PDF(Pubmed)
Abstract：
Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians\' negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.
摘要：
暴露疗法（ET）是焦虑相关表现（包括焦虑症）的有效心理治疗的重要组成部分，强迫症（强迫症），和创伤后应激障碍（PTSD），并且在临床实践中经常未得到充分利用。使用理论域框架(TDF)，本系统综述综合了现有关于焦虑相关表现的ET实施决定因素的文献,并研究了表现和发育亚组之间的差异.使用混合方法评估工具评估了52项符合条件的研究，将389个结果(99%)映射到TDF上。结果表明，临床医生对ET后果的负面信念通常与实施减少有关。似乎还发现，虽然广泛的未指定ET培训可能与改善焦虑症的实施有关；复杂演示文稿的更大实施（即，PTSD）可能需要更专业的培训，涉及实际组件。域的子集(例如，社会/职业角色和身份)占大多数结果，而有些仍未开发(即，乐观；强化；记忆，注意,和决策过程)或开发不足(即，行为调节)。同样，特定的演示文稿和发育亚组(即，PTSD和成年人)在文献中的结果比例高于其他文献(即，强迫症和青年）。探索ET实施的未来研究，在特定的演讲和发展亚组中，将受益于整合实施科学框架，以指导有针对性的发展，缩小ET治疗焦虑相关表现的研究与实践差距的综合策略。
