Exposure Treatments for Anxiety Disorders

Johan Rosqvist, Psy.D., is Assistant Professor of the Counseling Psychology Program at the School of Professional Psychology of Pacific University.

• 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.