A meta-analysis of the effects of training clinicians in exposure therapy on knowledge, attitudes, intentions, and behavior
Abstract
Despite evidence that exposure therapy is an effective way to treat anxiety, many clinicians fail to implement it appropriately. The current review investigated whether training can improve practicing clinicians' beliefs about and implementation of exposure therapy. A systematic search of four databases (PsycINFO, Medline, Scopus, and ProQuest Dissertations and Theses) identified fifteen studies evaluating the impact of training in exposure therapy. A series of meta-analyses revealed that training had large-sized positive effects on clinicians' knowledge of exposure therapy (d+ = 1.18), attitudes towards exposure therapy (d+ = 0.84), and self-efficacy associated with delivering exposure therapy (d+ = 0.72). There were, however, only medium-sized positive effects on clinicians' intentions to use exposure therapy (d+ = 0.41) and behavior (d+ = 0.35). These findings suggest that training can provide clinicians with the knowledge and confidence to use exposure therapy, but might not be sufficient to promote changes in practice. Future research should consider incorporating volitional interventions into training (e.g., if-then planning or implementation intentions), in order to bridge this gap.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Negative beliefs about exposure therapy negatively impact the frequency with which therapists offer exposure therapy.
“Negative beliefs also seem to negatively impact the frequency in which therapists offer exposure therapy (Trivasse et al., 2020).”
From EFFECT OF TRAINING ON BELIEFS ABOUT EXPOSURE THERAPY IN EXPERIENCED THERAPISTS (2023) · cites this paper as Trivasse et al., 2020
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
1 retracted
On the Evolving Nature of Exposure Therapy
Schare, M. L., & Wyatt, K. P. (2013) · Behavior Modification · doi:10.1177/0145445513477421 · Cited by 10 · see citing works
RetractedThe theory of planned behavior
Ajzen, I. (1991) · Organizational Behavior and Human Decision Processes · doi:10.1016/0749-5978(91)90020-t · Cited by 90,587 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1977) · Psychological Review · doi:10.1037/0033-295x.84.2.191 · Cited by 43,925 · see citing works
A guideline of selecting and reporting intraclass correlation coefficients for reliability research
Koo, T. K., & Li, M. Y. (2016) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2016.02.012 · Cited by 29,639 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
Downs, S. H., & Black, N. (1998) · Journal of Epidemiology and Community Health · doi:10.1136/jech.52.6.377 · Cited by 8,252 · see citing works
Cialdini, R. B., Reno, R. R., & Kallgren, C. A. (1990) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.58.6.1015 · Cited by 5,965 · see citing works
Implementation intentions: Strong effects of simple plans.
Gollwitzer, P. M. (1999) · American Psychologist · doi:10.1037/0003-066x.54.7.493 · Cited by 5,478 · see citing works
Implementation intentions and goal achievement: a meta-analysis of effects and processes
Gollwitzer, P. M., & Sheeran, P. (2006) · Advances in Experimental Social Psychology · doi:10.1016/s0065-2601(06)38002-1 · Cited by 3,236 · see citing works
Sheeran, P., & Webb, T. L. (2016) · Social and Personality Psychology Compass · doi:10.1111/spc3.12265 · Cited by 2,185 · see citing works
Self-citationA Fail-Safe N for Effect Size in Meta-Analysis
Orwin, R. G. (1983) · Journal of Educational Statistics · doi:10.2307/1164923 · Cited by 2,064 · see citing works
Are there valid proxy measures of clinical behaviour? a systematic review
Hrisos, S., Eccles, M. P., Francis, J. J., Dickinson, H. O., Kaner, E. F. S., Beyer, F., & Johnston, M. (2009) · Implementation science : IS · doi:10.1186/1748-5908-4-37 · Cited by 1,860 · see citing works
Normative social influence is underdetected
Nolan, J. M., Schultz, P. W., Cialdini, R. B., Goldstein, N. J., & Griskevicius, V. (2008) · Personality and Social Psychology Bulletin · doi:10.1177/0146167208316691 · Cited by 1,772 · see citing works
Goal Achievement: The Role of Intentions
Gollwitzer, P. (1993) · European Review of Social Psychology · doi:10.1080/14792779343000059 · Cited by 1,754 · see citing works
Field, A. P., & Gillett, R. (2010) · British Journal of Mathematical and Statistical Psychology · doi:10.1348/000711010x502733 · Cited by 1,162 · see citing works
Godin, G., Bélanger-Gravel, A., Eccles, M., & Grimshaw, J. (2008) · Implementation Science · doi:10.1186/1748-5908-3-36 · Cited by 1,096 · see citing works
Beidas, R. S., & Kendall, P. C. (2010) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2009.01187.x · Cited by 1,085 · see citing works
Suurmond, R., van Rhee, H., & Hak, T. (2017) · Research Synthesis Methods · doi:10.1002/jrsm.1260 · Cited by 881 · see citing works
A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD
Becker, C. B., Zayfert, C., & Anderson, E. (2004) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00138-4 · Cited by 759 · see citing works
Data dredging, bias, or confounding: They can all get you into the BMJ and the Friday papers
Smith, G. D., & Ebrahim, S. (2002) · BMJ · doi:10.1136/bmj.325.7378.1437 · Cited by 434 · see citing works
Augmenting the Theory of Planned Behavior: Roles for Anticipated Regret and Descriptive Norms1
Sheeran, P., & Orbell, S. (1999) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.1999.tb02298.x · Cited by 415 · see citing works
Memon, A., Taylor, K., Mohebati, L. M., Sundin, J., Cooper, M., Scanlon, T., & de Visser, R. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-012337 · Cited by 401 · see citing works
Cognitive and behavioral treatments for anxiety disorders: A review of meta‐analytic findings
Deacon, B. J., & Abramowitz, J. S. (2004) · Journal of Clinical Psychology · doi:10.1002/jclp.10255 · Cited by 400 · see citing works
Non-communicable diseases must have greater priority, says WHO
Zarocostas, J. (2009) · British medical journal · doi:10.1136/bmj.b2857 · Cited by 391 · see citing works
Evidence-based treatment and therapist drift
Waller, G. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.10.018 · Cited by 359 · see citing works
Self-citationvan Minnen, A., Hendriks, L., & Olff, M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.12.003 · Cited by 282 · see citing works
The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments
Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.07.003 · Cited by 273 · see citing works
Frank, H. E., Becker-Haimes, E., & Kendall, P. (2020) · Clinical Psychology · doi:10.1111/cpsp.12330 · Cited by 271 · see citing works
Waller, G., & Turner, H. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.005 · Cited by 256 · see citing works
Self-citationChildren's perceptions of peer influence on eating concerns
Oliver, K. K., & Thelen, M. H. (1996) · Behavior Therapy · doi:10.1016/s0005-7894(96)80033-5 · Cited by 256 · see citing works
Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R., & McGrath, P. B. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.04.006 · Cited by 248 · see citing works
Strategic automation of emotion regulation.
Gallo, I. S., Keil, A., McCulloch, K. C., Rockstroh, B., & Gollwitzer, P. M. (2009) · Journal of Personality and Social Psychology · doi:10.1037/a0013460 · Cited by 235 · see citing works
O’Connor, S., Tully, M., Ryan, B., Bradley, J., Baxter, G. D., & McDonough, S. (2015) · BMC Research Notes · doi:10.1186/s13104-015-1181-1 · Cited by 227 · see citing works
Gunter, R. W., & Whittal, M. L. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.11.001 · Cited by 224 · see citing works
Dimeff, L., Koerner, K., Woodcock, E., Beadnell, B., Brown, M. Z., Skutch, J., Paves, A., Bazinet, A., & Harned, M. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.011 · Cited by 208 · see citing works
Ougrin, D. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-200 · Cited by 201 · see citing works
Edmunds, J. M., Beidas, R., & Kendall, P. (2013) · Clinical Psychology · doi:10.1111/cpsp.12031 · Cited by 198 · see citing works
Factors associated with practitioners’ use of exposure therapy for childhood anxiety disorders
Whiteside, S. P. H., Deacon, B. J., Benito, K., & Stewart, E. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.04.001 · Cited by 194 · see citing works
Why do clinicians exclude anxious clients from exposure therapy?
Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.01.004 · Cited by 185 · see citing works
Dissemination of Evidence-Based Practices for Anxiety Disorders in Wyoming
Hipol, L. J., & Deacon, B. (2013) · Behavior Modification · doi:10.1177/0145445512458794 · Cited by 169 · see citing works
Pittig, A., Kotter, R., & Hoyer, J. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.07.003 · Cited by 160 · see citing works
Sheeran, P., Aubrey, R., & Kellett, S. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.6.853 · Cited by 151 · see citing works
Toli, A., Webb, T. L., & Hardy, G. E. (2016) · British Journal of Clinical Psychology · doi:10.1111/bjc.12086 · Cited by 137 · see citing works
Self-citationFarrell, N. R., Deacon, B. J., Kemp, J. J., Dixon, L. J., & Sy, J. T. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.03.007 · Cited by 133 · see citing works
“Contents may vary”: a pilot study of treatment histories of OCD patients
Stobie, B., Taylor, T., Quigley, A., Ewing, S., & Salkovskis, P. M. (2007) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246580700358x · Cited by 109 · see citing works
Training Research: Practical Recommendations for Maximum Impact
Beidas, R., Koerner, K., Weingardt, K. R., & Kendall, P. (2011) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-011-0338-z · Cited by 107 · see citing works
Therapist perceptions and delivery of interoceptive exposure for panic disorder
Deacon, B. J., Lickel, J. J., Farrell, N. R., Kemp, J. J., & Hipol, L. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.02.004 · Cited by 101 · see citing works
Brown, A. M., Deacon, B. J., Abramowitz, J. S., Dammann, J., & Whiteside, S. P. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.04.010 · Cited by 94 · see citing works
Harned, M. S., Dimeff, L. A., Woodcock, E. A., Kelly, T. B., Zavertnik, J., Contreras, I., & Danner, S. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.04.005 · Cited by 92 · see citing works
Coyne, J. C., Thombs, B. D., & Hagedoorn, M. (2010) · Health Psychology · doi:10.1037/a0017633 · Cited by 81 · see citing works
Exposure therapy has a public relations problem
Richard, D. C. S., & Gloster, A. T. (2007) · Handbook of Exposure Therapies · doi:10.1016/b978-012587421-2/50019-3 · Cited by 77 · see citing works
Gega, L., Norman, I. J., & Marks, I. M. (2007) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2006.02.009 · Cited by 76 · see citing works
Theory-based training strategies for modifying practitioner concerns about exposure therapy.
