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Jim Van Os - One of the best experts on this subject based on the ideXlab platform.
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neural responses during extinction learning predict Exposure Therapy outcome in phobia results from a randomized controlled trial
Neuropsychopharmacology, 2020Co-Authors: Iris Lange, Bram Vervliet, Jindra Bakker, Stijn Michielse, Machteld Marcelis, Marieke Wichers, Jim Van Os, Liesbet GoossensAbstract:Extinction learning is assumed to represent a core mechanism underlying Exposure Therapy. Empirical evaluations of this assumption, however, are largely lacking. The current study investigated whether neural activations and self-report outcomes during extinction learning and extinction recall could specifically predict Exposure Therapy response in specific phobia. In this double-blind randomized controlled trial, individuals with spider phobia (N = 45; female/male = 41/4) were on group basis randomly allocated to Exposure Therapy (n = 25; female/male = 24/1) or progressive muscle relaxation (PMR; n = 20; female/male = 17/3). Intervention effects were measured with the Fears of Spiders questionnaire. Participants also underwent a three-day fear conditioning, extinction learning, and extinction recall paradigm during functional magnetic resonance imaging at baseline. Extinction outcomes were self-reported fear and threat expectancy, and neural responses during conditioned stimulus processing and during extinction-related prediction errors (US omissions) in regions of interest (ventromedial prefrontal cortex (vmPFC) and nucleus accumbens). Results showed that Exposure Therapy resulted in stronger symptom reductions than PMR (Cohen’s d = 0.90). Exposure Therapy response was specifically predicted by prediction-error related vmPFC activation during early extinction. There were also indications vmPFC activations during conditioned safety stimulus processing at early extinction predicted Therapy outcome. Neural activations during extinction recall and self-report data did however not predict Therapy outcome. These findings indicate that Exposure Therapy may rely on neural extinction learning processes. Prediction errors are thought to drive the extinction learning process, and prediction error-related vmPFC activation specifically predicted Therapy outcome. The extent to which vmPFC processes safety signals may additionally be predictive of Exposure Therapy response, but the specificity is less clear.
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the predictive value of neural reward processing on Exposure Therapy outcome results from a randomized controlled trial
Progress in Neuro-psychopharmacology & Biological Psychiatry, 2019Co-Authors: Bram Vervliet, Silvia Papalini, Iris Lange, Jindra Bakker, Stijn Michielse, Machteld Marcelis, Marieke Wichers, Jim Van OsAbstract:Abstract Background Exposure is the gold standard treatment for phobic anxiety and is thought to represent the clinical application of extinction learning. Reward sensitivity might however also represent a predictive factor for Exposure Therapy outcome, as this Therapy promotes positive experiences and involves positive comments by the therapist. We hypothesized that high reward sensitivity, as expressed by elevated reward expectancy and reward value, can be associated with better outcome to Exposure Therapy specifically. Methods Forty-four participants with a specific phobia for spiders were included in the current study. Participants were randomly assigned to Exposure Therapy (n = 25) or progressive muscle relaxation (PMR) (n = 19). Treatment outcome was defined as pre- versus post-Therapy phobia symptoms. Before treatment, functional brain responses and behavioral responses (i.e. reaction time and accuracy) during reward anticipation and consumption were assessed with the Monetary Incentive Delay task (MID). Behavioral and neural responses in regions of interest (i.e. nucleus accumbens, ventromedial prefrontal cortex and the ventral tegmental area) as well as across the whole-brain were subsequently regressed on treatment outcomes. Results Exposure Therapy was more effective in reducing phobia symptoms than PMR. Longer reaction times to reward cues and lower activation in the left posterior cingulate cortex during reward consumption were selectively associated with symptoms reductions following Exposure Therapy but not following PMR. Only within the Exposure Therapy group, greater symptom reduction was related to increased activation in the ventrolateral prefrontal cortex during reward anticipation, and decreased activation in the medial prefrontal cortex during reward consumption. Conclusion Results indicate that individual differences in reward sensitivity can specifically predict Exposure Therapy outcome. Although activation in regions of interest were not related to Therapy outcome, regions involved in attentional processing of reward cues were predictive of phobic symptom change following Exposure Therapy but not PMR.
