Topic 8: Core Beliefs & Behavioral Exposure {by 11/1}

[Core Beliefs] – Watch MDD-18: Core Beliefs – Modifying 3 – Behavioral Experiment [MDD-18: Early Session Stage – Late Phase on website].  Answer the following (you can be brief): (1) In what ways was this behavioral experiment helpful in providing “evidence” for this client’s new core belief?  (2) What could be another behavioral experiment for this client that could potentially strengthen his new core belief?

 

[Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter).  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?  Your original post should be posted by the beginning of class 11/1.  Have your two replies posted no later than 11/3.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

30 Comments (+add yours?)

  1. Jayson Hidalgo
    Oct 28, 2018 @ 13:04:13

    The behavioral experiment was very helpful in providing “evidence” for Mark’s new core belief. Doing the experiment which Mark had to ask his colleagues if one of them wanted to have a get together with his wife and their significant other, the experiment helped differentiate and provide some distance between Mark’s old core belief and new core belief. Mark’s old core belief was unlikeable and his new developed core belief focused on feeling likeable. Mark’s experiment went well and he and his wife got together with one of his colleague and their significant other and Mark stated they all had a great time. After reviewing Mark’s thoughts and feelings once the experiment was over, Mark began to accept his new core belief because the experiment allowed Mark to actually experience the concept of his new core belief as his colleague accepted his invitation to get together proving that Mark can be a pretty likeable guy which due to Mark’s pleasant experience, it is slowly defeating his old core belief. I especially liked the part of the worksheet where it mentioned about “Evidence for New Core Belief” and “Evidence against Old Core Belief”. Dr. V simply reviewed the experiment once again with Mark and suggested to Mark to name some evidence that supports his new core belief and to name some evidence against his old core belief. What is being done here, is simply trying to make the old core belief even older and simply have Mark try to forget about the old core belief and with the evidence for his new core belief, it allows Mark to believe in more of this new core belief and obtain a more adaptive perspective.

    Mark asked his colleagues to get together for a dinner and went out for pizza, however there are other ways for Mark to feel the sense of being liked without actually having to go out along with his wife and colleague just to feel liked. For example, a simple complement can go a long way. I know this experiment was successful and Mark probably felt hesitant about doing this intense exercise, but I feel like a less intense exercise would have been just as beneficial. Maybe at work, Mark could simply ask a co-worker or colleague to work together with a project work related and feel just as happy knowing this co-worker or colleague would like to work with him. Mark did not really have to go to the extreme of involving his wife along with his other colleague’s wife just to feel liked. Mark could have done something at work with a colleague to feel accepted and liked by doing something together.

    To name a few, behavioral exposure is very effective among disorders such as social anxiety disorder, panic disorder, and posttraumatic stress disorder. What they share in common is that they involve the individual’s distress being primarily caused by him or her feeling anxiety and a sense of fear. It is true that other disorders such as substance use disorders can cause an individual to experience a degree of anxiety, but I believe behavioral exposure would not be effective against a person who has a drug problem. Behavioral exposure focuses on an individual’s anxiety/fear causing distress so it will not be effective to use against a person who has a substance use disorder since the primary focus on treating a person who has a substance use disorder would be treating their distress coming from the drug and their anxiety will be hopefully diminished because of treating the drug first. Furthermore, the distress a person with substance use disorder is not due to their anxiety or fear, but is due to their drug intake. Consequently, behavioral exposure will be very effective among certain disorders such as anxiety disorders and a few other disorders such as PTSD because distress primarily comes from the person’s anxiety and degree of fear which behavioral exposure’s main target is to treat a person’s distress caused by anxiety and fear.

    A caution that I can first think of to consider when implementing behavioral exposure interventions is for the therapist to not be involved too much in the exposure. The book mentioned that the therapist can later become a safety behavior if the therapist is constantly with the client whenever the client is performing their exposure intervention. The client is supposed avoid any safety behaviors when doing the exposure to prevent a sense of relief or be able to use their coping strategies to deal with their anxiety. The client must deal with the anxiety and fear straight, but with these safety behaviors or coping behaviors, the client will not learn to successfully deal with their intense anxiety and exposure will not work. The therapist will at first be with the client when first performing the exposure, but much later, the therapist needs to step back and allow the client to independently perform the exposure intervention on their own. If the therapist is constantly with the client during exposure intervention for a long period then the client can have their therapist become a safety behavior as they will feel safe and feel less anxiety/fear knowing their therapist will always be there for them for support. However, the main focus is to allow the client to independently learn to perform the exposure and if the therapist is constantly there, then it will hinder the client from independently learning to deal with their anxiety/fear on their own. Another thing that I just thought of is when will a therapist know exactly when to let the client perform the exposure intervention on their own? I know the therapist will constantly be assessing a client’s degree of anxiety during their exposure interventions together, but will there will be a certain anxiety degree such as the individual reporting an anxiety rating of 5 to indicate to the therapist that the client is ready to perform the exposure on their own since their anxiety rating is not too severe anymore.