Farrell, N., Deacon, B., Dixon, L., & Lickel, J. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.09.003 · Cited by 74 · see citing works
Farrell, N. R., Kemp, J. J., Blakey, S. M., Meyer, J. M., & Deacon, B. J. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.08.011 · Cited by 71 · see citing works
Therapists’ Perspectives on the Effective Elements of Consultation Following Training
Beidas, R., Edmunds, J. M., Cannuscio, C., Gallagher, M., Downey, M. M., & Kendall, P. (2013) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-013-0475-7 · Cited by 63 · see citing works
Wolitzky-Taylor, K., Fenwick, K., Lengnick-Hall, R., Grossman, J., Bearman, S. K., Arch, J., Miranda, J., & Chung, B. (2018) · Community Mental Health Journal · doi:10.1007/s10597-018-0252-x · Cited by 62 · see citing works
Harned, M., Dimeff, L., Woodcock, E., & Skutch, J. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.08.015 · Cited by 55 · see citing works
Ruzek, J., Eftekhari, A., Rosen, C., Crowley, J., Kuhn, E., Foa, E., Hembree, E., & Karlin, B. (2016) · Psychological Trauma · doi:10.1037/tra0000004 · Cited by 49 · see citing works
Patient satisfaction with behavioral treatments for panic disorder with agoraphobia
Cox, B., Fergus, K., & Swinson, R. (1994) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(94)90001-9 · Cited by 49 · see citing works
Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.12.002 · Cited by 44 · see citing works
Schumacher, S., Gaudlitz, K., Plag, J., Miller, R. E., Kirschbaum, C., Fehm, L., Fydrich, T., & Ströhle, A. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.07.016 · Cited by 37 · see citing works
Casper, E. S. (2008) · Psychiatric Services · doi:10.1176/appi.ps.59.7.747 · Cited by 36 · see citing works
Schumacher, S., Miller, R., Fehm, L., Kirschbaum, C., Fydrich, T., & Ströhle, A. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.10.020 · Cited by 25 · see citing works
Impact of education on clinicians' attitudes to exposure therapy for eating disorders
Waller, G., D'Souza Walsh, K., & Wright, C. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.11.014 · Cited by 23 · see citing works
Self-citationJ. Light, R., & B. Pillemer, D. (1986) · Educational Researcher · doi:10.3102/0013189x015008016 · Cited by 17 · see citing works
Reid, A. M., Guzick, A., Balkhi, A. M., McBride, M. K., Geffken, G., & Mcnamara, J. P. H. (2017) · Training and Education in Professional Psychology · doi:10.1037/tep0000159 · Cited by 15 · see citing works
Schumacher, S., Schopka, N. M., Heinrich, M., & Knaevelsrud, C. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000371 · Cited by 6 · see citing works
Wright, C., & Waller, G. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23171 · Cited by 5 · see citing works
Self-citationA Novel Dissemination Effort for Prolonged Exposure: Practice and Dissemination Curriculum
Chin, E., Bernecker, S. L., Buchanan, E., Cunningham, S. R., Schumacher, J., & Coffey, S. (2019) · Psychological Trauma · doi:10.1037/tra0000362 · Cited by 3
Flagged first, then by citations
9 of the 81 references couldn’t be matched to a known paper.
Research works printed but not linked: 12
- Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2011). Exposure therapy for anxiety: Principles and practice. New York: Guilford Press.
- Borenstein, M., Hedges, L. V., Higgins, J., & Rothstein, H. R. (2009). Introduction to metaanalysis . Wiley.
- Cochrane Consumers and Communication Review Group. (2016). Heterogeneity and subgroup analyses in Cochrane Consumers and Communication Group reviews: Planning the analysis at protocol stage . Available from http://cccrg.cochrane.org.
- Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159. doi: 10.1037/00332909.112.1.155 · DOI
- Conner, M., & Norman, P. (2005). Predicting health behavior. Open University Press. Cooper, H. M. (1986). Integrating research: A guide for literature reviews . Sage.
- Kaye, J. L. (2018). Targeting therapists' experiential avoidance during exposure delivery: An experimental investigation to improve the quality of exposure-based interventions. (Unpublished doctoral dissertation). Drexel University, Philadelphia, USA
- Kobak, K. A., Wolitzky-Taylor, K., Craske, M. G., & Rose, R. D. (2017). Therapist training on cognitive behavior therapy for anxiety disorders using internet-based technologies. Cognitive Therapy and Research, 41, 252-265. doi:10.1007/s10608-016-9819-4 · DOI
- Lenhard, W., & Lenhard, A. (2016). Calculation of effect sizes. Dettelbach, Germany: Psychometrica. Available at https://www.psychometrica.de/effect\_size.html. doi: 10.13140/RG.2.1.3478.4245 · DOI
- Light, R. & Pillemer, D. (1984). Summing up: The science of reviewing research . Harvard University Press.
