Therapist perceptions and delivery of interoceptive exposure for panic disorder

Deacon, Brett J.; Lickel, James J.; Farrell, Nicholas R.; Kemp, Joshua J.; Hipol, Leilani J.

doi:10.1016/j.janxdis.2013.02.004

Cited by 77 publications

(78 citation statements)

References 28 publications

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“…This low level of usage is similar to that in other diagnostic groups (e.g., Becker, Zayfert & Anderson, 2004), and is explained at least in part by similar intra-clinician characteristics (Deacon, Lickel, Farrell, Kemp & Hipol, 2013;. In the anxiety disorders, the reasons given for not using exposure are more related to clinicians' negative beliefs about exposure therapy (e.g., Deacon, Lickel, et al, 2013) than to evidence of possible outcomes . In both anxiety and eating disorders, clinician anxiety is also associated with poorer use of exposure-based methods (Meyer, Farrell, Kemp, Blakey & Deacon, 2014;Turner et al, 2014).…”

Section: Impact Of Education On Clinicians' Attitudes To Exposure Thesupporting

confidence: 59%

Impact of education on clinicians' attitudes to exposure therapy for eating disorders

Waller

Walsh

Wright

2016

Behaviour Research and Therapy

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Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Addressing clinicians' attitudes to exposure therapy AbstractIt is well established that clinicians use exposure therapy far less often than the evidence would suggest is justified. This shortfall has been explained as being at least partly a result of clinicians' beliefs and attitudes about exposure and their trait anxiety. Recent studies have shown that attitudes to exposure therapy for anxiety disorders can be improved through a simple educational approach. This study aimed to determine whether a similar educational approach can improve therapists' attitudes to exposure therapy for the eating disorders, and whether clinician's pre-intervention characteristics influenced the impact of the training. Thirty-four eating disorder clinicians (30 female, four male; mean age = 39.0 years; 85.3% Caucasian) attended a 90-minute didactic teaching session on the subject of the use of exposure in treatment of eating disorders. Their attitudes to exposure therapy were measured before and after the workshop, in a within-subject design. The outcome was a substantial improvement in attitudes, with a strong effect size (Cohen's d = 1.68) that was comparable to the outcome of a similar intervention among clinicians working with anxiety disorders. The improvement was not related to clinicians' anxiety levels, but was greater among those whose attitudes were more negative at the outset of the teaching. While this finding needs to be tested for long-term maintenance and its relationship to change in clinical practice, it adds to the evidence that a simple educational intervention is sufficient to result in substantial improvement in clinicians' attitudes to exposure therapy.

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Section: Impact Of Education On Clinicians' Attitudes To Exposure Thesupporting

confidence: 59%

Impact of education on clinicians' attitudes to exposure therapy for eating disorders

Waller

Walsh

Wright

2016

Behaviour Research and Therapy

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“…Concerns about ET typically stem from the fact that these treatments require clinicians to deliberately elicit anxiety by having clients confront the stimuli that make them anxious so that new learning can occur. Despite the fact that common clinician concerns (e.g., that ET will lead to symptom exacerbation or dropout) are not supported by empirical data (Deacon et al, 2013; Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002; Hembree et al, 2003; Olatunji et al, 2009), many clinicians remain hesitant or unwilling to use ET. Importantly, clinicians who have received training in ET endorse concerns about ET at rates comparable to those who have not received training (Becker et al, 2004), suggesting that existing training methods may not adequately address these attitudinal barriers.…”

Section: Barriers To the Dissemination And Implementation Of Etmentioning

confidence: 99%

Exposing Clinicians to Exposure: A Randomized Controlled Dissemination Trial of Exposure Therapy for Anxiety Disorders

et al. 2014

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Objective The present study evaluated three technology-based methods of training mental health providers in exposure therapy (ET) for anxiety disorders. Training methods were designed to address common barriers to the dissemination of ET, including limited access to training, negative clinician attitudes toward ET, and lack of support during and following training. Method Clinicians naïve to ET (N=181, Mage = 37.4, 71.3% female, 72.1% Caucasian) were randomly assigned to: 1) an interactive, multimedia online training (OLT), 2) OLT plus a brief, computerized motivational enhancement intervention (OLT+ME), or 3) OLT + ME plus a web-based learning community (OLT+ME+LC). Assessments were completed at baseline, post-training, and 6 and 12 weeks following training. Outcomes include satisfaction, knowledge, self-efficacy, attitudes, self-reported clinical use, and observer-rated clinical proficiency. Results All three training methods led to large and comparable improvements in self-efficacy and clinical use of ET, indicating that OLT alone was sufficient for improving these outcomes. The addition of the ME intervention did not significantly improve outcomes in comparison to OLT alone. Supplementing the OLT with both the ME intervention and the LC significantly improved attitudes and clinical proficiency in comparison to OLT alone. The OLT+ME+LC condition was superior to both other conditions in increasing knowledge of ET. Conclusions Multi-component trainings that address multiple potential barriers to dissemination appear to be most effective in improving clinician outcomes. Technology-based training methods offer a satisfactory, effective, and scalable way to train mental health providers in evidence-based treatments such as ET.

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“…Deacon, Farrell, and colleagues (2013) found in a sample of over 600 therapists that the average clinician has a moderate degree of negative beliefs about exposure therapy. Surprisingly, even self-reported exposure therapists harbor these negative beliefs (Deacon, Farrell, et al, 2013; Deacon, Lickel, Farrell, Kemp, & Hipol, 2013; Richard & Gloster, 2007). Several myths about exposure therapy are prevalent, including beliefs that exposure therapy leads to high attrition rates and symptom exacerbation (Olantunji et al, 2009) and that exposures do not generalize to the real world (Feeny, Hembree, & Zoellner, 2003).…”

mentioning

confidence: 99%

Ethical Considerations in Exposure Therapy With Children

Gola¹,

Beidas

Antinoro-Burke³

et al. 2016

Cognitive and Behavioral Practice

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Despite the abundance of research that supports the efficacy of exposure therapy for childhood anxiety disorders and OCD, negative views and myths about the harmfulness of this treatment are prevalent. These beliefs contribute to the underutilization of this treatment and less robust effectiveness in community settings compared to randomized clinical trials. Although research confirms that exposure therapy is efficacious, safe, tolerable, and bears minimal risk when implemented correctly, there are unique ethical considerations in exposure therapy, especially with children. Developing ethical parameters around exposure therapy for youth is an important and highly relevant area that may assist with the effective generalization of these principles. The current paper reviews ethical issues and considerations relevant to exposure therapy for children and provides suggestions for the ethical use of this treatment.

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Therapist perceptions and delivery of interoceptive exposure for panic disorder

Cited by 77 publications

References 28 publications

Impact of education on clinicians' attitudes to exposure therapy for eating disorders

Impact of education on clinicians' attitudes to exposure therapy for eating disorders

Exposing Clinicians to Exposure: A Randomized Controlled Dissemination Trial of Exposure Therapy for Anxiety Disorders

Ethical Considerations in Exposure Therapy With Children

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