    Reply

    • Alyce Almeida
      Oct 29, 2018 @ 17:10:25

      Jayson I like your focus on the therapist being too involved during the exposure period. I totally didn’t touch base on this because I didn’t realize how important but also damaging we could be as therapists if we don’t realize we could potentially be too much of assistance. Though we would want to bring our clients comfort, we also have to remember that we can’t enable them either, making sure we understand that exposure needs to be challenged fully, meaning that clients themselves need to face all of those fears they struggle with. Great point!

      Reply

  2. Melissa Pope
    Oct 29, 2018 @ 06:48:25

    The behavioral experiment watched for this weeks video allowed for the client to go out on his own to validate and strengthen his new core belief. Previously he believed that he was an unlikable guy, and for his experiment decided to ask another co-worker couple out on a double date with his girlfriend. The ways in which this experiment provided “evidence” for his new core belief is first, the other couple said yes to the initial invitation. Mark then stated that during dinner, they all laughed and had a good evening. Lastly, the other couple seemed to enjoy themselves so much that at the end of the date, they verbally initiated another date. All of the above is “evidence” that Mark is like-able and that others enjoy his company. Another behavioral experiment that Mark could try is inviting a co-worker during a lunch hour out for a walk at the local park, and then maybe lunch afterward. So much of our world is centered around food, and socializing during lunch is short-lived, but to add a walk into the mix takes out the busyness of eating and focuses primarily on the social aspect of a relationship.

    Behavioral exposure is an effective method for treating many anxiety related disorders; such as PTSD, OCD, Panic Disorder, Agoraphobia, and Social Phobia. The purpose of behavioral exposure is to “expose” and individual to the trigger that causes stress, which they have been avoiding as a means to cope with their heightened distress. What makes this effective is that in the moment what causes distress is a physiological response, this feeling eventually will subside even if confronting a trigger. This teaches a client that they can “do it”, which reinforces their self-efficacy beliefs and also encourages/promotes more healthy/adaptive means of coping with the distress. As with all treatment techniques, understanding a clients “readiness” to perform must be considered. With behavioral exposure, if the client is not ready to confront what they have been avoiding, forcing them to do so will only heighten the distress and avoidance that you, the therapist are trying to minimize. The risk of the exposure also should be considered. If the risk seems high you want to break it down and take “baby steps” with some clients to continually move forward. Your judgement as a therapist of what the projected outcome will be, including any safety behaviors before engaging in exposure should be well thought out, to promote new adaptive behaviors/thoughts.

    Reply

    • Alyce Almeida
      Oct 29, 2018 @ 17:06:29

      Melissa I focused on Mark taking on lunch with a co-worker as the next experiment as well. I think you make a great point that Mark could really use this to increase his social relationships with his co-workers. He obviously struggles with negative thoughts around his co-workers and them not liking him. Having him focus on these relationships will continue to introduce new positive thoughts and core beliefs into Mark’s life.

      Reply

    • Amanda Russo-Folco
      Oct 29, 2018 @ 20:26:43

      Melissa, I did not really think of that idea for a behavioral experiment. It is so common to socialize around food, maybe because I’m Italian, but just going for a walk in the park is a great idea. It really does just focus on the social aspect of the friendship. Also, I totally agree when you said “The risk of the exposure also should be considered. If the risk seems high you want to break it down and take “baby steps” with some clients to continually move forward.” This is important because it is important to go at the speed of the client and if the therapist is not on the same page as the client, it could not work. It is very important to make sure the therapist and client communicate through these exposure techniques and to make sure they move at the same speed.

      Reply

    • Sam
      Oct 30, 2018 @ 09:02:48

      Melissa,
      I like that you added that a therapists judgement on outcomes and safety behaviors should be considered in regards to precautions for exposure therapy. I agree with this and also mentioned that a therapist should feel competent in their treatments using exposure therapy. In this sense, like you mentioned, they should think through the logistics of it all, and examine any obstacles that may potentially emerge, and more importantly, they should inform the client of such information. Nice post.

      Reply

    • Deanna Tortora
      Oct 30, 2018 @ 21:30:16

      ” but to add a walk into the mix takes out the busyness of eating and focuses primarily on the social aspect of a relationship.”
      Melissa,
      I know a few other people already commented on the behavioral experiment that you thought of but I couldn’t help but also chime in. I really love your idea of going for a walk. I had mentioned that Mark had said he’d love to get to the park more, and suggested that he invite a coworker or friend with a dog to go to the dog park with him. I really like how you pointed out that the point of his social interactions isn’t to get food, but to build on his social relationships and see how much the people around him value him [Mark] and like him. I think going for a walk gives less focus on a task in front of you, and more focus on the person you are with. I completely agree that getting some exercise with a friend and having quality one on one (That meets one of his aforementioned goals of getting to the park again) is a great experiment.

      Reply

    • Marissa Martufi
      Nov 01, 2018 @ 12:55:15

      Melissa, I like that you mentioned a client’s readiness in regards to behavioral exposure. It is such an important component. I agree that as the therapist, it should be kept in mind, that the goal is to minimize any risks or negative outcomes. Obviously, as the therapist, you want to do what is best for your specific client. Therefore, it is important to consider a client’s readiness to face exposure and begin this approach to treatment. I like how you included the break down into baby steps with clients who may not be fully ready for this approach. Taking baby steps can be helpful, and also allow you and the client to move forward but still at the client’s pace.

