implosive therapy


Summary: A method for extinguishing anxiety by a saturation exposure to the feared stimulus situation or its substitute.

Top Publications

  1. Bolton D, Perrin S. Evaluation of exposure with response-prevention for obsessive compulsive disorder in childhood and adolescence. J Behav Ther Exp Psychiatry. 2008;39:11-22 pubmed
    ..Effect size in the main intention-to-treat analysis was 1.23 and in the secondary per protocol analysis was 1.64. This study lends further support to the view that E/RP is an effective treatment for childhood OCD. ..
  2. Leutgeb V, Schäfer A, Schienle A. An event-related potential study on exposure therapy for patients suffering from spider phobia. Biol Psychol. 2009;82:293-300 pubmed publisher
    ..The therapy effect consisted of a significant enhancement of late LPP amplitudes in response to spider pictures. Results are discussed in terms of reduced attentional avoidance. ..
  3. Sánchez Meca J, Rosa Alcázar A, Marín Martínez F, Gómez Conesa A. Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clin Psychol Rev. 2010;30:37-50 pubmed publisher
    ..Publication bias and several methodological factors were discarded as a threat against the validity of our results. Finally the implications of the results for clinical practice and for future research are discussed. ..
  4. Olatunji B, Huijding J, de Jong P, Smits J. The relative contributions of fear and disgust reductions to improvements in spider phobia following exposure-based treatment. J Behav Ther Exp Psychiatry. 2011;42:117-21 pubmed publisher
    ..The implications of these findings for conceptualizing the role of fear and disgust emotions in the maintenance and treatment of spider phobia are discussed...
  5. Ito L, de Araujo L, Tess V, de Barros Neto T, Asbahr F, Marks I. Self-exposure therapy for panic disorder with agoraphobia: randomised controlled study of external v. interoceptive self-exposure. Br J Psychiatry. 2001;178:331-6 pubmed
    ..Rates of improvement on main outcome measures averaged 60% at post-treatment and 77% at follow-up. The three methods of self-exposure were equally effective in reducing panic and agoraphobic symptoms in the short- and long-term. ..
  6. Catani C, Kohiladevy M, Ruf M, Schauer E, Elbert T, Neuner F. Treating children traumatized by war and Tsunami: a comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry. 2009;9:22 pubmed publisher Identifier:NCT00820391. ..
  7. Hauner K, Mineka S, Voss J, Paller K. Exposure therapy triggers lasting reorganization of neural fear processing. Proc Natl Acad Sci U S A. 2012;109:9203-8 pubmed publisher
    ..These effects were linked to fear-extinction mechanisms identified in animal models, thus opening new opportunities for the treatment and prevention of debilitating anxiety disorders. ..
  8. van Oppen P, van Balkom A, Smit J, Schuurmans J, Van Dyck R, Emmelkamp P. Does the therapy manual or the therapist matter most in treatment of obsessive-compulsive disorder? A randomized controlled trial of exposure with response or ritual prevention in 118 patients. J Clin Psychiatry. 2010;71:1158-67 pubmed publisher
    ..In contrast to other studies, we did not find a supposed benefit of therapist-controlled ERP versus self-controlled ERP in patients with OCD. Identifier: NTR1444. ..
  9. Robjant K, Fazel M. The emerging evidence for Narrative Exposure Therapy: a review. Clin Psychol Rev. 2010;30:1030-9 pubmed publisher
    ..Emerging evidence suggests that NET is an effective treatment for PTSD in individuals who have been traumatised by conflict and organised violence, even in settings that remain volatile and insecure. ..

More Information


  1. Parsons T, Rizzo A. Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. J Behav Ther Exp Psychiatry. 2008;39:250-61 pubmed
    ..This highlights the need for future research studies that report uniform and detailed information regarding presence, immersion, anxiety and/or phobia duration, and demographics. ..
  2. Rosa Alcázar A, Sánchez Meca J, Gómez Conesa A, Marín Martínez F. Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clin Psychol Rev. 2008;28:1310-25 pubmed publisher
    ..Finally, the implications of the results for clinical practice and for future research in this field were discussed. ..
  3. Hagenaars M, van Minnen A. Posttraumatic growth in exposure therapy for PTSD. J Trauma Stress. 2010;23:504-8 pubmed publisher
    ..The results indicate that posttraumatic growth may be a valuable new concept in trauma therapy. ..
