She has done a lot of research on mechanisms of fear reduction
Fear will return over time. The fear is not eradicated after exposure, but there is a competing memory based on the safety that has been learnt during the exposure.
If a distressing unexpected trigger occurs later then the fear will occur.
Anxious people are not good at inhibiting fear i.e. in the amygdala.
Extinction learning unlike original fear learning, is context specific, so can easily return in adifferent context.
Duration of exposure is not so important.
Need to violate expectancies e.g. ask the patient what they need to do for the bad thing to happen, then do exposure.
Add extra triggers during exposure. E.g. add interceptive to driving exposure, add in social rejections to social exposure.
Cognitive restructuring is not good before exposure as it is shifting expectancy: should be done afterwards.
Variability is good e.g. triggering object and duration:different spiders, different height situations. this is a slight effect.
Good to enhance tolerance of fear.
Throw in many contexts in exposure: familiar/unfamiliar, accompanied/not, on or off medication.
New rules of exposure:
Mixed in level of difficulty not graded (if possible), does not have to be prolonged, add in extra stimuli, repeated exposure especially to a variety of triggers, ensure focused attention to stimuli, cognitive restructuring after exposure.Can try to enhance positive mood towards stimuli. Use affect labeling ‘I’m feeling anxious…’
BE do not focus on duration and they do focus on violating experiments, so this is good. BE needs to be better at facing a more variable range of exposures. BE need to ensure patient is focused on stimuli. Do CT afterwards not before. Can try to enhance positive mood towards stimuli. Use affect labeling ‘I’m feeling anxious…’