Personalized Exposure Therapy: A Person-Centered Transdiagnostic Approach [Pehme köide]

(Professor of Psychology and Psychiatry, University of Texas, Austin), (Professor of Psychology, Boston University), (Research Associate Professor, University of Texas, Austin)
  • Formaat: Paperback / softback, 240 pages, kõrgus x laius x paksus: 234x157x15 mm, kaal: 368 g
  • Ilmumisaeg: 03-Oct-2019
  • Kirjastus: Oxford University Press Inc
  • ISBN-10: 0190602457
  • ISBN-13: 9780190602451
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  • Formaat: Paperback / softback, 240 pages, kõrgus x laius x paksus: 234x157x15 mm, kaal: 368 g
  • Ilmumisaeg: 03-Oct-2019
  • Kirjastus: Oxford University Press Inc
  • ISBN-10: 0190602457
  • ISBN-13: 9780190602451
Teised raamatud teemal:
Evidence overwhelmingly shows that exposure therapy is effective for the treatment of anxiety and related disorders. Its adoption into clinical practice has been slow, however-in part because the available one-size-fits-all manuals often leave patients and clinicians unsatisfied.

Personalized Exposure Therapy provides expert guidance to clinicians on conducting exposure-based interventions in a targeted and flexible fashion. Providing detailed information on a range of strategies for maximizing clinical outcomes from exposure, this book features a case formulation approach that personalizes the timing and nature of exposure practice. Case examples, scripts, and worksheets, presented in a practical, mentor-based format for planning and enacting individual sessions, ensure that clinical procedures are readily accessible for in-session use. Personalized Exposure Therapy is appropriate for early-career and experienced clinicians alike, and will also be suitable for use in graduate courses in clinical psychology, counselling, social work, nursing and psychiatry.

Arvustused

This book describes cutting-edge advances in cognitive science and integrates them with what is known from intensive clinical study to help clinicians design and provide the kind of treatment patients with anxiety disorders most need. At every step, the conceptual understanding is grounded in the examples, scripts, and handouts that make this book 'session ready' for clinicians and their patients. Unlike some manuals, this book is not a session-by-session treatment manual. Instead, it provides a comprehensive perspective on the principles and procedures behind exposure interventions. * Edna B. Foa, PhD, Professor in Psychiatry and Director of the Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman School of Medicine * Personalized Exposure Therapy belongs in the hands of every clinician who wants to treat fear-based disorders successfully. In clear language, Smits, Powers, and Otto bring the principles of exposure therapy to life, with compelling case examples and a clearly articulated rationale. Clinicians of all levels will find a wealth of useful, practical information in this book. * David F. Tolin, PhD, Director, Anxiety Disorders Center, The Institute of Living, and author of Doing CBT: A Comprehensive Guide to Working with Behaviors, Thoughts, and Emotions * [ This book] shares the secrets that every successful exposure therapist knows. The authors, rock stars of exposure therapy, explain the principles clearly, offer explicit guidelines to put them into action, and present clinical examples to bring these principles to life. This volume covers everything from assessment through treatment to termination, including suggestions of assessment instruments. It is very engaging, practical, and well written and details real life situations such as when medications are involved in exposure therapy. Every clinician who treats a patient with anxiety should read this cover to cover, and it will help them provide better treatment for the rest of their therapeutic lives. * Barbara O. Rothbaum, PhD, ABPP, Professor in Psychiatry, Director, Veterans Program and Trauma and Anxiety Recovery Program, Paul A. Janssen Chair in Neuropsychopharmacology, Associate Vice Chair of Clinical Research, Emory University School of Medicine *

