Exposure Therapies Applied To Food Addiction
Exposure Therapies
A common element in most behavior therapies is exposing the client to stimuli that evoke discomfort until he or she becomes used to them. Much research has been carried out in which clients are exposed to feared stimuli and are prevented from making an avoidance or escape response. The client is strongly urged to continue to attend to the anxiety-eliciting stimuli despite the stressful effects that usually accompany this effort.
Exposure therapy has been used in treating food addiction,
phobic and obsessive-compulsive disorder. A critical
element of the treatment is motivating the client to
maintain contact with the actual noxious stimuli or with
their imagined presence until he or she becomes used to
them. This might mean, for example, exposing a compulsive
hand washer to dirt until the hand washing no
longer occurs, or encouraging such a person to think
about dirt, perhaps imagined first as household dust and
later as particularly noxious dirt such as vomit or feces.
The therapist 's task is to identify all components of the
stimulus that evoke an avoidance or escape response and
to continue the exposure until the evoked response no
longer occurs.
Two types of therapy based on the exposure
principle are systematic desensitization, implosive therapy.
Only when a client is comfortable with one level of fear-producing
stimuli is the next, slightly stronger stimulus introduced.
Exposure therapy refers to therapist-controlled exposure
to the imagined re-creation of a complex, high-intensity
fear-arousing situation. Exposure means
that the individuals actual feared situation
rather than imagining.
In vivo exposure may be conducted gradually, beginning
with low levels of stimulus intensity, or rapidly,
by exposing the client immediately to high-intensity and
prolonged stimulation. This rapid, intense exposure, is
called flooding.
~Systematic desensitization, which is used primarily
in the treatment of strong fears, is based on conditioning.
The client is taught to relax and then is
presented with a series of stimuli that are graded from
low to high according to their capacity to evoke anxiety.
The treatment of death phobia illustrates how systematic
desensitization is used. The patient 's fears are arranged
in a hierarchy, with the items in the hierarchy
ranging, in descending order, from human corpses to
funeral processions, black clothes, dead dogs, and floral
wreaths . The therapy begins with items that are low in
the hierarchy, such as seeing a wreath. The therapist
tries to teach the client to remain relaxed while imagining
or actually seeing a wreath. When the client can
maintain a relaxed state consistently, the therapy proceeds
with stimuli that are higher in the hierarchy.
A therapist does not try to produce cures overnight
with conditioning procedures. Usually, the process
of reducing the level of an emotional response to a
stimulus that should be neutral is a gradual one. Clinical
applications of systematic desensitization have shown
that clients who are treated in this way become less upset
by previously feared situations and better able to
manage their anxiety. It is possible that the most effective
part of systematic desensitization is the client's exposure
to gradually increasing levels of fear-arousing
stimuli under nonthreatening conditions. Individuals
who can mentally rehearse being exposed to the upsetting,
fear-arousing-situations show particularly high levels
of improvement.
Implosive therapy is based on the belief that many
conditions, including anxiety disorders, are outgrowths
of painful prior experience the patient to unlearn
them, the original situation must re-created so that it
can be experienced without pain. Therapists who use
Implosion asks their clients to imagine scenes related
to comp particular personal conflicts and to recreate
the anxiety felt in those scenes. The therapist strives to
heighten the realism of the re-creation and to help the
patient extinguish the anxiety that was created by the
original aversive conditions. In addition, the client is
helped to adopt more mature forms of behavior.
Implosive therapy uses the methods and ideas of
both behavioral and psychodynamic theories. Although
it is not uniformly effective in reducing anxiety, research
to date suggests that it, like desensitization, can reduce
many intense fear.
The term vivo exposure means that the exposure
is a real-life setting plot simply in the
imaginations of the client and the therapist as they sit in
the therapist's office. The difference between in
vivo exposure and flooding might be compared to the difference
between wading into a swimming pool and jumping
in at the deep end. For example, an agoraphobic
client who experienced intense anxiety anywhere outside
her home might be asked to go to a crowded shopping
center with the therapist and remain there until her desire
to escape disappeared. Using this procedure, someone
with a specific fear can lose it in only three sessions (Marks, 1997).
