Habituation of Stress in Psychotherapists Performing Subsequent in Vivo Exposures - A Case Series

• Published in: Journal of psychotherapy integration 2017-06, Vol.27 (2), p.218-224
• Main Authors: Schumacher, Sarah, Betzler, Felix, Miller, Robert, Kirschbaum, Clemens, Ströhle, Andreas
• Format: Article
• Language: English
• Subjects: Exposure Therapy; Female; Habituation; Human; Occupational Stress; Psychotherapists; Psychotherapy Training
• ISSN: 1053-0479; 1573-3696
• DOI: 10.1037/int0000086

In the treatment of phobic patients, in vivo exposure is a highly effective, yet rarely applied approach. Among other factors, stress experienced by therapists while performing this intervention might contribute to the reluctance of its application. Also, this technique is still strongly associated to traditional behavior therapy and rarely considered by other orientations in the sense of technical eclecticism. It is investigated whether therapist trainees show a habituation of perceived psychological and physiological stress across several exposure sessions. Psychological and physiological stress was assessed in 5 inexperienced therapist trainees before, during and after 3 subsequent in vivo exposures. Salivary cortisol levels served as a marker for the physiological stress response. Due to the small sample size, only descriptive statistics are reported. On a descriptive level, therapists displayed peak levels of cortisol at onset of exposure session and decreasing concentrations over the course of each session. Overall, levels of cortisol concentrations decreased across the 3 subsequent sessions. With regard to psychological stress, within session, but not across session, habituation was determined. The presented findings provide first and only descriptive indications of habituation of physiological stress after performance of several exposure sessions in novice therapists. Application of this powerful intervention needs to be addressed in clinical training and should be encouraged to be used as a tool regardless of psychotherapeutic orientation. ¿Psicoterapeutas muestran habituación de estrés a través de sesiones de exposiciones en vivo? - Una serie de casos En el tratamiento de pacientes fóbicos, la exposición en vivo es muy efectiva, pero es una técnica aplicada raramente. El estrés experimentados por terapeutas mientras llevan a cabo la intervención puede contribuir a la reticencia de usar este método, entre otras razones. Adicionalmente, la técnica sigue siendo fuertemente asociada con la terapia conductual tradicional y raramente es considerada por otras orientaciones en la moda de eclecticismo técnico. Es investigado si los terapeutas aprendices demuestran una habituación de estrés percibido psicológico y fisiológico a través de varias sesiones de exposición. Estrés psicológico y fisiológico fue observado en cinco terapeutas aprendices sin experiencia antes, durante y después de tres exposiciones consecutivas. Niveles de cortisol salival fueron us