Topic 8: Behavioral Exposure {by 10/29}

[Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter).  (Judy Beck neglects behavioral exposure in her book.)  For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress?  (2) What are some cautions to consider when implementing behavioral exposure interventions?

 

[Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns.  Answer the following (you can be brief): (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?  (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?

 

Your original post should be posted by 10/29.  Have your two replies posted no later than 10/31.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

23 Comments (+add yours?)

  1. Allie Supernor
    Oct 25, 2020 @ 08:42:49

    Part One-
    (1). According to our text, there is extensive research that demonstrates the effectiveness of behavioral exposure techniques for a variety of anxiety and anxiety-related disorders. When a person experiences anxiety, they experience negative automatic thoughts and increased physiological arousal, resulting in avoiding their stressor. Therefore, by continuing to avoid the source of distress, they experience a reduction in anxiety and learn to stay away from it. This maladaptive behavior is called negative reinforcement. This avoidance works in short-term relief but in the long term can be determinantal because the client isn’t learning any skills to cope with said anxiety. The rationale behind behavioral exposure techniques is that the situations being avoided are the things we confront. Behavioral exposure is so effective because this exposure breaks up the avoidance pattern and ultimately tackles the anxiety at the source, while simultaneously allowing an individual to develop adaptive coping skills. (2). I believe one precaution that comes to mind is being sure to do the groundwork first! You do not want to expose the client too soon and then would only reinforce the anxiety even further! That is why techniques such as developing a hierarchy of feared situation for graded exposure are so beneficial. This way you don’t move too quickly and reinforced the anxiety further.
    Part Two-
    (1). Lindsay experiences reoccurring panic attack. She decided to go to the grocery store for exposure and experienced an unexpected panic attack. She rated it a 9 of intensity and experienced “I couldn’t escape” and “I lost control” for negative automatic thoughts. I would classify these negative automatic thoughts as catastrophizing as a cognitive distortion. Lindsay was assuming the worst and thinking she was going to have a heart attack and die right there in the isle. (2). During this panic attack Lindsay experienced quite a few bodily sensations and physiological reactions. She described body getting warm/hot, sweaty palms, tightness in her chest and heart racing/pounding. Further, after she became more self-aware and perceived others as noticing her attack, she experienced nausea, choking feeling and a general sense of loss of control. Due to this severity, Lindsay escaped and left the grocery store. After watching the video, it is evident that her husband waiting in the car was a true safety behavior. The second she escaped to him and saw him waiting her body instantly relaxed. Dr. V noted in his session that a true exposure would take place without Lindsay’s husband.

    Reply

    • Alison Kahn
      Oct 26, 2020 @ 20:46:27

      Allie,

      I really enjoyed your through explanation of the benefits of behavioral exposure. I especially liked how you highlighted the extensive research around the effectiveness of behavioral exposure in anxiety related disorders. I also spoke about avoidance and negative reinforcement in my post. Specifically, how avoidance can act as a short-term relief for anxiety but not a long-term solution like behavioral exposure.

      Reply

    • Madi
      Oct 28, 2020 @ 17:31:40

      Hi Allie,
      I thought you showed a good understanding of anxiety and how they avoid situations. Thoes situations are what the behavior exposure is about. I find the research behind behavior exposure and phobias to be very interesting. I also agree with you about how we need to be careful when doing behavior exposure! I completely agree with you about Lindsay and thought you did a good job at explaining it! I also like how you discussed her husband as a safe person.

      Reply

  2. Alison Kahn
    Oct 26, 2020 @ 20:42:35

    (1) Why is behavioral exposure very effective for certain disorders/types of distress?
    Behavioral exposure is effective for certain disorders/types of distress because it addresses avoidance patterns common with disorders such as anxiety and depression. In other words, a client needs to be exposed to what causes anxiety in order to break his or her pattern of avoidance from said stimulus. Further, behavioral exposure is more likely to provide long-term relief from the anxiety-inducing stimuli than avoidance, which often provides short-term relief, but does not address the overall problem. Finally, behavioral exposure provides a visual depiction of how anxiety and fear develop into maladaptive cognitive and behavioral avoidance patterns. That is, the client is able to visualize the way in which a negative or fear-inducing situation impacts his or her emotional/behavioral response, and as such, he or she can learn and understand the cause and effect of these circumstances, which ultimately helps the client to modify his or her behaviors with more knowledge and intent.

