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

Abstract

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.

Investigating Bang for Your Training Buck: A Randomized Controlled Trial Comparing Three Methods of Training Clinicians in Two Core Strategies of Dialectical Behavior Therapy

“…Indeed, all three training methods resulted in significant and comparable gains in clinical use and proficiency, with clinicians increasing to moderate levels on both outcomes. Consistent with the emerging consensus in the field, these results suggest that relatively brief didactic trainings may need to be augmented with supervision or consultation for clinicians, perhaps particularly those with no prior experience in a given EST, to reach a high level of competence and to further increase knowledge gains (e.g., Beidas et al, 2012;Harned et al, 2014;Herschell et al, 2010;Miller, Yahne, Moyers, Martinez & Pirritano, 2004;Sholomskas et al, 2005). Given that lack of available supervision is a primary barrier to implementation cited by clinicians in this study and others (e.g., Dimeff et al, 2009), more work is clearly needed to develop effective methods of making supervision and consultation more widely available.…”

Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders Using Internet-Based Technologies

“…Our findings are also in line with research in clinical supervision of EBPs demonstrating that engaging in role plays with expert supervisors results in better use of EBPs than discussions during supervision (Bearman et al, 2013). Supplementing online training with motivational interviewing and regular group calls with a supervisor following training has also shown to increase clinical proficiency and knowledge of course content (Harned et al, 2014). Taken together, there is a growing body of research pointing to the critical utility of role play skill practice and expert involvement after didactic training in order to maintain high fidelity to CBT and other EBPs.…”

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

“…Indeed, in several studies it has been shown that training resulted in fewer beliefs about the potential harmful effects of exposure therapy (Deacon et al, 2013; Harned et al, 2014; Ruzek et al, 2016; van den Berg et al, 2016) or EMDR (D. Farrell & Keenan, 2013), but it is unclear whether these more positive beliefs indeed translate to more (adequate) use of these treatments (Gray, Elhai, & Schmidt, 2007). In addition, following on from this training, therapists may need support or supervision so that the need for exposure to their own feared situations, i.e.…”