Why do clinicians exclude anxious clients from exposure therapy?
Why do clinicians exclude anxious clients from exposure therapy?
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DOI：
10.1016/j.brat.2014.01.004
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发表时间：
2014-03-01
影响因子：
4.1
通讯作者：
Deacon, Brett J.
中科院分区：
文献类型：
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作者：
Meyer, Johanna M.;Farrell, Nicholas R.;Deacon, Brett J.
尽管研究证明了暴露疗法对病理性焦虑的有效性，但临床医生并未充分利用这种治疗方法。轶事证据和临床经验表明，对暴露疗法持保留态度的治疗师倾向于根据被认为预测反应更差的客户特征将客户排除在这种治疗之外。当基于不能可靠地预测不良结果的特征而做出例外时，客户面临与投资于不太有效的治疗相关的机会成本。本调查评估了治疗师的可能性，排除客户暴露，由于不同的客户和治疗师的特点。暴露治疗师（N = 182）完成了一项在线调查，其中包括治疗师对暴露量表的信念，焦虑敏感性指数-3和断腿异常量表（BLES），这是一种基于25种不同的客户特征评估将客户排除在暴露之外的可能性的新方法。BLES表现出良好的心理测量特性。最有可能导致从暴露治疗中排除的客户特征是共病精神病、情感脆弱和不愿参与暴露。更大的可能性排除客户从暴露与较高的治疗师焦虑敏感性和认可的负面信念暴露疗法。这些研究结果的临床和培训的影响进行了讨论。(C)2014爱思唯尔有限公司版权所有。
Despite research demonstrating the effectiveness of exposure therapy for pathological anxiety, this treatment is underutilized by clinicians. Anecdotal evidence and clinical experience suggest that therapists who possess reservations about exposure therapy tend to exclude clients from this treatment based on client characteristics believed to predict worse response. When exceptions are made based on characteristics that do not reliably predict poor outcomes, clients face the opportunity cost associated with investment in less effective treatments. The present investigation assessed therapists' likelihood of excluding clients from exposure due to different client and therapist characteristics. Exposure therapists (N = 182) completed an online survey that included the Therapist Beliefs about Exposure Scale, Anxiety Sensitivity Index-3, and the Broken Leg Exception Scale (BLES), a novel measure assessing the likelihood of excluding clients from exposure based on 25 different client characteristics. The BLES demonstrated good psychometric properties. Client characteristics most likely to result in exclusion from exposure therapy were comorbid psychosis, emotional fragility, and reluctance to participate in exposure. Greater likelihood of excluding clients from exposure was associated with higher therapist anxiety sensitivity and endorsement of negative beliefs about exposure therapy. Clinical and training implications of these findings are discussed. (C) 2014 Elsevier Ltd. All rights reserved.