Ethical Issues When Considering Exposure

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Abstract

Exposure-based treatments are arguably among the most successful and efficacious psychological treatments for the anxiety disorders (Deacon and Abramowitz, Journal of Clinical Psychology 60: 429–441, 2004). Unfortunately, despite decades of empirical support from clinical trials, the administration of these treatments in real-world clinical practice continues to lag considerably. Although there are a number of reasons for this gap between research and practice (e.g., lack of competently trained therapists, restrictions and insufficient resources in community clinics), misinformation about exposure-based treatments has emerged as a clear barrier and has led to a “public relations problem” for this effective treatment (Richard and Gloster, Comprehensive handbook of the exposure therapies pp. 409–425, 2007). The public relations problem is based on the erroneous belief that exposure treatment is cruel and unethical because it causes undue harm. The present chapter aims to address the ethical issues involved in considering and implementing exposure, including addressing whether exposure therapy causes harm, clinician competency, supervision and training, ethical issues surrounding public exposures, safety issues, disclosure during treatment planning, and the use of exposure therapy with children.