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Exposure-Based CBT Interventions

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Presentation on theme: "Exposure-Based CBT Interventions"— Presentation transcript:

1 Exposure-Based CBT Interventions

2 Exposure Therapies: Overview
Anxiety disorders Contraindications Different than systematic desensitization Orientation/commitment Imaginal exposure In vivo exposure Cognitive processing Differences between exposure protocols for OCD, panic, phobias & PTSD

3 Avoidance & Learning 2-factor theory:
Events Stimulus Generalization (S) FEAR (R) Reinforces avoidance Avoidance or escape from future triggers Temporary Relief (neg. ref)

4 How Exposure Therapy Works
Events Stimulus Generalization (S) FEAR (R) Extinction blocks avoidance Block avoidance of external (i.e., triggers) and internal cues (e.g., thoughts, feelings) that are aversive but safe New Learning Memory integrated Cues are not dangerous Approach replaces avoidance Cognition changes Emotional engagement and processing

5 Rationale for Exposure Therapies
They work! They promote new learning via emotional processing They facilitate cognitive changes

6 Exposure Therapies: In Brief
Orientation/commitment Psychoeducation Imaginal exposure In vivo exposure Cognitive processing Sessions can be minutes 1-2 times per week At least 8 weeks, usually weeks, but can last longer Goal is reduction of symptoms and enhanced life functioning

7 Prolonged Exposure in PTSD
Exposure to cues without reinforcement of danger/bad outcomes Index trauma used Describe trauma in detail in present tense Encouraged to include more & more detail Descriptions repeated and recorded (SUDS) Clients assigned homework Goal is emotional engagement and processing of memories without avoidance

8 Exposure and Response Prevention in OCD
Exposure to cues without reinforcement of danger/bad outcomes Less typically includes imaginal exposure In vivo exposure is hierarchical Clients assigned homework Family is involved Goal is to reduce compulsive behaviors in order to reduce obsessions and impairment

9 Exposure Therapy and Panic Disorder
Exposure to cues without reinforcement of danger/bad outcomes May include imaginal exposure In vivo exposure is hierarchical May include breathing training May include cognitive restructuring Clients assigned homework Goal is to reduce avoidance and escape behavior in order to reduce panic and impairment

10 Exposure Therapy and Social Anxiety
Exposure to cues without reinforcement of danger/bad outcomes May include imaginal exposure In vivo exposure is hierarchical May include group therapy component Includes cognitive restructuring Clients assigned homework Goal is to reduce avoidance and escape behavior in order to reduce social avoidance and impairment

11 Evidence-Based Manuals

12 Integrating Skills Before Exposure Therapy
Cognitive skills Behavioral Skills Awareness of problematic ways of thinking Discrimination between emotions Awareness of action urges Awareness of consequences Acceptance of thoughts as thoughts not as truth Cognitive restructuring Cognitive flexibility Self-acceptance Self-compassion Decreasing avoidance or escape behavior Decreasing acute negative affect skillfully Increasing positive affect Living consistent with values Interpersonal skills

13 What is and is not Exposure Therapy?
Rigid procedures Life Evidence base Talking about + principles anything painful Session-by-session “cookbook” protocol for all patients


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