Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany.
Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Depress Anxiety. 2021 Nov;38(11):1169-1181. doi: 10.1002/da.23204. Epub 2021 Jul 22.
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.
This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression.
Both treatments resulted in substantial improvements at post (PeEx-I: d = 1.50, PeEx-S: d = 1.78) and follow-up (PeEx-I: d = 2.34; PeEx-S: d = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TR = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse.
Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
通过时间强化暴露治疗，可以满足焦虑障碍的暴露治疗优化需求。应在具有共病的不同焦虑障碍中，检验症状缓解和公共卫生获益的效果。
本项多中心随机对照试验比较了两种基于预测误差的暴露疗法（PeEx）变体在各种焦虑障碍中的疗效（均为 12 次疗程+2 次强化疗程，每次 100 分钟）：暴露疗程压缩至 2 周的时间强化暴露（PeEx-I，n=358）和每周进行暴露疗程的标准非强化暴露（PeEx-S，n=368）。主要结局是焦虑症状（治疗前、治疗后和 6 个月随访）。次要结局是总体严重程度（贯穿所有疗程）、生活质量、残疾天数和共病抑郁。
两种治疗方法在治疗后（PeEx-I：d=1.50，PeEx-S：d=1.78）和随访（PeEx-I：d=2.34；PeEx-S：d=2.03）时均显示出显著改善。两组在治疗后和随访时的症状缓解程度均相同。然而，PeEx-I 的治疗反应时间（中位数=68 天）比 PeEx-S（108 天；TR=0.68）短 32%。有趣的是，在强化暴露期间的脱落率较低。PeEx-I 在随访时还能降低残疾天数和提高生活质量，而不会增加复发。
两种侧重于跨诊断性暴露治疗的治疗方法变体都能有效降低严重焦虑障碍的症状严重程度和残疾程度。时间强化暴露治疗可加快治疗反应速度，具有明显的公共卫生获益，并且在暴露阶段的脱落率较低，而复发率没有增加。临床医生在以时间强化的方式进行暴露治疗时，可以期待更好或至少相同的结果。
