How to do Exposure Therapy?
Some of the rules for constructing a good program of Exposure Therapy are:
The subject should have a final goal which should represent non-phobic behavior. This might be (for example) to hold a large snake and rub it against their cheek for several minutes. They should also have in mind a series of intermediate steps such that once they have partially habituated to one step the next is close enough to it that they can readily move on. Such a sequence is called a hierarchy. It may be explicit, in the form of a list of increasingly challenging tasks, or implicit, in the form of a set of principles for escalating the exposure. The therapist will decide which of these will be more useful for the subject. (A useful way of constructing such a hierarchy is the Method of Factors. At every stage the subjects self-exposure should be completely voluntary - a criterion that may be derived from the theory of cognitive dissonance. One important corollary of this principle is that, at every moment, the subject must have an easy way of terminating the exposure. By choosing not to escape - and therefore practising a competing response - the subject thereby weakens the arousal-escape connection. The arousal experienced at any point should be the maximum that the subject is prepared to accept (this is the main difference between Exposure Therapy and Systematic desensitization). It's useful if at each stage the subject asks themselves "is there anything more I could do?" By considering which factors they can manipulate they should be able to keep moving smoothly up their hierarchy. Research by Marks and Rachmann citation needed demonstrated that optimum results are obtained with daily practice lasting at least an hour; and that the daily session should be ended by allowing the level of arousal to fall off to around half its peak value. For this reason it's useful for the subject to keep a note of their arousal level on a 0-8 scale (where 0=no arousal and 8=intolerable arousal). Before this fall-off phase the level of arousal should be maintained at an uncomfortable but tolerable level. </s>