      Reply

  3. Alyce Almeida
    Oct 29, 2018 @ 17:04:13

    1. I’d like to start off by saying that Mark is finally seeing himself in a different way- finally! The behavioral experiment was helpful in providing evidence for the new core belief since Mark was not only able to reflect on his previous negative core belief, but also open to discuss how it’s change, and what has worked for him. I think the experiment was successful since it got him to actively test his core belief by having him ask his co-workers out to dinner. That is a big step for him, then they all went out to dinner and ended up having a great time. All those factors are evidence right there on this new core belief on him feeling likable. It helped lay out what he wanted to do, and the potential outcomes which ended positively for him and even surprised him on how well it went. I think another behavioral experiment that could strengthen his new core belief is Mark asking to have lunch with another co-worker. This was a previous issue for him and his past core belief, so tackling that next might be the best option.
    2. Behavioral exposure is very effective because it targets the anxiety disorders. It’s useful in exposing individuals to the fears that cause their anxiety in the first place. Once individuals are able to understand their triggers, and identify there needs to be a change, exposure is their way of practicing and mastering managing such trigger(s) in order to better react in future situations. I think exposure really gives the client the full control over their disorder, but also real sense of confidence since they are ready to challenge their own anxiety and truly change their behavior. It also gives them a sense of accomplishment which is beneficial throughout this process. Cautions to consider when implementing behavioral exposure is knowing whether or not your client is even ready for this step. This is where rapport and a good relationship with your client comes in since you’ll be able to feel out whether or not this is the right step for them. The client themselves has to be ready to do exposure, and be willing to accept all potential outcomes whether it be positive or negative. Safety is top priority, so assessing what could or could not happen needs to be addressed as well before following through.

    Reply

    • Melissa Pope
      Oct 30, 2018 @ 13:07:12

      Could not agree more with you reponse to how the behavioral experiement helped strengthen Marks’ new core belief. I did not write it but I particularly enjoyed how you ephasized that the pleasant positve experience “surprised” him because his past perception is “nobody likes me” so they will obviously say “no” or “something will go wrong”. This was a great experiement and thankfully it went better than anticipated for Mark.

      Reply

    • Mikala Korbey
      Oct 31, 2018 @ 17:30:32

      “I think exposure really gives the client the full control over their disorder, but also real sense of confidence since they are ready to challenge their own anxiety and truly change their behavior.”

      Alyce, I really like that you mentioned this in your post. I really did not think of it as them having control over their disorder. I would think that this sense of control might not come until they feel more comfortable with whatever it is they are doing exposure with. For example, if someone was afraid of open spaces, initially, they may not feel confident or as though they have control over their disorder. But after several times of exposure to being in open spaces, they may begin to feel this sense of control. Again, this is something I never thought of until reading your post and I’m very glad you brought that up.

      Reply

    • Shannon O'Brien
      Nov 02, 2018 @ 13:32:16

      Alyce, I really liked how you mentioned rapport in your post about behavioral exposure! It appears that rapport and trust is vital for implementing exposure. Having a mutual understanding of the expectations of exposure is important as well so both the client and therapist can remain on the same page. At this point in therapy, there will be a lot of intense emotions provoked by the challenge of exposure, so a strong and respectful relationship will be necessary in order to encourage and support the client.

      Reply

    • Jayson Hidalgo
      Nov 02, 2018 @ 21:36:34

      It was very nice that you touched upon the caution of knowing whether or not a client is even ready to perform such exposure interventions. I agree that the therapist needs to know their client well and have this rapport to be able to realize and recognize whether or not their client is emotionally stable to perform situations that will intensity provoke their anxiety. If a client is not ready, then performing these exposure interventions will simply not be safe for them.

      Reply

    • Nicole Plona
      Nov 03, 2018 @ 23:55:41

      I wanted to start by staying that i had the same reaction to watching the video and it so nice to see Mark making the connection to the idea that he isn’t actually unlikeable. This type of behavioral experiment was perfect for Mark and really helped provide evidence towards his new core belief. Though these types of experiments in therapy can be risky, i feel as though it was the perfect task to put into play for someone like Mark and his present situations.

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  4. Mikala Korbey
    Oct 29, 2018 @ 19:23:39

    Providing clients with evidence opposing their old core beliefs and supporting their new one further reinforces the benefits of the new core belief. In Mark’s case, it showed him that it turned out better than he had expected. Filling out the sheet gave him a good visual aid so he could see why this new core belief is so important and helpful. Mark was able to see what he thought about the behavioral experiment before and after, which helped him realize that he is not totally “unlikeable” like he previously believed. Mark had to actually devise a plan, trouble shoot it ahead of time, and allowed for him to review how it went and how he felt. This can be really helpful because he can allow himself to create a plan for the night but also to come up with alternatives in case it does not go as planned. The space to reflect on how it went and how he felt is also really important because it allows him to think back on his feelings and to further reinforce that he had a good time and people wanted to spend time with him. The section for evidence for his new core belief just further emphasizes its importance and shows him that he as made progress. Another behavioral experiment that Mark could do, is to continue asking people at work to go out for lunch with him. He could also potentially ask Melissa’s friends to go out, so he can expand his network of friends and meet her friends. Additionally, he could plan another date with he couple he just went out with, and that could further reinforce that they enjoyed his company and liked hanging out with him.

