Psych 282 - Chapter 24 - Fear and Anxiety Reduction Procedures PDF

Preview

Summary

Chapter 24 – Fear and Anxiety Reduction Procedures Introduction  Fear and anxiety reducing procedures are based on principles of operant and respondent conditioning Defining Fear and Anxiety Problems  Fear: Occurs when a stimulus situation elicits autonomic nervous system arousal and the individua...

Description

Chapter 24 – Fear and Anxiety Reduction Procedures Introduction  Fear and anxiety reducing procedures are based on principles of operant and respondent conditioning Defining Fear and Anxiety Problems  Fear: Occurs when a stimulus situation elicits autonomic nervous system arousal and the individual engages in behavior to avoid or escape from the stimulus situation o Compromised of both operant and respondent behavior  Anxiety: A term used to describe respondent behavior involving the activation of the autonomic nervous system (including rapid heart rate, shallow rapid breathing, and increased muscle tension) o Autonomic arousal is an establishing operation that increases the probability of operant behavior involving escape or avoidance responses o Typically, some event functions as a conditioned stimulus (CS) to elicit the autonomic arousal as a conditioned responses (CR) o The operant behavior functions to escape from or avoid the CS o Bodily responses are respondent behaviors  In the case of a dog bite, the role of respondent conditioning in the development of the fear is obvious – in many other case, the person with the fear cannot remember a past event that may have conditioned the feared stimulus o Although the feared stimulus clearly elicits anxiety as a CR, how that feared stimulus became a CS may be unknown o However, knowledge of how a fear was conditioned is not necessary to help the person overcome the feat o What is important is to identify all the stimuli that currently function as CSs and elicit the fear responses (the CRs)  One other issue to consider in understanding fear and anxiety problems is that sometimes a problem that appears to be a fear or anxiety problem is simply an operant behavior with no respondent behavior or fear component o It is important to conduct a functional assessment of the supposed fear behavior to determine what function it serves for the child Procedures to Reduce Fear and Anxiety  Behavior-modification procedures are used to help people overcome problems of fear or anxiety, involving relaxation training, systematic desensitization, and in vivo desensitization and are based on principles of respondent conditioning, operant conditioning, or a combination of the two Relaxation Training  Relaxation Training: A procedure for teaching a person the skills needed to decrease autonomic arousal (anxiety) by producing an incomputable state of relaxation; progressive muscle relaxation, diaphragmatic breathing, attention-focusing exercises, and behavioral relaxation training are types of relaxation training procedures o Strategies that people use to decrease the autonomic arousal that they experience as a component of fear and anxiety problems o The person engages in specific relaxation behaviors that result in bodily responses opposite to the autonomic arousal  Whereas bodily response such as tense muscles, rapid heart rate, cold hands, and rapid breathing are part of autonomic arousal, relaxation exercises produce bodily responses such as decreases in muscle tension, heart rate, and breathing rate and warming of the hands o Once the person produces these opposite bodily responses, they report a decrease in anxiety  Four common relaxation training approaches are progressive muscle relaxation, diaphragmatic breathing, attention-focusing exercises, and behavioral relaxation training Progressive Muscle Relaxation  Progressive Muscle Relaxation (PMR): A relaxation procedure in which the client learns to tense and relax each of the major muscle groups of the body; by this means, the client decreases muscle tension and autonomic arousal in the body  Tensing and relaxing the muscles leave them more relaxed than in their initial state  To use PMR, the person must first learn how to tense and relax each of the major muscles of the body o Can learn from a therapist, listening to an audio tape of the procedure, or from reading a description  Having learned how to tense each of the muscle groups, the client can begin the relaxation procedure o First, the client gets into a comfortable position in a comfortable chair in a quiet room with no major distractions o Next, the client closes their eyes and tenses and relaxes each muscle group o Starting with the first muscle group, the dominant hand and arm, the client tenses the muscles for about 5 seconds and then abruptly released the tension o The client focuses on the decreased level of tension in the muscle group for 5-10 seconds and then moves to the next muscle group on the list: the other hand and arm o The client repeats this process until all the muscle groups have been tensed and relaxed  When the process is complete, the muscles of the body should be less tense and more relaxed than they were at the beginning of the relaxation exercise  Once people have practiced PMR many times, they can begin to relax without themselves tensing and relaxing each muscle group o Because the PMR procedure teaches people to control their own muscle tension, they can then decrease muscle tension in situations in which they are likely to experience more tension  To facilitate this process, people often use a cue word o The cue word becomes associated with the relaxation response o The cue word develops into a CS that elicits relaxation as a CR

