Therapeutic process during exposure: Habituation model
Section snippets
Overview
According to the habituation model, exposure is effective because it provides structured contact with a feared stimulus while minimizing opportunity for avoidance, escape or ritualizing. The primary goal during exposures is anxiety reduction, which occurs through contact with a feared stimulus in the absence of avoidance, escape, and ritualizing. Thus, when fear elicited by a stimulus has decreased (and avoidance, escape, and ritualizing have not occurred), habituation is said to have taken
Selecting an exposure task
We will consider each of the following clinical issues in the context of the three tenets of habituation theory during exposure: fear activation, minimization of anxiety-reducing behavior, and habituation.
Exposure rationale
The rationale for the exposure should include a discussion of the exposure technique more broadly, as well as specific information about how we believe exposures work. Ideally, this should happen at the beginning of treatment as part of more general psychoeducation about OCD and treatment options. Many times it will be appropriate to repeat the rationale over the course of treatment and to use experiences during exposure to illustrate the theory underlying the rationale. The description of
Optimal therapist behaviors during exposure
Optimal therapist behaviors during exposure are presented in Table 1. Prescribed therapist behaviors are those that theoretically function to increase or maintain the client׳s contact with the exposure stimulus and would therefore facilitate the occurrence of habituation. These include discouraging client avoidance behavior (e.g., asking Monica to maintain eye contact with unlabeled food, asking her to avoid asking questions about the food, asking her to “re-expose” by touching the exposure
Ending exposure
When is the exposure “done?” It is appropriate to end an exposure when anxiety has reduced and was judged by the therapist to be mostly in the absence of anxiety reducing behaviors. There is no standard exposure length, and setting a time limit as a way to titrate exposure difficulty is not optimal (see “Proscribed techniques” above). However, savvy therapists with clients who habituate quickly may use this as an opportunity to increase the difficulty of the exposure in order to provide the
Conclusion
When considering the habituation model, it is important to distinguish conceptually between the mechanism underlying exposure, the therapeutic process that engages that mechanism, and intermediate outcomes that indicate the mechanism is being engaged. The therapeutic process variables outlined in this paper are based on functional analysis and are thought to engage the mechanism, but are not the mechanism itself. Likewise, habituation can be conceptualized as an intermediate treatment outcome
References (54)
- et al.
Strategies for improving long-term outcomes in cognitive behavioral therapy for obsessive–compulsive disorder: insights from learning theory
Cognitive and Behavioral Practice
(2014) - et al.
The relevance of analogue studies for understanding obsessions and compulsions
Clinical Psychology Review
(2014) - et al.
The promise of extinction research for the prevention and treatment of anxiety disorders
Biological Psychiatry
(2006) - et al.
Emotional processing and fear measurement synchrony as indicators of treatment outcome in fear of flying
Journal of Behavior Therapy and Experimental Psychiatry
(1990) - Benito, K. (2014). Effective therapist behaviors during EX/RP for pediatric OCD. In: Proceedings of the Paper Presented...
- et al.
CBT specific process in exposure-based treatments: initial examination in a pediatric OCD sample
Journal of Obsessive Compulsive and Related Disorders
(2012) - et al.
The contribution of relaxation and expectancy to fear reduction via graded, imaginal exposure to feared stimuli
Behaviour Research and Therapy
(1979) - et al.
Integrating behavioral theory with OCD assessment using the Y-BOCS/CY-BOCS symptom checklist
Journal of Obsessive–Compulsive and Related Disorders
(2012) - et al.
Optimizing inhibitory learning during exposure therapy
Behaviour Research and Therapy
(2008) - et al.
Is aversive learning a marker of risk for anxiety disorders in children?
Behaviour Research and Therapy
(2008)