Cue exposure

Distress-tolerance skills always accompany cue exposure. True or False ... 

There are different ways to use exposure with clients. The first method, called in vivo exposure, means that you expose the client under real-life conditions. In vivo exposure allows clients to practice for experiences they will likely face regularly in the real world under the controlled conditions of therapy. Let me present an example of how in vivo exposure would work with a client. Suppose your client has chronic pain and a history of abusing prescription pain-controlling medicines. Chronic pain in this instance represents a cue for drug use. You would most certainly want your client to learn how to confront his or her chronic pain directly without resorting to use of the pain medicines. In vivo cue exposure to pain in session would encourage the client to face his or her pain in real life without responding in the old way. 

An important exception is that you do not want to teach your client to use distraction skills when engaging in cue-exposure experiences. As mentioned earlier, exposure requires experiencing some discomfort in order for the client to become desensitized to the drug-related cues. Since some distress-tolerance skills may involve distraction, they should not be used during cue exposure or used by clients to avoid exposure exercises. 

In addition, stimulus-control and cue-exposure techniques (see Chapter 5) can be used effectively as relapse prevention strategies. Stimulus control means that the client learns how to control her or his level of exposure, and under what conditions, to a particular cue that had been associated with drug use. Cue exposure, as you may remember, uses exposure and response-prevention strategies in session to reduce the power of a drug-use cue to trigger cravings or urges to use. 

When in doubt, though, use cue exposure whenever possible to reduce the power of a cue. 

Colado MI, O Shea E Green AR (2004). Acute and long-term effects of MDMA on cerebral dopamine biochemistry and function. Psychopharmacology, 173, 249-63 Cole JC Sumnall HR ( 2003). Altered states The clinical effects of ecstasy. Pharmacology and Therapeutics, 98, 35-58 Conklin CA Tiffany ST (2002). Applying extinction research and theory to cue-exposure addiction treatments. Addiction, 97, 155-67... 

Rankin, H. (1982) Cue exposure in South London , in N.Hay and P. Nathan (eds) Clinical Cases in the Behaviour Treatment of Alcoholism, New York Plenum Press. 

Integrating Systematic Cue Exposure with Standard Treatment in Recovering Drug-Dependent Patients." Addictive Behaviors 15 355-65. 

Monti PM, RohsenowDJ, Swift RM, Gulliver SB, Colby SM, Mueller TI, Brown RA, Gordon A, Abrams DB, Niaura RS, Asher MK (2001) Naltrexone and cue exposure with coping and communication skills training for alcoholics treatment process and 1-year outcomes. Alcohol Clin Exp Res 25 1634-1647... 

Figure 1. Mean body length of fathead minnow hatchlings for experiment one (A) and experiment three (B), influenced by cue exposure during the embryo stage.

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