    (2) What are some cautions to consider when implementing behavioral exposure interventions?
    Some cautions that come to mind in regard to implementing behavioral exposure interventions are related to a client’s readiness to address distressing stimuli as well as potential hesitancy to engaging in relaxation and exposure techniques. If a client is experiencing significant distress as it relates to a particular stimuli or situation, he or she may need to “ease in” to the exposure process rather than be bombarded with the undesirable stimuli. Too much too soon could potentially reinforce avoidance patterns. A client may also be hesitant to engage in relaxation or exposure techniques for various reasons (he or she doesn’t believe the techniques will be effective, the techniques may be daunting, the techniques expose the client to an unwanted or feared stimuli, the client has successfully utilized avoidance and may struggle to engage in a technique which forces him or her to directly confront the stimuli, etc.) I imagine it is all about knowing your client and determining when he or she is ready to engage in these therapeutic techniques.

    (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?
    The client’s primary negative automatic thoughts when experiencing a panic attack at the grocery store were that she cannot escape and that she was losing control of the situation and her reaction to it. She spoke about a sense of needing help and feeling as though she was having a heart attack. From her description of the event, the client was likely experiencing a catastrophic cognitive distortion.

    (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?
    The client described several physiological responses to her associated automatic thoughts while in the grocery store. Namely, she spoke about an elevated heart rate, a tight chest, feeling hot, having sweaty palms, nausea, a sensation of choking, and a sense that others around her were noticing her distress which only perpetuated it. Regarding safety behaviors, the client spoke about feeling a sense of relief and a decrease in physiological symptoms when she made it out of the grocery store to the parking lot where she saw her husband.

    Reply

    • Madi
      Oct 28, 2020 @ 17:31:08

      Hi Alison,
      I like how you worded that behavior exposure is breaking the escape / avoidant behavior. I also like how you used the phrase “too much too soon” because I feel like that’s the core caution for behavior exposure. I also really liked your depiction of Lindsay and your analysis of it.

      Reply

    • Francesca DePergola
      Oct 29, 2020 @ 13:47:44

      Hi Alison,
      I thought you gave such great and detailed responses to all the questions asked. I really enjoyed how you mentioned engaging in relaxation and exposure techniques under cautions because I overlooked that aspect. I never thought of relaxation techniques that could be daunting to clients, but I realize that now that you mention it because it can be for some. This is important to note because if they did feel uncomfortable at any level, it might not go as planned or be effective enough at the moment.

      Reply

    • Selene Anaya
      Oct 29, 2020 @ 13:50:16

      Hi Alison! I agree that it is super important to assess the readiness of the client. If the client isn’t ready for the amount or the extent of the exposure that will take place, it is very likely that their anxieties will just heighten especially if the exposure is done with the therapist. Then, if the exposure is done with the therapist and it makes things worse, it is possible that the relationship might be harmed and/or the client may be less motivated to keep trying. Therefore, good communication with and assessment of the client are crucial when deciding the “levels” or “steps” of exposure that are going to be taken.

      Reply

  3. Madi
    Oct 28, 2020 @ 17:30:40

    1. Behavior Exposure
    a. Behavioral exposure is very effective for certain disorders because it attacks the root of the problem. For anxiety disorders, specifically phobias, exposure therapy is very useful. When a person has a phobia the exposure therapy is where the person is exposed to the thing that they are afraid of. In more general terms with anxiety, exposure therapy works because the person is avoiding or trying to escape from something. The behavior exposure works well because the person has to face what they are trying to escape or avoid
    b. Some cautions are that the behavior exposure intervention might be too intense for some clients; they might now be ready for that level of intensity. The client needs to have certain foundational groundwork before the engaged in a behavior exposure.
    2. PDA-6
    a. The client’s primary negative automatic thought is that she is losing control. The client spoke about going into the grocery store alone. When the isle became crowded with people she began to have a panic attack. The client was catastrophizing by assuming the worst possible situation, which she explicitly imagined that she was going to have a heart attack.
    b. The client’s response to her associated automatic thoughts and physiological arousal are her body getting warm, sweaty palms, tight chest, racing heart, and nauseous. She noticed that other people were noticing that she was having a panic attack, which made it worse.