In the treatment of most anxiety disorders, exposure
has produced consistently good results, with
improvements lasting for up to several years. The longer
the exposure to the critical stimulus, the better the results.
How well exposure treatment works depends on
the client's motivation and on specific factors in his or
her life. For example, when compulsive rituals are triggered
by home cues (which is true in many cases), treatment
needs to be conducted in the home setting. Failure
to improve can usually be traced to failure to comply
with treatment instructions, particularly by not seeking
exposure to fear-arousing stimuli. In one study, compulsives
received in vivo exposure therapy in their homes.
The client's task was to avoid responding compulsively
when the evoking stimuli were present.
This shows changes in the clients' ratings of their levels of
anxiety when exposed to the evoking stimuli. If the
client refrained from compulsive behavior in the presence
of the stimuli , the level of anxiety decreased immediately
after exposure and the decrease was maintained
1 and 6 months later in the presence of the
compulsion-evoking stimuli.
An important task for future research is to find out
why exposure is effective. When a client "gets used to"
an upsetting stimulus, what is going on is one possible
explanation is that as clients find that they can handle a
little exposure to upsetting stimuli and note that their
anxiety levels subside, quickly they gain confidence in
themselves and develop the courage to persist in their
efforts to overcome their problems.
The most effective behavioral technique for treating
compulsive rituals is a combination of exposure and
psychotherapy. A compulsive washer, for example,
is allowed to become dirty, or even made dirty, and
then is ordered not to wash. A typical treatment might
allow one minute shower every fifth day. Full exposure
reduces hypersensitivity to dirt and the associated anxiety
response and eventually eliminates the compulsive
ritual. Exposure usually has to be done outside
the psychotherapist 's office, and trained helpers may be
needed-wives, husbands, friends, or nurse-therapists.
Exposure in fantasy is less effective, but sometimes it is
the only possible way- for example, a patient cannot
actually run over someone.
Exposure therapy and other behavioral approaches
are not highly effective with people who are "pure obsessives,"
that is, who do not engage in rituals or avoidant behavior.
Because depression is a factor in many of these cases,
antidepressant drugs are often used in the
treatment.
A common element in most behavior therapies is exposing the client to stimuli that evoke discomfort until he or she becomes used to them. Much research has been carried out in which clients are exposed to feared stimuli and are prevented from making an avoidance or escape response. The client is strongly urged to continue to attend to the anxiety-eliciting stimuli despite the stressful effects that usually accompany this effort.
Exposure therapy has been used in treating food addiction,
phobic and obsessive-compulsive disorder. A critical
element of the treatment is motivating the client to
maintain contact with the actual noxious stimuli or with
their imagined presence until he or she becomes used to
them. This might mean, for example, exposing a compulsive
hand washer to dirt until the hand washing no
longer occurs, or encouraging such a person to think
about dirt, perhaps imagined first as household dust and
later as particularly noxious dirt such as vomit or feces.
The therapist 's task is to identify all components of the
stimulus that evoke an avoidance or escape response and
to continue the exposure until the evoked response no
longer occurs.
Two types of therapy based on the exposure
principle are systematic desensitization, implosive therapy.
Only when a client is comfortable with one level of fear-producing
stimuli is the next, slightly stronger stimulus introduced.
Exposure therapy refers to therapist-controlled exposure
to the imagined re-creation of a complex, high-intensity
fear-arousing situation. Exposure means
that the individuals actual feared situation
rather than imagining.
In vivo exposure may be conducted gradually, beginning
with low levels of stimulus intensity, or rapidly,
by exposing the client immediately to high-intensity and
prolonged stimulation. This rapid, intense exposure, is
called flooding.
~Systematic desensitization, which is used primarily
in the treatment of strong fears, is based on conditioning.
The client is taught to relax and then is
presented with a series of stimuli that are graded from
low to high according to their capacity to evoke anxiety.
The treatment of death phobia illustrates how systematic
desensitization is used. The patient 's fears are arranged
in a hierarchy, with the items in the hierarchy
ranging, in descending order, from human corpses to
funeral processions, black clothes, dead dogs, and floral
wreaths . The therapy begins with items that are low in
the hierarchy, such as seeing a wreath. The therapist
tries to teach the client to remain relaxed while imagining
or actually seeing a wreath. When the client can
maintain a relaxed state consistently, the therapy proceeds
with stimuli that are higher in the hierarchy.
