The ‘Fears conquered with exposure and habituation’ protocol
The protocol should be delivered by a trained practitioner, supporting the ‘Fears Conquered’ selfhelp material, which has been tested to conform to good practice guidelines in self-help and have a suitable reading age. In line with NICE guidelines treatment for panic and agoraphobia should be exposure and habituation, integrated with use of an appropriate task based self-help material, with support session number dependant upon patient response and engagement to treatment homework (the treatment dose). Each session lasting 20-30 minutes for the homework review and subsequent weeks homework planning (subject to local variation for additional content needed in sessions). This should be delivered in weekly sessions, phased out as required as treatment progresses towards discharge. The protocol should end with relapse management using the relevant pages within the material. The change methods and scaffolding components of the protocol are:
Change Method/ Scaffolding Technique Explaining the fear response and maintenance cycle
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Target A scaffolding technique to give the patient information about the adrenalin response, symptoms and how the body can learn to fear these symptoms and a cycle of panic, avoidance, escape and safety seeking can take hold, how exposure and habituation helps to break this cycle by helping the body to over-learn it does not need to produce fear on response to these triggers.
Duration/Dose A one off psycho-eduction task. At end of assessment/first treatment session depending on time available. This should be physiological in nature explaining the purpose of the symptoms of arousal, focused on accurately explaining the fear response and misinterpretation by the body of these symptoms relevant to the individual patient presentation, how the body has learnt to treat these normal physical symptoms inside of arousal and at other times as a sign of threat should be included, with normalisation of key individual patient symptoms of concern. It should be discussed how avoidance and safety seeking serves to maintain the disorder in a vicious cycle, but this learning can be reversed through the treatment. This should be reinforced through the reading in the patient self-help material.
© Marie Chellingsworth (2020). The CBT Resource.
