In many physical illnesses, self-care is an important factor in whether or not the patient gets well. For example, diabetics are given much of the responsibility for treating their condition (eg. injecting themselves with insulin, monitoring their diet, etc.). Self-care is becoming a central theme in behavior therapy. Marks (1994) examines the role of a particular form of self-care, self-exposure, in behavior therapy.

In the many of the behavioral treatments of anxiety disorders (eg. systematic desensitization, successive approximation, programmed practice), exposure to the anxiety-causing stimulus is often part of the therapy. When patients are given the responsibility of exposing themselves to this stimulus (without the presence of the therapist), it is termed "self-exposure." Studies by Ghosh, Marks, and Carr (1988) showed no significant differences in the outcomes of a group of phobics who used self- exposure instructions they read themselves from a self-help book and a group of phobics who used self-exposure instructions given by a psychiatrist. Lelliot et al (1987) found that agoraphobics gained no lasting benefit from the addition of three to six 45- minute sessions of therapist-guided exposure to self-exposure with a self-instruction manual.

A study by Marks et al (1988) assigned subjects with obsessive-compulsive disorder to one of three conditions: self-exposure for 23 weeks; self-exposure for 8 weeks, then therapist-accompanied exposure for 15 weeks; and anti-exposure (asking the subjects to avoid the things that cause the anxiety that leads to their obsessive- compulsive behaviors). The results showed that the subjects in the exposure conditions fared much better than those in the anti-exposure condition. Furthermore, there was not a significant difference between the group of subjects that received therapist-accompanied exposure and the group that did not.

The results of these studies show that a behavior therapist does not need to be involved in every step of their patient's treatment. Rather, the therapist can help their client plan and carry-out a treatment strategy, and still effectively treat their disorder. Due to simple instruction manuals, diary sheets, and an understanding of the role of relatives (who can act as co-therapists), self-exposure therapy is becoming increasingly easy to use; and patient are more likely to comply with treatments instructions that are easy to follow.

References
Ghosh, A., Marks, I.M., & Carr, A. C. (1988). Self-exposure for phobias. British Journal of Psychiatry, 152, 674-678.

Lelliot, P., Marks, I. M., Monteiro, W.O., Tsakiris, F., & Noshirvani, H. (1987). Agoraphobics 5 years after imipramine and exposure. Journal of Nervous and Mental Disease, 175, 599-605.

Marks, I.M., Lelliot, P., Basoglu, M., Noshirvani, H., Monteiro, W., & Kasvikis, Y. (1988). Clomipramine and exposure for obsessive-compulsive disorder: Replication and extension. British Journal of Psychiatry, 152, 522-534.

Marks, I. (1994). Behavior therapy as an aid to self-care. Current Directions in Psychological Science, 3, 19-22.

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