Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial

Pittig, Andre; Heinig, Ingmar; Goerigk, Stephan; Thiel, Freya; Hummel, Katrin; Scholl, Lucie; Deckert, Jürgen; Pauli, Paul; Domschke, Katharina; Lueken, Ulrike; Fydrich, Thomas; Fehm, Lydia; Plag, Jens; Ströhle, Andreas; Kircher, Tilo; Straube, Benjamin; Rief, Winfried; Koelkebeck, Katja; Arolt, Volker; Dannlowski, Udo; Margraf, Jürgen; Totzeck, Christina; Schneider, Silvia; Neudeck, Peter; Craske, Michelle G.; Hollandt, Maike; Richter, Jan; Hamm, Alfons O.; Wittchen, Hans‐Ulrich

doi:10.1002/da.23204

Cited by 32 publications

(71 citation statements)

References 40 publications

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“…Data were taken from a multicenter controlled clinical trial for optimizing exposure therapy for adults with anxiety disorders (Heinig et al, 2017;Pittig et al, 2021). This trial was preregistered at the NIMH Protocol Registration System (01EE1402A) and the German Register of Clinical Studies (DRKS00008743).…”

Section: General Study Designmentioning

confidence: 99%

“…Means (with standard deviation) or number (with percent) for samples included in analyses of exposure records and outcome association. a Due to the small number of cases diagnosed with independent Agoraphobia and Panic Disorder (see Pittig et al, 2021), we included these cases in the PD/AG group. Results remained the same when separating cases with these primary disorders.…”

Section: General Study Designmentioning

confidence: 99%

“…Patients in psychopharmacological treatment could be included when medication was stable for at least three months. In total, 726 patients were included in the main trial (Pittig et al, 2021).…”

Section: Patientsmentioning

confidence: 99%

“…While some patients show full remission of symptoms, others do not fully benefit (Loerinc et al, 2015). Moreover, average treatment success tends to stabilize or improve in the long-run (e.g., Carpenter et al, 2018;Gloster et al, 2013;Loerinc et al, 2015), but some individuals show a return of symptoms after successful treatment (Craske & Mystkowski, 2006;Pittig et al, 2021). Thus, although exposure-based CBT is highly effective, these findings highlight a need for optimization on the individual level.…”

Section: Introductionmentioning

confidence: 99%

“…To this end, the present study analyzed 8484 standardized records of exposure exercises from 651 patients with panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), and multiple specific phobias (SP). Patients completed multiple exposure exercises during a 14-session manualized exposure-based CBT and standardized diagnostic assessments before (npre = 651) and after treatment (npost = 605) (Heinig et al, 2017;Pittig et al, 2021). For each exposure exercise, patients indicated the specific anticipated threat and rated their subjective probability that this threat would occur during exposure (i.e., threat expectancy).…”

Section: Introductionmentioning

confidence: 99%

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Change of threat expectancy as mechanism of exposure-based psychotherapy for anxiety disorders: Evidence from 8484 exposure exercises of 605 patients

Pittig¹,

Heinig²,

Goerigk³

et al. 2022

Preprint

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Individual responses to behavioral treatment of anxiety disorders vary considerably, calling for better understanding of underlying processes. This study examined the violation and change of threat beliefs during exposure. From 8484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: Expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy.

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Section: General Study Designmentioning

confidence: 99%

Section: General Study Designmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Change of threat expectancy as mechanism of exposure-based psychotherapy for anxiety disorders: Evidence from 8484 exposure exercises of 605 patients

Pittig¹,

Heinig²,

Goerigk³

et al. 2022

Preprint

Self Cite

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Effect of Psychotherapy on Intolerance of Uncertainty: A Systematic Review and Meta‐Analysis