    Reply

  4. Eileen Kinnane
    Oct 28, 2020 @ 21:21:28

    1a. Behavioral exposure can be effective because it addresses the core of the presenting issue, especially in anxiety disorders. It helps clients in exposing them to exactly what is causing them distress. It is also beneficial for providing for long-term relief. The exposure forces the client to face their fears and will hopefully realize that some or all of their anxiety is irrational or adaptable.

    1b. It’s important to know that too much exposure, or poorly timed exposure can be really detrimental to the client. It can be too intense and the client may not be ready. It’s important to gradually expose a client to a situation so they are not overwhelmed with fear and panic and are then refusing to continue practicing exposure.

    2a.In response to experiencing a panic attack at the grocery store, Lindsay’s negative automatic thoughts were “I can’t escape” and “I lost control.” This panic attack was triggered by the crowdedness in the aisle at the grocery store. It appears that Lindsay was catastrophizing the situation by imagining she was going to have a heart attack.

    2b. Linsday’s physiological responses in association with her automatic thoughts include and increased heart rate, tightness in her chest, sweaty palms, nausea, and feeling hot. She also explained that she felt like she was choking and she noticed/perceived that others were witnessing her experience the panic attack. It seems that her safety behavior was running out of the store and going to the car where her husband was waiting. She expressed that she felt better once she was with him.

    Reply

    • Francesca DePergola
      Oct 29, 2020 @ 13:44:30

      Hi Eileen,
      I like how you mention the long-term benefits of using behavioral exposure. I think that is one of the most important factors of behavioral exposure since the issue the client is having is avoiding what is feared which only provides short-term relief. I agreed and mentioned very similar things in your answers in my post as well. I felt that watching Lindsey and how she escaped she relied heavily on her husband for relief that truly exemplified his presence as being a safety measure.

      Reply

  5. Francesca DePergola
    Oct 28, 2020 @ 23:25:02

    Behavioral Exposure 1
    (1) Why is behavioral exposure very effective for certain disorders/types of distress?
    Behavioral exposure is very effective for certain disorders/types of distress that are rooted in anxiety and/or fear. Since more anxiety and fearful situations make an individual want to avoid it at all costs, the person is negatively reinforced. In some cases, this anxiety and fear can disrupt daily functioning so much that they are unable to do simple tasks. Where an individual might see avoidance as not the issue blanketed in safety behaviors, they are worsening their experience. Behavioral exposure is so crucial for those who experience such debilitating anxiety and fear because it forces the person to come face to face with what they are so anxious and scared of. With guidance from a properly trained and educated professional along with techniques to relax and cope, it can be the difference from being so fearful and anxious to slowly warming up and losing that fear.
    (2) What are some cautions to consider when implementing behavioral exposure interventions?
    Some cautions to consider when implementing behavioral exposure interventions depends on the client. It depends on how much anxiety or fear they have about the situation and how well the counselor is at implementing the most efficient and suitable interventions at the right time. If the counselor focuses on too low of exposure it might seem childlike and they might get discouraged, if it is too high of exposure it might be too much and too fast for the client to the point they feel they are a failure. So, the biggest caution is knowing the client and the balance that must be kept while using these interventions.

    Behavioral Exposure 2
    (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?
    The client’s primary negative automatic thought was that she was losing control. She was catastrophizing the situation by interpreting her panic into something that she believed to be a heart attack. Although she was just in the grocery store, she began to be extremely overwhelmed by fear and anxiety to the point of a panic attack. If the client were to go her whole life avoiding situations as such, there are obvious consequences to living a life in such fear. Behavioral exposure was done to help her and those who feel similarly to come face to face with their fears and not avoid them.
    (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?
    The client’s responded in this situation with typical panic physiological symptoms that included increased heart rate, feeling hot, sense of choking, sweaty hands, tight chest, and so on. Once the client left the store, it was clear that her husband is a safety measure.

    Reply

    • Selene Anaya
      Oct 29, 2020 @ 13:43:08

      Hey Francesca! I really liked how you considered that having a balance of the amount of behavioral exposure can be important. I have not thought about how too little exposure might seem childlike and how that alone might be enough to discourage them. We saw in the video how Lindsay thought she was ready and decided to try out the exposure herself and it ended up being too much for her. Through that, we saw and Dr. V mentioned that she has yet to learn coping skills that would help her cope more effectively with her thoughts and feelings of the situation. I also like how you briefly mentioned that this process can look different for different clients and it is important to understand the client and tailor it to them.

