The wooden ladder on the Apple tree piece by piece, climbing up or into an Elevator for people with phobias or Anxiety that is sometimes unimaginable. Welding them runs down the back down, the heart seems to come thick and fast, the throat constricted. Little threatening situations to feel for fear of diseased dangerous to life and for you to horror scenarios.

Handler to search for the exact situations with the parties Concerned in the framework of the so-called exposure therapy. This is one of the most effective approaches to treatment behavior therapy to combat anxiety disorders. The confrontation with the object or Situation that triggers anxiety, has been found not only in the case of phobias as effective, but also in diseases such as constraints or panic disorders.

Nevertheless, the confrontation method is applied in this country to rare, as several studies from Germany show. What is the reason?

Too short, too infrequent, at the wrong place

A survey of the Technical University of Dresden under the direction of 684 behavioral therapists revealed in 2017, that only about half of the behavior, the confrontation method is generally therapists for the treatment of anxiety disorders apply. The authors of the study complain that the exposure will also often faulty: it was not sufficiently intensive to short and also think too often in the doctor’s office, and rarely in places from the everyday life of the patient.

This is a problem especially for the patients. “The diseases can be in the case of insufficient treatment of chronic,” emphasizes Jürgen Hoyer, one of the study’s authors. The Professor for Behavioural psychotherapy at the Dresden University warns that depression can arise if the Fears of a longer period of time.

Hoyer would like to scold, not a therapist. He wants to find out what is wrong and a discussion, so something changed. The reasons for a further investigation of wrong ideas about organizational problems to their own Shyness. So about a quarter of the practitioners believed that patients get upset at the confrontation too much, even traumatized. “These assumptions are not found to be in accordance with current Research,” comment on Hoyer and colleagues in their study.

Another Problem is failure be the end of hours of Therapy and the time required. “Therapists need to schedule more time than usual, sometimes other patients move for cancellations or hours,” says Hoyer. “Not infrequently, the patient jump, then, but in the short term, from the confrontation an hour – because of their Fears.”

The psychiatrist and psychotherapist, Ulrich Voderholzer, has discovered a similar restraint, such as Hoyer in his study. In a survey of 216 therapist behavior, Japanese-trained psychologists and physicians asked Voderholzer and colleagues, how to go to the dentist with obsessive-Compulsive disorder works. Almost every fifth therapist applied the confrontation, therefore, never or only from time to time, and if so, mostly in the private treatment rooms. They feared side effects, they chose mostly a different therapy. Many were also not sufficiently qualified, and could therefore be.

“Therapists would have to overcome their own Fears,” calls Voderholzer, who as the Medical Director of the Schön Klinik Roseneck am Chiemsee. Because of the damage that comes when you keep patients the highly effective exposure, is much greater than the risk of a mental Overload of the Affected. Voderholzer and colleagues speak in the study of “phobia à deux”, a fear on both sides.

Not for any fear of patients suitable

“For some of the conversation in your own treatment room feels more comfortable and safer than the exposure in the living room of the patient,” commented Voderholzer. A third of the behavioural therapy should consist of Exercises, exposure and behavioral experiments. Currently, the therapy in many practices, however, there is a 90 to 100 percent of calls.

From the survey, however, also shows that confrontations in the treatment of everyday life are quite possible: “There are many established therapists to perform, despite the hurdles of exposure, regularly and successfully,” says Voderholzer.

Thorsten Padberg of the German society for behavior therapy, is convinced that the exposure will used where it is needed. Not everyone is afraid of the patient can be treated with a confrontation, criticism, he finds, therefore, covered: “The point of view of the researchers seems to be a very mechanical. There is a diagnosis and the appropriate Intervention. It’s not that simple,” says Padberg, treated for 15 years as a behavior therapist in private practice regularly with exposure. “Many therapists consider exactly what role the disease plays in the life of the patient and develop based on a treatment path.”

Please more practice!

Exposure is an effective method, but studies of their effectiveness and application are not always transferred to the reality: “In some studies, only patients with panic disorder, for example,” says Padberg. “Often, these also have, in addition, a Depression, often the first thing that need to be worked on.” Patients would then be confronted, and with good reason with fear objects.

Hoyer and Voderholzer suggest to rethink. Unfavorable and false notions of the treatment would have to be in the education and training corrected and avoided. Therapists should take advantage of the consultation with colleagues, in Supervision, and here about their personal barriers to exposure speak. “In training, the method should be practiced in addition a lot more,” says Voderholzer.

Video: phobias – When fear creates in the mind