WEEK 1
OVERVIEW AND HISTORY OF EXPOSURE THERAPY FOR
ANXIETY
When does learning take place?
When a person repeatedly confronts a feared stimulus in the absence of the expected feared
consequence.
What is anxiety?
An organisms’ response to the perception of threat
What are three levels of the fight-or-flight reponse?
Physiological level
Cognitive level Shift in attention toward perceived threat
Behavioral level
When is anxiety abnormal?
When it occurs in the absence of danger or when it is out of proportion relative to the actual
threat
Where does excessive anxiety stem from?
The misperception of a safe situation as dangerous
What are two consequences of misperceiving safe stimuli as dangerous?
Vicious cycle of perception of threat due to emotional reasoning bias
Development of strategies for avoiding these fears
What is the fundamental psychological mechanism in all anxiety disorders?
Relatively safe stimuli are misperceived as dangerous, leading to unnecessary anxiety and
avoidance or escape behaviors that perpetuate the problem
What are three parts of the Comprehensive Etiological Model of Anxiety (Mineka &
Zinbarg)?
Early learning experiences
Occurrence and context of stressful events
Genetic or temperamental vulnerability
Why are maintenance factors of importance for exposure therapy?
Because etiological factors cannot be changed, but maintenance factors can be changed
What are three elements necessary for successful and durable treatment of clinical
fear and anxiety?
1. Patients must be presented with information that is incompatible with their
maladaptive beliefs about the dangerousness or intolerability of feared stimuli
2. Behaviors that interfere with the acquisition and consolidation of this new information
must be eliminated
3. This new information must be strengthened in memory and generalized as broadly as
possible so that it is recalled in diverse contexts and over time
What three things do you want to understand by doing your assessment on anxiety?
1. The contexts in which anxiety is triggered
2. The anticipated feared consequences of encountering fear triggers
3. The strategies used to seek safety from harm and reduce anxiety by avoiding
What 3 points does rationale about therapy include?
, 1. A clear explanation of the problem
2. Information about how exposure is commonly experienced, including provocation and
distress
3. The therapists’ role as coach and ally
What three points is learning focused on?
1. Whether the expected negative outcome occurred
2. How manageable it was if it did occur
3. The degree to which the patient’s distress was tolerable
What is systematic desensitization?
Weakening the association between anxiety and the phobic stimulus by pairing the phobic
stimulus with a psychological state that is incompatible with anxiety
What is reciprocal inhibition?
Anxiety inhibits a positive stimulus and the positive stimulus inhibits anxiety
What are the two limitations of habituation learning?
1. Fear levels during exposure are not consistently reliable indices of long-term fear
extinction
2. It shames the experience of anxiety
What are two aims of exposure therapy based on inhibitory learning?
1. Patients develop new non-threatening cognitions
2. Enhancing the accessibility of these new safety-based cognitions in different contexts
over time
ANXIETY DISORDERS: WHY THEY PERSIST AND HOW TO
TREAT THEM
What are the six maintaining processes in anxiety disorders?
Safety seeking behavior
Attentional deployment
Spontaneously occurring images
Emotional reasoning
Memory processes
Nature of the perceived threat
What are safety seeking behaviors?
Behaviors that are performed in order to prevent or minimize a feared catastrophe
What is attentional deployment?
In anxiety disorders, attention towards threat cues (panic disorder, hypochondriacs) and
attention away from threat cues (social anxiety disorder) is found
What is emotional reasoning?
Using perceived body sensations to make inferences about how anxious you appear and
how poorly you come across.
What are two types of memory processes contributing to the maintenance of anxiety
disorders?
1. Tendency to selectively retrieve information which confirms their worst fears
, 2. Dissociation between explicit and implicit memory
What is affect without recollection in PTSD?
The triggering of intense affect by the presence of stimuli that were associated with the
trauma, without simultaneous recollection of the traumatic event
Why are symptoms of PTSD persistent in some people and not in others, based on the
maintenance factor of nature of the perceived threat?
