Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear?

Deacon, Brett J.; Sy, Jennifer T.; Lickel, James J.; Nelson, Elizabeth A.

doi:10.1016/j.jbtep.2009.10.004

Cited by 70 publications

(61 citation statements)

References 31 publications

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“…We are aware of two studies that investigated the acceptability of CBT with safety behaviour. Deacon, Sy, Lickel, and Nelson (2010) compared the acceptability of exposure and exposure with the judicious use of safety behaviour and found no between-group differences. How ever, treatment acceptability was assessed using a single-item prompt with unknown psychometric properties.…”

mentioning

confidence: 99%

Safety Behaviour Enhances the Acceptability of Exposure

Levy¹,

Radomsky²

2013

Cognitive Behaviour Therapy

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Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than ERP. Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders.

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confidence: 99%

Safety Behaviour Enhances the Acceptability of Exposure

Levy¹,

Radomsky²

2013

Cognitive Behaviour Therapy

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“…Concretamente, el uso de toallitas higiénicas después de exposiciones en individuos con miedo a la contaminación no condujo a mayor recuperación espontánea de miedo o asco que la exposición sin toallitas higiéni-cas. De modo similar, Deacon y colaboradores no han conseguido replicar los efectos perjudiciales de seguir realizando conductas de seguridad (incluyendo la disponibilidad de la conducta de seguridad pero sin llegar a llevarla a cabo) durante la exposición, en este caso en la claustrofobia (Deacon et al, 2010;Sy, Dixon, Lickel, Nelson, y Deacon, 2011). A pesar de ello, la capacidad de las conductas de seguridad de mitigar el aprendizaje de extinción probablemente varía en función de la "ratio" entre inhibición y extinción en un ensayo determinado.…”

Section: Estrategias Terapéuticas Para Potenciar El Aprendizaje Inhibunclassified

Maximizar la terapia de exposición: Un enfoque basado en el aprendizaje inhibitorio

Torrents-Rodas

Fullana

Vervliet

et al. 2015

RPPC

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Resumen: A pesar de la efectividad de la terapia de exposición para el tratamiento de los trastornos de ansiedad, algunos pacientes no se benefi cian de ella o experimentan un retorno del miedo después del tratamiento. La investigación sugiere que las personas con ansiedad presentan défi cits en los mecanismos supuestamente implicados en la terapia de exposición, como el aprendizaje inhibitorio. Centrarse en estos mecanismos podría mejorar la efi cacia de los procedimientos basados en la exposición. El principal objetivo de este artículo es proporcionar ejemplos a los clínicos sobre cómo optimizar la terapia de exposición aplicando el modelo de aprendizaje inhibitiorio. Las estrategias de optimización incluyen 1) violación de expectativas, 2) extinción intensifi cada, 3) refuerzo ocasional durante la extinción, 4) retirada de señales de seguridad, 5) variabilidad, 6) claves de recuperación, 7) contextos múltiples y 8) etiquetado de las emociones. Mediante estudios de caso se mostrarán formas de aplicar estas técnicas en varios trastornos de ansiedad.Palabras clave: Aprendizaje inhibitorio; terapia de exposición; trastorno obsesivo-compulsivo; trastorno de estrés postraumáti-co; fobia social; fobia específi ca; trastorno de pánico. Maximizing exposure therapy: An inhibitory learning approachAbstract: Despite the effectiveness of exposure therapy for treating anxiety disorders, a number of patients fail to benefi t or experience a return of fear after treatment. Research suggests that anxious individuals show defi cits in the mechanisms believed to underlie exposure therapy, such as inhibitory learning. Targeting these processes may help improve the effi cacy of exposure-based procedures. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from a "fear habituation" approach and "belief disconfi rmation" approach within standard cognitive-behavior therapy. Exposure optimization strategies include 1) expectancy violation, 2) deepened extinction, 3) occasional reinforced extinction, 4) removal of safety signals, 5) variability, 6) retrieval cues, 7) multiple contexts, and 8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders.Keywords: Inhibitory learning; exposure therapy; obsessive-compulsive disorder; posttraumatic stress disorder; social phobia; specifi c phobia; panic disorder.La terapia de exposición, o la confrontación repetida de los estímulos que provocan miedo, ha sido la base fundamental de la terapia cognitivo-conductual para los trastornos de ansiedad desde sus inicios. La exposición toma Recibido: 28 octubre 2014; aceptado: 10 noviembre 2014.

