Ethical issues and ethical therapy associated with anxiety disorders

The prevalence of anxiety disorders is among the highest of all psychiatric diagnoses, with a lifetime morbidity rate of nearly 30%. Given this prevalence, it is important to identify effective and ethical treatments. Empirically based treatments considered efficacious for anxiety disorders largely include cognitive behavioral treatments (CBT), and among these, exposure therapy stands out as both useful and potentially concerning. Ethical concerns regarding exposure treatment for anxiety include fears of symptom exacerbation, high treatment dropout rates, client safety concerns, and the blurring of boundary lines between therapists and clients. Although concerns have been raised regarding exposure treatment generally, specific concerns have been raised related to the treatment of post-traumatic stress disorder (PTSD) given the vulnerable nature of the population. Despite these concerns, research largely supports both the efficacy and safety of exposure therapy. The present chapter provides a review of extant literature highlighting potential ethical concerns, research regarding the raised concerns, and suggestions for minimizing risk in treatment.