  4. Farrell N, Deacon B, Kemp J, Dixon L, Sy J. Do negative beliefs about exposure therapy cause its suboptimal delivery? An experimental investigation. J Anxiety Disord. 2013;27:763-71 pubmed publisher
    ..g. encouraging clients' use of oppositional actions). The present findings suggest that therapist reservations about exposure cause suboptimal delivery and may adversely affect client outcomes. ..
  5. Rizzo A, Parsons T, Lange B, Kenny P, Buckwalter J, Rothbaum B, et al. Virtual reality goes to war: a brief review of the future of military behavioral healthcare. J Clin Psychol Med Settings. 2011;18:176-87 pubmed publisher
    ..S. Army University Affiliated Research Center, and this paper will detail efforts to use virtual reality to deliver exposure therapy, assess PTSD and cognitive function and provide stress resilience training prior to deployment. ..
  6. Schnurr P, Lunney C. SYMPTOM BENCHMARKS OF IMPROVED QUALITY OF LIFE IN PTSD. Depress Anxiety. 2016;33:247-55 pubmed publisher
    ..For most domains of quality of life, treating a patient until the patient no longer meets diagnostic criteria would be optimal. For some domains, further improvements may result by helping a patient achieve remission. ..
  7. Meyerbröker K, Emmelkamp P. Virtual reality exposure therapy in anxiety disorders: a systematic review of process-and-outcome studies. Depress Anxiety. 2010;27:933-44 pubmed publisher
    ..The implications for implementation into clinical practice are considered. ..
  8. Early M, Erickson C, Wink L, McDougle C, Scott E. Case report: 16-Year-old male with autistic disorder with preoccupation with female feet. J Autism Dev Disord. 2012;42:1133-7 pubmed publisher
    ..Implications for diagnosis and treatment of individuals with Autistic Disorder displaying problematic behaviors are presented. ..
  9. Harned M, Dimeff L, Woodcock E, Skutch J. Overcoming barriers to disseminating exposure therapies for anxiety disorders: a pilot randomized controlled trial of training methods. J Anxiety Disord. 2011;25:155-63 pubmed publisher
  10. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther. 2010;39:81-91 pubmed publisher
    ..Although treatment gains were moderate, these results indicate that NET is a promising approach for the treatment of PTSD in asylum-seekers living in unstable conditions. ..
  11. Scharfstein L, Beidel D, Finnell L, Distler A, Carter N. Do pharmacological and behavioral interventions differentially affect treatment outcome for children with social phobia?. Behav Modif. 2011;35:451-67 pubmed publisher
    ..The relationship of social skill to social avoidance and the importance of social skills training to enhance social competence in the treatment of childhood SP are discussed. ..
  12. Wolff J, Symons F. An evaluation of multi-component exposure treatment of needle phobia in an adult with autism and intellectual disability. J Appl Res Intellect Disabil. 2013;26:344-8 pubmed publisher
    ..An exposure approach was effective in reducing phobic behavior and may be flexible enough to accommodate component changes and leaner reinforcement schedules applicable to real-world settings. ..
  13. Metts T. Addressing environmental health Implications of mold exposure after major flooding. AAOHN J. 2008;56:115-20; quiz 121-2 pubmed
    ..Occupational health professionals should encourage workers to seek health care if they experience any symptoms that may be linked to mold exposure. ..
  14. Martin M, Violante A, Barberis E. Fate of arsenite and arsenate in flooded and not flooded soils of southwest Bangladesh irrigated with arsenic contaminated water. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2007;42:1775-83 pubmed
  15. Gradus J, Suvak M, Wisco B, Marx B, Resick P. Treatment of posttraumatic stress disorder reduces suicidal ideation. Depress Anxiety. 2013;30:1046-53 pubmed publisher
    ..CPT exhibited a larger influence on suicidal ideation than PE, although the magnitude of the difference was small in size. Inclusion of PTSD screening and treatment could enhance suicide prevention efforts. ..
  16. Burrows R, Ali K. Novel boom/skirt systems for improvement of water quality in estuarial impoundments subject to saline influx. Water Sci Technol. 2001;43:357-63 pubmed
    ..Retrofitting of novel low cost floating boom/skirt baffle system is proposed here for alleviation of the problem. ..