Page L. Anderson - One of the best experts on this subject based on the ideXlab platform.
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Maximizing the impact of virtual reality Exposure Therapy for anxiety disorders.
Current opinion in psychology, 2020Co-Authors: Page L. Anderson, Anthony MolloyAbstract:The impact of virtual reality on access to Exposure Therapy and recovery from anxiety is unrealized, but an argument can be made that this is about to change. Virtual reality Exposure Therapy for anxiety disorders is safe, effective, and, in most cases, as effective as in vivo Exposure Therapy. Clinician attitudes toward virtual reality are now more positive than negative. Moderately priced virtual reality systems are commercially available. Self-guided and fully automated programs for specific fears are new, scalable, potentially game-changing developments. Future research that assesses cultural bias and external validity will position virtual reality Exposure Therapy to address mental health disparities, to realize its potential to increase access to effective treatment for anxiety disorders, and to improve public health.
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A meta-analytic examination of attrition in virtual reality Exposure Therapy for anxiety disorders.
Journal of anxiety disorders, 2018Co-Authors: Amanda A. Benbow, Page L. AndersonAbstract:Abstract A proposed advantage of virtual reality Exposure Therapy for anxiety disorders is that people will be less likely to drop out of treatment prematurely if the treatment involves facing one’s fear in a virtual world rather than the real world, but this has yet to be empirically tested. The present meta-analyses assess the odds of dropout from virtual reality Exposure Therapy compared to in vivo Exposure Therapy, estimate the overall rate of dropout from virtual reality Exposure treatment, and test potential moderating variables. The odds ratio meta-analysis indicated that there was no significant difference in the likelihood of attrition from virtual reality Exposure Therapy relative to in vivo Exposure Therapy. The overall attrition rate for virtual reality Exposure Therapy across 46 studies with a combined sample size of 1057 participants was 16%. This rate is slightly lower than other estimates of dropout from in vivo Therapy and from cognitive-behavioral Therapy for anxiety disorders. Incorporation of between-session intervention (i.e., homework) was identified as a moderator; specifically, inclusion of between-session interventions in the treatment was associated with better retention. Overall, the findings of the present study indicate that virtual reality Exposure and in vivo Exposure Therapy show similar rates of attrition.
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virtual reality Exposure Therapy for social anxiety disorder a randomized controlled trial
Journal of Consulting and Clinical Psychology, 2013Co-Authors: Page L. Anderson, Matthew Price, Shannan M Edwards, Mayowa Obasaju, Stefan K Schmertz, Elana Zimand, Martha R CalamarasAbstract:Objective This is the first randomized trial comparing virtual reality Exposure Therapy to in vivo Exposure for social anxiety disorder. Method Participants with a principal diagnosis of social anxiety disorder who identified public speaking as their primary fear (N = 97) were recruited from the community, resulting in an ethnically diverse sample (M age = 39 years) of mostly women (62%). Participants were randomly assigned to and completed 8 sessions of manualized virtual reality Exposure Therapy, Exposure group Therapy, or wait list. Standardized self-report measures were collected at pretreatment, posttreatment, and 12-month follow-up, and process measures were collected during treatment. A standardized speech task was delivered at pre- and posttreatment, and diagnostic status was reassessed at 3-month follow-up. Results Analysis of covariance showed that, relative to wait list, people completing either active treatment significantly improved on all but one measure (length of speech for Exposure group Therapy and self-reported fear of negative evaluation for virtual reality Exposure Therapy). At 12-month follow-up, people showed significant improvement from pretreatment on all measures. There were no differences between the active treatments on any process or outcome measure at any time, nor differences on achieving partial or full remission. Conclusion Virtual reality Exposure Therapy is effective for treating social fears, and improvement is maintained for 1 year. Virtual reality Exposure Therapy is equally effective as Exposure group Therapy; further research with a larger sample is needed, however, to better control and statistically test differences between the treatments.
