Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten
Anwendung und systemische Barrieren
Abstract
Zusammenfassung.Theoretischer Hintergrund: Expositionsbasierte Interventionen gehören zu den wirksamsten Methoden bei der Behandlung von Angststörungen. Dennoch legen vergangene Studien nahe, dass Exposition in der verhaltenstherapeutischen Routinepraxis nur selten eingesetzt wird. Barrieren, die eine Anwendung verhindern, wurden bisher nicht systematisch erfasst. Fragestellung und Methode: Hauptziel dieser Studie war eine praxis-orientierte Erhebung systemischer Barrieren und Veränderungswünschen bei der Anwendung von Exposition aus Sicht ambulant tätiger Verhaltenstherapeutinnen und -therapeuten. Mittels postalischer Befragung wurden diese Barrieren sowie die Anwendungshäufigkeit von expositionsbasierten Interventionen erfasst (N = 684). Ergebnisse: Gemäß Selbstbericht wurde bei weniger als der Hälfte der Behandlungen von Angststörungen eine Form der Exposition eingesetzt (46.8 %), wobei die Anwendungshäufigkeit stark zwischen den Behandelnden variierte. Exposition wurde hauptsächlich in der eigenen Praxis, durchschnittlich für eine Dauer von einer Stunde und mit einer wöchentlichen bis zweiwöchentlichen Frequenz eingesetzt. Eine häufigere Anwendung war mit jüngerem Alter, weniger Berufsjahren und mehr expositionsspezifischen Aus- und Weiterbildungsstunden assoziiert. Systemische Barrieren bezogen sich besonders auf finanzielle Aspekte und das Aufwand-Vergütungsverhältnis, Unklarheiten bezüglich Versicherungs- und Abrechnungsaspekten, sowie das begrenzte Stundenkontingent. Schlussfolgerung: Exposition bei Angststörungen scheint nicht so häufig und intensiv eingesetzt zu werden, wie in aktuellen evidenzbasierten Leitlinien empfohlen wird. Diverse systemische Barrieren erschweren die Anwendung in der ambulanten Routineversorgung.
Abstract.Background: Exposure-based interventions are one of the most effective techniques for the treatment of anxiety disorders. Previous research, however, indicated that exposure is rarely utilized in routine care. Barriers that prevent the utilization of exposure in routine care have not been systematically examined. Method: The present study aimed to assess barriers of exposure utilization related to the German health-care system as well as favored changes from the perspective of behavioral therapists working in routine care. Barriers and self-reported frequency of exposure utilization were assessed via postal survey (N = 684). Results: Self-reported utilization indicated that some form of exposure was utilized in less than half of the treatments focusing on an anxiety disorder (46.8 %), which varied strongly between therapists. If utilized, exposure was mainly conducted in the clinician’s office, for an average of 1 hr per exposure exercise, and at a weekly or biweekly frequency. More frequent utilization was associated with younger age, a lower number of years working as a therapist, and a higher number of exposure-related hours during clinical training and qualification. Frequent barriers were especially related to financial factors and the effort–compensation ratio, uncertainties about legal liability when conducting exposure outside one’s office, and a limited amount of insurance-granted sessions. Conclusion: Exposure for anxiety disorders still seems to be less frequently and intensively utilized as suggested by current evidenced-based practice guidelines. A variety of barriers within the health-care system hamper the utilization by behavioral therapists working in routine care.
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