Study Guide for Exam #3 Psych 383Exposure & Behavior Therapies:Understand the main tenets of exposure-based therapies – learning theory; conceptualization of psychopathology; key therapeutic processes & principles:Mowrer’s two-factor theory of learning (below)Psychopathology – conditioned anxiety & avoidance; Freud’s neurotic paradox – failure of maladaptive anxiety to extinguish despite its self-defeating nature(short-term = learned behavior decreases anxiety; long-term = learned behavior promotes even more avoidance & intensity of anxiety); Emotional Processing Theory (Foa & Kozak) – traumatic or feared experiences that go unprocessed remain pathologically represented in memory(thus, must make effort to process the traumatic or feared experience & to alter the fear structure)Therapy process – extinction = reduction of conditioned fear/anxiety because no longer reinforced by avoidance; exposure & response-prevention (E/RP) – activates pathological structure while at same time introduces corrective info that can be transformed into more adaptive memory structure; approaches on continuum from gradual to intense, and from imaginal to in-vivoTherapy principles – exposure therapist must “stay with” exposure-based exercise until anxiety at least partially extinguished; need to be well-disciplined & overcome own tendency to avoid producing discomfort in others; rationale & confidence in treatment are key (transparent rationale for “tough love”); in theory, no relationshipneeded to complete treatment principles (however, relationship can be facilitative … empathy, trust, safety, support)Know Mowrer’s two-factor theory of learning:1. Classical conditioning – pair aversive stimulus with neutral (conditioned) stimulus; conditioned fear response2. Operant conditioning – conditioned fear/anxiety response motivates avoidance of conditioned stimulus; avoidance response associated with fear/anxiety reduction; anxiety reduction reinforces avoidant behaviorGeneralization – stimuli similar to conditioned stimulus elicit similar fear and, thus, more expansive avoidanceUnderstand the meaning of key exposure therapy terms – extinction, exposure & response-prevention, imaginal & invivo exposure, etc.:Extinction = reduction of conditioned fear/anxiety because no longer reinforced by avoidanceExposure & Response-Prevention (E/RP) = activates pathological structure while at same time introduces corrective info that can be transformed into more adaptive memory structureImaginal & In Vivo Exposure = approaches on continuum from gradual to intenseKnow the main research findings for exposure-based therapies (know the main themes of the research base vs. findings from specific studies):Various levels of support for Implosive Therapy & EMDR; most impressive support for E/RP for OCD (significant improvement in 60-75% of patients; more effective than antidepressant medications (especially for rituals); less side effects & dropout, greater maintenance than medications)Know the primary critiques & limitations of exposure-based approaches:Really just part of behavioral tradition & learning paradigm; exposure insufficient (goal of treatment to make unconscious conscious, not simply to make the fear less fearful); involve “acting on/doing to” points vs. “being with” patients; treatment could be worse than disorder!; treatment too late in the game (need to address socialcauses to fear conditioning)Familiarize yourself with key terms in chapter 8 of P&N:Learned avoidance: serves to reduce anxiety in the short termResponse prevention: extinguishes anxiety by forcing the animal to remain in the presence of the conditioned stimuliGeneralization: anything similar to original fear conditioned stimulus will elicit similar feelings of fear and anxiety Imaginal exposure: feared stimulus is presented to patient through their imaginationIn vivo exposure: feared stimulus presented in real life situationHabituation: 50% reduction in anxiety to fear producing stimuli is achievedBreathing retraining: teaching clients to breathe calmly from the diaphragmCue exposure: (in treatments for addictive disorders) using aversive stimulus to recondition patient so that the smell of beer/sight of vodka bottle no longer elicits original conditioned responses (happiness)Symptom exacerbation: prolonged exposure might cause this (symptoms get worse) which leads to premature termination or inferior outcomesClinical significance: ensures the magnitude of treatment gains is substantial and meaningfulStatistical significance: this alone tends to inflate small, insubstantial treatment gains (useless)Virtual Reality (VR): exposure therapy integrates real time computer graphics, visual display and other sensory input devices to immerse patients in computer simulated environment that they find anxiety producingDismantling Studies: Research designs to break down a psychotherapy into its constituent ingredients to determine which are the active ingredientsValidity of Cognition (VOC) scale: a positive cognition assessed on seven points where 1 is completely false and 7 is completely trueSubjective units of distress (SUD): 0 is no stress and 10 is highest stress imaginable. Patients are asked to give SUD rating of how they are feeling right that moment while holding the memory and negative cognition in mindDesensitization phase: longest phase, asked to bring up traumatic image, think of the negative cognition and notice the feelings attached to it as he or she follows the therapist's hands with his or her eyesInstallation: install and increase the strength of the positive cognitionCognitive interweave: proactive version of EMDR that deliberately interlaces clinician derived statementswith client generated material instead of relying solely on the clients spontaneous processingLooping: Repetitive thoughts that do not move and that block processingPro bono: free of costTreatment fidelity: effectiveness of EMDR for PTSD (this is the example used) appears to be higher in rigorous studies that closely follow the specific treatment protocol Know the most defining characteristics of behavioral approaches:Focus on behavior & learning principles; environmental conditions vs. internal personality traits; active & directive treatment; assessment & regular evaluation; incorporating person’s everyday life into treatment; treatment as an empirical endeavorUnderstand the main tenets of behavior therapies – learning theory;