Targeting clinician concerns about exposure therapy: A pilot study comparing standard vs. enhanced training

doi:10.1016/j.brat.2016.08.011

Behaviour Research and Therapy

Volume 85, October 2016, Pages 53-59

https://doi.org/10.1016/j.brat.2016.08.011 Get rights and content

Highlights

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Clinicians received either standard or enhanced exposure therapy training.
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Clinician concerns about exposure and self-reported exposure delivery were assessed.
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Enhanced training yielded greater reductions in clinician concerns about exposure.
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Self-reported exposure delivery was superior among enhanced training clinicians.
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Reductions in concerns mediated the effect of training type on exposure delivery.

Abstract

Owing to concerns about the safety and tolerability of exposure therapy, many clinicians deliver the treatment in an overly cautious manner, which may limit its effectiveness. Although didactic training in exposure reduces clinician concerns about the treatment to a moderate extent, improved training strategies are needed to minimize these concerns and improve exposure delivery. The present study compared the effectiveness of a standard (i.e., didactic) exposure therapy training model to an “enhanced” training paradigm encompassing strategies derived from social-cognitive theory on attitude change. Clinicians (N = 49) were assigned to one of the two training approaches. Relative to standard training, clinicians who received enhanced training showed: (a) significantly greater reductions in concerns about exposure from pre- to post-training, and (b) superior self-reported delivery of the treatment. Reduction in concerns during training mediated the effects of training condition on clinicians' self-reported exposure delivery. These findings underscore the importance of addressing clinician concerns about exposure therapy in training contexts.

Section snippets

Participants

Participants (N = 49) were mental health clinicians attending an 8-h workshop on the theory and practice of exposure therapy for anxiety. The sample age ranged from 31 to 73 years (M = 51.5, SD = 10.5). The majority of participants were women (n = 32, 65.3%) and Caucasian (n = 46, 93.9%). Nearly all reported earning either a Master's degree (n = 37, 75.5%) or Ph.D. (n = 9, 18.4%). On average, the sample had 18.7 years of experience (SD = 9.6) in clinical practice. Participants endorsed the

Preliminary analyses

The conditions did not differ significantly in age, t(45) = 0.73, p = 0.47, or years of experience in the mental health profession, t(46) = 0.61, p = 0.55. Additionally, there were no significant differences between training conditions in gender, χ² (1, n = 49) = 0.35, p = 0.56, ethnicity, χ² (4, n = 49) = 2.91, p = 0.23, theoretical orientation, χ² (5, n = 49) = 3.63, p = 0.60, or highest degree obtained, χ² (3, n = 49) = 1.18, p = 0.76.

Change in concerns about and knowledge of exposure therapy

Descriptive statistics for all dependent measures at both

Discussion

Despite the recognized need to disseminate exposure therapy to clinicians in a manner that minimizes concerns about this treatment, there is little empirical guidance as to how this goal may be accomplished. The present study compared the effectiveness a theory-based exposure therapy training model to a standard training model offering didactic instruction in the theory and practice of exposure. Results supported our hypothesis that the enhanced training model would lead to greater reductions

References (26)

J.S. Abramowitz
The practice of exposure therapy: Relevance of cognitive-behavioral theory and extinction theory
Behavior Therapy
(2013)
J.S. Abramowitz et al.
Strategies for improving long-term outcomes in cognitive-behavioral therapy for obsessive-compulsive disorder: Insights from learning theory
Cognitive and Behavioral Practice
(2014)
J. Aronson et al.
Reducing the effect of stereotype threat on African American college students by shaping theories of intelligence
Journal of Experimental Social Psychology
(2002)
C.B. Becker et al.
A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD
Behaviour Research and Therapy
(2004)
K.G. Benito et al.
CBT-specific process in exposure-based treatments: Initial examination in a pediatric OCD sample
Journal of Obsessive-Compulsive and Related Disorders
(2012)
M.G. Craske et al.
Maximizing exposure therapy: An inhibitory learning approach
Behaviour Research and Therapy
(2014)
B.J. Deacon et al.
Assessing therapist reservations about exposure therapy for anxiety: Development and validation of the therapist beliefs about exposure scale
Journal of Anxiety Disorders
(2013)
B. Deacon et al.
Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial
Behaviour Research and Therapy
(2013)
B.J. Deacon et al.
Therapist perceptions and delivery of interoceptive exposure for panic disorder
Journal of Anxiety Disorders
(2013)
N.R. Farrell et al.
Theory-based training strategies for modifying practitioner concerns about exposure therapy
Journal of Anxiety Disorders
(2013)

N.R. Farrell et al.

Do negative beliefs about exposure therapy cause its cautious delivery? an experimental investigation

Journal of Anxiety Disorders

(2013)

M.S. Harned et al.

Predicting adoption of exposure therapy in a randomized controlled dissemination trial

Journal of Anxiety Disorders

(2013)

M.S. Harned et al.

Exposing clinicians to exposure: A randomized controlled dissemination trial of exposure therapy for anxiety disorders

Behavior Therapy

(2014)

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Targeting clinician concerns about exposure therapy: A pilot study comparing standard vs. enhanced training

Highlights

Abstract

Section snippets

Participants

Preliminary analyses

Change in concerns about and knowledge of exposure therapy

Discussion

Behavior Therapy

Cognitive and Behavioral Practice

Journal of Experimental Social Psychology

Behaviour Research and Therapy

Journal of Obsessive-Compulsive and Related Disorders

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Behavior Therapy