When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors
Section snippets
Therapist factors
Training in and experience with exposure for PTSD are likely to influence the decision to use the approach. When Becker et al. (2004) asked the practising psychologists in their survey to rate these two factors, they found that only 31% had had formal training in the use of imaginal exposure (IE) and that this group was more likely to report current use of the technique than the untrained respondents. When asked to list the factors that prevented them from using IE, the respondents indicated
Patient factors
Patient variables, such as comorbidity and treatment preference may also be of importance in the therapists' choice of treatment. Becker et al. (2004) reported that a large number of clinicians (37%) saw any comorbid diagnosis as a likely contraindication for exposure (IE) for PTSD. Exploring patient preferences for exposure versus medication, Zoellner, Feeny, and Bittinger (2009) reported a similar trend: fewer therapists opted for exposure when PTSD patients had a concurrent depression.
Participants
A total of 296 trauma experts took part in our study conducted during the 2008 Annual NtVP Conference (the ‘Nederlandstalige Vereniging voor Psychotrauma’; the Dutch–Flemish Association for Psychotrauma). Forty-one participants (13.8%) did not consent to their contribution being used for research purposes. The final sample thus consisted of 255 participants: 84 men and 167 women (with four respondents not specifying their sex), with an average age of 48.83 (SD = 9.83). All participants were
Explorative survey results
Table 1 shows the means and standard deviations (SDs) for the experts' responses to the four expert variables under study per treatment type.
Discussion
In an attempt to find an explanation for the minimal use of imaginal exposure, an evidence based technique, in the treatment of posttraumatic stress disorder, we conducted an explorative survey among 255 trauma experts practising in Belgium and the Netherlands looking at level of training, treatment credibility, perceived barriers and the therapist's sex. Further, we experimentally studied the effect of patients' comorbidity and treatment preferences by randomizing the trauma experts to two
Acknowledgements
The wireless voting system used in the study reported was funded by ‘Achmea Stichting Slachtoffer en Samenleving’.
The authors are indebted to all participants for their willingness to participate in and their contribution to this study. They also like to thank the ‘Nederlandstalige Vereniging voor PsychoTrauma’ for the opportunity to conduct this research during their annual conference. They also thank José Kerstholt for her advice regarding clinical decision-making processes.
References (26)
- et al.
“I need to talk about it”: a qualitative analysis of trauma-exposures women's reasons for treatment choice
Behavior Therapy
(2008) - et al.
An analog study of patient preferences for exposure versus alternative treatments for posttraumatic stress disorder
Behaviour Research and Therapy
(2007) - et al.
A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD
Behaviour Research and Therapy
(2004) - et al.
Factors impacting trauma treatment practice patterns: the convergence/divergence of science and practice
Anxiety Disorders
(2008) - et al.
The acceptability and preference for the psychological treatment of PTSD
Behaviour Research and Therapy
(2006) - et al.
What you believe is what you want: modeling PTSD-related treatment preferences for sertraline or prolonged exposure
Journal of Behavior Therapy and Experimental Psychiatry
(2009) - et al.
Treatment choice for PTSD
Behaviour Research and Therapy
(2003) - et al.
Why, why, why? Reason giving and rumination as predictors of response to activation- and insight-oriented treatment rationales
Journal of Clinical Psychology
(1999) Diagnostic and statistical manual for mental disorders
(2000)- et al.
Dissemination of exposure therapy in the treatment of posttraumatic stress disorder
Journal of Traumatic Stress
(2006)
Cognitive–behavioral therapy for adults
Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related Posttraumatic Stress Disorder
Journal of Consulting and Clinical Psychology
Reasons underlying treatment preference. An exploratory study
Journal of Interpersonal Violence
Cited by (196)
Exposure therapy in patients with harm-related obsessive-compulsive disorder: The theory-practice gap and its relation to experiential avoidance and negative beliefs about exposure
2024, Journal of Obsessive-Compulsive and Related DisordersVirtual reality eye movements are not inferior to computerized eye movements and exposure in ameliorating aversive memories
2023, Computers in Human Behavior ReportsComparing the unified protocol for transdiagnostic treatment of emotional disorders to prolonged exposure for the treatment of PTSD: Design of a non-inferiority randomized controlled trial
2023, Contemporary Clinical Trials Communications