A therapist does not try to produce cures overnight
with conditioning procedures. Usually, the process
of reducing the level of an emotional response to a
stimulus that should be neutral is a gradual one. Clinical
applications of systematic desensitization have shown
that clients who are treated in this way become less upset
by previously feared situations and better able to
manage their anxiety. It is possible that the most effective
part of systematic desensitization is the client's exposure
to gradually increasing levels of fear-arousing
stimuli under nonthreatening conditions. Individuals
who can mentally rehearse being exposed to the upsetting,
fear-arousing-situations show particularly high levels
of improvement.
Implosive therapy is based on the belief that many
conditions, including anxiety disorders, are outgrowths
of painful prior experience the patient to unlearn
them, the original situation must re-created so that it
can be experienced without pain. Therapists who use
Implosion asks their clients to imagine scenes related
to comp particular personal conflicts and to recreate
the anxiety felt in those scenes. The therapist strives to
heighten the realism of the re-creation and to help the
patient extinguish the anxiety that was created by the
original aversive conditions. In addition, the client is
helped to adopt more mature forms of behavior.
Implosive therapy uses the methods and ideas of
both behavioral and psychodynamic theories. Although
it is not uniformly effective in reducing anxiety, research
to date suggests that it, like desensitization, can reduce
many intense fear.
The term vivo exposure means that the exposure
is a real-life setting plot simply in the
imaginations of the client and the therapist as they sit in
the therapist's office. The difference between in
vivo exposure and flooding might be compared to the difference
between wading into a swimming pool and jumping
in at the deep end. For example, an agoraphobic
client who experienced intense anxiety anywhere outside
her home might be asked to go to a crowded shopping
center with the therapist and remain there until her desire
to escape disappeared. Using this procedure, someone
with a specific fear can lose it in only three sessions (Marks, 1997).
In the treatment of most anxiety disorders, exposure
has produced consistently good results, with
improvements lasting for up to several years. The longer
the exposure to the critical stimulus, the better the results.
How well exposure treatment works depends on
the client's motivation and on specific factors in his or
her life. For example, when compulsive rituals are triggered
by home cues (which is true in many cases), treatment
needs to be conducted in the home setting. Failure
to improve can usually be traced to failure to comply
with treatment instructions, particularly by not seeking
exposure to fear-arousing stimuli. In one study, compulsives
received in vivo exposure therapy in their homes.
The client's task was to avoid responding compulsively
when the evoking stimuli were present.
This shows changes in the clients' ratings of their levels of
anxiety when exposed to the evoking stimuli. If the
client refrained from compulsive behavior in the presence
of the stimuli , the level of anxiety decreased immediately
after exposure and the decrease was maintained
1 and 6 months later in the presence of the
compulsion-evoking stimuli.
An important task for future research is to find out
why exposure is effective. When a client "gets used to"
an upsetting stimulus, what is going on is one possible
explanation is that as clients find that they can handle a
little exposure to upsetting stimuli and note that their
anxiety levels subside, quickly they gain confidence in
themselves and develop the courage to persist in their
efforts to overcome their problems.
The most effective behavioral technique for treating
compulsive rituals is a combination of exposure and
psychotherapy. A compulsive washer, for example,
is allowed to become dirty, or even made dirty, and
then is ordered not to wash. A typical treatment might
allow one minute shower every fifth day. Full exposure
reduces hypersensitivity to dirt and the associated anxiety
response and eventually eliminates the compulsive
ritual. Exposure usually has to be done outside
the psychotherapist 's office, and trained helpers may be
needed-wives, husbands, friends, or nurse-therapists.
Exposure in fantasy is less effective, but sometimes it is
the only possible way- for example, a patient cannot
actually run over someone.
Exposure therapy and other behavioral approaches
are not highly effective with people who are "pure obsessives,"
that is, who do not engage in rituals or avoidant behavior.
Because depression is a factor in many of these cases,
antidepressant drugs are often used in the
treatment.
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