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Dynamic hierarchies: a control system paradigm for exposure therapy

Published online by Cambridge University Press:  01 March 2009

Alec Brady  and
David Raines
Alec Brady*
Affiliation:
Department of Psychology, University of Chester, Chester, UK
David Raines
Affiliation:
Department of Psychology, University of Chester, Chester, UK
*
*Author for correspondence: Mr A. Brady, Whittington CBT, 25 Hunshelf Park, Stocksbridge, Sheffield S36 2BT, S. Yorkshire, UK. (email: [email protected])
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Abstract

Exposure therapy is a widely used and well-evidenced treatment for a variety of avoidance behaviours. This paper offers a modest proposal for an improvement in how it is carried out (‘dynamic hierarchies’). The theoretical and practical context is set out, including some thoughts on the role of appraisals and cognitive dissonance, and some advantages of the method are suggested.

Keywords

Acceptancebehavioural therapybelief modificationcognitive appraisalstherapy
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 2 , Issue 1 , March 2009 , pp. 51 - 62
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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References

Recommended follow-up reading

Festinger, L (1957). A Theory of Cognitive Dissonance. Evanston, IL: Row Peterson.CrossRefGoogle Scholar
Marks, IM (1981). Cure and Care of Neuroses: Theory and Practice of Behavioral Psychotherapy. New York: John Wiley & Sons.Google Scholar
Powers, WT (1973). Behavior: The Control of Perception. Edison, NJ: Aldine Transaction.Google Scholar
Becker, CB, Zayfert, C, Anderson, E (2004). A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD Behaviour Research and Therapy 42, 277–292.Google Scholar
Coldwell, SE, Getz, T, Milgrom, P, Prall, CW, Spadafora, A, Ramsay, DS (1998). CARL: a LabVIEW 3 computer program for conducting exposure therapy for the treatment of dental injection fear. Behaviour Research and Therapy 36, 429–441.Google Scholar
Cole, F, Macdonald, H, Carus, C, Howden-Leach, H (2005). Overcoming Chronic Pain: A Self-Help Guide Using Cognitive Behavioral Techniques. London: Robinson.Google Scholar
Craske, MG, Barlow, DH (2007). Mastery of Your Anxiety and Panic: Workbook for Primary Care Settings. New York: Oxford University Press.Google Scholar
Eberle, TM, Rehm, LP, McBurney, DH (1975). Fear decrement to anxiety hierarchy items – effects of stimulus intensity. Behaviour Research and Therapy 13, 255–261.Google Scholar
Ellis, A (1962). Reason and Emotion in Psychotherapy. New York: Lyle Stuart.Google Scholar
Feeny, NC, Hembree, EA, Zoellner, LA (2003). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice 10, 85–90.Google Scholar
Festinger, L (1957). A Theory of Cognitive Dissonance. Evanston, IL: Row Peterson.Google Scholar
Festinger, L, Carlsmith, JM (1959). Cognitive consequences of forced compliance. Journal of Abnormal and Social Psychology 58, 203–210.Google Scholar
Galovski, TE, Resick, PA (2008). Cognitive processing therapy for posttraumatic stress disorder secondary to a motor vehicle accident: a single-subject report. Cognitive and Behavioral Practice. Published online: 21 July 2008. doi:10.1016/j.cbpra.2007.11.005.CrossRefGoogle Scholar
Hayes, SC, Wilson, KG, Gifford, EV, Follette, VM, Strosahl, K (1996). Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology 64, 1152–1168.CrossRefGoogle ScholarPubMed
Hare, RM (1969). Descriptivism. In: The Is-Ought Question: A Collection of Papers on the Central Problem in Moral Philosophy (ed. Hudson, W. D.), pp. 240–259. London: Macmillan.Google Scholar
Hawton, K, Salkovskis, PM, Kirk, J, Clark, DM (1989). Cognitive Behaviour Therapy for Psychiatric Problems. Oxford: Oxford University Press.Google Scholar
Hebb, DO (1949). The Organization of Behavior: A Neuropsychological Theory. New York: Wiley. (Reprinted by Lawrence Erlbaum Associates, 2002.).Google Scholar
Kendall, PC, Robin, JA, Hedtke, KA, Suveg, C, Flannery-Schroeder, E, Gosch, E (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice 12, 136–148.Google Scholar
Lang, P (1968). Fear reduction and fear behavior: problems in treating a construct. In: Research in Psychotherapy, vol. 3 (ed.Shlien, J.), pp. 90–103. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Lazarus, RS, Smith, CA (1988). Knowledge and appraisal in the cognition–emotion relationship. Cognition & Emotion 2, 281–300.Google Scholar
