A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD

Abstract

Although research supports the efficacy of exposure therapy for PTSD, some evidence suggests that exposure is under-utilized in general clinical practice. The purpose of this study was to assess licensed psychologists' use of imaginal exposure for PTSD and to investigate perceived barriers to its implementation. A total of 852 psychologists from 3 states were randomly selected and surveyed. An additional 50 members of a trauma special interest group of a national behavior therapy organization were also surveyed. The main survey results indicate that a large majority of licensed doctoral level psychologists do not report use of exposure therapy to treat patients with PTSD. Although approximately half of the main study sample reported that they were at least somewhat familiar with exposure for PTSD, only a small minority used it to treat PTSD in their clinical practice. Even among psychologists with strong interest and training in behavioral treatment for PTSD, exposure therapy is not completely accepted or widely used.Clinicians also appear to perceive a significant number of barriers to implementing exposure.

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

“…We, however, found that the posttreatment PTSD symptom amelioration persisted up to six months. Second, TFT programmes may evoke serious adverse events or symptom exacerbations (Becker, Zayfert, & Anderson, 2004; van Minnen et al, 2010) and these risks are assumed to be higher in intensive treatment programmes and in more vulnerable PTSD patients with ICD-11 Complex PTSD symptoms such as the present population. We found no evidence for this assumption.…”

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

“…Despite the effectiveness of trauma-focused treatments (TFTs) for post-traumatic stress disorder (PTSD) (Watts et al, 2013), these treatments are underused in clinical practice, even among trained clinicians (Becker, Zayfert, & Anderson, 2004; Hipol & Deacon, 2013). For instance, in one study it was shown that prolonged exposure (PE) was hardly used by therapists in the USA (Becker et al, 2004), a finding that was replicated in Europe for both PE and eye movement desensitization and reprocessing (EMDR) (van Minnen, Hendriks, & Olff, 2010).…”

“…For instance, in one study it was shown that prolonged exposure (PE) was hardly used by therapists in the USA (Becker et al, 2004), a finding that was replicated in Europe for both PE and eye movement desensitization and reprocessing (EMDR) (van Minnen, Hendriks, & Olff, 2010). Many therapists feel uncomfortable in directly addressing traumatic memories and evoke high levels of fear in the treatment sessions (Becker et al, 2004; Grimmett & Galvin, 2015). …”

“…It is known that not only patient-related characteristics, such as comorbidity (Becker et al, 2004; van Minnen et al, 2010), but also therapist-related factors, are strongly related to the underuse of TFTs (Harned, Dimeff, Woodcock, & Contreras, 2013; Hundt, Harik, Barrera, Cully, & Stanley, 2016; Laska, Smith, Wislocki, Minami, & Wampold, 2013), such as therapists’ negative beliefs or expectations about the application of TFT (N. R. Farrell, Deacon, Kemp, Dixon, & Sy, 2013; Meyer, Farrell, Kemp, Blakey, & Deacon, 2014; van Minnen et al, 2010) or therapists’ own anxiety sensitivity (Meyer et al, 2014), indicating that some therapists may simply be afraid to conduct this type of therapy. In addition to these hesitations to start a TFT, during the TFTs some therapists drift from the protocol (Waller, 2009) or deliver their (exposure) treatment in a suboptimal way, for instance by using anxiety-diminishing techniques (Hipol & Deacon, 2013), avoiding encouraging patients to carry out exposure exercises that elevate high levels of anxiety, or avoiding the application of (therapist-assisted) exposure in vivo during the treatment sessions (N. R. Farrell et al, 2013; Hipol & Deacon, 2013).…”

“…‘going crazy’ or not being able to function normally (de Kleine, Hendriks, Becker, Broekman, & van Minnen, 2017; Foa & Kozak, 1986). Therapists’ fears include the fear that patients may deteriorate as a result of the emotions evoked by the trauma-focused sessions or that TFT might harm patients (Becker et al, 2004; Deacon et al, 2013; Grimmett & Galvin, 2015). An interesting study in this regard showed that (novice) therapists showed high levels of stress, both physiologically (cortisol) and psychologically, at the beginning of an exposure in vivo session with an anxiety-disordered patient, and these stress levels decreased both within and across three exposure sessions (Schumacher, Betzler, Miller, Kirschbaum, & Ströhle, 2017).…”