    Behavioral exposure can be effective because it requires that the clients confront what it is that they fear or tend to avoid. It helps to break their avoidance patterns and aids in more long-term relief. Specifically, it helps to relieve anxiety-related distress an individual may experience. Once individuals know what triggers them, they can then begin to work with their therapist to determine how they are going to confront it. These techniques are things that can be used outside of the sessions and even after therapy ends. Once individuals learn these techniques and finds what works for them, they can use them for the rest of their life as they deem necessary. There are some cautions to consider when implementing these experiments however. Clients will initially experience increased fear, so it is important to make sure that they are truly ready for it. Clients need to also be able to identify their own anxious and/or fearful behavior patterns (with the help of the therapist, of course) so that they know what to improve on. It is possible that some clients are nervous to begin using these techniques, so it is crucial that the therapist reviews the rationale and method for each one, and explain the importance. The therapist and the clients will review and practice these methods before sending them off to do them on their own, so this should eliminate some of their worry, but it is still something to be mindful of.

    Reply

    • Amanda Russo-Folco
      Oct 29, 2018 @ 20:20:05

      I liked your additional behavioral experiment for Mark. I feel that that would be a good idea and would expand his friend network. I also really liked how you said: “Once individuals learn these techniques and find what works for them, they can use them for the rest of their life as they seem necessary.” This is super important and the ideal point of these techniques which is why it is very important for the therapist to fully explain the techniques so they can remember it for themselves. If they ever go through the situation themselves, then they can remember it and reduce their distress on their own without the therapist there. Overall, I liked all of your ideas and agreed with them.

      Reply

    • Sam
      Oct 30, 2018 @ 09:09:15

      Mikala,
      I think an important point in your response regarding cautions to consider when providing exposure therapy is that the therapist should provide review and practice before the client engages in this form of therapy. To add to this, I would say that by doing so, the therapist and client should work collaboratively to choose and agree on certain exposures. This can help the client feel like a part of the process instead of having someone tell them what to do, especially telling them to do something that may cause them distress. Great post.

      Reply

    • Nicole Plona
      Nov 04, 2018 @ 00:01:34

      First i wanted to start off by saying that i really liked your idea for an alternative behavioral experiment for Mark. I think it could be a great idea to get Melissa’s other friends involved with the lunch and dinner outings. This give more opportunities for Mark to feel included in a group and to potentially make new friends outside of his coworkers. Overall i feel like you did a great job summarizing how the behavioral experiment was beneficial for Mark to find more evidence towards his new core belief of not being unlikeable.

      Reply

  5. Amanda Russo-Folco
    Oct 29, 2018 @ 20:11:08

    1) The ways in which this behavioral experiment was helpful in providing “evidence” for this client’s new core belief is that when he asked his friends to go out, they did not say no, they said yes. It was also helpful for Mark to see how he hypothesized his ideas and talking about the coping mechanisms that he would have done if his night did not go as planned and if they said no. It was very helpful for Mark because he said that this time he was not going to shut down or withdraw from the situation. He would go out with Melissa anyway, even if the other couples did not end up going. He starts to understand that it is not a personal thing and that people’s lives do get in the way sometimes. Although his friends did say yes, this made Mark feel good. He was happy he took the risk. He saw that the outcome was better than he had expected. He started to realize that he is not unlikeable and that he is likable. He had the courage to ask out friends he was not really close too and this is something he never imagined himself doing. It is also very important that Mark would not let his friends saying “no” ruin his night and that he would still go out with Melissa, unlike before when he would let it ruin his entire night and would just want to be alone from everyone. Overall, the outcome of his night was very fun, and he was excited to hear that they wanted to do this again some other time. Another behavioral experiment for Mark that could potentially strengthen his new core belief is maybe he could plan a get together at his house for a sports event and invite his friends over again and see how the night would play out. This could strengthen his new core belief because if everyone comes, then he will feel even more valued and likable in the situation.

    2) Behavioral exposure is very effective for certain disorders/types of distress because it helps individuals to feel that they are safe and not alone. These techniques are initiated in early or middle phase of therapy to help relieve anxiety-related distress and to help cope with related life stressors. These techniques are used frequently throughout between sessions and long after therapy ends. It is important to confront the situation that is being avoided because if not, the same situation is going to keep reoccurring and the pattern is always going to continue. Although, avoiding the problem will help the individual feel a sense of relief at that very moment, the next time the situation occurs, the client will continue to avoid and continue to be in a vicious cycle. The client needs to be exposed to what they feel anxious or fear too. Behavioral exposure is effective because it has the opposite effect of avoidance. Although exposing clients to previously avoided situations will initially result in increased fear/anxiety, the client will realize that the psychological arousal does not last forever and will eventually decrease over time. Eventually, the client will learn that the situation is no longer threatening. Some cautions to consider when implementing behavioral exposure interventions is that the individual could experience significant distress and physiological arousal. It is very important to be aware of the client’s behavior. Some clients may not be ready to be exposed to their fear or the situation that makes them anxious and they could have panic or anxiety attacks. It is important to do these exposures when the client is ready. It is also important for the client to be educated on the exposure techniques so they will know what to expect.

