CBT Exposure Therapy & Response Prevention 2 — Questions and Answers
Question 1: In ERP for OCD, what does 'response prevention' specifically refer to?
- Blocking the therapist's corrective feedback
- Refraining from performing compulsions during or after exposure (Correct answer)
- Preventing the client from rating their anxiety levels
- Stopping intrusive thoughts before they escalate
Correct answer: Refraining from performing compulsions during or after exposure
Response prevention means the client deliberately refrains from engaging in compulsive behaviors after confronting the feared stimulus, allowing habituation or inhibitory learning to occur.
Question 2: Which term describes the phenomenon where anxiety peaks and then naturally declines during a prolonged exposure exercise?
- Reciprocal inhibition
- Within-session habituation (Correct answer)
- Extinction burst
- Cognitive restructuring
Correct answer: Within-session habituation
Within-session habituation refers to the decrease in anxiety that typically occurs when a client remains in contact with a feared stimulus long enough without performing compulsions.
Question 3: A client with contamination OCD washes her hands 30 times daily. The therapist asks her to touch a doorknob and then sit for 45 minutes without washing. This best illustrates:
- Systematic desensitization with relaxation
- Imaginal flooding followed by in vivo exposure
- ERP combining situational exposure with ritual blocking (Correct answer)
- Cognitive challenging of overestimated threat
Correct answer: ERP combining situational exposure with ritual blocking
This procedure is a classic ERP intervention: the client contacts the feared stimulus (doorknob) and then refrains from the compulsive ritual (hand washing).
Question 4: Inhibitory learning theory suggests that ERP works primarily because:
- Anxiety becomes classically conditioned to relaxation cues
- A new non-threatening memory trace is formed that competes with the fear memory (Correct answer)
- The autonomic nervous system permanently resets its threat threshold
- Cognitive distortions are directly challenged through logical disputation
Correct answer: A new non-threatening memory trace is formed that competes with the fear memory
Inhibitory learning posits that exposure creates a new inhibitory memory that competes with the original fear memory, rather than erasing it.
Question 5: Which exposure format involves the client confronting feared situations in real life rather than through imagination?
- Interoceptive exposure
- Imaginal exposure
- In vivo exposure (Correct answer)
- Virtual reality exposure
Correct answer: In vivo exposure
In vivo exposure involves direct, real-world contact with feared stimuli, which is generally considered the most potent form of exposure.
Question 6: A therapist notices a client subtly holds his breath and tenses his muscles during exposure to avoid feeling anxious. This behavior is best described as:
- A successful coping strategy
- Safety behavior that undermines the exposure (Correct answer)
- An example of cognitive restructuring
- Interoceptive avoidance that is acceptable during early sessions
Correct answer: Safety behavior that undermines the exposure
Safety behaviors reduce short-term distress but prevent the client from learning that the feared outcome would not have occurred without the behavior.
Question 7: What is the primary rationale for starting with lower items on a fear hierarchy rather than the most feared situation?
- To match medication dosing schedules
- To build initial success experiences and therapeutic alliance while reducing dropout (Correct answer)
- Because high-anxiety exposures are ethically prohibited
- To comply with insurance billing requirements for gradual progress
Correct answer: To build initial success experiences and therapeutic alliance while reducing dropout
Beginning with less distressing items allows the client to experience early success, builds confidence, and reduces dropout risk before progressing to more challenging exposures.
CBT Exposure Therapy & Response Prevention 2
In ERP for OCD, what does 'response prevention' specifically refer to?