o

Reciting the cue word also helps the person avoid thoughts that might elicit anxiety

Diaphragmatic Breathing  Diaphragmatic Breathing: A type of relaxation exercise in which one engages in slow, rhythmic breathing, using the diaphragm muscle to pull air deep into the lungs o Also called deep breathing or relaxed breathing  At each inhalation, the person uses the muscles of the diaphragm to pull oxygen deep into the lungs  Because anxiety or autonomic arousal most often involves shallow, rapid breathing, diaphragmatic breathing decreases anxiety by replacing this breathing pattern with a more relaxed pattern  To learn diaphragmatic breathing, a person should get into a comfortable sitting position and place a hand on the abdomen, just below the rib cage o This is the location of the diaphragm muscle  On inhaling, the person should feel the abdomen move out ward as diaphragm pulls the breath of air deep into the lungs o Should not be pulled in  The shoulders should be motionless during breathing  After learning to breathe correctly, with the abdomen expanding at each inhalation, the person is ready to begin the breathing exercise  To practice diaphragmatic breathing to decrease anxiety, the person sits, stands, or lies down in a comfortable position, with eyes closes, and inhales slowly for 3-5 seconds until the lungs are comfortably filled with air o The person then exhales for 3-5 seconds o It is best to inhale and exhale during the nose o The person should focus attention on the sensations involved in breathing to avoid thinking about anxiety-provoking thoughts  Diaphragmatic breathing exercises are a component of most other relaxation procedures Attention-Focusing Exercises  Attention-Focusing Exercises: A type of anxiety-reduction strategy in which one focuses attention on a pleasant or neutral stimulus to remove attention from the anxiety-producing stimulus o Include mediation, guided imagery, and hypnosis  In mediation, the person focuses attention on a visual, auditory, or kinesthetic stimulus  In guided imagery or visualization exercises, the person visualizes or imagines pleasant scenes or images o This exercise focuses the person’s attention so that it cannot be focused on anxiety-producing thoughts or images o If many senses are engaged, the person is more likely to imagine the scene fully and to displace any anxiety-provoking thoughts or images  In hypnosis, the person focuses attention on the hypnotic suggestions form the therapist/audiotape o In the hypnotic trance, attention is simply focused on the therapist’s words so that the person is less aware of external stimuli, including anxiety-provoking thoughts and images o A person can practice self-hypnosis by reciting hypnotic suggestions from a script to induce a state of relaxation  Attention-focusing procedures are typically used as components of other relaxation procedures Behavioral Relaxation Training  Behavioral Relaxation Training: A type of relaxation training in which one assumes a relaxed posture in all of the major muscle groups of the body to achieve relaxation o Similar to PMR, except that the person does not tense and relax each muscle group o Includes components of the other relaxation procedures: focus on muscle tensions, correct breathing, and attention focusing  The person sits in a recliner, with all parts of their body supported by the chair, and the therapist provides instructions for the client to put each part of his or her body into the correct position Three Essential Components of Relaxation Procedures  Reducing muscle tension  Relaxed breathing  Attention focusing Systematic Desensitization  Systematic Desensitization: A procedure used to treat a fear or phobia o The person first learns relaxation, then the person develops a hierarchy of fear-provoking situations, and then finally the person uses the relaxation procedure as they imagine each situation in the hierarchy, starting with the least fear-producing situation and gradually working up to the most fear-producing situation o The goal is to replace the fear response with the relaxation response as each situation is imagined  Phobia: A fear in which the level anxiety or escape and avoidance behavior is severe enough to disrupt the person’s life  The use of the systematic desensitization procedure has three important steps o The client learns relaxation skills using one of the procedures described earlier o The therapist and client develop a hierarchy of fear-producing stimuli o The client practices the relaxation skills while the therapist describes scenes from the hierarchy  Once the client can maintain the relaxation response while imagining every scene from the hierarchy, the systematic desensitization is complete Developing the Hierarchy



