Abstract
The prevalence of anxiety disorders is among the highest of all psychiatric diagnoses, with a lifetime morbidity rate of nearly 30 %. Given this prevalence, it is important to identify effective and ethical treatments. Empirically based treatments considered efficacious for anxiety disorders largely include cognitive behavioral treatments (CBT) , and among these, exposure therapy stands out as both useful and potentially concerning. Ethical concerns regarding exposure treatment for anxiety include fears of symptom exacerbation, high treatment dropout rates, client safety concerns, and the blurring of boundary lines between therapists and clients. Although concerns have been raised regarding exposure treatment generally, specific concerns have been raised related to the treatment of post-traumatic stress disorder (PTSD) given the vulnerable nature of the population. Despite these concerns, research largely supports both the efficacy and safety of exposure therapy. The present chapter provides a review of extant literature highlighting potential ethical concerns, research regarding the raised concerns, and suggestions for minimizing risk in treatment.
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References
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Arlington, Virginia
Barrera TL, Mott JM, Hofstein RF et al (2013) A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder. Clin Psychol Rev 33(1):24–32. doi:10.1016/j.cpr.2012.09.005
Baxter AJ, Scott KM, Vos T et al (2013) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43(5):897–910. doi:10.1017/S003329171200147X
Beck JS (2011) Cognitive behavior therapy: basics and beyond, 2nd edn. New York
Cahill SP, Foa EB, Hembree EA et al (2006) Dissemination of exposure therapy in the treatment of posttraumatic stress disorder. J Trauma Stress 19(5):597–610. doi:10.1002/jts
Castillo DT, C’de Baca J, Qualls C et al (2012) Group exposure therapy treatment for post-traumatic stress disorder in female veterans. Mil Med 177(12):1486–1491. doi:10.7205/MILMED-D-12-00186
Chambless DL, Baker MJ, Baucom DH et al (1998) Update on empirically validated therapies. II. Clin Psychologist 51(1):3–16
Deacon BJ, Farrell NR (2013) Therapist barriers to the dissemination of exposure therapy. In: Storch EA, McKay D (eds) Handbook of treating variants and complications in anxiety disorders. New York
Deacon BJ, Farrell NR, Kemp JJ et al (2013) Assessing therapist reservations about exposure therapy for anxiety disorders: The therapist beliefs about exposure scale. J Anxiety Disord 27(8):772–780. doi:10.1016/j.janxdis.2013.04.006
Farrell NR, Deacon BJ, Dixon LJ et al (2013a) Theory-based training strategies for modifying practitioner concerns about exposure therapy. J Anxiety Disord 27(8):781–787. doi:10.1016/j.janxdis.2013.09.003
Farrell NR, Deacon BJ, Kemp JJ et al (2013b) Do negative beliefs about exposure therapy cause its suboptimal delivery? An experimental investigation. J Anxiety Disord 27(8):764–771. doi:10.1016/j.janxdis.2013.03.007
Foa EB, Zoellner LA, Feeny NC et al (2002) Does imaginal exposure exacerbate PTSD symptoms? J Consult Clin Psych 70(4):1022–1028. doi:10.1037//0022-006X.70.4.1022
Frye LA, Spates CR (2012) Prolonged exposure, mindfulness, and emotion regulation for the treatment of PTSD. Clin Case Stud 11(3):184–200. doi:10.1177/1534650112446850
Gillihan SJ, Hembree EA, Foa EB (2012) Behavior therapy: exposure therapy for anxiety disorders. In: Dewan MJ, Steenbarger BN, Greenberg RP (eds) The art and science of brief psychotherapies: an illustrated guide, 2nd edn. Arlington, Virginia
Glenn D, Golinelli D, Rose RD et al (2013) Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement. J Consult Clin Psych 81(4):639–649. doi:10.1037/a0033403
Goisman RM, Gutheil TG (1992) Risk management in the practice of behavior therapy: boundaries and behavior. Am J Psychother 46(4):532–543
Goisman RM, Warshaw MG, Keller MB (1999) Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder, and social phobia, 1991–1996. Am J Psychiat 156(11):1819–1821