If you interpret your normal intrusive recollections and other symptoms negatively, thinking
they indicate that you are going mad or losing control, you may engage in thought
suppression and other dysfunctional strategies that could prolong the intrusions and other
symptoms.
, A CONTEMPORARY LEARNING THEORY PERSPECTIVE ON
THE ETIOLOGY OF ANXIETY DISORDERS
What are factors that influence who develops specific phobia and who does not?
Vicarious conditioning of fears and phobias
Individual differences in the acquisition of fears and phobias
Selective associations in the conditioning of fears and phobias
What is vicarious conditioning?
The act of learning things through observing the reactions, attitudes, and emotions of others
rather than direct exposure to it yourself.
What is the Diathesis-Stress perspective on specific phobias and what are its main
three factors?
It explains why many individuals who undergo traumatic experiences do not develop phobias
Genetic vulnerability for phobias
Personality vulnerabilities for phobias
Differences in life experiences
What are three factors in differences in life experiences in phobias?
Impact of prior experiences
Impact of contextual variables during conditioning
Impact of post-event variables
Impact of prior experiences – What is latent inhibition?
Simple prior exposure to a conditioned stimulus before the CS and US are paired reduces
the amount of conditioning to the CS when paired.
Impact of prior experiences – What is control over your environment in specific
phobias?
History of control over your environment makes you more invulnerable to developing phobias
following trauma.
Impact of contextual variables during conditioning – Explain this
Having control over the traumatic event has impact on fear acquisition
Impact of post-event variables – What is the inflation effect?
A person who is exposed to a more intense traumatic experience (not paired with the CS)
after conditioning of a mild fear is likely to show an increase in fear of the CS.
What is the US revaluation process in the inflation effect?
When a person receives verbally or socially transmitted information about the US being more
dangerous than when they experienced it. This results in inflated level of fear to the CS.
What is true about the mental rehearsal of CS-US relationships?
It can lead to enhanced strength of conditioned fear response
What is true about selective associations in the conditioning of fears and phobias?
Primates are evolutionary prepared to associate certain kinds of objects with aversive
events.
OVERVIEW AND HISTORY OF EXPOSURE THERAPY FOR
ANXIETY
When does learning take place?
When a person repeatedly confronts a feared stimulus in the absence of the expected feared
consequence.
What is anxiety?
An organisms’ response to the perception of threat
What are three levels of the fight-or-flight reponse?
Physiological level
Cognitive level Shift in attention toward perceived threat
Behavioral level
When is anxiety abnormal?
When it occurs in the absence of danger or when it is out of proportion relative to the actual
threat
Where does excessive anxiety stem from?
The misperception of a safe situation as dangerous
What are two consequences of misperceiving safe stimuli as dangerous?
Vicious cycle of perception of threat due to emotional reasoning bias
Development of strategies for avoiding these fears
What is the fundamental psychological mechanism in all anxiety disorders?
Relatively safe stimuli are misperceived as dangerous, leading to unnecessary anxiety and
avoidance or escape behaviors that perpetuate the problem
What are three parts of the Comprehensive Etiological Model of Anxiety (Mineka &
Zinbarg)?
Early learning experiences
Occurrence and context of stressful events
Genetic or temperamental vulnerability
Why are maintenance factors of importance for exposure therapy?
Because etiological factors cannot be changed, but maintenance factors can be changed
What are three elements necessary for successful and durable treatment of clinical
fear and anxiety?
1. Patients must be presented with information that is incompatible with their
maladaptive beliefs about the dangerousness or intolerability of feared stimuli
2. Behaviors that interfere with the acquisition and consolidation of this new information
must be eliminated
3. This new information must be strengthened in memory and generalized as broadly as
possible so that it is recalled in diverse contexts and over time
What three things do you want to understand by doing your assessment on anxiety?
1. The contexts in which anxiety is triggered
2. The anticipated feared consequences of encountering fear triggers
3. The strategies used to seek safety from harm and reduce anxiety by avoiding
What 3 points does rationale about therapy include?
