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Review of Exposure Therapy for Anxiety: Principles and Practice, Second Edition

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The second edition of Exposure Therapy for Anxiety: Principles and Practice by Jonathan Abramowitz, Brett Deacon, and Stephen Whiteside is an invaluable reference and practical guide for new therapists and… Click to show full abstract

The second edition of Exposure Therapy for Anxiety: Principles and Practice by Jonathan Abramowitz, Brett Deacon, and Stephen Whiteside is an invaluable reference and practical guide for new therapists and seasoned practitioners alike. The authors note that while various anxiety disorders have differing fear cues, misperceptions, and maladaptive coping responses, the underlying conceptual framework remains the same. That is, objectively safe stimuli are misperceived as dangerous. The resulting maladaptive coping responses (e.g., avoidance, safety behaviors) temporarily relieve the unnecessary anxiety yet inadvertently perpetuate the problem. Consequently, the authors take a transdiagnostic approach and focus on the application of therapeutic exposure to promote fear tolerance and inhibitory learning as effective, empirically supported mechanisms of change. The authors aptly revised their book in this second edition consistent with advances in research and the field’s understanding of anxiety. Most notably, the authors moved to an inhibitory learning perspective from the emotional processing perspective that underscored the text’s first edition. The book is divided into three sections: fundamentals of exposure therapy, implementation of exposure therapy for specific types of fears, and special considerations in the use of exposure therapy. The first section introduces the reader to exposure therapy by covering a brief history of the topic. Chapter 2 discusses advances in research to date and reviews efficacy and effectiveness of exposure whilst providing strategies for readers on consuming literature and identifying effective treatments. The book then moves into the conceptual nature of clinical anxiety and rationale for the use of exposure (Chapter 3), functional assessment and treatment planning (Chapters 4 and 5), and implementation strategies (Chapter 6). Abramowitz et al. (2019) strike a balance between depth and breadth by succinctly—yet comprehensively— covering the fundamental components of anxiety and therapeutic exposure. The second section, covered in Chapters 7 through 15, discusses the use of exposure for a variety of specific fears. In line with the transdiagnostic framework, the authors illustrate how treatment may be modified to address specific fear cues and make note that such modification need not be synonymous with different treatment nor necessitate the use of a different treatment manual. Consistent with this approach, the section focuses on specific fears (e.g., unwanted intrusive thoughts, health concerns, incompleteness feelings) rather than on diagnostic categories per se. Each chapter reviews the overarching clinical presentation related to the specific fear, conceptual basis for use of exposure, goals of the functional assessment, and practical guidance for obtaining key information related to common cues, feared consequences, and safety behaviors. Further, each chapter also provides guidance for presenting the rationale for exposure, and suggestions for exposure implementation and response prevention. The authors conclude each chapter with an illustrative case example and additional resources for the reader. The third section reviews important considerations in the use of exposure as well as a variety of ancillary topics of interest including managing complexities (Chapter 16), working with children (Chapter 17), involving significant others in treatment (Chapter 18), combining exposure with medication (Chapter 19), maintaining treatment gains (Chapter 20), using technology (Chapter 21), application of acceptance and commitment therapy concepts with exposure (Chapter 22), and a risk–benefit analysis of exposure coupled with general ethical considerations (Chapter 23). The book is a must-read for students and trainees as well as seasoned clinicians looking for a comprehensive, practical, readable text that is rooted in contemporary research. The authors emphasize the goals of exposure throughout, * Allison L. Baier [email protected]

Keywords: chapter; anxiety; exposure therapy; exposure; edition

Journal Title: Journal of Contemporary Psychotherapy
Year Published: 2020

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