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Virtual reality Exposure Therapy and standard (in vivo) Exposure Therapy in the treatment of fear of flying.
Behavior therapy, 2006Co-Authors: Barbara O. Rothbaum, Larry F Hodges, Page L. Anderson, Elana Zimand, Delia Lang, Jeff WilsonAbstract:This controlled clinical trial tested virtual reality Exposure (VRE) Therapy for the fear of flying (FOF), a relatively new and innovative way to do Exposure Therapy, and compared it to standard (in vivo) Exposure Therapy (SE) and a wait list (WL) control with a 6- and 12-month follow-up. Eighty-three participants with FOF were randomly assigned to VRE, SE, or WL. Seventy-five participants, 25 per group, completed the study. Twenty-three WL participants completed randomly assigned treatment following the waiting period. Treatment consisted of 4 sessions of anxiety management training followed either by Exposure to a virtual airplane (VRE) or an actual airplane at the airport (SE) conducted over 6 weeks. Results indicate that VRE was superior to WL on all measures, including willingness to fly on the posttreatment flight (76% for VRE and SE; 20% for WL). VRE and SE were essentially equivalent on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment. Follow-up assessments at 6 and 12 months indicated that treatment gains were maintained, with more than 70% of respondents from both groups reporting continued flying at follow-up. Based on these findings, the use of VRE in the treatment of FOF was supported in this controlled study, suggesting that experiences in the virtual world can change experiences in the real world.
Barbara O. Rothbaum - One of the best experts on this subject based on the ideXlab platform.
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Virtual Reality Exposure Therapy for PTSD
Oxford Medicine Online, 2016Co-Authors: Michael J. Roy, Albert Rizzo, Joann Difede, Barbara O. RothbaumAbstract:Expert treatment guidelines and consensus statements identified imaginal Exposure Therapy as a first-line treatment for posttraumatic stress disorder (PTSD) more than a decade ago. Subsequently, an Institute of Medicine report concluded that cognitive–behavioral Therapy with Exposure Therapy is the only Therapy with sufficient evidence to recommend it for PTSD. Imaginal Exposure has been the most widely used Exposure approach. It requires patients to recall and narrate their traumatic experience repeatedly, in progressively greater detail, both to facilitate the therapeutic processing of related emotions and to decondition the learning cycle of the disorder via a habituation–extinction process. Prolonged Exposure, one of the best-evidenced forms of Exposure Therapy, incorporates psychoeducation, controlled breathing techniques, in vivo Exposure, prolonged imaginal Exposure to traumatic memories, and processing of traumatic material, typically for 9 to 12 Therapy sessions of about 90 minutes each. However, avoidance of reminders of the trauma is a defining feature of PTSD, so it is not surprising that many patients are unwilling or unable to visualize effectively and recount traumatic events repeatedly. Some studies of imaginal Exposure have reported 30% to 50% dropout rates before completion of treatment. Adding to the challenge, some patients have an aversion to “traditional” psychoTherapy as well as to pharmacoTherapy, and may find alternative approaches more appealing. Younger individuals in particular may be attracted to virtual reality-based therapies.
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Virtual reality Exposure Therapy for combat-related PTSD.
