1. Exposure Therapy & Aversive Therapy
Lesson 17

2. 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) ~

3. 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 ~

4. Exposure Therapies:Techniques
Direction of therapy
Therapist directed
Self-managed
Additional procedures
Competing responses
Response prevention
Exaggerated scenes ~

5. Systematic Desensitization
Brief/Graduated Exposure Therapy
Fear & relaxation incompatible
Developed by Wolpe
3 components
Relaxation Training
Fear Hierarchy
Graded Pairing ~

6. 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 ~

7. Systematic Desensitization: Other competing responses
Emotive imagery
Pleasant thoughts replace fear
Humor/laughter
No learning required
Coping with disease ~

8. Systematic Desensitization: Other Target Behaviors
Anger
Asthmatic attacks
Insomnia
Motion sickness
Nightmares
Problem drinking
Sleepwalking
Speech disorders
Body image disturbances
Racial Prejudice

9. 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 ~

10. Flooding Prolonged/Intense Exposure Therapy
Also called implosive therapy
In vivo or imaginal
Treatment for
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Agoraphobia ~

11. 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 ~

12. 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 ~

13. Modeling Participant modeling Or Guided participation
Construct fear hierarchy
Start with least feared stimulus
Therapist experiences first
Then client ~

14. Aversive Therapy Punishment of target behaviors
Instrumental conditioning
Raversive stimulus
E.g., chronic vomiting  shock
Problems
Avoidance of therapy (drop out)
Disruptive CERs
 punishment of others
Ethics concerns ~

15. “More Acceptable” Punishers
Target Behavior
Punisher
Trichotillomania (Pulling out hair)
Compulsive eating
Nail biting
Face slapping
Bruxism
Biting other children
Snap rubber band on wrist
Cigarette smoke
Bitter substance
Water mist sprayed in face
Loud noise
Mild mouthwash

16. 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 ~