  17. Powers M, Deacon B. Dissemination of empirically supported treatments for anxiety disorders: introduction to the special issue. J Anxiety Disord. 2013;27:743-4 pubmed publisher
    ..The articles that follow consider the causes of this dissemination failure, highlight areas of success, and offer constructive remedies for addressing this important public health problem. ..
  18. Kaczkurkin A, Asnaani A, Alpert E, Foa E. The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving. Behav Res Ther. 2016;79:7-14 pubmed publisher
    ..These results support the relationship between greater PTSD symptoms leading to greater alcohol craving and suggest that reducing PTSD symptoms may be beneficial to reducing craving in those with co-occurring PTSD/SUD. ..
  19. McLay R, Graap K, Spira J, Perlman K, Johnston S, Rothbaum B, et al. Development and testing of virtual reality exposure therapy for post-traumatic stress disorder in active duty service members who served in Iraq and Afghanistan. Mil Med. 2012;177:635-42 pubmed
    ..Further study will be needed to determine the wider utility of the method and to determine if it offers advantages over other established PTSD treatment modalities. ..
  20. Schneier F, Neria Y, Pavlicova M, Hembree E, Suh E, Amsel L, et al. Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial. Am J Psychiatry. 2012;169:80-8 pubmed publisher
    ..Combined treatment medication and prolonged exposure therapy deserves further study in larger samples with diverse forms of PTSD and over longer follow-up periods. ..
  21. Ishikawa S, Motomura N, Kawabata Y, Tanaka H, Shimotsu S, Sato Y, et al. Cognitive behavioural therapy for Japanese children and adolescents with anxiety disorders: a pilot study. Behav Cogn Psychother. 2012;40:271-85 pubmed publisher
    ..For the most part, similar outcomes were found in both the group and individual formats of CBT. This study provides preliminary support for the transportability of CBT in both an individual and group format to Japan. ..
  22. Leiner A, Kearns M, Jackson J, Astin M, Rothbaum B. Avoidant coping and treatment outcome in rape-related posttraumatic stress disorder. J Consult Clin Psychol. 2012;80:317-21 pubmed publisher
    ..A small subset of women with initially low levels of avoidant coping are unlikely to experience a therapeutic response from PE or EMDR. ..
  23. Price M, Gros D, Strachan M, Ruggiero K, Acierno R. Combat experiences, pre-deployment training, and outcome of exposure therapy for post-traumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Clin Psychol Psychother. 2013;20:277-85 pubmed publisher
    ..Together, these findings suggest that increased combat exposure is associated with poor treatment response in veterans with PTSD; however, this can be reduced by elevated pre-deployment preparedness. ..
  24. Myers K, Carlezon W. D-cycloserine effects on extinction of conditioned responses to drug-related cues. Biol Psychiatry. 2012;71:947-55 pubmed publisher
    ..We conclude that it is as yet unclear whether DCS-coupled CET might be a useful approach in the treatment of addiction. ..
  25. Renninger S. Clinical application of meta-concepts that are essential to client change. Psychotherapy (Chic). 2013;50:302-6 pubmed publisher
    ..Each concept is described. Clinical and research support is provided. Therapist and client dialogue is used to illustrate each concept. ..
  26. Cook J, O Donnell C, Dinnen S, Bernardy N, Rosenheck R, Hoff R. A formative evaluation of two evidence-based psychotherapies for PTSD in VA residential treatment programs. J Trauma Stress. 2013;26:56-63 pubmed publisher
    ..Suggestions for improving the adoption of PE and CPT are noted, including distilling manualized treatments to essential common elements. ..
  27. Hartanto D, Kang N, Brinkman W, Kampmann I, Morina N, Emmelkamp P, et al. Automatic mechanisms for measuring subjective unit of discomfort. Stud Health Technol Inform. 2012;181:192-6 pubmed
    ..Overall, dialogue dependent timing mechanism seems superior followed by the speech dependent and context independent timing mechanism. ..
  28. Riley B, Smith D, Oakes J. Exposure therapy for problem gambling in rural communities: a program model and early outcomes. Aust J Rural Health. 2011;19:142-6 pubmed publisher
    ..These findings will inform future treatment planning and service delivery for rural clients, and guide further research into the effectiveness of exposure therapy for problem gambling. ..