    Reply

    • Deanna Tortora
      Oct 30, 2018 @ 21:40:51

      “Some cautions to consider when implementing behavioral exposure interventions is that the individual could experience significant distress and physiological arousal. It is very important to be aware of the client’s behavior. Some clients may not be ready to be exposed to their fear or the situation that makes them anxious and they could have panic or anxiety attacks. It is important to do these exposures when the client is ready. It is also important for the client to be educated on the exposure techniques so they will know what to expect.”
      Amanda,
      I couldn’t agree more! I think it is really important to make sure that the therapist is aware of the obvious, our clients will be uncomfortable during exposure interventions! Sometimes we can forget that these interventions that are seemingly simple, can cause a lot of distress. We need to make sure we are always aware of this, as well as keeping the client informed of what we are doing together and why. I agree that keeping a client informed and educated in all aspects of their treatment can really help with the distress, but can also help with giving motivation and reason for engaging in the intervention. I would like to add that it is equally important to know when to let the client struggle and when to let the client try to work it out without the therapist’s assistance. That way they can learn from their struggles and practice using their techniques so that they will eventually be able to dispel their distress on their own!

      Reply

  6. Sam
    Oct 30, 2018 @ 08:56:19

    1. The behavioral experiment worksheet, allowed Mark to essentially establish a new core belief and find evidence to support it, while disproving an old negative core belief. Mark chose to work on diminishing his old core belief of being unlikeable by focusing on the belief that he is generally a likeable guy. In this case, Mark expressed that during the night out, his friends seemed to like him and laugh with him, which provided him with evidence that he is not as unlikeable as he thought he was. In addition, he mentions that his friends expressed they would like to go out again, which indicates to Mark that he is likeable, because if he wasn’t, they would not have asked to hang out again. This worksheet also allows Mark to examine potential problems that may result in weakening the evidence for his new core beliefs. However, with this, Mark is able to write down positive coping and problem-solving strategies to help him overcome difficult negative thoughts and behaviors that may have reinforced his old core belief, which allows him to continue to focus on his new core belief. There may be a vast amount of experiences mark could plan in order to strengthen his new core belief of being likeable. For one, Mark can ask out more of his friends and colleagues to hang out and have a good time to increase his feelings of being likeable. However, it may prove to be beneficial to go out and create new friendships. This may prove to Mark that it is not just the people he has known for a while that like him, rather, it may show him that he can branch out and make new friends because he is generally a likeable person.

    2. Behavioral exposure has been proven to be an effective form of treatment for numerous disorders including agoraphobia, panic disorder, OCD, PTSD, and social phobia. This is because, behavioral exposure works to eliminate the behavioral avoidance patterns that are associated with confronting fears and anxieties that have resulted in or from such disorders. In this sense, behavioral exposure is proposed to modify such patterns by confronting the situations that are being avoided. Through this, new information can be discovered that essentially disconfirms the unrealistic fears and anxieties the individual may hold that lead to distress and avoidant behaviors. Exposure can include different forms such as imaginal exposure or in vivo exposure where the client either vividly imagines a situation that causes fear or anxiety and does not avoid it, or gradually exposing themselves to stressful situations. However, more importantly, behavioral exposure is effective as it may emphasize different contents of exposure specific to the clients concerns. In this case, the client may feel that the treatment is specifically tailored to their needs and not just a form of treatment that is the same for everyone. Nevertheless, caution should be considered when determining the client’s level of readiness for exposure therapy. This is because, this form of treatment can result in a temporary increase of distress and high emotionality or physiological arousal. Thus, if not implemented correctly, the positive effects of exposure therapy may decline and become ineffective or worse, increase fears and anxieties. Also, from my perspective, some therapist may run into problems in regards to ethical beliefs. In some cases, I believe that therapists might feel that purposely evoking stress in their clients for new learning to occur could go against their beliefs, and may lead them to feel they are doing more harm than good. However, this would more so have to do with the therapist’s comfort, competence, and professionalism in providing the treatment.

    Reply

    • Melissa Pope
      Oct 30, 2018 @ 13:19:52

      Sam,

      Your explanation for the effectivness of behavioral exposure was very well put and
      I particularly enjoyed your wording of “new information can be discovered that disconfirms the unrealistic fears and anxieties…that leads to avoidant behaviors. As the reading and evidence suggests counteracting avoidant behaviors allows for clients to first hand experience and understand the physiolgical response to their stress is unrealistic and can be modifyed. I also liked how you made the point that behavioral exposure is “tailored made” for clients, which is helpful for clients to feel special and one-of-a kind, and to not be just clumped into a group with a number.

