Benito Kristen G, Walther Michael
Alpert Medical School of Brown University/Bradley-Hasbro Children's Research Center.
J Obsessive Compuls Relat Disord. 2015 Jul 1;6:147-157. doi: 10.1016/j.jocrd.2015.01.006.
The current paper outlines the habituation model of exposure process, which is a behavioral model emphasizing use of individually tailored functional analysis during exposures. This is a model of therapeutic process rather than one meant to explain the mechanism of change underlying exposure-based treatments. Habitation, or a natural decrease in anxiety level in the absence of anxiety-reducing behavior, might be best understood as an intermediate treatment outcome that informs therapeutic process, rather than as a mechanism of change. The habituation model purports that three conditions are necessary for optimal benefit from exposures: 1) fear activation, 2) minimization of anxiety-reducing behaviors, and 3) habituation. We describe prescribed therapist and client behaviors as those that increase or maintain anxiety level during an exposure (and therefore, facilitate habituation), and proscribed therapist and client behaviors as those that decrease anxiety during an exposure (and therefore, impede habituation). We illustrate model-consistent behaviors in the case of Monica, as well as outline the existing research support and call for additional research to further test the tenets of the habituation model as described in this paper.
本文概述了暴露过程的习惯化模型，这是一种行为模型，强调在暴露过程中使用个性化的功能分析。这是一个治疗过程模型，而非旨在解释基于暴露的治疗背后的改变机制。习惯化，即在没有减轻焦虑行为的情况下焦虑水平自然下降，或许最好被理解为一种为治疗过程提供信息的中间治疗结果，而非一种改变机制。习惯化模型声称，要从暴露中获得最佳益处，需要三个条件：1）恐惧激活，2）将减轻焦虑行为最小化，3）习惯化。我们将规定的治疗师和来访者行为描述为在暴露期间增加或维持焦虑水平（从而促进习惯化）的行为，而将被禁止的治疗师和来访者行为描述为在暴露期间降低焦虑（从而阻碍习惯化）的行为。我们在莫妮卡的案例中展示了与模型一致的行为，并概述了现有的研究支持，同时呼吁进行更多研究以进一步检验本文所述习惯化模型的原则。
