The Impact of Australian Psychologists’ Education, Beliefs, Theoretical Understanding, and Attachment on the Use and Implementation of Exposure Therapy

Abstract

The objective of this study was to investigate the relative contributions of university education, exposure specific training, and beliefs about exposure therapy (ET) in relation to the frequency, duration, and intense delivery of ET by Australian psychologists. Associations between clinicians’ use of and theoretical conceptualisation of ET, and attachment style were also evaluated. A total of 115 Australian psychologists (N = 94 females) completed an online survey. Findings revealed that a majority of participants used cognitive behaviour therapy (93%) and ET (88%) to treat anxiety disorders, including obsessive-compulsive disorder. The majority who used ET (90%) reported using therapist-assisted in vivo exposure with clients. Findings also showed that therapists spend 42% of session time on exposure. Moreover, therapists who reported more comprehensive training had more positive beliefs about ET. Positive beliefs about ET, and clearer conceptualisation of treatment, were related to greater use and more intense implementation of ET. Psychologists with a more preoccupied or dismissive attachment style were less likely to deliver intense ET. The findings suggest that ET-specific training may be a powerful medium to improving the adoption and application of ET. Clinician's theoretical conceptualisation of ET and interpersonal attachment style are also worthy targets for future research and training in ET.

Barriers to the use of exposure therapy by psychologists treating anxiety, obsessive‐compuslive disorder, and posttraumatic stress disorder in an Australian sample

“…Findings are consistent with those found across other countries, particularly where samples of psychologists have been used and where training programs have a heavy emphasis on CBT (Sars & van Minnen, 2015). Previous research has highlighted the importance of confidence (Trivasse et al, 2020), beliefs about exposure therapy (Deacon et al, 2013;Schumacher et al, 2018) and knowledge of theoretical underpinnings (Rowe & Kangas, 2020), as has been found here. This research, therefore, provides further support for previously identified barriers to use and for elements that, if addressed in clinical training, may increase use.…”

“…Whilst meta‐analytic findings have demonstrated that training leads to improvements in knowledge, training has not been reliably demonstrated to increase intention or use of exposure therapy (Trivasse et al, 2020). Whilst CBT is frequently taught in tertiary education and practiced in clinical settings in Australia (Rowe & Kangas, 2020), training programs may not routinely address a clinician's intention or motivation to use exposure therapy, which has been suggested as key to improving the science‐practice gap (Trivasse et al, 2020). Therefore, whilst conventional training may help, the addition of particular components may be required to improve the science‐practice gap.…”

“…Several barriers to the use of exposure therapy have been identified. These include negative beliefs about exposure (Deacon et al, 2013; Pittig et al, 2019); confidence in credibility of exposure (Sars & van Minnen, 2015), confidence in clinician's own ability to use exposure (Trivasse et al, 2020); practical barriers (Pittig et al, 2019); clinicians own worry and/or anxiety sensitivity (Reid et al, 2017) and lack of knowledge of the theoretical underpinnings of exposure therapy (Rowe & Kangas, 2020). Whilst this research has been of much value, the extent and nature of these barriers require further assessment, particularly within the Australian context.…”

Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review

“… Adults (unspecified). (Rowe & Kangas, 2020 ) Quantitative descriptive Survey Anxiety-related presentations (combined anxiety disorders and OCD). Adults (unspecified).…”