- McDonough, M., & Marks, I. M. (2002). Teaching medical students exposure therapy for phobia/panic: Randomized, controlled comparison of face-to-face tutorial in small groups vs. solo computer instruction. Medical Education, 36, 412-417. doi: 10.1046/j.1365-2923.2002.01210.x · DOI
- Richard, D. C. S., & Lauterbach, D. (2007). Handbook of exposure therapies . Elsevier.
- Rosqvist, J. (2005). Exposure treatments for anxiety disorders: A practitioner's guide to concepts, methods, and evidence-based practice. Routledge
Cited by
Sorted by citations
Tourists and AI: A political ideology perspective
van Esch, P., Cui, Y. G., Das, G., Jain, S. P., & Wirtz, J. (2022) · Annals of Tourism Research · doi:10.1016/j.annals.2022.103471 · Cited by 62 · see citing works
Henrich, S., & Worthington, R. (2021) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2021.1987367 · Cited by 44 · see citing works
“This reflects the most recent results by Trivasse et al. (2020) who found that the implementation of therapeutic role playing is often hindered by therapist’s lack of knowledge, making specific training necessary.”
BackgroundMcNally, X., Webb, T. L., Smith, C., Moss, A., & Miller, J. G. (2024) · Conservation Biology · doi:10.1111/cobi.14237 · Cited by 43 · see citing works
Self-citationRacz, J. I., Bialocerkowski, A., Calteaux, I., & Farrell, L. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00478-3 · Cited by 33 · see citing works
“This is vital as unspecified ET training dominates the literature and is associated with only medium-sized improvements in the use of ET (Trivasse et al., 2020).”
BackgroundMethodInfluentialSeuling, P. D., Czernin, N. S., & Schiele, M. A. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104074 · Cited by 28 · see citing works
“Furthermore, therapists may be hesitant to incorporate exposure exercises in treatment (Becker et al., 2004; Farrell et al., 2013; Moritz et al., 2019), even after receiving specific training in this area (Trivasse et al., 2020).”
Langthorne, D., Beard, J., & Waller, G. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2191824 · Cited by 23 · see citing works
“Studies investigating interventions to increase the use of exposure therapy were excluded due to a pre-existing metaanalysis (Trivasse et al., 2020).”
BackgroundInfluentialSelf-citationRagnarsson, E. H., Reinebo, G., Ingvarsson, S., Lindgren, A., Beckman, M., Alfonsson, S., Hedman-Lagerlöf, M., Rahm, C., Sahlin, H., Stenfors, T., et al. (2024) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.3003 · Cited by 21 · see citing works
Moses, K., Gonsalvez, C., & Meade, T. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23470 · Cited by 20 · see citing works
Assessing and promoting the use of implementation intentions in clinical practice.
Duhne, P. G. S., Horan, A., Ross, C., Webb, T. L., & Hardy, G. (2020) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2020.113490 · Cited by 15 · see citing works
Self-citationBurton, M. S., Rothbaum, B., & Rauch, S. (2022) · Depression and Anxiety · doi:10.1002/da.23240 · Cited by 14 · see citing works
“, 2015) despite unfounded clinician fears to the contrary (Trivasse et al., 2020).”
BackgroundKline, A. C., Klein, A. B., Bowling, A. R., & Feeny, N. C. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.01.002 · Cited by 18 · see citing works
Kanyinga, F. B., Gogovor, A., Dofara, S., Gadio, S., Tremblay, M., Daniel, S. J., Rivest, L.-P., & Légaré, F. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04597-3 · Cited by 13 · see citing works
“In addition, CPD courses could attempt to close the intention-behavior gap with such methods as audit and feedback, “if-then” plans, commitment to change statements, or other methods of support for clinicians to follow through on their intentions [54, 55].”
