title: Therapists' and patients' stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study.
abstract: Exposure therapy is considered an effective treatment strategy for phobic anxiety, however, it is rarely applied in clinical practice. The under-usage might be due to various factors of which heightened stress levels not only in patients but also in therapists are presumed to be of particular relevance. The present study aimed to investigate whether different forms of exposure might lead to varying physiological and psychological stress responses in therapists and phobic patients. 25 patients with specific phobia underwent individual cognitive behavioural therapy, performed by 25 psychotherapist trainees, applying exposure sessions in graduated form or the flooding technique. Patients and therapists provided subjective evaluations of stress and five saliva samples for analysis of salivary cortisol and alpha-amylase either during two graduated exposure sessions or during one flooding session, while a regular therapy session served as control condition. Therapists displayed heightened salivary alpha-amylase release during exposure of the flooding, but not the graduated, type. Patients showed elevated salivary cortisol during flooding exposure numerically, however, not on a statistically significant level. Therapists reported more pronounced subjective stress during flooding compared to graduated exposure. Elevated stress levels should be addressed in clinical training in order to improve application of exposure in routine practice.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany; Department of Psychology, Humboldt-University at Berlin, Berlin, Germany. Electronic address: sarah.schumacher@charite.de.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schumacher
authors.affiliation: Department of Biopsychology, Technical University Dresden, Dresden, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Miller
authors.affiliation: Department of Psychology, Humboldt-University at Berlin, Berlin, Germany.
authors.forename: Lydia
authors.initials: L
authors.lastname: Fehm
authors.affiliation: Department of Biopsychology, Technical University Dresden, Dresden, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
authors.affiliation: Department of Psychology, Humboldt-University at Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fydrich
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ströhle
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D010698:Phobic Disorders / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D011613:Psychotherapy; D012463:Saliva / Q000737:chemistry; D055291:Salivary alpha-Amylases / Q000378:metabolism; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology
chemical_list: D055291:Salivary alpha-Amylases; D006854:Hydrocortisone
keywords: Exposure therapy; Psychotherapist trainees; Salivary alpha-amylase; Salivary cortisol; Specific phobia