ABSTRACT
DBT employs exposure procedures when clients engage in maladaptive behaviours as a consequence of unwarranted emotions (i.e. not based on the objective facts of the current situation). Distinguishing it from traditional exposure therapies that focus on fear, DBT applies exposure procedures to the full range of emotions (e.g. shame, anger, sadness and joy) that become causal links leading to target behaviours. For example, one client experienced extreme shame (i.e. beyond what the comments warranted) any time her husband commented negatively about any aspect of her appearance. The client then either purged or severely restricted her food consumption to decrease the shame. Although the client's individual therapist included other solutions in the analysis (e.g. mindfulness of negative judgements, challenging of negative assumptions, interpersonal skills to change the husband's comments) these solutions had a limited impact because of the severity of the shame. Using exposure to desensitize the client to the husband's comments proved critical. As expected, the exposure procedures directly decreased the client's shame response and her subsequent eatingdisorder behaviour. As an additional bene®t, the decrease in shame also increased the client's ability to use other skills.
