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Therapist Barriers to the Dissemination of Exposure Therapy

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Handbook of Treating Variants and Complications in Anxiety Disorders

Abstract

Although exposure-based cognitive-behavioral therapy (CBT) has been recommended as the first line of treatment for anxiety disorders, it is rarely implemented by clinicians in practice. In part, issues with dissemination of this treatment can explain this occurrence; however, even clinicians who have received training in exposure-based CBT are not using it in practice. This chapter examines the therapist barriers to dissemination of exposure-based therapy and discusses approaches to overcome them.

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References

  • Abramowitz, J. S. (1996). Variants of exposures and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 27, 583–600.

    Article  Google Scholar 

  • Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2010). Exposure therapy for anxiety: Principles and practice. New York: Guilford Press.

    Google Scholar 

  • Addis, M. E., Wade, W. A., & Hatgis, C. (1999). Barriers to dissemination of evidence-based practices: Addressing practitioners concerns about manual-based psychotherapies. Clinical Psychology: Science and Practice, 6, 430–441.

    Article  Google Scholar 

  • American Psychiatric Association. (2011). American Psychiatric Association practice guidelines. Retrieved January 31, 2011, from http://www.psychiatryonline.com/pracGuide/pracGuideHome.aspx

  • American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Available on the World Wide Web http://www.apa.org/ethics/

  • APA Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285.

    Article  Google Scholar 

  • Baker, T. B., McFall, R. M., & Shoham, V. (2009). Current status and future prospects of clinical psychology: Toward a scientifically principled approach to mental and behavioral health care. Psychological Science in the Public Interest, 9, 67–103.

    PubMed  Google Scholar 

  • Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Journal of the American Medical Association, 283, 2529–2536.

    Article  PubMed  Google Scholar 

  • Barlow, D. H., Levitt, J. T., & Bufka, L. F. (1999). The dissemination of empirically supported treatments: A view to the future. Behaviour Research and Therapy, 37, S147–S162.

    Article  PubMed  Google Scholar 

  • Becker, C., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes toward utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292.

    Article  PubMed  Google Scholar 

  • Berke, D. M., Rozell, C. A., Hogan, T. P., Norcross, J. C., & Karpiak, C. P. (2011). What clinical psychologists know about evidence-based practice: Familiarity with online resources and research methods. Journal of Clinical Psychology, 67, 329–339.

    Article  PubMed  Google Scholar 

  • Böhm, K., Förstner, U., Külz, A., & Voderholzer, U. (2008). Versorgungsrealität der zwangsstörungen: Werden expositionsverfahren eingesetzt? Verhaltenstherapie, 18, 18–24.

    Article  Google Scholar 

  • Brown, A., Deacon, B. J., Abramowitz, J. S., & Whiteside, S. P. (2007). Parents’ perceptions of pharmacological and cognitive-behavioral treatments for childhood anxiety disorders. Behaviour Research and Therapy, 45, 819–828.

    Article  PubMed  Google Scholar 

  • Clark, D. M., Layard, R., Smithies, R., Richards, D. C., Suckling, R., & Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.

    Article  PubMed  Google Scholar 

  • Deacon, B. J., & Abramowitz, J. S. (2004). Cognitive and behavioral treatment for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60, 429–441.

    Article  PubMed  Google Scholar 

  • Deacon, B. J., & Abramowitz, J. S. (2005). Patients’ perceptions of pharmacological and cognitive-behavioral treatments for anxiety disorders. Behavior Therapy, 36, 139–145.

    Article  Google Scholar 

  • Foa, E., Hembree, E., & Rothbaum, B. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences, therapist guide. New York, NY: Oxford University Press.

    Google Scholar 

  • Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York, NY: Guilford Press.

    Google Scholar 

  • Franklin, M., Huppert, J., Garcia, A., Freeman, J., March, J., & Foa, E. (2004, November). Therapist effects in a randomized controlled trial for pediatric OCD. Poster session presented at the annual meeting of the Association for Advancement of Behavior Therapy, New Orleans, LA.

    Google Scholar 

  • Freiheit, S. R., Vye, C., Swan, R., & Cady, M. (2004). Cognitive-behavioral therapy for anxiety: Is dissemination working? The Behavior Therapist, 27, 25–32.

    Google Scholar 

  • Garb, H. N., & Boyle, P. A. (2003). Understanding why some clinicians use pseudoscientific methods: Findings from research on clinical judgment. In S. O. Lilienfeld, S. J. Lynn, & J. M. Lohr (Eds.), Science and pseudoscience in clinical psychology (pp. 17–38). New York: Guilford Press.

    Google Scholar 

  • Goisman, R. M., Warshaw, M. G., & Keller, M. B. (1999). Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder, and social phobia, 1991–1996. The American Journal of Psychiatry, 156, 1819–1821.

    PubMed  Google Scholar 

  • Gray, M. J., Elhai, J. D., & Schmidt, L. O. (2007). Trauma professionals’ attitudes toward and utilization of evidence-based practices. Behavior Modification, 31, 732–748.

    Article  PubMed  Google Scholar 

  • Gunter, R. W., & Whittal, M. L. (2010). Dissemination of cognitive-behavioral treatments for anxiety disorders: Overcoming barriers and improving patient access. Clinical Psychology Review, 30, 194–202.

    Article  PubMed  Google Scholar 

  • Harned, M. S., Dimeff, L. A., Woodcock, E. A., & Skutch, J. M. (2011). Overcoming barriers to disseminating exposure therapies for anxiety disorders: A pilot randomized controlled trial of training methods. Journal of Anxiety Disorders, 25, 155–163.

    Article  PubMed  Google Scholar 

  • Heuzenroeder, L., Donnelly, M., Haby, M. M., Mihalopoulos, C., Rossell, R., Carter, R., et al. (2004). Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Australia and New Zealand Journal of Psychiatry, 38, 602–612.

