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行为治疗师在暴露治疗方面的挣扎:自我报告的可操作性、消极信念以及治疗师对暴露干预的困扰。

The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability, Negative Beliefs, and Therapist Distress About Exposure-Based Interventions.

机构信息

Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.

Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.

出版信息

Behav Ther. 2019 Mar;50(2):353-366. doi: 10.1016/j.beth.2018.07.003. Epub 2018 Aug 3.


DOI:10.1016/j.beth.2018.07.003
PMID:30824251
Abstract

Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.

摘要

暴露疗法是基于证据的认知行为治疗(CBT)治疗焦虑症、创伤后应激障碍(PTSD)和强迫症(OCD)的核心组成部分。然而,先前的研究记录表明,暴露疗法在常规护理中很少被使用,这突显了持续存在的传播不足的问题。本研究从在门诊常规护理中工作的行为心理治疗师的角度探讨了暴露疗法传播的障碍(N=684)。一项邮寄调查评估了三类障碍:(a)在门诊私人执业环境中进行暴露疗法的可行性,(b)对暴露的负面信念,以及(c)与使用暴露相关的治疗师困扰。此外,还评估了治疗不同焦虑症、PTSD 和 OCD 时进行暴露的自我报告能力。在每个类别中的单个障碍中,都发现了很高的一致性(例如,不可预测的时间管理、患者无故缺勤的风险、患者病情恶化的风险、表面效果,或暴露对治疗师来说非常费力)。单独来看,对每个类别的平均同意程度与自我报告的暴露利用率呈中度负相关(-.35≤r≤-.27)。在多元回归模型中,只有对可操作性和负面信念障碍的平均同意程度与使用率显著相关。研究结果表明,需要采用针对个人、实际和系统障碍的多层次方法来优化暴露疗法的传播。因此,传播工作可能会受益于采用一些策略,例如改变负面信念、为治疗师提供适应性压力管理,或提高暴露疗法的可行性。

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