Post-Traumatic Stress Disorder, 2009Co-Authors: Judith Cukor, Barbara O. Rothbaum, Michael J. Roy, Joann Difede, Maryrose Gerardi, Stephanie Alley, Christopher Reist, Albert RizzoAbstract:War is one of the most challenging environments that a human can experience. The cognitive, emotional, and physical demands of a combat environment place enormous stress on even the best-prepared military personnel. The OEF-OIF (Operation Enduring Freedom-Operation Iraqi Freedom) combat theatre, with its ubiquitous battlefronts, ambiguous enemy identification, and repeated extended deployments, was anticipated to produce significant numbers of military personnel with post-traumatic stress disorder (PTSD) and other mental disorders. Recent studies are now confirming this expectation. Among the many approaches that have been used to treat PTSD, Exposure Therapy appears to have the best-documented therapeutic efficacy. Such treatment typically involves the graded and repeated imaginal reliving of the traumatic event within the therapeutic setting and is believed to provide a low-threat context in which the patient can begin to therapeutically process trauma-relevant emotions as well as decondition the learning cycle of the disorder via a habituation/extinction process. While the efficacy of imaginal Exposure has been established in multiple studies with diverse trauma populations, many patients are unwilling or unable to effectively visualize the traumatic event. To address this problem, researchers have recently turned to the use of virtual reality (VR) to deliver Exposure Therapy by immersing patients in simulations of trauma-relevant environments that allow for precise control of stimulus conditions. This chapter presents an overview of PTSD Exposure Therapy, a description of VR, and the rationale for how this technology has been applied as a tool to deliver Exposure Therapy along with a brief review of current research. We then provide a description of the current Virtual Iraq Exposure Therapy system and treatment protocol and present initial results from an open clinical trial with active duty military personnel and a brief case study. The chapter concludes with a summary of future directions in which VR technology can be further applied to more comprehensively address a range of PTSD-relevant issues.
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Pharmacological enhancement of learning in Exposure Therapy
Handbook of Exposure Therapies, 2007Co-Authors: Kerry J. Ressler, Michael Davis, Barbara O. RothbaumAbstract:Publisher Summary PharmacoTherapy has been thought to be contraindicated in combination with behavior Therapy for the treatment of many anxiety disorders, particularly phobias and performance anxiety, because it was thought to interfere with the effectiveness of Exposure Therapy. Recent progress has been made in understanding the learning processes that underlie a potential mechanism of Exposure Therapy—namely, extinction. “Extinction” refers to the decrement in a conditioned response (CR) over time following the repeated Exposure to a conditioned stimulus (CS) in the absence of the expected unconditioned stimulus (UCS). More recent work has focused on extinction of fear behaviors in addition to the extinction of appetitive behaviors. Experimentally conditioned fear has been studied in both animals and humans as a useful model of anxiety disorders. With fear conditioning, a learned fear response is established following the pairing of an aversive UCS to a neutral CS. During extinction, repeated presentation of the CS in the absence of the UCS results in the loss of the conditioned fear to the CS. From an operational perspective, extinction may thus be defined as “a reduction in the strength or probability of a conditioned fear response as a consequence of repeated presentation of the CS in the absence of the UCS.”
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Virtual reality Exposure Therapy and standard (in vivo) Exposure Therapy in the treatment of fear of flying.
Behavior therapy, 2006Co-Authors: Barbara O. Rothbaum, Larry F Hodges, Page L. Anderson, Elana Zimand, Delia Lang, Jeff WilsonAbstract:This controlled clinical trial tested virtual reality Exposure (VRE) Therapy for the fear of flying (FOF), a relatively new and innovative way to do Exposure Therapy, and compared it to standard (in vivo) Exposure Therapy (SE) and a wait list (WL) control with a 6- and 12-month follow-up. Eighty-three participants with FOF were randomly assigned to VRE, SE, or WL. Seventy-five participants, 25 per group, completed the study. Twenty-three WL participants completed randomly assigned treatment following the waiting period. Treatment consisted of 4 sessions of anxiety management training followed either by Exposure to a virtual airplane (VRE) or an actual airplane at the airport (SE) conducted over 6 weeks. Results indicate that VRE was superior to WL on all measures, including willingness to fly on the posttreatment flight (76% for VRE and SE; 20% for WL). VRE and SE were essentially equivalent on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment. Follow-up assessments at 6 and 12 months indicated that treatment gains were maintained, with more than 70% of respondents from both groups reporting continued flying at follow-up. Based on these findings, the use of VRE in the treatment of FOF was supported in this controlled study, suggesting that experiences in the virtual world can change experiences in the real world.
