Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions☆
Highlights
► Identification of strategies to augment the efficacy of exposure. ► Review of additive effect of common coping skills over exposure alone. ► Review of new coping strategies to enhance exposure. ► Recommendations to examine mechanisms of change during exposure.
Section snippets
Evidence for Additive Effects of Traditional Coping Skills
Coping skills traditionally included in CBT for PD/A are cognitive restructuring and either breathing retraining and/or relaxation. Presumably, the effects of exposure are augmented by applying the skills (e.g., disputing the probability of a harmful outcome while being exposed to a feared situation and showing that dysregulated physiology can be partially regulated). In the following, we review the evidence for the augmenting effects of traditionally taught cognitive and behavioral skills on
Exploring Mechanism of Therapy Success in PD
Kazdin (2007) cogently outlined the importance of mechanism research, including the potential to optimize the way in which treatment is delivered and thereby enhance outcomes. However, despite the invocation for mechanism research, less than a handful of psychosocial intervention studies have tested mediation properly. In the following we examine the meditational evidence for traditional coping skills in PD.
Future Directions in the Implementation, Assessment, and Evaluation of Current and Novel Coping Skills in Augmenting Exposure
There is a pressing need for both objective and online measurement of purported mediators, and evaluation of the degree to which change in those indices are predictive of change in subsequent symptom outcomes. Below we illustrate the implementation of online assessments using examples of two recently developed therapeutic approaches. The first exemplifies the direct manipulation and assessment of dysfunctional respiration, and the second illustrates a novel approach of assessing online thought
Assessment of Cognitive Appraisal/Acceptance Skills: Think-Aloud Paradigm
In a recent pilot study, we tested the feasibility of a modified and extended version of the think-aloud paradigm (Davison et al., 1991, Davison et al., 1997, Williams et al., 1997). The paradigm is aimed at assessing concurrent, situation-specific, and participant representative thoughts both during skill acquisition and application. This online method of recording verbalizations provides a sample of thinking that differs from the constraints of forced-choice formats and retrospective
Conclusion
Empirical support for an augmenting effect of traditional coping skills (cognitive and biobehavioral) on exposure is lacking. However, the extant reliance on delivery of coping skills detracts from examining the degree to which acquisition of coping skills and their application during exposure therapy enhance outcomes. At present, implementation of appraisal techniques (as taught in CT) are largely assessed retrospectively; likewise the assessment of core physiological processes (i.e., PCO2 in
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2022, Journal of Behavioral and Cognitive TherapyInternet-delivered exposure therapy versus internet-delivered cognitive behavioral therapy for panic disorder: A pilot randomized controlled trial
2021, Journal of Anxiety DisordersCitation Excerpt :The presentation order is likely based on the assumption that arousal reduction or cognitive therapy components are necessary to prepare individuals for more challenging exposure tasks, particularly when the online program is self-directed or delivered remotely (van Ballegooijen et al., 2016). However, it is unclear whether iCBT for panic disorder requires all of these components, or whether similar or better outcomes could be achieved by focusing on the putative key component: exposure (Meuret et al., 2012; Sánchez-Meca et al., 2010). The current study will thus examine how an exposure-based internet intervention compares to multi-component iCBT.
History and theoretical underpinnings of exposure therapy
2020, Exposure Therapy for Children with Anxiety and OCD: Clinician's Guide to Integrated TreatmentEnhancing Stress Management Coping Skills Using Induced Affect and Collaborative Daily Assessment
2017, Cognitive and Behavioral PracticeCitation Excerpt :Coping skills interventions may tacitly assume that delivery of skills training translates into effective utilization of these skills. Meuret and colleagues (2012), in reviewing the lack of evidence that coping skills trainings augment the efficacy of exposure therapy, have called for the independent measurement of both frequency of use and effectiveness of the coping skills. In IA, the therapist is able to evaluate the quality of the client’s cognitive reappraisals and self-instructional self-statements during rehearsal of the integrated coping response.
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The pilot study mentioned is in part funded by the generous support of the Beth and Russell Siegelman Foundation (Meuret).