Chapter 11 - Poorly Executed Exposures

Summary

Exposure therapy is widely recognized as an effective psychological treatment for OCD but it is not successful in every case. Poorly executed exposure techniques could be implicated. Negative perceptions contribute to poor execution, pitfalls, or the underutilization of this therapy altogether. This, along with common ED misconceptions that are cultural and disorder-specific, can also result in poor treatment for those with EDs. It is important that the therapist has a thorough understanding of the patient’s presentation to ensure that exposures target the precise core fear for new learning. Lack of understanding can lead to mistakes and missed opportunities to enhance exposure, such as failing to explain the rationale, reducing safety behaviors, or overusing a hierarchy. An inexperienced therapist may not understand the importance of discussing the role of family and friends and how their accommodation can perpetuate symptoms, hindering new learning and preventing lasting change. The therapist should be able to identify the core fear, triggers, and avoidance behaviors in the patient and use strategies to enhance inhibitory learning and maximize the chances of successful treatment.