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Exposure Therapy for posttraumatic stress disorder.
American journal of psychotherapy, 2002Co-Authors: Barbara O. Rothbaum, Ann C. SchwartzAbstract:Exposure Therapy is a well-established treatment for Posttraumatic Stress Disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Exposure methods include confrontation with frightening, yet realistically safe, stimuli that continues until anxiety is reduced. A review of the literature on Exposure Therapy indicates strong support from well-controlled studies applied across trauma populations. However, there are many misconceptions about Exposure Therapy that may interfere with its widespread use. These myths and clinical guidelines are addressed. It is concluded that Exposure Therapy is a safe and effective treatment for PTSD when applied as directed by experienced therapists.
Stefan G. Hofmann - One of the best experts on this subject based on the ideXlab platform.
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Neuroenhancement of Exposure Therapy in Anxiety Disorders
Neuroscience, 2015Co-Authors: Stefan G. Hofmann, Elizabeth Mundy, Joshua CurtissAbstract:Although Exposure-based treatments and anxiolytic medications are more effective than placebo for treating anxiety disorders, there is still considerable room for further improvement. Interestingly, combining these two modalities is usually not more effective than the monotherapies. Recent translational research has identified a number of novel approaches for treating anxiety disorders using agents that serve as neuroenhancers (also known as cognitive enhancers). Several of these agents have been studied to determine their efficacy at improving treatment outcome for patients with anxiety and other psychiatric disorders. In this review, we examine d-cycloserine, yohimbine, cortisol, catecholamines, oxytocin, modafinil, and nutrients such as caffeine and amino fatty acids as potential neuroenhancers. Of these agents, d-cycloserine shows the most promise as an effective neuroenhancer for extinction learning and Exposure Therapy. Yet, the optimal dosing and dose timing for drug administration remains uncertain. There is partial support for cortisol, catecholamines, yohimbine and oxytocin for improving extinction learning and Exposure Therapy. There is less evidence to indicate that modafinil and nutrients such as caffeine and amino fatty acids are effective neuroenhancers. More research is needed to determine their long term efficacy and clinical utility of these agents.
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A randomized placebo-controlled trial of d-cycloserine and Exposure Therapy for posttraumatic stress disorder
Journal of psychiatric research, 2012Co-Authors: Brett T. Litz, Michael W. Otto, Kristalyn Salters-pedneault, Maria M. Steenkamp, John A. Hermos, Richard A. Bryant, Stefan G. HofmannAbstract:D-Cycloserine (DCS) is a partial NMDA receptor agonist that has been shown to enhance therapeutic response to Exposure-based treatments for anxiety disorders, but has not been tested in the treatment of combat-related posttraumatic stress disorder (PTSD). The aim of this randomized, double-blind, placebo-controlled trial was to determine whether DCS augments Exposure Therapy for PTSD in veterans returning from Iraq and Afghanistan and to test whether a brief six-session course of Exposure Therapy could effectively reduce PTSD symptoms in returning veterans. In contrast to previous trials using DCS to enhance Exposure Therapy, results indicated that veterans in the Exposure Therapy plus DCS condition experienced significantly less symptom reduction than those in the Exposure Therapy plus placebo condition over the course of the treatment. Possible reasons for why DCS was associated with poorer outcome are discussed. Clinicaltrials.gov Registry #: NCT00371176; A Placebo-Controlled Trail of D-Cycloserine and Exposure Therapy for Combat-PTSD; www.clinicaltrials.gov/ct2/results?term=NCT00371176.
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cognitive processes during fear acquisition and extinction in animals and humans implications for Exposure Therapy of anxiety disorders
Clinical Psychology Review, 2008Co-Authors: Stefan G. HofmannAbstract:Anxiety disorders are highly prevalent. Fear conditioning and extinction learning in animals often serve as simple models of fear acquisition and Exposure Therapy of anxiety disorders in humans. This article reviews the empirical and theoretical literature on cognitive processes in fear acquisition, extinction, and Exposure Therapy. It is concluded that Exposure Therapy is a form of cognitive intervention that specifically changes the expectancy of harm. Implications for Therapy research are discussed.
