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(p. 195) Addressing the Impact of Different Settings and Institutional Resistance 

(p. 195) Addressing the Impact of Different Settings and Institutional Resistance
(p. 195) Addressing the Impact of Different Settings and Institutional Resistance

Carolyn Black Becker

, Nicholas R. Farrell

, and Glenn Waller

Page of

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date: 25 February 2020

It is important to be aware of how different treatment settings and institutional barriers can undermine the effectiveness of exposure. These barriers often manifest in the team dynamic (e.g., the team that treats the exposure therapist as a threat to the patient’s equanimity), in outpatient service provision issues, and particularly in more intensive care provision issues. In each of these, the context in which patients are exposed to feared stimuli needs to be appropriately diverse to ensure that they are able to voluntarily engage in exposure and overcome their use of avoidance and safety behaviors in the broader context of everyday life. Yet, the team and service can purposefully or inadvertently enhance the patient’s use of avoidance and safety behaviors if the structures are not responsive to patients’ needs. These issues need to be addressed by the team as a whole, rather than by the individual clinician.

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