List of Figures
xi
List of Tables
xiii
List of Boxes
xv
1 Introduction
1(10)
1.1 What Is Exposure Therapy?
1(4)
1.2 The Art of "Playing" with Fear
5(2)
1.3 Personalized Exposure Therapy
7(2)
1.4 How to Use This Book
9(2)
2 Thinking Through Exposure
11(20)
2.1 Fear as a Set of Memories
11(8)
2.1.1 The Structure of Memories: An Example
12(6)
2.1.2 Context and Expectancy
18(1)
2.2 The Structure of Fear Memories and Its Implications for Exposure Therapy
19(8)
2.2.1 The Degree of Match to Fear Cues
19(1)
2.2.2 Contexts
20(2)
2.2.3 Evaluation of Outcome
22(4)
2.2.4 Helping Patients Attend to What Was Learned
26(1)
2.3 Learning to Learn
27(2)
2.4 Summary
29(2)
3 General Approach
31(39)
3.1 Principal Assumptions
31(2)
3.2 Planning for Exposure Therapy
33(12)
3.2.1 Phone Call
33(4)
3.2.2 Questionnaire Battery
37(1)
3.2.3 Intake Interview
38(2)
3.2.4 Initial Case Formulation
40(3)
3.2.5 Self-Monitoring
43(2)
3.3 Delivery of Exposure Therapy
45(17)
3.3.1 Socialization to the Exposure Therapy Model
45(6)
3.3.2 Developing the Exposure Exercise
51(3)
3.3.3 Deviating from the Default
54(3)
3.3.4 Systematic, Deliberate, Prolonged, and Repeated
57(3)
3.3.5 Facilitating Learning during Exposure Practice: In-Exercise Strategies
60(2)
3.4 Processing of Exposure Therapy
62(4)
3.4.1 End-of-Session Processing
63(1)
3.4.2 Assigning Homework
64(2)
3.5 Treatment Progression
66(3)
3.6 Conclusions
69(1)
4 Assessing Success
70(14)
4.1 Overview
70(2)
4.2 Approach
72(11)
4.2.1 Early Sessions
73(2)
4.2.2 During Exposure Practice
75(5)
4.2.3 Immediately after Exposure Practice
80(1)
4.2.4 At the Beginning of the Session
81(1)
4.2.5 Termination
82(1)
4.3 Conclusions
83(1)
5 Fear of Emotions and Related Physical Sensations
84(37)
5.1 Overview
84(2)
5.2 Interoceptive Exposure
86(1)
5.2.1 Phobic Conditions: Fearing the Cue or Fearing the Cued Fear?
86(1)
5.3 The Case of Anna
87(3)
5.3.1 Explaining Anna's Presenting Problems
88(2)
5.4 Assessing the Severity and Profile of Interoceptive Fears
90(1)
5.5 Interoceptive Exposure Practice
91(18)
5.5.1 Generic Approach
91(3)
5.5.2 Personalized Approach
94(5)
5.5.3 What Is the Patient to Do during Exposure?
99(1)
5.5.4 Thinking about Interoceptive Exposure Broadly
99(2)
5.5.5 Progression
101(2)
5.5.6 Attending to Context
103(5)
5.5.7 Attending to Safety Behaviors
108(1)
5.6 Use of Naturalistic Symptom Evocation and Extending Treatment Gains
109(3)
5.7 Targeting Fears of Emotions and Related Bodily Sensations across the Disorders
112(3)
5.8 Considering the Prototypical Session and Intervention
115(2)
5.9 Troubleshooting Some Nonresponse Traps
117(2)
5.10 Conclusions
119(2)
6 Fear of People
121(28)
6.1 The Case of Sydney
121(4)
6.1.1 Making Sense of Why Sydney Feels the Way She Feels
122(3)
6.2 Intervention Targets
125(4)
6.2.1 Consider Intervening on the Likelihood Bias First
127(2)
6.3 Exposure Practice
129(15)
6.3.1 Basic Conditions
129(2)
6.3.2 Personalizing Practice
131(1)
6.3.3 The Parameters
132(7)
6.3.4 Progression
139(5)
6.4 When to Do What
144(3)
6.4.1 Prototypical Session
145(1)
6.4.2 Prototypical Intervention
146(1)
6.5 Troubleshooting
147(1)
6.6 Conclusions
147(2)
7 Fear of Thoughts, Images, and Trauma Memories
149(38)
7.1 Overview
149(4)
7.1.1 Factors That Enhance the Fears of One's Own Cognitive Content
151(2)
7.2 The Role of Imaginal Exposure in Treating Fears of Cognitive Content
153(9)
7.2.1 Planning for Imaginal Exposure
154(1)
7.2.2 Developing a Script for Imaginal Exposure
155(2)
7.2.3 Delivering Imaginal Exposure
157(1)
7.2.4 Progressing with Imaginal Exposure
158(1)
7.2.5 Complementing Imaginal Exposure with Interoceptive and In Vivo Exposure
159(1)
7.2.6 Prototypical Session and Intervention
160(2)
7.3 Transdiagnostic Considerations
162(1)
7.4 Treating Fears of Thoughts in GAD
163(6)
7.4.1 Targets for Intervention
165(1)
7.4.2 Developing an Intervention Plan
165(1)
7.4.3 Education about Worry as a Coping Strategy
166(1)
7.4.4 Cost-Benefit Analysis of New Behaviors Alternative Strategies
167(1)
7.4.5 Common Pitfalls When Targeting Fears of Thoughts
168(1)
7.5 Treating Fears of Images in OCD
169(6)
7.5.1 Education about the Nature of Obsessions and Compulsions
171(1)
