Offering Your Anxious Clients the Standard of Care

Offering Your Anxious Clients the Standard of Care

                              Offering Your Anxious Clients the ‘Gold Standard’ of Care

         Exposure therapy has long been supported as the ‘gold standard’ treatment for anxiety disorders. Despite strong empirical support for the effectiveness of exposure therapy, many therapists underutilize exposure therapy in the treatment of anxiety and related disorders.

Studies examining why clinicians tend to underutilize exposure therapy indicate several important factors.

These factors include:

  • Lack of appropriate training or supervision to learn these methods.
  • Holding negative or inaccurate perceptions about exposure therapy and when it is contraindicated.
  • Clinician belief that clients will reject the treatment, drop out of treatment, or that exposure therapy may cause harm to clients by asking them to engage with aversive experiences.

In summary, clinicians tend to underutilize the ‘gold standard’ of treatments for anxiety and related disorders because they tend to have little training or experience with it. A key factor in alleviating these issues is offering more training and consultation on utilization of exposure-based treatments.

If you would like to learn more about using exposure therapy in your practice:

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     by Perry Leynor, LPC Associate under the supervision of Paula Maloney, LPC-S.    

Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49-53. https://doi:10.1016/j.brat.2014.01.004

Social Anxiety: Making a difference with exposure and Acceptance and Commitment Therapy

Social Anxiety: Making a difference with exposure and Acceptance and Commitment Therapy

According to the National Institute of Mental Health, 12.1% of adults experience social anxiety disorder (SAD) at some time in their lives. Social anxiety disorder is characterized by a high degree of fear related to social situations which usually leads to avoidance of situations involving other people (National Institute of Mental Health). Several treatments have been evaluated for SAD including Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Cognitive behavior therapy emphasizes changing beliefs about negative thoughts as well as exposing the person to unpleasant thoughts and situations, and although CBT is effective for the majority of patients, about 25% do not respond to treatment (Dalrymple & Herbert, 2007). Acceptance and Commitment Therapy is different from CBT in that it encourages acceptance of negative thoughts instead of focusing on changing the thoughts. In addition, ACT promotes the use of mindfulness, which aids the patient in fully experiencing the present moment without judgment. The results of ACT have been positive for a number of conditions including depression, substance abuse, chronic pain, and psychosis; however, less research has been conducted evaluating ACT for social anxiety (Dalrymple & Herbert, 2007). Therefore, a recent study by Dalrymple and Herbert (2007) examined a treatment package that included exposures combined with various components of ACT to treat SAD. In this study, the authors recruited 19 adults with social anxiety disorder and provided individual treatment for 1 hour per week. Initial sessions focused on aiding participants in recognizing that attempts to control the past have no value. Later sessions focused on accepting undesirable thoughts and acting according to personal goals while being exposed to challenging social situations which caused some anxiety. Mindfulness was also incorporated to help participants become aware of undesirable thoughts without making judgments about their thoughts or trying to control their thoughts in any way or make them go away. Throughout treatment, participants also completed homework outside of scheduled treatment time. At the end of the study, 17 participants had completed treatment and on average, their levels of fear decreased by approximately 30% and levels of avoidance decreased by approximately 60%. In addition, 93% of the participants were highly satisfied with the treatment.

Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for Generalized Social Anxiety Disorder. Behavior Modification, 31, 543-68.

National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml