Optimizing exposure-based CBT for anxiety disorders via enhanced extinction: Design and methods of a multicentre randomized clinical trial.
Exposure-based psychological interventions currently represent the empirically best established first line form of cognitive-behavioural therapy for all types of anxiety disorders. Although shown to be highly effective in both randomized clinical and other studies, there are important deficits: (1) the core mechanisms of action are still under debate, (2) it is not known whether such treatments work equally well in all forms of anxiety disorders, including comorbid diagnoses like depression, (3) it is not known whether an intensified treatment with more frequent sessions in a shorter period of time provides better outcome than distributed sessions over longer time intervals. This paper reports the methods and design of a large-scale multicentre randomized clinical trial (RCT) involving up to 700 patients designed to answer these questions. Based on substantial advances in basic research we regard extinction as the putative core candidate model to explain the mechanism of action of exposure-based treatments. The RCT is flanked by four add-on projects that apply experimental neurophysiological and psychophysiological, (epi)genetic and ecological momentary assessment methods to examine extinction and its potential moderators. Beyond the focus on extinction we also involve stakeholders and routine psychotherapists in preparation for more effective dissemination into clinical practice.
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Ingmar
0000-0002-7762-4327
I
Heinig
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Andre
0000-0003-3787-9576
A
Pittig
Department of Psychology, Universität Greifswald, Greifswald, Germany.
Jan
J
Richter
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Katrin
K
Hummel
Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
Isabel
I
Alt
Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
Kristina
K
Dickhöver
Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
Jennifer
J
Gamer
Department of Psychology, Universität Greifswald, Greifswald, Germany.
Maike
M
Hollandt
Department of Psychiatry and Psychotherapy, Universitätsklinikum Münster, Münster, Germany.
Katja
K
Koelkebeck
Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.
Anne
A
Maenz
Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.
Sophia
S
Tennie
Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
Christina
C
Totzeck
Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.
Yunbo
Y
Yang
Department of Psychiatry and Psychotherapy, Universitätsklinikum Münster, Münster, Germany.
Volker
V
Arolt
Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
Jürgen
J
Deckert
Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.|Department of Psychiatry, Universitätsklinikum Freiburg, Freiburg, Germany.
Katharina
K
Domschke
Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
Thomas
T
Fydrich
Department of Psychology, Universität Greifswald, Greifswald, Germany.
Alfons
A
Hamm
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Jürgen
J
Hoyer
Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.
Tilo
T
Kircher
Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
Ulrike
U
Lueken
Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
Jürgen
J
Margraf
Protect-AD Study Site Cologne, Cologne, Germany.
Peter
P
Neudeck
Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
Paul
P
Pauli
Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.
Winfried
W
Rief
Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
Silvia
S
Schneider
Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany.
Benjamin
B
Straube
Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
Andreas
A
Ströhle
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Hans-Ulrich
HU
Wittchen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology / Q000534:rehabilitation*; D001521:Behavior Therapy / Q000379:methods*; D005108:Extinction, Psychological; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009482:Neurophysiology; D011601:Psychophysics; D016896:Treatment Outcome; D055815:Young Adult
anxiety disorders; exposure therapy; extinction; randomized clinical trial