**6. The use of Prolonged CS Exposure (PE)**

The technique of prolonged CS exposure was first developed by Thomas G. Stampfl in the late 1950's. Despite considerable pressure to publish, he refused to publish until two experimental outcome studies were conducted to support his clinical finding. They were provided by Hogan (1966) who used a psychiatric hospitalized population, and Levis & Carrera (1967) who used an outpatient population. He then published his first article (Stampfl & Levis, 1967). He labeled his new response prevention approach, Implosive Therapy (IT). He first used an in vivo extinction approach but changed to an imagery approach due to the ability to introduce hypothesized conditioned stimulus (CS) that do not lend themselves readily to in vivo exposure (e.g., the fear of bodily injury). Stampfl adapted

A Review of Childhood Abuse Questionnaires and Suggested Treatment Approaches 15

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Reliability and validity in a clinical sample. Unpublished manuscript, University of

a revision of Mowrer's two factor avoidance theory (see Levis, 1979). His theory (Stampfl, 1970, Levis, 1985) has received strong experimental support at the human and infrahuman level of analyses (Levis, 1979, 1985) including a resolution of Freud's neurotic paradox as to why clinical symptoms persist over time (Levis & Brewer, 2001). The technique has been successfully used in the treatment of obsessive compulsive behavior (Foa, 2000); in the treatment of panic disorders (Levis, 1987); phobic behavior (Stampfl & Levis, 1967) and depression (Boyd & Levis 1980). The IT technique is an operational design feedback technique capable of re-activating trauma memories. The frequent use of Stampfl's therapist directed imagery technique lead to the development of a free-recall technique (referred to as patient directed IT or brain release therapy). This approach appears capable of providing a complete re-activation of trauma experiences (Levis, 1988; Levis 1995; Kirsch & Levis, 2001).

Today, prolonged exposure therapy is perhaps the most frequent and empirically supported technique for use for patient diagnosed with PTSD including survivors of childhood abuse (see Morrison, 2011). Yet as Morrison regrettably notes, some therapists avoid its use. Part of the concern is related to the fear that the high levels of anxiety elicited may be harmful to the patent. This fear exists despite the strong experimental evidence that the approach is not harmful (see Boudewyns & Levis, 1975; Boudweyn & Shipley 1983). Another key factor in the avoidance of using PE relates to the emotional impact on the therapist who witnesses the patient's trauma as they re-experience their historical emotional trauma. Despite this difficulty, I have found the law of extinction will eventually work for both the patient and the therapist resulting in a strong positive reinforcement when a reduction for symptomatology occurs. It has also been my experience that trauma victims rarely terminate therapy prematurely or miss a session.

In closing, it is my hope this chapter will not only alert the reader to the frequent and devastating effects that childhood abuse has on the adult survivors of abuse but also serve as an alert to practitioners as to the importance of providing a comprehensive assessment of the potential presences of an abusive childhood history in their patients.

#### **7. References**


a revision of Mowrer's two factor avoidance theory (see Levis, 1979). His theory (Stampfl, 1970, Levis, 1985) has received strong experimental support at the human and infrahuman level of analyses (Levis, 1979, 1985) including a resolution of Freud's neurotic paradox as to why clinical symptoms persist over time (Levis & Brewer, 2001). The technique has been successfully used in the treatment of obsessive compulsive behavior (Foa, 2000); in the treatment of panic disorders (Levis, 1987); phobic behavior (Stampfl & Levis, 1967) and depression (Boyd & Levis 1980). The IT technique is an operational design feedback technique capable of re-activating trauma memories. The frequent use of Stampfl's therapist directed imagery technique lead to the development of a free-recall technique (referred to as patient directed IT or brain release therapy). This approach appears capable of providing a complete re-activation of trauma experiences (Levis, 1988; Levis 1995; Kirsch & Levis, 2001). Today, prolonged exposure therapy is perhaps the most frequent and empirically supported technique for use for patient diagnosed with PTSD including survivors of childhood abuse (see Morrison, 2011). Yet as Morrison regrettably notes, some therapists avoid its use. Part of the concern is related to the fear that the high levels of anxiety elicited may be harmful to the patent. This fear exists despite the strong experimental evidence that the approach is not harmful (see Boudewyns & Levis, 1975; Boudweyn & Shipley 1983). Another key factor in the avoidance of using PE relates to the emotional impact on the therapist who witnesses the patient's trauma as they re-experience their historical emotional trauma. Despite this difficulty, I have found the law of extinction will eventually work for both the patient and the therapist resulting in a strong positive reinforcement when a reduction for symptomatology occurs. It has also been my experience that trauma victims rarely terminate

In closing, it is my hope this chapter will not only alert the reader to the frequent and devastating effects that childhood abuse has on the adult survivors of abuse but also serve as an alert to practitioners as to the importance of providing a comprehensive assessment of

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**2** 

*USA* 

**Sexual Abuse Histories Among** 

*Fordham University, Graduate School of Social Service* 

**A Descriptive Study** 

**Incarcerated Older Adult Offenders:** 

Mary Beth Morrissey, Deborah Courtney and Tina Maschi

In the United States today, there are over 2.2 million incarcerated adults held in custody in U.S. state or federal prisons or local jails (Glaze, 2010). Prison facilities are oftentimes filled to capacity or in some cases, so overcrowded that conditions violate the constitutional rights of adults in prison (Brown v. Plata, 2011; Sabol & West, 2009; West & Sabol, 2008). Official statistics paint a contemporary portrait of the 1.5 million adult sentenced prisoners under state or federal jurisdiction who are mostly male (93%) and from diverse racial and ethnic backgrounds including Black American (36%), Caucasian (31%), and Latino (20%)(West & Sabol, 2008). Black males continue to have the highest incarceration rates across all age categories compared to White or Latino males (Sabol & Couture, 2008). There is a growing number of older adults in both state and federal prisons, approaching nearly 5% of inmates 55 and older in custody of state prisons in 2007, and over 7% of inmates 56 and older in federal prison in 2009 (Cox & Lawrence, 2010; Sabol & Couture, 2008). This aging prisoner population, which is five times larger than in 1990, presents a significant public health challenge that the correctional system is not adequately equipped to address (Falter, 1999; Reimer, 2008). Moreover, the high prevalence of trauma among older adults in prison and psychological distress associated with trauma experiences raise serious concerns about the well-being of this population (Krause, 2004). Studies have shown that approximately 93% of juvenile and adult prisoners have had prior exposure to trauma, such as being a victim of and/or witness to sexual abuse (Harlow, 1999). The high prevalence of trauma histories, especially earlier life sexual victimization, within the incarcerated older adult offenders is a major concern. If these traumatic histories go unidentified and untreated, it is likely that unresolved subjective distress about these past events may be heightened, resulting in persistent or resurfacing of post-traumatic stress symptoms or increased likelihood of criminal offending including the perpetration of sexual abuse (Leach, Burgess, Holmwood, 2008). Identifying the types of traumatic experiences, particularly sexual abuse histories, experienced by older adult offenders is important to developing comprehensive approaches to assessment, treatment and program planning for older adults in prison (Dawes, 2009; Rikard & Rosenberg, 2007; Shimkus, 2004). While there are various types of traumatic and stressful experiences in the lives of incarcerated older adults, sexual victimization is an area that demands individualized attention, especially given the high rates of sexual victimization histories prior to prison that occur within this population. For instance, traumatic sexual victimization experiences among offenders occur

**1. Introduction** 