      Reply

    • Marissa Martufi
      Nov 03, 2018 @ 23:18:27

      Sam, I liked reading your post. Like Melissa also said in response to your post, I like how you mentioned that new information can be discovered through behavioral exposure, specifically information that can disconfirm the unrealistic fears and anxieties. It is important to consider the client’s avoidant behaviors, as well as experience the client’s responses to the avoidance or distressing behaviors. I also like how you mentioned that behavioral exposure can be interpreted by the client as something that is uniquely designed or tailored to them and their situation. I agree that therapists should proceed with caution as the client may not necessarily be ready for this therapeutic approach.

      Reply

  7. Deanna Tortora
    Oct 30, 2018 @ 21:23:58

    [Core Beliefs]
    (1) This behavioral experiment was helpful in providing “evidence” for this client’s new core belief because it allowed Mark to experience a situation where his old core belief was not compatible. Going to dinner on a couples’ date and experiencing how the other couple wanted to hang out with Mark again, was evidence that Mark was likable. They would not have otherwise wanted to do it again. This information helped support Mark’s new core belief that he is likable as it gives evidence in support of it. Essentially, Mark is retraining himself to actually believe the new core belief, and having evidence for it certainly helps. This experiment helped Mark think differently and to believe his new belief, and also to make Mark do things that act as a self-fulfilling prophecy and make his belief come true. This experiment helps Mark to engage in activities with people, and even if they say no, to have a plan to do something in place of it rather than isolate himself and shut down from the “rejection”. Mark sought out others and gained the opportunity to see others that like him. Even if the couple had rejected the date, Mark could have spent time with Melissa. Mark himself said that he could have a good time even if others say no. This helps Mark to see that others do like him, and even if people say no, he has others that do want to spend time with him, he is likeable. This experiment gave him the opportunity to succeed and feel good about himself, and gain support for the core belief of being likable, disrupting the maladaptive pattern of the old belief that he was not likeable.
    (2) Another behavioral experiment for this client that could potentially strengthen his new core belief is to invite another coworker who has a dog to go to the dog park with him and his dog sometime. Mark could also re-invite his work friend to lunch. Mark had mentioned that the friend that had rejected him before, did invite him out to lunch for another time. Mark should follow up on this and take him up on his offer. This would help to solidify to Mark that he is likable and that for other reasons his coworker had said no to lunch. His back up could be to ask others to lunch. Mark could also invite a coworker to a short “water cooler” style break, a coffee break, anything. Sometimes it can be beneficial at work to take a quick break and catch a breather. Mark could ask a coworker to join him. All his socialization does not have to be around food. It could be any kind of get together really.

    [Behavioral Exposure]
    (1) Why is behavioral exposure very effective for certain disorders/types of distress?
    Behavioral exposure is very effective for certain disorders/types of distress because it disrupts the maladaptive cycle of reinforced behaviors. That is, by exposing clients to that of which they are anxious and fearful of and teaching them that they can learn to not be fearful and anxious of them, and/or that they can manage their fear and not avoid, disrupts the avoidant behaviors that the clients are reinforcing so as to not feel fearful or anxious. Those with certain disorders and types of distress avoid that which makes them fearful or anxious and learn that they are safe if they avoid. This pattern of behavior is maladaptive because they do not learn how to cope with their fears and anxieties nor do they learn skills on how to work it out for themselves. Exposing themselves to the situations that cause fear and anxiety disrupts the maladaptive pattern of avoidant behaviors and helps clients to take the steps to learning how to manage their fear and anxieties. Being exposed to what they fear, helps them to manage their distress as they learn exactly how they can manage their distress.
    (2) Some cautions to consider when implementing behavioral exposure interventions are:
    -Making sure the client has psychoeducation from the therapist on their distress/disorder and about behavioral exposure interventions. The client should be aware of what they will be undertaking and why.
    -Being sure that your client understands why exposure is effective. A client that understands why it is effective and why they will do what they will do, will help them to understand the process.
    -Making sure the client is ready for exposure (from minimal minor exposure such as imaginary to in vivo). Has the client mastered and/or learned some relaxation techniques and knows how to implement them? The client should be built up for certain interventions. Helping the client to develop the tools they will need will help the client to manage their distress and fears.
    -Are they able to manage their fear or anxiety enough to confront/try confronting their anxiety and fear? Being aware of whether or not the client can manage their anxiety, and/or their struggles during interventions can help guide the client and therapist on what needs more work.
    -Making sure the client is gradually getting ready for in vivo. Having the client be aware that you are building them up to confront a fear in real life, will help them to be informed but also be aware that they are preparing for the real thing at some point. The therapist does not want to catch the client off guard, but rather prepare them for what is coming.
    -Make sure the client has actually built up to in vivo exposure. Using other forms of exposure before in vivo and making sure they learned and/or mastered them, will help prevent pushing a client before they are ready and causing harm.
    -When using certain behavioral interventions, the therapist should be cautions to not be overly involved. They should allow the client to struggle a bit and confront their fears and anxieties, but also experience them and learn to manage them on their own. This is assuming that they have had appropriate supports from the therapist to be able to do this on their own. The therapist should also keep in mind that behavioral exposure can be uncomfortable for clients, but it is a necessary tactic for alleviating distress. Overall, the therapist needs to know when to “dance with the client”, when to step in and assist, when to step out and observe their client dance, and when to cut in and help them again.

