Keywords: Exposure, Anxiety, Case Conceptualization / Formulation Level of Familiarity: Moderate Recommended Readings: Craske, M.G., Treanor, M., Conway, C.C., Zbozniak, T., Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23., Garner, L., & Steinberg, E., McKay, D. (2021). Exposure therapy. In A. Wenzel (Ed.). Handbook of Cognitive Behavioral Therapy (pp. 275-312). Washington, DC: American Psychological Association Press., McKay, D., & Ojserkis, R. (2015). Exposure in experiential context: Imaginal and in vivo approaches. In N. Thoma & D. McKay (Eds.), Working with Emotion in Cognitive Behavioral Therapy: Techniques for Clinical Practice (pp. 83-104). New York, NY: Guilford., Stopa, L. (2021). Imagery in cognitive-behavioral therapy. New York: Guilford.,
Evidence-based treatment for anxiety, trauma, and obsessive-compulsive disorders emphasize the inclusion of imagery to facilitate new emotional learning related to the avoided stimuli (Garner, Steinberg, & McKay, 2021; McKay & Ojserkis, 2015). This imagery-based approach to treatment is either accompanied by in vivo exposure, or as a stand-alone intervention when in vivo is not possible. There are several challenges clinicians must overcome in developing imagery. First, therapists must determine the nature of the content for imagery. Second, calibrating the imagery content to be tolerable must be formulated. Third, the clinician must engage in language evocative of the full range of sensory experiences, as well as culturally-informed content for the imagery. This requires clinicians to conceive of ‘imagery’ as more than a visualization-based experience. Examination of the empirical literature and clinical guides provide little specific information on how to systematically address each of these essential therapeutic components of imagery-based interventions. Research in linguistics provides additional guidance on methods of evoking potent images, including culturally-informed and sensitive approaches (Tye, 1991). Further complicating imagery based treatment is the recent emphasis on inhibitory learning (Craske et al., 2014), which shifts the focus to new learning rather than habituation. In the experience of the presenter, the formulation of imagery-based approaches is a frequent topic of professional consultation. This Master Clinician Seminar aims to provide clinicians with a structured model for developing imagery-based exposure to handle the aforementioned three challenges. The session will include audiotape illustrations and exercises for attendees to practice new skills.
* Overview of imagery * Integration of imagery with exposure procedures * Assessing extent client can engage in imagery - Training the client in imagery (Group Practice Exercise #1) - Practicing imagery alone, with low emotional charge * Pulling in all the sense for imagery (Group Practice Exercise #2) * Creating conditions where imagery is compelling - Translational research applications * Q & A
Learning Objectives:
At the end of the session, the learner will be able to:
Explain the utility of imagery as part of comprehensive exposure-based therapy, either in conjunction with in vivo intervention, or as a stand-alone method of anxiety reduction.
Describe the methods of imagery development, relying on both the recent developments in inhibitory learning, and the existing research in linguistics.
Develop evidence-based treatment programs for anxiety, trauma, and obsessive-compulsive disorders.
Integrate inhibitory learning methods into imagery-based treatment.
Determine methods for formulating culturally-informed imagery-based models of exposure treatment.
Long term Goal #1: Learners will apply imagery with clients who receive in vivo exposure, relying on a fuller range of sensory experiences.
Long term Goal #2: Learners will identify clients who would benefit from direct imagery training as part of a comprehensive approach to exposure treatment implementation.
