Impact of education on clinicians' attitudes to exposure therapy for eating disorders
Abstract
It is well established that clinicians use exposure therapy far less often than the evidence would suggest is justified. This shortfall has been explained as being at least partly a result of clinicians' beliefs and attitudes about exposure and their trait anxiety. Recent studies have shown that attitudes to exposure therapy for anxiety disorders can be improved through a simple educational approach. This study aimed to determine whether a similar educational approach can improve therapists' attitudes to exposure therapy for the eating disorders, and whether clinician's pre-intervention characteristics influenced the impact of the training. Thirty-four eating disorder clinicians (30 female, four male; mean age = 39.0 years; 85.3% Caucasian) attended a 90-min didactic teaching session on the subject of the use of exposure in treatment of eating disorders. Their attitudes to exposure therapy were measured before and after the workshop, in a within-subject design. The outcome was a substantial improvement in attitudes, with a strong effect size (Cohen's d = 1.68) that was comparable to the outcome of a similar intervention among clinicians working with anxiety disorders. The improvement was not related to clinicians' anxiety levels, but was greater among those whose attitudes were more negative at the outset of the teaching. While this finding needs to be tested for long-term maintenance and its relationship to change in clinical practice, it adds to the evidence that a simple educational intervention is sufficient to result in substantial improvement in clinicians' attitudes to exposure therapy.
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Previous studies lacked a control condition, so it was not possible to determine whether any disorder-related teaching would have had the effect on clinicians' beliefs about exposure.
“However, the lack of any control condition in those previous studies means that it was not possible to determine whether any disorder-related teaching would have had this effect.”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Waller et al., 2016
The Results (p. 8) state that this study had no control group, and the Discussion (p. 12) calls for a comparison with education that does not address exposure therapy. That supports the concern that the observed change might not be specific to exposure-related teaching, but the paper does not establish that all the previous studies lacked control conditions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredGiven the effect sizes of the previous studies, these f values are relatively conservative, meaning that a smaller sample would be likely to be adequate.
“Given the effect sizes of the previous studies (Deacon et al., 2013; Waller et al., 2016), these f values are relatively conservative, meaning that a smaller sample would be likely to be adequate.”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Waller et al., 2016
Early educational interventions have proven promising in improving clinicians' attitudes to exposure.
“Early educational interventions have proven promising in this way.”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Waller, D'Souza Walsh, and Wright (2016)
Teaching clinicians about exposure positively impacts their beliefs about the value of exposure.
“First, teaching clinicians about exposure does impact positively on their beliefs about the value of this technique.”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Waller et al., 2016
Waller, D'Souza Walsh, and Wright (2016) showed a similar impact of a 90-minute didactic teaching session on clinicians' attitudes to exposure.
“In the field of eating disorders, Waller, D'Souza Walsh, and Wright (2016) have shown a similar impact of a 90-minute didactic teaching session on clinicians' attitudes to exposure.”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Waller, D'Souza Walsh, and Wright (2016)
The Deacon et al. (2013) and Waller et al. (2016) studies are both limited by the lack of any control condition.
“While the Deacon et al. (2013) and Waller et al. (2016) studies show promising results, they are both limited by the lack of any control condition.”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Waller et al. (2016)
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- Authors
- Waller, G., D'Souza Walsh, K., & Wright, C.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Waller, Glenn
- ORCID
- Waller, Glenn
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 76
- Pages
- 76-80
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2183393836
- Cited by
- 23
- References
- 21
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 2 · 2021: 3 · 2020: 5 · 2019: 4 · 2018: 1 · 2016: 2 · 2015: 1
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- exposure therapy, eating disorders, clinician attitudes, clinician education, therapist training, treatment underuse, trait anxiety, cognitive behavioral therapy
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Feeding and Eating Disorders, Attitude of Health Personnel, Education, Professional, Female, Humans, Implosive Therapy, Inservice Training, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Psychotherapy, Surveys and Questionnaires, Teaching
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