Exposure Therapy

Exposure therapy is a type of therapy that helps people overcome things,

activities, or situations that cause fear or anxiety. It’s used by therapists and
psychologists to help treat conditions such as post-traumatic stress
disorder (PSTD) and phobias.

People have a tendency to avoid things and situations they’re afraid of.
According to the American Psychological Association, the idea behind exposure
therapy is exposing people to stimuli that cause distress in a safe environment
helps them decrease avoidance and overcome their fear.

Joseph Wolpe (1915–1997) was one of the first psychiatrists to spark

interest in treating psychiatric problems as behavioral issues. He sought
consultation with other behavioral psychologists, among them James G.
Taylor (1897–1973), who worked in the psychology department of
the University of Cape Town in South Africa.

Although most of his work went unpublished, Taylor was the first
psychologist known to use exposure therapy treatment for anxiety,
including methods of situational exposure with response prevention—a
common exposure therapy technique still being used. [37] Since the 1950s,
several sorts of exposure therapy have been developed,
including systematic desensitization, flooding, implosive
therapy, prolonged exposure therapy, in vivo exposure therapy, and
imaginal exposure therapy.

What exactly is exposure therapy?

Exposure therapy is a technique used by therapists to help people overcome

fears and anxieties by breaking the pattern of fear and avoidance. It works by
exposing you to a stimulus that causes fear in a safe environment.
For example, a person with social anxiety may avoid going to crowded areas or
parties. During exposure therapy, a therapist would expose the person to these
types of social settings to help them become comfortable in them.

It’s thought that there are four primary ways that exposure therapy may help:

 Emotional processing. Exposure therapy helps you create realistic

beliefs about a feared stimulus.
 Extinction. Exposure therapy can help you unlearn negative associations
with a feared object or situation.
 Habituation. Repeated exposure to a feared stimulus over time helps
decrease your reaction.
 Self-efficacy. Exposure therapy helps show you that you’re able to
overcome your fear and manage your anxiety.

Are there different types of exposure therapies?

According to the American Psychological Association, some of the potential

variations of exposure therapies include:

 In vivo exposure. It involves facing your fear in real life. For example,
someone with arachnophobia may interact with a spider.
 Imaginal exposure. A thing or situation is imagined vividly. For example, a
person who’s afraid of birds might be asked to picture being on a beach
filled with seagulls.
 Virtual reality exposure. Virtual reality technology may be used in
situations when it’s difficult to experience the cause of fear in reality. For
example, somebody with a fear of flying may use a flight simulator.
 Interoceptive exposure. This type of exposure triggers a physical
sensation to show that it’s harmless, even if it’s feared. For example,
somebody who’s afraid of lightheadedness because they think it means
they’re having a stroke may be instructed to stand up quickly.
What conditions can exposure therapy help treat?

Exposure therapy is used to treat anxiety disorders, including the following:

 generalized anxiety disorder

 obsessive-compulsive disorder (OCD)
 phobias
 panic disorder
 post-traumatic stress disorder
 social anxiety disorder

How does exposure therapy work?

The techniques a therapist uses during exposure therapy depend on the

condition being targeted.

Here’s what you may experience.

1. Once the cause of your fear or anxiety has been identified, your therapist
or psychologist will start the process by exposing you to the feared
stimulus.
2. Often, they use a graded approach, where they start by exposing you to a
mildly feared stimulus or a mild version of your stimulus.
3. Over time, your therapist will expose you to more feared stimuli in a safe
environment.
4. The number of sessions and length of time your treatment will take
depends on your progress.

