CBT Exposure Therapy & Response Prevention 3 — Questions and Answers
Question 1: Interoceptive exposure is most specifically indicated for which condition?
- Social anxiety disorder
- Panic disorder with agoraphobia (Correct answer)
- Specific phobia of spiders
- OCD with aggressive obsessions
Correct answer: Panic disorder with agoraphobia
Interoceptive exposure targets feared bodily sensations (e.g., racing heart, dizziness) and is a cornerstone treatment for panic disorder.
Question 2: A client reports that her anxiety during exposure sessions never drops below a SUDS of 60, even after 60 minutes. The MOST clinically appropriate next step is to:
- Terminate exposure therapy and switch to medication
- Investigate potential safety behaviors or cognitive avoidance maintaining anxiety (Correct answer)
- Immediately move to the highest item on the fear hierarchy
- Shorten exposure duration to 10 minutes to avoid overwhelming the client
Correct answer: Investigate potential safety behaviors or cognitive avoidance maintaining anxiety
Persistently high SUDS often signals covert safety behaviors, subtle avoidance, or cognitive strategies that are blocking inhibitory learning.
Question 3: Which of the following best exemplifies 'massed exposure'?
- Daily 10-minute exposure sessions spread across 6 months
- Completing multiple high-intensity exposures in rapid succession within a single extended session (Correct answer)
- Spreading exposures evenly across multiple separate days
- Alternating exposure days with cognitive restructuring sessions
Correct answer: Completing multiple high-intensity exposures in rapid succession within a single extended session
Massed exposure concentrates many exposures into one or a few intensive sessions, which research shows can produce rapid and durable fear reduction.
Question 4: The term 'fear structure' as used by Foa and Kozak (1986) refers to:
- The diagnostic hierarchy used to classify anxiety disorders
- A cognitive-affective memory network containing information about feared stimuli, responses, and their meaning (Correct answer)
- The anatomical pathways in the amygdala associated with fear
- The therapist's case conceptualization of avoidance patterns
Correct answer: A cognitive-affective memory network containing information about feared stimuli, responses, and their meaning
Foa and Kozak described a fear structure as an associative memory network linking stimulus, response, and meaning elements that must be activated and modified during exposure.
Question 5: A therapist designs an exposure for a client afraid of embarrassment in which the client intentionally spills coffee on himself in a café. This technique specifically targets:
- Contamination fears via ERP
- Social anxiety through shame attack exercises (Correct answer)
- Specific phobia via systematic desensitization
- PTSD through prolonged exposure narrative
Correct answer: Social anxiety through shame attack exercises
Shame attack exercises, developed in REBT and adapted in CBT, involve intentionally engaging in mildly embarrassing behaviors to demonstrate that social catastrophe does not occur.
Question 6: Which statement about the relationship between exposure dosage and outcome is MOST supported by current research?
- Longer total exposure time is always more effective than shorter time
- Variability in exposure contexts and cues enhances long-term fear reduction (Correct answer)
- Anxiety must reach at least 80 SUDS for exposure to be therapeutic
- Fear must be completely extinguished within session for gains to transfer
Correct answer: Variability in exposure contexts and cues enhances long-term fear reduction
Conducting exposures across varied contexts, times, and cues strengthens inhibitory learning and reduces the probability of return of fear.
Question 7: When using imaginal exposure for PTSD, the therapist typically asks the client to narrate the traumatic memory:
- In the third person to maintain emotional distance
- In the past tense with eyes open to reinforce reality testing
- In the present tense with eyes closed to maximize emotional engagement (Correct answer)
- Using only factual language devoid of sensory details
Correct answer: In the present tense with eyes closed to maximize emotional engagement
Foa's Prolonged Exposure protocol instructs clients to revisit the trauma memory in the present tense with eyes closed to promote emotional processing and activation of the fear structure.
CBT Exposure Therapy & Response Prevention 3
Interoceptive exposure is most specifically indicated for which condition?