Exposure In Vivo with and Without Presence of a Therapist: Does It Matter?
Cognitive-behavioral therapies (CBT) are well established as first line treatments for anxiety disorders. Particularly exposure is often discussed as a crucial intervention for promoting therapeutic change. A large number of studies suggests that exposure alone or in combination with other interventions is highly effective in reducing anxiety and anxiety-related avoidance across different anxiety disorders However, the questions of why they are so effective and by which mechanisms of action CBT works remain unclear. One issue that is rarely discussed in this context is the role of the therapist during exposure exercises. This chapter reviews evidence from studies providing data on the relevance of therapist presence during exposure, focussing on anxiety disorders and panic/agoraphobia in particular. In addition, findings from a large multicenter randomized clinical control study on the role of therapist-assisted exposure in vivo for patients with panic disorder and agoraphobia are presented, suggesting that therapists’ presence during in-vivo exposure yields faster results; however, if carefully prepared, self-directed exposure exercises might gain similar effects in the long run.
KeywordsAnxiety Disorder Panic Disorder Relaxation Training Phobic Disorder Active Control Group
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