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Augmentation of Exposure Therapy With D-Cycloserine for Social Anxiety Disorder
Archives of general psychiatry, 2006Co-Authors: Stefan G. Hofmann, Jasper A. J. Smits, Alicia E. Meuret, Naomi M. Simon, Mark H. Pollack, Katherine Eisenmenger, Michael Shiekh, Michael W. OttoAbstract:Context:Social anxiety disorder (SAD) is common and debilitating.AlthoughExposureTherapyisoneofthemost effective forms of psychoTherapy for this disorder, many patients remain symptomatic. Fear reduction in Exposure Therapy is similar to extinction learning, and early clinical data with specific phobias suggest that the treatment effects of Exposure Therapy for SAD may be enhanced with D-cycloserine, an agonist at the glutamatergic N-methyl-D-aspartate receptor.
Brett J Deacon - One of the best experts on this subject based on the ideXlab platform.
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Therapist beliefs about Exposure Therapy implementation
The Cognitive Behaviour Therapist, 2020Co-Authors: Johanna M. Meyer, Peter J. Kelly, Brett J DeaconAbstract:Exposure Therapy is consistently indicated as the first-line treatment for anxiety-related disorders. Unfortunately, therapists often deliver Exposure Therapy in an overly cautious, less effective manner, characterized by using their own ‘therapist safety behaviours’. Cognitive behavioural models postulate that beliefs about therapist safety behaviours are related to their use; however, little is known about the beliefs therapists hold regarding therapist safety behaviour use. The present study aimed to identify the beliefs Exposure therapists have regarding the necessity of therapist safety behaviours and to examine the relationship between this construct and therapist safety behaviour use. Australian psychologists (n = 98) completed an online survey that included existing measures of therapist safety behaviour use, therapist negative beliefs about Exposure Therapy, likelihood to exclude anxious clients from Exposure Therapy, and use of intensifying Exposure techniques. Participants also completed the Exposure Implementation Beliefs Scale (EIBS), a measure created for the present study which assesses beliefs regarding the necessity of therapist safety behaviours. Beliefs about the necessity of therapist safety behaviours – particularly in protecting the client – significantly predicted therapist safety behaviour use. Findings suggest that Exposure Therapy training media should aim to decrease therapist safety behaviour use by addressing beliefs about the necessity of therapist safety behaviours, especially in protecting the client.Key learning aims(1) To understand what therapist safety behaviours are in the context of Exposure Therapy.(2) To identify common beliefs about therapist safety behaviours.(3) To understand how beliefs about therapist safety behaviours relate to therapist safety behaviour use.(4) To consider how Exposure Therapy delivery may be improved by modifying beliefs about therapist safety behaviours.(5) To explore how beliefs about therapist safety behaviours may be modified to reduce therapist safety behaviour use.
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Why do clinicians exclude anxious clients from Exposure Therapy
Behaviour research and therapy, 2014Co-Authors: Johanna M. Meyer, Nicholas R. Farrell, Joshua J. Kemp, Shannon M. Blakey, Brett J DeaconAbstract:Despite research demonstrating the effectiveness of Exposure Therapy for pathological anxiety, this treatment is underutilized by clinicians. Anecdotal evidence and clinical experience suggest that therapists who possess reservations about Exposure Therapy tend to exclude clients from this treatment based on client characteristics believed to predict worse response. When exceptions are made based on characteristics that do not reliably predict poor outcomes, clients face the opportunity cost associated with investment in less effective treatments. The present investigation assessed therapists' likelihood of excluding clients from Exposure due to different client and therapist characteristics. Exposure therapists (N = 182) completed an online survey that included the Therapist Beliefs about Exposure Scale, Anxiety Sensitivity Index-3, and the Broken Leg Exception Scale (BLES), a novel measure assessing the likelihood of excluding clients from Exposure based on 25 different client characteristics. The BLES demonstrated good psychometric properties. Client characteristics most likely to result in exclusion from Exposure Therapy were comorbid psychosis, emotional fragility, and reluctance to participate in Exposure. Greater likelihood of excluding clients from Exposure was associated with higher therapist anxiety sensitivity and endorsement of negative beliefs about Exposure Therapy. Clinical and training implications of these findings are discussed.
