Abstract
Exposure therapy is highly effective especially in treatment of anxiety. In routine care, however, this effective method is in fact rarely applied. Different reasons might account for this deficit. Exposure therapy confronts therapists with personal and structural challenges that seem to conflict with his usual work routines. Besides logistic challenges such as unpredictable duration of exposure, therapist’s attitudes as well as fears seem to play an important role. Also, there is a lack of knowledge and skills concerning how to apply exposure appropriately and how to deal with the patient’s avoidance tendencies when encountering exposure situations. Further, clear guidelines on how to implement exposure in routine care are lacking.
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References
Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 27(4), 583–600.
Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. Canada Journal of Psychiatry, 51(7), 407–416.
Barlow, D. H. (1990). Long-term outcome for patients with panic disorder treated with cognitive therapy. Journal of Clinical Psychology, 51(12), 17–23. Suppl A.
Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Journal of the American Medical Association, 283, 2529–2536.
Barlow, D. H., Levitt, J. T., & Bufka, L. F. (1999). The dissemination of empirically supported treatments: A view to the future. Behavior Research and Therapy, 37(Suppl 1), 147–162.
Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behavior Research and Therapy, 42, 277–292.
Bichescu, D., Neuner, F., Schauer, M., & Elbert, T. (2007). Narrative exposure therapy of imprisonment-related chronic posttraumatic stress disorder and depression. Behaviour Research and Therapy, 45, 2212–2220.
Böhm, K., Förstner, U., Külz, A., & Voderholzer, U. (2008). Versorgungsrealität der Zwangsstörungen: Werden Expositionsverfahren eingesetzt? Verhaltenstherapie, 18, 18–24.
Borgeat, F., Stankovic, M., Khazaal, Y., Weber Rouget, B., Baumann, M. C., Riquier, F., et al. (2009). Does the form or the amount of exposure make a difference in the Cognitive-Behaviour Therapy treatment of social phobia? The Journal of Nervous and Mental Disease, 197(7), 507–513.
Boulougouris, J. C., & Marks, I. M. (1969). Implosion (flooding) – A new treatment for phobias. British Medicine Journal, 21, 721–723.
Bouton, M. E. (2007). Learning and Behavior: A Contemporary Synthesis. Sunderland, MA: Sinauer Associates Inc.
Cahill, S. P., Foa, E. B., Hembree, E. A., Marshall, R. D., & Nacash, N. (2006). Dissemination of exposure therapy in the treatment of posttraumatic stress disorder. Journal of Traumatic Stress, 19(5), 597–610.
Carey, T. A. (2011). Exposure and reorganization: The what and how of effective psychotherapy. Clinical Psychology Review, 31, 236–248.
Deacon, B. J., Sy, J. T., Lickel, J. J., & Nelson, E. A. (2010). Does the judicious use of safety behaviors improve the efficacy and acceptability of exposure therapy for claustrophobic fear? Journal of Behavior Therapy and Experimental Psychiatry, 41(1), 71–80. Epub 24 Oct 2009.
Einsle, F., Lang, T., Helbig, S., & Wittchen, H. U. (2007). Improving the treatment of panic disorder with agoraphobia: A multicenter randomized controlled therapy study to facilitate understanding the mechanisms of action in exposure therapy. Anxiety Disorders: A Quarterly Report, 4(3), 7–8.
Emmelkamp, P. M. G. (1994). Behavior therapy with adults. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 379–427). New York: Wiley.
Fedoroff, I. C., & Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psychopharmacology, 21(3), 311–324.
Feeny, N. C., Hembree, E. A., & Zoellner, L. A. (2003). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 85–90.
Fischer, G., & Reddemann, L. (2003). Traumaadaptierte tiefenpsychologische fundierte und analytische Psychotherapie. Psychotherapie, 48, 199–209.
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964.
Frank, M., & Fiegenbaum, W. (2000). Wer kommt, wer geht, wer profitiert? Wirkfaktoren der kognitiven Vorbereitung auf eine massierte Konfrontationstherapie bei Angstpatienten. Psychotherapie im Dialog, 3, 61–66.
Franklin, M. E., Abramowitz, J. S., Kozak, M. J., Levitt, J. T., & Foa, E. B. (2000). Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology, 68, 594–602.
Freiheit, S., Vye, C., Swan, R., & Cady, M. (2004). Cognitive-behavioral therapy for anxiety: Is dissemination working? The Behavior Therapist, 27, 25–32.
Gloster, A. T., Wittchen, H. U., Einsle, F., Lang, T., Helbig-Lang, S., Fydrich, T., et al. (2011). Psychological treatment for panic disorder with agoraphobia: A randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT. Journal of Consulting and Clinical Psychology, 79(3), 406–420.
Goisman, R. M., Rogers, M. P., Steketee, G. S., Warshaw, M. G., Cuneo, P., & Keller, M. B. (1993). Utilization of behavioral methods in a multicenter anxiety disorders study. Journal of Clinical Psychiatry, 54, 213–218.
Hand, I. (1993). Verhaltenstherapie für Zwangskranke und deren Angehörige. In H. J. Möller (Ed.), Therapie psychotischer Erkrankungen. Stuttgart: Enke-Verlag.
Hand, I. (2000). Reizkonfrontation. In M. Linden & M. Hautzinger (Eds.), Verhaltenstherapie, Techniken und Methoden (pp. 164–174). Berlin: Springer.
Hautzinger, M. (1997). Exposition und Reizkonfrontation. Psychotherapeut, 42, 119–125.