For example, if you’re afraid of mice, the therapist might start by showing you
pictures of mice during your first session. In the next session, they might bring a
live mouse in a cage. In a third session, they might have you hold a mouse.
 Token Economy
Token economy is a behavior modification technique that is widely used in applied behavior
analysis (ABA) therapy. It is a system of rewards that is used to reinforce positive behavior and
reduce negative behavior. Token economy is a type of behavior modification technique that uses
tokens or points as rewards for positive behavior. Tokens can be any item that is valued by the
individual, such as stickers, chips, or coins. The tokens are given to the individual immediately
after they exhibit the desired behavior. Tokens can be exchanged later for a preferred item or
activity, such as toys, games, or extra screen time.
Token economy is based on the principles of operant conditioning, which is the idea that
behavior is shaped by its consequences. Positive behavior is reinforced by rewarding it, while
negative behavior is reduced by ignoring it or using punishment.
Token economy is effective because it reinforces positive behavior without the need for
immediate rewards. It also provides a visual representation of progress, which can be
motivating for individuals.
Only in the 1960s the first real token economies arose in psychiatric hospitals. Teodoro Ayllon,
Nathan Azrin and Leonard Krasner were important pioneers in these early years.[8][9] The very
first token economy bearing that name was founded by Ayllon and Azrin in 1961 at Anna State
Hospital in Illinois. In the 1970s the token economies came to a peak and became widespread.
Does Token Economy Work in ABA Therapy?
Token economy is a commonly used technique in ABA therapy, which is a form of therapy that
focuses on the principles of behaviorism to teach new skills and reduce unwanted behaviors. In
ABA therapy, token economy is used to reinforce positive behavior and teach new skills.
The first step in implementing token economy in ABA therapy is to identify the specific
behaviors that need to be reinforced. This may include behaviors such as following instructions,
completing tasks, or demonstrating appropriate social skills.
Once the target behaviors have been identified, the therapist will create a token economy
system that is tailored to the individual’s needs.
The token economy system typically involves a chart or board that displays the target behaviors
and the corresponding tokens.
The individual earns tokens for exhibiting the target behaviors, and the tokens are exchanged
later for a preferred item or activity. The therapist will also set up a schedule for token
exchanges, which may be daily, weekly, or monthly.
The effectiveness of token economy in ABA therapy depends on several factors, including the
individual’s motivation and the consistency of the rewards. It is important for the rewards to be
meaningful and desirable to the individual in order to maintain their motivation. The rewards
should also be consistent and timely to reinforce the desired behavior.
Features Of Token Economy
Application of Token Economy
Special education (for children with developmental or learning disabilities, hyperactivity,
attention deficit, or behavioral disorders), regular education, colleges, various types of group
homes , military divisions, nursing homes, addiction treatment programs, patients with
Schizophrenia, occupational settings, family homes (for marital or parenting difficulties), and
hospitals may also use token economies. Token economies can be used individually or in groups.

GRADED TASK ASSIGNMENT

Features
Graded homework assignment is a widely used behavioral technique in Aaron Beck’s cognitive
therapy for the treatment of depressive disorders.
Graded Homework Assignment it is used especially in the early stages of therapy, and / or when
the patient is very depressed, in order to get him out of that state of apathy and absolute
apathy. The therapist’s goal will be to restore the patient’s previous level of functioning before
the depression.
A CBT clinician uses graded task assignment to teach the patient how to break down an activity
into a series of smaller, more manageable steps. The patient is encouraged to initially attempt to
complete the first step only. Once that step has been completed, the patient can move on to the
next step. Once success with that step has been achieved, the next step is attempted, and so
on.
The application of the graded tasks will allow incorporating more cognitive techniques in more
advanced phases of the treatment, when the patient’s mood is better.
The technique consists of assigning the patient tasks with different degrees of difficulty, that
pose a challenge for him but with a high probability of success. The tasks will be graduated, that
is, their level of difficulty will go from less to more, and each time they will be more complex for
the patient.
The therapist should record the patient’s expectations of difficulty and effectiveness about the
different tasks or activities, as well as the degree of realism regarding these expectations. It will
also be Important, as therapy progresses, to contrast the patient’s evaluations about their
performance.
Example
Ali wanted to do an activity but felt like it was too difficult. Below is a partial example showing
how we broke it down into more manageable steps. Try to fill out box 4 and 5 with your
suggestions. Once you are finished, select the box number to see what we came up with.
GO TO A BASEBALL GAME WITH A FRIEND
Step 1. Decide which friend Joe wants to invite.
Step 2. Call friend to ask if he wants to go to a game & come up with a possible date.
Step 3. Go online to look up game schedule & ticket prices and availability
Step 4. write your ideas here
Step 5. Write your ideas here
Step 6. Go to game