  29. Gros D, Yoder M, Tuerk P, Lozano B, Acierno R. Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person. Behav Ther. 2011;42:276-83 pubmed publisher
    ..Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies. ..
  30. Pigliucci M, Kolodynska A. Phenotypic plasticity and integration in response to flooded conditions in natural accessions of Arabidopsis thaliana (L.) Heynh (Brassicaceae). Ann Bot. 2002;90:199-207 pubmed
    ..While the major components of the plants' multivariate phenotypic architecture were not significantly affected by environmental changes, many of the details were different under flooded and non-flooded conditions. ..
  31. Wang Z, Zhu T. [Responses of interspecific relationships among main herbaceous plants to flooding disturbance in Songnen Plain, northeastern China]. Ying Yong Sheng Tai Xue Bao. 2003;14:892-6 pubmed
  32. Van der Leeden A, van Widenfelt B, van der Leeden R, Liber J, Utens E, Treffers P. Stepped care cognitive behavioural therapy for children with anxiety disorders: a new treatment approach. Behav Cogn Psychother. 2011;39:55-75 pubmed publisher
    ..A more intensive treatment is offered when initial CBT is insufficient, providing children additional opportunities to reach the desired outcome. ..
  33. Andreano J, Liang K, Kong L, Hubbard D, Wiederhold B, Wiederhold M. Auditory cues increase the hippocampal response to unimodal virtual reality. Cyberpsychol Behav. 2009;12:309-13 pubmed publisher
    ..Additionally, multimodal presentation elicited increased activity in the hippocampus, a region well known to be involved in learning and memory. The implications of this finding for exposure therapy are discussed. ..
  34. Kumar R, Lloyd D. Recent advances in the treatment of Acanthamoeba keratitis. Clin Infect Dis. 2002;35:434-41 pubmed
    ..Immunization thus may eventually become the best approach for reduction of the incidence of amebic infection in humans...
  35. Shrestha S, Robertson S, Stanley M. Innovations in research for treatment of late-life anxiety. Aging Ment Health. 2011;15:811-21 pubmed publisher
    ..Continued investigation of evidence-based treatments for geriatric anxiety will allow greater understanding of how best to tailor the interventions to fit the needs of older adults. ..
  36. Zandberg L, Zang Y, McLean C, Yeh R, Simpson H, Foa E. Change in obsessive-compulsive symptoms mediates subsequent change in depressive symptoms during exposure and response prevention. Behav Res Ther. 2015;68:76-81 pubmed publisher
    ..These data indicate that reductions in co-morbid depressive symptoms during EX/RP for OCD are largely driven by reductions in obsessive-compulsive symptoms. ..
  37. Bluett E, Zoellner L, Feeny N. Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD. J Behav Ther Exp Psychiatry. 2014;45:97-104 pubmed publisher
    ..Results suggest that distress reduction in imaginal exposure is not a key mechanism underlying therapeutic change in PE. ..
  38. Yoder M, Lozano B, Center K, Miller A, Acierno R, Tuerk P. Effectiveness of prolonged exposure for PTSD in older veterans. Int J Psychiatry Med. 2013;45:111-24 pubmed
    ..13-1.90) and the retention rate was high (85%). Importantly, no adverse medical or psychiatric events were reported over the course of the study. Results are discussed and limitations, along with future directions, are presented. ..
  39. Green R, Bates L, Smyth A. Impediments to recovery in New Orleans' Upper and Lower Ninth Ward: one year after Hurricane Katrina. Disasters. 2007;31:311-35 pubmed
    ..This paper concludes with a discussion of how pre- and post-disaster inequalities have slowed recovery in the Lower Ninth Ward and of the implications this has for post-disaster recovery planning there and elsewhere. ..
  40. Solem S, Hansen B, Vogel P, Ottesen Kennair L. The efficacy of teaching psychology students exposure and response prevention for obsessive-compulsive disorder. Scand J Psychol. 2009;50:245-50 pubmed publisher
    ..The treatment effects observed at the 6 month follow-up period were promising. The results are encouraging for training students in evidence based treatment for specific disorders. ..