  

Once the client learns the relaxation procedures, the therapist and client develop a hierarchy of the fear-producing stimuli o Hierarchy: Used in systematic desensitization or in vivo desensitization procedures; in the hierarchy (also called a “fear hierarchy”), various fearful situations are listed in order from least to most fear-provoking  Each new situation in the hierarchy is only slightly more fear-provoking than the previous situation The client uses a fear-rating scale and identifies the amount of fear that is produced by a variety of situations related to the feared stimulus The fear-rating scale is called a “subjective units of discomfort scale” o 0 = absence of fear/anxiety, 100 = maximum amount of fear or anxiety Fear-producing situations should be identified across the range of fear levels so that the hierarchy is composed of situations with low, middle, and high fear scores

Progressing Through the Hierarchy  Having developed relaxation skills and constructed the hierarchy with the therapist, the client is ready to begin systematic desensitization and progress through the hierarchy  At the start of the session, the client practices relaxation exercises  After the client signals a state of relaxation, the therapist describes the first scene in the hierarchy, which produces little anxiety  Once the client has successfully imagined this scene while maintain relaxation, the client moves to the next step in the hierarchy  This process continues over the course of a number of treatment session until the client can maintain relaxation through all of the scenes in hierarchy  Thus, in systematic desensitization, the client relaxes while imagining the feared stimulus; the client does not make actual contact with the fear-producing stimulus o Contract this procedure with the in-vivo (real-life) desensitization, in which the client is gradually exposed to the actual fearproducing stimulus while maintaining relaxation In Vivo Desensitization  In Vivo Desensitization: A procedure for treating a fear or phobia; the client first learns relaxation, then develops a fear hierarchy in which the fear provoking situations are ordered from least to most fear-producing, then finally the client makes actual contact with the fear-producing situation at each step in the hierarchy in turn while maintaining relaxation as a response that is incompatible with the fear response o Similar to systematic desensitization, except that the client gradually approaches or is gradually exposed to the actual fearproducing stimulus  To use the in vivo desensitization procedure, the client: o Learns relaxation skills o Develops a hierarchy of situation involving the fear-producing stimulus, and o Experiences each situation in the hierarchy while maintaining relaxation as an alterative response to replace the fear response  Relaxation training is not always used during in vivo desensitization o Three other strategies can be used to prevent an increase in anxiety as the client advances through the hierarchy  The therapist might simply provide reinforcement for approach behavior at each hierarchy step  Alternatively, the therapist might have to client engage in other reinforcing activities or in distracting activities at each hierarchy step  Finally, the therapist might provide reassuming physical contact by holding the client’s hand or placing a hand on the client’s back as the client progresses through the hierarchy  Contact Desensitization: A type of in vivo desensitization in which the therapist provides reassuring physical contact, such as holding the client’s hand or placing a hand on the client’s back, as the client progresses through the hierarchy Advantages and Disadvantages of Systematic and In Vivo Desensitization  Advantage of in vivo desensitization is that the client makes actual contact with the feared stimulus o Desirable behavior in the presence of the feared stimulus is reinforced as an alternative behavior to escape or avoidance – there is no problem with generalization from imagination to the actual fear situation o Once the client has progressed through the hierarchy, they has demonstrated successful performance in the fear-producing situation  Disadvantage of in vivo desensitization is that it is more difficult and possibly more time-consuming and costly then systematic desensitization  However, whenever possible, in vivo desensitization is preferred over systematic desensitization  Advantage of systematic desensitization is that it is easier and more convenient for the client to imagine the feared stimulus than to come into contact with it  Disadvantage of systematic desensitization is that the results may not fully generalize to the actual fear-producing situation o The client may be able to maintain relaxation while imagining the fear-producing situation but may not be able to do so while experiencing the actual situation Other Treatments for Fears  Flooding: A procedure in which the person is exposed to the feared stimulus at full intensity for a prolonged period until their anxiety subsides in the presence of he feared stimulus o Initially, the person experiences heightened anxiety in the presence of the feared stimulus, but over time the level of anxiety decreases through a process of respondent extinction

