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