Kemp, J, et al, “Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation”

Joshua Kemp, Kristen Benito, Jennifer Herren, Zoe Brown, Hannah E. Frank and Jennifer Freeman

Abstract:

Background: Exposure therapy is a highly effective but underutilized treatment
for anxiety disorders. A primary contributor to its underutilization is therapist level negative beliefs about its safety and tolerability for patients. Given functional similarities between anxious beliefs among patients and negative beliefs among therapists, the present protocol describes how exposure principles can be leveraged during training to target and reduce therapist negative beliefs.

Methods: The study will take place in two phases. First, is a case-series analysis to
fine-tune training procedures that is already complete, and the second is an ongoing
randomized trial that tests the novel exposure to exposure (E2E) training condition
against a passive didactic approach. A precision implementation framework will
be applied to evaluate the mechanism(s) by which training influences aspects of
therapist delivery following training.

Anticipated results: It is hypothesized that the E2E training condition will produce
greater reductions in therapists’ negative beliefs about exposure during training
relative to the didactic condition, and that greater reduction in negative beliefs
will be associated with higher quality exposure delivery as measured by coding of
videotaped delivery with actual patients.

Conclusion: Implementation challenges encountered to date are discussed
along with recommendations for future training interventions. Considerations for
expansion of the E2E training approach are also discussed within the context of
parallel treatment and training processes that may be tested in future training trials