Exposure Treatments for Anxiety Disorders: A Practioner's Guide to Concepts, Methods, and Evidence-Based Practice

By Johan Rosqvist | Go to book overview

CHAPTER 5
Complicating Factors
in Anxiety Treatment:
Obstacles and Solutions

Do the thing you fear and death of fear is certain.

—Ralph Waldo Emerson

Empirically supported treatments for anxiety disorders should work, and should work well at that, or so the literature suggests. However, anxiety treatment only works if the treatment is delivered and performed as it was designed and intended. In short, if patients do not do what they fear, then the death of that fear is very uncertain! There may be many reasons why what should work does not. When treatment is not progressing as anticipated, it behooves practitioners to carefully consider what complicating factors might serve as obstacles to optimal outcome. There are a multitude of reasons, both patient- and practitioner-based. When exploring reasons, it is important for practitioners to not fall into the trap of thinking of patients as resisting treatment per se, because such a stance might readily lead to committing the fundamental attribution error (i.e., the patient [not the circumstances] is construed to be at fault or as a bad person). If these obstacles can be met and understood, then perhaps those challenges can be turned into opportunities for successful outcomes (Freeman & McCloskey, 2003). Without critically examining the challenges, improvement is unlikely, and, if treatment fails, it is relatively clear that patients will just continue to seek treatment elsewhere; thus, in an effort to reduce overall medical utilization, effective treatments need to be delivered, and obstacles to such interventions need to be surmounted. Indeed, overcoming such challenges collaboratively can enhance ultimate outcome. What follows are discussions of various, common challenges that have been

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