L. Teusch et H. Bohme, Is the exposure principle really crucial in agoraphobia? The influence of client-centered "nonprescriptive" treatment on exposure, PSYCHOTH RE, 9(1), 1999, pp. 115-123
Exposure treatment is regarded as a crucial factor for the effective reduct
ion of agoraphobic symptoms. Recent empirical studies indicate conflict cen
tered therapies to be effective as well. The present study deals with diffe
rent effects of client-centered therapy, behavioral exposure treatment, and
a combination of them both on patient readiness for exposure to phobic sit
uations. The readiness for exposure to phobic situations (behavioral resist
ance), as well as the impairment due to phobic symptoms (interference), wer
e measured with a "99 mm-visual-analogue-scale." Forty patients diagnosed w
ith panic disorder and agoraphobia were included. Twenty of them were treat
ed with client-centered therapy, and twenty were treated additionally with
behavioral exposure treatment. The results were compared with the data on 7
2 patients, who were treated exclusively with behavioral exposure treatment
. Measurements were made at the beginning (T1) and at the end (T2) of thera
py, and after six months (T3) and one year follow-up (T4).
Behavioral exposure, either alone or combined with client-centered therapy,
significantly supported patient determination to exposure to phobic situat
ions more than client-centered treatment alone. However, at a one-year foll
ow-up, no further differences could be observed. The results indicate there
was a delayed but finally equivalent influence of an experiential and conf
lict-centered approach-without any exposure instruction-on the readiness to
phobic situation exposure. The results are dis cussed in terms of the spec
ific mechanisms of change facilitated by different therapeutic strategies,
and especially by recent concepts of disorder and process oriented client-c
entered treatment. The results raise doubts about whether or not exposure i
nstructions and systematic exposure to phobic situations are really crucial
in overcoming agoraphobic symptoms.