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“…Although research shows that safety behaviors do have the potential to be counter-productive if they promote a misattribution of safety, or interfere with the development of self-efficacy or other mechanisms of emotional processing during exposure practices (Parrish, Radomsky, & Dugas, 2008), there is evidence that these strategies are not always detrimental to treatment outcome. In fact, some researchers (e.g., Deacon, Sy, Lickel, & Nelson, 2010) have found no reliable benefits or drawbacks associated with the judicious use of safety behaviors in exposure therapy, while others (e.g., Milosevic & Radomsky, 2008;Rachman, Radomsky, & Shafran, 2008;Rachman, Shafran, Radomsky, & Zysk, 2011;Sy, Dixon, Lickel, Nelson, & Deacon, 2011) have found that the judicious use of safety behaviors during graduated exposure exercises may present advantages over traditional exposure-based treatments by allowing clients to: (a) approach their feared situation more rapidly; and (b) stay in that situation for a longer period of time relative to those individuals who are told to drop their use of safety behaviors -both of which may serve to enhance the exposure practice rather than interfere with it. For example, research suggests that safety behaviors that focus on impression management (e.g., behavioral rehearsal, feigning friendly behavior towards others) rather than avoidance (e.g., avoiding eye contact, not speaking) are not typically associated with negative perceptions by others in a social context (Hirsch, Meynen, & Clark, 2004).…”

Section: Safety Behaviors-friend or Foe?mentioning

confidence: 99%

Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder

Rogojanski¹,

Rego²

2013

PCSP

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In their comprehensive case study, Jensen, Hougaard, and Fishman (2013) examined the microlevel mechanisms of change for a socially anxious client who underwent one-week of intensive group-based cognitive behavioral therapy (CBT) and experienced rapid symptom improvement. Our commentary focuses on two key components in the cognitive model of social anxiety, which this study highlights -the role of safety behaviors and interrogating the social environment, as well two topics that are applicable to anxiety treatments in general -integrating acceptance-based strategies into CBT and novel approaches in treatment delivery. We highlight what can be learned from Jensen and colleagues' case study by incorporating both empirical research and our own clinical anecdotes.Key words: cognitive behavior therapy; social anxiety disorder; mechanisms of change; exposure therapy; anxiety; case studies; clinical case studies; case series ______________________________________________________________________________We thoroughly enjoyed reading Jensen, Hougaard, and Fishman's (2013) case study of the mechanisms of change in a social phobia client following intensive group-based cognitive behavioral therapy (CBT). This article described Sara, a woman diagnosed with Social Anxiety Disorder who suffered from a primary fear of blushing, and explored mechanisms of change related to her rapid recovery following a brief, intensive treatment. This treatment was based primarily on the work of David Clark and colleagues and comprised of three individual weekly treatment sessions, followed by one week of 5-hour intensive daily group treatment, and five weekly individual follow-up sessions largely for consolidation of treatment gains. Although we're quite familiar with this treatment model and have utilized it with numerous clients individually in our own clinical practices, the authors of this article provide a novel approach for delivering this treatment -in terms of both format and frequency. Being zealous cognitive behavior therapists, we were intrigued by this approach and will focus this commentary on

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Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear?

Cited by 70 publications

References 31 publications

Safety Behaviour Enhances the Acceptability of Exposure

Safety Behaviour Enhances the Acceptability of Exposure

Maximizar la terapia de exposición: Un enfoque basado en el aprendizaje inhibitorio

Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder

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