598 CHAPTER 15
Could you use aversion therapy to help someone with a phobia?Because phobias are already very unpleasant, aversive conditioning is not the most
useful method of therapy. But although desensitization remains one of the more common
therapies for phobias, it does not always bring quick results.
EXPOSURE THERAPIES Behavioral techniques that introduce the client to situations,
under carefully controlled conditions, which are related to their anxieties or fears are
called exposure therapies. Exposure can be accomplished through a variety of routes
and is intended to promote new learning. It can be in vivo (“in life”), where the client is
exposed to the actual anxiety-related stimulus; imaginal, where the client visualizes or
imagines the stimulus; and even virtual, where virtual reality (VR) technology is used
(Najavits, 2007). (For more on virtual reality in psychology, see the Applying Psychology
to Everyday Life section at the end of this chapter.)
For example, if Chang-sun has social anxiety disorder (fairly rare for Korean males,
at a lifetime prevalence of only about 0.1 percent; Sadock et al., 2007), for in vivo expo-
sure he might have to attend a social event; for imaginal exposure he might be asked to
visualize himself attending a social event; and for virtual exposure, Chang-sun might
experience a social event, such as attending a dinner party, through VR technology.
Exposure methods can introduce the feared stimulus gradually or quite suddenly.
A gradual, or graded, exposure involves the client and therapist developing a fear hierar-
chy as in systematic desensitization: Exposure begins at the least feared event and pro-
gresses through to the most feared, similar to desensitization. If the exposure is rapid and
intense, it begins with the most feared event and is called flooding (Gelder, 1976; Olsen,
1975). Flooding is used under very controlled conditions and, like graded exposure, pro-
duces extinction of the conditioned fear response by preventing an escape or avoidance
response (e.g., Chang-sun would not be allowed to leave the party).
Eye-movement desensitization and reprocessing, or EMDR, is an exposure-based ther-
apy sometimes used in the treatment of PTSD. As originally formulated, it involves very
brief and repeated imaginal flooding, cognitive reprocessing and desensitization of the
fearful event, and rapid eye movements or other bilateral stimulation (Shapiro, 2001,
2012). However, it is a somewhat controversial therapy, as it evolved from the founder ’s
personal observation, not psychological theory or modification of techniques for other
disorders, and research has suggested the eye movements or other bilateral stimulation
serve little to no purpose (Lilienfeld et al., 2015; Resick et al., 2008).exposure therapies
behavioral techniques that expose
individuals to anxiety- or fear-related
stimuli, under carefully controlled
conditions, to promote new learning.
flooding
technique for treating phobias and
other stress disorders in which the per-
son is rapidly and intensely exposed to
the fear-provoking situation or object
and prevented from making the usual
avoidance or escape response.
Table 15.1 Fear Hierarchy
Situation Fear Level
Being bitten by a rabbit 100
Petting a rabbit on the head 90
Petting a rabbit on the back 80
Holding a rabbit 70
Touching a rabbit held by someone else 60
Seeing someone I trust hold a rabbit 50
Being in a room with a rabbit 40
Thinking about petting a rabbit 30
Looking at pictures of rabbits 20
Watching the movie Hop 10
Items are ranked by level of fear from most fearful, Fear = 100, to least fearful, Fear = 0.Interactive