The concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.

中文翻译：

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重新概念化暴露及其对认知行为和心理动力学实践的一些启示

暴露的概念在临床心理学的研究和实践中无处不在，尤其是在认知行为模型中。然而，关于“暴露疗法”中的暴露如何表征仍然存在混淆和模棱两可。当前的定义被认为是不充分的，因为每个定义都确定了暴露过程的某些特征，但忽略了其他特征。因此，提出了一个详细的暴露模型，在此称为再暴露-灭绝学习过程. 这个过程涉及一个复杂的因果情况，包括临床特征（原因/原因、C)，作用于一个人（领域，F），重新暴露于引发焦虑的刺激，然后进行消退学习，随着时间的推移，导致治疗变化（效果/效果，乙）。重要的是，再暴露和消退学习是两个不同于用于实现它们的治疗程序（即技术和方法）的过程。此外，这些过程与特定的治疗或临床干预模型没有内在联系。因此，它们是逻辑上独立于用于便利他们的程序。考虑到这种重新概念化，我们建议在移情中工作，这是心理动力学心理治疗的基石，可以理解为促进再暴露-灭绝学习过程的补充和有效方法。我们认为，这是通过使一个人能够反复重新评估他们在治疗关系的发展动态中表现出来的可怕期望来实现的。最后，探讨了这个精心设计的模型所表明的一些临床意义。