Using Technology to Promote Therapist Use of Exposure Therapy for Childhood Anxiety Disorders: A Randomized Pilot Study

Whiteside, Stephen P.; Biggs, Bridget K.; Ollendick, Thomas H.; Dammann, Julie E.; Tiede, Michael S.; Hofschulte, Deanna R.; Reneson‐Feeder, Stephanie; Cunningham, Megan; Sawchuk, Nicholas R.; Geske, Jennifer R.; Brennan, Elle

doi:10.1016/j.beth.2022.01.010

Cited by 8 publications

(24 citation statements)

References 36 publications

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“…Unfortunately, the similar, but greater increase in exposure use that was previously documented with the AC-app intervention was not associated with enhanced patient outcomes (Whiteside et al, 2022). As such, the variations in practice settings observed here suggest that clinician behavior is malleable, but sufficient change is challenging to achieve.…”

Section: Discussionmentioning

confidence: 44%

“…Using all of the session recordings, the proportion of session recordings from each phase (orientation vs. treatment) did not differ significantly between the TAU and AC-app conditions. Previously reported results (Whiteside et al, 2022) indicated that therapists in the AC-app condition used more exposure than those in TAU condition (estimate = 0.32, p < 0.001). A series of multilevel models indicated that sessions in the TAU condition included more AMS (estimate = 0.23, p < 0.001), than the sessions in the AC-app condition, while the use of general therapy and other strategies did not differ significantly (Table 5).…”

Section: Objective Four: Effect Of Trainingmentioning

confidence: 89%

“…The treatment protocol, which has been described previously (Whiteside, Biggs, et al, 2020;Whiteside et al, 2022), is designed to maximize engagement in exposure by: (1) beginning in-session exposure as soon as possible,…”

Section: Ac-appmentioning

confidence: 99%

“…In fact, therapist self‐reported improvements in fidelity are often not reflected in direct observation (R. S. Beidas & Kendall, 2010). Direct coding of therapy sessions can provide a more accurate and detailed understanding of the amount of time dedicated to different techniques, which may also serve as a proxy for intervention “dosage.” To date, coding has only been applied to exposure use (Hedtke et al, 2009; Tiwari et al, 2013; Whiteside et al, 2022) and is consistent with low use in nonresearch settings. For instance, when implementing the second half of CBT packages in controlled research settings, therapists dedicate 52% of the session to planning, doing, and reviewing exposure although only approximately 20% of the session is spent conducting exposure in session (Hedtke et al, 2009; Tiwari et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…For instance, when implementing the second half of CBT packages in controlled research settings, therapists dedicate 52% of the session to planning, doing, and reviewing exposure although only approximately 20% of the session is spent conducting exposure in session (Hedtke et al, 2009; Tiwari et al, 2013). In contrast, community therapists appear to devote only 31% of session time to all aspects of exposure with a mere 10% spent completing in‐session exposure (Whiteside et al, 2022). To date, there is no objective observational data detailing what therapeutic activities occur in the remaining 50%–70% of session time.…”

Section: Introductionmentioning

confidence: 99%

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Using session recordings to understand the content of community‐based treatment for childhood anxiety disorders and response to technology‐based training

et al. 2023

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ObjectiveThe goal of the current study is to advance efforts to increase the quality of care for childhood anxiety disorder (CADs) through (1) detailing the content of community‐based treatment sessions, (2) exploring the validity of therapist surveys, (3) examining the influence of setting differences, and (4) testing the effects of a technology‐based training on use of nonexposure strategies.MethodsThirteen therapists were randomly assigned to technology‐based training in the use of exposure therapy or treatment as usual (TAU) for CADs. Therapeutic techniques were coded from 125 community‐based treatment sessions.ResultsConsistent with survey responses community therapists spent the majority of session time reviewing symptoms (34% of session time), implementing nonexposure cognitive behavioral therapy (CBT; 36%), and rarely engaged in exposure (3%). An integrated behavioral health setting was associated with greater endorsement of exposure on survey, p < 0.05, although this difference was not significant in session recordings, p = 0.14. Multilevel models indicated that technology‐based training that has been shown to increase exposure, also decreased use of nonexposure CBT techniques (2% vs. 29%, p < 0.001).ConclusionThe study supports the validity of survey‐based findings that community‐based care for CADs consists of non‐exposure CBT techniques. Efforts should be invested in dissemination of within‐session exposure.

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Section: Discussionmentioning

confidence: 44%

Section: Objective Four: Effect Of Trainingmentioning

confidence: 89%

Section: Ac-appmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using session recordings to understand the content of community‐based treatment for childhood anxiety disorders and response to technology‐based training

et al. 2023

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Effects of Training in Cognitive Behavioural Therapy and Motivational Interviewing on Mental Health Practitioner Behaviour: A Systematic Review and Meta‐Analysis

Ragnarsson,

Reinebo,

Ingvarsson

et al. 2024

Clin Psychology and Psychoth

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Effective training of mental health professionals is crucial for bridging the gap between research and practice when delivering cognitive behavioural therapy (CBT) and motivational interviewing (MI) within community settings. However, previous research has provided inconclusive evidence regarding the impact of training efforts. The current study aimed to systematically search, review and synthesize the literature on CBT and MI training to assess its effect on practitioner behavioural outcomes. Following prospective registration, a literature search was conducted for studies where mental health practitioners were exposed to training in face‐to‐face CBT or MI, reporting on at least one quantitative practitioner behavioural outcome. A total of 116 studies were eligible for the systematic review, and 20 studies were included in four meta‐analyses. The systematic review highlights the need to establish psychometrically valid outcome measures for practitioner behaviour. Results of the meta‐analyses suggest that training has a greater effect on practitioner behaviour change compared to receiving no training or reading a treatment manual. Training combined with consultation/supervision was found to be more effective than training alone, and no differences were found between face‐to‐face and online training. Results should be interpreted with caution due to methodological limitations in the primary studies, large heterogeneity, and small samples in the meta‐analyses. Future directions are discussed.

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

Racz,

Bialocerkowski,

Calteaux

et al. 2024

Clin Child Fam Psychol Rev

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Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians’ negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.

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Using Technology to Promote Therapist Use of Exposure Therapy for Childhood Anxiety Disorders: A Randomized Pilot Study

Cited by 8 publications

References 36 publications

Using session recordings to understand the content of community‐based treatment for childhood anxiety disorders and response to technology‐based training

Using session recordings to understand the content of community‐based treatment for childhood anxiety disorders and response to technology‐based training

Effects of Training in Cognitive Behavioural Therapy and Motivational Interviewing on Mental Health Practitioner Behaviour: A Systematic Review and Meta‐Analysis

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

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