Predicting adoption of exposure therapy in a randomized controlled dissemination trial
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The present study examined organizational, client, and therapist characteristics as predictors of use of and proficiency in exposure therapy (ET) after training. Therapists naïve to ET (N=181) were randomized to: (1) online training (OLT), (2) OLT plus motivational enhancement (ME), or (3) OLT+ME plus a learning community. Twelve weeks after training, self-reported use of ET in clinical practice was high (87.5%) and therapists demonstrated moderate clinical proficiency. Use of ET was predicted by therapist degree, self-efficacy, and knowledge. Clinical proficiency was predicted by therapist anxiety sensitivity, attitudes, and knowledge, as well as organizational and client barriers. Several of these effects were moderated by training condition, indicating that therapists who received more comprehensive training were less impacted by barriers and showed enhanced adoption in the presence of facilitating factors. Overall, these results suggest that the primary barriers to the adoption of ET are therapist, not organizational or client, factors.
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This pattern of drift is attributable in part to anxious therapists being less likely to undertake some elements of evidence-based therapies, particularly the exposure-based elements.
“In part, this pattern of drift is attributable to anxious therapists being less likely to undertake some elements of evidence-based therapies -particularly the exposurebased elements.”
From Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy (2016) · cites this paper as Harned et al., 2013
The Results (§3.3.3) and Discussion (§4) report that therapists with higher anxiety sensitivity were less proficient in implementing exposure therapy, and suggest they may avoid or prematurely end exposure tasks. But the study did not establish that general therapist anxiety causes treatment drift: §3.2.3 found no significant association between anxiety sensitivity and reported use of exposure therapy, and the Discussion calls for research on general anxiety. (LLM, conf=0.86)
Experimental — accuracy not yet measuredClinician anxiety is a key factor underlying CBT therapists' failure to employ evidence-based methods, particularly those that are exposure-based.
“Clinician anxiety has been identified as a key factor underlying CBT therapists' failure to employ evidence-based methods -particularly those that are exposure-based.”
From Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy (2016) · cites this paper as Harned et al., 2013
The Results (§3.3.3) associate greater therapist anxiety sensitivity with lower proficiency in exposure therapy, supporting a narrower version of the claim. But proficiency was assessed in simulated role-plays, not as failure to use evidence-based methods in practice; the combined model (§3.3.4) did not find anxiety sensitivity independently significant. The paper also distinguishes anxiety sensitivity from general clinician anxiety, so it does not establish clinician anxiety as a key underlying factor across CBT methods. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe pattern of some clinicians moving from exposure to other CBT techniques in response to their own anxiety might explain the disparity between the evidence base for exposure-based methods and their poor uptake in routine clinical practice.
“This pattern of some clinicians moving from exposure to other CBT techniques in response to their own anxiety might go some way to explaining the disparity between the evidence base for exposure-based methods and their poor uptake in routine clinical practice (Harned et al., 2013).”
From Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy (2016) · cites this paper as Harned et al., 2013
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredHigher anxiety sensitivity predicts less competence and greater reluctance in the delivery of exposure therapy.
“Higher anxiety sensitivity predicted less competence and greater reluctance in the delivery of exposure therapy (Harned et al., 2013; Meyer et al., 2014).”
From EFFECT OF TRAINING ON BELIEFS ABOUT EXPOSURE THERAPY IN EXPERIENCED THERAPISTS (2023) · cites this paper as Harned et al., 2013
The Results (§3.3.3; page unavailable) report that greater baseline anxiety sensitivity predicted less clinical proficiency in exposure therapy in the individual analysis. The Introduction only suggests that such therapists may be less likely to adopt exposure therapy; it does not establish greater reluctance to deliver it. The combined model (§3.3.4) also found that anxiety sensitivity was not a significant predictor of proficiency. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSimple education about the use of exposure-based methods within CBT is an effective strategy.
“To summarise, simple education about the use of exposure-based methods within CBT is an effective strategy, which might go some way to ensuring that this highly effective intervention is used by many more clinicians (Harned et al., 2013).”
From The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study (2020) · cites this paper as Harned et al., 2013
The Introduction (page unavailable) says online training can effectively increase clinicians’ knowledge of exposure therapy. But it also says training succeeds only if it leads to clinical adoption; the Discussion (page unavailable) identifies a combination of teaching, attitudinal intervention, practice and consultation as particularly effective. The paper therefore does not establish that simple education alone will increase clinicians’ use of exposure methods. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Therapists use exposure-based methods relatively rarely, despite their extensive empirical support.
“A common finding is that therapists use exposure-based methods relatively rarely, despite their extensive empirical support (Harned et al., 2013).”
From Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy (2016) · cites this paper as Harned et al., 2013
How likely we are to implement evidence-based therapies is driven at least in part by the information that we have about them and the attitudes that we hold towards them.
“In general, how likely we are to implement these evidence-based therapies is driven at least in part by the information that we have about them and the attitudes that we hold towards them”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as Harned, Dimeff, Woodcock & Contreras, 2013
Maintained discussion of new learning is particularly beneficial in the implementation of exposure therapy.
“Beyond the use of manuals, maintained discussion of new learning appears to be particularly beneficial in the implementation of exposure therapy (Harned et al., 2013).”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as Harned et al., 2013
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Attitudes and applications of chairwork amongst CBT therapists: a preliminary survey
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Dissemination of psychosocial treatments for anxiety: The importance of taking a broad perspective
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Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis
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Teaching evidence-based practice: A comparison of two disciplines
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Chinese Therapists’ Beliefs About Exposure Therapy for Anxiety and Obsessive-Compulsive Disorders
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Supporting Clinicians in Implementing Exposure Therapy for Anxiety and Related Disorders
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Gauging Perceptions and Attitudes About Student Anxiety and Supports Among School-Based Providers
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Artificial intelligence (AI) for virtual reality exposure therapy (VRET): A systematic review
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Therapist Anxious Distress and Avoidance of Implementing Time-Out
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Barriers to Implementing Evidence-Based Treatments for Anxiety Disorders in Community Settings
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EFFECT OF TRAINING ON BELIEFS ABOUT EXPOSURE THERAPY IN EXPERIENCED THERAPISTS
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Treatment of Sexual Obsessive-Compulsive Symptoms During Exposure and Response Prevention
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A look in the mirror - body exposure in clinical practice
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A qualitative study of therapists’ use of empirically supported techniques for PTSD
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Developing targeted training strategies for exposure therapy
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Therapeuts’ Beliefs about Exposure Therapy
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Updating Training in the Medical Field
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Exposure-Based Strategies in Treating Eating Disorders, the Use of
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- Authors
- Harned, M. S., Dimeff, L. A., Woodcock, E. A., & Contreras, I.
- Affiliations
- Behavioral Tech Research, Inc. (US)
- Corresponding author
- Harned, Melanie S.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 27
- Issue
- 8
- Pages
- 754-762
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC3758433
- OpenAlex
- W2145064735
- Cited by
- 108
- References
- 29
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 8 · 2021: 16 · 2020: 6 · 2019: 13 · 2018: 7 · 2017: 10 · 2016: 7 · 2015: 7 · 2014: 2 · 2013: 7
- FWCI
- 13.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R44MH082474)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- exposure therapy, treatment adoption, dissemination, therapist training, online training, motivation enhancement, learning communities, therapist self-efficacy, anxiety sensitivity, clinical competence, anxiety disorders, organizational factors, client factors
- MeSH terms
- Adult, Anxiety Disorders, Clinical Competence, Female, Humans, Implosive Therapy, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Motivation, Patients, Organizational Culture, Self Efficacy, Internet
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