Despite the fact that methods of exposure therapy have proven to be highly effective in various empirical studies, they are still underused and sometimes subject to controversial discussion.

There have been significant developments: In recent years, methods of exposure therapy have been applied in various areas of therapy, including body dysmorphic disorder and hypochondriasis. Exposure techniques also play an important role in the so called third wave therapies (Acceptance & Commitment Therapy, Dialectical Behavior Therapy).

And there is more recently a revival of exposure in panic and agoraphobia and GAD. On the other hand, a large number of scientific articles discuss the practical applications (ethical aspects, amount of exposure) and the theoretical foundations (habituation) of exposure therapy.

In order to provide an overview of the current debate and to point out the latest developments in the area of exposure therapy, we have decided to present the current state of discussion (most contributors are scientist-practitioners) to an interested professional audience.

Behavioral and biological research in behavioral techniques were developed recent years have produced partially con- already in the early 1970s (Hand et al. tradictory treatment results and recom- 1974) and have proved extremely success- mendations for phobias with and without ful in long-term follow-ups (Hand et al. 1986). The occurrence of panic attacks panic attacks, for panic disorder, and for anxiety disorders in a broader sense. independent of phobic trigger situations The new classification of anxiety disor- is almost never mentioned as an obstacle to the effective behavioral therapy of ders in both DSM-III (1980) and its revision DSM-IIIR (1987), which gives phobias. panic attacks a key role with regard to Until very recently, professional interac- etiology, differential diagnoses, and treat- tion and mutual evaluation regarding ment has not only stimulated research in these contradictory views and results have this field but has also provoked growing been almost non-existent. Together with controversy among clinicians and resear- European and American colleagues, we chers. Biologically oriented authors have addressed these questions in a previous interpreted anxiety disorders with panic volume, examining in more detail the attacks as "endogenous" disorders linked epidemiological, psychopathological, and to depression, claiming pharmacological experimental evidence for each of these treatments to be the essential interven- positions (Hand and Wittchen 1986).

Since its initial publication more than 50 years ago, the DSM has systematized the complex intellectual and clinical process of diagnosing mentally ill persons through the use of categories and classification. The manuals have provided a consistent diagnostic language for clinical work, research, and teaching; have established a common international taxonomic standard; and have provided psychiatrists with a means of communicating with patients and the public. With a new iteration of the DSM on the horizon, the APA has initiated a multiphase research review process designed to set the stage for the fifth revision, due to be published in 2013.

This book brings together the most promising research presented at the conference "The Future of Psychiatric Diagnosis: Refining the Research Agenda," which was convened by the APA, in collaboration with the World Health Organization and the U.S. National Institutes of Health. Conferees were challenged to go beyond the current categorical definitions set forth in DSM-III and DSM-IV and suggest ways of incorporating more quantitative, dimensional concepts into DSM-V. The resulting work: - Addresses the challenge of creating dimensional measures that are compatible with existing categorical definitions and do not unduly disrupt clinical practice- Applies a dimensional approach to a broad range of diagnoses, including substance dependence, major depressive episode, psychosis, anxiety disorders, developmental psychopathology, and personality disorders- Facilitates the development of broadly agreed upon criteria that researchers worldwide can use in planning and conducting future research exploring the etiology and pathophysiology of mental disorders- Identifies and encourages the empirical research necessary to allow informed decision making regarding deficiencies acknowledged in DSM-IV- Promotes international collaboration with the objective of eliminating the remaining disparities between DSM-V and the International Classification of Diseases Mental and Behavioural Disorders Section, the next edition of which is due to be released in 2014.

The book's painstaking scholarship and thoughtful conclusions should stimulate interest in finding new ways of combining categorical and dimensional approaches in psychiatric nosology. Clinicians and researchers in the United States and the international psychiatric community will discover, in these pages, the beginnings of a new, quantitative methodology that represents the next stage in the evolution of DSM.

Im deutschen Sprachraum fehlt bisher eine zusammenfassende, praxisnahe Darstellung der raschen und oft nur noch schwer uberschaubaren Entwicklung der Verhaltenstherapie in verschiedenen Bereichen der Medizin. Die 1987 erfolgte Einfuhrung der Verhaltenstherapie in die Krankenversorgung, mit der dadurch erforderlich gewordenen Intensivierung der Aus- und Weiterbildung von Therapeuten, macht diese Lucke ebenso deutlich, wie der breite Indikationskatalog fur Verhaltenstherapie in den seit 1987 gultigen neuen Psychotherapierichtlinien der Krankenkassenverbande und der kassenarztlichen Vereinigungen. Die heute sehr vielschichtigen Anwendungsbereiche der Verhaltenstherapie bei psychiatrischen, somatischen und Abhangigkeits-Erkrankungen werden in diesem Buch praxisnah auf dem aktuellen Forschungsstand dargestellt. Durch die breite Auswahl der behandelten Erkrankungen stellt dieser Band eine reprasentative, exemplarische Zusammenfassung standardisierter wie innovativer Behandlungs- und Forschungsmodelle dar. Durchgangig werden die Handlungs- und Behandlungsstrategie und die Erstellung eines ubergeordneten Storungsmodells als unerlassliche Grundlagen der Indikationsstellung und der Anwendung spezifischer, z.T. symptomgerichteter Techniken herausgearbeitet.

Die beiden Hauptgruppen klinischer Kopfschmerzsyndrome, die wcgen ihres funktionellen Charakters in der psychosomatischen Praxis am haufigsten vorkommen, die Migrane und verwandte "vaskulare" Kopf- schmerzen einerseits und die sog. "Spannungskopfschmerzen" anderer- seits, werden pathophysiologisch unterschiedlich erklart. Dies ist in anderen Kapiteln dieses Bandes ausfuhrlicher dargelegt, so daB hier einige einleitende Bemerkungen genugen. Nach WOLFF (1963j vgl. HEYCK 1975) ist die Migrane ein biphasischer ProzeB, bei dem auf eine schmerzfreie Phase intrakranieller Minder- durchblutung ("Aura") die eigentliche Schmerzphase mit extrakranieller Mehrdurchblutung folgt (Anfall). Die Kopfschmerzen in dieser Phase gehen vermutlich auf die starke Dehnung der glatten Muskelfasern in den extrakraniellen Arterien zurlick. Die reine Form des Spannungskopf- schmerzes hingegen wird lokal von chronischen Muskelverspannungen im Kopf-Hals-Schulterbereich bedingt. In beiden Fallen konnen die Ursa- chen sehr vielfaltig sein. Die Differentialdiagnose ist oft schwierig, und gerade in der psychosomatischen Praxis finden sich haufiger Misch- formen, deren atiologischer Ausgangspunkt nach einer langen Chronifi- zierung nicht mehr identifiziert werden kann (PHILIPS 1977). Bei Muskelverspannungen konnen sekundar GefaBreaktionen auftreten, und umgekehrt flihren migranoide Kopfschmerzen auch zu erhohtem Tonus in der Kopf- und Halsmuskulatur. Psychologische Belastungsfaktoren spie- len in beiden Fallen eine erhebliche Rolle und dienen kaum der Diffe- rentialdiagnose. Spezifische Interventionen durch Biofeedback-Training der gestorten physiologischen Funktion wurden entsprechend den genannten atiologi- schen Hypothesen bei der Migrane am Kopfkreislauf, beim Spannungskopf- schmerz an der Skelettmuskulatur ansetzen. Nach diesem Prinzip sind in der Vergangenheit EMG-Feedback bei Spannungskopfschmerz (BUDZYNSKI & STOYVA 1975 u. a.; vgl.