Exposure therapy

With exposure therapy (also: confrontation method ) is defined as a psychotherapeutic intervention in the field of behavioral therapies. In the behavioral literature, the terms exposure and exposure exercises are used interchangeably. The behavioral exposure therapy has proven in a variety of scientific studies to be effective, particularly in the treatment of phobias clearly structured.

Description of the method of treatment

The basic principle of this method of treatment is the confrontation with anxiety-provoking stimuli. Such stimuli may be social situations (social phobia), department stores, buses, subways, etc. ( agoraphobia ) or individual specific stimuli, such as spiders, high altitude, etc. ( specific phobia ). When panic disorder own body sensations are triggering anxiety (such as a rapid heart rate ), as they are evaluated as a precursor of a panic attack.

Core feature of most anxiety disorders is the avoidance of anxiety-provoking stimuli. Prevention is understood by behavior therapists as a disturbance sustaining condition because it prevents new experiences, and thus makes it difficult to deal with the dreaded stimuli / situations.

Method

In the exposition confronted the patient. , Under the guidance of the psychotherapist with the specific anxiety-provoking stimuli for him Together with the patient developed an explanatory model for the respective complaints to the preparation of the confrontation in the context of psychoeducation. From the model, the confrontation Rational means of learning psychology principles derived: This states that the fear strength is not as expected by the patient, can rise to infinity, but inevitably achieved through habituation with time a plateau and ultimately falls, even if the feared stimulus does not avoid but " remains in the situation." Thus, by the real experience of confrontation, the fear will be " forgotten ".

Based on the model of explanation, the actual confrontation with the feared situations is therapeutically prepared. This includes the purification and increasing importance of success for the patient, increasing its expected to cope with the exposure and finally the selection of the conditions and the specific procedure. A in the sense of " unlearning of fear" successful confrontation is thus a complex psychological process and no way be equated with the fact that the patient is " just have to make only his fear." The first exposure exercises typically take place in the company of the therapist. With increasing security on the part of the patient performs the exercises in this other independently continue without accompaniment of the therapist.

Mechanisms of action

The confrontation is to allow for a review of the fears of the patient. In contrast to the approach allows avoidance of confrontation with the reality of the person concerned, new experiences, and hence an alteration of the fears, as well as in case of success in strengthening its management capacity in the fearful situation. In addition, the continued practice of independent patients of habituation to the anxiety-provoking stimuli and thus further and persistent reduction of fear is to serve. Taken together, both ultimately describes a learning experience that successfully addressing the previously dreaded challenge even for non- proving illness fears allows comparable.

However, this does not exclude the high risk of recurrence. Massive extinction, the use of safety signals during exposure therapy session and extinction in multiple contexts (Multiple Context Exposure) are currently discussed approaches for the prevention of recurrence.

Differentiation of different approaches

Depending on whether the patient is confronted with his fear in reality or in the imagination, a distinction is made between a confrontation in vivo or in sensu. Imagination exercises can facilitate the approach to the anxiety, but also be used for practicing modified reactions. Another distinctive possibility is made between the massed and graduated confrontation. In the massed confrontation confronted the patient after the preparatory phase immediately with his greatest fears in order to achieve the fastest possible results. At the graduate confrontation a fear hierarchy is first created and selected in consultation with the therapist at the beginning of the confrontation exercises easier problem situation exist in the greater expectations of success. An example of a massaged in vivo confrontation is the flooding.