Table of Contents
When is prolonged exposure therapy not recommended?
Though it can be very effective for PTSD, prolonged exposure therapy may not be for everybody. Research suggests PE may not be the best treatment option if you have PTSD along with another mental health condition or complication such as: Borderline personality disorder (BPD) Substance use disorder. PE therapy is effective in helping people overcome PTSD generally. It also helps in reducing related suicidal thinking, excessive guilt, anxiety, and depression. Studies have generally found that PE therapy produces symptom improvement in 80% to 90% of people who do it. Those participants who received CPT demonstrated significantly more improvement in PTSD symptoms, depression, anxiety, guilt, and social adjustment. Forty percent of Veterans who received CPT no longer had PTSD by the end of treatment. The exposure to the feared objects, activities or situations in a safe environment helps reduce fear and decrease avoidance. Exposure therapy has been scientifically demonstrated to be a helpful treatment or treatment component for a range of problems, including: Phobias. Panic Disorder. In exposure therapy, a person is exposed to a situation, event, or object that triggers anxiety, fear, or panic for them. Over a period of time, controlled exposure to a trigger by a trusted person in a safe space can lessen the anxiety or panic. Exposures do not cause harm, but rather set up situations in which the client fears that harm will occur. As with all treatments, however, there are steps a therapist can take to minimize the risk and maximize the benefit of exposure therapy.
Is Prolonged exposure therapy ethical?
If practitioners believe the delivery of exposure is harmful then ethical considerations are warranted, as practitioners must first “take care and do no harm” and “safeguard the welfare and rights” of their patients. (APA, 2010). According to the available evidence, exposure is not inherently harmful. The main negative beliefs about exposure were: a) that arousal reduction strategies would be necessary for clients to tolerate evoked distress; b) that exposure would work poorly for complex cases; c) that exposure addresses superficial symptoms rather than the “root” of the problem; and d) the risk that clients will … Client characteristics most likely to result in exclusion from exposure therapy were comorbid psychosis, emotional fragility, and reluctance to participate in exposure. Unfortunately, the effects of exposure therapy are not permanent, and many people experience a relapse. Exposure therapy can be helpful for social anxiety that is not so extreme that it renders you housebound or facing severe panic attacks in most social or performance situations. If you do find yourself with severe symptoms, exposure therapy practiced on your own may be too difficult. Exposure Therapy is behavioral therapy and therefore falls under the larger term of Behavioral Therapy. Exposure with Response Prevention is a specific type of Exposure Therapy that was designed to treat OCD.
Can exposure therapy backfire?
In fact, it could backfire and make the patient even more frightened of that thing. This is particularly true of exposure therapy, which can backfire badly, but even the tape recordings or constant flow of images involved in flooding can be too much for some patients. During exposure therapy, a therapist guides you through the process of confronting whatever causes you anxiety. There are three techniques one might experience in exposure therapy: in vivo, imaginal and flooding. The main negative beliefs about exposure were: a) that arousal reduction strategies would be necessary for clients to tolerate evoked distress; b) that exposure would work poorly for complex cases; c) that exposure addresses superficial symptoms rather than the “root” of the problem; and d) the risk that clients will … A fear-inducing situation activates a small group of neurons in the amygdala. Exposure therapy silences these fear neurons, causing them to be less active. As a result of this reduced activity, fear responses are alleviated. There are 4 major theories that attempt to explain the psychological mechanisms of exposure therapy: habituation, extinction, emotional processing, and self-efficacy (Table 2). Habituation theory purports that after repeated presentations of a stimulus, the response to that stimulus will decrease. Prolonged Exposure (PE) therapy is an evidence-based psychotherapy for PTSD. The therapy allows you to work through painful memories in a safe and supportive environment. It also allows you to participate in activities you have been avoiding because of the trauma.
What are potential problems with exposure therapy?
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. Regarding psychotherapy, there are a number of potential adverse effects which are discussed, ranging from worsened or novel symptoms, such as symptom substitution [4–8], to dependence from the therapist [9], stigmatisation [10], relationship problems or even separation [11, 12], as well as misuse of alcohol or drugs, … Psychiatric research has several important ethical issues which are different from other medical disciplines. These issues are related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo related, vulnerability, exploitation, operational challenges, among others. In fact, therapy can be harmful, with research showing that, on average, approximately 10 per cent of clients actually get worse after starting therapy. Yet belief in the innocuousness of psychotherapy remains persistent and prevalent. Anywhere from 50 to 75 percent of people who go to therapy report some benefit—but at least 5 percent of clients get worse as a result of treatment. (For people from marginalized groups, harmful outcomes may be even more common.)
Is exposure therapy controversial?
Although sometimes controversial, exposure therapy is still considered one of the most effective psychological techniques for the treatment of phobias and anxiety. Cognitive behavioral therapy (CBT) often incorporates the same systematic desensitization methods used in exposure therapy. CBT also focuses on the specific thoughts and beliefs you have associated with the phobias. Though it can be very effective for PTSD, prolonged exposure therapy may not be for everybody. Research suggests PE may not be the best treatment option if you have PTSD along with another mental health condition or complication such as: Borderline personality disorder (BPD) Substance use disorder. Exposure and response prevention (ERP) therapy is one of the most effective forms of treatment for OCD. Under the guidance of mental health professionals, people who receive ERP therapy can gradually reduce their anxieties and stop the problematic cycle of OCD. Narrative exposure therapy is a treatment for trauma disorders, particularly in individuals suffering from complex and multiple trauma. It has been most frequently used in community settings and with individuals who experienced trauma as result of political, cultural or social forces (such as refugees). EMDR therapy sets up a learning state that allows these experiences to be stored appropriately in the brain. This is the main difference between exposure therapy and EMDR; in other words, the individual is not re-exposed to the trauma.