    Reply

    • Mikala Korbey
      Oct 31, 2018 @ 17:41:44

      “They should allow the client to struggle a bit and confront their fears and anxieties, but also experience them and learn to manage them on their own.”

      Dee, I really like that you brought this point up when talking about some of the things to be cautious about with behavioral experiments. Reading this, I immediately thought, I bet I would be that therapist that jumps in too early because I want to help and fix the problem for them. I even have a hard time doing that now with my students struggling to do “simple” tasks. This is definitely something I will need to be mindful of in the future when doing behavioral experiments. I feel like these things do not get said enough, that yes we are here to help the clients reduce their distress, but at the same time, it is okay for them to confront their fears and feel all the feelings associated with it, because the practice will help them be able to better cope in the future. I’m really glad you mentioned this.

      Reply

    • Shannon O'Brien
      Nov 02, 2018 @ 13:24:07

      Deanna, I enjoyed your thoughts on Mark as many were similar to mine! Specifically, your comment about going out with just Melissa if his friends were unable was one of the biggest changes I noticed in Mark. Before he would withdraw and become depressed. Now, he has the ability to see that just because his friends can’t go out, doesn’t mean that he still can’t go out with Melissa and have a good time. He seems to have developed adaptive automatic thoughts and coping skills when faced with that situation! I also liked your “coffee break” idea for a further experiment. It is something small and brief that can be easily implemented into his work day!

      Reply

  8. Shannon O'Brien
    Nov 01, 2018 @ 11:40:23

    The behavioral experiment worksheet helped Mark provide evidence for his new core belief by helping him challenge his old core belief both on paper and in vivo. He was able to identify a feeling of apprehensiveness and a group of negative automatic thoughts while thinking about how dinner with friends and Melissa would go. He was able to acknowledge despite being apprehensive or nervous that they would say no he was still excited to try to ask them all out to dinner. Mark was able to identify affective potential coping skills that he could have used had they said no to going out to dinner. I think his comments about still going out with Melissa was a huge step in the right direction as he typically withdraws when he feels rejected or disliked. His rationale for why they would say no (he did not know them as well as his other friends) seemed valid to me and I thought that the insight he had into their relationship was an improvement from earlier sessions. The clear evidence was that everyone appeared to have a good time and stated they would like to go out again in the future. I think other behavioral experiments Mark could partake in would be getting lunch/dinner, going to the movies or sporting events, taking a hiking, etc. I think getting out into all types of social contexts with different groups of people would be beneficial. Being able to generalize the feelings of being liked and accepted throughout all aspects of Mark’s life, no matter the people or setting he is in, seems important and would be a goal of mine as his therapist.

    Behavioral exposure is effective for anxiety disorders such as agoraphobia, OCD, panic disorder, PTSD, and social phobia. Due to the level of anxiety and negative automatic thoughts, people tend to experience increased physiological arousal. As a result, avoidant behaviors are exhibited in order to provide relief from the distress. This immediate sense of relief is then reinforced because it acts as a temporary fix, therefore increasing the likelihood of future avoidance of distressing situations. Behavioral exposure starts with identifying and assessing patterns that trigger anxiety or fear in clients. Therapists must identify triggering events, associated negative automatic thoughts, physiological responses, anxiety responses, and outcomes. Next, it is important for therapists to provide clients with relaxation techniques they can use when presented with distress. Techniques such as progressive muscle relaxation, diaphragm breathing, and visualization can be useful for clients in order to either prevent or manage anxiety. Therapists and clients should now collaboratively modify anxious thoughts by analyzing cognitive distortions such as catastrophizing, magnification or risks, and minimizing of own coping skills. This can be accomplished by determining scenarios or outcomes that are more realistic, by assessing the probability of alternative outcomes, and by developing coping plans for worst-case scenarios. Finally, therapists and clients are faced with the actual exposure and confronting of the anxiety and fear. First, it is essential to develop a hierarchy of feared situations for graded exposure. Here, therapists and clients work together to identify rationale for the hierarchy, identify feared situations, rate the degree of expected anxiety for each situation, identify unhelpful coping strategies, and develop the hierarchy for exposure. Imaginal exposure involves clients imagining themselves in a distressing situation and how they may deal with it. Finally, in vivo exposure is when clients directly experience the distressing situation inside or outside of the office. This is the most effective way to practice the techniques described above and use them in order to decrease both cognitive and physiological distress. A caution that should be considered is implementing behavioral exposure too early or pushing clients too far. Therapists should work on their clients lowest rated feared situations and work up to higher-rated feared situations. it may be challenging for clients to identify anxious patterns or they may be hesitant to procedure with the exposure, so taking time while still being encouraging and reassuring is a balance that needs to be created by therapists. In addition, if clients are experiencing difficulties implementing relaxation techniques, that may be assign that exposure may be too much at that point in time. In sum, clients need to be fully aware and educated on what exposure entails and be capable of implementing strategies practiced in session.

