CBT specific process in exposure-based treatments: Initial examination in a pediatric OCD sample

Benito, Kristen; Conelea, Christine A.; Garcia, Abbe; Freeman, Jennifer B.

doi:10.1016/j.jocrd.2012.01.001

Cited by 30 publications

(29 citation statements)

References 44 publications

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“…A microanalytic coding system (Exposure Process Coding System; EPCS) has been designed to measure the therapist and client behaviors outlined in this paper ( Benito, Conelea, Garcia, and Freeman, 2012 ). Pilot data from the EPCS in a small sample of young children with OCD indicate initial feasibility, reliability, and validity ( Benito, Conelea, Garcia, & Freeman, 2012 ). Furthermore, some observed therapist behaviors during exposure using the EPCS (i.e.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic process during exposure: Habituation model

Benito

Walther

2015

Journal of Obsessive-Compulsive and Related Disorders

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The current paper outlines the habituation model of exposure process, which is a behavioral model emphasizing use of individually tailored functional analysis during exposures. This is a model of therapeutic process rather than one meant to explain the mechanism of change underlying exposure-based treatments. Habitation, or a natural decrease in anxiety level in the absence of anxiety-reducing behavior, might be best understood as an intermediate treatment outcome that informs therapeutic process, rather than as a mechanism of change. The habituation model purports that three conditions are necessary for optimal benefit from exposures: 1) fear activation, 2) minimization of anxiety-reducing behaviors, and 3) habituation. We describe prescribed therapist and client behaviors as those that increase or maintain anxiety level during an exposure (and therefore, facilitate habituation), and proscribed therapist and client behaviors as those that decrease anxiety during an exposure (and therefore, impede habituation). We illustrate model-consistent behaviors in the case of Monica, as well as outline the existing research support and call for additional research to further test the tenets of the habituation model as described in this paper.

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Section: Discussionmentioning

confidence: 99%

Therapeutic process during exposure: Habituation model

Benito

Walther

2015

Journal of Obsessive-Compulsive and Related Disorders

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“…Future studies should also integrate the examination of SUDS changes during ERP with the occurrence of external events (e.g., avoidance behavior) in order to construct a more complete model of exposure processes in youth. For example, Benito and colleagues (2012) reported a set of coding variables including child, therapist, and parent statements and behaviors that may be fruitful to examine in relation to distress ratings during ERP. Second, this study used multiple therapist-report measures of exposure processes, which as subjective measures are susceptible to various biases.…”

Section: Discussionmentioning

confidence: 99%

“…Second, studies with youth and adults have examined quantitative characteristics of exposure, such as the number of exposures completed per session and the amount of session time spent on conducting exposures, and findings for youth have been inconsistent. Hedtke et al (2009) found in their sample with non-OCD anxiety disorders that completing fewer exposure tasks predicted improved outcomes, whereas Benito et al (2012) found in a sample of young children with OCD that the duration of exposures was unrelated to outcomes. Thus, further research is needed regarding the association between quantitative exposure characteristics and treatment outcomes.…”

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confidence: 97%

Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD

Kircanski

Peris²

2014

J Abnorm Child Psychol

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Recent research on the treatment of adults with anxiety disorders suggests that aspects of the in-session exposure therapy process are relevant to clinical outcomes. However, few comprehensive studies have been conducted with children and adolescents. In the present study, 35 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age=12.9 years, 49% male, 63% Caucasian) completed 12 sessions of exposure and response prevention (ERP) in one of two treatment conditions as part of a pilot randomized controlled testing of a family focused intervention for OCD. Key exposure process variables, including youth self-reported distress during ERP and the quantity and quality of ERP completed, were computed. These variables were examined as predictors of treatment outcomes assessed at mid-treatment, post-treatment, and three-month follow-up, partialing treatment condition. In general, greater variability of distress during ERP and completing a greater proportion of combined exposures (i.e., exposures targeting more than one OC symptom at once) were predictive of better outcomes. Conversely, greater distress at the end of treatment was generally predictive of poorer outcomes. Finally, several variables, including within- and between-session decreases in distress during ERP, were not consistently predictive of outcomes. Findings signal potentially important facets of exposure for youth with OCD and have implications for treatment. A number of results also parallel recent findings in the adult literature, suggesting that there may be some continuity in exposure processes from child to adult development. Future work should examine additional measures of exposure process, such as psychophysiological arousal during exposure, in youth.

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“…The EIBS was created for the current study to assess the beliefs therapists hold regarding their own safety behaviours when delivering exposure therapy. An initial pool of 10 items was generated based on an informal review of the literature on therapist reservations about exposure therapy (Benito et al, 2012;Deacon and Farrell, 2013;Deacon et al, 2013c;Farrell et al, 2013;Harned et al, 2013;Olatunji et al, 2009), exposure therapy treatment manuals (Abramowitz et al, 2019;Barlow and Craske, 2006;Foa et al, 2012;Kendall and Hedtke, 2006), and clinical experience of the authors. Respondents rate items based on the degree to which they believe that their safety behaviours while delivering exposure therapy (as determined by the ETDS Coping Exposure subscale) are necessary for a variety of outcomes (e.g.…”

Section: Exposure Implementation Beliefs Scale (Eibs)mentioning

confidence: 99%

Therapist beliefs about exposure therapy implementation

Meyer

Kelly

Deacon³

2020

tCBT

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Exposure therapy is consistently indicated as the first-line treatment for anxiety-related disorders. Unfortunately, therapists often deliver exposure therapy in an overly cautious, less effective manner, characterized by using their own ‘therapist safety behaviours’. Cognitive behavioural models postulate that beliefs about therapist safety behaviours are related to their use; however, little is known about the beliefs therapists hold regarding therapist safety behaviour use. The present study aimed to identify the beliefs exposure therapists have regarding the necessity of therapist safety behaviours and to examine the relationship between this construct and therapist safety behaviour use. Australian psychologists (n = 98) completed an online survey that included existing measures of therapist safety behaviour use, therapist negative beliefs about exposure therapy, likelihood to exclude anxious clients from exposure therapy, and use of intensifying exposure techniques. Participants also completed the Exposure Implementation Beliefs Scale (EIBS), a measure created for the present study which assesses beliefs regarding the necessity of therapist safety behaviours. Beliefs about the necessity of therapist safety behaviours – particularly in protecting the client – significantly predicted therapist safety behaviour use. Findings suggest that exposure therapy training media should aim to decrease therapist safety behaviour use by addressing beliefs about the necessity of therapist safety behaviours, especially in protecting the client. Key learning aims (1) To understand what therapist safety behaviours are in the context of exposure therapy. (2) To identify common beliefs about therapist safety behaviours. (3) To understand how beliefs about therapist safety behaviours relate to therapist safety behaviour use. (4) To consider how exposure therapy delivery may be improved by modifying beliefs about therapist safety behaviours. (5) To explore how beliefs about therapist safety behaviours may be modified to reduce therapist safety behaviour use.

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CBT specific process in exposure-based treatments: Initial examination in a pediatric OCD sample

Cited by 30 publications

References 44 publications

Therapeutic process during exposure: Habituation model

Therapeutic process during exposure: Habituation model

Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD

Therapist beliefs about exposure therapy implementation

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