Should only be used by a professional During in vivo desensitization, the person is exposed to the feared stimulus much more gradually; thus, they do not experience the discomfort that is experienced in the early stages of flooding Modeling: A type of prompt in which the trainer demonstrates the target behavior for the learner; modeling works best in conjunction with instructions, in situations in which the learner has an opportunity to rehearse the behavior immediately in a role-play o Has been used as successful treatment for fears, especially in children o In the modeling procedure, the child observes another person approaching the feared stimulus or engaging in a feared activity, and the child is then more likely to engage in similar behavior o o



Chapter Summary  A fear is composed of operant and respondent behaviors o A particular stimulus situation elicits autonomic arousal as a respondent behavior, and the person engages in escape or avoidance responses as the operant behavior when the fear producing stimulus is present o The bodily responses involved in autonomic arousal are called anxiety  Relaxation exercises are used to help a person replace autonomic arousal with a relaxation response in the anxiety-producing situation  Relaxation can be produced by four basic techniques: progressive muscle relaxation, in which a person tenses and relaxes each major muscle group in body; diaphragmatic breathing exercises, in which the person breathes slowly and deeply; attention-focusing exercises, in which attention is directed away from the anxiety-producing stimulus and toward a calming scene; and behavioral relaxation training, a technique that focuses on relaxed postures o All relaxation exercises address muscle tension, proper breathing, and attention focus  Systematic desensitization and in vivo desensitization are procedures to help a person overcome a fear o In systematic desensitization, the person relaxes and imagines scenes of fear-producing situations arranged in a hierarchy from least to most fear-producing  During in vivo desensitization, the person is exposed gradually to the actual fear-producing situations (arranged in a hierarchy from least to most fear producing) while maintaining relaxation or engaging in a behavior opposite to escape or avoidance o The important component of systematic and in vivo desensitization is the progression through a hierarchy that result in gradual exposure to more fear-producing scenes or situations o The advantage of in vivo desensitization is that the client makes actual contact with the feared stimulus, so generalization is enhanced o The disadvantage is the time and effort involved in conducting the procedure o The advantage of systematic desensitization is that it is easier and more convenient to carry out o The disadvantage is that the results may not fully generalize to the actual fear producing situation

Chapter Quiz – Chapter 24 1.

Describe how respondent behavior is involved in a fear or anxiety problem. Provide an example, identify the CS and CR in your example.

2.

Describe how operant behavior is involved in a fear or anxiety problem. Provide an example. Identify the operant behavior and describe how the behavior is reinforced.

3.

Describe the respondent behavior Trisha exhibited as apart of her fear of talking in front of the class.

4.

Describe the operant behavior Allison exhibited as apart of her fear of spiders.

5.

Describe progressive muscle relaxation.

6.

Describe diaphragmatic breathing.

7.

Describe attention-focusing exercises.

8.

Describe behavioral relaxation training.

9.

In each of the four approaches to relaxation described in questions 5-8, describe how muscle tension, breathing, and attention focus are addressed.

10. Describe systematic desensitization. What is a hierarchy, and what role does it play in systematic desensitization?

11. Describe in vivo desensitization. How does in vivo desensitization differ from systematic desensitization?

12. What are the advantages and disadvantages of systematic desensitization.

13. What are the advantages and disadvantages of in vivo desensitization?

14. Would you choose systematic desensitization or in vivo desensitization to help a child overcome a fear of the dark? Why?...