Whatever Happened To In Vivo Therapy?

One of my most fulfilling moments as a clinician over the past 50 years has been conducting exposure and in vivo behavioral therapy with patients with anxiety and phobias. However, it seems that for both myself and many of my colleagues, the practice of working with patients in real-life situations to overcome their fears is much less used than before.

The disruption in in vivo therapy practice may be due to a number of factors: First, the development of new, more effective drugs to reduce anxiety has made guided practice in the presence of a therapist less necessary. Additionally, the acceptance and development of new treatment methods such as commitment therapy, manual therapy, virtual reality (VR) and of course online remote therapy (especially since the start of the pandemic) have allowed patients to practice many of the skills that their therapists are teaching them at home instead of in real settings.

However, I believe that in vivo practice of phobias and anxieties should be an important tool in the therapist's therapeutic arsenal.

ভিভো থেরাপি ব্যবহার করার ক্ষেত্রে আমার সূচনাটি ফোবিয়াস এবং বিভ্রান্তির উপর কেট সোমারস্কেলের সাম্প্রতিক বই থেকে নিম্নলিখিত উদ্ধৃতিতে সর্বোত্তমভাবে বর্ণনা করা হয়েছে: "1975 সালে, নিউ ইয়র্কেও, আচরণগত থেরাপিস্ট ব্যারি লুবেটকিন ব্রোন্টোফোবিয়ায় ভুগছেন এমন একজন 45 বছর বয়সী মহিলার চিকিত্সা করেছিলেন৷ তিনি সর্বদা বজ্রপাতের সন্ধানে ছিলেন, তিনি তাকে বলেছিলেন, এবং যখন তিনি তার বেসমেন্টে বজ্রপাত শুনেছিলেন, তখন তিনি ভয়ে কেঁপে উঠেছিলেন। ভয়টি অন্যান্য আকস্মিক বিকট শব্দে ছড়িয়ে পড়ে, যেমন গাড়ির ব্যাকফায়ারিং ইগনিশন, বেলুন বিস্ফোরণ এবং নিম্ন-উড়ন্ত বিমানের গর্জন। তিনি নিউইয়র্কে গ্রীষ্মের ঝড়ের কারণে আতঙ্কিত হয়েছিলেন এবং ইতিমধ্যেই তার ফোবিয়া নিরাময়ে অক্ষম দুজন সাইকোথেরাপিস্ট দ্বারা চিকিত্সা করার পরে এলাকা ছেড়ে যাওয়ার কথা বিবেচনা করেছিলেন। মহিলা লুবেটকিনকে বলেছিলেন যে তিনি যুদ্ধকালীন ইউরোপে তার শৈশবকালে তার ব্রোন্টোফোবিয়াকে ডেট করেছিলেন, যখন তিনি শেল এবং বোমা বিস্ফোরণের ভয় পেয়েছিলেন।

"After Lubetkin patiently learned his relaxation techniques, he took him to a local planetarium, where they showed a projectionist a three-minute film about a thunderstorm. The patient relaxed before watching the film and then watched it again and again that day, eight times in total. He did the same on seven more visits to the planetarium. He then told Lubetkin that his phobic symptoms had improved. He spent less time worrying about lightning, he said, and even during a thunderstorm. And he thought he could stay upstairs in the house he was going in. Also, the noise of the crash or the plane didn't bother them that much.

Here is a sample list of other Vivo colleagues and I have performed with patients. Almost all had been with or before practicing relaxation and anxiety management techniques, including breathing, cognitive restructuring and mindfulness meditation. The therapist is always present.

1. "Picnic" during breaks and talk in elevators.
2. Sit on a park bench and name the owners and their dogs in ascending order of dog size.
3. Relax on balconies or terraces of high-rise buildings.
4. Visit the American Museum of Natural History with entomologists and see the various insect exhibits.
5. Drive subway cars one stop at a time and take breaks on the tracks.
6. Eat at a variety of restaurants, from less crowded to more crowded.
7. Drive on quiet roads and freeways
8. Invite and advise patients who create online profiles. Then help them make the initial calls for potential appointments.
9. Take a patient to a movie and sit further away from them as the movie progresses.

In fact, there are endless human experiences that hold people back, shame and worry where quick therapist counseling can be extremely helpful.

It should be understood that upon leaving the practice environment, another signed agreement regarding the scope and boundaries of actual practice often requires compliance with all legal and ethical obligations.