Therapists are as Stressed as Patients During In Session Exposure

The Article Can Be Found Here

Overview:  This study tested subjective stress and physiological stress (cortisol and alpha amylase) in patients and novice therapists during an in-session exposure therapy session compared to a non-exposure therapy session.  They found that both patients and therapists showed elevated physiological stress compared to a non-exposure session, and reported the same level of subjective stress directly prior to the exposure.  Amount of experience in conducting exposure did not predict lower subjective or physiological stress.  Fortunately, despite high stress levels, both therapists and patients rated exposures as highly effective.  The authors suggest that these findings may help explain why exposure therapy, despite its effectiveness, is underutilized. 

Discussion Questions:

1.  What are the implications of parallel processes of anxiety and avoidance occurring in patients and their therapists?  Should therapist training incorporate skills for therapists in managing anxiety around conducting in session exposures?

2.  Could these findings explain widespread therapist resistance to conducting in session exposures?  What other possible explanations are there?

3.  Do these findings match your own experience with conducting in session exposures, and do you think it contributed to any avoidance on your part?  I know I definitely got anxious when I first started, and got feedback multiple times from my supervisors that I ended the exposures too soon or didn't push the client far enough!