      Reply

    • Allie Supernor
      Oct 29, 2020 @ 15:24:57

      Hi Francesca, I really appreciated that your post noted the caution around moving too slowly. There is the potential that the client may feel like you’re babying them and you explained that perfectly! When i drafted my post, I struggled to find any other cautions. I talked about moving too quickly and completely forgot about what the result would be of moving too slowly or taking too small of steps.

      Reply

    • Alison Kahn
      Oct 29, 2020 @ 17:40:51

      Francesca,

      I like how you spoke about the effectiveness of behavioral exposure specifically as it relates to anxiety and fear. I also really like how you mentioned that the distress caused by a feared stimuli can lead to significant impairment of an individual’s daily functioning. I think this is an extremely important thing to consider when working with a client who is experiencing anxiety.

      Reply

  6. Selene Anaya
    Oct 29, 2020 @ 12:52:04

    [Behavioral Exposure] 1 –

    1)  There is a lot of research that supports the effectiveness of behavioral exposure for certain disorders and/or types of distress. More specifically, anxiety and anxiety-related disorders. When clients are anxious about something, they tend to have negative automatic thoughts and heightened physiological arousal which usually results in the behavior or avoidance of the source of the distress. These individuals negatively reinforce themselves to avoid the situations that are causing them distress because doing so reduces their anxiety and the physiological symptoms they may be experiencing. Behavioral exposure allows for clients to slowly learn how to cope with the experiences that cause them distress so they can effectively do so when they are experienced in the future. With gradual exposure, clients will learn cognitively that the situation that they once perceived as threatening is no longer a threat while also learning coping skills to use whenever they encounter another stressful/anxiety-provoking situation.

    (2) We kind of saw it when Lindsay went to the store wanting to test what she has been learning and failed because she skipped the necessary steps in therapy that would eventually help her get there. This emphasizes the importance of taking gradual steps that will eventually lead to the desired outcome/result of the exposure. If the client is exposed too soon without enough preparation, it is possible the anxiety about the situation will grow because the client believes that he/she knows enough to perform well when really there is still a lot of work to be done. Clients will still feel the physiological arousal at first, but exposing them slowly will help them realize that the arousal won’t last forever and after many exposures, it will significantly decrease over time.

    [Behavioral Exposure] 2-

    (1) In response to the event, the client’s primary negative automatic thought was that she could not escape and with her physiological feelings, she thought if she was having a heart attack she would not be able to get help if she stayed in the situation. A possible cognitive distortion would be catastrophic thinking.

    (2) Her physiological arousal was unexpected because she really believed that she had the knowledge to know that she would be okay. After she noticed her physiological arousal to the aisle becoming crowded, she started to think that others could see how she was responding to the situation (sweaty palms, heart racing, etc.). She then avoided the situation and escaped to safety which could have negatively reinforced the thoughts she was having and the behavior of escaping. The fact that she felt relieved after she left and got to the car with her husband, reinforces to her that escaping and avoiding the situation is best.

    Reply

  7. Haley Scola
    Oct 29, 2020 @ 14:12:37

    Behavioral Exposure

    (1a). Behavioral exposure is so effective for certain disorders such as anxiety, depression, and panic attack disorder because when an individual experiences intense levels of distress and physiological arousal from a stressor, they tend to avoid this stressor altogether in order to avoid such distress. Because of this, behavioral activation works to increases an individual’s skills and psychoeducation to understand what exactly is happening. For example, in the second part of this discussion post we see Lindsey who says her mind and body tell her she is having a heart attack and this experience is very real and intense. Because of this she avoids such stressors like grocery stores or restaurants completely. Using behavioral activation, she is able to become aware on a conscious level that she is indeed not having a heart attack and it is a panic attack/physiological symptom that make her feel this way. Although this avoidance works in short-term ways, this can be significantly detrimental to the client’s life satisfaction by avoiding large areas of life since they do not obtain coping skills to relieve the anxiety. Behavioral activation separates patterns of avoidance and find the “root” of the problem and teaches the client how to adaptively handle this.

    (2a). A caution when implementing behavioral exposure interventions is that this needs to be done in a slow but steady process. If the client jumps ahead without adaptive coping skills to effectively handle the stress (like Lindsey in PDA-6) then this may reverse any progress and, in some cases, make the client worse than when they first came in.

