Dissemination of exposure-based treatment for anxiety: Experiential training for community therapists

Abstract

Background: Although exposure is considered an active ingredient in evidence-based treatments (EBTs) for anxiety, it is infrequently used in routine clinical care settings. Therapist-level barriers to the use of exposure include inadequate training and negative beliefs about exposure. Prior efforts to train therapists in exposure therapy have resulted in knowledge but not behavior change. This study employed a novel training strategy, experiential learning, designed to improve the translation of knowledge into clinical practice. This study’s aims were to assess the feasibility and acceptability of experiential training (ET), as well as to conduct exploratory inferential analyses examining knowledge, attitudes, and use of exposure following training. Methods: Participants included 28 therapists working in routine clinical care settings. They were randomized to one of two conditions to learn about exposure therapy: training as usual (TAU) or ET (i.e., undergoing a one-session treatment for fear of spiders). Both workshops lasted one day, and participants were expected to attend weekly consultation calls for three months after training. Qualitative interviews were conducted at the end of the consultation call period. Results: The ET was feasible and acceptable to participants. Qualitative interviews suggested that participants, including those who were fearful of spiders, had a positive response to the training and found it to be useful. Quantitative analyses found that there was a significantly greater increase in the number of exposures used following ET than TAU at 1-month follow up. Both conditions demonstrated significant increases in knowledge, attitudes toward exposures, and self-efficacy following the training. Conclusions: The findings suggest that, consistent with previous research, a one-day training resulted in significant improvements in therapist-level factors that may affect the use of exposure. In addition, there is initial evidence that ET resulted in greater use of exposure after training, which applied more broadly, could increase the number of clients receiving an EBT for anxiety. The results provide promising evidence for the utility and acceptability of ET as a strategy to increase the use of EBTs in clinical practice.