Psychological Therapies 599A primary exposure-based treatment for PTSD is prolonged exposure (PE), which
involves both exposure and components of cognitive-behavioral therapy. to Learn-
ing Objective 15. 5. The approach involves four primary components: education about
PTSD and common trauma reactions, learning to breathe in a relaxing and calming way,
repeated in vivo exposure to safe activities, objects, situations, or places that are causing
the person anxiety, and repeated, prolonged imaginal exposure to memories associated
with the trauma (Foa et al., 2007). As with many other treatments for trauma, a primary
goal of treatment is to help individuals approach memories and stimuli they fear or avoid
to overcome their anxiety and to process the emotions associated with the trauma (Foa
et al., 2007; Ruzek et al., 2014). Preliminary research suggests PE and successful remission
of PTSD may lead to changes in brain structures associated with the positive changes,
such as the anterior cingulate cortex (Helpman et al., 2016).
Exposure and response prevention (EX/RP), or exposure and ritual prevention, is
one of the most effective strategies for treating OCD (Bornheimer, 2015; Fisher & Wells,
2005; Lilienfeld et al., 2013; Strauss et al., 2015). Grounded in behavioral theory and the
core component of exposure, like PE, it also has features of cognitive-behavioral ther-
apy. to Learning Objective 15. 5. In short, it encourages individuals with OCD
to gradually and regularly expose themselves to the things that trigger their obsessive
thoughts but not to engage in their typical compulsive act or process (Strauss et al., 2015).
In addition to adults with OCD, it has also been demonstrated to be effective with youth
(Kircanski & Peris, 2015).
THERAPIES BASED ON OPERANT CONDITIONING Operant conditioning techniques
include reinforcement, extinction, shaping, and modeling to change the frequency
of voluntary behavior. to Learning Objectives 5.8, 5.9, 5.13, and 5.14. In the
treatment of psychological disorders, the goal is to reduce the frequency of undesirable
behavior and increase the frequency of desirable responses.
One of the advantages of using operant conditioning to treat a problem behavior
is that results are usually quickly obtained rather than having to wait through years
of more insight-oriented forms of therapy. When bringing the behavior under control
(rather than finding out why it occurs in the first place) is the goal, operant and other
behavioral techniques are very practical. There’s an old joke about a man whose fear of
things hiding under his bed is cured by a behavioral therapist in one night. The therapist
simply cut the legs off the bed.
MODELING Modeling, or learning through the observation and imitation of a model,
is discussed in Chapter Five. The use of modeling as a therapy is based on the work of
Albert Bandura, which states that a person with specific fears or someone who needs to
develop social skills can learn to do so by watching someone else (the model) confront
those fears or demonstrate the needed social skills (Bandura et al., 1969). In participant
modeling, a model demonstrates the desired behavior in a step-by-step, gradual process.
The client is encouraged by the therapist to imitate the model in the same gradual, step-
by-step manner (Bandura, 1986; Bandura et al., 1974). The model can be a person actually
present in the same room with the client or someone viewed on video. For example, a
model might first approach a dog, then touch the dog, then pet the dog, and finally hug
the dog. A child (or adult) who fears dogs would watch this process and then be encour-
aged to repeat the steps that the model demonstrated.
Behavioral therapists can give parents or others advice and demonstrations
on how to carry out behavioral techniques. Once a person knows what to do, mod-
eling is a fairly easy technique. Modeling has been effective in helping children
with dental fears (Klorman et al., 1980; Ollendick & King, 1998), social withdrawal
(O’Connor, 1972), phobias (Hintze, 2002), and while interacting with LEGO© play
materials, to facilitate improved social skills in children with autism spectrum disorder
(LeGoff, 2004).
modeling
learning through the observation and
imitation of others.participant modeling
technique in which a model demon-
strates the desired behavior in a step-
by-step, gradual process while the client
is encouraged to imitate the model.