Marken, RS (1997). The dancer and the dance: methods in the study of living control systems. Psychological Methods 2, 436–446.CrossRefGoogle Scholar
Marken, RS (1999). PERCOLATe: perceptual control analysis of tasks International Journal of Human-Computer Studies 50, 481–487.Google Scholar
Marks, IM (1981). Cure and Care of Neuroses: Theory and Practice of Behavioral Psychotherapy. New York: John Wiley & Sons.Google Scholar
McGlynn, FD (1971). Individual versus standardized hierarchies in the systematic desensitization of snake-avoidance, Behaviour Research and Therapy 9, 1–5.Google Scholar
Milosevic, I, Radomsky, AS (2008). Safety behaviour does not necessarily interfere with exposure therapy. Behaviour Research and Therapy. Published online: 27 June 2008. doi:10.1016/j.brat.2008.05.011.CrossRefGoogle Scholar
Parkinson, B (1997). Untangling the appraisal-emotion connection. Personality and Social Psychology Review 1, 62.Google Scholar
Rachman, S, Lopatka, C (1988). Return of fear: underlearning and overlearning. Behaviour Research and Therapy 26, 99–104.Google Scholar
Rachman, S, Robinson, S, Lopatka, C (1987). Is incomplete fear-reduction followed by a return of fear? Behaviour Research and Therapy 25, 67–69.CrossRefGoogle ScholarPubMed
Richard, D, Lauterbach, D (eds) (2006). Handbook of Exposure Therapies. New York: Academic Press.Google Scholar
Rosenblatt, F (1958). The Perceptron: a probabilistic model for information storage and organization in the brain, Cornell Aeronautical Laboratory. Psychological Review 65, 386–408.CrossRefGoogle Scholar
Saxby, PJ (1973). Phobic responses and cognitive dissonance arousal. Behavior Therapy 4, 230–234.Google Scholar
Tryon, WW, Misurell, JR (2008). Dissonance induction and reduction: a possible principle and connectionist mechanism for why therapies are effective. Clinical Psychology Review 28, 1297–1309.Google Scholar
Vodde, TW, Gilner, FH (1971). The effects of exposure to fear stimuli on fear reduction. Behaviour Research and Therapy 9, 169–175.Google Scholar
Watson, JP, Gaind, R, Marks, IM (1972). Physiological Habituation To Continuous Phobic Stimulation Behaviour Research and Therapy 10, 269–278.Google Scholar
Williams, JMG, Watson, FN, MacLeod, C, Mathews, A (1997). Cognitive Psychology and Emotional Disorders, 2nd edn. Chichester: Wiley.Google Scholar
Wolpe, J, Rachman, S (1960). Psychoanalytic ‘evidence’: a critique based on Freud's case of Little Hans. Journal of Nervous and Mental Disease 131, 135–148.Google Scholar
Zimbardo, PG (1969). Cognitive Control of Motivation: the Consequences of Choice and Dissonance. Glenview: Scott, Foreman and Co.Google Scholar
Zlomke, K, Davis, TE (2008). One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behavior Therapy. Published online: 4 February 2008. doi:10.1016/j.beth.2007.07.003.Google Scholar
Becker, CB, Zayfert, C, Anderson, E (2004). A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD Behaviour Research and Therapy 42, 277–292.Google Scholar
Coldwell, SE, Getz, T, Milgrom, P, Prall, CW, Spadafora, A, Ramsay, DS (1998). CARL: a LabVIEW 3 computer program for conducting exposure therapy for the treatment of dental injection fear. Behaviour Research and Therapy 36, 429–441.Google Scholar
Cole, F, Macdonald, H, Carus, C, Howden-Leach, H (2005). Overcoming Chronic Pain: A Self-Help Guide Using Cognitive Behavioral Techniques. London: Robinson.Google Scholar
Craske, MG, Barlow, DH (2007). Mastery of Your Anxiety and Panic: Workbook for Primary Care Settings. New York: Oxford University Press.Google Scholar
Eberle, TM, Rehm, LP, McBurney, DH (1975). Fear decrement to anxiety hierarchy items – effects of stimulus intensity. Behaviour Research and Therapy 13, 255–261.Google Scholar
Ellis, A (1962). Reason and Emotion in Psychotherapy. New York: Lyle Stuart.Google Scholar
Feeny, NC, Hembree, EA, Zoellner, LA (2003). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice 10, 85–90.Google Scholar
Festinger, L (1957). A Theory of Cognitive Dissonance. Evanston, IL: Row Peterson.Google Scholar
Festinger, L, Carlsmith, JM (1959). Cognitive consequences of forced compliance. Journal of Abnormal and Social Psychology 58, 203–210.Google Scholar
