Symposium 10 - Creative Approaches to Exposure: Acceptability, Mechanisms, Effectiveness and Patient Experiences

Chair(s)

• 

  Jane Gregory, Psy.D. (she/her/hers)

  Clinical Psychologist
  University of Oxford
  Oxford, England, United Kingdom

Discussant(s)

• 

  Michelle Craske, Ph.D.

  Distinguished Professor
  University of California Los Angeles
  Los Angeles, California, United States

Presenter(s)

• 

  Jean-Philippe Gagné, Ph.D. (he/him/his)

  Assistant Professor
  Université du Québec à Montréal
  Montreal, Quebec, Canada
• 

  Jennie Kuckertz, Ph.D.

  Administrative Director of Research
  McLean Hospital/Harvard Medical School
  Belmont, Massachusetts, United States
• 

  Joon Lee, B.A.

  Graduate Student
  Concordia University
  Montréal, Quebec, Canada
• 

  Jane Gregory, Psy.D. (she/her/hers)

  Clinical Psychologist
  University of Oxford
  Oxford, England, United Kingdom

Exposure therapy is recommended as a core part of first line treatment for many anxiety and related disorders. However, there are many challenges for patients and clinicians in effective delivery of exposure techniques, including uncertainty about the approach, logistics of delivering it, ethical concerns, difficulty addressing complexity of presentations and mismatches between the techniques and the target mechanisms of change. These challenges can be addressed using variations on traditional habituation-based, in vivo exposure therapy based, although a lot of the evidence for alternatives is based on controlled laboratory experiments, which may not reflect real-world clinical application.

This symposium will discuss creative applications of exposure techniques in hospital and outpatient clinic settings. Covering patients with a range of anxiety and related disorders, these presentations will cover initial acceptability of different rationales for exposure techniques, change mechanism targets, patient outcomes and patient experiences of treatment.

The first presentation will report on the acceptability of two different rationales for exposure therapy, habituation and inhibitory learning, using data from a vignette study in a hospital clinic, with adults waiting for treatment for an anxiety disorder or related condition. The second presentation reports on the relationship between mechanisms of change and clinical outcomes when using a novel clinical tool designed to integrate multiple theories of exposure, using data from a hospital program for OCD and related disorders. The third presentation reports on a study from a hospital clinic, using virtual reality exposure therapy (VRET) for patients with anxiety disorders, comparing outcomes from VRET compared to patients in the same clinic receiving traditional in vivo exposure therapy. The fourth presentation describes patient experiences of using exposure techniques based on inhibitory learning principles in the context of misophonia, a newly identified condition related to sensitivity to specific sounds, in a specialist outpatient clinic.

The discussant will reflect on these real-world applications of alternatives to traditional exposure, drawing on her extensive experience of developing and testing novel approaches to exposure using an inhibitory learning framework. The discussion will reflect on the value of adapting evidence-based techniques to align with the needs and preferences of patients and the importance of building the evidence base for these adaptations.

Presentations:

• 4:06 PM - 4:27 PM PDT

  (SYM 10) Perceived Acceptability of Habituation- and Inhibitory Learning-based Rationales for Exposure Therapy in a Clinical Sample
  

  Speaker: Jean-Philippe Gagné, Ph.D. (he/him/his) – Université du Québec à Montréal

  Co-Author: Joon Lee, B.A. – Concordia University

  Co-Author: Jesse Renaud, Ph.D. (she/her/hers) – McGill University

  Co-Author: Gail Myhr, MD (she/her/hers) – Centre for CBT Research, Training and Intervention, McGill University Health Centre
• 4:27 PM - 4:48 PM PDT

  (SYM 10) What Did You Learn? Quantifying Mechanistic Activation in Real-world Exposure Therapy Sessions for OCD and Anxiety Disorders
  

  Speaker: Jennie M. Kuckertz, Ph.D. – McLean Hospital/Harvard Medical School

  Co-Author: Nicholas Kim, B.S. – McLean Hospital / Harvard Medical School

  Co-Author: Sarah C. Jessup, B.S. – Vanderbilt University

  Co-Author: Jason W. Krompinger, ABPP, Ph.D. – New England Center for OCD and Anxiety

  Co-Author: Jacob Nota, Ph.D. – McLean Hospital/Harvard Medical School

  Co-Author: Nathaniel Van Kirk, Ph.D. – OCD Institute, McLean Hospital

  Co-Author: Martha J. Falkenstein, Ph.D. (she/her/hers) – McLean Hospital/Harvard Medical School
• 4:48 PM - 5:09 PM PDT

  (SYM 10) Effectiveness of Virtual Reality Exposure Therapy for Anxiety Disorders: Findings for a Real-world Clinic
  

  Speaker: Joon Lee, B.A. – Concordia University

  Co-Author: Jesse Renaud, Ph.D. (she/her/hers) – McGill University

  Co-Author: Gail Myhr, MD (she/her/hers) – Centre for CBT Research, Training and Intervention, McGill University Health Centre

  Co-Author: Jean-Philippe Gagné, Ph.D. (he/him/his) – Université du Québec à Montréal
• 5:09 PM - 5:30 PM PDT

  (SYM 10) Patient Experiences of Engaging with Sounds Using Inhibitory Learning Principles in CBT for Misophonia
  

  Speaker: Jane Gregory, Psy.D. (she/her/hers) – University of Oxford

  Co-Author: Alice Vaughn, Assistant Psychologist – Oxford Health NHS Foundation Trust

  Co-Author: Tom Graham, Counselling Psychologist – Oxford Cognitive Therapy Centre