Chapter 10:
Prolonged/Intense
Exposure Therapy
PSY4030 6.0D
CBT Chapter 10
Development and
Maintenance of Fear
Two Factor Theory
1. Fears develop by classical
conditioning:
• A neutral event is associated with a
fearful event
• Fear elicited by neutral event
PSY4030 6.0D
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
PSY4030 6.0D
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
PSY4030 6.0D
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
PSY4030 6.0D
CBT Chapter 10
Implosive Therapy
• Extension of imaginal flooding
1. Use of hypothesized anxiety
producing cues (the “why” factor)
2. Exaggerated scenes
3. Elaboration of scenes (visualizations
may change)
PSY4030 6.0D
CBT Chapter 10
Eye Movement Desensitization
and Reprocessing (EMDR)
1.
•
•
•
•
Assessment and preparation
Identifying the traumatic memory
Identifying body sensations
Assessing level of anxiety (SUD)
Thinking of an adaptive belief
PSY4030 6.0D
CBT Chapter 10
Eye Movement Desensitization
and Reprocessing (EMDR)
2.
•
•
•
•
•
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
PSY4030 6.0D
CBT Chapter 10
Eye Movement Desensitization
and Reprocessing (EMDR)
3. Cognitive Restructuring
• Imagine (formerly) traumatic image
while verbalizing adaptive belief
• Assessment of anxiety level
PSY4030 6.0D
CBT 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
Flooding is good for ritualistic acts/thoughts
PSY4030 6.0D
CBT Chapter 10