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Chapter 10: Prolonged/Intense Exposure Therapy. Development and Maintenance of Fear. Two Factor Theory Fears develop by classical conditioning: A neutral event is associated with a fearful event Fear elicited by neutral event. Development and Maintenance of Fear. Two Factor Theory
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Chapter 10:Prolonged/Intense Exposure Therapy CBT Chapter 10
Development and Maintenance of Fear Two Factor Theory • Fears develop by classical conditioning: • A neutral event is associated with a fearful event • Fear elicited by neutral event CBT Chapter 10
Development and Maintenance of Fear Two Factor Theory 2. Fear is maintained by operant conditioning • Avoidance of fear inducing situation (negative reinforcement) Flooding attempts to uncouple the neutral situation from the fear by changing the operant contingency CBT Chapter 10
Flooding • Exposure to stimuli that produce high anxiety • No gradation • Exposure is long enough so that discomfort peaks and starts to decline • Extremely uncomfortable but often very brief therapy CBT Chapter 10
Flooding • Can be in vivo or imaginal • No competing response • Usually includes response prevention of maladaptive coping strategies • Avoiding fight or flight response • Triggers the maintaining behaviour • More effective than drugs in some cases CBT Chapter 10
Implosive Therapy • Extension of imaginal flooding • Use of hypothesized anxiety producing cues (the “why” factor) • Exaggerated scenes • Elaboration of scenes (visualizations may change) CBT Chapter 10
Eye Movement Desensitization and Reprocessing (EMDR) • Assessment and preparation • Identifying the traumatic memory • Identifying body sensations • Assessing level of anxiety (SUD) • Thinking of an adaptive belief CBT Chapter 10
Eye Movement Desensitization and Reprocessing (EMDR) • Imaginal Flooding • Visualization of traumatic image • Verbalization of maladaptive belief • Rapid visual tracking to simulate REMs associated with dreaming • Assessment of anxiety • Move onto final step once anxiety has been sufficiently reduced CBT Chapter 10
Eye Movement Desensitization and Reprocessing (EMDR) • Cognitive Restructuring • Imagine (formerly) traumatic image while verbalizing adaptive belief • Assessment of anxiety level CBT Chapter 10
Downside of Flooding • Higher dropout rates than more gradual therapies • Potential danger of becoming even more anxious • Given equal effectiveness, clients likely to choose systematic desensitization over flooding • SD good for anxiety/avoidance behaviour • Flooding is good for ritualistic acts/thoughts CBT Chapter 10