Galovski, TE, Resick, PA (2008). Cognitive processing therapy for posttraumatic stress disorder secondary to a motor vehicle accident: a single-subject report. Cognitive and Behavioral Practice. Published online: 21 July 2008. doi:10.1016/j.cbpra.2007.11.005.CrossRefGoogle Scholar
Hayes, SC, Wilson, KG, Gifford, EV, Follette, VM, Strosahl, K (1996). Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology 64, 1152–1168.CrossRefGoogle ScholarPubMed
Hare, RM (1969). Descriptivism. In: The Is-Ought Question: A Collection of Papers on the Central Problem in Moral Philosophy (ed. Hudson, W. D.), pp. 240–259. London: Macmillan.Google Scholar
Hawton, K, Salkovskis, PM, Kirk, J, Clark, DM (1989). Cognitive Behaviour Therapy for Psychiatric Problems. Oxford: Oxford University Press.Google Scholar
Hebb, DO (1949). The Organization of Behavior: A Neuropsychological Theory. New York: Wiley. (Reprinted by Lawrence Erlbaum Associates, 2002.).Google Scholar
Kendall, PC, Robin, JA, Hedtke, KA, Suveg, C, Flannery-Schroeder, E, Gosch, E (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice 12, 136–148.Google Scholar
Lang, P (1968). Fear reduction and fear behavior: problems in treating a construct. In: Research in Psychotherapy, vol. 3 (ed.Shlien, J.), pp. 90–103. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Lazarus, RS, Smith, CA (1988). Knowledge and appraisal in the cognition–emotion relationship. Cognition & Emotion 2, 281–300.Google Scholar
Marken, RS (1997). The dancer and the dance: methods in the study of living control systems. Psychological Methods 2, 436–446.CrossRefGoogle Scholar
Marken, RS (1999). PERCOLATe: perceptual control analysis of tasks International Journal of Human-Computer Studies 50, 481–487.Google Scholar
Marks, IM (1981). Cure and Care of Neuroses: Theory and Practice of Behavioral Psychotherapy. New York: John Wiley & Sons.Google Scholar
McGlynn, FD (1971). Individual versus standardized hierarchies in the systematic desensitization of snake-avoidance, Behaviour Research and Therapy 9, 1–5.Google Scholar
Milosevic, I, Radomsky, AS (2008). Safety behaviour does not necessarily interfere with exposure therapy. Behaviour Research and Therapy. Published online: 27 June 2008. doi:10.1016/j.brat.2008.05.011.CrossRefGoogle Scholar
Parkinson, B (1997). Untangling the appraisal-emotion connection. Personality and Social Psychology Review 1, 62.Google Scholar
Rachman, S, Lopatka, C (1988). Return of fear: underlearning and overlearning. Behaviour Research and Therapy 26, 99–104.Google Scholar
Rachman, S, Robinson, S, Lopatka, C (1987). Is incomplete fear-reduction followed by a return of fear? Behaviour Research and Therapy 25, 67–69.CrossRefGoogle ScholarPubMed
Richard, D, Lauterbach, D (eds) (2006). Handbook of Exposure Therapies. New York: Academic Press.Google Scholar
Rosenblatt, F (1958). The Perceptron: a probabilistic model for information storage and organization in the brain, Cornell Aeronautical Laboratory. Psychological Review 65, 386–408.CrossRefGoogle Scholar
Saxby, PJ (1973). Phobic responses and cognitive dissonance arousal. Behavior Therapy 4, 230–234.Google Scholar
Tryon, WW, Misurell, JR (2008). Dissonance induction and reduction: a possible principle and connectionist mechanism for why therapies are effective. Clinical Psychology Review 28, 1297–1309.Google Scholar
Vodde, TW, Gilner, FH (1971). The effects of exposure to fear stimuli on fear reduction. Behaviour Research and Therapy 9, 169–175.Google Scholar
Watson, JP, Gaind, R, Marks, IM (1972). Physiological Habituation To Continuous Phobic Stimulation Behaviour Research and Therapy 10, 269–278.Google Scholar
Williams, JMG, Watson, FN, MacLeod, C, Mathews, A (1997). Cognitive Psychology and Emotional Disorders, 2nd edn. Chichester: Wiley.Google Scholar
Wolpe, J, Rachman, S (1960). Psychoanalytic ‘evidence’: a critique based on Freud's case of Little Hans. Journal of Nervous and Mental Disease 131, 135–148.Google Scholar
Zimbardo, PG (1969). Cognitive Control of Motivation: the Consequences of Choice and Dissonance. Glenview: Scott, Foreman and Co.Google Scholar
Zlomke, K, Davis, TE (2008). One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behavior Therapy. Published online: 4 February 2008. doi:10.1016/j.beth.2007.07.003.Google Scholar
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