    PDA-6

    (1b). Lindsey was driven to the grocery store by her husband and she attempted to go in alone. Her primary negative automatic thoughts in response to this started with noticing the people around her increase. She then began noticing her physiological symptoms and had the negative automatic thoughts of “I cannot escape”, “what happens if I were to have a panic attack right now?”, and that she was “losing control”.

    (2b). When people would walk by, Lindsey felt her body getting warm, palms getting sweaty, her chest was getting tight, and the more she noticed these symptoms her heart started racing. She then said she became nauseous and had a pit in her stomach which she had not felt in a while. She then had the feeling she was chocking and losing control. The more she became aware of her physical symptoms and that others were beginning to notice her, the more the symptoms increased. She said she felt as if she was losing control and she needed to get out. Although she reminded herself, she was not having a heart attack, she left the carriage and got into the car with her husband and “immediately felt better”. She stated that he knows how to “handle her” when she “gets like that” and had relief of the physiological symptoms once she saw him in the car.

    Reply

    • Allie Supernor
      Oct 29, 2020 @ 15:29:43

      Haley, I really liked that your post cautioned us that we have the potential to leave the client’s worse off! I think that is something that can be easily forgotten. We can absolutely negatively reinforce the fear by moving at the wrong pace.

      Reply

    • Brigitte Manseau
      Oct 31, 2020 @ 23:36:57

      Hi Haley,
      I like how you mentioned that exposure interventions need to be implemented slowly and consistently. I agree, if steps are carried out too quickly the client’s disorder could worsen. In this week’s video, we saw how a client may react if he/she rushes into a situation that he/she is not yet properly prepared for.

      Reply

    • Eileen Kinnane
      Nov 01, 2020 @ 10:21:06

      Hi Haley,

      I really liked how you mentioned the long-term potential for avoidance behaviors with anxiety disorders. It’s important that we gradually introduce settings that the client might be avoiding in order to help them work to ease their anxieties.

      Reply

  8. Trey Powers
    Oct 29, 2020 @ 15:14:48

    Behavioral Exposure
    1.
    Certain situations or objects within a client’s environment have the capacity to cause them so much anxiety or distress, that they are unable to function properly when confronted with them. This may come from complete avoidance, or extreme anxiety/panic attacks when confronted with the feared stimulus. Because of the level of anxiety that is experienced as a result of these stimuli, the fear that clients experience is deeply engrained, as is their desire to avoid them, or sooth themselves while confronting them. Such thought and behavioral patterns therefore cannot sufficiently be broken by using talk therapy or hypothetical situations alone, and instead require direct exposure to the stimulus in question. While it may seem at first to be counterproductive to deliberately put a client into a situation in which they are highly likely to experience intense anxiety and/or panic, there is therapeutic benefit that can be derived from such a practice. Although the client will initially be overwhelmed by their anxiety, especially if they are deprived of their comfort objects/individuals, this visceral anxiety stemming from the fight-or-flight response that they experience only lasts for a relatively short amount of time. Once the client realizes that they are not, in fact, in any danger, and that no harm has come to them while in the feared situation, they relax and understand that their fear was unwarranted. Over time, and with repeated exposure, clients will come to the understanding that their fear of these situations or stimuli is unnecessary, as there will likely never be true danger associated with them.
    2.
    When preparing to utilize exposure therapy, it is vital that preliminary steps be taken with the client prior to the actual exposure. First, they must be taught relaxation techniques and other positive coping strategies that can be implemented during the exposure, or whenever they experience intense anxiety. This provides clients with a way of controlling their response when they feel the onset of anxiety or panic, and can mediate the intensity of their fear response. It also serves as an alternative to any negative or ineffective coping strategies that they may have been engaging in previously. Second, it is important to gain an understanding of what situations or stimuli cause the client anxiety, and how strong their anxiety response is to each. Establishing a hierarchy of anxiety-provoking stimuli is essential preparatory work, as having a client be exposed to a stimulus that is too high on the list will overwhelm them, and may reinforce their negative coping strategies, as well as their belief that the fear they experience is warranted. It is also essential that the counselor monitors the client’s experience throughout the exposure, and intervenes when appropriate and as necessary in order to ensure that the client remains in control throughout the exposure.

