Search Results

Pavlovian phenomena have long served as models for the etiology, treatment, and relapse from treatment of diverse disorders (e.g., phobias, addictions). Here, the chapter briefly reviews Pavlovian conditioning models of anxiety disorders, experimental extinction models of exposure therapy, and recovery from extinction models of relapse following exposure therapy. It then focuses on how research on experimental extinction has led to the development of specific behavioral techniques to reduce recovery from extinction and hence relapse from exposure therapy. These techniques include conducting extinction treatment in multiple contexts, giving a massive amount of extinction, increasing the time between extinction trials and between extinction sessions, administering extinction in the presence of a second excitor, and testing in the presence of a retrieval cue from extinction. It is concluded that these behavioral techniques, all of which were discovered in the experimental laboratory, are potent and important tools to be considered by psychotherapists trying to make their patients less susceptible to relapse.

This chapter examines the control capacities of individuals with certain mental disorders and how, specifically, their reasons-responsiveness improves with treatment. Successful talk therapy, in particular, can bring individuals with disorders of agency closer to full-blown agency. The discussion focuses, first, on Agoraphobia and Exposure Therapy and, second, on Borderline Personality Disorder and Dialectical Behavior Therapy. We can see effective techniques of talk therapy, such as gradual exposure or radical acceptance exercises, as operating on the ability of patients to respond appropriately to reasons. In this way, reasons-responsiveness is a lens through which to better appreciate the flourishing of patients, via improved control in both moral and nonmoral contexts. The chapter bridges philosophical concepts of reasons-responsiveness with key psychiatric constructs, such as distress tolerance and experiential avoidance.

This chapter describes a treatment plan for people suffering from posttraumatic stress disorder and panic disorder. The first step is to perform assessment, which includes interviewing the patient, suicide/self-harm assessment, drug screening, crisis action plan, and safety contract. The second step is to establish equilibrium by ensuring that the patient adheres to the medication prescribed to him/her, activity scheduling, making the patient feel safe, paradoxical intention, exposure therapy, and helping the patient deal with flashbacks/nightmares. The third step is to address social and environmental issues that could prevent the patient from stabilizing fully or cause relapse of crisis episodes and involves building social supports, linking to resources, and changing the system. The last two steps cover relapse prevention (increasing internal locus of control, motivational enhancement, changing dysfunctional thinking), and recovery philosophy (client-led treatment, utilizing/improving personal strengths and resources, empowerment, prevention and recovery).

A regulatory battle for control ensues in the central nervous system following a mismatch between the current physiological state of an organism as mapped in viscerosensory brain regions and the predicted body state as computed in visceromotor control regions. The discrepancy between the predicted and current body state (i.e. the “somatic error”) signals a need for corrective action, motivating changes in both cognition and behavior. This chapter argues that anxiety disorders are fundamentally driven by somatic errors that fail to be adaptively regulated, leaving the organism in a state of dissonance where the predicted body state is perpetually out of line with the current body state. Repeated failures to quell somatic error can result in long-term changes to interoceptive circuitry within the brain. This chapter explores the neuropsychiatric sequelae that can emerge following chronic allostatic dysregulation of somatic errors and discusses novel therapies that might help to correct this dysregulation.