Hoffmann, N., & Hofmann, B. (2004). Expositionen bei Ängsten und Zwängen. Beltz: Weinheim.
Lindenmeyer, J., Kolling, R., & Zimdsars, P. (2002). Und ewig lockt das Suchtgedächtnis – Expositionsbehandlung bei Alkoholabhängigkeit. In F. Sucht (Ed.), Die Zukunft der Suchtbehandlung – Trends und Prognosen (pp. 140–149). Geesthacht: Neuland-Verlag.
Maercker, A., Zöllner, T., Rabe, S., & Karl, A. (2003). Treating PTSD in motor-vehicle accident victims with exposure-plus cognitive reconstructuring: First results of a RCT with psychometric and neurobiological outcomes. European Psychotherapy, 4, 112–113. Special Edition.
Margraf, J., & Schneider, S. (1992). Therapeutische Beziehung und Therapieerfolg bei Angststörungen. In J. Magraf & J. C. Brengelmann (Eds.), Die Therapeut-Patient-Beziehung in der Verhaltenstherapie (pp. 135–160). München: Röttger.
Marks, I. M. (2002). The maturing of therapy. British Journal of Psychiatry, 180, 200–204.
Marks, I. M., Boulougouris, J. C., & Marset, P. (1971). Flooding versus desensitization in the treatment of phobic patients: A crossover study. British Journal of Psychiatry, 119, 353–375.
Marks, I. M., Kenwright, M., McDonough, M., Whittaker, M., & Mataix-Cols, D. (2004). Saving clinicians’ time by delegating routine aspects of therapy to a computer: A randomized controlled trial in phobia/panic disorder. Psychological Medicine, 34(1), 9–17.
Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behavior Research and Therapy, 4(4), 273–280.
Moulds, M. L., & Nixon, R. D. (2006). In vivo flooding for anxiety disorders: Proposing its utility in the treatment posttraumatic stress disorder. Journal of Anxiety Disordes, 20(4), 498–509.
Neudeck, P. (2005). “Bedrohliche Hasen” – Konfrontationstherapie bei Panikstörung. In P. Neudeck & H. U. Wittchen (Eds.), Konfrontationstherapie bei psychischen Störungen (pp. 17–46). Göttingen: Hogrefe-Verlag.
Neudeck, P. (2007). Reizkonfrontation in der Praxis. Vortrag bei der Eröffnungsveranstaltung der Verhaltenstherapiewoche in Dresden.
Neudeck, P., & Wittchen, H. U. (2005). Konfrontationstherapie bei psychischen Störungen. Göttingen: Hogrefe-Verlag.
Neuner, F. (2008). Stabilisierung vor Konfrontation in der Traumatherapie-Grundregel oder Mythos? Verhaltenstherapie, 18, 109–118.
Powers, M. B., Smits, J. A. J., & Telch, M. J. (2004). Disentangling the effects of safety-behavior utilization and safety-behavior availability during exposure-based treatment: A placebo-controlled trial. Journal of Consulting and Clinical Psychology, 72(3), 448–454.
Rachman, S. (1979). The return of fear. Behaviour Research and Therapy, 17(2), 164–166.
Richard, D. C. S., & Gloster, A. T. (2007). Exposure therapy has a public relations problem: A dearth of litigation amid a wealth of concern. In D. C. S. Richard & D. Lauterbach (Eds.), Handbook of exposure therapy (pp. 409–425). Amsterdam: Academic.
Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008). Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clinical Psychology Review, 28(8), 1310–1325.
Roth, C., Siegl, J., Aufdermauer, N., & Reinecker, H. (2004). Therapie von Angst- und Zwangspatienten in der verhaltenstherapeutischen Praxis. Verhaltenstherapie, 14, 16–21.
Salkovskis, P. M., Clark, D. M., Hackman, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574.
Sanchez-Meca, J., Rosa-Alcazar, A. I., Marin-Martinez, F., & Gomez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis. Clinical Psychology Review, 30, 37–50.
Schulte, D., Künzel, R., Pepping, G., & Schulte-Bahrenberg, T. (1991). Maßgeschneiderte Psychotherapie versus Standardtherapie bei der Behandlung von Phobikern. In D. Schulte (Ed.), Therapeutische Entscheidungen (pp. 15–42). Göttingen: Hogrefe.
Stanley, M. W., & Turner, S. M. (1995). Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behavior Therapy, 26, 163–186.
Thwaites, R., & Freeston, M. H. (2005). Safety-Seeking Behaviours: Fact or Function? How Can We Clinically Differentiate Between Safety Behaviours and Adaptive Coping Strategies Across Anxiety Disorders? Behavioural and Cognitive Psychotherapy, 33, 177–188.
Traue, H. C., & Jerg-Bretzke, L. (2008). Wie verarbeiten Therapeuten die traumatischen Erfahrungen ihrer Klienten? Verhaltenstherapie & Verhaltensmedizin, 29(2), 171–174.
van Oppen, P., van Balkom, A. J. L. M., Smit, J. H., Schuurmans, J., van Dyck, R., & Emmelkamp, P. M. G. (2010). Does the therapy manual or the therapist matter most in treatment of obsessive-compulsive disorder? A randomized controlled trial of exposure with response or ritual prevention in 118 patients. Journal of Clinical Psychiatry, 71(9), 1158–1167.
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Neudeck, P., Einsle, F. (2012). Dissemination of Exposure Therapy in Clinical Practice: How to Handle the Barriers?. In: Neudeck, P., Wittchen, HU. (eds) Exposure Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3342-2_3
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