Category: Dissemination / Implementation

Symposium

How Do Clinicians Deliver Exposure Therapy for Anxiety? Intensive and Anxiety-Reducing Delivery and Therapist Clusters

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

Keywords: Anxiety | Exposure | Dissemination
Presentation Type: Symposium

Introduction: Research has demonstrated that exposure therapy is underutilized among community clinicians. However, little research has been conducted on how and why clinicians deliver exposure therapy when they use it. The present two studies were conducted to examine exposure therapy delivery styles among clinicians who use this treatment, as well as therapist characteristics associated with delivery styles. It was hypothesized that clinicians would evidence either an intensive (anxiety-increasing) or coping (anxiety-reducing) delivery style, and that delivery style would be associated with negative beliefs about exposure therapy and related clinician characteristics.


 Methods: In Study 1, 330 community clinicians who reported using exposure therapy completed the 18-item Exposure Therapy Delivery Scale (ETDS) and measures of negative beliefs about exposure, anxiety sensitivity, and likelihood of excluding clients from exposure for questionable reasons (e.g., perceived emotional fragility). In Study 2, 134 community clinicians who work with anxious children completed the ETDS and measures of negative beliefs about exposure, perceived client/parent barriers to exposure, and beliefs about why and how exposure therapy works.


Results: In Study 1, the ETDS demonstrated excellent psychometric properties and had a clear 2-factor structure reflecting intensive and coping exposure delivery styles. Cluster analysis using the two ETDS scales revealed two distinct clusters: intensive exposure therapists (N = 144) and coping exposure therapists (N = 186). Large between-group effect sizes were obtained on measures of negative beliefs about exposure and excluding clients from exposure for questionable reasons. In Study 2, cluster analysis replicated the intensive (N = 27) and coping (N = 107) therapist clusters from Study 1. Coping therapists had higher negative beliefs about exposure, perceived more client/parent barriers to exposure, perceived their role as reducing anxiety, and viewed exposure as working by providing clients with coping skills (all d’s > 1.0).


 Discussion: Findings from Study 1 and Study 2 indicate that clinicians who use exposure therapy can be reliably classified as having an intensive (anxiety-increasing) or coping (anxiety-reducing) delivery style. Compared to intensive exposure therapists, coping exposure therapists appeared more concerned about the dangers of anxiety and exposure therapy and viewed their role as reducing client anxiety via the provision of coping skills. These results have important clinical implications. Although research suggests exposure therapy is more effective when delivered in an intensive and prolonged manner that maximizes inhibitory learning, most therapists do not deliver exposure this way and perceive this delivery style as risky and intolerable. Our findings indicate that efforts to improve the dissemination of exposure therapy should address delivery style and popular but largely unfounded therapist concerns about the dangers of intensive exposure. 

Nicholas R. Farrell

Clinical Supervisor
Rogers Memorial Hospital

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