BABCP spring meeting: David Barlow's unified protocol - interoceptive/situational exposures and relapse prevention (sixth post)
Last updated on 4th March 2016
I wrote yesterday about "Emotional avoidance, emotion driven behaviours & physical sensation tolerance (fifth post)". Today's is the last post in this series of six on David Barlow & colleagues' new unified protocol for treating anxiety, depression & other related psychogical disorders. It covers the last two modules in their eight module treatment - "Interoceptive & situational emotion exposures" (4 to 6 sessions) and "Maintenance & relapse prevention" (1 session).
In many ways this exposure work is more familiar to CBT therapists than some other aspects of the unified protocol - but I very much like the way the exposure is presented & handled to reflect recent research understanding. The aim is to "Understand the purpose of emotion exposures", "Learn how to design effective emotion exposure exercises", "Develop a fear and avoidance hierarchy" and "Repeatedly practice confronting strong emotions through emotion exposure exercises". In the "Client workbook" it is highlighted that, in many ways, this is now the heart of the treatment - "The key concept ... is emotion exposure. During this part of treatment, you will gradually confront specific situations, images, and/or activities that may produce strong or intense emotional reactions. This is an opportunity to put the skills learned so far into practice and, in so doing, gain confidence that you can handle your emotional difficulties as they unfold. It is very important that you commit to making time and effort during this last part of treatment, because this is the chance for the greatest, longest-lasting changes to occur."
In the workbook this phase of treatment is nicely described with a learning-to-ride-a-bicycle metaphor. It's good. And in the "Therapist guide" it is emphasised "We refer to these exposures as 'emotion exposures' because the primary focus of the exposure is not the specific situation, image, or activity, but rather the emotion itself." and "The goal of emotion exposures is not immediate reduction in the emotional response. Rather, the goal is for patients to learn something new as a result of the experience. Consistent with a focus on emotions and emotion regulation, conceptually all exposures are directed towards patients experiencing their emotions fully (which means reducing patterns of avoidance) and implementing new responses. Tolerance of emotions is a critical learning goal of emotion exposures."
More to follow ...