Factors associated with practitioners’ use of exposure therapy for childhood anxiety disorders

Abstract

The current study examines factors related to use of exposure therapy by clinicians who treat children with anxiety disorders. A sample of 331 therapists from a variety of backgrounds (i.e., social workers, doctoral psychologists, masters level counselors, and marriage and family therapists) completed a survey regarding use of exposure and other treatment techniques for childhood anxiety disorders, as well as beliefs about exposure and child resiliency. Although the majority of therapists endorsed a CBT orientation (81%) and use of CBT techniques, exposure therapy was rarely endorsed. Holding a PhD in psychology as well as more positive beliefs about exposure and child resiliency were associated with greater use of exposure. The results suggest that exposure-based therapy is rarely offered in community settings and that dissemination should focus on individual evidence-based principles and correcting therapist misconceptions.

Secondary outcomes from the pediatric obsessive compulsive disorder treatment study II

“…Emerging neuroscience research also supports the importance of contextually based fear extinction learning, particularly for adolescents (Pattwell et al, 2016). However, many therapists report not using exposure-focused CBT due to beliefs that exposure may exacerbate patient anxiety, cause undue harm, or be otherwise unsafe or intolerable (Whiteside et al, 2016). Our findings indicate that exposure-based CBT at best improves secondary outcomes and, at a minimum, does not likely lead to worsening of the psychiatric symptoms we measured.…”

Use of evidence-based assessment for childhood anxiety disorders in community practice

“…This same sample was also used to examine treatment practices in a study reported elsewhere (Whiteside, Deacon, Benito, & Stewart, 2016). Two hundred and sixty-five of the respondents provided their profession, which included social workers (SW; n = 113, 42.6%), doctoral level psychologists (PhD; n = 49, 18.5%; and PsyD; n = 31, 11.7%), masters degree licensed counselors ( n = 44, 16.6%), and marriage and family therapists (MFT; n = 28, 10.6%).…”

“…These are also the disorders covered by commonly used structured diagnostic interviews and rating scales (i.e., Silverman & Albano, 1996 and Birmaher et al, 1997 respectively). These clinicians were emailed a follow-up survey about their assessment (current study) and treatment practices (Whiteside, Deacon, Benito, & Stewart, 2016). A total of 339 respondents completed the questions regarding EBA and were included in the current study.…”

Predictors of clinician use of exposure therapy in community mental health settings

“…Use of exposure, or confronting fear stimuli within the context of CBT, is the key ingredient of intervention leading to improved outcomes (Kendall et al, 2006; Peris et al, 2015). Despite scientific recognition that exposure is critical to the success of CBT for anxiety, recent estimates suggest that only 10–30 percent of clinicians endorse using exposure therapy in routine clinical care (Becker, Zayfert, & Anderson, 2004; Borntrager, Chorpita, Higa-McMillan, Daleiden, & Starace, 2013; Trask, Fawley-King, Garland, & Aarons, 2016; Whiteside, Deacon, Benito, & Stewart, 2016; Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015). To date, most studies examining exposure use in the context of routine clinical care have largely focused on documenting the rates of exposure use with adult clients with anxiety or post-traumatic stress disorder (PTSD); the few studies with youth populations suggest comparably low rates of exposure use for anxious youth (Higa-McMillan, Kotte, Jackson, & Daleiden, 2016; Whiteside et al, 2016).…”