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DSM Case Studies

Marla is a 24-year-old woman who recently graduated from college and began a new job at an advertising firm. She suffers from extreme fear of social situations. In college, she avoided parties and large gatherings and tended to keep to herself. Now that she is working, it is becoming increasingly difficult for her to avoid social situations. Her boss and co-workers expect her to attend office functions and client parties as networking is a large part of the job. Marla is very artistic and creative and has already designed several successful ads for clients, but she is afraid that she will lose her job because of the difficulties she is experiencing socially.

1.Define the target behavior in this case study.
2.Describe how respondent behavior is involved in the development of an anxiety problem. Identify the CS and CR in this example.
3.Discuss the difference between systematic and in-vivo desensitization. What are the advantages/disadvantages of each procedure?
4.Design a behavior modification procedure for Marla and explain the rationale for your selection. Be sure to include a discussion of behavior hierarchy, relaxation procedures and de-sensitization procedures.

Case Study 2: Jon

Jon is a 6-year-old boy, with normal intelligence, who has a hair-pulling habit. The hair pulling occurs most often during periods of inactivity, such as during TV watching, quiet time in school, or waiting in line with his parents.

1.Define the target behavior in this case study.
2.What is the behavioral excess or deficit involved in this example? What are some of the possible short- and long-term implications of this behavior for the client?
3.Design a habit reversal procedure for Jon that includes the use of differential reinforcement and identification of an appropriate competing response.
4.Suppose that Jon was cognitively impaired. How would you change your habit reversal procedure to increase its effectiveness?

Solution Preview

Marla:

Marla appears to be suffering from Social phobia. Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR [APA], 2000), Social Phobia, or Social Anxiety Disorder is a "marked and consistent fear of social or performance situations in which embarrassment may occur (Criterion A); exposure to the social or performance almost invariably provokes an immediate anxiety response" (p. 450). Given this criteria, her target behavior is her social phobia, namely the fear of social situations. Her behavior that results in the avoidance of social gatherings is consistent with the characterization of anxiety associated with this disorder

(a) Marla's target behavior is fear of social situations

(b) The conditioned stimuli include large social gatherings and/or parties, which she seeks to avoid

(c) Systematic desensitization is a technique used in behavioral therapy when an individual is exposed to a feared object while practicing
relaxation techniques. The advantage of systematic desensitization is that the fear had been conditioned and can be unconditioned by exposure to the feared object, a disadvantage is that some phobias are difficult to treat and may require too many sessions. Studies suggest that only a small number of people would benefit from brief therapeutic interventions to treat this disorder (e.g. Klein et al as cited in Plotnik, 1993).
When desensitization techniques are used to treat phobias that involve real life situations (as opposed to simulations), the technique is referred to as "in vivo (real life) desensitization" (Plotnik, 1993, p. 574). This technique has an advantage in that persons are exposed to the actual feared object or event, and may be beneficial in treating simple phobias. However, Plotnik points to a disadvantage in that in vivo desensitization may not be effective for more chronic phobias, because of the length of time needed to treat these more chronic phobias.

(d) Marla will be trained in relaxation techniques that ...

Solution Summary

DSM Case Studies are examined. The target behavior in the case study is defined. How respondent behavior is involved in the development of an anxiety problem is examined.

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