Therapeutic process during exposure: Habituation model

Abstract

The current paper outlines the habituation model of exposure process, which is a behavioral model emphasizing use of individually tailored functional analysis during exposures. This is a model of therapeutic process rather than one meant to explain the mechanism of change underlying exposure-based treatments. Habitation, or a natural decrease in anxiety level in the absence of anxiety-reducing behavior, might be best understood as an intermediate treatment outcome that informs therapeutic process, rather than as a mechanism of change. The habituation model purports that three conditions are necessary for optimal benefit from exposures: 1) fear activation, 2) minimization of anxiety-reducing behaviors, and 3) habituation. We describe prescribed therapist and client behaviors as those that increase or maintain anxiety level during an exposure (and therefore, facilitate habituation), and proscribed therapist and client behaviors as those that decrease anxiety during an exposure (and therefore, impede habituation). We illustrate model-consistent behaviors in the case of Monica, as well as outline the existing research support and call for additional research to further test the tenets of the habituation model as described in this paper.

Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial

“…For example, researchers found that individuals with agoraphobia ventured further from their homes during exposure exercises when told that such exercises were part of treatment as opposed to merely assessment (Southworth & Kirsch, 1988). While there a handful of conceptualizations of the process of change for ERP, two somewhat distinct theory-driven approaches to framing ERP for OCD currently exist, including (a) traditional cognitive-behavioral approaches that emphasize anxiety reduction and the modification of dysfunctional cognitions (Benito & Walther, 2015;Foa, Huppert, & Cahill, 2006), and (b) acceptance and commitment therapy-based (ACT) approaches that emphasize willingness to experience anxiety, valued living, and cognitive defusion (fostering an "observer perspective" with regard to private experiences; Twohig, 2009;. These frameworks also incorporate distinct, yet overlapping, goals of exposure (anxiety reduction vs. valued living), approaches to targeting the anxiety provoked during exposure exercises (habituation vs. acceptance), and approaches to addressing fear-based cognitions (testing and modifying vs. defusing from them; Arch et al, 2015).…”

Parent and Clinician Perspectives on the Participation of Children with Cerebral Palsy in Community-Based Football: A Qualitative Exploration in a Regional Setting

“…Secondly, the club's capacity to provide opportunities for the child to try out football before enrolling in the activity was discussed to be helpful in encouraging the child to decide if they would enjoy the activity. Indeed, theories of graded exposure suggest that gradual exposure to a potentially stressful event can reduce anxiety leading to the event [42].…”

Using Family‐Based Exposure With Response Prevention to Treat Obsessive‐Compulsive Disorder in Young Children: A Case Study

“…There are several different theoretical frameworks a therapist could use to approach exposure (see Conelea & Freeman, ). One of these frameworks is the habituation model, which proposes that exposure reduces anxiety through habituation to feared stimuli, and that the process of habituation is passive and internal (Benito & Walther, ). According to this theory, optimal exposure would involve activating the fear, minimizing behaviors that function to reduce anxiety (i.e., negative reinforcement via rituals, avoidance), and allowing time to pass so that anxiety will run its course and attenuate on its own (i.e., habituation).…”