    Assessment of Anxious Patterns
    1.
    As the client was in an increasingly crowded aisle of the grocery store, the began to have negative automatic thoughts that contributed to her anxiety. The first was a thought that she was losing control, and the second was they she was unable to escape the situation. As her automatic thoughts and physiological arousal compounded each other, she began to engage in catastrophizing, where she envisioned herself having a heart attack right there, and worried how she would get help and whether she would survive.
    2.
    The physiological symptoms that the client began experiencing while in the aisle were feeling hot, sweaty palms, tightness in her chest, elevated heart rate, and then eventually nausea and feelings of choking. In terms of her safety behaviors, she escaped the situation, after which she reported feeling better. Additionally, once she saw her husband in their car, she also reported feeling better, and being ready to go home.

    Reply

  9. Brigitte Manseau
    Oct 29, 2020 @ 15:59:36

    1a. Behavioral exposure is especially effective for anxiety disorders because it directly addresses clients’ source of distress. Behavior exposure is when clients are exposed to the anxiety provoking situations that they have been avoiding. Through behavior exposure clients are able to disrupt their behavioral avoidance pattern. When clients avoid the source of their distress they experience short-term relief which acts as negative reinforcement. That avoidance can become detrimental to clients because they are unable to cope with their source of distress. Behavioral exposure provides long-term relief for people with anxiety-related disorders because clients learn how to cope with the source of their distress and they are able to confront the avoided situations.
    1b. One caution to consider is how ready and prepared the client is to confront their source of distress. It is important to make sure that the client is not ill prepared or rushed into a step that he or she is not ready for. If the client takes on a step that is too much to handle at that point it can be overwhelming and reinforce their behavioral avoidance pattern. As we know everyone is different. Therefore, one client may need the first step of exposure to be broken down into two or three parts while another client could handle the whole first step of exposure.

    2a. Lindsay’s negative automatic thoughts in response to the aisle becoming crowded was that she couldn’t escape and she did not have a sense of control. At one point Lindsay mentioned how she thought she would have a heart attack and she was unsure how she would get help in the crowded aisle. The cognitive distortion Lindsay had was catastophizing.
    b. In response to her associated automatic thoughts Lindsay had several physiological reactions. The body sensations she experienced were sweaty palms, feeling very warm, chest feeling tight, increased heart rate, nausea, and feeling like she was choking. As for safety behaviors, Lindsay left the grocery store to escape the situation and hopped back into the car with her husband. She immediately felt a sense of relief once she was in her husband’s presence which helped reinforce her behavioral avoidance pattern.

    Reply

  10. Christopher LePage
    Oct 29, 2020 @ 17:59:32

    1) Behavioral exposure is so beneficial for certain disorders, because of how it helps break down maladaptive patterns that an individual may be exhibiting. Specifically, when you look at a disorder such as anxiety, behavioral exposure is extremely beneficial. With some individuals with anxiety they may avoid certain events/environments to avoid the onset of anxiety, which is potentially depilating to an individual’s life. Behavioral exposure can use techniques such as flooding to help a client no longer avoid these situations.
    2) One of the reasons that behavioral exposure may be a cause of concern, is that every individual is different. Some people may feel that the exposure to certain stimuli may be too overwhelming for them which may be discouraging for your client to follow-up on their therapy sessions. Another cause of concern is that with behavioral exposure the client may not follow the instructions as well as they had been instructed to.
    3) Her primary negative automatic thoughts that she was experiencing was that she was losing control over the situation, and that she would not be able to escape the store. She was also concerned about her elevating physiological symptoms leading to a panic attack.
    4) Her response to her physiological symptoms (chest tightening, sweaty palms, feeling nauseous) was that she left the store, and met back up with her husband who was waiting for her. After she was in the car she felt more at ease and her physiological symptoms started to decrease.

    Reply

    • Eileen Kinnane
      Nov 01, 2020 @ 10:24:06

      Hi Chris,

      I found it interesting how you noted that clients might be discouraged by therapy if the behavioral exposure is too intense for the client. It’s important for us as clinicians to remind the clients of the steps they take just by being willing to practice exposure. That can be something they never thought they’d be ready to try, and while the exposure itself might be too much, the possibility of trying is a step in the right direction, even if the client doesn’t see it that way.

      Reply

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Adam M. Volungis, PhD, LMHC

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