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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behaviour Therapy, 27, 583–600.
Abramowitz, J. S. (2006). Understanding and treatment obsessive-compulsive disorder: A cognitive-behavioral approach. Mahwah: Erlbaum.
American Psychological Association (APA). (2002). Ethical principles of psychologists and code of conduct. http://www.apa.org/ethics/. Accessed 9 Aug 2010.
Barnett, J. E., Lazarus, A. A., Vasquez, M., Moorehead-Slaughter, O., & Johnson, W. B. (2007). Boundary issues and multiple relationships: Fantasy and reality. Professional Psychology: Research and Practice, 38, 401–410.
Bouton, M. E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52, 976–986.
Brown, A., Deacon, B. J., Abramowitz, J. S., Dammann, J., & Whiteside, S. P. (2007). Parents’ perceptions of pharmacological and cognitive-behavioral treatments for childhood anxiety disorders. Behavior Research and Therapy, 45, 819–828.
Cash, T. F., & Hrabosky, J. I. (2003). The effects of psychoeducation and self-monitoring in a cognitive-behavioral program for body-image improvement. Eating Disorders: The Journal of Treatment & Prevention, 11, 255–270.
Cox, B. J., Fergus, K. D., & Swinson, R. P. (1994). Patient satisfaction with behavioral treatments for panic disorder with agoraphobia. Journal of Anxiety Disorders, 8, 193–206.
Craske, M. G., Dirk, H., & Vansteenwegen, D. (2006). Fear and learning: From basic processes to clinical implications. Washington: American Psychological Association.
Craske, M. G., Kircanski, K., Zelikowski, M., Mystowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5–27.
Deacon, B. J., & Abramowitz, J. S. (2004). Cognitive and behavioral treatment for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60, 429–441.
Deacon, B. J., & Abramowitz, J. S. (2005). Patients’ perceptions of pharmacological and cognitive-based treatments for anxiety disorders. Behavior Therapy, 36, 139–145.
Feeny, N., Hembree, E., & Zoellner, L. (2003). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 85–90.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A., & Alverez-Conrad, J. (2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology, 70, 1022–1028.
Gabbard, G. O. (1994). Teetering on the precipice: A commentary on Lazarus’s “How certain boundaries and ethics diminish therapeutic effectiveness”. Ethics & Behavior, 4, 283–286.
Harris, S. R. (2002). Dual relationships and university counseling center environments. In A. A. Lazarus & O. Zur (Eds.), Dual relationships and psychotherapy (pp. 337–347). New York: Springer.
Hembree, E. A., Foa, E. B., Dorfan, N. M., Street, G. P., Kowalski, J., & Tu, X. (2003). Do patients dropout prematurely from exposure therapy for PTSD? Journal of Traumatic Stress, 16, 552–562.
Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632.
Kamphuis, J. H., & Telch, M. J. (2000). Effects of distraction and guided threat reappraisal on fear reduction during exposure-based treatments for specific fears. Behaviour Research and Therapy, 38, 1163–1181.
Lazarus, A. A. (1994). How certain boundaries and ethics diminish therapeutic effectiveness. Ethics & Behavior, 4, 255–261.
Lazarus, A. A. (1998). How do you like these boundaries? The Clinical Psychologist, 51, 22–25.
Lazarus, A. A. (2007). Restrictive draconian views must be vigorously challenged. Professional Psychology: Research and Practice, 38, 405–406.
Mineka, S., Mystkowski, J. L., Hladek, D., & Rodriguez, B. I. (1999). The effects of changing contexts on return of fear following exposure therapy for spider fear. Journal of Consulting and Clinical Psychology, 67, 599–604.
Norton, G. R., Allen, G. E., & Hilton, J. (1983). The social validity of treatments for agoraphobia. Behaviour Research and Therapy, 21, 393–399.
Öst, L. G., Stridh, B. M., & Wolf, M. (1998). A clinical study of spider phobia: Prediction of outcome after self-help and therapist-directed treatments. Behaviour Research and Therapy, 36, 17–35.
Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16, 172–180.
Pope, K. S., & Keith-Spiegel, P. (2008). A practical approach to boundaries in psychotherapy: Making decisions, by passing blunders, and mending fences. Journal of Clinical Psychology: In Session, 64, 1–15.
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, 448–454.
Prochaska, J., & Norcross, J. (1999). Systems of psychotherapy: A transtheoretical analysis (4th ed.). Pacific Grove: Brooks/Cole.
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.), Comprehensive handbook of the exposure therapies (pp. 409–425). New York: Academic Press.
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.
Sloan, T., & Telch, M. J. (2002). The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: An experimental investigation. Behaviour Research and Therapy, 20, 235–251.
Stewart, S. H., & Watt, M. C. (2008). Introduction to the special issues on interoceptive exposure in the treatment of anxiety and related disorders: Novel applications and mechanisms of actions. Journal of Cognitive Psychotherapy, 22, 291–302.
Wolitzky, K. B., & Telch, M. J. (2009). Augmenting in vivo exposure with fear antagonistic actions: A preliminary test. Behavior Therapy, 40, 57–71.
Zur, O. (2001). Out of-office experience: When crossing office boundaries and engaging in dual relationships are clinically beneficial and ethically sound. The Independent Practitioner, 21, 96–98.
Zur, O. (2005). The dumbing down of psychology: Faulty beliefs about boundary crossing and dual relationships. In R. H. Wright & N. A. Cummings (Eds.), Destructive trends in mental health: The well-intentional path to harm (pp. 252–282). New York: Taylor & Francis Group.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Wolitzky-Taylor, K.B., Viar-Paxton, M.A., Olatunji, B.O. (2012). Ethical Issues When Considering Exposure. In: Davis III, T., Ollendick, T., Öst, LG. (eds) Intensive One-Session Treatment of Specific Phobias. Autism and Child Psychopathology Series. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3253-1_10
Download citation
DOI: https://doi.org/10.1007/978-1-4614-3253-1_10
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-3252-4
Online ISBN: 978-1-4614-3253-1
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)