Clinician-Reported Determinants of Evidence-Based Practice Use in Private Practice Mental Health
Milgram, L., Freeman, J. B., Benito, K., Elwy, A. R., & Frank, H. E. (2022) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-022-09551-w · Cited by 12 · see citing works
“, practice-based evidence; Barkham & Mellor-Clark, 2003) and tailor exposure (and other EBPs) to meet the needs of those delivering and receiving them (Trivasse et al., 2020).”
BackgroundWoodard, G. S., Triplett, N. S., Frank, H. E., Harrison, J. P., Robinson, S., & Dorsey, S. (2021) · Implementation Research and Practice · doi:10.1177/26334895211057883 · Cited by 11 · see citing works
“Second, few studies have examined if and how changes in attitudes toward exposure translates to clinical practice (Trivasse et al., 2020).”
BackgroundMethodResultInfluentialBergeron, L., Décary, S., Djade, C., Daniel, S. J., Tremblay, M., Rivest, L.-P., & Légaré, F. (2022) · JMIR Medical Education · doi:10.2196/34299 · Cited by 10 · see citing works
“While a 2006 review by Eccles et al [61] “provide[d] encouragement for the contention that there is a predictable relationship between the intentions of a health professional and their subsequent behaviour,” CPD activities making use of the determinants of intention as dependent variables should also integrate methods…”
MethodTherapyTrainer: Using AI to Train Therapists in Written Exposure Therapy
Stade, E. C., Eichstaedt, J., Kaysen, D. L., Salesha, A., Greenberger, A., Singhvi, S., & Stirman, S. (2025) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2025.06.005 · Cited by 9 · see citing works
Frank, H. E., Milgram, L., Freeman, J., & Benito, K. (2022) · Frontiers in Health Services · doi:10.3389/frhs.2022.892294 · Cited by 9 · see citing works
“Even when therapists do receive training, actual use of exposure remains somewhat limited (20).”
BackgroundRoudbarani, F., Modica, P. T., Maddox, B., Bohr, Y., & Weiss, J. (2022) · Autism · doi:10.1177/13623613221106400 · Cited by 9 · see citing works
“…clients, a recent meta-analysis found that clinician training on exposure therapy was associated with higher clinician knowledge of exposure therapy, more favourable attitudes towards using exposure therapy and confidence in delivering exposure-based interventions (Trivasse et al., 2020).”
BackgroundIt’s all in the name: why exposure therapy could benefit from a new one
Becker-Haimes, E., Stewart, R., & Frank, H. E. (2022) · Current Psychology · doi:10.1007/s12144-022-03286-6 · Cited by 9 · see citing works
New trends in digital marketing emergence during pandemic times
Sukaini, A. K. M. A., Sumra, K. B., Khan, R., & Awan, T. (2022) · International Journal of Innovation Science · doi:10.1108/ijis-08-2021-0139 · Cited by 8 · see citing works
Earleywine, M., Oliva, A. B., Leo, J. A. D., & Banks, R. (2024) · Journal of Psychedelic Studies · doi:10.1556/2054.2024.00265 · Cited by 8 · see citing works
“This trend persists despite evidence suggesting that patients perceive these therapies positively, even if the exposure elements induce discomfort (See Trivasse, Webb, & Waller, 2020; van Minnen, Hendriks, & Olff, 2010).”
BackgroundAxelsson, E., & Hedman-Lagerlöf, E. (2023) · Expert review of pharmacoeconomics & outcomes research · doi:10.1080/14737167.2023.2250915 · Cited by 7 · see citing works
“The promotion of best practice CBT – which commonly includes exposure or behavioral experiments – requires clinicians to be informed about both the benefits and harms of treatment, as well as policy makers being explicit about the components of evidence-based CBT [81].”