7.5.2 Enhancing Cognitive Flexibility
172(2)
7.5.3 Common Pitfalls When Targeting Fears of Images
174(1)
7.6 Treating Fears of Memories in PTSD
175(11)
7.6.1 Recovering from Trauma
177(1)
7.6.2 Education about the Nature and Treatment of PTSD
177(1)
7.6.3 Imaginal Exposure to the Trauma Memory
178(3)
7.6.4 Processing Is Focused on the Meaning of the Trauma and Trauma Reactions
181(1)
7.6.5 In Vivo Exposure to Trauma Cues and Avoided Situations
182(1)
7.6.6 Subsequent Sessions
183(1)
7.6.7 Pitfalls When Targeting the Fears of Trauma Memories
184(2)
7.7 Conclusions
186(1)
8 Combining Exposure Therapy with Medications
187(14)
8.1 Overview
187(1)
8.2 Treating Patients Already Taking Medication
187(4)
8.3 The Simultaneous Initiation of Combination Treatment
191(1)
8.4 Referrals for Help with Medication Discontinuation
192(4)
8.5 The Case of Steve
196(3)
8.6 A Return to Considering Resilience
199(2)
9 Assessment Strategies
201(8)
9.1 Overview
201(1)
9.2 Fear of Emotions and Related Physical Sensations
201(2)
9.2.1 Intervention Targets
201(2)
9.2.2 Outcomes
203(1)
9.3 Fear of People
203(2)
9.3.1 Intervention Targets
203(1)
9.3.2 Outcomes
204(1)
9.4 Fear of Thoughts, Images, and Trauma Memories
205(4)
9.4.1 Intervention Targets
205(2)
9.4.2 Outcomes
207(2)
10 Psychoeducation about Anxiety, Fear, and the Role of Exposure
209(10)
10.1 Overview
209(1)
10.2 The Alarm System: Worry, Anxiety, and Panic
209(1)
10.3 Definitions: Stress, Worry, Anxiety, and Fear/Panic
209(3)
10.4 True versus False Alarms
212(1)
10.5 Anxiety versus Anxiety Disorder
213(1)
10.6 Understanding Your Anxiety
213(3)
10.7 More on Exposure Therapy
216(2)
10.8 Conclusions
218(1)
11 Bibliography
219(4)
11.1 Overview
219(1)
11.2 Key References
219(2)
11.3 References for
Chapter 9
221(2)
About the Authors 223(2)
Index 225
Dr. Jasper A. J. Smits is Professor of Psychology and Psychiatry at the University of Texas at Austin, where he directs a research lab and clinic that focus on the treatment of anxiety and related disorders. Among his core interests are developing strategies that enhance exposure therapy outcomes and the training of clinicians in the delivery of this empirically-supported intervention. Dr. Smits is a federally-funded investigator who has published over 200 articles, chapters, and books spanning his interests. He also is a member of the Scientific Council of the Anxiety and Depression Association of America, consults to industry, and provides regular workshops on the treatment of anxiety and related disorders at national and international meetings. Dr. Mark B. Powers is Director of Trauma Research at Baylor Scott & White, conducting federally funded projects at two Level 1 Trauma Centers including Baylor University Medical Center in Dallas and Scott & White Medical Center in Temple. He collaborates with local police as a member of the Critical Incident Stress Management and Crisis/Hostage Negotiation teams. Dr. Powers is certified in prolonged exposure therapy for PTSD and Exposure with Ritual Prevention for OCD after training at the Center for the Treatment and Study of Anxiety with Dr. Edna Foa. He also served as a Beck Scholar at the Beck Institute for Cognitive Therapy and Research. He has published over 150 articles, books, and book chapters, and is Editor-in-Chief of the journal Cognitive Behaviour Therapy. Dr. Michael W. Otto is Professor of Psychological and Brain Sciences and Senior Fellow at the Institute for Health System Innovation and Policy at Boston University. Dr. Otto has had a major career focus on developing and validating new psychosocial treatments for anxiety and mood disorders. His attention to principles underlying behavior-change successes includes research on addictive behaviors, medication adherence, sleep, and exercise. Across these areas of interest, Dr. Otto has published over 400 articles and 20 books. He has served as President of the Association for Behavioral and Cognitive Therapies and President of Division 12 of the American Psychological Association, and received the Division 12 award for Distinguished Scientific Contributions to Clinical Psychology.

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