1. PSY4030 6.0DCBT Chapter 10 Chapter 10: Prolonged/Intense Exposure Therapy

2. PSY4030 6.0DCBT Chapter 10 Development and Maintenance of Fear Two Factor Theory 1.Fears develop by classical conditioning: A neutral event is associated with a fearful eventA neutral event is associated with a fearful event Fear elicited by neutral eventFear elicited by neutral event

3. PSY4030 6.0DCBT Chapter 10 Development and Maintenance of Fear Two Factor Theory 2. Fear is maintained by operant conditioning Avoidance of fear inducing situation (negative reinforcement)Avoidance of fear inducing situation (negative reinforcement) Flooding attempts to uncouple the neutral situation from the fear by changing the operant contingency

4. PSY4030 6.0DCBT Chapter 10 Flooding Exposure to stimuli that produce high anxietyExposure to stimuli that produce high anxiety — No gradation Exposure is long enough so that discomfort peaks and starts to declineExposure is long enough so that discomfort peaks and starts to decline Extremely uncomfortable but often very brief therapyExtremely uncomfortable but often very brief therapy

5. PSY4030 6.0DCBT Chapter 10 Flooding Can be in vivo or imaginalCan be in vivo or imaginal No competing responseNo competing response Usually includes response prevention of maladaptive coping strategiesUsually includes response prevention of maladaptive coping strategies — Avoiding fight or flight response — Triggers the maintaining behaviour More effective than drugs in some casesMore effective than drugs in some cases

6. PSY4030 6.0DCBT Chapter 10 Implosive Therapy Extension of imaginal floodingExtension of imaginal flooding 1.Use of hypothesized anxiety producing cues (the “why” factor) 2.Exaggerated scenes 3.Elaboration of scenes (visualizations may change)

7. PSY4030 6.0DCBT Chapter 10 Eye Movement Desensitization and Reprocessing (EMDR) 1.Assessment 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

8. PSY4030 6.0DCBT Chapter 10 Eye Movement Desensitization and Reprocessing (EMDR) 2.Imaginal Flooding Visualization of traumatic imageVisualization of traumatic image Verbalization of maladaptive beliefVerbalization of maladaptive belief Rapid visual tracking to simulate REMs associated with dreamingRapid visual tracking to simulate REMs associated with dreaming Assessment of anxietyAssessment of anxiety Move onto final step once anxiety has been sufficiently reducedMove onto final step once anxiety has been sufficiently reduced

9. PSY4030 6.0DCBT Chapter 10 Eye Movement Desensitization and Reprocessing (EMDR) 3.Cognitive Restructuring Imagine (formerly) traumatic image while verbalizing adaptive beliefImagine (formerly) traumatic image while verbalizing adaptive belief Assessment of anxiety levelAssessment of anxiety level

10. PSY4030 6.0DCBT Chapter 10 Downside of Flooding 1.Higher dropout rates than more gradual therapies 2.Potential danger of becoming even more anxious 3.Given equal effectiveness, clients likely to choose systematic desensitization over flooding SD good for anxiety/avoidance behaviour SD good for anxiety/avoidance behaviour Flooding is good for ritualistic acts/thoughts Flooding is good for ritualistic acts/thoughts