    Reply

    • Jayson Hidalgo
      Nov 02, 2018 @ 21:51:10

      I liked how you mentioned the caution when conducting exposure interventions too early or too far. As said in the book, the therapist will create a list of the lowest rated fear situations to the highest fear situation in which the therapist needs to begin at a low rate to introduce the client what exposure is like so the client can be more mentally aware about how the procedure is done and it helps the client become prepare to tackle on the more intense rated feared situations later.

      Reply

  9. Marissa Martufi
    Nov 01, 2018 @ 12:48:14

    After watching this session with Mark, I sort of felt a bit of excitement for the progress that has been made and that we have followed throughout these therapy sessions/videos. This behavioral experiment was helpful in providing “evidence” for Mark’s new core belief because it allowed for him to reflect on his previous negative ore belief, and talk about how he felt that he was unlikeable. I enjoyed hearing him talk about this behavioral experiment, which involved him asking a co-worker and his co-worker’s spouse to go on a double date with him and Melissa. The evidence, or outcome from this ‘experiment’ or asking his co-worker to go out, resulted in his co-worker saying yes and the couples having a great night out. Mark reflected on this experiment and independently noted several reasons why he is likeable, or why his previous core belief is no longer valid. After hearing Mark describe his fun night out with friends, which included him and Melissa being on time and having no stress regarding getting to the place; Mark also indicated that there was even mention of them all doing this again in the future, proving that his co-workers do enjoy spending time with him and like him. It was nice to hear Mark list off all the positive aspects of his night out and how good he felt as a result of it. This provides evidence of the progress that Mark has made and shows the confidence beginning to show through Mark’s behaviors and thoughts. It was helpful to see how this behavioral experiment could be useful in allowing clients to gather evidence for their new core belief. In Mark’s case, another behavioral experiment that could be implemented is Mark asking out another co-worker to go get lunch, or even drinks or dinner after work, without Melissa or his co-worker’s spouse. Eventually Mark could further this experiment and maybe even invite several co-workers to grab dinner or lunch. This could also be beneficial for Mark, especially if some co-workers are unable to attend due to personal circumstances such as a prior commitment or illness, etc. Mark would then need to implement his coping mechanisms to manage this sort of, potential change in plans, without internalizing it as being unlikeable.
    Behavioral exposure is very effective for certain disorders/types of distress because it allows for individuals to cope with distress or stressors, and also feel that they can face these stressors. Dr. V mentions in chapter 9, the avoidance component or avoidant behavior that many individuals have with regard to facing stressors or situations that cause distress. Individuals avoid these things, in order to avoid the anxiety or distress that it induces. Exposure therapy works to allow the individual to not only face what they are avoiding, but also relieve the anxiety or distressful emotions that the individual may have experienced. Overall, exposure therapy works to break the individual’s pattern of avoidant behaviors, and instead introduce coping mechanisms that allow the individual to no longer avoid these exposures in the future. It is important to consider that exposure can be difficult for some clients. Therefore, exposure therapy is typically done with caution, considering that some clients may be extremely fearful or anxious to begin exposure. It is also important to consider the client’s readiness to begin exposure. If a client is not ready to begin behavioral exposure, this can result in more negative outcomes, as opposed to positive.

    Reply

  10. Nicole Plona
    Nov 01, 2018 @ 16:00:07

    1) This behavioral experiment was helpful for Mark in providing “evidence” for his new core belief by allowing him to view the steps it takes to complete and work towards a goal. Once completing the goal that was set during this experiment, the completion itself becomes evidence towards his new core belief. I think this is a great process for someone like Mark to go through because I feel as though without physical proof written out in front of his all of the negative factors are the only. By asking his coworker out to dinner, it allows him to open himself up to a positive experience without getting it stuck in his head that he’s unlikable and that it is not worth asking. It was even better that the dinner went well which in return provided even more evidence towards his new core belief. In regards to another potential behavioral experiment that could benefit Mark and his new core belief would be to invite some of his coworkers or some other friends for a game night. This would allow Mark to branch out as far as types of outing he goes to with peers other than just dinner but would also show that he is a likable guy to hang out with.

    2) Behavioral exposure is very effective for specific types of distress and disorders because it focuses in on dealing with the anxiety behind the situations. This type of task takes the situation or object that causes an individual to become stressed or anxious and exposes the individual to it in a way that will benefit them. This process allows the individual to understand what exactly in the event or situation sets them off or triggers them and then that gives them something to focus on when they are trying to make changes to the way they react. With this new understanding they will be able to control their behaviors and reactions when a trigger is present. Some cautions to consider when implementing behavioral exposure interventions would be that this type of intervention can cause the individual a lot of stress to start off with and it is important that they know some type of calming technique. If a client doesn’t know how to calm themselves down in stressful situations appropriately then I would never want to proceed with that type of treatment. There also needs to be a solid level of trust established between the counselor and client because that is most likely the only way a counselor would know that their client is actually ready to proceed with this type of intervention.

    Reply

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Adam M. Volungis, PhD, LMHC

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