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Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety Disorders Patrick Nicholas Pacific Nu Iversity

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Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety Disorders Patrick Nicholas Pacific Nu Iversity View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CommonKnowledge Pacific nivU ersity CommonKnowledge School of Professional Psychology Theses, Dissertations and Capstone Projects 7-23-2010 Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety Disorders Patrick Nicholas Pacific nU iversity Recommended Citation Nicholas, Patrick (2010). Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety Disorders (Doctoral dissertation, Pacific nivU ersity). Retrieved from: http://commons.pacificu.edu/spp/187 This Dissertation is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at CommonKnowledge. It has been accepted for inclusion in School of Professional Psychology by an authorized administrator of CommonKnowledge. For more information, please contact [email protected]. Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety Disorders Abstract Common factors of different approaches to treatment could potentially reveal what is most effective in psychotherapy. It would seem as though psychoanalysis and exposure therapy would be based on very different theories, but they appeared to have striking similarities. An attempt was made to develop an argument for both theoretical orientations having similar factors for theory and treatment. The format employed for developing the argument was a synthesis and extension of the literature. The similarities of psychoanalytic theory and the theory of exposure therapy provided an impetus for discussing the effective factors for treating select anxiety disorders. The differences between the two approaches provided new opportunities for further research with regard to integrating techniques to improve therapy for anxiety disorders. Degree Type Dissertation Rights Terms of use for work posted in CommonKnowledge. Comments Library Use: LIH This dissertation is available at CommonKnowledge: http://commons.pacificu.edu/spp/187 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license.] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific nivU ersity Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. [email protected] This dissertation is available at CommonKnowledge: http://commons.pacificu.edu/spp/187 COMMON FACTORS OF PSYCHOANALYTIC THEORY AND EXPOSURE THERAPY FOR TREATING SELECT ANXIETY DISORDERS A DISSERTATION SUBMITTED TO THE FACULTY OF SCHOOL OF PROFESSIONAL PSYCHOLOGY PACIFIC UNIVERSITY, FOREST GROVE, OREGON BY PATRICK NICHOLAS IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PSYCHOLOGY JULY 23, 2010 Approved:________________________ Johan Rosqvist, Psy.D. ________________________ James Lane, Ph.D. PROFESSOR AND DEAN:________________________ Michel Hersen, Ph.D., ABPP ii ABSTRACT Common factors of different approaches to treatment could potentially reveal what is most effective in psychotherapy. It would seem as though psychoanalysis and exposure therapy would be based on very different theories, but they appeared to have striking similarities. An attempt was made to develop an argument for both theoretical orientations having similar factors for theory and treatment. The format employed for developing the argument was a synthesis and extension of the literature. The similarities of psychoanalytic theory and the theory of exposure therapy provided an impetus for discussing the effective factors for treating select anxiety disorders. The differences between the two approaches provided new opportunities for further research with regard to integrating techniques to improve therapy for anxiety disorders. Keywords: psychoanalysis, psychoanalytic, exposure therapy, therapeutic action iii TABLE OF CONTENTS Page ABSTRACT…………………………………………………….……………………ii LIST OF TABLES…………………………………………………………………...iv LIST OF FIGURES………………………………………………………………….v INTRODUCTION…………………………………………………………….……..1 STATEMENT OF PROBLEM AND PURPOSE OF STUDY………….………....10 METHODS……………………………………………………….…………………11 THEORIES OF EXPOSURE THERAPY………………………….………………13 Posttraumatic Stress Disorder……………………………………………….…..23 Obsessive-Compulsive Disorder…………………………………………….….25 Specific Phobia……………………………………………………………….…26 COMPARISONS OF PSYCHOANALYSIS FOR ANXIETY DISORDERS….…31 Cathartic Theory and PTSD...…………………………………………….…….35 Revised Theories of Psychoanalysis………………………………………....…58 Psychoanalysis and Obsessive-Compulsive Disorder…………………….……74 Psychoanalysis and Specific Phobia………………………………….………...89 Integrative Literature………………………………………………….………..97 RESULTS……………………………………………………………….….……..125 DISCUSSION…………………………………………….………….…….……..140 SUMMARY……………………………………………….………….…….…….146 REFERENCES……………………………………………….……….…….……151 iv LIST OF TABLES Page Table 1……………………………………………………………………………….21 Table 2……………………………………………………………………………….23 Table 3………………………………………………………………………………127 Table 4………………………………………………………………………………130 Table 5………………………………………………………………………………135 Table 6………………………………………………………………………………137 v LIST OF FIGURES Page Figure 1………………………………………………………………………………38 Figure 2………………………………………………………………………………77 Figure 3………………………………………………………………………………90 1 INTRODUCTION Anxiety disorders have been described as a prevalent problem within our society. In fact, Barlow (2002) referred to anxiety disorders as “the single largest mental health problem in the country” (p. 22). It was important to have a complete understanding and develop the best available treatment methods for our most prevalent mental health problem. Posttraumatic Stress Disorder (PTSD) had a lifetime prevalence of approximately 8% in the U.S. population (American Psychiatric Association, 2000), making it a relatively common disorder. Marciniak (2005) determined that PTSD was associated with relatively high treatment costs and was the most costly to treat of all the anxiety disorders. Other costs associated with PTSD were substantial impairment in workforce performance in terms of lost productivity or absenteeism (Greenberg, et al. 1999; Lepine, 2002). The disorder resulted from people being exposed to an event that posed the risk of real or threatened injury of death, which created intense fear for the person. Violence and war have always been a part of our society, so it was not surprising that researchers found that being exposed to a traumatic event in the United States was not uncommon, but different segments of the population were impacted at different rates. A survey of adult women in the United States (Resnick, Kilpatrick, Dansky, Saunders, and Best 1993) found that the lifetime exposure rate to any trauma was 68.9% and the lifetime prevalence of PTSD was 12.6%. The rate of PTSD was much higher among female crime victims. The researchers reported that female victims of a physical assault had a lifetime prevalence of PTSD of 38.5% and female rape victims had a lifetime prevalence of PTSD of 32.0%. 2 Hoge et al. (2004) sampled U.S. military personnel and found that 12.9% of Army soldiers met criteria for PTSD following their deployment from the conflict in Iraq. The researchers noted a linear relationship between combat experience in Iraq and PTSD. They reported that 9.3% of soldiers met criteria for PTSD who experienced one or two firefights, 12.7% met criteria after experiencing three to five firefights, and 19.3% met criteria after experiencing more than five firefights. Among the soldiers who reported they were in a firefight, Hoge et al. found that five was the median number of total firefights they experienced. The researchers also found a statistically significant relationship between being injured in combat and PTSD. Clearly then, comprehensive information about the comparative effectiveness of available interventions for PTSD was needed to guide clinicians and inform consumers. Unfortunately, early research on treatment of trauma has methodological flaws (Taylor et al., 2003), other studies have produced conflicting results (e.g., Tarrier et al., 1999; Taylor et al.), and insight therapies had not been empirically tested. However, as will become clear in the following review of the research, several interventions have proven efficacious for reducing PTSD symptoms and clinical experience has supported other methods of treating clients diagnosed with PTSD. The treatment and study of PTSD has faced some unique challenges. There has been a controversy over whether the PTSD construct and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) diagnosis was valid. PTSD was one of the few disorders of the DSM where an etiology was not specified.
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