COVERT SENSITIZATION
Definition
Covert sensitization is a form of behavior therapy in which an undesirable behavior is paired
with an unpleasant image in order to eliminate that behavior.
Purpose
As with other behavior modification therapies, covert sensitization is a treatment grounded in
learning theory—one of the basic tenets being that all behavior is learned and that undesirable
behaviors can be unlearned under the right circumstances. Covert sensitization is one of a group
of behavior therapy procedures classified as covert conditioning, in which an aversive stimulus
in the form of a nausea-or anxiety-producing image is paired with an undesirable behavior to
change that behavior. It is best understood as a mixture of both the classical and the operant
conditioning categories of learning.
Based on research begun in the 1960s, psychologists Joseph Cautela and Albert Kearney
published the 1986 classic The Covert Conditioning Handbook, which remains a definitive
treatise on the subject.
The goal of covert sensitization is to directly eliminate the undesirable behavior itself, unlike
insight-oriented psychotherapies that focus on uncovering unconscious motives in order to
produce change. The behaviors targeted for modification are often referred to as “maladaptive
approach behaviors,” which includes behaviors such as alcohol abuse, drug abuse, and smoking;
pathological gambling; overeating; sexual deviations, and sexually based nuisance behaviors
such as obscene phone calling. The type of behavior to be changed and the characteristics of
the aversive imagery to be used influence the treatment, which is usually administered in an
outpatient setting either by itself or as a component of a multimodal program. Self-
administered homework assignments are almost always part of the treatment package. Some
therapists incorporate covert sensitization with hypnosis in the belief that outcome is enhanced.
Description
The patient being treated with covert sensitization can expect a fairly standard set of
procedures. The therapist begins by assessing the problem behavior, and will most likely
measure frequency, severity, and the environment in which it occurs. Depending upon the type
of behavior to be changed, some therapists may also take treatment measures before, during,
and after physiological arousal (such as heart rate) to better assess treatment impact. Although
the therapeutic relationship is not the focus of treatment, the behavior therapist believes that
good rapport will facilitate a more successful outcome and strives to establish positive but
realistic expectations. Also, a positive relationship is necessary to establish patient confidence in
the rationale for exposure to the discomfort of unpleasant images.
The therapist will explain the treatment rationale and protocol. Patient understanding and
consent are important, since, by intention, he or she will be asked to experience images that
arouse unpleasant and uncomfortable physical and psychological associations. The therapist
and patient collaborate in creating a list of aversive images uniquely meaningful to the patient
that will be applied in the treatment. Standard aversive images include vomiting, snakes,
spiders, vermin, and embarrassing social consequences. An aversive image is then selected
appropriate to the target problem behavior. Usually, the image with the most powerful aversive
response is chosen. The patient is instructed on how to relax—an important precursor to
generating intense imagery. The patient is then asked to relax and imagine approaching the
situation where the undesirable behavior occurs (for example, purchasing donuts prior to
overeating).
If the patient has a difficult time imagining the scene, the image may be presented verbally by
the therapist. As the patient imagines getting closer to the situation (donut store), he or she is
asked to clearly imagine an unpleasant consequence (such as vomiting) just before indulging in
the undesirable behavior (purchasing donuts and overeating).
The scene must be imagined with sufficient vividness that a sense of physiological discomfort
or high anxiety is actually experienced. Then the patient imagines leaving the situation and
experiencing considerable relief. The patient learns to associate unpleasant sensations (nausea
and vomiting) with the undesirable behavior, leading to decreased desire and avoidance of the
situation in the future. An alternative behavior incompatible with the problem behavior may be
recommended (eat fruit when hungry for a donut).
The patient is given the behavioral homework assignment to practice self-administering the
treatment. The patient is told to alternate the aversive scenes with scenes of self-controlled
restraint in which he or she rejects the undesirable behavior before indulging in it, thus avoiding
the aversive stimulus.
The procedure is practiced several times with the therapist in the office, and the patient
practices the procedure ten to 20 times during each home session between office sessions. The
patient is then asked to practice in the actual situation, imagining the aversive consequences
and avoiding the situation. With much variation, and depending upon the nature of the
behavior targeted for change, the patient may see the therapist anywhere from five to 20
sessions over a period of a few weeks to several months. The treatment goal is to eliminate the
undesirable behavior altogether.
Risks
Covert sensitization is comparatively risk-free. This is in contrast to the medical and ethical
concerns raised by some other aversive procedures such as aversion therapy, in which potent
chemical and pharmacological stimulants may be used as aversants.
Normal Results
Depending upon the objectives established at the beginning of treatment, patients successfully
completing covert sensitization might expect to stop the undesirable behavior. And, if they
practice relapse prevention techniques, they can expect to maintain the improvement. Although
this treatment may appear to be relatively simple, it has been found to be quite effective for
treating many circumscribed problem behaviors.