principles of conducting exposure-based therapy

Implementing exposure

Marks summarized the key principles of conducting exposure-based therapy as: live exposure is preferable to ‘fantasy exposure’, although the latter could be used ‘when the real stimuli evoking fear are not readily accessible for live exposure’.

Self-exposure (or self-directed exposure) is, generally, of equivalent value to therapist-aided exposure; longer exposure periods reduce fear more than shorter ones – 50-minute sessions are recommended; practice between treatment sessions should occur; in OCD completing the ritual was not a problem as long as the ritual did not terminate the exposure session; response prevention was better if self-imposed; rapid exposure (flooding) can yield better gains than graded exposure although it is important to go at the pace of the client; response-induction aids such as grading and varying the tasks, attending to all fear cues, modelling when necessary may be of value; modelling is of use to demonstrate tasks but is not necessary for all; praise for progress motivates the patient.

Clients are asked to maintain a diary of their anxiety rating before, during (at its worst) and after (just as the exposure is finishing) on a weekly basis. These serve to give both the client and therapist objective self-ratings of anxiety over time without having to rely on memory. Given these principles it is necessary to determine how they may be applied in practice.