BackgroundExposures for anxiety: A survey of practicing school psychologists
Weiss, S., Shernoff, E. S., Lekwa, A. L., & Shahidullah, J. D. (2024) · Psychology in the schools (Print) · doi:10.1002/pits.23208 · Cited by 6 · see citing works
Jelinek, L., Balzar, A., Moritz, S., Reininger, K. M., & Miegel, F. (2021) · The Behavior Therapist · doi:10.1016/j.beth.2021.05.004 · Cited by 6 · see citing works
Racz, J. I., Perkes, I., Bialocerkowski, A., Dyason, K. M., Grisham, J., McKenzie, M., & Farrell, L. (2025) · Child Psychiatry and Human Development · doi:10.1007/s10578-024-01805-z · Cited by 5 · see citing works
“A meta-analysis of 15 studies indicated that training clinicians in exposure therapy is consistently associated with large improvements in their knowledge, attitudes, and self-efficacy [20].”
InfluentialRudrabhatla, A., Flowers, S. N., Becker-Haimes, E., & Sanchez, A. L. (2024) · Current Developmental Disorders Reports · doi:10.1007/s40474-024-00306-x · Cited by 5 · see citing works
“There is also growing evidence that many clinicians experience their own anxiety about using ERP with their clients, which persists even after training in ERP and leads them to underuse it or avoid it [47–51].”
Jelinek, L., Balzar, A., Moritz, S., Liebherz, S., & Yassari, A. H. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100860 · Cited by 7 · see citing works
Wade, T. D., & Waller, G. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104826 · Cited by 4 · see citing works
Self-citationLee, K.-D., Grace, E., McDonald, L., & Chambers, R. (2022) · Clinical Psychology · doi:10.1080/13284207.2022.2035651 · Cited by 4 · see citing works
Exposure-based Interventions for Chronic Pain and Bodily Symptoms: A Special Interest Meeting Report
Schemer, L., Glogan, E., Sjouwerman, R., Ahm, R., Ashar, Y. K., Boddez, Y., Boersma, K., Cañeiro, J. P., Cima, R. F. F., den Hollander, M., et al. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.104998 · Cited by 3 · see citing works
“In addition, individual patient-partners advocated the use of testimonials, which can provide role models and opportunities to see others facing similar challenges, give insight into the treatment process, and inspire hope (Schemer et al., 2023).”
Beyond mental well-being: A One Health perspective on biophobias
Mammola, S., Nanni, V., Martino, S., Correia, R., Eckert, E. M., Norberg, M. M., & Soga, M. (2025) · BioScience · doi:10.1093/biosci/biaf084 · Cited by 6 · see citing works
“This may be because, despite strong evidence for the superiority of exposure therapy, many therapists are not trained in delivering it, and when they have been, they may adapt it in an overly cautious manner that reduces its effectiveness (Trivasse et al. 2020 ).”
Supporting Clinicians in Implementing Exposure Therapy for Anxiety and Related Disorders
Frank, H. E., Woodard, G., & Martinez, R. G. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01612-w · Cited by 3 · see citing works
“Unfortunately, trainings that focus on cognitive behavioral therapy (CBT) interventions that include exposure rarely result in increased use of exposure [15].”
Ortiz, C., & Fastman, M. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102893 · Cited by 3 · see citing works
Klein, A. B., Kline, A. C., Bowling, A. R., & Feeny, N. C. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23221 · Cited by 3 · see citing works
EFFECT OF TRAINING ON BELIEFS ABOUT EXPOSURE THERAPY IN EXPERIENCED THERAPISTS
Clinical Psychology Group, F. O. S. A. B. S., VAN MALSEN, J., GREEVEN, A., PsyQ. Postal address: Lijnbaan 4, 2. V. T. H., VAN EMMERIK, A., & Clinical Psychology Group, F. O. S. A. B. S. (2023) · Journal of Evidence-Based Psychotherapies · doi:10.24193/jebp.2023.2.14 · Cited by 2 · see citing works
Haugen, T., Halvorsen, J., Friborg, O., Schei, B., Hagemann, C., & Kjelsvik, M. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2443279 · Cited by 2 · see citing works
Kemp, J., Norris, L. A., Fenley, A., Kidd, A., Mamaril, E., Herren, J. A., Freeman, J., & Benito, K. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.06.003 · Cited by 2 · see citing works
Emery-Tiburcio, E. E., Porter, L., Wang, S., & Buehler, S. (2024) · Aging & Mental Health · doi:10.1080/13607863.2024.2389543 · Cited by 2 · see citing works
“Meta-analysis of other similar studies reported larger knowledge gains, but behavior change of only d = 0.35 (Trivasse et al., 2020).”