  41. Poon M. Hypnosis for complex trauma survivors: four case studies. Am J Clin Hypn. 2009;51:263-71 pubmed
    ..Data from self-reports, observation and objective measures indicates a significant reduction in the trauma symptoms after treatment. ..
  42. Gros D, Strachan M, Ruggiero K, Knapp R, Frueh B, Egede L, et al. Innovative service delivery for secondary prevention of PTSD in at-risk OIF-OEF service men and women. Contemp Clin Trials. 2011;32:122-8 pubmed publisher
  43. Ljotsson B, Hedman E, Lindfors P, Hursti T, Lindefors N, Andersson G, et al. Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther. 2011;49:58-61 pubmed publisher
    ..This study suggests that internet-delivered CBT based on exposure and mindfulness has long-term beneficial effects for IBS-patients. ..
  44. van den Hout M, Engelhard I, Toffolo M, van Uijen S. Exposure plus response prevention versus exposure plus safety behaviours in reducing feelings of contamination, fear, danger and disgust. An extended replication of Rachman, Shafran, Radomsky & Zysk (2011). J Behav Ther Exp Psychiatry. 2011;42:364-70 pubmed publisher
    ..Findings were obtained from a non-clinical sample. The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments. ..
  45. Felmingham K, Dobson Stone C, Schofield P, Quirk G, Bryant R. The brain-derived neurotrophic factor Val66Met polymorphism predicts response to exposure therapy in posttraumatic stress disorder. Biol Psychiatry. 2013;73:1059-63 pubmed publisher
    ..This study provides the first evidence that the BDNF Val66Met genotype predicts response to cognitive behavior therapy in PTSD and is in accord with evidence that BDNF facilitates extinction learning. ..
  46. Cervo L, Di Clemente A, Orru A, Moro F, Cassina C, Pich E, et al. Inhibition of glycine transporter-1 reduces cue-induced nicotine-seeking, but does not promote extinction of conditioned nicotine cue responding in the rat. Addict Biol. 2013;18:800-11 pubmed publisher
  47. Bodaly R, Jansen W, Majewski A, Fudge R, Strange N, Derksen A, et al. Postimpoundment time course of increased mercury concentrations in fish in hydroelectric reservoirs of northern Manitoba, Canada. Arch Environ Contam Toxicol. 2007;53:379-89 pubmed
    ..Downstream effects were apparent because many reservoirs downstream of other impoundments had higher Hg concentrations in fish than would be expected on the basis of flooding amount. ..
  48. Furey J, Fredrickson H, Foote C, Richmond M. Post-Katrina fecal contamination in Violet Marsh near New Orleans. Int J Environ Res Public Health. 2007;4:84-92 pubmed
    ..The work was performed as part of the Interagency Performance Evaluation Task Force investigation into the consequences of the failures of the New Orleans levee system. ..
  49. Beutel M, Scheurich V, Knebel A, Michal M, Wiltink J, Graf Morgenstern M, et al. Implementing panic-focused psychodynamic psychotherapy into clinical practice. Can J Psychiatry. 2013;58:326-34 pubmed
    ..Numéro d’enregistrement d’essai clinique : German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111–1112–4245). ..
  50. Vijver M, Vink J, Miermans C, Van Gestel C. Metal accumulation in earthworms inhabiting floodplain soils. Environ Pollut. 2007;148:132-40 pubmed
    ..Internal levels of most essential metals were higher in spring. In general, no clear patterns in metal uptake were found and repetition of the sampling campaign will probably yield different results. ..
  51. Johnson S, Price M, Mehta N, Anderson P. Stereotype confirmation concerns predict dropout from cognitive behavioral therapy for social anxiety disorder. BMC Psychiatry. 2014;14:233 pubmed publisher
  52. Wolf E, Lunney C, Schnurr P. The influence of the dissociative subtype of posttraumatic stress disorder on treatment efficacy in female veterans and active duty service members. J Consult Clin Psychol. 2016;84:95-100 pubmed publisher
  53. Rey Y, Marin C, Silverman W. Failures in cognitive-behavior therapy for children. J Clin Psychol. 2011;67:1140-50 pubmed publisher
    ..A case illustration highlights these factors, which resulted in the child not advancing positively in treatment. The article concludes with key practice recommendations. ..