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assessing therapist reservations about Exposure Therapy for anxiety disorders the therapist beliefs about Exposure scale
Journal of Anxiety Disorders, 2013Co-Authors: Brett J Deacon, Nicholas R. Farrell, Laura J. Dixon, Joshua J. Kemp, Annie R Zhang, Patrick B McgrathAbstract:a b s t r a c t Exposure Therapy is underutilized in the treatment of pathological anxiety and is often delivered in a suboptimal manner. Negative beliefs about Exposure appear common among therapists and may pose a barrier to its dissemination. To permit reliable and valid assessment of such beliefs, we constructed the 21-item Therapist Beliefs about Exposure Scale (TBES) and examined its reliability and validity in three samples of practicing clinicians. The TBES demonstrated a clear single-factor structure, excellent inter- nal consistency (˛s = .90-.96), and exceptionally high six-month test-retest reliability (r = .89). Negative beliefs about Exposure Therapy were associated with therapist demographic characteristics, negative reactions to a series of Exposure Therapy case vignettes, and the cautious delivery of Exposure Therapy in the treatment of a hypothetical client with obsessive-compulsive disorder. Lastly, TBES scores decreased markedly following a didactic workshop on Exposure Therapy. The present findings support the reliability and validity of the TBES.
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Theory-based training strategies for modifying practitioner concerns about Exposure Therapy
Journal of anxiety disorders, 2013Co-Authors: Nicholas R. Farrell, Brett J Deacon, Laura J. Dixon, James J. LickelAbstract:Despite the well-established efficacy of Exposure Therapy in the treatment of pathological anxiety, many therapists believe this treatment carries an unacceptably high risk for harm, is intolerable for patients, and poses a number of ethical quandaries. These beliefs have been shown to account for two related problems: (a) underutilization of Exposure Therapy, and (b) overly cautious and suboptimal delivery the treatment, which likely attenuates treatment outcomes. At present, there is little guidance for those who train Exposure therapists to address these concerns. This article reviews therapist negative beliefs about Exposure Therapy and discusses their modification based on findings from social and cognitive psychology pertinent to belief change, including dual-processing in reasoning, the need for cognition and affect, and attitude inoculation. A number of strategies are offered for augmenting training in Exposure Therapy in order to promote positive beliefs about the treatment. These strategies involve: (a) therapists engaging in simulated Exposure Therapy exercises and presenting arguments in defense of Exposure's safety, tolerability, and ethicality, and (b) training therapists using emotion-based appeals (e.g., case examples) to supplement research findings. Directions for future research on practitioner concerns about Exposure Therapy are discussed.
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The Ethics of Exposure Therapy for Anxiety Disorders
Exposure Therapy, 2012Co-Authors: Brett J DeaconAbstract:Exposure-based cognitive-behavioral Therapy (CBT) is the most empirically supported psychological treatment for the anxiety disorders. However, few therapists provide Exposure Therapy to their clients. Although the poor dissemination of Exposure-based treatments may be partially attributable to a shortage of suitably trained therapists, Exposure Therapy also suffers from a “public relations problem” among practitioners who believe it to be intolerable, unsafe, and unethical. This chapter provides an overview of ethical issues and considerations relevant to the use of Exposure Therapy. It is argued that Exposure Therapy may be delivered in an ethical, tolerable, and safe manner by therapists who take reasonable steps to create a professional context. Specific strategies for avoiding potential ethical conflicts in the use of Exposure-based treatments are discussed.
