
Chapter 8
Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.
Exposure Therapies
Directly confront feared stimuli & activate
intense emotions
Particularly useful in tx of anxiety & trauma
3 exposure therapies in chapter
Implosion (Stampl)
Exposure (Foa)
EMDR (Shapiro)
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A Sketch of Thomas Stampfl
1923 Convinced that avoidance is at heart of
psychopathology
Attempted to integrate psychoanalytic and
behavioral therapy
First behavioral researcher to
demonstrate efficacy of implosion
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Theory of Psychopathology
Symptoms that characterize pathology
are learned avoidance responses
Avoidance reduces anxiety in short term,
but produces more anxiety in long term
People learn to avoid not only anxious
situations but also imagining those
situations
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Theory of Therapeutic
Processes
Goal: extinction (gradual dissipation of
conditioned anxiety due to lack of
reinforcement)
Client is asked to imagine in detail the
anxiety-provoking situation
The anxiety-producing scene cannot be
left until some extinction has occured
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Therapeutic Relationship
Relationship not needed if tapes or films can
be used as anxiety-eliciting stimuli
Clients need to trust therapist to experience
anxiety-eliciting stimuli long enough for
extinction to occur
Empathy offered during evaluation to create
effective implosive scenes, but not during
implosion itself
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Practicalities of Implosive
Therapists extinguish their own anxiety
about scenes to effectively present them
to clients
3 to 30, individual sessions
Sessions run over typical 50 minutes
Precautions, such as sound proofing
rooms, implemented
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Effectiveness of Implosive
Therapy
More effective than no treatment &
placebo
Found effective with PTSD combat
veterans
Comparable, if not superior, effectiveness
with alternative psychotherapies
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A Sketch of Edna Foa
Born in Israel in 1937
Spent most of education & career in
behavior therapy
Collaborated with colleagues in examining
exposure therapy for anxiety disorders
Premier proponent of prolonged exposure
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Theory of Psychopathology
Anxiety is conditioned response controlled
by two factors: respondent learning &
operant learning
Conditioning accounts for acquisition and
extinction of fear
Conceptualizes pathology in terms of both
behavioral and emotional processing
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Prolonged Exposure
Intensive (direct & immediate exposure)
vs. gradual (slow & incremental exposure)
Imaginal (imagining fear stimuli) vs. in
vivo (actual place or tactile material)
Total vs. partial response prevention
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Theory of Therapeutic
Processes
Clients given clear rationale for tx
Taught anxiety coping skills
Prolonged exposure
Given homework
Maintenance sessions as needed
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Therapeutic Relationship
Exposure therapist acts like an
effective, firm parent
Clients trust of therapist allows them to
stay in presence of feared stimuli
Therapist models confidence
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Practicalities of Exposure
Therapy
Similar to implosive therapy
8 – 12, 1 to 2 hour sessions
Homework assigned
Training widely available from
behavior & cognitive therapists
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Effectiveness of Exposure
Therapy
Effective in treating PTSD, OCD,
specific phobias, and social phobia
Small % of clients experience symptom
exacerbation
Low relapse rates
Treatment of choice for many anxiety
disorders
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A Sketch of Francine Shapiro
Discovered deliberate eye movements
made her thoughts less distressing
Founder of EMDR Institute & EMDR
Humanitarian Assistance Program
Controversial for controlling early
EMDR training
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Theory of Psychopathology
Psychopathology occurs when
information processing is blocked
Trauma is trapped or locked in the
neurophysiology
Everyday stimuli trigger re-experience
of traumatic event
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Therapeutic Processes
Adaptive information processing (AIP)
model
Counterconditioning via desensitization
and cognitive restructuring
Consciousness raising & catharsis
operate, but not as central mechanisms
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Phases of EMDR
Client history
Preparation
Desensitization
Installation
Body scan
Closure
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Theory of Therapeutic
Relationship
Characterized by empathy, trust, &
safety
Clinicians communicate respect for
client courage, but not during active
processing
Safe haven created through rapport,
teaching relaxation, “stop signal”
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Practicalities of EMDR
Typically 4 to 6, 90-minute sessions
Two weekend workshops and
supervised practice to acquire
competence
Providing pro bono treatment and
training in disaster areas
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Effectiveness of EMDR
Outperforms no treatment
As effective as other exposure methods
Listed as “probably efficacious” for civilian
PTSD
Eye movements have not been proven
necessary component
Remains controversial despite large
research base
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Criticisms of Exposure
Therapies
From a Behavioral Perspective
From a Psychoanalytic Perspective
From a Humanistic Perspective
From a Cultural Perspective
From an Integrative Perspective
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Future Directions
Implosive losing popularity
Exposure therapy on the rise for tx of
intransigent anxiety-based disorders
Virtual reality exposure will gain popularity
Future of EMDR is not clear, but research
will compare various processing methods
(e.g., eye movements, hand taps)
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Key Terms
adaptive information
processing
avoidance
conditioning/learning
avoidance repression
(cognitive avoidance)
avoidance responses
breathing retraining
classical/respondent
conditioning
cognitive interweave
Chapter 8
cue exposure
desensitization phase
dynamic cues
emotional processing
exposure therapy
extinction
Eye Movement
Desensitization &
Reprocessing (EMDR)
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Key Terms (cont.)
generalization
habituation
hypothesized avoidance
cues
imaginal exposure
implosive therapy
installation phase
in vivo exposure
looping
Chapter 8
neurotic paradox
operant/instrumental
conditioning
pro bono
prolonged exposure
response prevention
subjective units of
distress (SUD)
Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.
Recommended Websites
Center for Anxiety and Related Disorders:
www.bu.edu/anxiety/
Center for the Treatment and Study of Anxiety
(Foa): www.med.upenn.edu/ctsa/
EMDR Institute: www.emdr.com/
Intern Society for Traumatic Stress Studies:
www.istss.org/
Virtual Reality Exposure Therapy:
www.cc.gatech.edu/gvu/virtual/Phobia/phobia
Chapter 8
Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.
Chapter 8
Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.
Chapter 8
Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.