Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety ...

173 Pages·2016·0.56 MB·English

by  Patrick Nicholas

Pacific University
CommonKnowledge
School of Graduate Psychology College of Health Professions
7-23-2010
Common Factors of Psychoanalytic Theory and
Exposure Therapy for Treating Select Anxiety
Disorders
Patrick Nicholas
Pacific University
Recommended Citation
Nicholas, Patrick (2010). Common Factors of Psychoanalytic Theory and Exposure Therapy for Treating Select Anxiety Disorders
(Doctoral dissertation, Pacific University). Retrieved from:
http://commons.pacificu.edu/spp/187
This Dissertation is brought to you for free and open access by the College of Health Professions at CommonKnowledge. It has been accepted for
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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
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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. Among the controversies which
surrounded the PTSD diagnosis were that it was not a unitary syndrome but a combination of
other disorders (Bodkin, 2007), the diagnosis resulted from well-meaning advocates of war
veterans (McHugh & Treisman, 2007), and the mechanisms of traumatic memories were not
accounted for by the current definition of the disorder (Young, 2000).