    Article  Google Scholar 

  • Hipol, L. J., & Deacon, B. J. (in press). Dissemination of evidence-based practices for anxiety disorders in Wyoming: A survey of practicing psychotherapists. Behavior Modification.

    Google Scholar 

  • Hunsley, J., & Di Giulio, G. (2002). Dodo bird, phoenix, or urban legend: The question of psychotherapy equivalence. The Scientific Review of Mental Health Practice, 1, 11–22.

    Google Scholar 

  • Kozak, M. J., & Foa, E. B. (1997). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach. San Antonio, TX: Graywind Publications.

    Google Scholar 

  • Litz, B. (2002, November). The use of PE: Clinical decision making. Paper presented at the 18th annual meeting of the International Society for Traumatic Stress Studies, Baltimore, MD.

    Google Scholar 

  • McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments. American Psychologist, 65, 73–84.

    Article  PubMed  Google Scholar 

  • National Institute for Clinical Excellence. (2011). Clinical guidelines. Retrieved January 31, 2011, from http://guidance.nice.org.uk/CG.

  • Norton, G. R., Allen, G. E., & Hilton, J. (1983). The social validity of treatments for agoraphobia. Behaviour Research and Therapy, 21, 393–399.

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Cisler, J., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33, 557–577.

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16, 172–180.

    Article  Google Scholar 

  • Pediatric OCD Treatment Study (POTS) Team. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. Journal of the American Medical Association, 292, 1969–1976.

    Article  Google Scholar 

  • Persons, J. B., & Silberschatz, G. (1998). Are results of randomized controlled trials useful to psychotherapists? Journal of Consulting and Clinical Psychology, 66, 126–135.

    Article  PubMed  Google Scholar 

  • Rachman, S., Radomsky, A., & Shafran, R. (2008). Safety behaviors: A reconsideration. Behaviour Research and Therapy, 46, 163–173.

    Article  PubMed  Google Scholar 

  • Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317–327.

    Article  PubMed  Google Scholar 

  • Richard, D. C. S., & Gloster, A. T. (2007). Exposure therapy has a public relations problem: A dearth of litigation amid a wealth of concern. In D. C. S. Richard & D. Lauterbach (Eds.), Comprehensive handbook of the exposure therapies (pp. 409–425). New York: Academic Press.

    Chapter  Google Scholar 

  • Rothbaum, B. O., & Schwartz, A. C. (2002). Exposure therapy for posttraumatic stress disorder. American Journal of Psychotherapy, 56, 59–75.

    PubMed  Google Scholar 

  • Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., et al. (2000). Dismantling cognitive-behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68, 417–424.

    Article  PubMed  Google Scholar 

  • Slater, L. (2003, November 3). The cruelest cure. New York Times.

    Google Scholar 

  • Stein, M. B., Sherbourne, C. D., Craske, M. G., Means-Christensen, A., Bystritsky, A., Katon, W., et al. (2004). Quality of care for primary care patients with anxiety disorders. The American Journal of Psychiatry, 161, 2230–2237.

    Article  PubMed  Google Scholar 

  • Tavris, C. (2003). The widening scientist-practitioner gap: A view from the bridge. In S. O. Lilienfeld, S. J. Lynn, & J. M. Lohr (Eds.), Science and pseudoscience in clinical psychology (pp. ix–xviii). New York: Guilford Press.

    Google Scholar 

  • Taylor, C. B., King, R., Margraf, J., Ehlers, A., Telch, M., Roth, W. T., et al. (1989). Use of medication and in vivo exposure in volunteers for panic disorder research. The American Journal of Psychiatry, 146, 1423–1426.

    PubMed  Google Scholar 

  • van Minnen, A., Hendriks, L., & Olff, M. (2010). When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behaviour Research and Therapy, 48, 312–320.

    Article  PubMed  Google Scholar 

  • Weissman, M. M., Verdeli, H., Gameroff, M. J., Bledsoe, S. E., Betts, K., Mufson, L., et al. (2006). National survey of psychotherapy training in psychiatry, psychology, and social work. Archives of General Psychiatry, 63, 925–934.

    Article  PubMed  Google Scholar 

  • Wolfe, R. M., Sharp, L. K., & Wang, R. M. (2004). Family physicians’ opinions and attitudes to three clinical practice guidelines. The Journal of the American Board of Family Practice, 17, 150–157.

    Article  PubMed  Google Scholar 

  • Young, A. S., Klap, R., Sherbourne, C. D., & Wells, K. B. (2001). The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry, 58, 55–61.

    Article  PubMed  Google Scholar 

  • Young, A. S., Klap, R., Shoai, R., & Wells, K. B. (2008). Persistent depression and anxiety in the United States. Psychiatric Services, 59, 1391–1398.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychology, University of Wyoming, 3415, 1000 East University Avenue, Laramie, WY, 82071, USA

    Brett J. Deacon Ph.D. & Nicholas R. Farrell M.A.

Authors
  1. Brett J. Deacon Ph.D.
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  2. Nicholas R. Farrell M.A.
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Correspondence to Brett J. Deacon Ph.D. .

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Editors and Affiliations

  1. , Departments of Pediatrics, Psychiatry, a, University of South Florida, Tampa, 33612, Florida, USA

    Eric A. Storch

  2. , Department of Psychology, Fordham University, East Fordham Road 441, Bronx, 10458, New York, USA

    Dean McKay

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Deacon, B.J., Farrell, N.R. (2013). Therapist Barriers to the Dissemination of Exposure Therapy. In: Storch, E., McKay, D. (eds) Handbook of Treating Variants and Complications in Anxiety Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6458-7_23

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