, 1. A clear explanation of the problem
2. Information about how exposure is commonly experienced, including provocation and
distress
3. The therapists’ role as coach and ally
What three points is learning focused on?
1. Whether the expected negative outcome occurred
2. How manageable it was if it did occur
3. The degree to which the patient’s distress was tolerable
What is systematic desensitization?
Weakening the association between anxiety and the phobic stimulus by pairing the phobic
stimulus with a psychological state that is incompatible with anxiety
What is reciprocal inhibition?
Anxiety inhibits a positive stimulus and the positive stimulus inhibits anxiety
What are the two limitations of habituation learning?
1. Fear levels during exposure are not consistently reliable indices of long-term fear
extinction
2. It shames the experience of anxiety
What are two aims of exposure therapy based on inhibitory learning?
1. Patients develop new non-threatening cognitions
2. Enhancing the accessibility of these new safety-based cognitions in different contexts
over time
ANXIETY DISORDERS: WHY THEY PERSIST AND HOW TO
TREAT THEM
What are the six maintaining processes in anxiety disorders?
Safety seeking behavior
Attentional deployment
Spontaneously occurring images
Emotional reasoning
Memory processes
Nature of the perceived threat
What are safety seeking behaviors?
Behaviors that are performed in order to prevent or minimize a feared catastrophe
What is attentional deployment?
In anxiety disorders, attention towards threat cues (panic disorder, hypochondriacs) and
attention away from threat cues (social anxiety disorder) is found
What is emotional reasoning?
Using perceived body sensations to make inferences about how anxious you appear and
how poorly you come across.
What are two types of memory processes contributing to the maintenance of anxiety
disorders?
1. Tendency to selectively retrieve information which confirms their worst fears
, 2. Dissociation between explicit and implicit memory
What is affect without recollection in PTSD?
The triggering of intense affect by the presence of stimuli that were associated with the
trauma, without simultaneous recollection of the traumatic event
Why are symptoms of PTSD persistent in some people and not in others, based on the
maintenance factor of nature of the perceived threat?
If you interpret your normal intrusive recollections and other symptoms negatively, thinking
they indicate that you are going mad or losing control, you may engage in thought
suppression and other dysfunctional strategies that could prolong the intrusions and other
symptoms.
, A CONTEMPORARY LEARNING THEORY PERSPECTIVE ON
THE ETIOLOGY OF ANXIETY DISORDERS
What are factors that influence who develops specific phobia and who does not?
Vicarious conditioning of fears and phobias
Individual differences in the acquisition of fears and phobias
Selective associations in the conditioning of fears and phobias
What is vicarious conditioning?
The act of learning things through observing the reactions, attitudes, and emotions of others
rather than direct exposure to it yourself.
What is the Diathesis-Stress perspective on specific phobias and what are its main
three factors?
It explains why many individuals who undergo traumatic experiences do not develop phobias
Genetic vulnerability for phobias
Personality vulnerabilities for phobias
Differences in life experiences
What are three factors in differences in life experiences in phobias?
Impact of prior experiences
Impact of contextual variables during conditioning
Impact of post-event variables
Impact of prior experiences – What is latent inhibition?
Simple prior exposure to a conditioned stimulus before the CS and US are paired reduces
the amount of conditioning to the CS when paired.
Impact of prior experiences – What is control over your environment in specific
phobias?
History of control over your environment makes you more invulnerable to developing phobias
following trauma.
Impact of contextual variables during conditioning – Explain this
Having control over the traumatic event has impact on fear acquisition
Impact of post-event variables – What is the inflation effect?
A person who is exposed to a more intense traumatic experience (not paired with the CS)
after conditioning of a mild fear is likely to show an increase in fear of the CS.
What is the US revaluation process in the inflation effect?
When a person receives verbally or socially transmitted information about the US being more
dangerous than when they experienced it. This results in inflated level of fear to the CS.
What is true about the mental rehearsal of CS-US relationships?
It can lead to enhanced strength of conditioned fear response
What is true about selective associations in the conditioning of fears and phobias?
Primates are evolutionary prepared to associate certain kinds of objects with aversive
events.