Näsling,

Åström,

Jacobsson

et al. 2024

Clin Psychology and Psychoth

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Intolerance of uncertainty (IU) is the tendency to react negatively on affective, cognitive and behavioural levels to uncertain situations and to harbour negative beliefs about the implications of uncertainty. IU has been linked to psychopathology and shown to impact treatment outcomes. This study systematically reviewed the literature and performed a meta‐analysis of the effects of psychotherapy on IU. A total of 22 studies (1491 participants) were identified in online searches and included in the meta‐analyses. Analyses were performed on studies with passive and active control conditions. The pooled effect on IU from studies with passive control was large (g = −0.94 [95% CI −1.25 to −0.62]) but with significant heterogeneity. Pooled effects on IU from studies with active controls were not significant. Moderator analysis showed that among studies with a passive control condition, studies that recruited participants from clinical care facilities produced smaller effect sizes. Among studies with an active control condition, study quality significantly moderated the results, with higher quality leading to a larger effect size. These results indicate that changes in IU may be difficult to reliably achieve in psychotherapy and leave many questions about the effect of psychotherapy on IU unanswered, such as what active components produced the observed changes in studies with passive control.

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Incapacity to work due to mental disorders—economic, individual, and treatment-specific aspects

Melzner,

Kröger

2024

Bundesgesundheitsbl

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ZusammenfassungMit den Veränderungen der modernen Arbeitswelt gehen Belastungen einher, die die psychische Gesundheit von Arbeitnehmenden negativ beeinflussen können. Im Einklang damit zeigt sich ein Anstieg des Anteils der Arbeitsunfähigkeits(AU)-Tage aufgrund von psychischen Störungen auf zuletzt 17,7 % im Vergleich zu 10,9 % im Jahr 2007, womit 2021 Kosten in Höhe von 42,9 Mrd. € aufgrund von Bruttowertschöpfungsverlusten und Produktionsausfällen verbunden waren.Dieser Artikel gibt anhand aktueller gesundheitsökonomischer Studien einen Überblick über die volkswirtschaftlichen Auswirkungen von Arbeits- und Erwerbsunfähigkeit aufgrund psychischer Störungen in Deutschland. So sind in absoluten Zahlen die Ausgaben für Arbeitsunfähigkeit insbesondere bei häufigen psychischen Erkrankungen, wie affektiven und Angststörungen, hoch. Seltenere psychische Störungen, wie die posttraumatische Belastungsstörung (PTBS) und Essstörungen, verursachen im Verhältnis zu ihrer geringen Prävalenz insbesondere hohe Kosten aufgrund von Krankengeldzahlungen.Neben diesen wirtschaftlichen Implikationen werden die Konsequenzen von Arbeits- und Erwerbsunfähigkeit sowie Arbeitslosigkeit auf individueller Ebene beleuchtet und Erklärungsansätze vorgestellt. Letztere verdeutlichen die Notwendigkeit wirksamer Behandlungsmethoden. Dabei haben sich anerkannte Therapieverfahren als effizient in der Reduktion von AU-Tagen erwiesen. Dies gilt umso mehr für arbeitsplatzbezogene Interventionen, die dahin gehend konventionellen Verfahren überlegen zu sein scheinen. Arbeitsplatzbezogene Therapieverfahren legen einen Fokus auf die Planung der Wiedereingliederung. Weitere naturalistische Studien sind nötig, um die Übertragbarkeit der Wirksamkeit der Behandlungsmodelle auf andere Störungsbilder überprüfen zu können.

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Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial

Abstract: Background:The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions.

Cited by 32 publications

References 40 publications

Change of threat expectancy as mechanism of exposure-based psychotherapy for anxiety disorders: Evidence from 8484 exposure exercises of 605 patients

Change of threat expectancy as mechanism of exposure-based psychotherapy for anxiety disorders: Evidence from 8484 exposure exercises of 605 patients

Effect of Psychotherapy on Intolerance of Uncertainty: A Systematic Review and Meta‐Analysis

Incapacity to work due to mental disorders—economic, individual, and treatment-specific aspects

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