Dissemination of exposure in the treatment of anxiety disorders and post‐traumatic stress disorder among German cognitive behavioural therapists

Abstract

The efficacy of exposure is beyond doubt, which is reflected in guidelines recommending its application in the treatment of anxiety disorders and post-traumatic stress disorder (PTSD). Research suggests exposure to be underutilized in clinical practice in the United States and Europe. A systematic investigation of the dissemination of exposure in Germany is lacking. The present study examined the dissemination and application frequency of exposure among German cognitive behavioural therapists working in routine care. In an online-based survey, 331 psychotherapists provided information on treatment of patients with panic disorder, phobia, and PTSD. By means of multinomial logistic regression analysis, application frequency of exposure (non-users vs. users vs. frequent users) was predicted by various therapist characteristics. Younger age and less negative beliefs about exposure significantly predicted the affiliation to the frequent users group compared to the non-users in the treatment of panic disorder or phobia. Concerning treatment of PTSD, only negative beliefs about exposure was identified as significant predictor. Sex, educational level, and number of exposure sessions performed during clinical training were not of predictive value. Current findings suggest that negative beliefs about exposure and age impact the frequent provision of exposure to patients. Modification of negative attitudes might be achieved through specific training strategies.

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.…”

Cognitive behavior therapies for posttraumatic stress disorder.

“…Possible solutions include training lay therapists from the community (e.g., Neuner et al, 2008) and web-based interventions or telemedicine (e.g., Knaevelsrud & Maercker, 2007;Lange et al, 2003;Litz et al, 2007;Wild et al, 2016). Therapists attitudes such as skepticism toward evidence-based interventions and overestimation of the risks of exposure to trauma memories can also impede the implementation of TF-CBT (Foa et al, 2013;Schumacher et al, 2018).…”

Virtual Reality for Anxiety and Stress-Related Disorders: A SWOT Analysis

“…Initially, it emerged as an alternative for the delivery of in vivo exposure. Although applying exposure to anxiety disorders is one of the few undisputable procedures in clinical psychology research [8], a number of studies have shown that both therapists [9][10][11] and patients [12,13] are reluctant to undergoing in vivo exposure. In that sense, the possibility of creating virtual environments capable of provoking analogue emotional reactions to real stimuli arouse as an appealing strategy for the whole spectrum of ASRD.…”