InfluentialFreeman, J., Kemp, J., O’Connor, E. E., Herren, J. A., Georgiadis, C., Righi, G., & Benito, K. (2024) · JAACAP Open · doi:10.1016/j.jaacop.2024.06.005 · Cited by 2 · see citing works
“68,69 Furthermore, given the relatively low rates of sustainability in the use of exposure practices post training, 70 supervision practices that promote the long-term adoption of exposure practices are warranted.”
The use of exposure in anxiety-related disorders and associations with practitioner characteristics
Scheveneels, S., Hermans, D., Janssens, J., Greeven, A., & van Emmerik, A. V. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2518424 · Cited by 1 · see citing works
“Training aimed at changing these negative beliefs holds potential to increase the delivery of exposure treatment (Farrell et al., 2013; Trivasse et al., 2020).”
A look in the mirror - body exposure in clinical practice
Werthmann, J., Naumann, E., Vocks, S., Svaldi, J., & Hartmann, A. S. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01262-6 · Cited by 1 · see citing works
“…interventions may be needed to increase the implementation of exposure techniques in daily practice, for example interventions using implementation intentions or interventions reducing concerns and anxiety about exposure use (Farrell et al. 2016; Schumacher et al. 2015; Trivasse et al. 2020).”
Racz, J. I., Perkes, I., Bialocerkowski, A., Dyason, K. M., Grisham, J., McKenzie, M., & Farrell, L. (2025) · Children · doi:10.3390/children12020156 · Cited by 1 · see citing works
“Consistent with previous evaluations of skills in exposure therapy [38], this scale was developed for a previous study, where it demonstrated sensitivity to training [26].”
Kanimozhi, K., Kamaraj, V. K., Venkatachalam, Y., & Kuppusamy, M. (2026) · Advances in Integrative Medicine · doi:10.1016/j.aimed.2026.100735
Nordahl, K. B., Høstmælingen, A., Olseth, A. R., Apeland, A., Laland, H., Kjøbli, J., Rognstad, K., Bearman, S. K., Ugueto, A. M., Weisz, J. R., et al. (2026) · Child & Family Behavior Therapy · doi:10.1080/07317107.2026.2627559
“A meta-analysis on the effects of training clinicians in exposure therapy supports that training can give therapists knowledge and confidence to use exposure strategies (Trivasse et al., 2020).”
Fragebögen zum Verhalten von Psychotherapeut_innen bei der Durchführung von Expositionstherapien
Wolf, L., & Pedersen, A. (2026) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000851
- Authors
- Trivasse, H., Webb, T. L., & Waller, G.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Waller, Glenn
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 80
- Pages
- 101887
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W3041337596
- Cited by
- 51
- References
- 81
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 12 · 2023: 8 · 2022: 11 · 2021: 6 · 2020: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- exposure therapy, clinician training, anxiety disorders, clinician knowledge, clinician attitudes, self-efficacy, treatment intent, treatment behavior, implementation intentions, if-then planning
- MeSH terms
- Anxiety, Attitude, Health Personnel, Humans, Implosive Therapy, Health Knowledge, Attitudes, Practice, Self Efficacy, Intention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
