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