What Makes Treatments Work? Towards a New Paradigm beyond Behavioural and Cognitive Therapy  Background: Most psychotherapies that reduced anxiety disorders reliably in randomised controlled trials (RCTs) shared an element of habituation by systematic exposure. Recent work, however, suggests that exposure may not be necessary as well as sufficient to reduce fear. Results: In recent RCTs several psychotherapeutic approaches improved anxiety disorders without exposure: cognitive therapy without exposure in the form of behavioural experiments, muscle tensing, and problem-solving. Mindful meditation may be another way to reduce fear. There may be no single common path to fear-reduction. Certain therapy ingredients might act on specific emotional components with particular rippling effects on other loosely-liked components in fear networks. Conclusions: There may be one or several paths to fear-reduction, some of which may be one-way and others two-way. It is not yet known which mechanisms converge on common end paths of action and which act on unique routes, which act alone and which as cofactors. Particular experiments could help map the terrain further, and work is needed to evolve a widely agreed glossary of fear-reducing procedures.

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© 2001 S. Karger GmbH, Freiburg
2001
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