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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Psychological treatment principles including exposure

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Therapy encounter with immediate risk

Suicidal intent, acute intoxication or withdrawal, psychosis, severe dissociation, ongoing abuse, medical instability or a planned exposure that becomes objectively unsafe requires suspension of the exercise and urgent safety action.

Action: Stop the task, restore environmental and physiological safety, assess ABCDE where relevant and formulate suicide and safeguarding risk. Arrange emergency or crisis care and document what happened; resume treatment only after collaborative reassessment of indication, readiness and risk controls.

Synopsis

Formulate the processes maintaining anxiety, select a disorder-specific evidence-based psychological intervention, and deliver collaborative exposure that tests feared predictions without coercion, hidden rituals or avoidable safety behaviours.

  • Begin with a shared formulation linking trigger, interpretation, emotion, body response, attention, avoidance, ritual or safety behaviour and short- and long-term consequences.
  • Use the NICE-recommended protocol for the diagnosed problem: GAD CBT or applied relaxation, panic-focused CBT, individual social-anxiety CBT, ERP for OCD, or trauma-focused CBT and EMDR for PTSD.
  • Exposure is planned contact with a feared but sufficiently safe external or internal cue to test a specific prediction and learn without escape, ritual or unnecessary protection.
  • Grade difficulty collaboratively, define consent and a stop plan, repeat tasks and vary context; success is new learning and expanded function, not immediate absence of anxiety.
  • Interoceptive exposure evokes benign sensations in panic, ERP prevents compulsions and mental neutralising in OCD, and trauma-focused work processes memories and meanings rather than using generic flooding.
  • Safety behaviours can hide disconfirming evidence; reduce them deliberately while retaining protections needed for genuine medical, disability or environmental risk.
  • Measure symptoms, function, homework, avoidance and adverse events, and review therapy fidelity before concluding that psychological treatment has failed.

Key red flags

An exposure involving unsafe driving, severe allergy, uncontrolled cardiopulmonary disease, genuine violence or another objective hazard must not proceed as a routine behavioural experiment.

Suicidal planning, escalating self-harm, severe self-neglect or harm to dependants requires a safety pathway alongside or before scheduled therapy.

Marked dissociation, loss of orientation, psychosis or intoxication during memory or situational work requires grounding, assessment and reformulation rather than forced continuation.

A therapist, relative or institution coercing disclosure or maximal exposure without informed agreement can cause harm and undermines valid psychological treatment.

Investigation priorities

01
Disorder-specific formulationFirst step

Map triggers, predictions, attention, emotion, bodily response, avoidance, rituals and consequences.

Management branches

Treatment selectionMatch protocol to formulation

Assessment identifies an anxiety, obsessive-compulsive or trauma-related problem suitable for psychological care.

  1. Confirm the primary syndrome, comorbidities, risk and goals and explain the evidence-based psychological options and their expected workload.
  2. Select the disorder-specific NICE pathway and a trained supervised practitioner, adapting communication and delivery without removing active ingredients.
  3. Agree baseline outcomes, likely temporary distress, between-session practice, review points and what would prompt safety escalation or reformulation.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE CG113 GAD and panic disorder recommendationsManualised GAD and panic psychological interventions, practitioner competence and treatment dose.
  • NICE CG159 social anxiety recommendationsIndividual disorder-specific CBT components and sequencing for social anxiety.
  • NICE CG31 OCD and BDD recommendationsERP intensity, mental rituals, family accommodation and treatment escalation.
  • NICE NG116 PTSD recommendationsTrauma-focused CBT and EMDR content, timing, safety and practitioner requirements.
  • NHS facing your fears exposure guidancePatient-facing graded exposure principles and the role of avoidance.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom