Exposure Treatments for Anxiety Disorders
A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice
Exposure Treatments for Anxiety Disorders is a unique volume, as it draws together the latest research on the rapidly-expanding field of anxiety disorders and illuminates how to correctly apply the proven methodology of behavioral therapy techniques to the variety of situations that face today's mental health professional. That said, cognitive therapy has in the last 10 years gotten increased attention as an alternative to behavior therapy in the treatment of anxiety disorders. But while it is gaining acceptance among practitioners, cognitive therapy has yet to illustrate substantial benefits above those that behavior therapy can already provide. In light of the aforementioned, coupled with the pressure many practitioners feel from managed care paradigms and shrinking healthcare coverage, this book will be a welcome resource allowing for increased clarity of action, accountability, and ultimately, positive client outcome. Each chapter is designed to address pivotal aspects in the assessment, formulation and diagnosis, and treatment of anxiety disorders, to a sufficient depth that the generalist practitioner will be comfortable using this book as a guide when working with the anxiety disordered client.
Table of Contents
Hersen, Foreword. Anxiety Phenomenon - Nature and Disorder. Description of Anxiety as a Normal Phenomenon and in Anxiety Disorders. Clinical Implications and Picture of Anxiety Disorders. Issues in Diagnosis of Anxiety. Epidemiology and Etiology of Anxiety Disorders. Course and Prognosis of Anxiety Disorders. Description of the Behavioral Treatment Strategy - Exposure. Exposure: A Definition and Explication. Escape and Avoidance: Maintaining Anxiety. Role of Exposure in Reducing Anxiety Responses. Habituation and Extinction: Ending Inaccurate Anxiety Responses. Processing Connectionist Neural Network (PDP-CNN) Models. Types of Exposure. In-vivo. In-imagination and Virtual Reality. Loop-tape, Disaster Scripts, Pictures, and Other Methods. Interoceptive versus Naturalistic. Therapist-assisted, and Partner-assisted versus Self-directed. Hierarchical versus Flooding. Single Session Treatment. Artificial Settings, Natural Environment and Ecological Relevance. Research Basis of the Phenomenon and its Treatment. Empirical Basis for Exposure with Anxiety Disorders. Empirically-supported, Empirically-validated, and Evidence-based Practice. Local Clinical Scientist, Educated Eclectic Empiricist, and Scientific (Evidence-based) Practice. Clinical Cases - Illustration of Assessment, Formulation and Treatment. Assessment Procedures for Anxiety Disorders. Broad-band Options. ADIS-IV. SCID. Disorder-specific, and Other, Narrow-band Procedures. Central Importance of Case Formulation and Conceptualization. Manuals, their Modular Use, and Manualized Treatment Strategies. Case Illustrations. Panic Disorder with Agoraphobia. Specific Phobia. Social Phobia. Obsessive-compulsive Disorder. Posttraumatic Stress Disorder. Generalized Anxiety Disorder. Health Anxiety. Trichotillomania. Compulsive Hoarding. Complicating Factors in Anxiety Treatment - Obstacles and Solutions. Medical and Substance Induced Anxiety. Axis II Presentations. Poor Insight, Delusional Beliefs, and Overvalued Ideation. Bipolar Disorder and Major Depressive Disorder. Motivational Interviewing and Motivation Enhancement Treatment. Generalizability, Transportation of Gains, and Ecological Relevance. Enhancing Collaboration: Utilization of Para-Professionals and Mentors. Legal Issues: PTSD, Litigation and Treatment Response.
Managed Care Considerations: Friend or Foe? Implications for Solutions: Systematic Use of Single-case Research, Enhanced Case Formulation, Functional Analysis, and Failure Analysis in Training and Practice. Maintenance and Follow-up Strategies - Future and Continued Progress. When to Stop Treatment: Issues of Progress, Timing, and Acquired Skills. How to Stop Treatment: Generalization Training. Stop Regression Towards Mean: Relapse Prevention Training and Return of Fear. Reaffirmation of Progress and Reminder of Principles: Booster Sessions. Continued Involvement: Mentoring Program. Professional and Public Persona - Conclusions and Future Directions for Disseminating and Increasing Use of Exposure Treatments. Professional and Public Perceptions. Hedonism 101: Desire and Drive to Feel Good, Not Bad.
Research-practice Gap. Future Directions and Recommendations. Appendix A: Manuals and Other Resources. Appendix B: Narrow-band Instruments. Appendix C: Clinical Significance, Reliable Change and Recovered Status Worksheet. References.
Johan Rosqvist, Psy.D., is Assistant Professor of the Counseling Psychology Program at the School of Professional Psychology of Pacific University.