Covert sensitization is best used in the treatment of which of the following:
A. Covert sensitization is a variant of aversive conditioning wherein images (e.g. of drinking situations) is paired with imaginary aversive stimuli (e.g. a scene of a person vomiting all over the place, or a scene of a person dying of alcohol-induced liver damage). It is called covert because neither the undesirable stimulus nor the aversive stimulus is actually presented except in the imagination. Sensitization refers to the intention to build up an avoidance response to the undesirable stimulus. This is based on aversion therapy.
Reference:
Parent management training is based on the principles of:
B. Parent management training was first established as a treatment programme by Gerald Patterson in the 1970s. The programme was based on the principles of learning theory, both operant theories and social learning theories, which teach parents to use positive reinforcers, like stickers, toys, or snacks to increase positive behaviour, while using time out tactics to reduce negative behaviour like temper tantrums. Focus is on one problem behaviour at a time. The parents are taught to observe the problem behaviour – the situations and timings at which it occurs. The frequency of this behaviour is usually charted to look at the progress, while abstinence from the behaviour is positively rewarded and indulgence in the behaviour is rewarded with time outs. Parents are also taught to identify behaviours that are incompatible with the ‘problem’ behaviour – e.g. talking nicely instead of whining. These are called ‘competing’ behaviours – and these are usually rewarded. Consistency in rewarding and punishing is important in this setting. This treatment is usually used in childhood disruptive disorders such as oppositional defiant disorder or conduct disorder. Shaping and chaining are operant techniques used to induce target behaviours. Approximating ‘da’ and ‘da’ to form the word ‘dada’ – to which the daddy hugs the child (reinforcer) is an example of shaping. Chaining is linking of more complex tasks such as wearing a pull-over shirt – this consists of a number of complex steps. Modelling is a social learning technique where a social behaviour is reinforced by society. For example a student who changes dress to fi t in with a certain group of students has a strong likelihood of being accepted and thus reinforced by that group.
Which of the following is the first step in systematic desensitization?
B. Systematic desensitization was first developed by Joseph Wolpe in the 1950s to treat phobic patients. It is based on the principles of counter-conditioning. It attempts to replace the ‘fear’ response to phobic stimuli with a new response (muscle relaxation) that is incompatible with fear. The first step in systematic desensitization is to train the clients in deep relaxation until they can rapidly achieve muscle relaxation when instructed to do so. The second step is to construct what is known as an ‘anxiety hierarchy’, in which the client’s feared situations are ordered from the least to the most anxiety-provoking. Thus, for example, a person with phobia for ‘cockroaches’ might regard a photograph of a cockroach as only modestly threatening, but a large, rapidly moving cockroach close by as highly threatening. The client reaches a state of deep relaxation, and is then asked to imagine (or is confronted by the photograph of a cockroach) the least threatening situation in the anxiety hierarchy. The client repeatedly imagines (or is confronted by) this situation until it fails to evoke any anxiety at all, indicating that the counterconditioning has been successful. This process is repeated while working through the levels in the anxiety hierarchy until the most anxiety-provoking situation is reached.
Habit reversal components include all the following except:
B. Habit reversal is a complex procedure used generally to treat tics, Tourette’s syndrome and stuttering. The treatment has fi ve components – training in becoming aware of the onset of the behaviour; monitoring the behaviour; training in initiating competing responses that are compatible with the behaviour; relaxation; and social support. Training in thought stopping is not a component of habit reversal training.
Orgasmic reconditioning is used in:
D. Orgasmic reconditioning was first described by Marquis in 1970. In this treatment, the individual is asked to masturbate regularly to their troublesome deviant fantasies, but at the point of orgasmic inevitability, to switch to a desired non-deviant fantasy. As treatment progresses, the non-deviant stimulus is introduced earlier and earlier in the arousal process until masturbation is achieved without the deviant fantasy. This technique obviously is used when the behaviour or sexual preference that is of concern is not in itself dangerous or causing a public nuisance. Following the treatment, further sexual and social skills training is usually needed to ensure that the arousal to non-deviant stimuli is maintained.
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