Therapist behavior during exposure treatment of agoraphobia.
Stay warm and quiet during exposure—client self-talk, not therapist chatter, predicts success.
01Research in Context
What this study did
The team watched tapes of exposure therapy for adults with agoraphobia. They coded every word the therapist said during the session.
They wanted to know which therapist comments helped clients improve. They tracked praise, questions, challenges, and support.
What they found
Therapists mostly gave warm, supportive statements. This style stayed the same across sessions.
Few therapist words linked to better outcomes. Challenging or demanding talk added no clear benefit.
How this fits with other research
Rojahn et al. (1994) extends this work. They found that the client’s own negative self-talk during exposure predicted success better than any therapist behavior.
Last et al. (1984) looked at the same clients one year earlier. They saw that adding cognitive tasks to exposure did not shift thoughts or results.
Emmelkamp et al. (1986) used a similar in-vivo setup. They showed exposure alone beat two cognitive therapies, backing the idea that the exposure itself drives change.
Why it matters
When you run exposure for anxiety, keep your words calm and supportive. Skip tough questions or confrontational lines. Instead, watch the client’s self-talk. End the task only when their negative thoughts drop close to zero. This simple shift puts the focus where it counts.
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02At a glance
03Original abstract
Therapist behaviors during treatment of agoraphobia by in vivo exposure were studied by recordings of verbal interactions between therapist and patient as rated by an independent observer. The behaviors most often used in the exposure treatment were praise, empathy, and feedback, while challenge, reminders of negative consequences, and explicit demands were used least often. Furthermore, the therapists were rather stable in their behaviors, as only three variables changed across the different phases of treatment. There was no difference in outcome for the two therapists' groups of patients, and only a few significant correlations between outcome and the different therapist behaviors emerged. The implications of these results are discussed.
Behavior modification, 1985 · doi:10.1177/01454455850094006