Exposure and response prevention

The second part of exposure is what is called response prevention, in which you as the therapist prevent the client from engaging in the old behavior while exposing him or her to the drug-using cue or trigger. Exposure to a cue followed 

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. 

In addition, exposure can be varied in terms of its dose. For example, you may want to start exposure with a mildly uncomfortable cue to begin with, and when 

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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. 

Treatment of OCD naturally lends itself to collaboration because it is dual-focused, utilizing both psychotherapy and medication. For the receptive patient, the combination can be quite effective in symptom reduction and/or alleviation. Psychotherapeutic intervention incorporates two fundamental elements designed to elicit anxiety and then cope with it exposure and response prevention. However, it is important to note that between 20 and 25% of patients with OCD will flatly refuse... 

Utilizing behavioral therapy that involves exposure and response prevention can be particularly effective in reducing panic symptoms (O Sullivan Marks, 1990). Where systematic desensitization has been used some clients find it particularly helpful when exposure to the anxiety-producing stimuli has been long enough to allow the anxiety to be markedly reduced (Marshall, 1996). Similarly, exposure to the feared stimulus is thought to be most effective when internal and external distractions from the phobic object or situation are minimized (Foa Kozak, 1986). Treatment of this type requires that the client be systematically exposed to the object or situation that provokes the fear and the subsequent avoidance. 

CBT is the treatment of choice for rmld OCD in both adolescents and adults. In the management of OCD, CBT involves exposure plus response prevention combined with cognitive therapy. When available, CBT should be offered to every OCD patient. Exposure involves having the patient perform actions that were formerly avoided. For instance, if a patient avoided touching the flush handle on a bathroom toUet, exposure would involve holding onto the handle. Response... 

Human research issues affect all programs in US-EPA. In its Office of Research and Development, US-EPA conducts research with human subjects to provide critical information on environmental risks, exposures, and effects in humans. This is referred to as first-party research. In both its Office of Research and Development and its program offices (including the Office of Air and Radiation, the Office of Water, the Office of Solid Waste and Emergency Response, and the Office of Prevention, Pesticides and Toxic Substances), US-EPA also supports research with human subjects conducted by others. This is referred to as second-party research. In aU this work US-EPA is committed to full compliance with the common rule. The US-EPA will continue to conduct and support such research, and to consider and rely on its results in US-EPA assessments and decisions. 

Asthma is considered as a chronic inflammatory disorder of the airways. This inflammation causes recurrent episodes of symptoms, variable airflow limitation, and increased airway responsiveness. Prevention of asthma involves both the prevention of the initial development of asthma (= primary prevention) and the prevention of exacerbation in patients with asthma (= secondary prevention). Primary prevention methods include reducing exposure to indoor allergens, particularly domestic mites, avoidance of passive smoking, especially by infants, and avoidance of vehicle emission pollutants, largely from incomplete combustion of petrol by car engines. 

Obsessive-compulsive disorder (OCD] is usually chronic, often debilitating, and much more common than previously believed. Not long ago, OCD was widely viewed as untreatable. The 1980s witnessed renewed optimism about the prognosis of OCD as new, more effective forms of pharmacotherapy (i.e., potent serotonin reuptake inhibitors [SRIs]] and behavior therapy (i.e., exposure/response prevention) were introduced and tested. Despite these advances, a substantial number of patients with OCD... 

Gillgrass, A.E., A.A. Ashkar, K.L. Rosenthal, and C. Kaushic. 2003. Prolonged exposure to progesterone prevents induction of protective mucosal responses following intravaginal immunization with attenuated herpes simplex virus type 2. J Virol 77 9845. 

In setting limits on exposure intended to prevent the occurrence of deterministic responses, the safety and uncertainty factors that are applied to the assumed thresholds for hazardous chemicals that cause deterministic effects usually are considerably larger (by at least a factor of 10) than the safety factor normally applied to the thresholds for deterministic responses from exposure to radiation. Furthermore, the assumed threshold usually is more conservative for hazardous chemicals than for radiation (i.e., a lower confidence limit of the threshold often is used for... 

Recently, some models have been derived to analyze the occurrence of interactive joint action in binary single-species toxicity experiments (Jonker 2003). Such detailed analysis models are well equipped to serve as null models for a precision analysis of experimental data, next to the generalized use of concentration addition and response addition as alternative null models. However, in our opinion these models are not applicable to quantitatively predict the combined toxicity of mixtures with a complexity that is prevalent in a contaminated environment, because the parameters of such models are typically not known. Recently a hazard index (Hertzberg and Teus-chler 2002) was developed for human risk assessment for exposure to multiple chemicals. Based on a weight-of-evidence approach, this index can be equipped with an option to adjust the index value for possible interactions between toxicants. It seems plausible that a comparable kind of technique could be applied in ecotoxicological risk assessments of mixtures for single species. However, at present, the widespread application of this approach is prevented by lack of available information. 

Mainly in response to the anthrax attacks in the United States, in 2002, the Centers for Disease Control and Prevention published a report entitled Crisis and Emergency Risk Communication (Reynolds, 2002). The report illustrates two prerequisites for successful risk communication credibility and trust. These two elements (Figure 11) may be highly important when dealing with uncertainty in exposure and risk assessment (Sjoberg, 2001). The prerequisites for credibility are accuracy of information and speed of release the main attributes of trust are empathy and openness. 

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