Exposure hierarchy
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In cognitive-behavioral therapy, specifically in exposure therapy , an exposure hierarchy is a graded list of stimuli that will generate an escalating level of arousal, for the purpose of producing habituation.
Creating an exposure hierarchy is one of the first steps taken for treating anxiety disorders and phobias, in exposure therapy. The hierarchy may be created in advance of a session of exposure (a static hierarchy) or may arise extempore during the session in response to developments (a dynamic hierarchy). It is not yet known which, if either, of these methods produces the better outcome. Either way, the client and clinician collaborate to create an individualized list according to the situation or stimuli that causes the most fear and avoidance to situation/stimuli that causes the least.[1]
Exposure hierarchies can list various situations or stimuli that causes anxiety or can be narrowed to a specific anxiety disorder. For example, an exposure hierarchy that involves a particular anxiety disorder, like social anxiety disorder, can include situations such as: asking a stranger for directions, ordering food in a restaurant, and so on. This instrument is useful for both the clinician and client because it highlights the areas that need the most attention; mainly because they are unique to the client. Clinicians can also refer back to this list to record the process made during and after treatment.[2] Additionally, exposure hierarchies can be rated by using the Subjective Units of Distress Scale.
Further reading
- Marks I (1981) Cure and Care of Neuroses: Theory and Practice of Behavioural Psychotherapy John Wiley & Sons Inc ISBN 978-0-471-08808-0
- Hawton K, Salkovskis PM, Kirk J, Clark DM (1989) Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide Oxford Medical Publications ISBN 978-0-19-261587-9
- Richard DCS, Lauterbach D (2006) Handbook of Exposure Therapies Academic Press ISBN 978-0-12-587421-2
- * An example of an exposure hierarchy list provided by the University of Exeter.
References
- ^ Read, K., Puleo, C.M., Wei, C., Cummings, C.M., & Kendall, P.C. Cognitive–behavioral treatment for pediatric anxiety disorders. In Vasa, R.A & Roy, A.K. (Ed.), Pediatric Anxiety Disorders. New York: Springer; 2013: 269-287
- ^ Katerelos, M., Hawley, L.L., Antony, M.M., & McCabe, R.E. (2008). "The exposure hierarchy as a measure of progress and efficacy in the treatment of social anxiety disorder". Behavior Modification. 32 (4): 504–518.
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