TF-CBT - 體內掌握 (9)

Which of the following is the best indicator that in vivo mastery exercises are necessary in TF-CBT?

a. If the child was unable to complete a trauma narrative successfully

b. If the narrative covered more traumatic events than were described in the trauma narrative that was created

c. If the child experiences anxiety and avoidance in response to safe, trauma-related environmental cues

d. If the parent is concerned that the child is not sufficiently fearful of dangerous people or situations (such as strangers or ambulance drivers)

c. If the child experiences anxiety and avoidance in response to safe, trauma-related environmental cues

Reducing unnecessary avoidance and cue-related anxiety are the only reasons to engage in in vivo exposure.

The exposure exercises used during the in vivo mastery component of TF-CBT should be:

a. Unplanned/unexpected, to prepare the child for unanticipated real-world situations

b. Repeated and controlled, to maximize the likelihood of success

c. Lengthy, if necessary, in order to allow for maximum anxiety reduction

d. Intensive, and designed to test the child's coping skills in extreme situations

b. Repeated and controlled, to maximize the likelihood of success

It is important to plan and monitor exposure to feared stimuli so that the child's experience results in mastery, not increased fear and avoidance.

Jane, age 9, has completed the Trauma Narrative and is preparing to share it with her foster mother in treatment. Neither Jane nor her foster mother reports any continuing avoidance behaviors. What is the best course of action regarding in vivo mastery?

a. Provide psychoeducation about in vivo activities in case avoidance returns, and proceed to Conjoint Session planning.

b. Just skip the module entirely and move to Conjoint Session planning.

c. Conduct in vivo mastery exercises for things that Jane used to fear, just to make sure that fear has been extinguished

d. Conduct imaginal mastery exercises about things Jane used to fear, then move to in vivo exercises if necessary.

a. Provide psychoeducation about in vivo activities in case avoidance returns, and proceed to Conjoint Session planning.

Some discussion of avoidance behaviors and how to handle them should they emerge later is the best strategy here, but the full module need not be implemented.

Where on the hierarchy of feared stimuli should the therapist begin the in vivo mastery exercises?

a. With the least feared item on the hierarchy

b. With the most feared item on the hierarchy

c. Somewhere in the middle, enough to generate some fearful emotion but not be overwhelming

d. With whichever item the child, caregiver, and therapist think is most appropriate

d. With whichever item the child, caregiver, and therapist think is most appropriate

This should be a joint decision with input from all parties.

Michelle, 11, witnessed her mother get stabbed at home and has lingering fears about ambulances and siren noises. They remind her of the night her mother was attacked. She has created a hierarchy of feared situations with her therapist. At the high end of the hierarchy is seeing an ambulance close up with the siren blaring. At the bottom is seeing a picture of an ambulance. Several other items fall between these extremes. How should the therapist begin working on helping Michelle overcome her fears?

a. Since people rarely encounter ambulances or sirens, it's not even necessary to help reduce Michelle's siren-related fears.

b. The therapist and Michelle should create a plan for looking at pictures of ambulances in the office and work their way up the hierarchy.

c. The therapist should arrange for an exposure session near a local emergency room where Michelle will confront siren noises directly.

d. Michelle, her caregiver, and the therapist should make a detailed plan to expose Michelle to an item from the middle of the hierarchy first.

e. The therapist and Michelle's caregiver should develop a plan to secretly arrange for Michelle to encounter siren noises without knowing they are coming.

d. Michelle, her caregiver, and the therapist should make a detailed plan to expose Michelle to an item from the middle of the hierarchy first.

When beginning work on a fear hierarchy, avoid choosing a item that may be too stressful or one that may be so easy that completing it does not seem like an achievement. Starting somewhere near the middle of the hierarchy is a good rule of thumb.

Dray, 15, and his mother are working through an exposure hierarchy related to his exposure to community violence. It's going pretty well, but Dray's mother tells you she doesn't know what to say when he says he can't stay in the exposure exercise any more. What suggestion should the therapist give her?

a. Tell Dray he has to stay in the situation until his fear reduces by 50%.

b. Tell Dray that they can leave whenever he says so.

c. Ask Dray if he can tolerate another 30 seconds in the situation before leaving. If he says no, then leave.

d. She should use ignoring to try to extinguish Dray's avoidance behavior and help extinguish his fears.

e. Instruct her to leave the situation right away, but to eliminate any planned rewards because the exercise was unsuccessful.

c. Ask Dray if he can tolerate another 30 seconds in the situation before leaving. If he says no, then leave.

Encouraging Dray to try to tolerate a little more time in the situation can increase his sense of mastery, but he should never be forced to do so if he feels like he can't.