Challenges to the traditional exposure paradigm: Variability in exposure therapy for contamination fears

Stanford University, Department of Psychology, Jordan Hall, Building 420, Stanford, CA 94305-2130, USA.
Journal of Behavior Therapy and Experimental Psychiatry (Impact Factor: 2.23). 11/2011; 43(2):745-51. DOI: 10.1016/j.jbtep.2011.10.010
Source: PubMed

ABSTRACT Traditional models and methods of exposure therapy utilize a fear hierarchy, whereby patients complete sets of exposures in a graduated manner, with the goal of fear habituation within and between sessions. In the current experiment, we examined whether this typical exposure paradigm was necessary to achieve clinical improvement.
Fifty undergraduate participants scoring in the top quartile of a self-report measure of contamination fears were randomly assigned to one of two groups: blocked and constant exposure (BC Group) and random and variable exposure (RV Group). Both groups completed three weekly sessions of exposure treatment, with subjective and psychophysiological indices of fear recorded throughout. Subjective, behavioral, and psychophysiological dependent measures were evaluated by an independent assessor at pre-treatment (PRE), post-treatment (POST), and two-week follow-up (2WFU).
Both the BC Group and RV Group exhibited decreases in subjective fear from PRE to POST and 2WFU, with no significant differences between groups. Partialing group, greater variability in subjective fear during exposure predicted lower subjective fear at 2WFU.
Despite significant findings for subjective fear, behavioral and psychophysiological findings were limited. Follow-up studies should investigate questions regarding traditional exposure within a clinical group.
These results support the notion that traditional exposure is sufficient, but not necessary, to produce clinical improvement in contamination-related fears. There may be benefits to variability in fear level during exposure, and evaluation of emotion variability during exposure therapy for other anxiety disorders is warranted.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: La asco, además del miedo, es un estado emocional prominente asociado con la evitación de estímulos perturbadores. Aunque la mayoría de la investigación se ha llevado a cabo en relación con el trastorno obsesivo-compulsivo (TOC), datos recientes han implicado la asco en la etiología de trastornos de ansiedad en general. Se ha demostrado que la disminución de la asco es clave para la reducción de los síntomas en personas con TOC. Sin embargo, son escasos los trabajos que exploren si estas intervenciones son eficaces en trastornos de ansiedad en la infancia con componentes prominentes de asco. Este estudio examinó cómo la propensión a la asco en niños con trastornos de ansiedad responde a la terapia cognitivo-conductual (TCC) con énfasis en la exposición. Cuarenta y un niños de 7 a 17 años, con trastornos de ansiedad, fueron evaluados en la propensión a la asco y tratados semanalmente con TCC intensiva. Se encontró que los niveles de asco disminuyeron tras el tratamiento en todos los diagnósticos de trastorno de ansiedad, siendo los niños con TOC primario los que mostraron reducciones significativamente mayores. Se discuten las implicaciones clínicas y sugerencias para futuras investigaciones sobre el tratamiento de la asco en relación con los trastornos de ansiedad infantil.
    International Journal of Clinical and Health Psychology 08/2014; DOI:10.1016/j.ijchp.2014.06.002 · 2.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper is part of a series that explores the application of different therapies to a case of obsessive–compulsive disorder (OCD). It describes the application of an optimizing inhibitory learning approach to exposure with response prevention for OCD. This paper covers the basic theory and applications of the optimizing inhibitory learning approach for OCD and provides a detailed case conceptualization. Specific examples illustrate how to conduct exposure in a manner that enhances inhibitory learning with the goal of enhancing long-term exposure therapy outcomes. The goal of this paper is to familiarize clinicians with the function that inhibitory learning serves in exposure treatment and how to apply the research findings to maximize inhibitory learning in the context of treating OCD.
    Journal of Obsessive-Compulsive and Related Disorders 12/2014; DOI:10.1016/j.jocrd.2014.12.002 · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The future of psychotherapy relies on the dialog with the basic science, being the identification of psychotherapeutifc biomarkers of efficacy a core necessity. Heart rate (HR) is one of the most studied psychophysiological parameters in anxiety disorders.Methods To investigate the impact of cognitive behavior therapy (CBT) on the HR of patients with anxiety disorders, we conducted a meta-analysis and systematic review. Electronic searches were conducted in the ISI/Web of Knowledge, PsychINFO and PubMed/MEDLINE for studies which evaluated HR at least once before and after CBT. Keywords related to anxiety disorders, HR and CBT were used in the search.Results474 studies, of which 47 were selected for the systematic review and 8 for the meta-analysis, were identified. The results provide evidence that CBT significantly decreases the HR of posttraumatic stress disorder patients. In social phobia, obsessive–compulsive disorder and acute stress disorder, the results point in the same direction, although it is still early to attribute the decrease in HR to CBT. In specific phobias, traditional exposure therapy showed greater effect size than exposure with distractors or without psycho-education.LimitationsMost of the randomized trials have not been conducted in accordance with rigorous methodological quality criteria.Conclusions Standardization in the methods used and in treatment protocols, as well as investigations in groups of patients with low physiological reactivity, are necessary in order to reach better conclusions. Notwithstanding these limitations, HR is beginning to emerge as a potential biomarker of efficacy in anxiety disorders.
    Journal of Affective Disorders 10/2014; 172. DOI:10.1016/j.jad.2014.09.058 · 3.71 Impact Factor

Katharina Kircanski