Category: Dissemination / Implementation


Progressive Cascading Model Improves Exposure Delivery in Trainee Therapists Learning Exposure Therapy for OCD

Sunday, November 19
8:30 AM - 10:00 AM
Location: Aqua Salon E & F, Level 3, Aqua Level

Keywords: Dissemination | Training / Training Directors | Exposure
Presentation Type: Symposium

Introduction: Exposure is the most critical ingredient in cognitive behavioral therapy for obsessive-compulsive disorder (OCD), but it is rarely used by most therapists in the community. Recent research indicates that community therapists often fear using exposure (“exposaphobia”) due to a lack of training, negative beliefs about exposure, and/or their own affective responses to stimuli used in more intense exposures. A recent cognitive-behavioral psychology education task force suggested that an increase in opportunities for specialized training during graduate training is warranted, and thus the development of empirically supported training models at the graduate level is paramount to accomplishing this goal and ultimately improving dissemination. The present study evaluated the University of Florida OCD Program’s training model called the Progressive Cascading Model (Balkhi, Reid, Guzick, Geffken, & McNamara, 2016), which emphasizes psychoeducation, experiential learning, affective alignment with exposure, and peer-to-peer mentoring through frequent co-therapy, competency-based evaluation, and dynamic group supervision.

Methods: Forty-two trainee therapists completed psychometrically validated self-report measure assessing their beliefs about exposure therapy (e.g. it is unethical, it can exacerbate symptoms), exposure therapy delivery, including cautious (e.g. allowing safety behaviors, terminating exposures early) and intense behaviors (e.g. modeling exposure tasks, conducting exposures in and out of session), and their disgust and anxiety sensitivity before and after a six-month rotation. Trainee therapists included five post-doctoral associates, eight clinical psychology interns, and 29 graduate students.

Results: Paired-samples t-tests indicate trainees experience significant reductions in cautious E/RP delivery (t [41] = 7.01, p < .001), negative beliefs towards exposure therapy (t[41] = 5.49, p < .001), and disgust sensitivity (t [41] = 3.44, p = .001). Results also suggested improvement in intense E/RP delivery that was trending towards significance (t [41] = -1.83, p = .075). Qualitative feedback suggested that trainees felt the co-therapy approach was most helpful in learning exposure techniques.

Discussion: The Progressive Cascading Model represents a promising training model for novice therapists learning exposure. Beyond improving the quality of exposure therapy delivery, this training model also appears to effectively challenge negative beliefs about exposure techniques and improve tolerance of disgust evoking stimuli. Flexible applications of this model to various settings and the presenter’s own experience training at the UF OCD clinic will also be discussed.

Andrew Guzick

Graduate Student
University of Florida


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Progressive Cascading Model Improves Exposure Delivery in Trainee Therapists Learning Exposure Therapy for OCD

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