Hembree EA, Foa EB, Dorfan NM et al (2003) Do patients drop out prematurely from exposure therapy for PTSD? J Trauma Stress 16(6):555–562. doi:10.1023/B:JOTS.0000004078.93012.7d
Hoffman DL, Dukes EM, Wittchen H-U (2008) Human and economic burden of generalized anxiety disorder. Depress Anxiety 25(1):72–90. doi:10.1002/da
James A, Cowdrey F, James C (2012) Anxiety disorders in children and adolescents. In: Sturmey P, Hersen M (eds) Handbook of evidence-based practice in clinical psychology, Vol 1: child and adolescent disorders. Hoboken, New Jersey
Karlin BE, Ruzek JI, Chard KM et al (2010) Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. J Trauma Stress 23(6):663–673. doi:10.1002/jts
Kehle-Forbes SM, Polusny MA, MacDonald R et al (2013) A systematic review of the efficacy of adding nonexposure components to exposure therapy for posttraumatic stress disorder. Psychol Traum: Theor Res Pract Policy 5(4):317–322. doi:10.1037/a0030040
Kessler RC, Greenberg PE (2002) The economic burden of anxiety and stress disorders. Neuropsychopharmacol: Fifth Gener Prog 67:981–992
Kessler RC, Petukhova M, Sampson NA et al (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Meth Psych Res 21(3):169–184. doi:10.1002/mpr
McManus F, Grey N, Shafran R (2008) Cognitive therapy for anxiety disorders: current status and future challenges. Behav Cogn Psychoth 36(06):695. doi:10.1017/S135246580800475X
Mendlowicz MV, Stein MB (2000) Quality of life in individuals with anxiety disorders. Am J Psychiat 157(5):669–682. doi:10.1176/appi.ajp.157.5.669
Mott JM, Sutherland RJ, Williams W et al (2013) Patient perspectives on the effectiveness and tolerability of group-based exposure therapy for posttraumatic stress disorder: preliminary self-report findings from 20 veterans. Psychol Traum: Theor Res Pract Policy 5(5):453–461
Muller KL, Schultz LT (2012) “Selling” exposure therapy. Prag Case Stud Psychother 8(4):288–295
Neuner F (2012) Safety first? Trauma exposure in PTSD. In: Neudeck P, Wittchen H-U (eds) Exposure therapy: rethinking the model—refining the method. New York
Olatunji BO, Cisler JM, Tolin DF (2010) A meta-analysis of the influence of comorbidity on treatment outcome in the anxiety disorders. Clin Psychol Rev 30(6):642–654. doi:10.1016/j.cpr.2010.04.008
Olatunji BO, Deacon BJ, Abramowitz JS (2009) The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cogn Behav Pract 16(2):172–180
Rauch SA, Eftekhari A, Ruzek JI (2012) Review of exposure therapy: a gold standard for PTSD treatment. J Rehabil Res Dev 49(5):679–687
Sburlati ES, Schniering CA, Lyneham HJ et al (2011) A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. Clin Child Fam Psych 14(1):89–109. doi:10.1007/s10567-011-0083-6
Schare ML, Wyatt KP (2013) On the evolving nature of exposure therapy. Behav Mod 37(2):243–256. doi:10.1177/0145445513477421
Tarrier N, Pilgrim H, Sommerfield C et al (1999) A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. J Consult Clin Psych 67(1):13–18
van Minnen A, Harned MS, Zoellner L et al (2012) Examining potential contraindications for prolonged exposure therapy for PTSD. Eur J Psychotraumatol 3:1–14
van Minnen A, Hendriks L, Olff M (2010) When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behav Res Ther 48(4):312–320. doi:10.1016/j.brat.2009.12.003
Wolitzky-Taylor KB, Viar-Paxton MA, Olatunji BO (2012) Ethical issues when considering exposure. In: Davis TEI, Ollendick TH, Ost LG (eds) Intensive one-session treatment of specific phobia. New York
Woody SR, Weisz J, McLean C (2005) Empirically supported treatments: 10 years later. Clin Psychologist 58(4):5–11
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Altis, K.L., Elwood, L.S., Olatunji, B.O. (2014). Ethical Issues and Ethical Therapy Associated with Anxiety Disorders. In: Lee, G., Illes, J., Ohl, F. (eds) Ethical Issues in Behavioral Neuroscience. Current Topics in Behavioral Neurosciences, vol 19. Springer, Berlin, Heidelberg. https://doi.org/10.1007/7854_2014_340
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DOI: https://doi.org/10.1007/7854_2014_340
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